Acute appendicitis (AA) in older individuals remains understudied. We aimed to assess AA characteristics in patients older than 60 years and evaluate the impact of comorbidities.
This retrospective ...study analyzed data from the American National Inpatient Sample between 2016 and 2019 to compare AA characteristics in patients younger and older than 60 years.
Of the 538,400 patients included, 27.5% were older than 60 years. Younger patients had a higher appendectomy rate (
< 0.01), while the complicated appendicitis rate was higher in older patients. Superficial wound infection, systemic infection, and mortality rates were higher in older patients (
< 0.01). Risk factors for superficial wound infection in patients younger than 60 years included cerebrovascular disease, chronic kidney disease, hypertension, heart failure, and obesity, whereas only heart failure was a risk factor in older patients. Risk factors for systemic infection in young patients included hypertension, heart failure, obesity, and diabetes mellitus, while in older patients they included hypertension, heart failure, and obesity. Complicated appendicitis was not a risk factor for infections in either group.
This study highlights a higher incidence of AA in older individuals than previously reported, with comorbidities posing differing risks for infections between age groups.
Background: Hybrid trauma management, namely the combination of open and endovascular techniques and/or the application of endovascular methods in the operating/emergency room, is a quickly growing ...concept worldwide. However, its implications are not well established. We aimed to review the current data regarding hybrid trauma management in medical literature. Methods: A review of the medical literature published between 2000 and 2020 using PubMed, Cochrane, Embase and Medline databases was performed in search of clinical studies regarding hybrid trauma treatments. Case-reports were excluded from this review. The manuscripts were analyzed regarding the mechanism, location, and type of injury, endovascular and surgical techniques utilized, and the outcome. Results: In total, 14 studies reporting hybrid trauma management in a total of 1,049 patients met the inclusion criteria and were analyzed. Blunt trauma was the leading trauma mechanism (87.1%) and the most common procedure was transcatheter arterial embolization, performed in 29.7% of patients. The overall mortality was 15.2%. Regarding case-control studies, 85.7% have shown hybrid trauma management to be associated with a shorter time from arrival to intervention, 42.9% reported lower rates of unfavorable outcome, and 28.6% reported reduced requirement for red blood cell transfusion as compared with conventional management. Conclusions: Accumulating data suggests that hybrid management may be associated with a shorter time from arrival to intervention, lower rates of unfavorable outcomes and a reduced requirement for red blood cell transfusion as compared with conventional management of trauma patients.
...in this study, the maximum participant age was 47 years in both the within 8 h group and within 24 h group, and most patients did not have any chronic disease; however, average age in the overall ...population is increasing and the incidence of appendicitis after the age of 60 years is reported to be approximately 15%.2 Exclusion of these patients might cause deviation of the results and influence conclusions. ...the authors concluded that scheduling patients for appendicectomy within 24 h had no effect on various clinical outcomes, including appendiceal perforation rate, severity of appendiceal inflammation, and postoperative complications, to name a few. Other studies have shown that the older population, patients with clinically significant concomitant morbidities, and individuals with long durations of preadmission symptoms have a higher risk of prolonged operation time, increased length of stay, and postoperative morbidity with increasing time to surgery.5 The possible explanation is that the longest time to surgery in this study was only 20 h, and the median preoperative delay was only 8 h difference between the groups. ...24% of the patients in the within 24 h group were operated on within 8 h. This proportion biases results, and accordingly, the authors performed an additional post-hoc, modified, per-protocol analysis, but it is a well known phenomenon that such initially unplanned analysis cannot be extrapolated to the final study results.
Abstract Background Rib fractures are considered a marker of exposure to significant traumatic energy. In children, because of high elasticity of the chest wall, higher energy levels are necessary ...for ribs to fracture. The purpose of this study was to analyze patterns of associated injuries in children as compared with adults, all of whom presented with rib fractures. Methods A retrospective cohort study involving blunt trauma patients with rib fractures registered in the National Trauma Registry was conducted. Results Of 6,995 trauma victims who were found to suffer from rib fractures, 328 were children and 6,627 were adults. Isolated rib fractures without associated injuries occurred in 19 children (5.8%) and 731 adults (11%). More adults had 4 or more fractured ribs compared with children ( P < .001). Children suffered from higher rates of associated brain injuries ( P = .003), hemothorax/pneumothorax ( P = .006), spleen, and liver injury ( P < .001). Mortality rate was 5% in both groups. Conclusions The incidence of associated head, thoracic, and abdominal solid organ injuries in children was significantly higher than in adults suffering from rib fractures. In spite of a higher Injury Severity Score and incidence of associated injuries, mortality rate was similar. Mortality of rib fracture patients was mostly affected by the presence of extrathoracic injuries.
Breast cancer is a common malignancy and a common cause of cancer-related mortality in women. Pre-treatment workup of breast cancer does not routinely include positron emission tomography scans. We ...aimed to review cases of women with breast cancer and a synchronous second primary malignancy. We present three cases of women with non-metastatic cancer in whom a synchronous second primary malignancy was found. Synchronous, second primary malignancies which were identified included rectal cancer, gastrointestinal stromal tumor, and non-small cell lung cancer. All second primary malignancies were identified by a PET-CT scan. In conclusion, PET-CT may be used for detection of secondary primary malignancies in select breast cancer patients.
PDF
