This prospective cohort study aimed to investigate the association of hyperbilirubinemia with perforated appendicitis in the pediatric population.
A total of 284 children in whom the diagnosis of ...acute appendicitis was established were included in this study. The patients were allocated in study groups in regard to operative findings. The first study group included patients who had perforated appendicitis (n = 64; 22.5%) whereas the patients in the second group had simple appendicitis (n = 220; 77.5%). Blood samples for serum bilirubin levels and acute inflammatory markers were taken before the patients underwent surgery. The primary outcome of the study was to investigate whether the level of serum bilirubin should be used to distinguish between simple and perforated appendicitis.
The median level of serum bilirubin in children with perforated appendicitis was 27 mcmol/L whereas the patients with simple appendicitis had lower median levels of serum bilirubin (10 μmol/L; p < 0.001). An area under the receiver operating characteristic (ROC) curve for total serum bilirubin was 0.876 (95% confidence interval CI, 0.820-0.929) in the patients who had a perforated appendicitis. An ROC analysis showed the best sensitivity (92%) and specificity (77.3%) for a cutoff value of 15.5 mcmol/L for total serum bilirubin (p < 0.001). Hyperbilirubinemia at admission was found in 35 patients (54.7%) with complicated appendicitis and in 14 patients (6.4%) with non-perforated appendicitis (p < 0.001). The modeling of collected data by multivariable logistic regression identified serum bilirubin concentration (odss ratio OR = 1.12; 95% CI, 1.07-1.18; p < 0.001), serum sodium concentration (OR = 0.64; 95% CI, 0.51-0.81; p < 0.001), body temperature (OR = 2.48; 95% CI, 1.05-0.84; p < 0.001), and duration of symptoms (OR = 1.06; 95% CI, 1.02-1.09; p < 0.001) as risk factors for perforated appendicitis.
Elevateds level of total serum bilirubin may be useful as an indicator of perforated appendicitis in children. Levels of bilirubin in serum is an inexpensive, simple, and available laboratory marker and should therefore be recommended in the initial evaluation for acute appendicitis in pediatric patients.
This prospective observational study aimed to evaluate the validity of appendicitis inflammatory response (AIR) score in differentiating advanced (perforated) from simple (non-perforated) ...appendicitis in pediatric patients.
A single-center prospective cross-sectional study was conducted between 1 January 2019 until 1 May 2020 including 184 pediatric patients who underwent appendectomy. Based on the intraoperative finding of advanced (
= 38) or simple (
= 146) appendicitis the patients were divided into two groups. Recipient-operator curve (ROC), with calculation of sensitivity and specificity of best cutoff and the area under the curve (AUC), were used to measure the diagnostic value and the potential for risk stratification of the AIR score, among the patients with simple or advanced acute appendicitis.
The median value of the AIR score in the perforated and non-perforated groups was 10 (interquartile range, IQR 9, 11), and was 7 (IQR 6, 9), respectively (
< 0.001). Based on the calculated value of AIR score, the patients were classified with a high precision into low, indeterminate and high risk groups for acute appendicitis (
< 0.001). A cutoff value of ≥9 was demonstrated to serve as a reliable indicator of perforated appendicitis with a sensitivity and a specificity of 89.5% and 71.9%, respectively (AUC = 0.80; 95% CI: 0.719-0.871;
< 0.001).
Acute appendicitis can be detected with a high level of sensitivity and specificity using the AIR score. Also, the AIR score may differentiate perforated from non-perforated appendicitis in pediatric patients with a high level of accuracy.
Background
The aim of this study was to compare lateral thermal damage of the appendix and clinical outcomes after laparoscopic appendectomy using new versus reused Harmonic scalpels.
Methods
A total ...of 100 consecutive patients with acute appendicitis who underwent laparoscopic appendectomy were enrolled in the two-center, randomized clinical trial. Using a computer random number generator, patients were allocated to
new
or
reused
group. Histopathological measurement of lateral thermal damage of the appendiceal base and mesoappendix, speed of transection of the appendiceal base, duration of surgery, subjective rating of device functionality, length of hospital stay, and complications were compared within groups.
Results
The median lateral thermal damage on the appendiceal base in the
new
group (
N
= 49) was 0.2 mm (IQR 0.1–0.2) and 0.1 mm (IQR 0.1–0.3) in the
reused
group (
N
= 51) (
P
= 0.644), while on the mesoappendix for both groups, thermal damage was 0.1 mm (IQR 0.1–0.2) (
P
= 0.418). The median time required for base transection in both groups was 8 s (IQR 7–9) (
P
= 0.776). The median duration of surgery was also comparable between the groups (22 min, IQR 20–30 vs 25 min, IQR 21–35;
P
= 0.233). Two postoperative complications in the new group and one in the reused group were recorded (4% vs 2%;
P
= 0.536). Surgeons’ subjective assessment of the instrument did not reveal significant difference between the groups in all of the investigated categories.
Conclusions
The results of our study support the reuse of Harmonic scalpels especially in the settings where economic constraints might hamper access to minimally invasive surgery to a larger number of patients. The results obtained on laparoscopic appendectomy might not be reproducible to other more demanding surgical procedures.
Trial registration
ClinicalTrials.gov
registry under identifier NCT04226482
Herein we report the case of a 63-year-old female tourist who presented to our Emergency Department with complete rectal prolapse. She had complained of diarrhea with traces of blood and mucus and ...had experienced fatigue after hiking. After the initial evaluation, it became clear that prolapse bares a large rectal tumor as a leading point. The prolapse was reduced under general anesthesia, along with a tumor biopsy. Further workup confirmed locally advanced adenocarcinoma of the rectum, which was treated with neoadjuvant chemoradiation followed by curative surgery in another hospital after repatriation. Rectal prolapse affects people of all ages, but it is more common in older adults, particularly women. Treatment options vary depending on the severity of the prolapse and can range from conservative measures to surgical interventions. This case report highlights the importance of early recognition and appropriate management of rectal prolapse in the emergency setting and the possibility of an underlying malignancy.
To the Editor,
Intussusception is a true pediatric emergency requiring a multidisciplinary approach. Clinical suspicion should lead directly toward an abdominal ultrasound or a contrast enema. As a ...part of modern point-of-care management, ultrasound has emerged as a readily available diagnostic modality even in rural hospitals. After establishing a diagnosis, the pediatric or general surgeon should decide upon further treatment, preferably enema reduction (1). The drawbacks of conservative treatment are reduction failure in 20% of the cases, risk of perforation, radiation load, higher rate of recurrence than that with operative treatment, and oversight of the potential leading point.
Subcutaneous emphysema may aggravate traumatic pneumothorax treatment, especially when mechanical ventilation is required. Expectative management usually suffices, but when respiratory function is ...impaired surgical treatment might be indicated. Historically relevant methods are blowhole incisions and placement of various drains, often with related wound complications. Since the first report of negative pressure wound therapy for the treatment of severe subcutaneous emphysema in 2009, only few publications on use of commercially available sets were published. We report on patient injured in a motor vehicle accident who had serial rib fractures and bilateral pneumothorax managed initially in another hospital. Due to respiratory deterioration, haemodynamic instability and renal failure patient was transferred to our Intensive Care Unit. Massive and persistent subcutaneous emphysema despite adequate thoracic drainage with respiratory deterioration and potentially injurious mechanical ventilation with high airway pressures was the indication for active surgical treatment. Negative-pressure wound therapy dressing was applied on typical blowhole incisions which resulted in swift emphysema regression and respiratory improvement. Negative pressure wound therapy for decompression of severe subcutaneous emphysema represents simple, effective and relatively unknown technique that deserves wider attention.
Gas gangrene is infectious disease caused by Clostridium perfringens infection.
We are presenting extremely rare case of gluteal clostridial myonecrosis after intramuscular injection of diclofenac in ...immunocompromised young patient on a long-standing corticosteroid therapy presented with sepsis and initially absent clinical signs of severe anaerobic infection. After delayed diagnosis, she was treated with aggressive surgical removal of necrosed tissue and targeted antibiotic therapy which led to a rapid improvement allowing application of a negative-pressure wound therapy device with favorable outcome.
This report shows the importance of timely diagnosis with pitfalls of imaging. It confirms that surgical debridement along with specific antibiotic therapy is the mainstay of treatment, but also promotes negative-pressure wound therapy which has proved convenient for accelerated closure of large incisions with tissue loss without any adverse effects or the need for complex reconstructive procedures.
Hirschsprung's disease is a congenital colonic aganglionosis, usually presented as inability or difficulty in passing of meconium, chronic and persistent obstipation, maleficent feeding, vomiting, ...distension and lethargy.
We presented a case of an in-vitro conceived quadruplet premature neonate who presented with pneumoperitoneum caused by transverse colon spontaneous perforation and microcolon appearance of distal bowel, treated by resection and temporary colostomy turns to be a rare manifestation of Hirschsprung's disease.
Assisted reproductive technologies increases chances for multiple pregnancies and may increase chance for major congenital anomalies. Rare manifestation of Hirschsprung's disease is spontaneous pneumoperitoneum which remains a surgical emergency. Delay in recognizing and treatment can significantly worsen prognosis. In neonate with intestinal perforation one should consider Hirschsprung's disease.
Časopis Medica Jadertina medicinski je znanstveno - stručni časopis Opće bolnice Zadar, čiji je prvi broj otisnut 1969. godine, prije 55 godina. Jedan je od najstarijih medicinskih časopisa u ...Republici Hrvatskoj. Potkraj šezdesetih godina prošlog stoljeća javila se ideja da tadašnji razvoj bolnice slijedi i unaprjeđenje znanstveno – stručne misli. Od 1987. godine časopis je dvojezičan, te se u njemu objavljuju članci na hrvatskom i engleskom jeziku, ovisno o izboru autora. Time je postignuta bolja vidljivost časopisa i u međunarodnoj znanstvenoj zajednici. Također, časopis je, uz hrvatske, postao otvoren i za strane autore. Tijekom Domovinskog rata časopis nije prestao izlaziti unatoč brutalnom razaranju grada i okolice, te ratnim stradanjima. Medica Jadertina je više puta mijenjala format i naslovnu stranicu, te cjelokupan grafički izgled. Od 2002. godine časopis počinje izlaziti u formatu A4 i s novim dizajnom naslovnice. Time je grafičko oblikovanje i uređivanje usklađeno s međunarodnim pravilima. Od 2002. godine svi radovi objavljeni u časopisu Medica Jadertina citirani su u cijelosti u bazi Scopus u kojoj je časopis indeksiran i danas. Od 2006.godine Medica Jadertina u cijelosti je vidljiva na Portalu hrvatskih znanstvenih i stručnih časopisa HRČAK. Tako je časopis među čitaocima dobio bolju vidljivost i dostupnost, kako u tiskanom, tako i u elektroničkom obliku.
Medica Jadertina is a medical, scientific, and professional journal of Zadar General Hospital. Its firstissue was pressed in 1969, 55 years ago, making it one of the oldest medical journals in Croatia.At the end of the sixties of the last century, there was an idea that the improvement of scientific andprofessional thought should accompany the development of the hospital. Since 1987, the journal has beenbilingual, with articles published in Croatian or English. This has also improved the journal's visibility inthe international scientific community. The journal has also become open to Croatian and foreign authors.During the Croatian War of Independence, the journal did not cease publishing despite the brutal destructionof the city and its surroundings and the war atrocities.Medica Jadertina has repeatedly changed its format, cover page, and overall graphic appearance. Since2002, the magazine has been published in A4 format with a new cover design. Thus, the journal's graphicdesign and editing were harmonized with the International Committee of Medical Journal Editors'Recommendations. Since 2002, all manuscripts published in Medica Jadertina are cited entirely in theScopus database.Since 2006, Medica Jadertina has provided open access through the Portal of Croatian scientific andprofessional journals (HRČAK). Thus, the magazine has increased its visibility among readers in paperand electronic forms.
Only several cases of postprocedural choleresis (biliary hyperproduction) were reported, and guidance on management is scarce, although an application of octreotide was anecdotally described. We ...herein present a rare post-obstructive choleresis complicated with acute kidney injury due to dehydration, successfully treated with an off-label application of octreotide. A 58-year-old female, following cholecystectomy and choledochotomy with numerous stones extraction, developed excessive bile loss via a T-tube complicated with acute kidney injury. Despite aggressive fluid replacement, the patient continued to deteriorate, prompting a trial of subcutaneous octreotide 0.1 mg three times per day over five days. Therapy yielded a rapid decline in bile production with improved diuresis and normalizing kidney function. The patient was discharged with a ligated T-tube, which we removed a month later. The followup was unremarkable, with normalized laboratory findings and symptom-free. Early use of octreotide could help resolve complicated biliary hyperproduction; however, further research is required to determine the risks and benefits of such an approach.
U literaturi je opisano samo nekoliko slučajeva poslijeopstrukcijske kolereze (hiperprodukcije žuči),smjernice o liječenju ne postoje, a primjena oktreotida se spominje anegdotalno.Ovdje predstavljamo rijetku poslijeoperacijsku kolerezu kompliciranu akutnom ozljedom bubrega zbogdehidracije, što je uspješno liječeno primjenom oktreotida izvan odobrene indikacije.U 58-godišnje bolesnice nakon kolecistektomije, koledokotomije i vađenja brojnih kamenaca, došlo jedo prekomjernog gubitka žuči preko T-drena, što se kompliciralo akutnom ozljedom bubrega. Unatočagresivnoj nadoknadi tekućine, stanje bolesnice se nastavilo pogoršavati, stoga smo se odlučili nasupkutanu primjenu oktreotida 0,1 mg, tri puta dnevno tijekom pet dana. Liječenje je dovelo do brzogsmanjenja produkcije žuči, poboljšanja diureze i normalizacije bubrežne funkcije. Bolesnica je otpuštena spodvezanim T-drenom koji smo odstranili mjesec dana kasnije. Kontrolni pregled je bio uredan,laboratorijski nalazi normalizirani, a bolesnica bez simptoma. Rana primjena oktreotida mogla bi pomoći u rješavanju komplicirane žučne hiperprodukcije, međutimpotrebna su daljnja istraživanja kako bi se utvrdili rizici i dobrobiti takvog pristupa.
PDF
