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European Radiology Feb 2022The goal of this study is to improve MRI-specific diagnostic criteria for pediatric appendicitis through comparison of normal and abnormal appendix-related imaging...
OBJECTIVES
The goal of this study is to improve MRI-specific diagnostic criteria for pediatric appendicitis through comparison of normal and abnormal appendix-related imaging features.
METHODS
A retrospective multireader-multicase design was used, including non-contrast MRI performed for suspected pediatric appendicitis following non-diagnostic US from January 2014 to December 2017. Positive diagnosis was defined by surgical pathology or symptom resolution after antibiotics. Four pediatric radiologists independently graded study biometrics while blinded to clinical data. Balanced complete block design was used to determine performance characteristics.
RESULTS
Global diagnosis of appendicitis (208 studies) had sensitivity 90.6% and specificity 97.7%. Median appendix diameter was 10.4 mm among positive cases and 5.8 mm among negative cases (p < 0.001) with an optimal diagnostic cutoff of 7.5 mm (sensitivity 89.4%, specificity 86.5%). Median appendix wall thickness was 2.6 mm among positive cases and 1.7 mm among negative cases (p < 0.001) with an optimal diagnostic cutoff of 2.3 mm (sensitivity 63.1%, specificity 82.9%). Performance characteristics for qualitative appendix features included distinguishable appendix luminal signal (sensitivity 89.6%, specificity 83.7%), intraluminal fluid-signal intensity (sensitivity 63.6%; specificity 52.3%), intraluminal signal intermediate between fluid and bowel wall (sensitivity 91.0%; specificity 37.1%), appendicolith (sensitivity 34.9%; specificity 100.0%), intraluminal layering (sensitivity 25.9%; specificity 100.0%), hyperintense appendix wall signal (sensitivity 31.7%; specificity 100.0%), periappendiceal fluid (sensitivity 66.8%; specificity 72.5%), periappendiceal fatty edema (sensitivity 91.3%; specificity 94.5%), and free pelvic fluid (sensitivity 88.5%; specificity 26.0).
CONCLUSIONS
This study provides MRI-specific performance of pediatric appendicitis quantitative and qualitative biometrics with peri-appendiceal fatty edema, appendix diameter > 7.5 mm, and distinguishable appendix luminal signal demonstrating the highest overall accuracy.
KEY POINTS
• This retrospective multireader-multicase study characterized magnetic resonance imaging-specific diagnostic accuracy of quantitative and qualitative biometrics for pediatric appendicitis. • The optimal quantitative diagnostic thresholds for an abnormal pediatric appendix at MRI included diameter and wall thickness of 7.5 mm and 2.3 mm, respectively. • Qualitative imaging biometrics with high specificity for pediatric appendicitis on MRI included the presence of distinguishable appendix lumen signal from wall signal, appendicolith, intraluminal fluid-fluid layer, appendix wall hyperintensity, and peri-appendiceal fatty edema.
Topics: Appendicitis; Appendix; Biometry; Child; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity
PubMed: 34383146
DOI: 10.1007/s00330-021-08120-4 -
Aktuelle Urologie Aug 2021
Topics: Appendix; Humans; Surgical Stomas; Urinary Bladder; Urinary Reservoirs, Continent; Urologic Surgical Procedures
PubMed: 34318463
DOI: 10.1055/a-1139-2930 -
Future Microbiology May 2020Surgical procedures for the symptomatic removal of the gallbladder and the vermiform appendix have been posited to adversely shift the assemblage of the intestinal... (Review)
Review
Surgical procedures for the symptomatic removal of the gallbladder and the vermiform appendix have been posited to adversely shift the assemblage of the intestinal microbiome increasing the risk of disease. The associated mechanisms have been linked with dysbiosis of the gut microbiota. Cholecystectomy causes changes of bile acid compositions and bile secretion patterns as bile acids interact with the intestinal microbiota in a bidirectional capacity. An appendectomy precludes the further recolonization of the proximal colon with a commensal biofilm that could maintain a stable intestinal microbiome. Epidemiological studies indicate that there is an increased risk of disease rather than causality following a cholecystectomy and appendectomy. This narrative review summarizes studies that report on the role that bile salts and the appendix, contribute to the assemblage of the intestinal microbiome in health and disease.
Topics: Animals; Appendix; Bile Acids and Salts; Gallbladder; Gastrointestinal Microbiome; Humans; Intestines
PubMed: 32478580
DOI: 10.2217/fmb-2019-0325 -
ANZ Journal of Surgery Oct 2020Recent advances in understanding of the biology of appendicitis are reviewed. Immunological aspects are discussed in the setting of a changing microbiome. Implications... (Review)
Review
Recent advances in understanding of the biology of appendicitis are reviewed. Immunological aspects are discussed in the setting of a changing microbiome. Implications for practice are summarized.
Topics: Acute Disease; Appendicitis; Appendix; Calculi; Humans
PubMed: 32510780
DOI: 10.1111/ans.16018 -
The British Journal of Surgery Oct 2020
Topics: Aged; Appendix; Cecal Diseases; Humans; Intestinal Obstruction; Intestine, Small; Male
PubMed: 33460095
DOI: 10.1002/bjs.11956 -
International Journal of Urology :... Aug 2020To study the long-term results of ureteral reconstruction with the appendix in patients with long ureteral strictures.
OBJECTIVE
To study the long-term results of ureteral reconstruction with the appendix in patients with long ureteral strictures.
METHODS
From 1998 to 2019, 26 patients were operated with substitution of extended defects of the ureter with the appendix. There were 22 women and four men (mean age 44.7 ± 11.3 years). One patient had stricture of the lumbar ureter because of a gunshot wound. He underwent substitution of the upper third of the right ureter with the appendix. In the other cases, we carried out substitution of the pelvis part of the ureter with appendix, in four cases from the left side. In the last 22 cases, a novel surgical technique for better appendicovesical anastomosis was carried out: a flap was dissected from the dome of the cecum to increase the diameter of anastomosis.
RESULTS
The postoperative follow-up period was from 1 to 21 years. A stricture of uretero-appendical anastomosis developed in four patients (15.4%). Resection of stricture and re-anastomosis was carried out in one case. In another two cases associated with similar complications, endoureterotomy and ureteral stenting were carried out. One patient was managed with percutaneous nephrostomy. Kidney function was restored in all patients. Good short-term results were achieved in 22 patients (84.6%) and long-term (from 1 to 21 years) results in 25 patients (96.2%).
CONCLUSIONS
In patients with long ureteral stricture, the use of the appendix can help to restore the function of the upper urinary tract.
Topics: Adult; Anastomosis, Surgical; Appendix; Female; Humans; Male; Middle Aged; Ureter; Ureteral Obstruction; Wounds, Gunshot
PubMed: 32476202
DOI: 10.1111/iju.14268 -
Asian Journal of Surgery Apr 2024
Topics: Humans; Appendix
PubMed: 38148262
DOI: 10.1016/j.asjsur.2023.12.115 -
Problemy Sotsial'noi Gigieny,... Sep 2022The aim of this review is to focus light on the history of the human vermiform appendix from the morphological, anatomical, surgical, classification of the origin,... (Review)
Review
The aim of this review is to focus light on the history of the human vermiform appendix from the morphological, anatomical, surgical, classification of the origin, types, blood supply aspects in order to understand the real function and summarized this information that positively impacts the clinical decision in case of appendicitis, the most popular surgical condition. Although the characteristic features of the normal and diseased appendix had been reported for many previous centuries, it was still the most common challenge facing every single day in the operation room. The appendectomy, the commonest surgical emergency procedure, may cause little confusion for the surgeons due to highly variable situations of inside the abdominal cavity. However, the recent imaging techniques have increased the surgeon's ability for crucial diagnosis of the diseased appendix. Besides the above-mentioned criteria, with its clinical features diagnosis and management, the author was deeply searched in many scientific databases including EMBASE, Cochrane Library, PubMed, Pubmed Central (PMC), Medline, Web of Science, and Scopus.
Topics: Humans; Appendix; Appendectomy; Appendicitis; Data Management
PubMed: 36282670
DOI: 10.32687/0869-866X-2022-30-5-926-932 -
Clinical Anatomy (New York, N.Y.) Jul 2021Appendix muscle bands (AMB) develop from the appendix muscle layer into the mesoappendix. There are few recent publications on this forgotten entity. The objectives of...
INTRODUCTION
Appendix muscle bands (AMB) develop from the appendix muscle layer into the mesoappendix. There are few recent publications on this forgotten entity. The objectives of this study were to assess the morphological features of AMB as detected at microscopy examination of appendectomy specimens.
METHODS
Sixty-six cases of AMB as detected on appendectomy specimens were assessed for microscopy features on routine hematoxilin and eosin stained tissue slides. The morphological features were analyzed with regard to the main clinico-pathological parameters.
RESULTS
AMBs were multiple in 35 cases. Most AMBs were located between the tip and cecal limit, 7 at the tip, and 1 at the cecal limit of the appendectomy specimen. Associated appendix lesions were: acute appendicitis, neuroma, mesoappendix cyst, muscle hiatus, and diverticulae (60,6,2,45, and 1, respectively). In 24 appendices, the AMB developed from the perihiatus muscle. Two microscopy types of AMBs were detected: muscle-AMB and mesoappendix-AMB.
CONCLUSION
AMB may be detected incidentally at microscopy of appendectomy specimens. Acute appendicitis was associated in most cases, independently on the microscopy type of AMB. Appendix abnormalities as neuroma, mesoappendix cyst, muscle hiatus, and diverticulae can be associated to AMBs.
Topics: Adult; Aged; Aged, 80 and over; Appendix; Female; Humans; Male; Microscopy; Middle Aged; Muscle, Smooth; Young Adult
PubMed: 32990348
DOI: 10.1002/ca.23689 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2022The aim: To study the features of morphoethiopathogenesis of acute appendicitis and the consequences after appendectomy. (Review)
Review
OBJECTIVE
The aim: To study the features of morphoethiopathogenesis of acute appendicitis and the consequences after appendectomy.
PATIENTS AND METHODS
Materials and methods: 10 preparations of human appendix were studied, from which 5 appendixes were normal in people who died in adulthood and old age and 5 processes were taken intraoperatively during appendectomy. Morphometric characteristics of the tissue structures of the preparations were compared with the systematic review data, the literature search by the following keywords: morphoethiopathy", "vermiform process", "lymphoepithelial formations", "digestive system", "lymphoid nodule", "Peyer's patches", "mucous membrane".
RESULTS
Results: Pathogenesis of acute appendicitis - it is a consistent, staged process that is completely subject to the laws of exudative inflammation in response to microbial aggression. Removal of the appendicular process should be approached carefully and based on possible immunological consequences. Removal of the appendix as an immunocompetent organ Unreasonable removal of pathohistological unchanged appendix has medical consequences (can lead to consequences such as colon cancer) and not only.
CONCLUSION
Conclusions: Our results suggest that the vermiform appendix retains its active function throughout human life. The study provides an overview with current knowledge about the etiology, pathogenesis and possible consequences of appendectomy as the main method of treatment of acute appendicitis. The search for ways to prevent appendicitis can be successful only by finding out the causes and factors that in some individuals cause the inability of the appendix to resist bacterial invasion. Appendix is necessary to fully support the immune responses of the digestive tract, but it belongs to the category of those organs, the loss of which during forced surgery does not cause significant damage to the body.
Topics: Acute Disease; Adult; Appendectomy; Appendicitis; Appendix; Child, Preschool; Humans; Inflammation
PubMed: 35907222
DOI: 10.36740/WLek202206112