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Cancers May 2024Neuroendocrine carcinomas (NECs) of the tubular gastrointestinal tract (GI-NECs) are rare and associated with worse clinical outcomes. This population-based study aims...
Neuroendocrine carcinomas (NECs) of the tubular gastrointestinal tract (GI-NECs) are rare and associated with worse clinical outcomes. This population-based study aims to highlight key demographics, clinicopathological factors, and survival outcomes in the US population. Data from 10,387 patients with GI-NECs were extracted from the Surveillance, Epidemiology, and End Result (SEER) database from 2000 to 2020. Most patients were >40 years old at the time of presentation with a median age of 63 years old, with almost equal ethnic distribution per US population data. The most common primary tumor site was the small intestine (33.6%). The metastatic spread was localized in 34.8%, regional in 27.8%, and distant in 37.3% of cases, and the liver was the most common site of metastasis (19.9%) in known cases of metastases. Most NEC patients underwent surgery, presenting the highest 5-year overall survival of 73.2% with a 95% confidence interval (CI) (95% CI 72.0-74.4%), while chemotherapy alone had the lowest 5-year survival of 8.0% (95% CI 6.4-10.0%). Compared to men, women had a superior 5-year survival rate of 59.0% (95% CI 57.6-60.5%). On multivariate analysis, age > 65 (HR 2.49, 95% CI 2.36-2.54%, ≤ 0.001), distant metastasis (HR 2.57, 95% CI 2.52-2.62%, ≤ 0.001), tumor size > 4 mm (HR 1.98, 95%, CI 1.70-2.31%, ≤ 0.001), esophageal (HR 1.49, 95% CI 0.86-2.58%, ≤ 0.001), transverse colon (HR 1.95, 95% CI 1.15-3.33%, ≤ 0.01), descending colon (HR 2.12, 95% CI 1.12, 3.97%, = 0.02) anorectal sites, and liver or lung metastases were associated with worse survival. Surgical intervention and tumors located in the small intestine or appendix showed a better prognosis. GI-NECs are a group of rare malignancies associated with a poor prognosis. Therefore, epidemiological studies analyzing national databases may be the best alternative to have a more comprehensive understanding of this condition, assess the impact of current practices, and generate prognosis tools.
PubMed: 38893117
DOI: 10.3390/cancers16111998 -
Journal of Clinical Medicine May 2024The role of infestation in the context of appendicitis is largely overlooked, but is considered an unexpected and significant appendicectomy finding. The aim of this...
The role of infestation in the context of appendicitis is largely overlooked, but is considered an unexpected and significant appendicectomy finding. The aim of this study was to investigate the frequency of findings in appendectomies and to evaluate the clinical and histopathologic features of patients with -associated acute appendicitis and those with appendiceal infestation. The medical records of all children who underwent an appendectomy in two large pediatric centers in Croatia between 1 January 2009 and 1 January 2024 were retrospectively reviewed. Of 6359 appendectomies, 61 (0.96%) children were diagnosed with on histopathology and included in further analysis. The groups were compared with regard to demographic characteristics, laboratory values, clinical features and histopathological findings. : The incidence of enterobiasis fluctuated slightly in the individual study years, but was constant overall. The median age of all patients was 11 years (IQR 8.5, 13), with females predominating (60.7%). Acute appendicitis was observed in 34% of the appendiceal species. The patients with infestation, without appendicitis, were younger (9 years (IQR 8, 13) vs. 12 years (IQR 10, 15); = 0.020), had longer duration of symptoms (36 h (IQR, 12, 48) vs. 24 h (IQR, 12, 36); = 0.034), lower body temperature (37 °C (IQR 36.8, 37.4) vs. 37.6 °C (IQR, 37, 38.6) = 0.012), lower Appendicitis Inflammation Response (AIR) score (3 (IQR 2, 5) vs. 7 (IQR 5, 9.5) < 0.001), lower incidence of rebound tenderness (57.1% vs. 20%; = 0.003) and less frequent vomiting (12.5% vs. 47.6%; = 0.004) compared to the patients with -associated acute appendicitis. Acute inflammatory markers in the laboratory showed significantly higher values in the group of patients with acute appendicitis: C-reactive protein ( = 0.009), White blood cells ( = 0.001) and neutrophils ( < 0.001). Eosinophilia was not found in any of the groups, although eosinophil counts were significantly higher in children who had infestation than in those with -related appendicitis (2.5% (IQR 0.9, 4.3) vs. 1.8% (IQR 0.7, 2.1); = 0.040). : Pediatric surgeons should consider infestation as a differential diagnosis when removing a vermiform appendix. Younger age, longer duration of symptoms, lower body temperature, lower AIR score, lower diameter of the appendix and normal laboratory inflammatory markers could predict infection in children presenting with right iliac fossa pain and avoid unnecessary appendectomy.
PubMed: 38892909
DOI: 10.3390/jcm13113198 -
Journal of Clinical Medicine May 2024Globally, acute appendicitis has an estimated lifetime risk of 7-8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the... (Review)
Review
Globally, acute appendicitis has an estimated lifetime risk of 7-8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8-12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients' baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option.
PubMed: 38892745
DOI: 10.3390/jcm13113034 -
International Journal of Molecular... May 2024Appendicitis is primarily diagnosed based on intraoperative or histopathological findings, and few studies have explored pre-operative markers of a perforated appendix....
Appendicitis is primarily diagnosed based on intraoperative or histopathological findings, and few studies have explored pre-operative markers of a perforated appendix. This study aimed to identify systemic biomarkers to predict pediatric appendicitis at various time points. The study group comprised pediatric patients with clinically suspected appendicitis between 2016 and 2019. Pre-surgical serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), intercellular cell-adhesion molecule-1 (ICAM-1), and endothelial selectin (E-selectin) levels were tested from day 1 to day 3 of the disease course. The biomarker values were analyzed and compared between children with normal appendices and appendicitis and those with perforated appendicitis (PA) and non-perforated appendicitis. Among 226 pediatric patients, 106 had non-perforated appendicitis, 102 had PA, and 18 had normal appendices. The levels of all serum proinflammatory biomarkers were elevated in children with acute appendicitis compared with those in children with normal appendices. In addition, the serum IL-6 and TNF-α levels in children with PA were significantly higher, with an elevation in TNF-α levels from days 1 and 2. In addition, serum IL-6 levels increased significantly from days 2 and 3 (both < 0.05). Serum ICAM-1 and E-selectin levels were elevated in the PA group, with consistently elevated levels within the first three days of admission (all < 0.05). These results indicate that increased serum levels of proinflammatory biomarkers including IL-6, TNF-α, ICAM-1, and E-selectin could be used as parameters in the prediction and early diagnosis of acute appendicitis, especially in children with PA.
Topics: Humans; Appendicitis; Child; Female; Male; Biomarkers; Cytokines; Intercellular Adhesion Molecule-1; Chemokines; Child, Preschool; Interleukin-6; Tumor Necrosis Factor-alpha; E-Selectin; Adolescent; Appendectomy
PubMed: 38892260
DOI: 10.3390/ijms25116076 -
Journal of Medical Case Reports Jun 2024Schistosomiasis is one of the endemic parasitic diseases in many developing countries. Despite this, appendicitis secondary to schistosomiasis is an uncommon condition...
BACKGROUND
Schistosomiasis is one of the endemic parasitic diseases in many developing countries. Despite this, appendicitis secondary to schistosomiasis is an uncommon condition even in some endemic areas. Schistosomal appendicitis, an incidentally discovered appendicitis associated with schistosomiasis histological findings, affects young males predominantly. Timely diagnosis and treatment, including appendectomy and anti-helminthic therapy, are crucial.
CASE REPORT
A 24-year-old Sudanese male patient presented with abdominal pain. Diagnosed with acute appendicitis, he underwent appendectomy, revealing appendix inflammation with Schistosoma ova in histopathology. Abdominal ultrasound detected no complications. Weakly positive Schistosoma serology was noted, but stool and urine analysis showed no infection evidence. Prescribed praziquantel, patient had 3-year post-op follow-up without complications.
CONCLUSIONS
This case report underscores the significance of including schistosomiasis in the differential diagnosis of appendicitis, particularly in regions where the disease is endemic. It underscores the necessity of histopathological evaluations for accurate diagnosis, emphasizing the potential implications for clinical practice in similar settings.
Topics: Humans; Appendicitis; Male; Young Adult; Praziquantel; Appendectomy; Anthelmintics; Schistosomiasis; Diagnosis, Differential; Abdominal Pain; Ultrasonography; Animals; Treatment Outcome; Appendix
PubMed: 38890741
DOI: 10.1186/s13256-024-04610-3 -
Gastroenterology Report 2024This article presents an overview of endoscopic retrograde appendicitis therapy (ERAT), an innovative and minimally invasive treatment for appendicitis with an... (Review)
Review
This article presents an overview of endoscopic retrograde appendicitis therapy (ERAT), an innovative and minimally invasive treatment for appendicitis with an appendix-preserving manner. Since its initial application in 2009, ERAT has gained significant popularity in China, due to its rapid recovery and minimal risk of complications. The ERAT procedures comprise several steps, including appendiceal orifice access and intubation, appendiceal lumen imaging, decompression and irrigation, fecalith removal, and stenting. ERAT has been used in various forms of complicated appendicitis, such as in pregnant women and children, with continuous improvements in both technique and safety. It has the potential to become the preferred diagnostic and treatment method for appendicitis. Until 2023, over 10,000 ERAT procedures have been successfully conducted in China, and the technique has gained more attention worldwide. However, challenges remain, including training, standardization of ERAT practice, research and technology improvement, enhancing public awareness, and fostering international collaboration. In summary, ERAT can be the standard treatment for appendicitis treatment, which represents a paradigm shift in the conventional clinical practice.
PubMed: 38887595
DOI: 10.1093/gastro/goae037 -
BMC Emergency Medicine Jun 2024Acute Appendicitis (AA) is one of the most common surgical emergencies worldwide. This study aims to investigate the predictive performances of 6 different Machine...
BACKGROUNDS
Acute Appendicitis (AA) is one of the most common surgical emergencies worldwide. This study aims to investigate the predictive performances of 6 different Machine Learning (ML) algorithms for simple and complicated AA.
METHODS
Data regarding operated AA patients between 2012 and 2022 were analyzed retrospectively. Based on operative findings, patients were evaluated under two groups: perforated AA and none-perforated AA. The features that showed statistical significance (p < 0.05) in both univariate and multivariate analysis were included in the prediction models as input features. Five different error metrics and the area under the receiver operating characteristic curve (AUC) were used for model comparison.
RESULTS
A total number of 1132 patients were included in the study. Patients were divided into training (932 samples), testing (100 samples), and validation (100 samples) sets. Age, gender, neutrophil count, lymphocyte count, Neutrophil to Lymphocyte ratio, total bilirubin, C-Reactive Protein (CRP), Appendix Diameter, and PeriAppendicular Liquid Collection (PALC) were significantly different between the two groups. In the multivariate analysis, age, CRP, and PALC continued to show a significant difference in the perforated AA group. According to univariate and multivariate analysis, two data sets were used in the prediction model. K-Nearest Neighbors and Logistic Regression algorithms achieved the best prediction performance in the validation group with an accuracy of 96%.
CONCLUSION
The results showed that using only three input features (age, CRP, and PALC), the severity of AA can be predicted with high accuracy. The developed prediction model can be useful in clinical practice.
Topics: Humans; Appendicitis; Machine Learning; Female; Male; Retrospective Studies; Adult; Middle Aged; Severity of Illness Index; C-Reactive Protein; ROC Curve; Algorithms; Adolescent; Acute Disease; Young Adult; Aged
PubMed: 38886641
DOI: 10.1186/s12873-024-01023-9 -
Case Reports in Surgery 2024Multiple types of fistulas associated with the appendix have been reported; however, duodenal fistula resulting from perforated acute appendicitis has only been...
Multiple types of fistulas associated with the appendix have been reported; however, duodenal fistula resulting from perforated acute appendicitis has only been documented in one previous case. In this report, we present the case of an 18-year-old male patient who was diagnosed to have a complicated appendicitis in its normal position with abscess formation. He was started on IV antibiotics and underwent a CT-guided drainage of the abscess with drain placement. Two days later due to biliary output from the drain, CT fistulography and diagnostic laparoscopy were performed that revealed the presence of a duodenal fistula. The potential for duodenal fistula formation in patients with complicated appendicitis must always be taken into consideration. Consequently, it is crucial to establish an appropriate management plan aimed at preventing additional serious complications arising from duodenal perforation.
PubMed: 38883267
DOI: 10.1155/2024/8269752 -
Cureus May 2024Gastrointestinal stromal tumors (GISTs) are a type of mesenchymal tumor of the gastrointestinal tract that originate anywhere in the gastrointestinal tract, with the...
Gastrointestinal stromal tumors (GISTs) are a type of mesenchymal tumor of the gastrointestinal tract that originate anywhere in the gastrointestinal tract, with the colon and appendix being the least recorded sites of occurrence. The following case report is that of a colonic GIST in a 53-year-old male and its histologic type. Included are notes on the recent additions and updates in the risk stratification of GISTs occurring in unusual sites with the relevant immunohistochemistry.
PubMed: 38883081
DOI: 10.7759/cureus.60383 -
Cureus May 2024Inguinal hernia is common. However, only a few cases have been reported in the literature of inguinal interparietal hernia, in which the herniated sac exits the...
Inguinal hernia is common. However, only a few cases have been reported in the literature of inguinal interparietal hernia, in which the herniated sac exits the intraperitoneal cavity through the deep inguinal ring and then protrudes into one of the anatomical planes of the anterior abdominal wall. Only one of the reported inguinal interparietal hernia cases was managed laparoscopically. We report the case of a right inguinal interparietal hernia in a young, healthy adult with a herniated cecum, terminal ileum, and appendix. He presented with right iliac fossa pain. On investigation, he was found to have an interparietal hernia in the inguinal region. Diagnostic laparoscopy showed a clear herniated cecum through the internal inguinal ring into the anterior abdominal wall. The patient was treated with regular laparoscopic hernioplasty and was discharged on the second postoperative day with no complications. Although the diagnosis might be difficult for interparietal hernias, laparoscopic diagnosis and management provide precise assessment and less invasive management.
PubMed: 38883002
DOI: 10.7759/cureus.60448