Acute Appendicitis: After Correct Diagnosis Conservative Treatment or Surgery?

Acute appendicitis is the most common surgical disease presented in ED. Ongoing evidence in the literature, in the last 20 years, shows a lot of benefits in favor of conservative treatment. Despite that conservative treatment does not gain the correct position at the daily practice up to day. A large number of parameters related to acute appendicitis, present diversity in their appearance, so the final estimation of the disease may by unclear and the decision for treatment may be incorrect. We analyze these parameters, aiming to clarify their role in correct diagnosis and decision making on appropriate treatment. In the present study a review of the literature is performed, regarding the etiology, pathology, clinical presentation, laboratory, and imaging data of acute appendicitis. The collection and correct estimation of these parameters, is the key for the correct diagnosis of acute appendicitis. Complicated or uncomplicated cases should be diagnosed preoperatively. The next step is the appropriate treatment, conservative or by surgery. At the present time, excluding generalized peritonitis and sepsis, the majority of patients with uncomplicated acute appendicitis and selected complicated cases can by treated successfully by conservative treatment. The majority of patients do not benefit from appendectomy

Η ΕΠΙΔΡΑΣΗ ΤΟΥ ΕΓΧΕΙΡΗΤΙΚΟΥ STRESS ΣΤΗΝ ΠΑΡΑΓΩΓΗ ΑΥΤΟΑΝΤΙΣΩΜΑΤΩΝ ΣΕ ΚΑΡΚΙΝΟ ΤΟΥ ΠΑΧΕΟΣ ΕΝΤΕΡΟΥ

Σ'ΑΥΤΗ ΤΗΝ ΕΡΓΑΣΙΑ ΜΕΛΕΤΗΘΗΚΑΝ ΟΡΙΣΜΕΝΟΙ ΠΑΡΑΜΕΤΡΟΙ ΤΟΥ ΑΝΟΣΟΛΟΓΙΚΟΥ ΣΥΣΤΗΜΑΤΟΣΣΕ ΑΣΘΕΝΕΙΣ ΜΕ ΚΑΡΚΙΝΟ ΠΑΧΕΟΣ ΕΝΤΕΡΟΥ. ΣΚΟΠΟΣ ΗΤΑΝ: Α) Η ΑΞΙΟΛΟΓΗΣΗ ΤΩΝ ΑΝΟΣΟΛΟΓΙΚΩΝ ΠΑΡΑΜΕΤΡΩΝ ΣΕ ΑΣΘΕΝΕΙΣ ΜΕ ΚΑΡΚΙΝΟ ΠΑΧΕΟΣ ΕΝΤΕΡΟΥ ΠΡΙΝ ΧΕΙΡΟΥΡΓΗΘΟΥΝ. Β) Η ΕΠΙΔΡΑΣΗ ΣΤΙΣ ΑΝΟΣΟΛΟΓΙΚΕΣ ΠΑΡΑΜΕΤΡΟΥΣ, ΤΗΣ ΧΕΙΡΟΥΡΓΙΚΗΣ ΑΦΑΙΡΕΣΗΣ ΤΗΣ ΠΛΕΙΟΝΟΤΗΤΑΣ ΤΩΝ ΝΕΟΠΛΑΣΜΑΤΙΚΩΝ ΚΥΤΤΑΡΩΝ. Γ) Η ΠΙΘΑΝΗ ΕΥΡΕΣΗ ΝΕΩΝ ΚΑΡΚΙΝΙΚΩΝ ΔΕΙΚΤΩΝ. Δ) Η ΕΥΡΕΣΗ ΚΑΠΟΙΟΥ ΠΡΟΓΝΩΣΤΙΚΟΥ ΔΕΙΚΤΗ, ΣΥΣΧΕΤΙΖΟΝΤΑΣ ΤΙΣ ΑΝΟΣΟΛΟΓΙΚΕΣ ΠΑΡΑΜΕΤΡΟΥΣ ΜΕ ΤΗ ΜΕΤΕΓΧΕΙΡΗΤΙΚΗ ΠΟΡΕΙΑ, ΕΞΕΛΙΞΗ ΚΑΙ ΕΠΙΒΙΩΣΗ ΤΩΝ ΑΣΘΕΝΩΝ. ΤΟ ΥΛΙΚΟ ΜΑΣ ΠΕΡΙΛΑΜΒΑΝΕΙ 43 ΑΣΘΕΝΕΙΣ ΜΕ ΚΑΡΚΙΝΟ ΠΑΧΕΟΣ ΕΝΤΕΡΟΥ ΚΑΙ 26 ΑΤΟΜΑ ΜΕ ΚΑΛΟΗΘΕΙΣ ΧΕΙΡΟΥΡΓΙΚΕΣ ΠΑΘΗΣΕΙΣ (ΧΟΛΟΛΙΘΙΑΣΗ-ΒΟΥΒΩΝΟΚΗΛΗ). ΟΙ ΜΕΤΡΗΣΕΙΣ ΤΩΝ ΑΝΟΣΟΛΟΓΙΚΩΝ ΠΑΡΑΜΕΤΡΩΝ ΕΓΙΝΑΝ ΠΡΟΕΓΧΕΙΡΗΤΙΚΑ, ΚΑΙ ΕΝΑ ΜΗΝΑ ΜΕΤΑ ΤΗΝ ΕΓΧΕΙΡΗΣΗ. ΜΕΤΡΗΘΗΚΑΝ ΟΙ ΑΝΟΣΟΦΑΙΡΙΝΕΣ, ΑΝΤΙΣΩΜΑΤΑ ΕΝΑΝΤΙ ΑΚΤΙΝΗΣ, ΜΥΟΣΙΝΗΣ, ΤΡΟΠΟΜΥΟΣΙΝΗΣ, ΑΝΤΙΘΥΡΟΕΙΔΙΚΑ ΑΥΤΟΑΝΤΙΣΩΜΑΤΑ, ΑΝΤΙΣΩΜΑΤΑ ΕΝΑΝΤΙ ΚΑΡΔΙΟΛΙΠΙΝΗΣ ΚΑΙ ΤΑ ΑΝΤΙΠΥΡΗΝΙΚΑ ΕΝΑΝΤΙ ΔΙΠΛΗΣ ΕΛΙΚΑΣ. ΤΑ ΣΥΜΠΕΡΑΣΜΑΤΑ ΗΤΑΝ: 1) ΑΝΤΙΣΩΜΑΤΑ ΕΝΑΝΤΙ ΚΑΡΔΙΟΛΙΠΙΝΗΣ ΒΡΕΘΗΚΑΝ ΣΕ ΠΡΟΕΓΧΕΙΡΗΤΙΚΑ ΚΑΙ ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ ΔΕΙΓΜΑΤΑ ΣΕ ΠΟΣΟΣΤΟ 32,5%, ΚΑΙ ΗΤΑΝ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΩΣ ΑΥΞΗΜΕΝΑ ΣΕ ΣΧΕΣΗ ΜΕ ΤΙΣ ΟΜΑΔΕΣ ΕΛΕΓΧΟΥ. 2)ΑΝΤΙΘΥΡΟΕΙΔΙΚΑ ΑΝΤΙΣΩΜΑΤΑ ΑΝΙΧΝΕΥΤΗΚΑΝ ΙΔΙΩΣ ΣΤΑ ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ ΔΕΙΓΜΑΤΑ (18,6%), ΠΟΣΟΣΤΟ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΑ ΑΥΞΗΜΕΝΟ ΣΕ ΣΧΕΣΗ ΜΕ ΤΙΣ ΟΜΑΔΕΣ ΕΛΕΓΧΟΥ, ΑΛΛΑ ΚΑΙ ΣΕ ΣΧΕΣΗ ΜΕ ΤΑ ΠΡΟΕΓΧΕΙΡΗΤΙΚΑ ΠΟΣΟΣΤΑ (4,65%). 3) ΣΤΑ ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ ΔΕΙΓΜΑΤΑ ΑΥΤΟΑΝΤΙΣΩΜΑΤΑ ΕΝΑΝΤΙ ΜΥΟΣΙΝΗΣ (62,7%) ΗΤΑΝ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΩΣ ΑΥΞΗΜΕΝΑ ΣΕ ΣΧΕΣΗ ΜΕ ΤΙΣ ΟΜΑΔΕΣ ΕΛΕΓΧΟΥ. (ΠΕΡΙΚΟΠΗ ΠΕΡΙΛΗΨΗΣ

Pheochromocytoma

Pheochromocytomas are rare tumors originating in the adrenal medulla. They may be sporadic or in the context of a hereditary syndrome. A considerable number of pheochromocytomas carry germline or somatic gene mutations, which are inherited in the autosomal dominant way. All patients should undergo genetic testing. Symptoms are due to catecholamines over production or to a mass effect. Diagnosis is confirmed by raised plasma or urine metanephrines or normetanephrines. Radiology assists in the tumor location and any local invasion or metastasis. All the patients should have preoperative preparation with α-blockers and/or other medications to control hypertension, arrhythmia, and volume expansion. Surgery is the definitive treatment. Follow up should be life-long

Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review

Liver resection for colorectal liver metastases (CRLM) is widely considered the treatment with the highest curative potential. However, not all patients derive the same oncological benefit, underlining the need for better patient stratification and treatment allocation. In this context, we performed a systematic review of the literature to determine the role of RAS status in selecting the optimal surgical strategy. Evidence comparing anatomical with non-anatomical resections depending on RAS mutational status was scarce and conflicting, with two studies reporting superiority in mutated RAS (mutRAS) patients and two studies reporting equivalent outcomes. The rate of incomplete microscopic resection (R1) was found to be increased among mutRAS patients, possibly due to higher micrometastatic spread lateral to the primary lesion. The impact of R1 resection margins was evaluated separately for mutRAS and wild-type patients in three studies, of which, two indicated an additive detriment to long-term survival in the former group. In the current era of precision surgery, RAS status can be utilized to predict the efficacy of liver resection in the treatment of CRLM, avoiding a potentially morbid operation in patients with adverse tumor profiles

Investigating Non-Pharmacological Stress Reduction Interventions in Pediatric Patients Confirmed with Salivary Cortisol Levels: A Systematic Review

For many children, hospitalization can lead to a state of increased anxiety. Being away from home, the invasive procedures undertaken, and the uncertainty of the outcome cause an uncomfortable situation in anticipation of real or imagined hazards. This systematic review aims to assess current evidence on the types of non-pharmacological interventions used and their impact on children’s anxiety or distress levels when they visit the hospital for planned or unplanned admissions. The Databases PubMed, Psych INFO, and Google Scholar were queried for papers published from January 2000 to March 2023 reporting the use of non-pharmacological interventions interacting with children in hospital or clinical environments and confirmed with saliva cortisol levels. A total of nine studies were retrieved. Across these studies, four different strategies of non-pharmacological interventions were used. Anxiety and distress were found to be reduced in the majority of the studies as confirmed with salivary cortisol. Overall, there is evidence that non-pharmacological interventions hold a promising role in reducing levels of anxiety or distress in children as confirmed with saliva cortisol. However, research on saliva cortisol as a tool of anxiety measurement requires higher quality studies to strengthen the evidence base

A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology)

Objectives. To present a step by step approach for the diagnosis of adrenal incidentaloma (AI)

A short review of primary aldosteronism in a question and answer fashion

Objectives. The aim of this study was to present up to date information concerning the diagnosis and treatment of primary aldosteronism (PA). PA is the most common cause of endocrine hypertension. It has been reported up to 24% of selective referred hypertensive patients. Methods. We did a search in Pub-Med and Google Scholar using the terms: PA, hyperaldosteronism, idiopathic adrenal hyperplasia, diagnosis of PA, mineralocorticoid receptor antagonists, adrenalectomy, and surgery. We also did cross-referencing search with the above terms. We had divided our study into five sections: Introduction, Diagnosis, Genetics, Treatment, and Conclusions. We present our results in a question and answer fashion in order to make reading more interesting. Results. PA should be searched in all high-risk populations. The gold standard for diagnosis PA is the plasma aldosterone/plasma renin ratio (ARR). If this test is positive, then we proceed with one of the four confirmatory tests. If positive, then we proceed with a localizing technique like adrenal vein sampling (AVS) and CT scan. If the lesion is unilateral, after proper preoperative preparation, we proceed, in adrenalectomy. If the lesion is bilateral or the patient refuses or is not fit for surgery, we treat them with mineralocorticoid receptor antagonists, usually spironolactone. Conclusions. Primary aldosteronism is the most common and a treatable case of secondary hypertension. Only patients with unilateral adrenal diseases are eligible for surgery, while patients with bilateral and non-surgically correctable PA are usually treated by mineralocorticoid receptor antagonist (MRA). Thus, the distinction between unilateral and bilateral aldosterone hypersecretion is crucial

Surgical treatment of perianal abscess and fistula-in-ano in childhood, with emphasis in children older than 2 years

Background: Anal sepsis in children ranges from perianal abscess to fistula-in-ano. It is mostly observed in boys younger than 2 years. Most are treated conservatively. In contrast, anal sepsis in older children presents significant similarities to that of adults and is predominantly treated surgically. We report our outcomes after surgical treatment of anal abscess and fistula-in-ano in children older than 2 years. Patients and Methods: Ninety-eight (98) children were operated on for anal abscess (46 patients; 47%) and/or fistula-in-ano (52 patients; 53%). Incision and drainage of the abscess was performed as outpatients. In patients with fistulas, fistulotomy was the main treatment approach. All patients were healthy without risk factors for anal sepsis. Results: In patients with anal abscess treated with incision and drainage, low recurrence (13%) or fistula formation rates were observed. Most anal fistulas were simple entities. Significant involvement of the anal sphincter was found in 3 (6%) of 52 patients. An abscess cavity between the anal canal and the perianal skin was found in 4 (8%) of 52 patients, and an enlarged cryptic gland was found in 5 (10%) of 52 cases. Fistulotomy was performed in all patients with additional seton placement in 3 (6%) of 52 and a cryptotomy in 5 (10%) of 52 patients. Conclusions: Anal abscesses in children are easily treated by incision and drainage with low recurrence of perianal sepsis. Fistulas can be treated successfully in most patients with a fistulotomy, whereas complex fistulas are uncommon. (c) 2012 Elsevier Inc. All rights reserved

A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology)

Objectives. To present a step by step approach for the diagnosis of adrenal incidentaloma (AI). Method. An extensive review of the literature was conducted, searching the Pub-Med and Google Scholar using the Mesh terms; Adrenal; Incidentaloma; Adrenal tumours; Radiology; Diagnosis. We also did a cross-referencing search of the literature. Comments on the new European guidelines are presented. Results. The majority of the tumours are non-functioning benign adenomas. The most important radiological characteristic of an adrenal incidentaloma is the radiation attenuation coefficient. Wash out percentage and the imaging characteristics of the tumour may help in diagnosis. Conclusion. Density less than 10 HU is in most cases characteristic of a lipid rich benign adenoma. More than 10 HU or/and history of malignancy raise the possibility for cancer. 1 mg dexamethasone test and plasma metanephrines should be done in all patients. If there is history of hypokalemia and/or resistant hypertension we test the plasma aldosterone to plasma renin ratio (ARR). Newer studies have shown that tumours even nonfunctioning and less than 4 cm may increase the metabolic risks so we may consider surgery at an earlier stage