Acute appendicitis in preschoolers: a study of two different populations of children

<p>Abstract</p> <p>Objective</p> <p>To assess the incidence and the risk factors implicated in acute appendicitis in preschoolers in our region.</p> <p>Methods</p> <p>Over a 7-year period, 352 children underwent appendectomy for suspected acute appendicitis. Of these, data for 23 children were excluded because no inflammation of the appendix was found on subsequent histology. Of the remaining 329, 82 were ≤ 5 years old (i.e., preschool children) and 247 were 5-14 years old. These two groups of children were further divided according to their religion into Muslims and Christian Orthodox: 43 of the children aged ≤ 5 years were Muslims and 39 were Christian Orthodox. A household questionnaire was designed to collect data concerning age, gender, type of residence area, living conditions, vegetable consumption, and family history of surgery for acute appendicitis as preschool children. The removed appendices were also assessed histologically for the amount of lymphoid tissue.</p> <p>Results</p> <p>Acute appendicitis of preschoolers developed more frequently in Muslims (39.4%) than in Christians (17.7%; <it>p </it>< 0.001). The lack of inside toilet facilities at home, overcrowded living conditions, living in rural areas, and the amount of appendix lymphoid tissue were significantly more frequent among the Muslim preschool children (<it>p </it>< 0.05), while there were no statistically significant differences between Muslim and Christian children with regard to gender, the family history of acute appendicitis, or the vegetable consumption (<it>p </it>> 0.05).</p> <p>Conclusions</p> <p>In our region, the percentage of preschool-aged Muslim children with acute appendicitis was remarkably high. One possible explanation for this finding could be the higher amount of lymphoid tissue in the wall of the appendix in Muslim preschool children together with their low standard of hygiene.</p

Omental infarction in an obese 10-year-old boy

Primary omental infarction (POI) has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US) examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intra-operative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction

The role of angiogenic activity in urethral reconstruction: experimantal study in rabbits

Aim of the Study: An experimental study was undertaken in order to estimate the angiogenic activity in free grafts and a pedicle-flap during urethral reconstruction of an urethral defect in an animal model. Methods: 28 White New Zealand rabbits were randomly divided into five groups (0, A, B, C and D). A ventral urethral defect was created in all groups. In the group O, (n=4), a simple closure of the defect was performed. Free penile skin graft (group A, n=6), pedicle penile skin graft (group B, n=6), buccal mucosal graft (group C, n=6), and bladder mucosal graft (group D, n=6) were used to bridge the urethral defect as an onlay patch. The animals were euthanasized on the 21st postoperative day. The angiogenic activity was assessed with immunohistochemistry, using the anti-CD31 MoAb and the phosphatase antialkaline phosphatase procedure. The native vascularity of penile skin as well as buccal and bladder mucosa was assessed in rabbits from Group O (n=3) Statistical analysis was performed by one way ANOVA and chi-square analysis. Main Results: The angiogenesis in a magnification of x 200 in groups O, A, B, C, and D was 34.1 ± 4.1 (mean±SD), 61.7 ± 6.4, 30.8 ±5.2, 94.3 ± 6.4, and 91.5 ± 7.2 vessels per optical field respectively. There were statistically significant differences (p0.05) between groups C and D and groups O and B. The native vascularity of penile skin, buccal mucosa and bladder mucosa was 23,3 ± 3,0, 24,6 ± 3,7 and 17,0 ± 2,6 vessels per optical field respectively. Conclusion: Buccal and bladder mucosal grafts exhibit higher angiogenic activity than free and pedicle penile skin flap when transplanted in urethral defects. As the buccal mucosal graft showed the higher angiogenic activity among the groups A and B and its harvesting is easier than bladder mucosa, we propose that in urethral reconstruction surgery the use of this graft might have the more reliable results.Σκοπός: Η πειραματική αυτή μελέτη έγινε με σκοπό να εκτιμηθεί η αγγειογενετική δραστηριότητα των ελεύθερων μοσχευμάτων πόσθης, βλεννογόνου στόματος και βλεννογόνου ουροδόχου κύστεως, καθώς και του μισχωτού μοσχεύματος πόσθης στην αποκατάσταση ελλειμμάτων ουρήθρας σε πειραματικό μοντέλο κονίκλου. Μέθοδος: Χρησιμοποιήθηκαν 28 λευκά κουνέλια τύπου Νέας Ζηλανδίας τα οποία χωρίστηκαν σε 5 ομάδες (Ο, Α, Β, Γ και Δ) . Στις Ομάδες Α, Β, Γ και Δ στο κοιλιακό τμήμα της ουρήθρας δημιουργήθηκε έλλειμμα. Η βλάβη αποκαταστάθηκε με ουρηθροπλαστική επικαθήμενου τύπου, χρησιμοποιώντας ελεύθερο μόσχευμα πόσθης στην ομάδα Α (n=6), μισχωτό μόσχευμα πόσθης στην ομάδα Β (n=6) και με μοσχεύματα βλεννογόνου στόματος και ουροδόχου κύστεως στις ομάδες Γ (n=6) και Δ (n=6) αντίστοιχα. Στην ομάδα Ο (ομάδα ελέγχου n=4) έγινε απλή ουρηθροτομή και σύγκλειση. Την 21η μετεγχειρητική ημέρα τα ζώα υποβλήθηκαν σε ευθανασία. Η αγγειογενετική δραστηριότητα εξετάστηκε με τη βοήθεια της ανοσοϊστοχημικής μεθόδου - τεχνικής αλκαλικής αντιαλκαλικής φωσφατάσης (APAAP) και με τη χρήση του μονοκλωνικού αντισώματος αντι-CD31. Σε 3 ζώα από την ομάδα Ο λήφθηκε ιστός από το δέρμα πόσθης, τον βλεννογόνο του στόματος και της ουροδόχου κύστεως για να ελεγχθεί η προϋπάρχουσα αγγείωση των μοσχευμάτων. H στατιστική επεξεργασία των αποτελεσμάτων έγινε με τη χρήση του one - way ANOVA. Αποτελέσματα: H μέση τιμή ± SD της αγγειογένεσης ανά οπτικό πεδίο σε μεγέθυνση επί 200 ήταν για την ομάδα Ο: 34,16 ± 4,12, την ομάδα Α: 61,7 ± 6,4, την ομάδα Β: 30,8 ± 5,2, την ομάδα Γ: 94,3 ± 6,4 και την ομάδα Δ: 91,5 ± 7,22. Υπήρξε στατιστικά σημαντική διαφορά (p0,05) μεταξύ των ομάδων Γ και Δ και Ο και Β. Η αγγείωση που προϋπήρχε στο δέρμα πόσθης καθώς και στους βλεννογόνους στόματος και ουροδόχου κύστης ήταν 23,3 ± 3,0/ 24,6 ± 3,7 και 17,0 ± 2,6 αγγεία ανά οπτικό πεδίο αντίστοιχα. Συμπεράσματα: Oι βλεννογόνοι ουροδόχου κύστης και στόματος παρουσιάζουν την μεγαλύτερη αγγειογενετική δραστηριότητα σε σχέση τόσο με το ελεύθερο όσο και με το μισχωτό μόσχευμα πόσθης όταν τοποθετηθούν σε ελλείμματα ουρήθρας. Μια και το μόσχευμα από βλεννογόνο στόματος παρουσιάζει την μεγαλύτερη αγγειογενετική δραστηριότητα και η λήψη του είναι ευκολότερη από αυτή του βλεννογόνου ουροδόχου κύστης, προτείνεται ότι η χρήση αυτού του μοσχεύματος σε ελλείμματα ουρήθρας μπορεί να δώσει ικανοποιητικά αποτελέσματα

Local peritonitis as the first manifestation of Crohn′s disease in a child

Crohn′s disease (CD) can occur anywhere in the gastrointestinal tract from the mouth to the anus and sometimes it presents in a nonspecific manner. Herein we describe a case of local peritonitis as the first manifestation of CD in an 11-year-old girl, and the subsequent method of treatment

What are the Risk Factors Responsible for the Delay in Diagnosis of Acute Appendicitis in Children? Eleven-year Research from a Single Institution

Introduction: We conducted a retrospective analysis of 602 children operated on for acute appendicitis (AA) in our department between 1/2007 and 12/2017.Aim: The aim of this study was to identify factors that are related to a delay in diagnosing AA in children. Furthermore, we’d like to strengthen our previous preliminary results by a) adding gender as a new factor and b) studying a much larger population.Materials and methods: The time that elapsed from the onset of symptoms to the surgical intervention was associated with gender, age, obesity, use of antibiotics prior to diagnosis, and the initial examination by a paediatric surgeon or another physician. Univariate and multivariate logistic regression method (backward method) was applied.Results: The diagnosis of AA was delayed by at least 48 hours in 287 patients (group A, 47.7%) and was made within 48 hours in 315 patients (group B, 52.3%). In multivariate model we noticed that boys who were examined by a paediatric surgeon and didn’t take antibiotics had decreased odds of having length of diagnostic period >48 hours, girls who received antibiotics compared to girls who do not use antibiotics are almost 12 times more likely to have length of diagnostic period >48 hours, the very young age has а main effect оn the diagnostic delay and girls who have been examined by other physician compared to females who have been examined by paediatric surgeon have decreased odds of having length of diagnostic period >48 hours.Conclusions: Therefore, physicians examining children with abdominal pain must keep in mind the multiple causes of diagnostic delay that may exist alone or in combination, and which can lead to serious complications and lengthen the hospital stay. Performing repeated examinations and asking for advice from a specialist specifically for children who are a special category of patients, in areas where it is rather impossible to use imaging techniques, could be the key to correctly diagnosing and treating AA

The Prognostic Value of Ultrasound Findings in Preoperatively Distinguishing between Uncomplicated and Complicated Types of Pediatric Acute Appendicitis Based on Correlation with Intraoperative and Histopathological Findings

Objective: This study compares the preoperative ultrasound findings of all children with a clinical picture of acute appendicitis on the basis of intraoperative and histopathological findings to assess the feasibility of this approach in preoperatively distinguishing between uncomplicated and complicated cases. Methods: This retrospective study includes 224 pediatric patients who underwent ultrasound prior to appendectomy at our institution between January 2016 and February 2022. Logistic regression analysis was used to investigate the association between sonographic and intraoperative histopathological findings. Results: Of the 224 participants, 61.1% were intraoperatively diagnosed with uncomplicated appendicitis (59.8% male). Multivariate logistic regression analysis revealed that patients with a higher appendiceal diameter, presence of appendicolith, and peritonitis were more likely to suffer from complicated appendicitis. Finally, the common anatomical position of the appendix and an appendiceal diameter greater than 6 mm had the highest sensitivity (94.6% and 94.5%, respectively) for predicting complicated appendicitis, with the most specific (99.3%) sonographic finding being the existence of an abscess. Conclusions: Preoperative abdominal ultrasound in children with a clinical diagnosis of acute appendicitis can distinguish between uncomplicated and complicated appendicitis in most cases of pediatric appendicitis. A higher appendiceal diameter, the presence of appendicolith, and peritonitis are parameters noted by ultrasound that strongly predict complicated appendicitis

Effects of the Antioxidant Quercetin in an Experimental Model of Ulcerative Colitis in Mice

Background and Objectives: Quercetin, a member of the flavanol family found in many fruits, vegetables, leaves and grains has been found to have a wide range of biological effects on human physiology. The aim of this study was to investigate the effects of quercetin, when administered orally in the form of the water-soluble inclusion complex with hydroxypropyl-b-cyclodextrin (Que-HP-β-CD), in an experimental model of ulcerative colitis in mice. Materials and Methods: Animals received either Dextran Sodium Sulphate (DSS), to induce colitis, + Que-HP-β-CD (Group A), DSS alone (Group B) or no intervention (control, Group C) for 7 days. All animals were weighed daily, and evaluation of colitis was performed using the Disease Activity Index (DAI). On day 7 a blood sample was taken from all animals, they were then euthanised, the large intestine was measured, and histological and immunochemical analyses were performed. Results: The DAI demonstrated an increase over time for the groups receiving DSS (Groups A and B) compared with the control group (Group C), with a significant degree of protection being observed in the group that also received quercetin (Group A): The DAI over time slope for Group B was higher than that for Group A by 0.26 points/day (95% Cl 0.20–0.33, p Conclusions: In conclusion, the administration of quercetin in an ulcerative colitis model in mice presents a therapeutic/prophylactic potential that warrants further investigation