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

The inhibition of toll-like receptors as immunomodulation strategy in sepsis

Although LPS tolerance is well characterized, it remains unknown if it is achieved even with single doses of lipopolysaccharide (LPS) and if it offers protection against lethal bacterial infections. To this end, C57B6 mice were assigned to groups A (sham); B (saline i.p followed after 24 h by i.p 30 mg/kg LPS); and C (3 mg/kg LPS i.p followed after 24 h by i.p 30 mg/kg LPS).Survival was monitored and animals were sacrificed early after lethal challenge for measurement of tumour necrosis factor-alpha (TNF-a) in serum; isolation of splenocytes and cytokine stimulation; and flow-cytometry for apoptosis and TREM-1. Experiments were repeated with mice infected i.p by Escherichia coli after challenging with saline or LPS. Mortality of group B was 72.2% compared with 38.9% of group C (p: 0.020). Serum TNF-a of group C was lower than group B. Expression of TREM-1 of group C on monocytes/neutrophils was greater than group B. Release of TNF-a, of IFNc and of IL-17 from splenocytes of group C was lower than group B and the opposite happened for IL-10 showing evidence of cellular reprogramming.In parallel, apoptosis of circulating lymphocytes and of splenocytes of group C was greater compared with group B. Pre-treatment of mice challenged by E. coli with low dose LPS led to 0% mortality compared with 90% of saline pre-treated mice; in these mice, splenocytes improved over time their capacity for release of IFNc.It is concluded that single low doses of LPS lead to early reprogramming of the innate immune response and prolong survival after lethal E. coli challenge.Παρά το γεγονός ότι το φαινόμενο της ανοχής στην ενδοτοξίνη είναι γνωστό δεν είναι ξεκάθαρο το κατά πόσο επάγεται ακόμη και από μικρές δόσεις λιποπολυσακχαριδίου (LPS) και κατά πόσο η προ-θεραπεία με χαμηλή δόση λιποπολυσακχαριδίου προσφέρει στην προστασία του οργανισμού έναντι σε θανατηφόρες βακτηριακές λοιμώξεις.Για να εξακριβώσουμε τα ανωτέρω αρσενικοί επίμυες C57B6 χωρίστηκαν σε ομάδα Α (εικονικά πειραματόζωα), ομάδα Β (χορήγηση φυσιολογικού ορού ενδοπεριτοναικά και μετά από 24 ώρες χορήγηση 30 mg/kg LPS) και ομάδα Γ (χορήγηση 3mg/kg LPS και εν συνεχεία μετά από 24 ώρες 30mg/kg LPS ενδοπεριτοναικά). Έγινε καταγραφή της επιβίωσης των ζωικών προτύπων και εν συνεχεία ευθανασία, αμέσως μετά από την χορήγηση θανατηφόρου δόσης λιποπολυσακχαριδίου, με σκοπό την μέτρηση του TNF-α στον ορό. Παράλληλα απομονώθηκαν σπληνοκύτταρα τα οποία υπεβλήθησαν σε διέγερση για την παραγωγή κυτταροκινών, ενώ πραγματοποίηθηκαν και μετρήσεις κυτταρομετρίας ροής για τον προσδιορισμό του TREM-1 και της απόπτωσης των κυκλοφορούντων λεμφοκυττάρων και σπληνοκυττάρων.Τα πειράματα επαναλήφθησαν με την χορήγηση E.Coli ενδοπεριτοναικά αφού τα ζωικά πρότυπα είχαν προηγουμένως υποβληθεί σε προ-θεραπεία με φυσιολογικό ορό ή LPS. Η θνητότητα στην ομάδα Β ήταν 72,2% ενώ η θνητότητα στην ομάδα Γ ήταν 38,9% (p:0.020). H συγκέντρωση του TNF-α στον ορό της ομάδας Γ ήταν μικρότερη σε σχέση με αυτή της ομάδας Β. Επίσης η έκφραση του TREM-1 επί των ουδετεροφίλων και μονοκυττάρων της ομάδας Γ ήταν υψηλότερη συγκριτικά με αυτή της ομάδας Β. Η απελευθέρωση TNF-α, IFNγ και IL-17 από τα σπληνοκύτταρα της ομάδας Γ ήταν μικρότερη από τα επίπεδα που παρατηρήθηκαν στην ομάδα Β ενώ το αντίθετο αποτέλεσμα κατεγράφηκε για την παραγωγή IL-10, γεγονός που οδηγεί στο συμπέρασμα ότι έλαβε χώρα κυτταρικός επαναπρογραμματισμός. Παράλληλα δε η απόπτωση των κυκλοφορούντων λεμφοκυττάρων και των σπληνοκυττάρων ήταν μεγαλύτερη στην ομάδα Γ συγκριτικά με την ομάδα Β.Επίσης, η προ-θεραπεία με χαμηλή δόση LPS προστάτεψε τους επίμυες μετά την χορήγηση θανατηφόρου δόσης E.Coli. Συγκεγκριμένα η θνητότητα των ζωικών προτύπων που είχαν υποβληθεί σε προ-θεραπεία με χαμηλή δόση LPS ήταν 0% σε αντίθεση με την ομάδα που είχε υποβληθεί σε προ-θεραπεία με φυσιολογικό ορό η οποία εμφάνισε θνητότητα 90%. Σε αυτούς τους μύες τα σπληνοκύτταρα κατάφεραν να επανακτήσουν την ικανότητα τους για την παραγωγή IFNγ με την πάροδο του χρόνου.Με βάση τα παραπάνω αποτελέσματα μπορούμε να πούμε ότι η προ-θεραπεία μέσω χορήγησης μικρών δόσεων LPS έστω και μια φορά οδηγεί σε πρόωρο επαναπρογραμματισμό του φυσικού ανοσιακού μηχανισμού και έχει όφελος στην επιβίωση μετά από θανατηφόρο χορήγηση E.Coli

Bilateral pulmonary nodules in an adult patient with bronchiolitis obliterans-organising pneumonia

A 58-year-old male ex-smoker was admitted to hospital because of nodular infiltrates on chest x rays. He was complaining of fatigue, dyspnoea with exertion, low grade fever and weight loss. Physical examination was unremarkable. Bronchoscopy was inconclusive but revealed endobronchial lesions of chronic active inflammation. The diagnosis of cryptogenic organising pneumonitis bronchiolitis obliterans-organising pneumonia (COP-BOOP) was established by open lung biopsy. Proliferative bronchiolitis with regions of organising pneumonia is the characteristic feature of COP. The radiological picture of bilateral pulmonary nodules is an infrequent manifestation of COP. Lung biopsy, open or with video assistance thoracic surgery, is recommended to confirm the diagnosis

PM10 levels at urban, suburban, and background locations in the eastern Mediterranean: local versus regional sources with emphasis on African dust

Summarization: PM10 levels were determined at different locations in a coastal site in the eastern Mediterranean to assess the relative contribution of local versus regional sources. Two campaigns were conducted: during the first, PM10 was monitored at three urban locations (kerbside/traffic/background) at different sampling periods, whereas during the second one, PM10 was simultaneously measured at two locations (urban/suburban). Both campaigns have shown that African dust transport was a major carrier of coarse particles. Daily PM10 concentrations of 547 μg m−3 and 234 μg m−3 were measured during the first and the second campaigns, respectively, both of them associated with severe dust storms. However, some dust episodes influenced lesser PM10 levels. The contribution from dust episodes to the measured concentration was estimated at 2–527 μg m−3 during the first campaign and 4–218 μg m−3 during the second campaign. Classification into dusty and non-dusty days has shown that local anthropogenic sources also influence ambient PM10 concentrations; however, few exceedances of the daily limit of 50 μg m−3 occurred during both campaigns. Particularly, it was found that domestic heating during cold months was a major contributor to PM10 levels followed by emissions from traffic with higher contribution of the latter during summer months (high touristic season) as well as non-traffic emissions (road dust resuspension). Hourly average PM10 concentration during the second campaign has shown that traffic-related emissions and/or road dust resuspension were associated with up to 40 μg m−3 whereas during wintertime late evening hours, PM10 concentration from heating reached up to 60 μg m−3 at the central urban location.Παρουσιάστηκε στο: Air Quality, Atmosphere and Healt

PM10 and PM2.5 levels in the Eastern Mediterranean (Akrotiri Research Station, Crete, Greece)

Summarization: Particulate matter measurements (PM10, PM2.5) using a beta radiation attenuation monitor were performed at the Akrotiri research station (May 2003–March 2006) on the island of Crete (Greece). The mean PM10 concentration during the measuring period (05/02/03–03/09/04) was equal to 35.0 ± 17.7 μg/m3 whereas the mean PM2.5 concentration (03/10/04–04/02/06) was equal to 25.4 ± 16.5 μg/m3. The aerosol concentration at the Akrotiri station shows a large variability during the year. Mean concentrations of particulate matter undergo a seasonal change characterised by higher concentrations during summer [PM10, 38.7 ± 10.8 μg/m3 (2003); PM2.5, 27.9 ± 8.7 μg/m3 (2004) and 27.8 ± 9.7 μg/m3 (2005)] and lower concentrations during winter [PM10, 28.7 ± 22.5 μg/m3 (2003/2004); PM2.5, 21.0 ± 13.0 μg/m3 (2004/2005) and 21.4 ± 21.9 μg/m3 (2005/2006)]. Comparative measurements of the PM10 concentration between the beta radiation attenuation monitor, a standardized low volume gravimetric reference sampler and a low volume sequential particulate sampler showed that PM10 concentrations measured by the beta radiation attenuation monitor were higher than values given by the gravimetric samplers (mean ratio 1.17 ± 0.11 and 1.21 ± 0.08, respectively). Statistical and back trajectory analysis showed that elevated PM concentrations (PM10, 93.8 ± 49.1 μg/m3; PM2.5: 102.9 ± 59.9 μg/m3) are associated to desert dust events. In addition regional transport contributes significantly to the aerosol concentration levels whereas low aerosol concentrations were observed during storm episodes.Παρουσιάστηκε στο: Water, Air, and Soil Pollutio