Diagnosis of acute appendicitis

AbstractAppendicitis is the most common abdominal emergency. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Abdominal pain is the primary presenting complaint of patients with acute appendicitis. Nausea, vomiting, and anorexia occur in varying degrees. Abdominal examination reveals localised tenderness and muscular rigidity after localisation of the pain to the right iliac fossa. Laboratory data upon presentation usually reveal an elevated leukocytosis with a left shift. Measurement of C-reactive protein is most likely to be elevated. The advances in imaginology trend to diminish the false positive or negative diagnosis. Radiographic image of faecal loading image in the caecum has a sensitivity of 97% and a negative predictive value that is 98%. In experienced hands, ultrasound may have a sensitivity of 90% and specificity higher than 90%. Helical CT has reported a sensitivity that may reach 95% and specificity higher than 95%. Despite all medical advances, the diagnosis of acute appendicitis continues to be a medical challenge

Treatment of Idiopathic Persistent Hiccups with Positive Pressure Ventilation -A Case Report-

A 41-year-old male patient presented with idiopathic persistent hiccups. The hiccups did not respond to pharmacologic treatments including cisapride, omeprazole, and baclofen. Phrenic nerve block was also ineffective. However, the persistent hiccups were successfully treated with short-term positive pressure ventilation using a short-acting muscle relaxant

Autoria de um trabalho científico

Durante a elaboração de um trabalho científico, uma das dificuldades que por ventura podem ocorrer é a escolha dos participantes da pesquisa que devem compor a sua autoria. Situação ainda mais desagradável é a ordenação dos autores, de acordo com o mérito de cada um no trabalho. Objetivo: Apresentar, de maneira justificada, uma proposta para a autoria do trabalho científico, mediante a contribuição de cada membro da equipe de pesquisadores. Método : Foi realizada uma avaliação da maneira de se propor a autoria científica nos principais centros de pesquisa do Brasil e na literatura pertinente, para a aquisição de subsídios com vista à presente proposta. Resultados: São apresentados em ordem de entrada os principais autores do trabalho e aqueles que devem merecer apenas agradecimento. Propõe-se uma escala numérica, com vistas à participação de cada membro da equipe, para facilitar a inclusão de cada um dos autores. Conclusões: O mérito da autoria científica deve ser restrito aos participantes que tiveram uma colaboração intelectual ao trabalho realizado, aliada a uma contribuição efetiva para a pesquisa ser realizada e concluída.Background. During the development of a scientific research, one of the main difficulties is to choose the authors of the paper from all participants of the investigation. The organization of the authorship, based on the contribution of each investigator is still more complex. Objective: To propose a justified indicator for the authorship of a scientific paper. Method: The author investigated the main research centers of Brazil in order to know their philosophy related to the authorship of a research. An assessment of the literature completed this study. Results: We present and justify the order of each investigator in the authorship or acknowledgment of the paper, based on his or her participation on the investigation Conclusion: The investigator deserves to be included as an author of a scientific paper only if he or she has an intellectual participation in the work and also effectively contributed with the execution and accomplishment of the research. [Rev Assoc Med Bras 2002; 48(1):60-5

A influência da presença de tecido muscular em local de cicatrização óssea

PURPOSE: The recovery of a bone fracture is a process that is not yet fully understood. The literature conflicts on the results obtained by the interposition of foreign tissue inside a damaged bone. The objective of the present study was to ascertain the effect of placing muscle tissue between the stumps of a fractured bone. METHOD: The study was carried out on 10 rabbits divided into 2 groups (n = 5): Group 1-partial fracture of the humerus and interposition of muscle tissue; Group 2-complete fracture of the humerus and interposition of muscle tissue. The fractured limb of all animals was immobilized for 8 weeks. At the end of this time, the rabbits were killed and their operated humeri were carefully removed for roentgenological and histological assessment. RESULTS: All humeri of Group 1 recovered their integrity and normal aspect. However, the healing of the humeri of Group 2 was not perfect. Gross angulation of the bone diaphysis occurred in all animals, and immature trabecular bone, osteochondral tissue, and persistence of muscle tissue substituted normal bone. CONCLUSIONS: Interposed muscle does not affect partial bone fracture healing but causes instability in a complete fracture.OBJETIVO: A recuperação de uma fratura óssea ainda não está bem compreendida. A literatura é controversa quanto aos resultados da interposição de tecidos no interior de uma lesão óssea. O objetivo do presente trabalho foi verificar o efeito da interposição de tecido muscular entre as partes de um osso fraturado. MÉTODO: Dez coelhos foram distribuídos em dois grupos (n=5): Grupo 1- secção parcial do úmero e interposição de tecido muscular; Grupo 2- secção completa do úmero e interposição de tecido muscular. Os membros fraturados de todos os animais foram imobilizados por oito semanas. No final desse período, os coelhos foram mortos e o úmero fraturado foi cuidadosamente removido para estudo radiográfico e histológico. RESULTADOS: Todos os úmeros do Grupo 1 recuperaram sua integridade e se apresentaram de aspecto normal. Entretanto, o processo de recuperação do Grupo 2 não foi perfeito. Angulações grosseiras da diáfise óssea ocorreram em todos os animais, e o osso normal foi substituído por trabéculas ósseas imaturas, tecido osteochondral e se caracterizaram pela persistência do tecido muscular. CONCLUSÕES: A interposição de tecido muscular não afeta o processo cicatricial de fraturas parciais, mas torna instável a fratura completa

Acompanhamento pós-operatório tardio de pacientes submetidos a esplenectomia subtotal

PURPOSE: Over the past 21 years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43), trauma (n = 31), Gaucher's disease (n = 4), myeloid hepatosplenomegaly due to myelofibrosis (n = 3), splenomegalic retarded growth and sexual development (n = 2), severe pain due to splenic ischemia (n = 2) and pancreatic cystadenoma (n = 1). Patients underwent a hematologic exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS: Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hyperension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.OBJETIVO: Durante 21 anos, realizamos mais de 200 esplenectomias subtotais para tratar diferentes condições patológicas. É fundamental conhecer os resultados pós-operatórios desse procedimento. MÉTODO: Todos os pacientes submetidos a esplenectomia subtotal foram convidados para serem submetidos a revisão. Pudemos reunir 86 pacientes operados em um período de um a vinte anos por hipertensão porta esquistossomática com sangramento prévio pelas varizes (n = 43), trauma (n = 31), doença de Gaucher (n = 4), hepatoesplenomegalia mielóide devido a mielofibrose (n = 3), retardo de desenvolvimento somático e sexual esplenomegálico (n = 2), dor intensa por isquemia esplênica (n = 2) e cistoadenoma corpocaudal pancreático (n = 1). Os pacientes foram submetidos a exame hematológico, avaliação imunológica, ultra-som, tomografia computadorizada, cintilografia e endoscopia digestiva alta. RESULTADOS: Aumento do número de leucócitos e plaquetas foram a única alteração hematológica encontrada. Não foram constatados distúrbios imunológicos. Varizes esofágicas ainda estavam presentes em pacientes operados de hipertensão porta, porém sem ressangramento. O ultra-som, a tomografia computadorizada e a cintilografia confirmaram a presença do remanescente esplênico funcionante, sem mudanças em seu tamanho. CONCLUSÃO: A esplenectomia subtotal parece ser um procedimento seguro e pode seu útil para tratar condições nas quais o baço estiver envolvido

Blood coagulation, platelets and haematocrit 1n male, female, and pregnant Göttlngen rmmplgs

Pigs are commonly used animals for research. Information on the coagulation system of an experimental animal is essential for scholars to select an appropriate model. We present information on coagulation and haematological parametersin Giittingen breed minipigs (male, female, and pregnant). Factor activities are expressed as percentage of human activity to facilitate interspecies comparison.Protein C was significantly higher, fibrinogen and platelets were significantly lower in pregnant compared to male pigs (p < 0.001 without Bonferroni-correction, p < 0.03 with Bonferroni-correction applied). As pregnant sows were older (30 +/- 11 months) than female non-pregnant animals (age 11+/- 8 months) and boars (8 +/- 2 months) an influence of age on the observed differences can’t be excluded.The Göttingen minipig is an animal suited for studies involving coagulation Iiieasurements. It should be noted, however, that compared to normal human values factor V (about 400% human) and Factor VIII (about 300% human) are higher inGöttingen breed minipigs and that haematocrit (33% absolute) is lower