Ultrasonography findings of appendicular wall thickness in acute appendicitis and recurrent appendicitis with pathological correlation

Background: Appendicitis is among most common cause for acute abdominal pain requiring operative management. This study is to establish relationship between wall thickness of acute appendicitis and recurrent appendicitis with its pathological outcome.Methods: In this prospective study, 24 patients of acute appendicitis and 8 patients of recurrent appendicitis presenting as acute appendicitis were examined by High resolution Ultrasonography within 48 hrs of acute onset of symptoms following a detailed clinical examination. Alvarado scoring was done in all patients. Acute appendicitis and recurrent appendicitis were differentiated on the basis of clinical details and timeline of illness. Post operatively all specimens underwent gross and histopath examination and were divided into subgroups and tabulated as “early acute appendicitis”, “acute suppurative appendicitis” and “acute gangrenous Appendicitis”.Results: Wall thickness of acute appendicitis and recurrent appendicitis (presenting with acute onset of symptoms) were tabulated. Patients with wall thickness of <3mm had statistically significant higher prevalence of acute gangrenous appendicitis on pathological correlation. Patients with recurrent appendicitis had higher incidence of wall thickness <3mm, consequently increased incidence of acute gangrenous appendicitis. The value of z was 6.0715. The value of p is <0.00001. The result was significant at p <0.01 according to SPSS 16, which correlates well with findings.Conclusions: Wall thickness is an important indicator in the management of acute or recurrent appendicitis, wall thickness of <3mm or >3mm was decisive in patient management. Reduced wall thickness of appendix in patients with acute or recurrent appendicitis correlate with higher incidence of acute gangrenous appendicitis therefore are at higher risk of perforation and should be managed aggressively by surgical intervention to avoid complications.

Primary pyomyositis in North India: a clinical, microbiological, and outcome study

BACKGROUND/AIMS: Pyomyositis is an infective condition with primary involvement of the skeletal muscles. There is sparse recent literature on patients with pyomyositis. METHODS: This study was carried out at emergency services of a tertiary care center located in subtropical area of Indian subcontinent. RESULTS: Sixty-two patients of primary pyomyositis formed the study cohort. Mean age of occurrence was 29.9 ± 14.8 years. There were 54 men. Twelve patients had underlying medical diseases. Muscle pain was seen in all 62 patients. Forty-eight patients (77.4%) had the fever. Most common site of involvement was thigh muscles (n = 29, 46.8%). Forty-nine patients (79%) presented in the suppurative stage of illness. Patients with comorbidities were older (age: median 36 years [interquartile range (IQR), 25 to 47] vs. 24 years [IQR, 16 to 35], p = 0.024), had higher culture positivity with gram-negative organisms (8/9 [88.89%] vs. 6/29 [20.69%], p = 0.001). Importantly, higher number of these patients received inappropriate antibiotics initially. Patients with positive pus culture result had higher complication rate (32/38 [84.21%] vs. 10/18 [55.56%], p = 0.044). Six patients (9.7%) had in-hospital mortality. Lower first-day serum albumin, initial inappropriate antibiotic therapy, and advanced form of the disease at presentation were associated with increased in-hospital mortality. CONCLUSIONS: Primary pyomyositis is not an uncommon disease entity. Patients with comorbidities were more likely to receive initial inappropriate antibiotic therapy. Patients with positive pus culture report had the higher rate of complications. Lower first-day serum albumin, initial inappropriate antibiotic therapy and advanced form of the disease at presentation were associated with increased in-hospital mortality.

Embryonal rhabdomyosarcoma of the middle ear presenting with aural polyp and facial nerve palsy

Rhabdomyosarcoma is a rare tumour in the middle ear and mastoid cavity in children and the diagnosis is difficult. Repeated histological examination may be essential to confirm the diagnosis. We report a 6 year old boy with a left aural polyp, otorrhoea and facial nerve palsy who was initially thought to have otitis media and mastoiditis. He had polypectomy and the tissue taken for histopathology suggested an inflammatory condition. Subsequently he had mastoidectomy. Tissue taken during mastoidectomy was however reported as rhabdomyosarcoma. The child developed a cerebral abscess and eventually succumbed. A literature review of the disease, radiological findings, immunohistochemical features and treatment options is described.