An Analysis of Role of Computed Tomography Scan Abdomen in Differentiating Perforated from Non-perforated Appendicitis Accurately and Comparing with Histopathology Reports

Background: Acute appendicitis is one of the most common abdominal surgical emergencies requiring accurate diagnosis. Itis characterized by obstruction of its lumen, leading to inflammation and finally perforation. To define its prognosis, choose anappropriate surgical procedure and to decide non-surgical treatment, the pre-operative diagnosis of perforated or non-perforatedappendicitis is very important.Aim of the Study: This study aims to analyze the diagnostic accuracy of computed tomography (CT) scan abdomen indifferentiating perforated from non-perforated appendicitis using histopathology as the final diagnosis.Materials and Methods: Aprospective, cross-sectional analytical study, wherein 85 patients diagnosed with acute appendicitisreferred to the radiological department for CT scan abdomen were included in the study. Patients aged between 15 and 70 yearswere included in the study. CT scan abdomen with and without contrast was performed on a Toshiba 64 Multislice CT scanner(Toshiba Medical Systems Corp., Tokyo, Japan) which was used for all the patients. All the CT scans were interpreted by the sameconsultant radiologists with a minimum of 5 years of experience. The radiological features for the diagnosis of non-perforatedacute appendicitis by CT were based on swollen appendix, thickened enhancing wall, and smudging of surrounding fat planes,whereas the radiological features for perforated appendicitis used were, with abscess formation, phlegmon, extraluminal air,extraluminal appendicolith, and focal defect in the appendicular wall. Histopathology of the specimen collected following surgerywas undertaken by the hospital consultant pathologist of more than 5-year experience.Observations and Results: Among the 85 patients included in this study for the analysis of CT scan abdomen features, therewere 57 (67.05%) males and 28 (32.94%) females with a male-to-female ratio of 2.03:1. The mean age of the patients was38.90 ± 6.70 years. The incidence of non-perforated appendicitis was 66/85 (77.64%) including males 44/85 (51.76%) andfemales 22/85 (25.88%). The incidence of perforated appendicitis was 19/85 (22.35%) and males were 12/85 (14.11%) and 7/85(8.23%) were female. Patients aged 15–45 years of both genders constituted to 63/85 (74.11%) of the total patients. Amongthese patients, presenting with non-perforated appendicitis was 51/85 (60%) and perforated appendicitis was 12/85 (14.11%).Conclusions: Multislice CT scan abdomen was considered as the modality of choice for acute appendicitis not only to confirmthe diagnosis but also it plays an important role in assessment of appendicular complication, particularly in the detection ofperforated appendix. Using one or more of the five radiological signs of CT scan abdomen to identify appendicular perforationraised the sensitivity significantly reaching 94.12%.

Clinical analysis of 95 cases of cervical tuberculous lymphadenopathy associated with abscess formation / 中国感染与化疗杂志

Objective To explore the clinical features and surgical treatment of cervical tuberculous lymphadenopathy associated with abscess formation.Methods The clinical data of 95 cases of cervical tuberculous lymphadenopathy associated with abscess formation were reviewed and analyzed retrospectively.All the patients were treated in Shenzhen Third People's Hospital during the period from February 2012 to May 2014.Results The mean age of the 95 patients was (27.8±8.2) years.The average duration of the disease was 4.0 months.The tuberculous lymphadenopathy was most frequently found in Level Ⅳ cervical lymph nodes.Thirty-four patients were complicated with pulmonary tuberculosis.History of surgical treatment for tuberculous cervical lymphadenopathy was reported in 26 cases.Sixty-five patients were managed with incision and drainage plus dress changing.Twenty-two patients underwent abscess rinsing,excision and primary wound closure.And 8 patients received excision of ulcers and sinuses,and lymphadenopathy cleaning.The average healing time was (2.11± 1.76) months for incision and drainage.Abscess and ulcer reoccurred in 18 of the 65 patients after healing completely by incision and drainage.All the patients treated by the other two surgical modalities were cured as primary healing except 2 patients,who received local flap grafting after primary surgery.Conclusions Cervical tuberculous lymphadenopathy associated with abscess formation has special features in diagnosis and treatment.Surgical approach is usually effective if optimized for individual patients.

Influence of 120 kDa Pyruvate:Ferredoxin Oxidoreductase on Pathogenicity of Trichomonas vaginalis

Trichomonas vaginalis is a flagellate protozoan parasite and commonly infected the lower genital tract in women and men. Iron is a known nutrient for growth of various pathogens, and also reported to be involved in establishment of trichomoniasis. However, the exact mechanism was not clarified. In this study, the author investigated whether the 120 kDa protein of T. vaginalis may be involved in pathogenicity of trichomonads. Antibodies against 120 kDa protein of T. vaginalis, which was identified as pyruvate:ferredoxin oxidoreductase (PFOR) by peptide analysis of MALDI-TOF-MS, were prepared in rabbits. Pretreatment of T. vaginalis with anti-120 kDa Ab decreased the proliferation and adherence to vaginal epithelial cells (MS74) of T. vaginalis. Subcutaneous tissue abscess in anti-120 kDa Ab-treated T. vaginalis-injected mice was smaller in size than that of untreated T. vaginalis-infected mice. Collectively, the 120 kDa protein expressed by iron may be involved in proliferation, adhesion to host cells, and abscess formation, thereby may influence on the pathogenicity of T. vaginalis.

Experience in treatment of post-ERCP peripancreatic and retroperitoneal abscess formation with non-operation management / 中华肝胆外科杂志

Objective To investigate the technique and clinic value of non-operation management for ERCP-related peripancreatic and retroperitoneal abscess. Methods Five patients with post-ERCP peripancreatic and retroperitoneal abscess were reviewed. Guided by ultrasonic or CT, all the 5 pa-tients underwent puncture and the drainage tube was disposed to the lowest place of abscess. Non-op-eration managements for patients also included the use of anti-inflammatory drugs and enzyme activity inhibition drugs. Results All patients responded to the draining treatment and discharged from hospi-tal after complete recovery. There was no conversion to surgical intervention. Mean draining duration was 52. 4(20-90)d and average hospital stay was 91.8(35-165)d. Conclusion Puncture and drainage management is an effective and safe approach for post-ERCP peripancreatic and retroperitoneal ab-scess. It has advantages of less trauma, less pain, fast recovery and low rate of complications. Punc-ture point should be situated at the bottom or lowest position of abscess and drainage can achieve the best results.

A Case with Perforated Gastric Leiomyoma / 대한소화기내시경학회지

Gastric leiomyomas, which arise from smooth muscle tissue, are the most common non-epi- thelial tumors occurring in the stomach. This tumor is most commonly found incidentally at surgery or autopsy. The incidence of the leiomyoma is about 1-3% of all gastric tumors and sex distribution is equal. We have recently experienced a 59-year-old housewife who had epigastric pain and soreness of one month's duration. Physical examination disclosed tenderness with palpated mass in the left upper quadrant. Gastrofiberscopic finding revealed esophageal diverticulum in the mid-esophagus and 2 x 2 x 1 cm sized submucosal intramural mass with centrally depressed umbilication through ulcerative change on the greater curvature of lower body. Within the umbilication, there were food materials and blood clots. The sleeve segmental resection of stomach was performed. The histopathologic and post operative findings were atypical leiomyoma, perforated with abscess formation to the omentum.

A Case with Perforated Gastric Leiomyoma / 대한소화기내시경학회지

Gastric leiomyomas, which arise from smooth muscle tissue, are the most common non-epi- thelial tumors occurring in the stomach. This tumor is most commonly found incidentally at surgery or autopsy. The incidence of the leiomyoma is about 1-3% of all gastric tumors and sex distribution is equal. We have recently experienced a 59-year-old housewife who had epigastric pain and soreness of one month's duration. Physical examination disclosed tenderness with palpated mass in the left upper quadrant. Gastrofiberscopic finding revealed esophageal diverticulum in the mid-esophagus and 2 x 2 x 1 cm sized submucosal intramural mass with centrally depressed umbilication through ulcerative change on the greater curvature of lower body. Within the umbilication, there were food materials and blood clots. The sleeve segmental resection of stomach was performed. The histopathologic and post operative findings were atypical leiomyoma, perforated with abscess formation to the omentum.