Appendicitis combined with Meckel's diverticulum obstruction, perforation, and inflammation in children: Three case reports.

BACKGROUND: Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding. CASE SUMMARY: This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided. CONCLUSION: Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.

Naples prognostic score: a novel predictor of survival in patients with HER2-positive breast cancer.

Purpose: The predictive significance of the Naples prognostic score (NPS) in HER2-positive breast cancer is unclear. Hence we sought to evaluate the relationship between NPS and the clinical outcomes in HER2-positive breast cancer patients. Methods: This study retrospectively collected and analyzed data from 173 HER2-positive breast cancer patients between August 2004 and February 2014. The Cox regression model was applied in univariate and multivariate statistical analysis. Results: In multivariate analysis, increased NPS score correlated significantly with poor overall survival (p = 0.001) and disease-free survival (p < 0.001). Conclusion: Our findings may point to NPS being a novel and reliable prognostic score system with favorable predictive ability for HER2-positive breast cancer patients.

Breast cancer is one of the most frequent cancers in females and the second leading cause of death among women worldwide. HER2-positive breast cancer has the characteristics of rapid growth, high risk of relapse and cancer migration and spreading. The predictive significance of the Naples prognostic score (NPS) in HER2-positive breast cancer is unknown. We hypothesized that NPS may improve prediction of outcomes in HER2-positive patients. A statistical analysis was conducted. Our results revealed that NPS was an independent predictive factor of overall survival and disease-free survival in patients with HER2-positive breast cancer.

Clinical features and factors leading to early recurrence of intussusception after saline reduction.

OBJECTIVE: To investigate the clinical characteristics of early recurrent intussusception after ultrasound-guided saline reduction, and to explore the factors leading to early recurrence. METHODS: The retrospective observational case-control study was conducted at Weifang People's Hospital, Shandong, China, and comprised data from January 2015 to December 2017 related to paediatric intussusception patients aged 0-12 years who underwent ultrasound-guided saline enema reduction. The patients were divided into two recurrent and non-recurrent groups. Clinical characteristics of the patients with early recurrence were analysed. Factors compared between the groups were gender, age, onset season, onset-to-treatment time interval, blood in stool, fever, diarrhoea, abdominal pain and vomiting, weight and pathology. Data was analysed using SPSS 22. RESULTS: Of the 672 subjects, 86(13%) were patient with early recurrence while 586(87%) had no early recurrence and acted as controls. Among the patients, 70(81.4%) were aged 6-36 months. In 52(60.5%) patients, recurrence was once, and in 23(26.7%) twice. There were 141 episodes of intussusception; 24(17%) occurring in <12 hours, 85(60.2%) in 12-24 hours. Also, 5(6%) patients required surgery for reduction. Compared to the controls, the second quarter, heavier body weight and pathology were the factors leading to early recurrence of intussusceptions (p<0.05). CONCLUSIONS: The second quarter, heavier body weight and pathological leading points were found to be factors leading to early recurrent intussusception.

Risk factors for short-term recurrent intussusception and reduction failure after ultrasound-guided saline enema.

OBJECTIVE: To investigate the safety and effectiveness of ultrasound-guided saline enema to treat intussusception and to analyze the risk factors affecting short-term recurrence and reduction failure. MATERIALS AND METHODS: We selected patients who had undergone intussusception reduction via ultrasound-guided saline enema from January 2010 to December 2017. The overall success rate, overall pathologic intussusception rate, and pathologic intussusception rate were calculated in each group. All the patients were divided into two groups: the successfully reduced group and the failed reduction group. Then, the successfully reduced patients were divided into two groups: the short-term recurrence group and the short-term non-recurrence group. The differences between each of the two sets of groups were analyzed, and the risk factors affecting short-term recurrence and failure of intussusception were analyzed. RESULTS: During the 8-year study period, a total of 1793 patients with intussusception were treated with ultrasound-guided saline enema reduction in our hospital. Among these patients, 1743 (97.2%) experienced successful reduction, 29 (1.6%) had pathologic intussusception, and 1 experienced perforation. After applying the univariate analysis and logistic regressive multivariate analysis, we found that age above 2 years and the absence of fever were risk factors for the early recurrence of intussusception. Pathologic intussusception was a risk factor for reduction failure. CONCLUSION: The overall success rate of ultrasound-guided saline enemas was 97.2%, and the pathologic intussusception rate was 1.6%. Age above 2 years and the absence of fever were risk factors for short-term recurrence, and pathologic intussusception was a risk factor for the failure of reduction.