Acute appendicitis with associated trichobezoar of feline hair.

A trichobezoar is an accumulation of ingested hair that forms a mass within the gastro-intestinal tract. Thrichobezoars usually consist of human hair and are known to cause obstruction and even perforation of gastrointestinal organs. There have been approximately seven reported cases of acute appendicitis with association trichobezoars found at the time of appendicectomy. We report a unique case of acute appendicitis with an associated trichobezoar of feline hair. A 15-year-old male presented with a 24-hour history of abdominal pain. A computed tomography scan demonstrated features of appendicitis with several hyperdensities within the base of the appendix. At the time of appendicectomy, the appendix was found to be perforated at the base. Faecoliths were identified containing numerous short, light-coloured hairs. Following the procedure, the family confirmed that they have a pet cat with short, light-coloured hair. The patient had an uneventful recovery.

Foreign body reaction to spilled gastric contents mimicking peritoneal metastasis of colorectal cancer.

Colorectal cancer represents the third most common cancer worldwide. The presence of peritoneal metastasis of colorectal cancer indicates Stage 4 disease with poor prognosis. We report a case of a foreign body reaction to plant material spilled during previous surgery, which mimicked peritoneal metastases. A 62-year-old male was found to have recto-sigmoid adenocarcinoma on colonoscopy. At the time of resection, peritoneal nodules were identified throughout the peritoneal cavity with the appearance of metastases. The resection was aborted, a diverting colostomy was fashioned and biopsies of the nodules were taken. The histology showed a foreign body reaction to plant material that was spilled during a sleeve gastrectomy that was performed 4 years prior. The patient subsequently underwent anterior resection with anastomosis and has recovered from surgery.

Acute presentation of multi-cystic peritoneal mesothelioma.

Multi-cystic peritoneal mesothelioma (MCPM) is a rare intra-abdominal neoplasm that occurs most commonly in young females. The disease usually presents as an incidental finding or with sub-acute abdominal pain. The mainstay of treatment is complete excision; however, local recurrence frequently occurs and malignant transformation has been reported. We describe a unique case of MCPM that presented with acute abdominal pain. A 32-year-old female presented with a 24-hour history of abdominal pain. Computed tomography abdomen demonstrated a low-density mass with surrounding inflammatory changes anterior to the ascending colon, which was initially thought to represent an abscess. A percutaneous drain was inserted; however, only clear fluid was aspirated and the lesion did not resolve. The patient subsequently underwent laparoscopy which identified a cystic structure overlying the ascending colon. The structure was excised whole with histology demonstrating MCPM. The patient recovered from surgery and will undergo a period of surveillance.

Surgical versus non-surgical management for pleural empyema.

BACKGROUND: Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. There is currently a lack of consensus regarding optimal treatment. OBJECTIVES: To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleural empyema. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015 to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015), Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS (1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for ongoing studies (December 2016). SELECTION CRITERIA: Randomised controlled trials that compared a surgical with a non-surgical method of management for all age groups with pleural empyema. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We included eight randomised controlled trials with a total of 391 participants. Six trials focused on children and two on adults. Trials compared tube thoracostomy drainage (non-surgical), with or without intrapleural fibrinolytics, to either VATS or thoracotomy (surgical) for the management of pleural empyema. Assessment of risk of bias for the included studies was generally unclear for selection and blinding but low for attrition and reporting bias. Data analyses compared thoracotomy versus tube thoracostomy and VATS versus tube thoracostomy. We pooled data for meta-analysis where appropriate. We performed a subgroup analysis for children along with a sensitivity analysis for studies that used fibrinolysis in non-surgical treatment arms.The comparison of open thoracotomy versus thoracostomy drainage included only one study in children, which reported no deaths in either treatment arm. However, the trial showed a statistically significant reduction in mean hospital stay of 5.90 days for those treated with primary thoracotomy. It also showed a statistically significant reduction in procedural complications for those treated with thoracotomy compared to thoracostomy drainage. We downgraded the quality of the evidence for length of hospital stay and procedural complications outcomes to moderate due to the small sample size.The comparison of VATS versus thoracostomy drainage included seven studies, which we pooled in a meta-analysis. There was no statistically significant difference in mortality or procedural complications between groups. This was true for both adults and children with or without fibrinolysis. However, mortality data were limited: one study reported one death in each treatment arm, and seven studies reported no deaths. There was a statistically significant reduction in mean length of hospital stay for those treated with VATS. The subgroup analysis showed the same result in adults, but there was insufficient evidence to estimate an effect for children. We could not perform a separate analysis for fibrinolysis for this outcome because all included studies used fibrinolysis in the non-surgical arms. We downgraded the quality of the evidence to low for mortality (due to wide confidence intervals and indirectness), and moderate for other outcomes in this comparison due to either high heterogeneity or wide confidence intervals. AUTHORS' CONCLUSIONS: Our findings suggest there is no statistically significant difference in mortality between primary surgical and non-surgical management of pleural empyema for all age groups. Video-assisted thoracoscopic surgery may reduce length of hospital stay compared to thoracostomy drainage alone.There was insufficient evidence to assess the impact of fibrinolytic therapy.A number of common outcomes were reported in the included studies that were not directly examined in our primary and secondary outcomes. These included duration of chest tube drainage, duration of fever, analgesia requirement, and total cost of treatment. Future studies focusing on patient-centred outcomes, such as patient functional scores, and other clinically relevant outcomes, such as radiographic improvement, treatment failure rates, and amount of fluid drainage, are needed to inform clinical decisions.

A normative database of thumb circumduction in vivo: center of rotation and range of motion.

This article reports a systematic research effort aimed at establishing a normative database of thumb circumduction range of motion (ROM) and related kinematic characteristics in vivo while examining the effects of anthropometry, gender, and direction of rotation. Twenty-eight (14 men, 14 women) anthropometrically diverse participants performed maximum voluntary thumb circumductions as the trajectories of the surface markers placed on their thumb landmarks were recorded by an optoelectronic motion capture system. A globographic representation method was employed to model the measured marker trajectories, determining the center of rotation and central reference axes for thumb circumduction. Thumb ROM was quantified using (a) the joint sinuses expressing the thumb orientation change with respect to the reference axes and (b) cone volumes circumscribed by the thumb at the distal phalangeal, interphalangeal, and metacarpophalangeal levels. Data analyses resulted in statistical summaries of the derived kinematic and ROM measures with significant effects identified and regression equations predicting the cone volumes. Potential applications of this research include ergonomic design of hand-operated controls or devices and evaluation of thumb impairments or disorders.