Appendicitis Medical and Health News Headlines

MR Imaging Evaluation of the Normal Appendix in Children and Adolescents.

Radiology. 2008 Aug 18;

Authors: Baldisserotto M, Valduga SG, da Cunha CF

Purpose: To evaluate asymptomatic children and adolescents to determine the rate of detection of the normal appendix at unenhanced magnetic resonance (MR) imaging. Materials and Methods: This study was approved by the medical ethics committees of the authors' institutions, and informed consent was obtained from participants' parents or guardians. Forty asymptomatic volunteers underwent MR imaging to detect the appendix. Mean age (+/- standard deviation) for the 18 boys was 12.8 years +/- 2.4 (range, 9-17 years) and for the 22 girls was 12.7 years +/- 2.7 (range, 8-17 years). The MR imaging protocol consisted of axial T1-weighted fast spin-echo (SE), axial and coronal T2-weighted fast SE, and axial T2-weighted fat-saturated fast SE sequences. Two observers interpreted results independently, and kappa coefficients were calculated to evaluate agreement. The rate of detection was defined as the percentage of times that the appendix was visualized with at least one sequence. Body mass index was recorded for all participants. Results: The normal appendix was detected by one observer in 19 cases (48%) and by the other in 20 cases (50%). The rate of appendix detection after observers reached a consensus was 48% (95% confidence interval: 32%, 64%). Interobserver agreement for appendix detection was good for most sequences analyzed. The greatest rate of normal appendix detection was found with the axial T2-weighted fast SE sequence (48%). Conclusion: The rate of normal appendix detection in children and adolescents at unenhanced MR imaging was 48%, which is similar to computed tomographic but lower than ultrasonographic detection rates. (c) RSNA, 2008.

PMID: 18710962 [PubMed - as supplied by publisher]

Localization of the Appendix at MR Imaging during Pregnancy: Utility of the Cecal Tilt Angle.

Radiology. 2008 Aug 18;

Authors: Lee KS, Rofsky NM, Pedrosa I

Purpose: To determine whether the cecal tilt angle on sagittal magnetic resonance (MR) images in pregnant patients correlates with the location of the appendix and gestational age and whether the cecal tilt angle can help predict the location of the appendix. Materials and Methods: This HIPAA-compliant retrospective study was approved by the institutional review board. Informed consent was waived. Of 146 consecutive pregnant patients suspected of having appendicitis (mean age, 29 years) who underwent MR imaging, 143 had MR images in which the appendix and cecum were identifiable in the sagittal plane. Two observers reviewed the MR images; findings were agreed upon by consensus. With use of sagittal single-shot fast spin-echo MR images, the cecal tilt angle was calculated as the angle between the imaging table and a line drawn between the cecal tip and the luminal center of the most proximal inflection point in the ascending colon. The location of the appendiceal base relative to the lumbosacral spine was recorded. Statistical analyses were performed by using Spearman and Pearson correlation coefficients to evaluate the relationship among gestational age, appendiceal base location, and cecal tilt angle. Receiver operating characteristic curve analysis was performed to assess the ability of the cecal tilt angle to help differentiate between a high and low appendiceal base level. Results: Cecal tilt angles showed moderate correlation with appendiceal base levels (Spearman correlation coefficient, 0.44; P < .001) and poor correlation with gestational age (Pearson correlation coefficient, 0.25; P = .002). Regardless of gestational age, cecal tilt angles of at least 90 degrees were predictive of a high appendiceal base level with a specificity of 98% (95% confidence interval: 92%, 100%). Conclusion: The cecal tilt angle is useful for localizing the appendix in pregnant patients at MR imaging and helps predict the location of the appendix within the right upper quadrant of the abdomen with high specificity, irrespective of gestational age. (c) RSNA, 2008.

PMID: 18710961 [PubMed - as supplied by publisher]

Peritoneal pseudomyxoma: results of a systematic policy of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Br J Surg. 2008 Aug 8;95(9):1164-1171

Authors: Elias D, Honoré C, Ciuchendéa R, Billard V, Raynard B, Dico RL, Dromain C, Duvillard P, Goéré D

BACKGROUND:: Pseudomyxoma peritonei (PMP) is characterized by progressive intraperitoneal accumulation of mucous and mucinous implants, usually derived from a ruptured, possibly malignant mucinous neoplasm of the appendix. Treatment based on complete cytoreductive surgery (CCRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is gaining support. The aim of this study was to identify pre- and perioperative factors of prognostic value. METHODS:: A total of 105 patients (with no residual tumours exceeding 2 mm) were treated with CCRS plus HIPEC based on oxaliplatin. Clinical, radiological, pathological factors and blood markers were analysed to determine their prognostic value for survival. RESULTS:: Mortality (7.6 per cent) and morbidity (67.6 per cent) were significantly correlated with peritoneal index, pathological grade and blood CA19.9 level. The median follow-up was 48 months. Seven patients died after hospital discharge. Overall and disease-free 5-year survival rates were 80.0 and 68.5 per cent respectively. The Cox model identified only two significant factors impacting on disease-free survival: CA19.9 level and pathological grade. CONCLUSION:: CCRS is the most effective treatment for PMP, and adding HIPEC prolongs long-term survival. Further strategies should focus on improving postoperative outcome in extended PMP. Copyright (c) 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

PMID: 18690633 [PubMed - as supplied by publisher]

Authors' reply: Changing trends in surgery for acute appendicitis (Br J Surg 2008; 95: 363-368).

Br J Surg. 2008 Aug 8;95(9):1188

Authors: Paterson HM, Qadan M, de Luca SM, Nixon SJ, Paterson-Brown S

PMID: 18690629 [PubMed - as supplied by publisher]