WorldWideScience

Sample records for facilities construction appended

  1. Appendicitis

    Science.gov (United States)

    ... function. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure, problems with ... to pass gas Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical ...

  2. Appendicitis

    Science.gov (United States)

    ... of lymph nodes in the intestines, or even parasites. Once the appendix is blocked, it becomes inflamed ... of appendicitis can happen in other illnesses (like kidney stones, pneumonia, and urinary tract infections). That's why ...

  3. Facility design, construction, and operation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-04-01

    France has been disposing of low-level radioactive waste (LLW) at the Centre de Stockage de la Manche (CSM) since 1969 and now at the Centre de Stockage de l`Aube (CSA) since 1992. In France, several agencies and companies are involved in the development and implementation of LLW technology. The Commissariat a l`Energie Atomic (CEA), is responsible for research and development of new technologies. The Agence National pour la Gestion des Dechets Radioactifs is the agency responsible for the construction and operation of disposal facilities and for wastes acceptance for these facilities. Compagnie Generale des Matieres Nucleaires provides fuel services, including uranium enrichment, fuel fabrication, and fuel reprocessing, and is thus one generator of LLW. Societe pour les Techniques Nouvelles is an engineering company responsible for commercializing CEA waste management technology and for engineering and design support for the facilities. Numatec, Inc. is a US company representing these French companies and agencies in the US. In Task 1.1 of Numatec`s contract with Martin Marietta Energy Systems, Numatec provides details on the design, construction and operation of the LLW disposal facilities at CSM and CSA. Lessons learned from operation of CSM and incorporated into the design, construction and operating procedures at CSA are identified and discussed. The process used by the French for identification, selection, and evaluation of disposal technologies is provided. Specifically, the decisionmaking process resulting in the change in disposal facility design for the CSA versus the CSM is discussed. This report provides` all of the basic information in these areas and reflects actual experience to date.

  4. Summer Appendicitis

    African Journals Online (AJOL)

    hanumantp

    diet, during summer months could be contribute to the higher incidence of appendicitis ... To examine the global trends in the seasonality of appendicitis, .... Iran. Summer. [11]. 1998-2004. 1331. Italy. Summer. [12]. 1991-1998. 65,675. Canada.

  5. Pediatric Appendicitis.

    Science.gov (United States)

    Rentea, Rebecca M; St Peter, Shawn D

    2017-02-01

    Appendicitis is one of the most common surgical pathologies in children. It can present with right lower quadrant pain. Scoring systems in combination with selective imaging and surgical examination will diagnose most children with appendicitis. Clinical pathways should be used. Most surgical interventions for appendicitis are now almost exclusively laparoscopic, with trials demonstrating better outcomes for children who undergo index hospitalization appendectomies when perforated. Nonoperative management has a role in the treatment of both uncomplicated and complicated appendicitis. This article discusses the workup and management, modes of treatment, and continued areas of controversy in pediatric appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Construction of high magnetic field facilities approved

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ On 25 January, the National Development and Reform Commission gave the green light to a proposal to construct high magnetic field facilities for experimental use. The suggestion was jointly submitted by the Ministry of Education and CAS.

  7. 42 CFR 136.110 - Facilities construction.

    Science.gov (United States)

    2010-10-01

    ... in the procurement standards for HHS grantees made applicable by subpart P of 45 CFR part 74. (4... 42 Public Health 1 2010-10-01 2010-10-01 false Facilities construction. 136.110 Section 136.110..., DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Grants for Development, Construction, and Operation...

  8. National Ignition Facility wet weather construction plan

    Energy Technology Data Exchange (ETDEWEB)

    Kugler, A N

    1998-01-01

    This report presents a wet weather construction plan for the National Ignition Facility (NIF) construction project. Construction of the NIF commenced in mid- 1997, and excavation of the site was completed in the fall. Preparations for placing concrete foundations began in the fall, and above normal rainfall is expected over the tinter. Heavy rainfall in late November impacted foundation construction, and a wet weather construction plan was determined to be needed. This wet weather constiction plan recommends a strategy, techniques and management practices to prepare and protect the site corn wet weather effects and allow construction work to proceed. It is intended that information in this plan be incorporated in the Stormwater Pollution Prevention Plan (SWPPP) as warranted.

  9. Construction Safety for the National Ignition Facility

    Energy Technology Data Exchange (ETDEWEB)

    Predmore, R

    2000-09-01

    This Construction Safety Program (CSP) for the National Ignition Facility (NIF) presents safety protocols and guidelines that management and workers shall follow to assure a safe and healthful work environment. Appendix A, a separate companion document, includes further applicable environmental, safety, and health requirements for the NIF Project. Specifically this document: {sm_bullet} Defines the fundamental site safety philosophy, {sm_bullet} Identifies management roles and responsibilities, {sm_bullet} Defines core safety management processes, {sm_bullet} Identifies LLNL institutional requirements, and {sm_bullet} Defines the functional areas and facilities accrued by the program and the process for transition of facilities, functional areas, and/or systems from construction to activation. Anyone willfully or thoughtlessly disregarding standards will be subject to immediate removal from the site. Thorough job planning will help ensure that these standards are met.

  10. Acute appendicitis diagnosis using artificial neural networks.

    Science.gov (United States)

    Park, Sung Yun; Kim, Sung Min

    2015-01-01

    Artificial neural networks is one of pattern analyzer method which are rapidly applied on a bio-medical field. The aim of this research was to propose an appendicitis diagnosis system using artificial neural networks (ANNs). Data from 801 patients of the university hospital in Dongguk were used to construct artificial neural networks for diagnosing appendicitis and acute appendicitis. A radial basis function neural network structure (RBF), a multilayer neural network structure (MLNN), and a probabilistic neural network structure (PNN) were used for artificial neural network models. The Alvarado clinical scoring system was used for comparison with the ANNs. The accuracy of the RBF, PNN, MLNN, and Alvarado was 99.80%, 99.41%, 97.84%, and 72.19%, respectively. The area under ROC (receiver operating characteristic) curve of RBF, PNN, MLNN, and Alvarado was 0.998, 0.993, 0.985, and 0.633, respectively. The proposed models using ANNs for diagnosing appendicitis showed good performances, and were significantly better than the Alvarado clinical scoring system (p < 0.001). With cooperation among facilities, the accuracy for diagnosing this serious health condition can be improved.

  11. Construction of STACY (Static Experiment Critical Facility)

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Kiyonobu; Onodera, Seiji; Hirose, Hideyuki [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment] [and others

    1998-08-01

    Two critical assemblies, STACY (Static Experiment Critical Facility) and TRACY (Transient Experiment Critical Facility), were constructed in NUCEF (Nuclear Fuel Cycle Safety Engineering Research Facility) to promote researches on the criticality safety at a reprocessing facility. STACY aims at providing critical data of uranium nitrate solution, plutonium nitrate solution and their mixture while varying concentration of solution fuel, core tank shape and size and neutron reflecting condition. STACY achieved first criticality in February 1995, and passed the licensing inspection by STA (Science and Technology Agency of Japan) in May. After that a series of critical experiments commenced with 10 w/o enriched uranium solution. This report describes the outline of STACY at the end of FY 1996. (author)

  12. Acute Appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Qvist, Niels

    2017-01-01

    BACKGROUND: The classification of acute appendicitis (AA) into various grades is not consistent, partly because it is not clear whether the perioperative or the histological findings should be the foundation of the classification. When comparing results from the literature on the frequency...... patients were included. In 116 (89 %) of these cases, appendicitis was confirmed histological. There was low concordance between the perioperative and histological diagnoses, varying from 16 to 76 % depending on grade of AA. Only 44 % of the patients receiving antibiotics postoperatively had a positive...... peritoneal fluid cultivation. CONCLUSION: There was a low concordance in clinical and histopathological diagnoses of the different grades of appendicitis. Perioperative cultivation of the peritoneal fluid as a standard should be further examined. The potential could be a reduced postoperative antibiotic use...

  13. Budget estimates: Fiscal year 1994. Volume 2: Construction of facilities

    Science.gov (United States)

    1994-01-01

    The Construction of Facilities (CoF) appropriation provides contractual services for the repair, rehabilitation, and modification of existing facilities; the construction of new facilities and the acquisition of related collateral equipment; the acquisition or condemnation of real property; environmental compliance and restoration activities; the design of facilities projects; and advanced planning related to future facilities needs. Fiscal year 1994 budget estimates are broken down according to facility location of project and by purpose.

  14. Design and construction of thermal striping test facility

    Energy Technology Data Exchange (ETDEWEB)

    Han, D. H.; Kim, J. M.; Nam, H. Y.; Choi, J. H.; Choi, B. H.; Jeong, J. Y.; Jeong, K. C.; Park, J. H.; Kim, T. J.; Kim, B. H

    2003-12-01

    Test facility was designed and constructed to generate of experimental data for the validation of turbulence model for analyzing thermal striping phenomena. Test facility consists mainly of test section, heat transfer system and control system. In this report design and construction process of test facility was described in detail.

  15. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis - a prospective study

    Science.gov (United States)

    2014-01-01

    Background The aim of the study was to construct a new scoring system for more accurate diagnostics of acute appendicitis. Applying the new score into clinical practice could reduce the need of potentially harmful diagnostic imaging. Methods This prospective study enrolled 829 adults presenting with clinical suspicion of appendicitis, including 392 (47%) patients with appendicitis. The collected data included clinical findings and symptoms together with laboratory tests (white cell count, neutrophil count and C-reactive protein), and the timing of the onset of symptoms. The score was constructed by logistic regression analysis using multiple imputations for missing values. Performance of the constructed score in patients with complete data (n = 725) was compared with Alvarado score and Appendicitis inflammatory response score. Results 343 (47%) of patients with complete data had appendicitis. 199 (58%) patients with appendicitis had score value at least 16 and were classified as high probability group with 93% specificity.Patients with score below 11 were classified as low probability of appendicitis. Only 4% of patients with appendicitis had a score below 11, and none of them had complicated appendicitis. In contrast, 207 (54%) of non-appendicitis patients had score below 11. There were no cases with complicated appendicitis in the low probability group. The area under ROC curve was significantly larger with the new score 0.882 (95% CI 0.858 – 0.906) compared with AUC of Alvarado score 0.790 (0.758 – 0.823) and Appendicitis inflammatory response score 0.810 (0.779 – 0.840). Conclusions The new diagnostic score is fast and accurate in categorizing patients with suspected appendicitis, and roughly halves the need of diagnostic imaging. PMID:24970111

  16. The status of LILW disposal facility construction in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min-Seok; Chung, Myung-Sub; Park, Kyu-Wan [Korea Radioactive Waste Management Corporation (KRMC), 89, Bukseong-ro, Gyeongju-si,, Gyeongsangbuk-do (Korea, Republic of)

    2013-07-01

    In this paper, we discuss the experiences during the construction of the first LILW disposal facility in South Korea. In December 2005, the South Korean Government designated Gyeongju-city as a host city of Low- and Intermediate-Level Radioactive Waste(LILW) disposal site through local referendums held in regions whose local governments had applied to host disposal facility in accordance with the site selection procedures. The LILW disposal facility is being constructed in Bongilri, Yangbuk-myeon, Gyeongju. The official name of the disposal facility is called 'Wolsong Low and Intermediate Level Radioactive Waste Disposal Center (LILW Disposal Center)'. It can dispose of 800,000 drums of radioactive wastes in a site of 2,100,000 square meters. At the first stage, LILW repository of underground silo type with disposal capacity of 100,000 drums is under construction expected to be completed by June of 2014. The Wolsong Low and Intermediate Level Radioactive Waste Disposal Center consists of surface facilities and underground facilities. The surface facilities include a reception and inspection facility, an interim storage facility, a radioactive waste treatment building, and supporting facilities such as main control center, equipment and maintenance shop. The underground facilities consist of a construction tunnel for transport of construction equipment and materials, an operation tunnel for transport of radioactive waste, an entrance shaft for workers, and six silos for final disposal of radioactive waste. As of Dec. 2012, the overall project progress rate is 93.8%. (authors)

  17. Construction Cost Growth for New Department of Energy Nuclear Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Kubic, Jr., William L. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2014-05-25

    Cost growth and construction delays are problems that plague many large construction projects including the construction of new Department of Energy (DOE) nuclear facilities. A study was conducted to evaluate cost growth of large DOE construction projects. The purpose of the study was to compile relevant data, consider the possible causes of cost growth, and recommend measures that could be used to avoid extreme cost growth in the future. Both large DOE and non-DOE construction projects were considered in this study. With the exception of Chemical and Metallurgical Research Building Replacement Project (CMRR) and the Mixed Oxide Fuel Fabrication Facility (MFFF), cost growth for DOE Nuclear facilities is comparable to the growth experienced in other mega construction projects. The largest increase in estimated cost was found to occur between early cost estimates and establishing the project baseline during detailed design. Once the project baseline was established, cost growth for DOE nuclear facilities was modest compared to non-DOE mega projects.

  18. Progress on Radioactive Waste Treatment Facilities Construction

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    In 2011, five projects were undertaken by radioactive waste projects management department, which are "Cold Commissioning of the Pilot Project on Radioactive Waste Retrieval and Conditioning (abbreviation 'Pilot Project')", "Radioactive Ventilation Project Construction (abbreviation 'Ventilation

  19. Management Information Control Systems for Educational Facility Construction Programs.

    Science.gov (United States)

    Halverson, Walter S.

    1989-01-01

    Describes a computerized management information control system for an educational facility construction program that allows access to more than 50 major system applications, using over 5,000 programs. (MLF)

  20. Imaging of appendicitis

    Directory of Open Access Journals (Sweden)

    Himal Gajjar

    2008-12-01

    Full Text Available Appendicitis is one of the commonest causes of abdominal pain requiring surgery. Early diagnosis and management are essential to reduce morbidity and mortality. Imaging is valuable in the diagnosis of cases that are clinically atypical. Imaging also allows evaluation of the complications of appendicitis. In certain circumstances, conservative treatment of complicated appendicitis with percutaneous drainage is appropriate.

  1. Construction of calibration pads facility, Walker Field, Grand Junction, Colorado

    Energy Technology Data Exchange (ETDEWEB)

    Ward, D.L.

    1978-08-01

    A gamma-ray spectrometer facility was completed at Walker Field Airport, Grand Junction, Colorado, in November 1976. This report describes spectrometers and their calibration, the construction of the spectrometer facility, the radioelement concentrations, procedures for using the facilites, and environmental considerations. (LK)

  2. Construction of thermal ratchet structural test facility

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyeong Yeon; Kim, J. B.; Yoo, B

    2000-12-01

    The objective of this study is to setup the thermal ratchet test facility to validate the NONSTA code that is under development for the inelastic structure analysis and to characterize the thermal ratchet behavior through structural thermal ratchet test. Thermal ratchet phenomenon, a progressive inelastic deformation can occur in the liquid metal reactor operating at high temperature above 500 deg C due to the moving temperature distribution along the axial direction as the hot free surface moves up and down due to the cyclic heat-up and cool-down of reactor operation. Thermal ratchet can cause a severe damage to the reactor structure. The structural ratchet test was performed and the test results were compared with those of the analysis using Chaboche constitutive model. The fabrication of the ratchet test facility was completed in 1/4 of 2000, the performance test was carried out in the second quarter of 2000, the noise reduction of thermocouples, measurements by laser displacement sensor with data acquisition system was carried out in the third quarter and the test results compared with those of the inelastic structure analysis in the forth quarter of 2000, which showed reasonable agreement with those of the tests.

  3. Indigenous Construction Materials for Theater Facilities

    Science.gov (United States)

    2013-09-01

    example, tools such as a hammer and nails for wood construction, or masonry tools for adobe, are easier to use than those needed to build a Hesco...Stabilizers result in an increase in soil strength and cohesion, reduced permeability , increased durability, and less soil expansion and shrinkage in wet...9 Soil-Cement 1 Water 7 Cement 2 Earth mortar 16 Wood 3 Nails 13 Stone 10 Foam 15

  4. Strategies for healthcare facilities, construction, and real estate management.

    Science.gov (United States)

    Lee, James G

    2012-05-01

    Adventist HealthCare offers the following lessons learned in improving the value of healthcare facilities, construction, and real estate management: Use an integrated approach. Ensure that the objectives of the approach align the hospital or health system's mission and values. Embrace innovation. Develop a plan that applies to the whole organization, rather than specific business units. Ensure commitment of senior leaders.

  5. Current trends in health facility planning, design, and construction.

    Science.gov (United States)

    Beale, Craig; Kittredge, Frank D

    2014-01-01

    It is critical now more than ever for today's healthcare facilities to serve as more than just a backdrop to the care provided--they can, and should, be an integral part of that care. In addition to promoting efficacy, delighting the senses, and placing patients and families at ease, facilities need to be high-performing, sustainable, and healthy environments. Creating today's healthcare facilities requires breaking through barriers in unexpected ways, and it often requires looking outside the healthcare profession for guidance. In this article, we explore current trends in health facility planning, design, and construction. Our focus is on the buildings that serve as venues for the provision of healthcare services across the full continuum, from prevention to critical care. In particular, we discuss four current broad trends and conclude with thoughts on future developments.

  6. NIF conventional facilities construction health and safety plan

    Energy Technology Data Exchange (ETDEWEB)

    Benjamin, D W

    1998-05-14

    The purpose of this Plan is to outline the minimum health and safety requirements to which all participating Lawrence Livermore National Laboratory (LLNL) and non-LLNL employees (excluding National Ignition Facility [NIF] specific contractors and subcontractors covered under the construction subcontract packages (e.g., CSP-9)-see Construction Safety Program for the National Ignition Facility [CSP] Section I.B. ''NIF Construction Contractors and Subcontractors'' for specifics) shall adhere to for preventing job-related injuries and illnesses during Conventional Facilities construction activities at the NIF Project. For the purpose of this Plan, the term ''LLNL and non-LLNL employees'' includes LLNL employees, LLNL Plant Operations staff and their contractors, supplemental labor, contract labor, labor-only contractors, vendors, DOE representatives, personnel matrixed/assigned from other National Laboratories, participating guests, and others such as visitors, students, consultants etc., performing on-site work or services in support of the NIF Project. Based upon an activity level determination explained in Section 1.2.18, in this document, these organizations or individuals may be required by site management to prepare their own NIF site-specific safety plan. LLNL employees will normally not be expected to prepare a site-specific safety plan. This Plan also outlines job-specific exposures and construction site safety activities with which LLNL and non-LLNL employees shall comply.

  7. Design and Construction of a Hydroturbine Test Facility

    Science.gov (United States)

    Ayli, Ece; Kavurmaci, Berat; Cetinturk, Huseyin; Kaplan, Alper; Celebioglu, Kutay; Aradag, Selin; Tascioglu, Yigit; ETU Hydro Research Center Team

    2014-11-01

    Hydropower is one of the clean, renewable, flexible and efficient energy resources. Most of the developing countries invest on this cost-effective energy source. Hydroturbines for hydroelectric power plants are tailor-made. Each turbine is designed and constructed according to the properties, namely the head and flow rate values of the specific water source. Therefore, a center (ETU Hydro-Center for Hydro Energy Research) for the design, manufacturing and performance tests of hydraulic turbines is established at TOBB University of Economics and Technology to promote research in this area. CFD aided hydraulic and structural design, geometry optimization, manufacturing and performance tests of hydraulic turbines are the areas of expertise of this center. In this paper, technical details of the design and construction of this one of a kind test facility in Turkey, is explained. All the necessary standards of IEC (International Electrotechnical Commission) are met since the test facility will act as a certificated test center for hydraulic turbines.

  8. Construction and Commissioning of PAL-XFEL Facility

    Directory of Open Access Journals (Sweden)

    In Soo Ko

    2017-05-01

    Full Text Available The construction of Pohang Accelerator Laboratory X-ray Free-Electron Laser (PAL-XFEL, a 0.1-nm hard X-ray free-electron laser (FEL facility based on a 10-GeV S-band linear accelerator (LINAC, is achieved in Pohang, Korea by the end of 2016. The construction of the 1.11 km-long building was completed by the end of 2014, and the installation of the 10-GeV LINAC and undulators started in January 2015. The installation of the 10-GeV LINAC, together with the undulators and beamlines, was completed by the end of 2015. The commissioning began in April 2016, and the first lasing of the hard X-ray FEL line was achieved on 14 June 2016. The progress of the PAL-XFEL construction and its commission are reported here.

  9. Design and Construction of a Scaled Whirl Tower Facility

    Science.gov (United States)

    Pickard, John Alexander

    Experimental development of helicopter rotors requires centrifugal testing before entry into a wind tunnel or flight test campaign. This centrifugal testing is performed on test rigs called whirl towers. These facilities are very rare, in fact there were none available in Canada at the time of writing this thesis, but they are very valuable experimental research tools. This thesis describes the design and construction of a whirl tower facility for the centrifugal testing of scaled helicopter rotors with actively controlled systems for reducing vibration. First, the trade-offs between the desired capabilities for the facility to be designed are reviewed, leading to the identification of a set of design requirements. Following this, various concepts for the drive system, frame, data acquisition, and safety infrastructure are proposed. From these, a final design is assembled, whose main advantage is its flexibility and robustness for developmental research. The whirl tower is capable of testing single or multi-bladed rotors (up to four blades), with blades between 1.0 and 1.6 m radius, up to 1,800 RPM frequency with no 'dead zones'. The whirl tower is equipped with a 60 HP, 575 V, AC motor, with flexible coupling and direct drive to the scaled rotor hub. The facility also features a digital telemetry system, slip rings for power and signal transmission for active control, interchangeable rotor heads with variable root distance, and a containment wall for protection from possible rotor blade failures. The manufacturing and construction of the facility, as well as its installation at the National Research Council in Ottawa, is described in detail.

  10. std::string Append

    Science.gov (United States)

    2015-10-01

    UNCLASSIFIED AD-E403 689 Technical Report ARWSE-TR-14026 STD ::STRING APPEND Tom Nealis...DATES COVERED (From – To) 4. TITLE AND SUBTITLE STD ::STRING APPEND 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...two or more strings together while developing a C++ application is a very common task. For std ::strings, there are two primary ways to achieve the

  11. Amoebiasis Presenting as Acute Appendicitis.

    Science.gov (United States)

    Ichikawa, Hitoshi; Imai, Jin; Mizukami, Hajime; Uda, Shuji; Yamamoto, Soichiro; Nomura, Eiji; Tajiri, Takuma; Watanabe, Norihito; Makuuchi, Hiroyasu

    2016-12-20

    We report a case of amoebic appendicitis without colitis symptoms. Acute appendicitis is commonly encountered by gastroenterologists in their daily practice. The number of cases of amoebiasis increases annually in Japan, and is thought to be associated with an increase in sexually transmitted disease or travel to endemic areas. However, acute amoebic appendicitis is rare and the prognosis is very poor compared to nonamoebic appendicitis. In our case, appendectomy was performed immediately after onset, and the patient was discharged without complications. It is difficult to differentiate between amoebic and nonamoebic appendicitis preoperatively, and the possibility of amoebic appendicitis should be kept in mind.

  12. Fiber Intake and Childhood Appendicitis.

    Science.gov (United States)

    Brender, Jean D.; And Others

    1985-01-01

    Parents of 135 children with appendicitis and of 212 comparison children were interviewed about their children's diet. Results suggest that a liberal intake of whole-grain breads and cereals may decrease the risk of appendicitis during childhood. (KH)

  13. Fiber Intake and Childhood Appendicitis.

    Science.gov (United States)

    Brender, Jean D.; And Others

    1985-01-01

    Parents of 135 children with appendicitis and of 212 comparison children were interviewed about their children's diet. Results suggest that a liberal intake of whole-grain breads and cereals may decrease the risk of appendicitis during childhood. (KH)

  14. Operative management of appendicitis.

    Science.gov (United States)

    St Peter, Shawn D; Snyder, Charles L

    2016-08-01

    Appendectomy has been the standard of care for appendicitis since the late 1800s, and remains one of the most common operations performed in children. The advent of data-driven medicine has led to questions about every aspect of the operation-whether appendectomy is even necessary, when it should be performed (timing), how the procedure is done (laparoscopic variants versus open and irrigation versus no irrigation), length of hospital stay, and antibiotic duration. The goal of this analysis is to review the current status of, and available data regarding, the surgical management of appendicitis in children. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Stump Appendicitis: A Clinical Enigma.

    Science.gov (United States)

    Çiftci, F; Abdurrahman, I; Tatar, Z

    2015-01-01

    Appendectomy is one of the most frequently performed operations. Stump appendicitis, as a postoperative complication of appendectomy, is inflammation of the remnant residue when an incomplete excision occurs. We present a patient with stump appendicitis who had been operated on, laparoscopically, for acute appendicitis 6 months before. The patient was diagnosed with acute appendicitis, underwent surgery, and was discharged on postoperative day 3 without complications. Stump appendicitis is a rare cause of acute abdominal disease but should be considered in the differential diagnosis. Ultrasonography is helpful in the diagnosis.

  16. MRI in suspected appendicitis

    NARCIS (Netherlands)

    Leeuwenburgh, M.M.N.

    2014-01-01

    Dit proefschrift richt zich op de optimalisatie van beeldvormende diagnostiek bij patiënten met een klinische verdenking op appendicitis, waarbij het gebruik van ‘magnetic resonance imaging’ (MRI) wordt verkend. Het proefschrift omvat de resultaten van de OPTIMAP-studie (OPTimisation of IMaging Appe

  17. MRI in suspected appendicitis

    NARCIS (Netherlands)

    Leeuwenburgh, M.M.N.

    2014-01-01

    Dit proefschrift richt zich op de optimalisatie van beeldvormende diagnostiek bij patiënten met een klinische verdenking op appendicitis, waarbij het gebruik van ‘magnetic resonance imaging’ (MRI) wordt verkend. Het proefschrift omvat de resultaten van de OPTIMAP-studie (OPTimisation of IMaging

  18. Acute appendicitis in pregnancy

    OpenAIRE

    Ortiz-Gualdrón César Augusto

    2012-01-01

    Acute appendicitis is the most common non-obstetric surgery pathology in pregnancy, itsincidence can be varied and occurs at a higher rate during the first and second trimesterof gestation. Its diagnosis is difficult and can be confused by the anatomical andphysiological changes during pregnancy, which alter their clinical presentation. Commonsymptoms are abdominal located pain, vomiting and nausea. The diagnosis is mainlyclinical, but laboratory tests and additional imaging help confirm or r...

  19. Appendicitis following blunt abdominal trauma.

    Science.gov (United States)

    Cobb, Travis

    2017-09-01

    Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. 36 CFR 1005.7 - Construction of buildings or other facilities.

    Science.gov (United States)

    2010-07-01

    ... AND PRIVATE OPERATIONS § 1005.7 Construction of buildings or other facilities. Constructing or attempting to construct a building, or other structure, boat dock, road, trail, path, or other way, telephone... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Construction of buildings or...

  1. 36 CFR 5.7 - Construction of buildings or other facilities.

    Science.gov (United States)

    2010-07-01

    ... OF THE INTERIOR COMMERCIAL AND PRIVATE OPERATIONS § 5.7 Construction of buildings or other facilities. Constructing or attempting to construct a building, or other structure, boat dock, road, trail, path, or other... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Construction of buildings or...

  2. Safety and environmental process for the design and construction of the National Ignition Facility

    Energy Technology Data Exchange (ETDEWEB)

    Brereton, S.J., LLNL

    1998-05-27

    The National Ignition Facility (NIF) is a U.S. Department of Energy (DOE) laser fusion experimental facility currently under construction at the Lawrence Livermore National Laboratory (LLNL). This paper describes the safety and environmental processes followed by NIF during the design and construction activities.

  3. 30 CFR 56.9303 - Construction of ramps and dumping facilities.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Construction of ramps and dumping facilities... Loading, Hauling, and Dumping Safety Devices, Provisions, and Procedures for Roadways, Railroads, and Loading and Dumping Sites § 56.9303 Construction of ramps and dumping facilities. Ramps and...

  4. Urinary biomarkers in pediatric appendicitis.

    Science.gov (United States)

    Salö, Martin; Roth, Bodil; Stenström, Pernilla; Arnbjörnsson, Einar; Ohlsson, Bodil

    2016-08-01

    The diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies. The aim of this study was to evaluate novel biomarkers in urine and to use the most promising biomarkers in conjunction with the Pediatric Appendicitis Score (PAS), to see whether this could improve the accuracy of diagnosing appendicitis. A prospective study of children with suspected appendicitis was conducted with assessment of PAS, routine blood tests, and measurements of four novel urinary biomarkers: leucine-rich α-2-glycoprotein (LRG), calprotectin, interleukin 6 (IL-6), and substance P. The biomarkers were blindly determined with commercial ELISAs. Urine creatinine was used to adjust for dehydration. The diagnosis of appendicitis was based on histopathological analysis. Forty-four children with suspected appendicitis were included, of which twenty-two (50 %) had confirmed appendicitis. LRG in urine was elevated in children with appendicitis compared to children without (p appendicitis compared to those with phlegmonous appendicitis (p = 0.003). No statistical significances between groups were found for calprotectin, IL-6 or substance P. LRG had a receiver operating characteristic area under the curve of 0.86 (95 % CI 0.79-0.99), and a better diagnostic performance than all routine blood tests. LRG in conjunction with PAS showed 95 % sensitivity, 90 % specificity, 91 % positive predictive value, and 95 % negative predictive value. LRG, adjusted for dehydration, is a promising novel urinary biomarker for appendicitis in children. LRG in combination with PAS has a high diagnostic performance.

  5. Construction safety program for the National Ignition Facility

    Energy Technology Data Exchange (ETDEWEB)

    Cerruti, S.J.

    1997-01-01

    The Construction Safety Program (CSP) for NIF sets forth the responsibilities, guidelines, rules, policies and regulations for all workers involved in the construction, special equipment installation, acceptance testing, and initial activation and operation of NIF at LLNL during the construction period of NIF. During this period, all workers are required to implement measures to create a universal awareness which promotes safe practice at the work site, and which will achieve NIF`s management objectives in preventing accidents and illnesses. Construction safety for NIF is predicated on everyone performing their jobs in a manner which prevents job-related disabling injuries and illnesses. The CSP outlines the minimum environment, safety, and health (ES&H) standards, LLNL policies and the Construction Industry Institute (CII) Zero Injury Techniques requirements that all workers at the NIF construction site shall adhere to during the construction period of NIF. It identifies the safety requirements which the NIF organizational Elements, construction contractors and construction subcontractors must include in their safety plans for the construction period of NIF, and presents safety protocols and guidelines which workers shall follow to assure a safe and healthful work environment. The CSP also identifies the ES&H responsibilities of LLNL employees, non-LLNL employees, construction contractors, construction subcontractors, and various levels of management within the NIF Program at LLNL. In addition, the CSP contains the responsibilities and functions of ES&H support organizations and administrative groups, and describes their interactions with the NIF Program.

  6. Construction safety program for the National Ignition Facility

    Energy Technology Data Exchange (ETDEWEB)

    Cerruti, S.J.

    1997-06-26

    The Construction Safety Program (CSP) for NIF sets forth the responsibilities, guidelines, rules, policies and regulations for all workers involved in the construction, special equipment installation, acceptance testing, and initial activation and operation of NIF at LLNL during the construction period of NIF.

  7. Construction and commissioning test report of the CEDM test facility

    Energy Technology Data Exchange (ETDEWEB)

    Chung, C. H.; Kim, J. T.; Park, W. M.; Youn, Y. J.; Jun, H. G.; Choi, N. H.; Park, J. K.; Song, C. H.; Lee, S. H.; Park, J. K

    2001-02-01

    The test facility for performance verification of the control element drive mechanism (CEDM) of next generation power plant was installed at the site of KAERI. The CEDM was featured a mechanism consisting of complicated mechanical parts and electromagnetic control system. Thus, a new CEDM design should go through performance verification tests prior to it's application in a reactor. The test facility can simulate the reactor operating conditions such as temperature, pressure and water quality and is equipped with a test chamber to accomodate a CEDM as installed in the power plant. This test facility can be used for the following tests; endurance test, coil cooling test, power measurement and reactivity rod drop test. The commissioning tests for the test facility were performed up to the CEDM test conditions of 320 C and 150 bar, and required water chemistry was obtained by operating the on-line water treatment system.

  8. Design and construction of the IEA Grimethorpe experimental facility

    Energy Technology Data Exchange (ETDEWEB)

    Broadbent, D.H.; Wright, S.J.; Kaden, M.

    1979-06-01

    In December 1975 the Governments of the United Kingdom, the United States of America, and the Federal Republic of Germany, under the auspices of the International Energy Agency, entered into an agreement to build a large pressurized fluidized bed combustion experimental facility. The function of the facility would be to extend the range of fluidization and combustion characteristics investigated from those of the relatively small rigs then in operation across the whole range of conditions potentially applicable to combined cycle power generation systems. The ranges of conditions to be investigated in the facility are pressures 6 to 12 bar, fluidizing velocity 0.6 to 3.0 m/s and bed temperatures 750 to 950/sup 0/C. The ultimate aim is to seek an optimum condition and establish a data base from which a demonstration plant could be designed and built.

  9. APPENDICITIS: YOUNG ADULTS ARE SUSCEPTIBLE

    Directory of Open Access Journals (Sweden)

    Somashekhar V. Hiremath

    2016-08-01

    Full Text Available CONTEXT Appendicitis is the one of the most common emergencies of the acute abdomen encountered by the clinicians; peritonitis is the common cause due to appendicular perforation. Ultrasonography of abdomen is the preferred method of diagnosis of acute appendicitis. The study is done to diagnose acute appendicitis in a tertiary care hospital to ascertain early diagnosis prevalent in this part of the country, which might differ from other studies. AIM To ascertain prevalence, presentation and management of appendicitis in this part of India in a tertiary care government hospital with provisional diagnosis of appendicitis. MATERIAL AND METHODS Cases of acute abdomen, clinical diagnosis of acute appendicitis admitted in KIMS Hospital, Hubli, a tertiary care government hospital, from January 2014 to January 2015 for materials of this study. 100 cases have been taken for study; cases included in this study are acute appendicitis, appendicular abscess; method used is USG abdomen, a simple diagnostic tool. RESULTS In present study, 100 cases of acute abdomen with clinical diagnosis of acute appendicitis were taken and laparotomy was done for 98 cases and two cases of appendicular abscess. Youngest patient was 7 years old and oldest was 65 years. Peak incidence between 11 to 30 years of age group and male to female ratio is 3:2. Postoperative wound infection was a common complication in 21 cases and retention of urine was noticed in 7 cases, and there was a death in one case due to septicaemia. CONCLUSION Acute appendicitis is a second most common indication for early laparotomy in KIMS Hospital, Hubli, first being perforative peritonitis. Acute appendicitis is common between 11 to 30 years of age group, early diagnosis and intervention is required to prevent appendicular perforation and its complications. Diagnosis of acute appendicitis is to be done in patients presenting with atypical pain, absence of vomiting does not rule out appendicitis. Anorexia

  10. 77 FR 33782 - License Amendment To Construct and Operate New In Situ Leach Uranium Recovery Facility; Uranium...

    Science.gov (United States)

    2012-06-07

    ... COMMISSION License Amendment To Construct and Operate New In Situ Leach Uranium Recovery Facility; Uranium... referenced. The Ludeman facility In Situ Leach Uranium Recovery Project License Amendment Request is... construct and operate a new in situ leach uranium recovery (ISL) facility at its Ludeman facility...

  11. Challenges in uncomplicated acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Fernando Resende; Ana Beatriz Almeida; Jose Costa Maia; Renato Bessa Melo

    2016-01-01

    Acute appendicitis is one of the most common abdominal emergencies requiring surgery. It still represents, however, a challenging diagnosis. In order to facilitate this process, several scoring systems were developed, namely, the Alvarado score, acute inflammatory response and Raja Isteri Pengiran Anak Saleha Appendicitis scores, which are the most used in clinical practice. This clinical condition encompasses a wide spectrum of clinical presentations, from the uncomplicated form to the one with diffuse peritonitis. Treatment of uncomplicated acute appendicitis remains a matter of discussion. Although appen-dectomy has been regarded as the gold-standard, conservative management with antibi-otics is gaining more and more acceptance. The approach to appendectomy constitutes another controversial issue, namely, its performance through an open or a laparoscopic approach, which seems to be establishing itself, in some centers, as the standard of care. With this paper, we intend to give some insight on the aforementioned topics, through a review of the available literature on uncomplicated appendicitis.

  12. Laparoscopic treatment of perforated appendicitis

    Science.gov (United States)

    Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

    2014-01-01

    The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

  13. Conservative treatment in acute appendicitis

    Directory of Open Access Journals (Sweden)

    G R Paudel

    2010-12-01

    Full Text Available INTRODUCTION: Acute appendicitis is one of the commonest surgical problems and appendectomy is one of the most commonly done operations in the emergency world wide. Though there have been occasional reports with conservative treatment in acute appendicitis, it is not being practiced as a routine. METHODS: All patients between ten to sixty years of age admitted at BPKIHS with the diagnosis of acute appendicitis over a period of one year were enrolled in the study. After taking informed consent the patients were managed conservatively. Those who did not respond to antibiotics within 24 hours were operated. Total hospital stay and complications were recorded and they were followed up at first week, sixth week and sixth month. The success rate, conversion rate, recurrence rate and morbidity and mortality pattern were assessed as the final outcome of conservative treatment of acute appendicitis. RESULTS: A total of 96 patients (48 males and 48 females underwent conservative treatment. The conservative treatment was successful in 79 (82.3% cases and failed in 11 (11.4% cases, which included: conversion to appendectomy during conservative treatment period 4 (4.2% cases, recurrence 7 (7.3% cases. There was no mortality in this study. CONCLUSION: Acute appendicitis can be treated successfully with conservative (antibiotics treatment with a short hospital stay. Though there is a risk of recurrence in some cases, all the complications after appendectomy can be eliminated with the conservative treatment. Keywords: acute appendicitis, appendicular lump, conservative management

  14. Direct facile screening of recombinant DNA vector constructs.

    Science.gov (United States)

    Winnard, Paul T; Challa, Rushi; Bhujwalla, Zaver M; Raman, Venu

    2014-04-01

    Direct efficient facile screening of bacterial transformants with the goal of selecting, retrieving, and using recombinant DNA is exemplified by simple visual-based colorimetric inspections or fluorescent protein-based assays. We describe pRedScript, which introduces the constitutive expression of a very bright red fluorescent protein into transformants. On agar plates, red colonies are simply visualized in ambient white light in stark contrast to recombinant transformants that are white. In addition, the bright red fluorescence of the reporter protein can also be harnessed as a sensitive signal for screening bacterial promoters during the development of optimized fermentation conditions.

  15. SIMULATIONS OF FLOWFIELDS AROUND UNDERWATER APPENDED BODIES

    Institute of Scientific and Technical Information of China (English)

    Huang Zhen-yu; Cheng Hong-rong; Zhou Lian-di; Miao Guo-ping

    2003-01-01

    The numerical method which is based on flux difference splitting, LU decomposition, and implicit high-resolution third-order Essentially Non-Oscillatory (ENO) scheme was constructed for the efficient computation of steady state solution to three-dimensional incompressible Navier-Stokes equations in general coordinates. The flowfields over underwater axisymmetric bodies, full-appended axisymmetric bodies and axisymetric bodies with a ring-wing duct were simulated. The method is proved to be capable of predicting the circumferential-mean velocity distribution at model scale to the accuracy of around 3% of measured values, and of predicting some details of flow features, for example, the wake harmonics.

  16. Cost Reduction Ability by Electricity Tariff Selection for Construction Facilities Located in Non-price Areas

    Directory of Open Access Journals (Sweden)

    Makasheva Svetlana

    2016-01-01

    Full Text Available State of the art in the tariff type selection in the retail and the wholesale electricity market for construction or reconstruction facilities located at Far East are considered. As a management solution the electricity tariff’s selection for enterprises at stage of construction or reconstruction is accented.

  17. Ecological studies related to construction of the Defense Waste Processing Facility on the Savannah River Site

    Energy Technology Data Exchange (ETDEWEB)

    Scott, D.E.; Pechmann, J.H.K.; Knox, J.N.; Estes, R.A.; McGregor, J.H.; Bailey, K. (ed.)

    1988-12-01

    The Savannah River Ecology Laboratory has completed 10 years of ecological studies related to the construction of the Defense Waste Processing Facility (DWPF) on the Savannah River Site. This progress report examines water quality studies on streams peripheral to the DWPF construction site and examines the effectiveness of refuge ponds'' in ameliorating the effects of construction on local amphibians. Individual papers on these topics are indexed separately. 93 refs., 15 figs., 15 tabs. (MHB)

  18. Construction safety program for the National Ignition Facility, Appendix A

    Energy Technology Data Exchange (ETDEWEB)

    Cerruti, S.J.

    1997-06-26

    Topics covered in this appendix include: General Rules-Code of Safe Practices; 2. Personal Protective Equipment; Hazardous Material Control; Traffic Control; Fire Prevention; Sanitation and First Aid; Confined Space Safety Requirements; Ladders and Stairways; Scaffolding and Lift Safety; Machinery, Vehicles, and Heavy Equipment; Welding and Cutting-General; Arc Welding; Oxygen/Acetylene Welding and Cutting; Excavation, Trenching, and Shoring; Fall Protection; Steel Erection; Working With Asbestos; Radiation Safety; Hand Tools; Electrical Safety; Nonelectrical Work Performed Near Exposed High-Voltage Power-Distribution Equipment; Lockout/Tagout Requirements; Rigging; A-Cranes; Housekeeping; Material Handling and Storage; Lead; Concrete and Masonry Construction.

  19. Renovation versus New Construction and Building Decision Tool for Educational Facilities

    Directory of Open Access Journals (Sweden)

    Carrie Pope

    2016-01-01

    Full Text Available Renovation of an existing building is an accomplished stem of the construction industry because it supplies financial diversification for construction stakeholders. Although several construction planning tools and stakeholder alignment exercises have been developed, no tool exists to assist project owners to decide between renovating an existing building and new construction with a comprehensive decision criteria. The objective of this research is to create and test a renovation versus new building support decision tool for construction project stakeholders. The renovation versus new building support decision tool was created based on an extensive review of existing support tools and construction industry needs. The created tool was implemented to evaluate decisions of educational facilities by university officials experienced in project management. Results show the tool was effective in identifying relevant topics for discussion and guiding a group of stakeholders through an exercise in decision-making. Specifically, the tool was implemented by construction management personnel for university facilities currently under construction to evaluate the decision to renovate an existing building or new construction. The main contribution of this research is a framework and support decision tool readily implementable for construction project stakeholders desiring to determine if renovation or new construction is the optimal path for their specific objectives.

  20. Construction of water intake facilities from partially drying up watercourses

    Directory of Open Access Journals (Sweden)

    Orlov Evgeniy Vladimirovich

    Full Text Available Partially ephemeral streams are complex objects that can still be used for water supply or irrigation of agricultural land. The problem of such streams is poorly studied, because the influence of various environmental factors complicates carrying out any experiments. Also it is not possible to make their full classification due to their very strong variability not only on a particular geographical belt, but also within separate areas of the river. All this undoubtedly complicates the task of the designers when designing the system. Creation of laboratory models, allowing us to evaluate the possibilities of a spring use for the purpose of water supply, is very promising. These watercourses have a large amount of suspended sediments, so it is not possible to use the standard scheme of water using of the coastal and fluvial water intake structures. It is proposed to organize the fight with the sediments in the flow chart of primary clarifiers, which will perform the function of settling suspensions, to facilitate the work of water treatment facilities. Also the creation of artificial prop is useful in order to achieve the required level of water in a watercourse for water organization. If under the bottom of the river there is underground water, and the permeability of the soil is good, it is possible to arrange the withdrawal of water through infiltration intakes, by setting the filter under the bottom of the watercourse with its connection to filter, from which the water will climb to submersible pumps. Additional filtration through the soil of the river bottom allows not using the scheme sumps, which significantly reduces the cost of epy incoming water treatment.

  1. Manhattan Project buildings and facilities at the Hanford Site: A construction history

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, M.S.

    1993-09-01

    This document thoroughly examines the role that the Hanford Engineer Works played in the Manhattan project. The historical aspects of the buildings and facilities are characterized. An in depth look at the facilities, including their functions, methods of fabrication and appearance is given for the 100 AREAS, 200 AREAS, 300 AREAS, 500, 800 and 900 AREAS, 600 AREA, 700 AREA, 1100 AREA and temporary construction structures.

  2. Landfills, Hazardous Waste - CONSTRUCTION_DEMOLITION_WASTE_IDEM_IN: Construction and Demoliton Waste Facilities in Indiana (Indiana Department of Environmental Management, Point Shapefile)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — CONSTRUCTION_DEMOLITION_WASTE_IDEM_IN is a point shapefile that contains construction and demolition waste facility locations in Indiana, provided by personnel of...

  3. [The local complications of appendicitis].

    Science.gov (United States)

    Ortega León, L H; Vargas Domínguez, A; Miranda Fraga, P

    1994-01-01

    In order to find out the predisposing factors of local complications after appendectomy in two general hospitals, 268 charts of patients with acute appendicitis confirmed by surgery were reviewed. There were 142 males and 126 females. All wounds were closed and prophylactic antibiotics were not used. Sixty patients (22 per cent) developed local complications; 49 (81.7 per cent) surgical wound infection and 11 (18.3 per cent) with intra-abdominal abscess. In the wound infection group 25 per cent had complicated acute appendicitis and only one per cent non-complicated acute appendicitis. The correlation between the preoperative period and wound sepsis showed, the longer period the higher incidence of wound infection, 1.7 per cent with less than 24 hr. 11 per cent with less than 72 hr. and 78.9 per cent with more than 96 hr.

  4. MRI for clinically suspected appendicitis during pregnancy.

    NARCIS (Netherlands)

    Cobben, L.P.; Groot, I.; Haans, L.; Blickman, J.G.; Puylaert, J.

    2004-01-01

    OBJECTIVE: The purpose of this study was to evaluate whether MRI can be used to accurately diagnose or exclude appendicitis in pregnant patients with clinically suspected appendicitis. CONCLUSION: Our results suggest that MRI is helpful in the examination and diagnosis of acute appendicitis in pregn

  5. Prevention by Design: Construction and Renovation of Health Care Facilities for Patient Safety and Infection Prevention.

    Science.gov (United States)

    Olmsted, Russell N

    2016-09-01

    The built environment supports the safe care of patients in health care facilities. Infection preventionists and health care epidemiologists have expertise in prevention and control of health care-associated infections (HAIs) and assist with designing and constructing facilities to prevent HAIs. However, design elements are often missing from initial concepts. In addition, there is a large body of evidence that implicates construction and renovation as being associated with clusters of HAIs, many of which are life threatening for select patient populations. This article summarizes known risks and prevention strategies within a framework for patient safety.

  6. Construction of material and life science experimental facility under high intensity proton accelerator project

    CERN Document Server

    Ikeda, Y

    2002-01-01

    The outline of construction of 1MW pulse spallation neutron source in the MLF experimental facility is explained in this paper. The object, project activities, project team and construction of group are stated. 1MW pulse nuclear spallation neutron source, neutron source design and technical problems, Hg target, the basic parameters, neutron source station, moderator, reflector, shield, shutter, low temperature system, facility, spectrometer, and neutron experimental device are explained. The nuclear calculation code and nuclear data used as technical support and computer environment are illustrated. (S.Y.)

  7. Scrotal absceso following an appendicitis

    Directory of Open Access Journals (Sweden)

    León Hernández Angélica,

    2014-07-01

    Full Text Available Appendicitis is the most common cause of acute abdomen in children; approximately one third of all cases present with appendiceal perforation at the time of surgery. Some of postoperative complications in this condition are abscesses. In unusual places such as the scrotum however, for an intraabdominal event to cause a scrotal abscess, fluid displacement requires the presence of a patent processus vaginalis. We report the case of a child with perforated appendix followed by a scrotum abscess owing to a permeable vaginal canal. The abscess was and the patient wes and treatment was performed based triple scheme antibiotics, evolving satisfactorily. Key words: appendicitis, postoperative complications, residual abscess, inguinal canal.

  8. How to diagnose acute appendicitis

    DEFF Research Database (Denmark)

    Mostbeck, Gerhard; Adam, E Jane; Nielsen, Michael Bachmann;

    2016-01-01

    Acute appendicitis (AA) is a common abdominal emergency with a lifetime prevalence of about 7 %. As the clinical diagnosis of AA remains a challenge to emergency physicians and surgeons, imaging modalities have gained major importance in the diagnostic work-up of patients with suspected AA in order...... appendicitis (AA). • Primary US for AA diagnosis will decrease ionizing radiation and cost. • Sensitivity of US to diagnose AA is lower than of CT/MRI. • Non-visualization of the appendix should lead to clinical reassessment. • Complementary MRI or CT may be performed if diagnosis remains unclear....

  9. Factors predictive of complicated appendicitis in children.

    Science.gov (United States)

    Pham, Xuan-Binh D; Sullins, Veronica F; Kim, Dennis Y; Range, Blake; Kaji, Amy H; de Virgilio, Christian M; Lee, Steven L

    2016-11-01

    The ability to predict whether a child has complicated appendicitis at initial presentation may influence clinical management. However, whether complicated appendicitis is associated with prehospital or inhospital factors is not clear. We also investigate whether hyponatremia may be a novel prehospital factor associated with complicated appendicitis. A retrospective review of all pediatric patients (≤12 y) with appendicitis treated with appendectomy from 2000 to 2013 was performed. The main outcome measure was intraoperative confirmation of gangrenous or perforated appendicitis. A multivariable analysis was performed, and the main predictors of interest were age 24 h, leukocytosis (white blood cell count >12 × 10(3)/mL), hyponatremia (sodium ≤135 mEq/L), and time from admission to appendectomy. Of 392 patients, 179 (46%) had complicated appendicitis at the time of operation. Univariate analysis demonstrated that patients with complicated appendicitis were younger, had a longer duration of symptoms, higher white blood cell count, and lower sodium levels than patients with noncomplicated appendicitis. Multivariable analysis confirmed that symptom duration >24 h (odds ratio [OR] = 5.5, 95% confidence interval [CI] = 3.5-8.9, P appendicitis. Increased time from admission to appendectomy was not a predictor of complicated appendicitis (OR = 0.8, 95% CI = 0.5-1.2, P = 0.2). Prehospital factors can predict complicated appendicitis in children with suspected appendicitis. Hyponatremia is a novel marker associated with complicated appendicitis. Delaying appendectomy does not increase the risk of complicated appendicitis once intravenous antibiotics are administered. This information may help guide resource/personnel allocation, timing of appendectomy, and decision for nonoperative management of appendicitis in children. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Using Consultants in the Design, Construction, and Occupancy of New Healthcare Facilities.

    Science.gov (United States)

    Stichler, Jaynelle F

    2015-11-01

    Nurse leaders are critical players in the design, construction, and occupancy of new healthcare facilities or renovation projects. While most hospitals and healthcare systems have internal resources needed to manage large projects, there is often a recognized need for expertise of external consultants during various phases of design and construction. The purpose of this article is to provide an overview of types of external consultants that can be contracted to ensure the success of the project from concept through initial occupancy.

  11. LSST summit facility construction progress report: reacting to design refinements and field conditions

    Science.gov (United States)

    Barr, Jeffrey D.; Gressler, William; Sebag, Jacques; Seriche, Jaime; Serrano, Eduardo

    2016-07-01

    The civil work, site infrastructure and buildings for the summit facility of the Large Synoptic Survey Telescope (LSST) are among the first major elements that need to be designed, bid and constructed to support the subsequent integration of the dome, telescope, optics, camera and supporting systems. As the contracts for those other major subsystems now move forward under the management of the LSST Telescope and Site (T and S) team, there has been inevitable and beneficial evolution in their designs, which has resulted in significant modifications to the facility and infrastructure. The earliest design requirements for the LSST summit facility were first documented in 2005, its contracted full design was initiated in 2010, and construction began in January, 2015. During that entire development period, and extending now roughly halfway through construction, there continue to be necessary modifications to the facility design resulting from the refinement of interfaces to other major elements of the LSST project and now, during construction, due to unanticipated field conditions. Changes from evolving interfaces have principally involved the telescope mount, the dome and mirror handling/coating facilities which have included significant variations in mass, dimensions, heat loads and anchorage conditions. Modifications related to field conditions have included specifying and testing alternative methods of excavation and contending with the lack of competent rock substrate where it was predicted to be. While these and other necessary changes are somewhat specific to the LSST project and site, they also exemplify inherent challenges related to the typical timeline for the design and construction of astronomical observatory support facilities relative to the overall development of the project.

  12. MRI features associated with acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Leeuwenburgh, Marjolein M.N. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Academic Medical Center, Department of Radiology (G1-223.1), Amsterdam (Netherlands); Jensch, Sebastiaan [Sint Lucas Andreas Hospital, Department of Radiology, Amsterdam (Netherlands); Gratama, Jan W.C. [Gelre Hospitals, Department of Radiology, Apeldoorn (Netherlands); Spilt, Aart [Kennemer Gasthuis, Department of Radiology, Haarlem (Netherlands); Wiarda, Bart M. [Alkmaar Medical Center, Department of Radiology, Alkmaar (Netherlands); Es, H.W. van [Sint Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Cobben, Lodewijk P.J. [Haaglanden Medical Center, Department of Radiology, Leidschendam (Netherlands); Bossuyt, Patrick M.M. [University of Amsterdam, Department of Clinical Epidemiology, Academic Medical Center, Amsterdam (Netherlands); Boermeester, Marja A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Collaboration: on behalf of the OPTIMAP study group

    2014-01-15

    To identify MRI features associated with appendicitis. Features expected to be associated with appendicitis were recorded in consensus by two expert radiologists on 223 abdominal MRIs in patients with suspected appendicitis. Nine MRI features were studied: appendix diameter >7 mm, appendicolith, peri-appendiceal fat infiltration, peri-appendiceal fluid, absence of gas in the appendix, appendiceal wall destruction, restricted diffusion of the appendiceal wall, lumen or focal fluid collections. Appendicitis was assigned as the final diagnosis in 117/223 patients. Associations between imaging features and appendicitis were evaluated with logistic regression analysis. All investigated features were significantly associated with appendicitis in univariate analysis. Combinations of two and three features were associated with a probability of appendicitis of 88 % and 92 %, respectively. In patients without any of the nine features, appendicitis was present in 2 % of cases. After multivariate analysis, only an appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall were significantly associated with appendicitis. The probability of appendicitis was 96 % in their presence and 2 % in their absence. An appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall have the strongest association with appendicitis on MRI. (orig.)

  13. The problems of design and construction of health facilities in Angola

    Directory of Open Access Journals (Sweden)

    Bindanda Antonio Afonso

    2014-03-01

    Full Text Available Angola is a country with great economic potential, which can contribute to the solution of construction, architecture and social problems of the country in case of rational use of financial resources. The author focuses on the negative factors that prevent the health authorities from the efficient construction of large hospitals and clinical facilities in Angola. Brief description of the Angolan population is given. The article provides a brief overview of the climate and overall social health problems. Basing on the stated goals, the following problems are considered: Features of architectural and planning decisions of clinical facilities and a brief description of the existing hospitals. The article deals with those minor progressive changes in planning decisions and in the siting of health facilities. Space-planning decisions, the most rational options and requirements for building new hospitals in Angola. The author indentified the main factors that influence architectural solutions for the design and construction of medical facilities. The most rational design options for clinic hospitals were determined. The objectives of the study were formulated with a view to identifying architectural solutions in the construction of new clinical hospitals. The main objective of the study is to improve health care in Angola. The problems are considered in order to identify rational architectural design of new clinical hospitals.

  14. Construction and operation of replacement hazardous waste handling facility at Lawrence Berkeley Laboratory. Environmental Assessment

    Energy Technology Data Exchange (ETDEWEB)

    1992-09-01

    The US Department of Energy (DOE) has prepared an environmental assessment (EA), DOE/EA-0423, for the construction and operation of a replacement hazardous waste handling facility (HWHF) and decontamination of the existing HWHF at Lawrence Berkeley Laboratory (LBL), Berkeley, California. The proposed facility would replace several older buildings and cargo containers currently being used for waste handling activities and consolidate the LBL`s existing waste handling activities in one location. The nature of the waste handling activities and the waste volume and characteristics would not change as a result of construction of the new facility. Based on the analysis in the EA, DOE has determined that the proposed action would not constitute a major Federal action significantly affecting the quality of the human environment within the meaning of the National Environmental Policy Act (NEPA) of 1969, 42 USC. 4321 et seq. Therefore, an environmental impact statement is not required.

  15. Status of the FLARE (Facility for Laboratory Reconnection Experiments) Construction Project and Plans as a User Facility

    Science.gov (United States)

    Ji, H.; Bhattacharjee, A.; Prager, S.; Daughton, W.; Chen, Y.; Cutler, R.; Fox, W.; Hoffmann, F.; Kalish, M.; Jara-Almonte, J.; Myers, C.; Ren, Y.; Yamada, M.; Yoo, J.; Bale, S. D.; Carter, T.; Dorfman, S.; Drake, J.; Egedal, J.; Sarff, J.; Wallace, J.

    2016-10-01

    The FLARE device (flare.pppl.gov) is a new intermediate-scale plasma experiment under construction at Princeton for the studies of magnetic reconnection in the multiple X-line regimes directly relevant to space, solar, astrophysical, and fusion plasmas, as guided by a reconnection phase diagram [Ji & Daughton, (2011)]. Most of major components either have been already fabricated or are near their completion, including the two most crucial magnets called flux cores. The hardware assembly and installation begin in this summer, followed by commissioning in 2017. Initial comprehensive set of research diagnostics will be constructed and installed also in 2017. The main diagnostics is an extensive set of magnetic probe arrays, covering multiple scales from local electron scales, to intermediate ion scales, and global MHD scales. The planned procedures and example topics as a user facility will be discussed.

  16. Association between climatic elements and acute appendicitis in Japan.

    Science.gov (United States)

    Sato, Yasuto; Kojimahara, Noriko; Kiyohara, Kosuke; Endo, Motoki; Yamaguchi, Naohito

    2017-05-01

    In Japan, it has been reported that an increase in atmospheric pressure is associated with a higher incidence of acute appendicitis. The aim of this epidemiologic study was to investigate the association between climatic elements and the incidence of acute appendicitis. A case-crossover design was used in the present study. Two wk before diagnosis was used for the target period. The same 2-wk period, but 1, 2, and 3 y before diagnosis, was used for the control period. The study participants were patients with acute appendicitis (10-29 y) from 14 facilities in the Greater Tokyo Area. Mean of the observed values for atmospheric pressure, temperature, relative humidity, and hours of sunshine calculated for each target and control period were used as climatic elements to investigate trends 1 and 2 wk before diagnosis. The year of diagnosis, a statistically significant moderate upward trend in atmospheric pressure was observed during the 2-wk period before diagnosis of acute appendicitis (tau = 0.47; P = 0.0213), whereas a weak nonsignificant downward trend was observed 1 y before diagnosis (tau = -0.29; P = 0.1596), and weak nonsignificant upward trends were observed 2 (tau = 0.24; P = 0.2505) and 3 y (tau = 0.28; P = 0.1634) before diagnosis. An association was found between atmospheric pressure and the incidence of acute appendicitis. However, no significant differences were found in relation to sex or age. These findings suggest that changes in atmospheric pressure are associated with the likelihood of patients visiting the hospital. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. The Methodology of Interactive Parametric Modelling of Construction Site Facilities in BIM Environment

    Science.gov (United States)

    Kozlovská, Mária; Čabala, Jozef; Struková, Zuzana

    2014-11-01

    Information technology is becoming a strong tool in different industries, including construction. The recent trend of buildings designing is leading up to creation of the most comprehensive virtual building model (Building Information Model) in order to solve all the problems relating to the project as early as in the designing phase. Building information modelling is a new way of approaching to the design of building projects documentation. Currently, the building site layout as a part of the building design documents has a very little support in the BIM environment. Recently, the research of designing the construction process conditions has centred on improvement of general practice in planning and on new approaches to construction site layout planning. The state of art in field of designing the construction process conditions indicated an unexplored problem related to connection of knowledge system with construction site facilities (CSF) layout through interactive modelling. The goal of the paper is to present the methodology for execution of 3D construction site facility allocation model (3D CSF-IAM), based on principles of parametric and interactive modelling.

  18. Lead Coolant Test Facility Technical and Functional Requirements, Conceptual Design, Cost and Construction Schedule

    Energy Technology Data Exchange (ETDEWEB)

    Soli T. Khericha

    2006-09-01

    This report presents preliminary technical and functional requirements (T&FR), thermal hydraulic design and cost estimate for a lead coolant test facility. The purpose of this small scale facility is to simulate lead coolant fast reactor (LFR) coolant flow in an open lattice geometry core using seven electrical rods and liquid lead or lead-bismuth eutectic. Based on review of current world lead or lead-bismuth test facilities and research need listed in the Generation IV Roadmap, five broad areas of requirements of basis are identified: Develop and Demonstrate Prototype Lead/Lead-Bismuth Liquid Metal Flow Loop Develop and Demonstrate Feasibility of Submerged Heat Exchanger Develop and Demonstrate Open-lattice Flow in Electrically Heated Core Develop and Demonstrate Chemistry Control Demonstrate Safe Operation and Provision for Future Testing. These five broad areas are divided into twenty-one (21) specific requirements ranging from coolant temperature to design lifetime. An overview of project engineering requirements, design requirements, QA and environmental requirements are also presented. The purpose of this T&FRs is to focus the lead fast reactor community domestically on the requirements for the next unique state of the art test facility. The facility thermal hydraulic design is based on the maximum simulated core power using seven electrical heater rods of 420 kW; average linear heat generation rate of 300 W/cm. The core inlet temperature for liquid lead or Pb/Bi eutectic is 420oC. The design includes approximately seventy-five data measurements such as pressure, temperature, and flow rates. The preliminary estimated cost of construction of the facility is $3.7M. It is also estimated that the facility will require two years to be constructed and ready for operation.

  19. Abdominal actinomycosis mimicking acute appendicitis.

    Science.gov (United States)

    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis

    2015-01-01

    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.

  20. Sonography in the diagnosis of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Ahmad Ryazi

    2003-09-01

    Full Text Available Graded compressive sonography may be useful as an adjuvant in the diagnosis of acute appendicitis. To determine the role of sonography in the differential diagnosis of acute appendicitis, preappendectomy sonographic data of 164 consecutive cases in Fatemeh-Zahra Teaching Hospital were evaluated. Of 113 (68.9% patients who had acute appendicitis in histopathology, 64 (56.6% cases had preoperative sonographic diagnosis of acute appendicitis. Of 51 patients who had normal appendices, 40 (78.4% cases had normal appendices in sonographic evaluations. Sensitivity, specificity and accuracy of sonography for acute appendicitis were 56.7%, 78.4% and 0.63, respectively. The positive and negative predictive values were 85.3% and 44.49% respectively. As a result, sonographic evaluation is an additional diagnostic tool in acute appendicitis.

  1. Abdominal cystic lymphangioma mimicking appendicitis.

    Science.gov (United States)

    Wake, Sarah; Abhyankar, Aruna; Hutton, Kim

    2013-06-01

    A cystic lymphangioma arising within the abdomen is a rare entity in children. It may present with an abdominal mass and symptoms of abdominal pain, vomiting, and anorexia. These nonspecific clinical symptoms are often attributed to more common acute pediatric conditions. In this report, we describe two pediatric cases of intra-abdominal cystic lymphangioma that were initially diagnosed and treated as appendicitis. True diagnosis was only achieved on surgical excision and pathological investigation of cystic material.

  2. Abdominal Cystic Lymphangioma Mimicking Appendicitis

    OpenAIRE

    Wake, Sarah; Abhyankar, Aruna; Hutton, Kim

    2013-01-01

    A cystic lymphangioma arising within the abdomen is a rare entity in children. It may present with an abdominal mass and symptoms of abdominal pain, vomiting, and anorexia. These nonspecific clinical symptoms are often attributed to more common acute pediatric conditions. In this report, we describe two pediatric cases of intra-abdominal cystic lymphangioma that were initially diagnosed and treated as appendicitis. True diagnosis was only achieved on surgical excision and pathological investi...

  3. The Construction of the Fast Resistive Bolometer for a SXR Measurement on the GIT-12 Facility

    Directory of Open Access Journals (Sweden)

    Jakub Cikhardt

    2013-01-01

    Full Text Available A lot of kinds of instruments are used for the SXR measurement at pulsed power facilities, but most of them are difficult to calibrate absolutely. For the determination of the energy of SXR radiated by the discharge on Z-pinches, it is possible to use the bolometer which can be calibrated analytically. The bolometer can be constructed with the sufficient sensitivity and, at the same time, with the time resolution in the order of nanoseconds. This bolometer was designed and constructed for the measurement on the 5MA facility GIT-12 at the Institute of High Current Electronics (IHCE of the Siberian Branch Russian Academy of Sciences in Tomsk. The experiments on GIT-12 with the neon and deuterium gas-puff load were diagnosed by the copper bolometer with the time resolution of 4 ns and the sensitivity of 12 V cm2 J-1.

  4. Application of Nuclear Regulatory Commission Regulation Equivalency to Construction of New Nuclear Facilities

    Energy Technology Data Exchange (ETDEWEB)

    BISHOP, G.E.

    1999-06-02

    The Spent Nuclear Fuels Project (SNFP) Office of the Department of Energy (DOE), Richland Operations Office, is charged with moving 2.100 metric tons of spent nuclear fuel elements left over from plutonium production into semi-permanent storage at DOE'S Hanford site in Washington state. In anticipation of eventual NRC regulation, the DOE decided to impose NRC requirements on new SNFP facility design and construction, specifically for the Cold Vacuum Drying Facility (CVDF) and the Canister Storage Building (CSB). The SNFP implemented this policy of ''NRC equivalency'' with the goal of achieving a level of nuclear safety equivalent to that of NRC-licensed fuel processing facilities. Appropriate features of the NRC licensing process were adopted. However, the SNFP maintained applicable DOE requirements in tandem with the NRC regulations. Project work is continuing, with the first fuel movement scheduled for November, 2000.

  5. Mixed Waste Management Facility (MWMF) closure, Savannah River Plant: Clay cap test section construction report

    Energy Technology Data Exchange (ETDEWEB)

    1988-02-26

    This report contains appendix 2 for the Clay Cap Test Section Construction Report for the Mixed Waste Management Facility (MWMF) closure at the Savannah River Plant. The Clay Cap Test Program was conducted to evaluate the source, Laboratory permeability, and compaction characteristics representative of Kaolin clays from the aiken, South Carolina vicinity. Included in this report are daily field reports Nos. 1 to 54. (KJD)

  6. National Ignition Facility start-up/operations engineering and special equipment construction health and safety plan

    Energy Technology Data Exchange (ETDEWEB)

    Huddleston, P C

    1998-05-08

    This document sets forth the responsibilities, interfaces, guidelines, rules, policy, and regulations for all workers involved in the S/O and SE construction, installation, and acceptance testing. This document is enforced from the first day that S/O and SE workers set foot on the NIF construction site until the end of the Project at Critical Decision 4. This document is applicable only to site activities, which are defined as those that occur within the perimeter of the fenced-off NIF construction zone and the Target Chamber Assembly Area (Helipad). The associated Special Equipment laydown and construction support areas listed in Appendix B are not under this plan; their safety provisions are discussed in the Appendix. Prototype and other support activities, such as the Amplifier Laboratory and Frame Assembly Unit assembly area, are not included in this plan. After completion of the Operational Readiness Review, the Facility Safety Procedure, Operational Safety Requirements, and Operational Safety Procedures are the governing safety documents for the operating facility. The S/O and SE project elements are required to implement measures that create a universal awareness of and promote safe job practices at the site. This includes all Lawrence Livermore National Laboratory (LLNL), Los Alamos National Laboratory, Sandia National Laboratories, University of Rochester, supplement labor organization, and subcontractor employees; visitors; and guests serving the S/O and SE effort.

  7. National Ignition Facility start-up/operations engineering and special equipment construction health and safety plan

    Energy Technology Data Exchange (ETDEWEB)

    Huddleston, P C

    1998-05-08

    This document sets forth the responsibilities, interfaces, guidelines, rules, policy, and regulations for all workers involved in the S/O and SE construction, installation, and acceptance testing. This document is enforced from the first day that S/O and SE workers set foot on the NIF construction site until the end of the Project at Critical Decision 4. This document is applicable only to site activities, which are defined as those that occur within the perimeter of the fenced-off NIF construction zone and the Target Chamber Assembly Area (Helipad). The associated Special Equipment laydown and construction support areas listed in Appendix B are not under this plan; their safety provisions are discussed in the Appendix. Prototype and other support activities, such as the Amplifier Laboratory and Frame Assembly Unit assembly area, are not included in this plan. After completion of the Operational Readiness Review, the Facility Safety Procedure, Operational Safety Requirements, and Operational Safety Procedures are the governing safety documents for the operating facility. The S/O and SE project elements are required to implement measures that create a universal awareness of and promote safe job practices at the site. This includes all Lawrence Livermore National Laboratory (LLNL), Los Alamos National Laboratory, Sandia National Laboratories, University of Rochester, supplement labor organization, and subcontractor employees; visitors; and guests serving the S/O and SE effort.

  8. Simultaneous acute appendicitis with right testicular torsion

    Directory of Open Access Journals (Sweden)

    Tanveer Akhtar

    2012-01-01

    Full Text Available We present a child with both acute appendicitis and torsion of the right testis presenting at the same time. Testicular torsion possibly occurring due to vomiting in acute appendicitis so far has not been reported in the literature.

  9. Infantile perforated appendicitis: A forgotten diagnosis

    Directory of Open Access Journals (Sweden)

    Katherine W. Gonzalez

    2015-04-01

    Full Text Available Acute appendicitis in the infant is a rare surgical diagnosis despite its frequency in older patients. The clinical presentation is often vague and can be misleading. We present the successful diagnosis and treatment of a 3 month old female with perforated appendicitis.

  10. Discriminating between simple and perforated appendicitis

    NARCIS (Netherlands)

    M. Bröker (Mirelle); E.M.M. van Lieshout (Esther); M. van der Elst (Maarten); L.P. Stassen (Laurents); T. Schepers (Tim)

    2012-01-01

    textabstractBackground: Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis. Methods: All consecutive patients who have under

  11. Appendiceal endometriosis differentially diagnosed from acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Gastón Astroza; Victor Faundes; René Nanjarí; Marcelo Fleiderman; Carlos Rodriguez

    2010-01-01

    @@ Endometriosis is a common disease in premenopausal women involving pelvic organs specially. However endometriosis that affects the appendix is rarely seen except appendiceal endometriosis that mimics acute appendicitis. In a patient with acute appendicitis we diagnosed and operated on, histopathological examination of the appendix revealed appendiceal endometriosis which caused symptoms.

  12. Discriminating between simple and perforated appendicitis

    NARCIS (Netherlands)

    M. Bröker (Mirelle); E.M.M. van Lieshout (Esther); M. van der Elst (Maarten); L.P. Stassen (Laurents); T. Schepers (Tim)

    2012-01-01

    textabstractBackground: Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis. Methods: All consecutive patients who have

  13. Ecological studies related to construction of the Defense Waste Processing Facility on the Savannah River Site

    Energy Technology Data Exchange (ETDEWEB)

    Pechmann, J.H.K.; Scott, D.E.; McGregor, J.H.; Estes, R.A.; Chazal, A.C.

    1993-02-01

    The Defense Waste Processing Facility (DWPF) was built on the Savannah River Site (SRS) during the mid-1980's. The Savannah River Ecology Laboratory (SREL) has completed 12 years of ecological studies related to the construction of the DWPF complex. Prior to construction, the 600-acre site (S-Area) contained a Carolina bay and the headwaters of a stream. Research conducted by the SREL has focused primarily on four questions related to these wetlands: (1) Prior to construction, what fauna and flora were present at the DWPF site and at similar, yet undisturbed, alternative sites (2) By comparing the Carolina bay at the DWPF site (Sun Bay) with an undisturbed control Carolina bay (Rainbow Bay), what effect is construction having on the organisms that inhabited the DWPF site (3) By comparing control streams with streams on the periphery of the DWPF site, what effect is construction having on the peripheral streams (4) How effective have efforts been to lessen the impacts of construction, both with respect to erosion control measures and the construction of refuge ponds'' as alternative breeding sites for amphibians that formerly bred at Sun Bay Through the long-term census-taking of biota at the DWPF site and Rainbow Bay, SREL has begun to evaluate the impact of construction on the biota and the effectiveness of mitigation efforts. Similarly, the effects of erosion from the DWPF site on the water quality of S-Area peripheral streams are being assessed. This research provides supporting data relevant to the National Environmental Policy Act (NEPA) of 1969, the Endangered Species Act of 1973, Executive Orders 11988 (Floodplain Management) and 11990 (Protection of Wetlands), and United States Department of Energy (DOE) Guidelines for Compliance with Floodplain/Wetland Environmental Review Requirements (10CFR1022).

  14. Cytological diagnosis of xanthogranulomatous appendicitis

    Science.gov (United States)

    Kaushik, Rajni; Gulati, Anchana; Vedant, Deepak; Kaushal, Vijay

    2017-01-01

    Xanthogranulomatous reaction can occur in any organ but the most common sites are kidney and gallbladder. Xanthogranulomatous appendicitis (XA) is a rare clinical entity. There are a few case reports of XA diagnosed on histopathology but none on cytology. Here we report a case of a 47-year-old lady who presented with acute abdomen and was found to have a mass lesion in the right iliac fossa. She was diagnosed with XA intraoperatively on imprint cytology that was subsequently confirmed on histopathological examination. Due to the rarity of XA itself and the use of imprint cytology for intraoperative diagnosis the case is being presented. PMID:28182060

  15. Environmental assessment report: Nuclear Test Technology Complex. [Construction and operation of proposed facility

    Energy Technology Data Exchange (ETDEWEB)

    Tonnessen, K.; Tewes, H.A.

    1982-08-01

    The US Department of Energy (USDOE) is planning to construct and operate a structure, designated the Nuclear Test Technology Complex (NTTC), on a site located west of and adjacent to the Lawrence Livermore National Laboratory. The NTTC is designed to house 350 nuclear test program personnel, and will accommodate the needs of the entire staff of the continuing Nuclear Test Program (NTP). The project has three phases: land acquisition, facility construction and facility operation. The purpose of this environmental assessment report is to describe the activities associated with the three phases of the NTTC project and to evaluate potential environmental disruptions. The project site is located in a rural area of southeastern Alameda County, California, where the primary land use is agriculture; however, the County has zoned the area for industrial development. The environmental impacts of the project include surface disturbance, high noise levels, possible increases in site erosion, and decreased air quality. These impacts will occur primarily during the construction phase of the NTTC project and can be mitigated in part by measures proposed in this report.

  16. Advances in technology for the construction of deep-underground facilities

    Energy Technology Data Exchange (ETDEWEB)

    1987-12-31

    The workshop was organized in order to address technological issues important to decisions regarding the feasibility of strategic options. The objectives of the workshop were to establish the current technological capabilities for deep-underground construction, to project those capabilities through the compressed schedule proposed for construction, and to identify promising directions for timely allocation of existing research and development resources. The earth has been used as a means of protection and safekeeping for many centuries. Recently, the thickness of the earth cover required for this purpose has been extended to the 2,000- to 3,000-ft range in structures contemplated for nuclear-waste disposal, energy storage, and strategic systems. For defensive missile basing, it is now perceived that the magnitude of the threat has increased through better delivery systems, larger payloads, and variable tactics of attack. Thus, depths of 3,000 to 8,000 ft are being considered seriously for such facilities. Moreover, it appears desirable that the facilities be operational (if not totally complete) for defensive purposes within a five-year construction schedule. Deep excavations such as mines are similar in many respects to nearsurface tunnels and caverns for transit, rail, sewer, water, hydroelectric, and highway projects. But the differences that do exist are significant. Major distinctions between shallow and deep construction derive from the stress fields and behavior of earth materials around the openings. Different methodologies are required to accommodate other variations resulting from increased depth, such as elevated temperatures, reduced capability for site exploration, and limited access during project execution. This report addresses these and other questions devoted to geotechnical characterization, design, construction, and excavation equipment.

  17. Malpractice in Cases of Pediatric Appendicitis.

    Science.gov (United States)

    Sullins, Veronica F; Rouch, Joshua D; Lee, Steven L

    2017-03-01

    Appendicitis is one of the most common diagnoses in children and is frequently the focus of alleged malpractice. Causes for medical malpractice claims and outcomes of disputes in pediatric patients with appendicitis are currently unknown. A retrospective database review of all medical malpractice claims concerning the diagnosis of appendicitis from 1984 to 2013 in pediatric patients was performed. Alleged claims, causes of malpractice, and outcomes were recorded and analyzed. Of the 203 included cases, failure or delays in diagnosing appendicitis are the most common causes of malpractice lawsuits and account for the majority of the largest payments to plaintiffs outcomes. Cases that ultimately went to trial resulted in defense verdicts in 67.5%. Mortality occurred in 19.9% of included cases. Timely diagnosis of appendicitis in children should be the focus of physicians across all specialties to improve patient safety and potentially reduce medicolegal liability.

  18. Construction and characterization of the redesigned PGAA facility at The University of Texas at Austin

    Energy Technology Data Exchange (ETDEWEB)

    Revay, Zs. [Institute of Isotopes, Hungarian Academy of Sciences, Budapest (Hungary)]. E-mail: revay@iki.kfki.hu; Harrison, R.K. [Nuclear Engineering Teaching Laboratory, The University of Texas at Austin (United States); Alvarez, E. [Nuclear Engineering Teaching Laboratory, The University of Texas at Austin (United States); Biegalski, S.R. [Nuclear Engineering Teaching Laboratory, The University of Texas at Austin (United States); Landsberger, S. [Nuclear Engineering Teaching Laboratory, The University of Texas at Austin (United States)

    2007-07-11

    The prompt gamma activation analysis (PGAA) facility at The University of Texas at Austin (UT) has been redesigned and reconstructed. As a result of the new shielding of the system, the neutron (at all energies) and gamma-ray backgrounds have been reduced by more than an order of magnitude, considerably improving the signal-to-noise ratio for the characteristic peaks. The prompt gamma peaks from the construction materials have also been decreased, providing better detection limits for elements. The calibration of the new system is shown in detail. All these efforts significantly improved the sensitivity and reliability of the chemical analyses performed in the facility. The characteristics of the improved PGAA system are also presented.

  19. Construction of the SCRIT electron scattering facility at the RIKEN RI Beam Factory

    Science.gov (United States)

    Wakasugi, M.; Ohnishi, T.; Wang, S.; Miyashita, Y.; Adachi, T.; Amagai, T.; Enokizono, A.; Enomoto, A.; Haraguchi, Y.; Hara, M.; Hori, T.; Ichikawa, S.; Kikuchi, T.; Kitazawa, R.; Koizumi, K.; Kurita, K.; Miyamoto, T.; Ogawara, R.; Shimakura, Y.; Takehara, H.; Tamae, T.; Tamaki, S.; Togasaki, M.; Yamaguchi, T.; Yanagi, K.; Suda, T.

    2013-12-01

    The SCRIT electron scattering facility, aiming at electron scattering off short-lived unstable nuclei, has been constructed at the RIKEN RI Beam Factory. This facility consists of a racetrack microtron (RTM), an electron storage ring (SR2) equipped with the SCRIT system, and a low-energy RI separator (ERIS). SCRIT (self-confining radioactive isotope ion targeting) is a novel technique to form internal targets in an electron storage ring. Experiments for evaluating performance of the SCRIT system have been carried out using the stable 133Cs1+ beam and the 132Xe1+ beam supplied from ERIS. Target ions were successfully trapped in the SCRIT system with 90% efficiency at a 250 mA electron beam current, and luminosity exceeding 1026/(cm2 s) was maintained for more than 1 s. Electrons elastically scattered from the target ions were successfully measured. Applicability of the SCRIT system to electron scattering for unstable nuclei has been established in experiments.

  20. [Treatment of acute appendicitis: Retrospective analysis].

    Science.gov (United States)

    Menclová, K; Traboulsi, E; Nikov, A; Hána, L; Rousek, M; Ryska, M

    Acute appendicitis is the most common cause of intra-abdominal emergency surgery worldwide. The approach to its treatment keeps changing. The number of acute appendectomies has been decreasing. Many patients are treated conservatively with success. Our study compares conservative and surgical treatment of acute appendicitis, including its complications in our department. We retrospectively analyzed the group of 117 patients hospitalized with the clinical diagnosis of acute appendicitis. We distinguished patients with complicated and uncomplicated appendicitis, and patients operated and treated conservatively. We evaluated complication rates and recurrences of the disease, respectively, in 1-year follow-up. The Student t test and Fishers exact test were used for the statistical analysis. In 2012 we hospitalized 117 patients with acute appendicitis: 83 patients (71%) for uncomplicated and 34 (29%) for complicated appendicitis. 41% of patients with complicated and 13% with uncomplicated appendicitis (p=0.02) were treated conservatively. Conservative treatment or laparoscopic surgery, respectively, were used more often in women ( p0.001). There was no failure of conservative treatment. Perioperative morbidity was 13%. No patient died. 6 patients (24%) of the conservatively treated group were hospitalized in the subsequent year for recurrent problems. 4 (16%) were reoperated. The rate of negative appendectomy (negative pathological findings) was 11%. The hospitalization time was shorter in patients treated conservatively or using laparoscopy, respectively, compared to the group of patients undergoing appendectomy. In the modern era of available complementary examinations and a broad spectrum of antibiotics the conservative approach is favoured as a treatment of complicated appendicitis. Conservative treatment of uncomplicated appendicitis is an option, but not the method of choice. Routine elective appendectomy after successful conservative treatment is groundless

  1. Radiation control aspects of the civil construction for a high power free electron laser (FEL) facility

    Energy Technology Data Exchange (ETDEWEB)

    Dunn, T.; Neil, G.; Stapleton, G.

    1996-12-31

    The paper discusses some of the assumptions and methods employed for the control of ionizing radiation in the specifications for the civil construction of a planned free electron laser facility based on a 200 MeV, 5 mA superconducting recirculation electron accelerator. Consideration is given firstly to the way in which the underlying building configuration and siting aspects were optimized on the basis of the early assumptions of beam loss and radiation goals. The various design requirements for radiation protection are then considered, and how they were folded into an aesthetically pleasing and functional building.

  2. A facile hydrothermal approach for construction of carbon coating on TiO2 nanoparticles

    OpenAIRE

    Olurode, Kehinde; Neelgund, Gururaj M.; Oki, Aderemi; Luo, Zhiphing

    2011-01-01

    Herein a facile hydrothermal approach is used to construct carbon coated TiO2 nanoparticles employing dextrose as the source of carbon. The procedure is operated at a low temperature of 200 °C. Fourier infrared spectroscopy demonstrated the successful coating of carbon on TiO2 nanoparticles. The phase composition of TiO2 and carbon coated TiO2 nanoparticles were studied using X-ray diffraction and the surface morphology was analyzed by scanning and transmission electron microscopy. The existe...

  3. Construction safety program for the National Ignition Facility Appendix A: Safety Requirements

    Energy Technology Data Exchange (ETDEWEB)

    Cerruti, S.J.

    1997-01-14

    These rules apply to all LLNL employees, non-LLNL employees (including contract labor, supplemental labor, vendors, personnel matrixed/assigned from other National Laboratories, participating guests, visitors and students) and construction contractors/subcontractors. The General Safety and Health rules shall be used by management to promote accident prevention through indoctrination, safety and health training and on-the-job application. As a condition for contracts award, all contractors and subcontractors and their employees must certify on Form S & H A-1 that they have read and understand, or have been briefed and understand, the National Ignition Facility OCIP Project General Safety Rules.

  4. [Appendicitis in children under 3].

    Science.gov (United States)

    Baeza Herrera, C; Guido Ramires, O; González Galicia, J A; Rojas Aro, E

    1994-01-01

    There are many differences between acute appendicitis in the older child and the infants. An understanding of the under three years of age child's response to intra-abdominal infection in contrast to that of the older child and an appreciation for the supportive treatment of the child are vitally important in further lowering the morbidity of young children with acute appendicitis. The purpose of the present study was to investigate the factors contributing to the high perforation rate seen in this age group. A retrospective analysis was done in 88 patients under the age of three who underwent appendectomy. These patients ranged from 4 and 35 months in age. There were 51 (77.4%) male patients. The main complaints were fever, pain and vomiting. Duration of symptoms was more than 24 hours in 80%. Abdominal radiographs showed signs of small bowel obstruction. Peritonitis was found in the majority of the cases (90%). overall morbidity was 31.8% and mortality 1.1%. These data suggest that duration of symptoms is directly proportional to complications rate.

  5. Environmental assessment: Proposed construction of Refuge operational facilities, water management facilities, wildlife oriented interpretation/recreation development, road and water management facilities rehabilitation, and implementation of a vegetation control plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The proposed action consists of the construction of facilities for refuge operation, water management, and wildlife-oriented interpretation and recreation; the...

  6. New construction of an inside-container drying facility in the central decontamination and water treatment facility (ZDW); Neubau einer Innenfasstrocknungsanlage in der Zentralen Dekontaminations- und Wasseraufbereitungsanlage (ZDW)

    Energy Technology Data Exchange (ETDEWEB)

    Hoffmann, Martin J.; Koischwitz, Ingmar [GNS Gesellschaft fuer Nuklear-Service mbH, Essen (Germany)

    2013-07-01

    For the future conditioning of radioactive liquid waste during the proceeding dismantling of the NPP Greifswald the GNS company provides the an inside-container drying facility in the frame of the new construction of ZDW (central decontamination and water treatment facility) including related infrastructure and media supply. The concept of the FAVORIT facility which is in operation since years has been refined; a fully automated version was realized so that no handling by the personnel is necessary for loading and unloading of the container station. Components of the vacuum system were optimized.

  7. SINBAD—The accelerator R&D facility under construction at DESY

    Energy Technology Data Exchange (ETDEWEB)

    Dorda, U., E-mail: ulrich.dorda@desy.de [DESY, Hamburg & Zeuthen (Germany); Assmann, R.; Brinkmann, R.; Flöttmann, K.; Hartl, I.; Hüning, M.; Kärtner, F.; Fallahi, A.; Marchetti, B.; Nie, Y.; Osterhoff, J.; Schlarb, H.; Zhu, J. [DESY, Hamburg & Zeuthen (Germany); Maier, A.R. [University Hamburg (Germany)

    2016-09-01

    The SINBAD facility (Short INnovative Bunches and Accelerators at DESY) is a long-term dedicated accelerator research and development facility currently under construction at DESY. It will be located in the premises of the old DORIS accelerator complex and host multiple independent experiments cost-effectively accessing the same central infrastructure like a central high power laser. With the removal of the old DORIS accelerator being completed, the refurbishment of the technical infrastructure is currently starting up. The presently ongoing conversion of the area into the SINBAD facility and the currently foreseen layout is described. The first experiment will use a compact S-band linac for the production of ultra-short bunches at hundred MeV. Once established, one of the main usages will be to externally inject electrons into a laser-driven plasma wakefield accelerator to boost the energy to GeV-level while maintaining a usable beam quality, ultimately aiming to drive an FEL. The second experiment already under planning is the setup of an attosecond radiation source with advanced technology. Further usage of the available space and infrastructure is revised and national and international collaborations are being established.

  8. SINBAD-The accelerator R&D facility under construction at DESY

    Science.gov (United States)

    Dorda, U.; Assmann, R.; Brinkmann, R.; Flöttmann, K.; Hartl, I.; Hüning, M.; Kärtner, F.; Fallahi, A.; Marchetti, B.; Nie, Y.; Osterhoff, J.; Schlarb, H.; Zhu, J.; Maier, A. R.

    2016-09-01

    The SINBAD facility (Short INnovative Bunches and Accelerators at DESY) is a long-term dedicated accelerator research and development facility currently under construction at DESY. It will be located in the premises of the old DORIS accelerator complex and host multiple independent experiments cost-effectively accessing the same central infrastructure like a central high power laser. With the removal of the old DORIS accelerator being completed, the refurbishment of the technical infrastructure is currently starting up. The presently ongoing conversion of the area into the SINBAD facility and the currently foreseen layout is described. The first experiment will use a compact S-band linac for the production of ultra-short bunches at hundred MeV. Once established, one of the main usages will be to externally inject electrons into a laser-driven plasma wakefield accelerator to boost the energy to GeV-level while maintaining a usable beam quality, ultimately aiming to drive an FEL. The second experiment already under planning is the setup of an attosecond radiation source with advanced technology. Further usage of the available space and infrastructure is revised and national and international collaborations are being established.

  9. Acute amebic appendicitis: report of a rare case.

    Science.gov (United States)

    Singh, Naorem Gopendro; Mannan, A A S Rifat; Kahvic, Mirza

    2010-01-01

    Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. We report a case of amebic appendicitis presenting with fever, severe pain in the right lower quadrant of the abdomen and rebound tenderness. Lab investigations revealed neutrophilic leukocytosis. The patient underwent appendectomy. Histopathological examination revealed numerous Entameba histolytica trophozoites in the mucosa of the appendix. Acute appendicitis of amebic origin does not appear frequently. Appendicular amebiasis can give the clinical features of acute appendicitis and should be treated accordingly.

  10. Appendicitis in Children. Clinical, diagnostic and pathogenic factors

    OpenAIRE

    Salö, Martin

    2016-01-01

    Background: Appendicitis is the most common disease requiring abdominal surgery in children. However, the diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies, especially in girls and young children. Further, the pathogenesis of acute appendicitis is not known. Aim: To examine acute appendicitis in children in the aspects of evaluation of the utility of the pediatric appendicitis score (PAS) in young children and evaluate factors respo...

  11. Appendicitis

    Science.gov (United States)

    ... Diet, & Nutrition Clinical Trials Cyclic Vomiting Syndrome Dental Enamel Defects and Celiac Disease Dermatitis Herpetiformis Dermatitis Herpetiformis ( ... 09, 2017 More News Related Conditions & Diseases Abdominal Adhesions Crohn's Disease Ulcerative Colitis Your Digestive System & How ...

  12. [Appendicitis in the aged (author's transl)].

    Science.gov (United States)

    Hupe, K

    1981-01-01

    In cases of partially uncharacteristic clinical symptoms with no typical leukocytosis and no ESR elevation, laparotomy reveals not seldom an acute phlegmonous appendix. As compared with the similar disease in younger people appendicitis of the aged presents more complications and a higher mortality rate which can partially explained by clinically meaningful secondary findings and a lesser degree of peritoneal inflammation. The mortality rate of appendicitis in the aged could be markedly reduced. This may be attributed to emergency operation of clinically diagnosed appendicitis in the aged, to improve anaesthetic technique, to infusion therapy and parenteral feeding and last not least postoperative administering of antibiotics.

  13. Radioactive Air Emmission Notice of Construction (NOC) for the Waste Receiving and Processing Facility (WRAP)

    Energy Technology Data Exchange (ETDEWEB)

    MENARD, N.M.

    2000-12-01

    This document serves as a notice of construction (NOC) pursuant to the requirements of Washington Administrative Code (WAC) 246-247-060, and as a request for approval to modify pursuant to 40 Code of Federal Regulations (CFR) 61.07 for the Waste Receiving and Processing (WRAP) Facility. The rewrite of this NOC incorporates all the approved revisions (Sections 5.0, 6.0, 8.0, and 9.0), a revised potential to emit (PTE) based on the revised maximally exposed individual (MEI) (Sections 8.0, 10.0, 11.0, 12.0, 13.0, 14.0, and 15.0), the results of a study on fugitive emissions (Sections 6.0, 10.0, and 15.0), and reflects the current operating conditions at the WRAP Facility (Section 5.0). This NOC replaces DOE/RL-93-15 and DOE/RL-93-16 in their entirety. The primary function of the WRAP Facility is to examine, assay, characterize, treat, verify, and repackage radioactive material and mixed waste. There are two sources of emissions from the WRAP Facility: stack emissions and fugitive emissions. The stack emissions have an unabated total effective dose equivalent (TEDE) estimate to the hypothetical offsite MEI of 1.13 E+02 millirem per year. The abated TEDE for the stack emissions is estimated at 5.63 E-02 millirem per year to the MEI. The fugitive emissions have an unabated TEDE estimate to the hypothetical offsite MEI of 5.87 E-04. There is no abatement for the fugitive emissions.

  14. Environmental assessment for the construction and operation of waste storage facilities at the Paducah Gaseous Diffusion Plant, Paducah, Kentucky

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-06-01

    DOE is proposing to construct and operate 3 waste storage facilities (one 42,000 ft{sup 2} waste storage facility for RCRA waste, one 42,000 ft{sup 2} waste storage facility for toxic waste (TSCA), and one 200,000 ft{sup 2} mixed (hazardous/radioactive) waste storage facility) at Paducah. This environmental assessment compares impacts of this proposed action with those of continuing present practices aof of using alternative locations. It is found that the construction, operation, and ultimate closure of the proposed waste storage facilities would not significantly affect the quality of the human environment within the meaning of NEPA; therefore an environmental impact statement is not required.

  15. Idiopathic Renal Infarction Mimicking Appendicitis

    Science.gov (United States)

    Lisanti, Francesco; Scarano, Enrico

    2017-01-01

    Renal infarction is a rare cause of referral to the emergency department, with very low estimated incidence (0.004%–0.007%). Usually, it manifests in patients aged 60–70 with risk factors for thromboembolism, mostly related to heart disease, atrial fibrillation in particular. We report a case of idiopathic segmental renal infarction in a 38-year-old patient, presenting with acute abdominal pain with no previous known history or risk factors for thromboembolic diseases. Because of its aspecific clinical presentation, this condition can mimic more frequent pathologies including pyelonephritis, nephrolithiasis, or as in our case appendicitis. Here we highlight the extremely ambiguous presentation of renal infarct and the importance for clinicians to be aware of this condition, particularly in patients without clear risk factors, as it usually has a good prognosis after appropriate anticoagulant therapy. PMID:28203466

  16. Acute Appendicitis in Infants. A Case Report

    Directory of Open Access Journals (Sweden)

    Sergio Luis González López

    2013-04-01

    Full Text Available Acute appendicitis is more common in school-age children, but it rarely occurs in infants. The younger the patient, the fastest the course of the disease. In addition, there are greater risks of complications. A case of a nine-month-old infant, admitted to the pediatric hospital with fever and diarrhea, is presented. After several tests, he underwent surgery. Peritonitis caused by acute gangrenous appendicitis was diagnosed. While the patient was in the intensive care unit, he suffered a septic shock and acute multiple organ failure. As a result, he died 24 hours later. The biopsy confirmed the diagnosis of acute gangrenous appendicitis. Acute appendicitis is a disease that must be considered by doctors who treat infants with fever, diarrhea and abdominal pain related to irritability. Thus, an early diagnosis of the disease as well as the implementation of an appropriate surgical treatment can be performed.

  17. Appendiceal taeniasis presenting like acute appendicitis.

    Science.gov (United States)

    Sartorelli, Alesso Cervantes; da Silva, Márcia Guimarães; Rodrigues, Maria Aparecida Marchesan; da Silva, Reinaldo José

    2005-09-01

    A case of parasitic appendicitis caused by Taenia sp. in a 28-year-old woman from Brazil is reported. Histopathological data and a description of the helminthe found in the appendix lumen are presented.

  18. A rare presentation of an acute appendicitis

    Science.gov (United States)

    Kordzadeh, Ali; Lorenzi, Bruno; Kalyan, Jiten P.; Hanif, Muhammad A.; Charalabopoulos, Alexandros

    2017-01-01

    Paraumbilical hernia sac usually contains omentum, bowel loop and rarely appendicular epiploicae, metastatic deposits and vermiform appendix. Presentation of acute appendicitis in a paraumbilical hernia is rare and limited to few case reports in the literature. Herein, we would like to report a case of a successfully treated acute appendicitis presenting in a paraumbilical hernia in an 84-year-old lady with 6-month follow-up. PMID:28096326

  19. [Enterobius vermicularis causing symptoms of acute appendicitis].

    Science.gov (United States)

    Antal, András; Kocsis, Béla

    2008-08-01

    The authors present a case of enterobiasis of the appendix. Enterobius infection is an uncommon cause of acute appendicitis. Preoperative diagnosis of pinworm infestation is almost impossible unless there is a strong clinical suspicion. Parasites may produce symptoms which resemble acute appendicitis. Careful observation of the appendix stump may lead to intraoperative diagnosis of enterobiasis. A quick diagnosis and appropriate treatment may prevent future complications.

  20. Outcomes of Nonoperative Management of Uncomplicated Appendicitis.

    Science.gov (United States)

    Bachur, Richard G; Lipsett, Susan C; Monuteaux, Michael C

    2017-07-01

    Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization. Retrospective analysis of administrative data from 45 US pediatric hospitals. Patients appendicitis between 2010 and 2016 were studied. NOM was defined by an ED visit for uncomplicated appendicitis treated with antibiotics and the absence of appendectomy at the index encounter. The main outcomes included trends in NOM among children with uncomplicated appendicitis and frequency of subsequent diagnostic imaging, ED visits, hospitalizations, and appendectomy during 12-month follow-up. 99 001 children with appendicitis were identified, with a median age of 10.9 years. Sixty-six percent were diagnosed with nonperforated appendicitis, of which 4190 (6%) were managed nonoperatively. An increasing number of nonoperative cases were observed over 6 years (absolute difference, +20.4%). During the 12-month follow-up period, NOM patients were more likely to have the following: advanced imaging (+8.9% [95% confidence interval (CI) 7.6% to 10.3%]), ED visits (+11.2% [95% CI 9.3% to 13.2%]), and hospitalizations (+43.7% [95% CI 41.7% to 45.8%]). Among patients managed nonoperatively, 46% had a subsequent appendectomy. A significant increase in NOM of nonperforated appendicitis was observed over 6 years. Patients with NOM had more subsequent ED visits and hospitalizations compared with those managed operatively at the index visit. A substantial proportion of patients initially managed nonoperatively eventually had an appendectomy. Copyright © 2017 by the American Academy of Pediatrics.

  1. Design and construction of models for the National Transonic Facility, part 1

    Science.gov (United States)

    Young, C. P., Jr.

    1985-01-01

    The design and construction of models for the National Transonic Facility (NTF) has resulted in significant technology developments in many areas. This lecture covers the development of design criteria and major research and development work that has contributed to the successful design and fabrication models for testing at full scale Reynolds number the NTF. Emphasis is placed on the materials aspect of the design and fabrication proces, including metallic materials, mechanical properties characterization, new steel alloy development, fracture toughness enhancement, and identification of fillers and solders suitable for use in cryogenic models. Quantitative data are provided which will be of value to the potential user of NTF or for application to the design and fabrication of model systems for other cryogenic wind tunnels.

  2. Outpatient surgery for acute uncomplicated appendicitis

    Directory of Open Access Journals (Sweden)

    Juan Pablo Martínez

    2015-04-01

    Full Text Available Introduction: Acute appendicitis is one of the main indications to abdominal surgery. When the appendicitis is not complicated, is possible to do an outpatient surgery. Objective: To describe postsurgical evolution of the patients who present uncomplicated acute appendicitis. Methods: A prospective study was carried out about the evolution of 100 patients with outpatient surgery for appendectomy by uncomplicated acute appendicitis. The study was performed in the Hospital Susana Lopez de Valencia (HSLV of Popayán, Colombia. A telephone survey was conducted during the 24 hours after surgery, to determinate potential complications like pain, nausea, vomiting and oral intolerance. Clinical histories were reviewed to determinate in case the patient has re-entered because of a possible post operative complication during 30 next days after surgical intervention. Histopathological findings were also reported. Results: During postsurgical follow up, 58% of the patients did not present any kind of pain, 95% tolerated oral route, 97% did not have vomiting and 90% did not have nausea. 3% re-entered because of type 1 infection around the surgical area, 4% because of pain. We found a histopathological concordance with the acute appendicitis diagnostic in 94% of the cases. All patients reported to be satisfied with the given attention in the postsurgery. Conclusions: Patients undergo appendectomy by uncomplicated acute appendicitis treated outpatient, has an appropriate tolerance to oral route and pain control.

  3. Imaging Acute Appendicitis: State of the Art

    Directory of Open Access Journals (Sweden)

    Diana Gaitini

    2011-01-01

    Full Text Available The goal of this review is to present the state of the art in imaging tests for the diagnosis of acute appendicitis. Relevant publications regarding performance and advantages/disadvantages of imaging modalities for the diagnosis of appendicitis in different clinical situations were reviewed. Articles were extracted from a computerized database (MEDLINE with the following activated limits: Humans, English, core clinical journals, and published in the last five years. Reference lists of relevant studies were checked manually to identify additional, related articles. Ultrasound (US examination should be the first imaging test performed, particularly among the pediatric and young adult populations, who represent the main targets for appendicitis, as well as in pregnant patients. A positive US examination for appendicitis or an alternative diagnosis of possible gastrointestinal or urological origin, or a negative US, either showing a normal appendix or presenting low clinical suspicion of appendicitis, should lead to a final diagnosis. A negative or indeterminate examination with a strong clinical suspicion of appendicitis should be followed by a computed tomography (CT scan or alternatively, a magnetic resonanace imaging (MRI scan in a pregnant patient. A second US examination in a patient with persistent symptoms, especially if the first one was performed by a less experienced imaging professional, is a valid alternative to a CT.

  4. Construction of the SCRIT electron scattering facility at the RIKEN RI Beam Factory

    Energy Technology Data Exchange (ETDEWEB)

    Wakasugi, M., E-mail: wakasugi@riken.jp [RIKEN Nishina Center for Accelerator Based Science, 2-1 Hirosawa,Wako, Saitama 351-0198 (Japan); Ohnishi, T. [RIKEN Nishina Center for Accelerator Based Science, 2-1 Hirosawa,Wako, Saitama 351-0198 (Japan); Wang, S. [Research Center for Electron Photon Science, Tohoku University, 1-2-1 Mikamine, Taihakuku, Sendai, Miyagi 982-0826 (Japan); Miyashita, Y. [RIKEN Nishina Center for Accelerator Based Science, 2-1 Hirosawa,Wako, Saitama 351-0198 (Japan); Adachi, T.; Amagai, T. [Research Center for Electron Photon Science, Tohoku University, 1-2-1 Mikamine, Taihakuku, Sendai, Miyagi 982-0826 (Japan); Enokizono, A. [Department of Physics, Rikkyo University, 3-34-1 Nishiikebukuro, Toshimaku, Tokyo 171-8501 (Japan); Enomoto, A. [Department of Physics, Saitama University, Urawa, Saitama 338-8570 (Japan); Haraguchi, Y. [Department of Electrical Engineering, Nagaoka University of Technology, 1603-1 Kamitomiokamachi, Nagaoka, Niigata 940-2188 (Japan); Hara, M.; Hori, T.; Ichikawa, S. [RIKEN Nishina Center for Accelerator Based Science, 2-1 Hirosawa,Wako, Saitama 351-0198 (Japan); Kikuchi, T. [Department of Electrical Engineering, Nagaoka University of Technology, 1603-1 Kamitomiokamachi, Nagaoka, Niigata 940-2188 (Japan); Kitazawa, R. [Research Center for Electron Photon Science, Tohoku University, 1-2-1 Mikamine, Taihakuku, Sendai, Miyagi 982-0826 (Japan); Koizumi, K.; Kurita, K. [Department of Physics, Rikkyo University, 3-34-1 Nishiikebukuro, Toshimaku, Tokyo 171-8501 (Japan); Miyamoto, T. [Research Center for Electron Photon Science, Tohoku University, 1-2-1 Mikamine, Taihakuku, Sendai, Miyagi 982-0826 (Japan); Ogawara, R.; Shimakura, Y. [Department of Physics, Rikkyo University, 3-34-1 Nishiikebukuro, Toshimaku, Tokyo 171-8501 (Japan); Takehara, H. [Department of Electrical Engineering, Nagaoka University of Technology, 1603-1 Kamitomiokamachi, Nagaoka, Niigata 940-2188 (Japan); and others

    2013-12-15

    The SCRIT electron scattering facility, aiming at electron scattering off short-lived unstable nuclei, has been constructed at the RIKEN RI Beam Factory. This facility consists of a racetrack microtron (RTM), an electron storage ring (SR2) equipped with the SCRIT system, and a low-energy RI separator (ERIS). SCRIT (self-confining radioactive isotope ion targeting) is a novel technique to form internal targets in an electron storage ring. Experiments for evaluating performance of the SCRIT system have been carried out using the stable {sup 133}Cs{sup 1+} beam and the {sup 132}Xe{sup 1+} beam supplied from ERIS. Target ions were successfully trapped in the SCRIT system with 90% efficiency at a 250 mA electron beam current, and luminosity exceeding 10{sup 26}/(cm{sup 2} s) was maintained for more than 1 s. Electrons elastically scattered from the target ions were successfully measured. Applicability of the SCRIT system to electron scattering for unstable nuclei has been established in experiments.

  5. Strategy of Construction and Demolition Waste Management after Chemical Industry Facilities Removal

    Science.gov (United States)

    Tashkinova, I. N.; Batrakova, G. M.; Vaisman, Ya I.

    2017-06-01

    Mixed waste products are generated in the process of irrelevant industrial projects’ removal if conventional techniques of their demolition and dismantling are applied. In Russia the number of unused chemical industry facilities including structures with high rate of wear is growing. In removing industrial buildings and production shops it is used conventional techniques of demolition and dismantling in the process of which mixed waste products are generated. The presence of hazardous chemicals in these wastes makes difficulties for their use and leads to the increasing volume of unutilized residues. In the process of chemical industry facilities’ removal this fact takes on special significance as a high level of hazardous chemicals in the waste composition demands for the realization of unprofitable measures aimed at ensuring environmental and industrial safety. The proposed strategy of managing waste originated from the demolition and dismantling of chemical industry facilities is based on the methodology of industrial metabolism which allows identifying separate material flows of recycled, harmful and ballast components, performing separate collection of components during removal and taking necessary preventive measures. This strategy has been tested on the aniline synthesis plant being in the process of removal. As a result, a flow of 10 wt. %, subjected to decontamination, was isolated from the total volume of construction and demolition waste (C&D waste). The considered approach allowed using the resource potential of more than 80wt. % of waste and minimizing the disposed waste volume.

  6. Synthesis of Multiester-appended and Multicarboxylic-appended Imidazolium Ionic Liquids

    Institute of Scientific and Technical Information of China (English)

    Wei Guo GENG; Xue Hui LI; Le Fu WANG; Hong Li DUAN; Wei Ping PAN

    2006-01-01

    Multiester-appended imidazolium ionic liquids were synthesized in a quatemization reaction between the imidazole derivatives carrying single or double esters and ethyl chloroacetate or bromoethane. Multicarboxylic-appended imidazolium ionic liquids were achieved from the hydrolysis of the corresponding ionic liquids. The influences of multifunctional groups on the transition temperatures and viscosity of these new ionic liquids were investigated.

  7. Heavy metals in recovered fines from construction and demolition debris recycling facilities in Florida.

    Science.gov (United States)

    Townsend, Timothy; Tolaymat, Thabet; Leo, Kevin; Jambeck, Jenna

    2004-10-01

    A major product recovered from the processing and recycling of construction and demolition (C&D) debris is screened soil, also referred to as fines. A proposed reuse option for C&D debris fines is fill material, typically in construction projects as a substitute for natural soil. Waste material that is reused in a manner similar to soil must first be characterized to examine potential risks to human health and the environment. In Florida, samples of C&D debris fines from 13 C&D debris recycling facilities were characterized for 11 total and leachable heavy metal concentrations. Total metal concentration results (mg/kg) were compared to existing data on background Florida soil concentrations and to Florida's risk-based soil cleanup target levels (SCTLs). All of the detected metals were found to be elevated with respect to background. The 95% upper confidence level of arsenic from 99 samples was 3.2 mg/kg; arsenic presented the greatest limitation to reuse when compared to the SCTLs. Lead was not found to pose a major problem, likely because of the relatively new building infrastructure in Florida, which results in less demolition debris and less material impacted by lead-based paint. The results of batch leaching tests conducted using simulated rainwater (mg/l) were compared directly to risk-based groundwater levels for Florida and were found not to pose a risk using existing risk assessment policies.

  8. Clean Construction Protocol for the National Ignition Facility Beampath and Utilities

    Energy Technology Data Exchange (ETDEWEB)

    Predmore, R A; VanDoren, D E; Stowers, I F; Stephenson, S A

    2002-01-04

    When the stadium-size, National Ignition Facility (NIF) is fully operational at the Lawrence Livermore National Laboratory (LLNL), its 192 laser beams will deliver 1.8 megajoules (500 terawatts) of energy onto a target to create extremely high temperatures and pressures for inertial confinement fusion research. Due to the high-energy-physics requirements of the NIF optical components, the optics and their surrounding beampath as well as the supporting utility systems must be fabricated, cleaned, assembled, and commissioned for precision cleanliness. This paper will provide an overview of the NIF cleanliness requirements, the clean construction protocol (CCP) specifications for the beampath and clean utilities, and techniques for verifying the CCP specifications. The NIF cleanliness requirements define limits for molecular and particulate contamination; the goal of these limits is to prevent contamination of the optical components. To prevent laser-induced damage and poor laser quality in the optical components, requirements for cleaning, assembly, installation, and commissioning in terms of particle and nonvolatile residue (NVR) levels are defined. The requirements in the interior of the beampath are parts-per-billion airborne molecular contamination (AMC) and Class 1 particulate levels. To achieve the cleanliness requirements for the beampath interior, a graded CCP approach is used as the NIF beampath and utilities are being constructed by a partnership between LLNL and the construction contractor, Jacobs Facilities, Inc. in a stadium-size Class 100,000 building. Installation of the beampath components utilizes localized mini-environments of Class 100 or better, with budgets of cleanliness exposure or ''class-hours'' for each clean connection. Garment, equipment, and operational considerations are evaluated with process verification. Verification of the beampath and utility cleanliness is performed with cleanliness exposure monitoring

  9. Measurements of nuclear data and possibility to construct the nuclear data production facility based on electron linac

    Energy Technology Data Exchange (ETDEWEB)

    Namkung, Won; Ko, In Soo; Cho, Moo Hyun; Kim, Gui Nyun; Lee, Young Seok; Kang, Heung Sik [Pohang University of Science and Technology, Pohang(Korea)

    2001-04-01

    In order to construct an infrastructure to produce nuclear data, we studied three main items; (1) Study on the possibility to construct a facility for nuclear data production, (2) Production of nuclear data for nuclear power plant, and (3) Pulsed neutron source based on a 100-MeV electron linac at Pohang Accelerator Laboratory (PAL). We confirmed the possibility to build a nuclear data production facility utilizing a 100-MeV electron linac at PAL and manpower who wanted to participate the nuclear data production experiments. In order to measure the nuclear data for nuclear power plant, we used several nuclear data production facilities in abroad. We measured total cross sections and neutron caprure cross sections for {sup nat}Dy and {sup nat}Hf using the pulsed neutron facility in the Research Reactor Institute, Kyoto University (KURRI). The neutron capture cross sections for {sup 161,162,163,164}Dy were measured at KURRI in the neutron energy region between 0.001 eV and several tens keV, and at the fast neutron facility in Tokyo Institute of Technology in the neutron energy region between 10 keV and 100 keV. We also measured the neutron capture cross sections and gamma multiplicity of {sup 232}Th at the IBR30 in Dubna, Russia. We have construct a pulsed neutron source using a 100-MeV electron linac at PAL. We measured neutron time-of-flight (TOF) spectra in order to check the characteristics of the pulsed neutron source. We also measured a neutron total cross sections of W and Cu. The pulsed neutron facility can be utilized in the education facility for nuclear data production and the test facility for the R and D purpose of the nuclear data production facility. 29 refs., 57 figs., 22 tabs. (Author)

  10. A Novel Reporting System to Improve Accuracy in Appendicitis Imaging

    Science.gov (United States)

    Godwin, Benjamin D.; Drake, Frederick T.; Simianu, Vlad V.; Shriki, Jabi E.; Hippe, Daniel S.; Dighe, Manjiri; Bastawrous, Sarah; Cuevas, Carlos; Flum, David; Bhargava, Puneet

    2015-01-01

    OBJECTIVE The purpose of this study was to ascertain if standardized radiologic reporting for appendicitis imaging increases diagnostic accuracy. MATERIALS AND METHODS We developed a standardized appendicitis reporting system that includes objective imaging findings common in appendicitis and a certainty score ranging from 1 (definitely not appendicitis) through 5 (definitely appendicitis). Four radiologists retrospectively reviewed the preoperative CT scans of 96 appendectomy patients using our reporting system. The presence of appendicitis-specific imaging findings and certainty scores were compared with final pathology. These comparisons were summarized using odds ratios (ORs) and the AUC. RESULTS The appendix was visualized on CT in 89 patients, of whom 71 (80%) had pathologically proven appendicitis. Imaging findings associated with appendicitis included appendiceal diameter (odds ratio [OR] = 14 [> 10 vs appendicitis. In this initially indeterminate group, using the standardized reporting system, radiologists assigned higher certainty scores (4 or 5) in 21 of the 28 patients with appendicitis (75%) and lower scores (1 or 2) in five of the seven patients without appendicitis (71%) (AUC = 0.90; p = 0.001). CONCLUSION Standardized reporting and grading of objective imaging findings correlated well with postoperative pathology and may decrease the number of CT findings reported as indeterminate for appendicitis. Prospective evaluation of this reporting system on a cohort of patients with clinically suspected appendicitis is currently under way. PMID:26001230

  11. ISABELLE: a proton-proton colliding beam facility. [Proposal for the construction of ISABELLE

    Energy Technology Data Exchange (ETDEWEB)

    None

    1977-04-01

    A proposal is presented for the construction of an Intersecting Storage Accelerator, ISABELLE, to be located at Brookhaven National Laboratory. At this major research facility, colliding beams of protons will be produced and studied by particle physicists. This proposal combines the interests of these particle physicists in exploring a new energy regime with the challenge of building a new research instrument. The proposal results from several years of considering such devices in parallel with extensive developmental work. The proposal is divided into several major parts. Following an introduction is an overall summary of the proposal covering its highlights. Part II contains a thorough discussion of the physics objectives that can be addressed by the storage ring. It begins with an explanation of current theoretical concepts that occupy the curiosity of high energy physicists. Then follows a brief discussion of possible experiments that might be assembled at the interaction regions to test these concepts. The third part of the proposal goes into the details of the design of the intersecting storage accelerators. It begins with a description of the entire facility and the design of the magnet ring structure. The processes of proton beam accumulation and acceleration are thoroughly described. The discussion then turns to the design of the components and subsystems for the accelerator. The accelerator elements are described followed by a description of the physical plant. The cost estimate and time scales are displayed in Part IV. Here the estimate has been based on the experience gained from working with the prototype units at the laboratory. The appendices are an important part of the proposal. The parameter list for the 200 x 200 GeV ISABELLE is carefully documented. An example of a possible research program can be found in an appendix. The performance of prototype units is documented in one of the appendices.

  12. Evidence for eosinophil degranulation in acute appendicitis

    Directory of Open Access Journals (Sweden)

    Santosh G

    2008-04-01

    Full Text Available Finding of increased numbers of eosinophils in the muscle in cases of acute appendicitis has led to the hypothesis that it may have an allergic origin. This study aimed to measure the eosinophil degranulation resulting in a rise in the serum of eosinophil granule proteins that would be expected in such cases. The levels of serum eosinophil cationic protein (ECP measured by chemiluminescence assay in acute appendicitis were compared, with those of appropriate controls. Mean (95% CI serum ECP (µg/L levels were: acute appendicitis 45.3 (27.7-63.0; normal appendix 22.7 (16.0-29.3; asthma 24.2 (4.6-43.8; and healthy volunteers 13.2 (8.3-18.1. In cases of acute appendicitis, there is an inverse relationship between duration of symptoms and serum ECP. However, this was not statistically significant. Significant local eosinophil activation and degranulation occurs in acute appendicitis, enough to cause a rise in serum levels of eosinophil chemotactic protein

  13. Can fruit seeds and undigested plant residuals cause acute appendicitis

    Directory of Open Access Journals (Sweden)

    Omer Engin

    2011-04-01

    Conclusions: The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

  14. Appendicitis in Children: Evaluation of the Pediatric Appendicitis Score in Younger and Older Children

    Directory of Open Access Journals (Sweden)

    Martin Salö

    2014-01-01

    Full Text Available Background. This study aimed to evaluate Pediatric Appendicitis Score (PAS, diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis. Method. 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years (n=102 and <4 years (n=20. Results. The mean PAS was lower among the younger compared with the older patients (5.3 and 6.6, resp.; P=0.005, despite the fact that younger children had more severe appendicitis (75.0% and 33.3%, resp.; P=0.001. PAS had low sensitivity in both groups, with a significantly lower sensitivity among the younger patients. Parent and doctor delay were confirmed in children <4 years of age with appendicitis. PAS did not aid in patients with doctor delay. Parameters in patient history, symptoms, and abdominal examination were more diffuse in younger children. Conclusion. PAS should be used with caution when examining children younger than 4 years of age. Diffuse symptoms in younger children with acute appendicitis lead to delay and to later diagnosis and more complicated appendicitis.

  15. Environmental assessment for the construction, operation, and decommissioning of the Waste Segregation Facility at the Savannah River Site

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-01-01

    This Environmental Assessment (EA) has been prepared by the Department of Energy (DOE) to assess the potential environmental impacts associated with the construction, operation and decontamination and decommissioning (D&D) of the Waste Segregation Facility (WSF) for the sorting, shredding, and compaction of low-level radioactive waste (LLW) at the Savannah River Site (SRS) located near Aiken, South Carolina. The LLW to be processed consists of two waste streams: legacy waste which is currently stored in E-Area Vaults of SRS and new waste generated from continuing operations. The proposed action is to construct, operate, and D&D a facility to process low-activity job-control and equipment waste for volume reduction. The LLW would be processed to make more efficient use of low-level waste disposal capacity (E-Area Vaults) or to meet the waste acceptance criteria for treatment at the Consolidated Incineration Facility (CIF) at SRS.

  16. Development of inherent technologies for advanced PWR core - A study on the current status and the construction feasibility of critical facilities

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Won Sik; Yang, Hyun Seok [Chosun University, Kwangju (Korea); Kim, Chang Hyo; Shim, Hyung Jin [Seoul National University, Seoul (Korea)

    1999-03-01

    The objective of this study is to examine the appropriateness of constructing critical facilities in our country and to decide a course of constructing them if necessary by surveying the status and utilization of foreign facilities and by investigating the demand for domestic facilities. We investigated the status and the utilization of foreign critical facilities through literature survey and personal visitation. In our judgement, critical facilities are necessary for developing the advanced reactors and fuels which are being studied as parts of the Nuclear R and D Program by MOST. Considering the construction cost and the current state of domestic economy, however, it is unjustifiable to build three different types of critical facilities (the light water, the heavy water, and the fast critical facility). It appears to be reasonable to build a light water critical, considering the construction cost, degree of utilization, and other constraints. (author). 89 refs., 134 figs., 64 tabs.

  17. Pediatric appendicitis: state of the art review.

    Science.gov (United States)

    Rentea, Rebecca M; Peter, Shawn D St; Snyder, Charles L

    2017-03-01

    Appendicitis is a common cause of abdominal pain in children. The diagnosis and treatment of the disease have undergone major changes in the past two decades, primarily as a result of the application of an evidence-based approach. Data from several randomized controlled trials, large database studies, and meta-analyses have fundamentally affected patient care. The best diagnostic approach is a standardized clinical pathway with a scoring system and selective imaging. Non-operative management of simple appendicitis is a reasonable option in selected cases, with the caveat that data in children remain limited. A minimally invasive (laparoscopic) appendectomy is the current standard in US and European children's hospitals. This article reviews the current 'state of the art' in the evaluation and management of pediatric appendicitis.

  18. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis.

    LENUS (Irish Health Repository)

    Emmanuel, Andrew

    2011-04-01

    No reliably specific marker for acute appendicitis has been identified. Although recent studies have shown hyperbilirubinaemia to be a useful predictor of appendiceal perforation, they did not focus on the value of bilirubin as a marker for acute appendicitis. The aim of this study was to determine the value of hyperbilirubinaemia as a marker for acute appendicitis.

  19. Fast track pathway for perforated appendicitis.

    Science.gov (United States)

    Frazee, Richard; Abernathy, Stephen; Davis, Matthew; Isbell, Travis; Regner, Justin; Smith, Randall

    2017-04-01

    Perforated appendicitis is associated with an increased morbidity and length of stay. "Fast track" protocols have demonstrated success in shortening hospitalization without increasing morbidity for a variety of surgical processes. This study evaluates a fast track pathway for perforated appendicitis. In 2013, a treatment pathway for perforated appendicitis was adopted by the Acute Care Surgery Service for patients having surgical management of perforated appendicitis. Interval appendectomy was excluded. Patients were treated initially with intravenous antibiotics and transitioned to oral antibiotics and dismissed when medically stable and tolerating oral intake. A retrospective review of patients managed on the fast track pathway was undertaken to analyze length of stay, morbidity, and readmissions. Thirty-four males and twenty-one females with an average age of 46.8 years underwent laparoscopic appendectomy for perforated appendicitis between January 2013 and December 2014. Pre-existing comorbidities included hypertension 42%, diabetes mellitus 11%, COPD 5% and heart disease 2%. No patient had conversion to open appendectomy. Average length of stay was 2.67 days and ranged from 1 to 12 days (median 2 days). Postoperative morbidity was 20% and included abscess (6 patients), prolonged ileus (3 patients), pneumonia (1 patient), and congestive heart failure (1 patient). Five patients were readmitted for abscess (3 patients), congestive heart failure (1 patient), and pneumonia (1 patient). A fast track pathway for perforated appendicitis produced shorter length of stay and acceptable postoperative morbidity and readmission. This offers the potential for significant cost savings over current national practice patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Construction of a Post-Irradiated Fuel Examination Shielded Enclosure Facility

    Energy Technology Data Exchange (ETDEWEB)

    Michael A. Lehto, Ph.D.; Boyd D. Christensen

    2008-05-01

    construction activities, which will include facility modifications and construction of one shielded enclosure. Follow-up activities will be to construct two additional shielded enclosures to complete the suite of three separate but connected remote operated examination areas. Equipment purchases are to be capital procurement spread out over several years on a funded schedule. This paper discusses safety and operational considerations given during the conceptual design phase of the project. The paper considers such things as project material at risk (MAR), new processes and equipment, potential hazards, and the major modification evaluation process to determine if a preliminary Documented Safety Analysis (PDSA) is required. As part of that process, an evaluation was made of the potential hazards with the new project compared to the existing and historical work and associated hazards in the affected facility.

  1. ACUTE APPENDICITIS- SONOLOGICAL AND HISTOPATHOLOGICAL CORRELATION

    Directory of Open Access Journals (Sweden)

    Anjani M. Reddy

    2016-12-01

    Full Text Available BACKGROUND The aim of the study is to study the- 1. Correlation between sonological and histopathological diagnosis of acute appendicitis. 2. Prevalence of acute appendicitis in various age groups. MATERIALS AND METHODS The study was conducted in the Department of Radiodiagnosis, MVJ Medical College and Research Hospital, Bangalore, for a period of 2 years from March 2013 to February 2015. Data collection was prospective. A computer-assisted search of all the reports of ultrasonography with the diagnosis of acute appendicitis was conducted within the departmental database. A total of 244 patients (128 male patients and 116 female patients with acute appendicitis were identified and the study was conducted. RESULTS In the study, total of 244 patients were diagnosed with acute appendicitis. Out of these, 128 patients were males and 116 patients were females. The incidence of acute appendicitis was most prevalent in age group between 21 to 30 years (36.5% in our study. The least incidence was noted in age group of above 60 yrs. with only 1 out of 244 patients (0.4% was diagnosed with acute appendicitis. The histological features noted were suppuration/inflammation, gangrenous, lymphoid hyperplasia and perforation. In our study, 143 inflammation/suppuration (58.6%, 37 gangrenous (15.1%, 24 lymphoid hyperplastic (9.8% and 1 perforation (0.4% was noted. Hence, the incidence of inflammation/suppuration was found to be most common and perforation was found to be the least finding. The suppurative/inflammatory feature was most common histological type in all the age groups except for the age group above 60 yrs. The gangrenous features were most commonly seen in the age group between 11 to 20 yrs. followed by 20 to 30 yrs. Faecolith was most commonly found in age group of 21 to 30 yrs. (12 cases followed by age group of 11 to 20 yrs. (10 cases. CONCLUSION It was noted that the incidence of acute appendicitis was most commonly noted in younger age group

  2. Extraintestinal heterotopic gastric tissue simulating acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Elizabeth Bender; Steven P Schmidt

    2008-01-01

    We describe the case of a 68-year-old otherwise healthy male who presented to our emergency room with signs and symptoms of acute appendicitis. Exploratory surgery revealed a normal appendix. Further examination revealed an enlarged lymph node-like mass of tissue near the appendix, in the ileocecal mesentery. This mass was removed and was found to be inflamed heterotopic gastric tissue. Although reports of heterotopic gastric tissue in the literature are common, we believe that this case represents the first report of inflamed heterotopic gastric tissue simulating appendicitis.

  3. Funiculitis mimicking appendicitis: A rare culprit

    Directory of Open Access Journals (Sweden)

    Lindsey L. Perea

    2017-01-01

    Full Text Available Acute appendicitis is an extremely common cause for pediatric admissions, most notably presenting with right lower quadrant pain. There are few other etiologies for a young male to have pain aside from appendicitis. We present a young boy who presented with right lower quadrant abdominal pain and fevers, but was found to have funiculitis. Funiculitis, or inflammation of the spermatic cord, is a very rare condition in the pediatric population, almost always occurring in the elderly with urinary flow conditions. We share our case to remind providers the importance of a full differential diagnosis.

  4. Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis

    Science.gov (United States)

    Hearne, Christopher B.; Taboada, Jorge

    2017-01-01

    Epiploic appendagitis (EA) is a rare cause of acute abdominal pain caused by inflammation of an epiploic appendage. It has a nonspecific clinical presentation that may mimic other acute abdominal pathologies on physical exam, such as appendicitis, diverticulitis, or cholecystitis. However, EA is usually benign and self-limiting and can be treated conservatively. We present the case of a patient with two episodes of EA, the first mimicking acute appendicitis and the second mimicking acute cholecystitis. Although recurrence of EA is rare, it should be part of the differential diagnosis of acute, localized abdominal pain. A correct diagnosis of EA will prevent unnecessary hospitalization, antibiotic use, and surgical procedures. PMID:28127129

  5. Evaluation of the microbiome in children's appendicitis.

    Science.gov (United States)

    Salö, Martin; Marungruang, Nittaya; Roth, Bodil; Sundberg, Tiia; Stenström, Pernilla; Arnbjörnsson, Einar; Fåk, Frida; Ohlsson, Bodil

    2017-01-01

    The role of the microbiome has been widely discussed in the etiology of appendicitis. The primary aim was to evaluate the microbiome in the normal appendix and in appendicitis specifically divided into the three clinically and histopathologically defined grades of inflammation. Secondary aims were to examine whether there were any microbiome differences between proximal and distal appendices, and relate the microbiome with histopathological findings. A prospective pilot study was conducted of children undergoing appendectomy for appendicitis. The diagnosis was based on histopathological analysis. Children with incidental appendectomy were used as controls. The proximal and distal mucosa from the appendices were analyzed with 16S rRNA gene sequencing. A total of 22 children, 3 controls and 19 appendicitis patients; 11 phlegmonous, 4 gangrenous, and 4 perforated appendices, were prospectively included. The amount of Fusobacterium increased and Bacteroides decreased in phlegmonous and perforated appendicitis compared to controls, but statistical significance was not reached, and this pattern was not seen in gangrenous appendicitis. No relation could be seen between different bacteria and the grade of inflammation, and there was a wide variation of abundances at phylum, genus, and species level within every specific group of patients. Further, no significant differences could be detected when comparing the microbiome in proximal and distal mucosa, which may be because the study was underpowered. A trend with more abundance of Fusobacteria in the distal mucosa was seen in appendicitis patients with obstruction (25 and 13 %, respectively, p = 0.06). The pattern of microbiome differed not only between groups, but also within groups. However, no statistically significant differences could be found in the microbiome between groups or clinical conditions. No correlation between a specific bacteria and grade of inflammation was found. In the vast majority of cases of

  6. Effect of animal facility construction on basal hypothalamic-pituitary-adrenal and renin-aldosterone activity in the rat.

    Science.gov (United States)

    Raff, Hershel; Bruder, Eric D; Cullinan, William E; Ziegler, Dana R; Cohen, Eric P

    2011-04-01

    Although loud noise and intense vibration are known to alter the behavior and phenotype of laboratory animals, little is known about the effects of nearby construction. We studied the effect of a nearby construction project on the classic stress hormones ACTH, corticosterone, renin, and aldosterone in rats residing in a barrier animal facility before, for the first 3 months of a construction project, and at 1 month after all construction was completed. During some of the construction, noise and vibrations were not obvious to investigators inside the animal rooms. Body weight matched for age was not altered by nearby construction. During nearby construction, plasma ACTH, corticosterone, and aldosterone were approximately doubled compared with those of pre- and postconstruction levels. Expression of CRH mRNA in the paraventricular nucleus of the hypothalamus, CRH receptor and POMC mRNA in the anterior pituitary, and most mRNAs for steroidogenic genes in the adrenal gland were not significantly changed during construction. We conclude that nearby construction can cause a stress response without long-term effects on hypothalamic-pituitary-adrenal axis gene expression and body weight.

  7. Acute amebic appendicitis: Report of a rare case

    Directory of Open Access Journals (Sweden)

    Singh Naorem

    2010-10-01

    Full Text Available Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. We report a case of amebic appendicitis presenting with fever, severe pain in the right lower quadrant of the abdomen and rebound tenderness. Lab investigations revealed neutrophilic leukocytosis. The patient underwent appendectomy. Histopathological examination revealed numerous Entameba histolytica trophozoites in the mucosa of the appendix. Acute appendicitis of amebic origin does not appear frequently. Appendicular amebiasis can give the clinical features of acute appendicitis and should be treated accordingly.

  8. Usefulness and limit of CT diagnosis on appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Kuchiki, Megumi; Takanashi, Toshiyasu [Sakata Municipal Hospital, Yamagata (Japan); Yamaguchi, Koichi

    1997-08-01

    CT was performed in 104 patients with abdominal pain suspected appendicitis. CT showed positive finding (abnormal appendix, appendicolith, pericecal inflammatory change, fluid collection, LN swelling, abscess) and complication of appendicitis clearly. CT diagnosis showed high accuracy than clinical diagnosis. CT proved its usefulness especially only CT imaging showed the correct diagnosis. On the other hand, diverticulitis and terminal ileitis common diagnostic disease of appendicitis showed similar clinical appearance and CT image, caused to be difficult to diagnose correctly. In the cases showing similar image to appendicitis or atypical image, CT also proved its limit of the diagnosis on appendicitis. (author)

  9. [Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation].

    Science.gov (United States)

    Prada Arias, Marcos; Salgado Barreira, Angel; Montero Sánchez, Margarita; Fernández Eire, Pilar; García Saavedra, Silvia; Gómez Veiras, Javier; Fernández Lorenzo, José Ramón

    2017-02-18

    Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5mg/L value could be used instead. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  10. Ultrasonography in the diagnosis of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Luciano Augusto Botter

    2005-09-01

    Full Text Available Objective: To evaluate the role of sonography in diagnosis ofacute appendicitis, with an emphasis on early evolution cases.Methods: From 240 cases with the diagnosis of appendicitis, aretrospective study of 149 patients submitted to appendicectomyat the Hospital Israelita Albert Einstein, in 2002, was carried out.The appendix of these 149 patients was visualized in apreoperative sonography and the diagnosis was confirmed byhistological examination. Patients were distributed into twogroups - initial and advanced - according to the measure of thelargest external diameter of the appendix. The statistical dataanalysis included demographic information (sex and age anddirect and indirect signs of acute appendicitis. Results: Therewere more cases of acute appendicitis in the groups aged 10-30years, mean age of 18.3 years in the initial group and 26.4 yearsin the advanced group. There was no statistically significantdifference regarding sex. The advanced group presented 4.5%of false-positive results and the initial group, 23.1%. Among thedirect signs, non-compressibility of the appendix stood out andwas observed in more than half cases; with regard to indirectsigns, hyperechogenicity of periappendiceal tissues wasobserved in up to 75% of cases in both groups. Conclusion: Therewas a statistically significant difference in false-positive cases,which were more often observed in the initial group. Therefore,sonographic follow-up is recommended in these cases.

  11. Acute appendicitis in pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Antônio Henriques de Franca Neto

    2015-04-01

    Full Text Available Introduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms “acute appendicitis” and “pregnancy”, in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. Results: the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. Discussion: clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. Conclusion: the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial.

  12. Enterobius vermicularis: A Controversial Cause of Appendicitis

    Directory of Open Access Journals (Sweden)

    "Gh Mowlavi

    2004-08-01

    Full Text Available Enterobiasis is undoubtedly one of the most common human helminths infections through the world, with an estimate of 1000 million cases worldwide. Although adult worms and their eggs are frequently found in inflamed appendices, but the role of the parasite in producing appendicitis in humans still remains controversial. Although acute appendicitis may occur at any age, but it is relatively rare at the extremes of age. A histopathological study of infested appendices with Enterobius vermicularis was performed in Khuzestan province, south western Iran, during 2001 to 2003. All 40 samples had surgically been removed during the emergency operations and histopathological process with (H&E staining has been performed for each. One of the main objects of this work was to collect more data about the possible role of this highly prevalent human round worm as a causative agent of appendicitis in humans, leading to different types of appendicitis in this part of the country. In this occasion over the slide examinations of the tissue sections, fewer cases than expected, with worm infested appendices were seen exclusively affected with this parasite.

  13. Diagnostic performance of ultrasound in acute appendicitis

    Directory of Open Access Journals (Sweden)

    Omar Alejandro Ortega

    2012-12-01

    Full Text Available Background: acute appendicitis (AA is the acute surgical abdominal disease more common in the Hospital Susana López de Valencia Popayán, Colombia; its diagnosis is one of the most common problems in emergency. Objective: to determined the operating performance of emergency ultrasound in suspected acute appendicitis. Methods: retrospective study conducted with data obtained from the first of January to 31 December 2011, including patients with presumed diagnosis of AA and abdominal ultrasound before surgery. Results: a total of 134 individuals who underwent surgery, with pre-procedure ultrasound report and pathology report. The performance of ultrasound resulted in a sensitivity of 73.2%, specificity 86.3%, positive predictive value of 96.4%, negative predictive value of 38.7%. Conclusion: the overall performance of abdominal ultrasound in the diagnosis of acute appendicitis in our hospital is acceptable. But its usefulness is poor in excluding the diagnosis of acute appendicitis. Because of its accessibility and low cost is the best test available for diagnosis in doubtful cases in emergency or difficult diagnosis.

  14. Right-sided diverticulitis mimics appendicitis.

    Science.gov (United States)

    Gilmore, Thomas; Jordan, Charlton; Edelstein, Elisabeth

    2013-01-01

    Right-sided diverticulitis is a rare source of right lower quadrant pain in Western society; however, it is quite common in Asian societies. Right-sided diverticulitis presents very similarly to appendicitis, with right lower quadrant pain, fever, nausea, and laboratory abnormalities, and is often seen in young patients. In this report, we present a case of right-sided diverticulitis. We review right-sided diverticulitis' diagnosis and management. It is important to diagnose right-sided diverticulitis because it is a good mimic of appendicitis and ideally should be diagnosed before a patient has unnecessary surgery. A 26-year-old Asian woman presented for evaluation of right lower quadrant pain and fever. She was initially thought to have appendicitis clinically, but had right-sided diverticulitis diagnosed by computed tomography (CT) scan. She was admitted and received intravenous antibiotics and bowel rest. Her right-sided diverticulitis resolved in 3 days. Severe right lower quadrant pain in young patients of Asian descent can be right-sided diverticulitis. Right-sided diverticulitis is a benign condition managed medically that mimics appendicitis. CT imaging seems to be the best way to avoid unnecessary surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Practical issues in treatment of appendicitis

    NARCIS (Netherlands)

    van Rossem, C.C.

    2016-01-01

    Appendicitis is a common cause of acute abdominal pain and an appendectomy is still the gold standard of treatment. In spite of the high incidence, variance in diagnostic and treatment modalities remains an issue among surgeons. In this thesis several practical issues in the diagnosis and treatment

  16. Unde venis? Amebiasis presenting as appendicitis.

    Science.gov (United States)

    Wilson, Dennis A; Wilson, Gerald A; Bryan, Charles S

    2013-06-01

    A returning traveler presenting with fever accompanied by abdominal "pressure" and pain proved to have amebic appendicitis, amebic liver abscess, and probable recent amebic dysentery--a rare combination of findings amply illustrating the value of asking "Unde venis--from where do you come?"

  17. Intrauterine contraceptive device appendicitis: A case report

    Institute of Scientific and Technical Information of China (English)

    Hao-Ming Chang; Teng-Wei Chen; Chung-Bao Hsieh; Chung-Jueng Chen; Jyh-Cherng Yu; Yao-Chi Liu; Kuo-Liang Shen; De-Chuan Chan

    2005-01-01

    Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforation by IUD can involve several neighboring organs. A case of acute appendicitis was caused by a Multiload Cu 375 IUD inserted previously.This is a rare complication and only fourteen previous cases were recorded in the literature.

  18. Practical issues in treatment of appendicitis

    NARCIS (Netherlands)

    van Rossem, C.C.

    2016-01-01

    Appendicitis is a common cause of acute abdominal pain and an appendectomy is still the gold standard of treatment. In spite of the high incidence, variance in diagnostic and treatment modalities remains an issue among surgeons. In this thesis several practical issues in the diagnosis and treatment

  19. An adult intussusception mimicking early appendicitis

    Institute of Scientific and Technical Information of China (English)

    Wei-Chun Tseng; Cheng-Ting Hsiao; Yu-Cheng Hung

    2012-01-01

    Adult intussusception is rare with variable clinical presentation. We reported a case of adult intussusception presenting with symptoms mimicking acute appendicitis. The patient presented as an abdominal pain from epigastric area with shifting gradually to RLQ. The atypical presentation of adult intussusception remains a diagnostic challenge to the emergency physician.

  20. 29 CFR 776.26 - Relationship of the construction work to the covered facility.

    Science.gov (United States)

    2010-07-01

    ... OF 1938 Construction Industry Individual Employee Coverage in the Construction Industry § 776.26... commerce or the engagement in commerce. For this reason the erection, maintenance or repair of dwellings...

  1. The planning, construction, and operation of a radioactive waste storage facility for an Australian state radiation regulatory authority

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, J.D.; Kleinschmidt, R.; Veevers, P. [Radiation Health, Queensland (Australia)

    1995-12-31

    Radiation regulatory authorities have a responsibility for the management of radioactive waste. This, more often than not, includes the collection and safe storage of radioactive sources in disused radiation devices and devices seized by the regulatory authority following an accident, abandonment or unauthorised use. The public aversion to all things radioactive, regardless of the safety controls, together with the Not In My Back Yard (NIMBY) syndrome combine to make the establishment of a radioactive materials store a near impossible task, despite the fact that such a facility is a fundamental tool for regulatory authorities to provide for the radiation safety of the public. In Queensland the successful completion and operational use of such a storage facility has taken a total of 8 years of concerted effort by the staff of the regulatory authority, the expenditure of over $2 million (AUS) not including regulatory staff costs and the cost of construction of an earlier separate facility. This paper is a summary of the major developments in the planning, construction and eventual operation of the facility including technical and administrative details, together with the lessons learned from the perspective of the overall project.

  2. Nonradioactive air emissions notice of construction for the Waste Receiving And Processing facility

    Energy Technology Data Exchange (ETDEWEB)

    1993-02-01

    The mission of the Waste Receiving And Processing (WRAP) Module 1 facility (also referred to as WRAP 1) is to examine assay, characterize, treat, and repackage solid radioactive and mixed waste to enable permanent disposal of the wastes in accordance with all applicable regulations. WRAP 1 will contain equipment and facilities necessary for non-destructive examination (NDE) of wastes and to perform a non-destructive examination assay (NDA) of the total radionuclide content of the wastes, without opening the outer container (e.g., 55-gal drum). WRAP 1 will also be equipped to open drums which do not meet waste acceptance and shipping criteria, and to perform limited physical treatment of the wastes to ensure that storage, shipping, and disposal criteria are met. The solid wastes to be handled in the WRAP 1 facility include low level waste (LLW), transuranic (TRU) waste, and transuranic and low level mixed wastes (LLMW). The WRAP 1 facility will only accept contact handler (CH) waste containers. A Best Available Control Technology for Toxics (TBACT) assessment has been completed for the WRAP 1 facility (WHC 1993). Because toxic emissions from the WRAP 1 facility are sufficiently low and do not pose any health or safety concerns to the public, no controls for volatile organic compounds (VOCs), and installation of HEPA filters for particulates satisfy TBACT for the facility.

  3. 29 CFR 776.30 - Construction performed on temporarily idle facilities.

    Science.gov (United States)

    2010-07-01

    ... that the repair or maintenance of a covered facility (including its machinery, tools, dies, and other... Bodden v. McCormick Shipping Corp., 188 F. (2d) 733. 54 Maneja v. Waialua Agricultural Co., 349 U.S....

  4. A facile approach for the construction of the oxetane ring from 5α-acyloxy-△4(20)-taxoids

    Institute of Scientific and Technical Information of China (English)

    LIU, Rui-Wu; YIN, Da-Li; GUO, Ji-Yu; LIANG, Xiao-Tian

    2000-01-01

    An oxetane ring can be constructed from 5α-acyloxy-△4(20)taxoids. Tne facile intramolecular acyl migration from 5- to 20-postion under slightly basic conditions enabled the const-uction of the oxetane ring in a convenient short cut, whereas the acyl migration from 2- to 20-position left the 2-hydroxyl ~~ble to a later benzoylation. An unexpected five-membered 4-O, 20-O sulfite ring was formed in the attempted construction of the oxetane ring with 5α-trifiate as a leaving group. After the construction of the oxetane ring, treatment with strong base LiHMDS and acetyl chloride gave the expected 4-O-acetate while treatment with acetic anhydride and DMAP gave a 4- O-acetoacetate.

  5. Characterization and remediation of soil prior to construction of an on-site disposal facility at Fernald

    Energy Technology Data Exchange (ETDEWEB)

    Hunt, A.; Jones, G. [Fluor Daniel Fernald, Inc., Cincinnati, OH (United States). Fernald Environmental Management Project; Janke, R. [Dept. of Energy (United States); Nelson, K. [Jacobs Engineering (United States)

    1998-03-01

    During the production years at the Feed Materials Production Center (FMPC), the soil of the site and the surrounding areas was surficially impacted by airborne contamination. The volume of impacted soil is estimated at 2.2 million cubic yards. During site remediation, this contamination will be excavated, characterized, and disposed of. In 1986 the US Environmental Protection Agency (EPA) and the Department of Energy (DOE) entered into a Federal Facility Compliance Agreement (FFCA) covering environmental impacts associated with the FMPC. A site wide Remedial Investigation/Feasibility Study (RI/FS) was initiated pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act, as amended by the Superfund Amendments and Reauthorization Act (CERCLA). The DOE has completed the RI/FS process and has received approval of the final Records of Decision. The name of the facility was changed to the Fernald Environmental Management Project (FEMP) to emphasize the change in mission to environmental restoration. Remedial actions which address similar scopes of work or types of contaminated media have been grouped into remedial projects for the purpose of managing the remediation of the FEMP. The Soil Characterization and Excavation Project (SCEP) will address the remediation of FEMP soils, certain waste units, at- and below-grade material, and will certify attainment of the final remedial limits (FRLs) for the FEMP. The FEMP will be using an on-site facility for low level radioactive waste disposal. The facility will be an above-ground engineered structure constructed of geological material. The area designated for construction of the base of the on-site disposal facility (OSDF) is referred to as the footprint. Contaminated soil within the footprint must be identified and remediated. Excavation of Phase 1, the first of seven remediation areas, is complete.

  6. 75 FR 15389 - No Child Left Behind School Facilities and Construction Negotiated Rulemaking Committee Meeting

    Science.gov (United States)

    2010-03-29

    ... issues; Discussion of report outline; Discussion of formula and approach to new school construction; Refinement of options for catalogue and tentative consensus; Finalization of subcommittees, logistics, next...

  7. 76 FR 2617 - No Child Left Behind School Facilities and Construction Negotiated Rulemaking Committee

    Science.gov (United States)

    2011-01-14

    ...-living (dormitory) situations. The following items will be on the agenda: Review and approve October 2010... renovation repairs and school construction and replacement; Review and discuss dormitory standards...

  8. Schistosomal appendicitis: Incidence in Japan and a case report

    Institute of Scientific and Technical Information of China (English)

    Tadashi Terada

    2009-01-01

    Schistosomal appendicitis is very rare in developed countries like the USA, Europe, and Japan. The author reviewed 311 pathologic archival specimens of vermiform appendix over the past 10 years. One case of schistosomal appendicitis was recognized. Therefore, the incidence of this disease was 0.32% in all appendices surgically resected in our hospital. The patient was a 41-year-old woman presenting with lower abdominal pain. She was a sailor traveling to many countries including endemic areas. Physical examination, laboratory data, and imaging modalities suggested an acute appendicitis, and appendectomy was performed under the diagnosis of ordinary appendicitis. Histologically, numerous schistosomal eggs were present in the vasculatures throughout the appendiceal walls. Some of the eggs were calcified. Stromal foreign body reaction was also recognized. The appendicitis was phlegmonous consisting of severe infiltrations of neutrophils and eosinophils. Acute serositis was also noted. Examination of feces revealed numerous eggs of Schistosoma mansoni. Clinicians should be aware of schistosomal appendicitis.

  9. Construction of BIM-based SMART-ITL Facility Management System

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Woo-Jin; Yi, Sung-Jae; Park, Hyun-Sik; Ryu, Sung-Uk; Bae, Hwang [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Hwang, Sang-Chul; Min, Byung-Eui [DDRsoft Co., Daejeon (Korea, Republic of)

    2015-10-15

    The flow area and volume are scaled down to 1/49. The ratio of the hydraulic diameter is 1/7. Therefore, SMART-ITL is a large-scale thermalhydraulic test facility with about 45 m height, which is consisted of 10 m underground and 35 m from the ground level. Until now, the management of design data and maintenance of large scale test facilities have been managed based on hard-copy information. Recently, Thermal Hydraulics Safety Research Division (THSRD) at Korea Atomic Energy Research Institute (KAERI) has developed Facility Management System (FMS) based Building Information Modeling (BIM) to manage its design data more effectively for these large scale test facilities of SMART-ITL and ATLAS, and this BIM technology has been applied to SMART-ITL at the first. This study proposed a method of effective management and maintenance of design data applied to the SMART-ITL. That is, a FMS was developed based on the BIM technology for SMART-ITL. Figure 2 shows an overview of FMS development process based on BIM technology. SMART-ITL FMS facilitates its management and maintenance more effectively and accurately by 3- dimensional visualization. It enables the shape information of large scale test facilities to be visualized intuitively in a virtual space, and the efficient maintenance of data and instruments is possible by linking 3D shape information.

  10. Gallbladder Volvulus Presenting as Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Zachary Bauman

    2015-01-01

    Full Text Available We encountered a case of gallbladder volvulus in an 88-year-old thin female in which the initial presentation was more consistent with that of acute appendicitis. After complete work-up, including physical exam, lab work, and computed tomography, the definite diagnosis of gallbladder volvulus was not made until intraoperative visualization was obtained. Gallbladder volvulus is a rare but serious condition, which requires a high clinical suspicion so prompt surgical intervention can be undertaken.

  11. Appendicitis in Pregnancy: Presentation, Management and Complications

    Directory of Open Access Journals (Sweden)

    Abdoulhossein Davoodabadi

    2016-06-01

    Full Text Available Background Diagnosis of acute appendicitis in pregnancy is difficult. Delay operation, increase complications. Objectives This study focused on early operation on base of careful history, precise physical examination, and rational close observation and evaluates its results with conventional investigation in pregnant women suspected acute appendicitis. Materials and Methods A cross sectional study in100 pregnant women and 100 aged matched non pregnant women underwent appendectomy during Sep 2011 - Dec 2014. The data were analyzed by chi-square test through SPSS 16.0. Results Age 16 - 37 years, mean age in pregnant women and no pregnant women were24.75 ± 4.4 and 27.56 ± 6.53 years (P > 0.05, respectively. 20 - 25 years age group, were more frequent = 44%. 70% patients were gravid 1, mean hospital stay in pregnant women, and non-pregnant women were 48 ± 6 and 85.2 ± 43.19 hours (P value < 0.001. respectively. acute appendicitis was confirmed histological in non-pregnant was 72%, but In pregnant women 62%, most cases were in the third Trimester 66% (n = 41. Peri umbilical pain, with migration to the right lower quadrant, was in 75% of patients. Right-lower-quadrant pain was the most common presenting symptom. Diagnosis (62% was made on base care full history and precise physical examination and close observation of 12 ± 8 hours. there were no maternal and fetal complications related to all of the appendectomies during the all trimester up to delivery period. Conclusions There are no diagnostic laboratory findings in acute appendicitis during pregnancy. Careful history and physical examination and close observation of 12 ± 8 hours are sufficient for surgery decision making. In spite of high negative appendectomy since it has no Surgical and obstetric complication, early Appendectomy without aggressive investigation recommend.

  12. Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis

    Directory of Open Access Journals (Sweden)

    Sevgi Buyukbese Sarsu

    2016-01-01

    Full Text Available Background. Acute appendicitis (AA associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluation. The area under a receiver operating characteristic (ROC curve (AUC was performed to examine diagnostic accuracy. Results. When WBC and CRP were used in combination, based on cut-off values of ≥13.1 × 103/μL for WBC counts and ≥1.17 mg/dL for CRP level, diagnostic parameters were as follows: sensitivity, 98.7%; specificity, 71.3%; PPV, 50.6%; NPV, 99.5%; diagnostic accuracy, 77.6%; LR(+, 3.44; LR(−, 0.017. AUC values were 0.845 (95% CI 0.800–0.891 for WBC and 0.887 (95% CI 0.841–0.932 for CRP. Conclusions. For complicated appendicitis, CRP has the highest degree of diagnostic accuracy. The diagnosis of appendicitis should be made primarily based on clinical examination, and obviously more specific and systemic inflammatory markers are needed. Combined use of cut-off values of WBC (≥13100/μL and CRP (≥1.17 mg/L yields a higher sensitivity and NPV for the diagnosis of complicated appendicitis.

  13. Design, construction and management of tailings storage facilities for surface disposal in China: case studies of failures.

    Science.gov (United States)

    Wei, Zuoan; Yin, Guangzhi; Wang, J G; Wan, Ling; Li, Guangzhi

    2013-01-01

    Rapid development of China's economy demands for more mineral resources. At the same time, a vast quantity of mine tailings, as the waste byproduct of mining and mineral processing, is being produced in huge proportions. Tailings impoundments play an important role in the practical surface disposal of these large quantities of mining waste. Historically, tailings were relatively small in quantity and had no commercial value, thus little attention was paid to their disposal. The tailings were preferably discharged near the mines and few tailings storage facilities were constructed in mainland China. This situation has significantly changed since 2000, because the Chinese economy is growing rapidly and Chinese regulations and legislation require that tailings disposal systems must be ready before the mining operation begins. Consequently, data up to 2008 shows that more than 12 000 tailings storage facilities have been built in China. This paper reviews the history of tailings disposal in China, discusses three cases of tailings dam failures and explores failure mechanisms, and the procedures commonly used in China for planning, design, construction and management of tailings impoundments. This paper also discusses the current situation, shortcomings and key weaknesses, as well as future development trends for tailings storage facilities in China.

  14. Construction and commissioning of the PETRA pilot plant facility for waste management studies

    Energy Technology Data Exchange (ETDEWEB)

    Dworschak, H.; Girardi, F.; Grossi, G.

    1989-10-01

    This paper describes the PETRA hot cell facility currently undergoing commissioning test at the Joint Research Centre-Ispra Establishment (Italy) and illustrated the possibilities and objectives of experimental work that can be carried out in the field of radioactive waste management. The facility includes the typical HA-processing steps of nuclear fuel reprocessing, i.e. dissolution, filtration, co-decontamination with on-line solvent regeneration for the production of significant quantities of medium and high-level solid and liquid wastes. These wastes will be used primarily for optimization, verification and demonstration studies at full radioactivity levels in relation to the safety and reliability of waste confinement and disposal concepts. The facility operates on fuel batches of 6 kg low enriched U equivalent, in a sequential processing mode. The waste streams can be treated by further extraction, concentration, precipitation, denitration and vitrification either as a whole or as separate fractions.

  15. Appendicitis/diverticulitis: diagnostics and conservative treatment.

    Science.gov (United States)

    Kruis, Wolfgang; Morgenstern, Julia; Schanz, Stefan

    2013-01-01

    Appendicitis and diverticulitis are very common entities that show some similarities in diagnosis and course of disease. Both are widely believed to be simple clinical diagnoses, which is in contrast to scientific evidence. An accurate diagnosis has to describe not only the initial detection, but particularly the severity of the disease. It is based mainly on cross-sectional imaging by ultrasound (US) and computed tomography (CT). Appendectomy is the standard treatment for acute appendicitis and is mandatory in complicated cases. Antibiotic therapy is similarly effective in uncomplicated appendicitis, but long-term results are not sufficiently known. Treatment of diverticulitis is related to the disease status. Complications such as perforation and bleeding require intervention. Uncomplicated diverticulitis as graded by US or CT are subject to conservative management, in the form of outpatient or hospital care. It is an unresolved debate as to whether antibiotic treatment offers benefits. Mesalazine seems at least to improve pain. The real challenge is treatment of recurrent diverticulitis. Lifestyle measures such as nutritional habits and physical activity are found to influence diverticular disease. Besides immunosuppression, obesity is a significant risk factor for complicated diverticulitis. Whether any medication such as chronic antibiotics, probiotics or mesalazine offers benefits is unclear. The indication for sigmoid resection has changed; it is no longer given by the number of attacks, but rather by structural changes as depicted by cross-sectional imaging.

  16. Laparoscopic appendectomy in complicated appendicitis: Is it safe?

    OpenAIRE

    Ashraf A Mohamed; Mahran, Khaled M

    2013-01-01

    Background: Because of lack of good evidence supporting laparoscopic approach for complicated appendicitis, we carried out this study to evaluate efficacy of laparoscopic appendectomy (LA) in management of patients with complicated appendicitis. Materials and Methods: This study was carried out in Surgical Department, Minia University, Egypt involving 214 patients underwent appendectomy for complicated appendicitis over three years. 132 patients underwent LA and remaining 82 patients underwen...

  17. Antibiotika som primær behandling af appendicitis

    DEFF Research Database (Denmark)

    Hupfeld, Line; Pommergaard, Hans-Christian; Burcharth, Jakob;

    2014-01-01

    Acute appendicitis has traditionally been treated surgically. Conservative approach with antibiotic treatment has been suggested as an alternative to the surgical procedure. The available studies on surgery versus antibiotics may indicate the safe use of conservative treatment for uncomplicated...... appendicitis, but the available studies are typically of low quality. Thus, further studies are needed to clarify the role of conservative treatment, and in the meantime appendectomy remains the standard treatment for acute appendicitis....

  18. Case Report and Management of Suspected Acute Appendicitis in Pregnancy

    OpenAIRE

    Murariu, Daniel; Tatsuno, Brent; Hirai, Cori-Ann M; Takamori, Ryan

    2011-01-01

    Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed a...

  19. Barium appendicitis: A single institution review in Japan

    Science.gov (United States)

    Katagiri, Hideki; Lefor, Alan Kawarai; Kubota, Tadao; Mizokami, Ken

    2016-01-01

    AIM To review clinical experience with barium appendicitis at a single institution. METHODS A retrospective review of patients admitted with a diagnosis of acute appendicitis, from January 1, 2013 to December 31, 2015 was performed. Age, gender, computed tomography (CT) scan findings if available, past history of barium studies, pathology, and the presence of perforation or the development of complications were reviewed. If the CT scan revealed high density material in the appendix, the maximum CT scan radiodensity of the material is measured in Hounsfield units (HU). Barium appendicitis is defined as: (1) patients diagnosed with acute appendicitis; (2) the patient has a history of a prior barium study; and (3) the CT scan shows high density material in the appendix. Patients who meet all three criteria are considered to have barium appendicitis. RESULTS In total, 396 patients were admitted with the diagnosis of acute appendicitis in the study period. Of these, 12 patients (3.0%) met the definition of barium appendicitis. Of these 12 patients, the median CT scan radiodensity of material in the appendix was 10000.8 HU, ranging from 3066 to 23423 HU (± 6288.2). In contrast, the median CT scan radiodensity of fecaliths in the appendix, excluding patients with barium appendicitis, was 393.1 HU, ranging from 98 to 2151 HU (± 382.0). The CT scan radiodensity of material in the appendices of patients with barium appendicitis was significantly higher than in patients with nonbarium fecaliths (P < 0.01). CONCLUSION Barium appendicitis is not rare in Japan. Measurement of the CT scan radiodensity of material in the appendix may differentiate barium appendicitis from routine appendicitis.

  20. Antibiotika som primær behandling af appendicitis

    DEFF Research Database (Denmark)

    Hupfeld, Line; Pommergaard, Hans-Christian; Burcharth, Jakob

    2014-01-01

    Acute appendicitis has traditionally been treated surgically. Conservative approach with antibiotic treatment has been suggested as an alternative to the surgical procedure. The available studies on surgery versus antibiotics may indicate the safe use of conservative treatment for uncomplicated...... appendicitis, but the available studies are typically of low quality. Thus, further studies are needed to clarify the role of conservative treatment, and in the meantime appendectomy remains the standard treatment for acute appendicitis....

  1. MRI for clinically suspected pediatric appendicitis: case interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Brian, James M.; Methratta, Sosamma T.; Hulse, Michael A.; Choudhary, Arabinda K.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Division of Pediatric Radiology, Department of Radiology, Hershey, PA (United States)

    2014-05-15

    As utilization of MRI for clinically suspected pediatric appendicitis becomes more common, there will be increased focus on case interpretation. The purpose of this pictorial essay is to share our institution's case interpretation experience. MRI findings of appendicitis include appendicoliths, tip appendicitis, intraluminal fluid-debris level, pitfalls of size measurements, and complications including abscesses. The normal appendix and inguinal appendix are also discussed. (orig.)

  2. The design, construction, and commissioning of a multi-use cyclotron facility

    Energy Technology Data Exchange (ETDEWEB)

    Ho, S.; Hutcheson, M.; Schick-Martin, D. [Saskatchewan Centre for Cyclotron Sciences, Saskatchewan (Canada); Dalzell, M.; Alexander, N. [Sylvia Fedoruk Canadian Centre for Nuclear Innovation, Saskatoon, Saskatchewan (Canada)

    2015-06-15

    The Sylvia Fedoruk Canadian Centre for Nuclear Innovation in Saskatchewan is in the process of commissioning the Saskatchewan Centre for Cyclotron Sciences that is to be used for both academic research and commercial radiopharmaceutical production. The hybrid nature of this facility comes with unique challenges in satisfying both the rigid demands of pharmaceutical production while providing the necessary flexibility for academic research. In order to meet these competing demands, the Fedoruk Centre has assembled a distinct combination of skill sets and areas of expertise to operate a facility with an interdisciplinary focus. (author)

  3. Role of the faecolith in modern-day appendicitis

    Science.gov (United States)

    Singh, JP

    2013-01-01

    Introduction The prevailing view on appendicitis is that the main aetiology is obstruction owing to faecoliths in adults and lymphoid hyperplasia in children. Faecoliths on imaging studies are believed to correlate well with appendicitis. Methods A retrospective chart review was conducted of 1,014 emergency appendicectomy patients between 2001 and 2011. Faecolith prevalence in adult and paediatric appendicectomy specimens with and without perforation was studied. The sensitivity and positive predictive value (PPV) of computed tomography (CT) for identifying faecoliths in the pathology specimen were examined. Results Overall, faecoliths were found in 18.1% (178/986) of appendicitis specimens and 28.6% (8/28) of negative appendicectomies. Faecolith prevalence for positive cases was 29.9% (79/264) in paediatric patients and 13.7% (99/722) in adults (pappendicitis but only 14.6% in non-perforated appendicitis (pappendicitis and 12.0% in non-perforated appendicitis (pappendicitis and 22.7% in non-perforated appendicitis (p=0.00). Sensitivity and PPV of preoperative CT in identifying faecoliths on pathology were 53.1% (86/162) and 44.8% (86/192) respectively. Conclusions Faecolith prevalence is too low to consider the faecolith the most common cause of non-perforated appendicitis. Faecoliths are more prevalent in paediatric appendicitis than in adult appendicitis. Preoperative CT is an unreliable predictor of faecoliths in pathology specimens. PMID:23317728

  4. Utility of Immature Granulocyte Percentage in Pediatric Appendicitis

    Science.gov (United States)

    Mathews, Eleanor K.; Griffin, Russell L.; Mortellaro, Vincent; Beierle, Elizabeth A.; Harmon, Carroll M.; Chen, Mike K.; Russell, Robert T.

    2014-01-01

    Background Acute appendicitis is the most common cause of abdominal surgery in children. Adjuncts are utilized to help clinicians predict acute or perforated appendicitis, which may affect treatment decisions. Automated hematologic analyzers can perform more accurate automated differentials including immature granulocyte percentages (IG%). Elevated IG% has demonstrated improved accuracy for predicting sepsis in the neonatal population than traditional immature to total neutrophil count (I/T) ratios. We intended to assess the additional discriminatory ability of IG% to traditionally assessed parameters in the differentiation between acute and perforated appendicitis. Materials and Methods We identified all patients with appendicitis from July 2012 to June 2013 by ICD-9 code. Charts were reviewed for relevant demographic, clinical, and outcome data, which were compared between acute and perforated appendicitis groups using Fischer’s exact and t-test for categorical and continuous variables, respectively. We utilized an adjusted logistic regression model utilizing clinical lab values to predict the odds of perforated appendicitis. Results 251 patients were included in the analysis. Those with perforated appendicitis had a higher white blood cell (WBC) count (p=0.0063), C-reactive protein (CRP) (pappendicitis. The c-statistic of the final model was 0.70, suggesting fair discriminatory ability in predicting perforated appendicitis. Conclusions IG% did not provide any additional benefit to elevated CRP and presence of left shift in the differentiation between acute and perforated appendicitis. PMID:24793450

  5. Sustainable Design Guidelines for the Construction of New Facilities and the Renovation of Existing Structures.

    Science.gov (United States)

    Dorsey, Judy; L'Esperance, Clare

    This guide summarizes research conducted at Colorado's Poudre School District (PSD) to develop guidelines for the desired performance outcomes from employing sustainable educational facility design, and it suggests approaches for attaining them. The guide also provides case studies and references to further investigate opportunities on specific…

  6. Constructed wetland with a polyculture of ornamental plants for wastewater treatment at a rural tourism facility

    DEFF Research Database (Denmark)

    Calheiros, Cristina S C; Bessa, Vânia S.; Mesquita, Raquel B R

    2015-01-01

    Sewage management in remote rural and mountain areas constitutes a challenge because of the lack of adequate infrastructure and economical capability. Tourism facilities, in particular, possess a special challenge because of huge variability in sewage production and composition as a consequence o...

  7. Constructed wetland with a polyculture of ornamental plants for wastewater treatment at a rural tourism facility

    DEFF Research Database (Denmark)

    Calheiros, Cristina S C; Bessa, Vânia S.; Mesquita, Raquel B R

    2015-01-01

    Sewage management in remote rural and mountain areas constitutes a challenge because of the lack of adequate infrastructure and economical capability. Tourism facilities, in particular, possess a special challenge because of huge variability in sewage production and composition as a consequence o...

  8. TRI mu P - a radioactive isotope trapping facility under construction at KVI

    NARCIS (Netherlands)

    Berg, GP; Dendooven, P; Dermois, O; Harakeh, MN; Hoekstra, R; Jungmann, K; Kopecky, S; Morgenstern, R; Rogachevskiy, A; Timmermans, R; Willmann, L; Wischut, HW

    2003-01-01

    At the Kernfysisch Versneller Instituut a new facility (TRImuP) is under development which aims, to investigate fundamental interactions using radioactive ions. A spectrum of radioactive isotopes will be produced in inverse-kinematics and fragmentation reactions using heavy-ion beams from the superc

  9. 45 CFR 1309.10 - Applications for the purchase, construction and major renovation of facilities.

    Science.gov (United States)

    2010-10-01

    ... available for a playground and for parking). If incidental alterations and renovations or major renovations...)(C)) and its implementing regulations (40 CFR parts 1500 through 1508), as well as a report showing the results of tests for environmental hazards present in the facility, ground water, and soil...

  10. Environmental Assessment: Construction and Operation of Security Forces & Command Post / Installation Control Center Facilities

    Science.gov (United States)

    2008-01-03

    Operation of Security Forces &Command Post/ICC Facilities January 03, 2008 91 6.0 PERSONS CONTACTED Russell Adams – 78th CEG/CEVQ Larry J. Allen...fPD believes the proposed project will have no adverse effect on Building 300, as defined in 36 CFR Parr 800.5(d)(l). Please note that historic and

  11. Technical documentation in support of the project-specific analysis for construction and operation of the National Ignition Facility

    Energy Technology Data Exchange (ETDEWEB)

    Lazaro, M.A.; Vinikour, W. [Argonne National Lab., IL (United States). Environmental Assessment Div.; Allison, T. [Argonne National Lab., IL (United States). Decision and Information Sciences Div.] [and others

    1996-09-01

    This document provides information that supports or supplements the data and impact analyses presented in the National Ignition Facility (NIF) Project-Specific Analysis (PSA). The purposes of NIF are to achieve fusion ignition in the laboratory for the first time with inertial confinement fusion (ICF) technology and to conduct high- energy-density experiments ins support of national security and civilian application. NIF is an important element in the DOE`s science-based SSM Program, a key mission of which is to ensure the reliability of the nation`s enduring stockpile of nuclear weapons. NIF would also advance the knowledge of basic and applied high-energy- density science and bring the nation a large step closer to developing fusion energy for civilian use. The NIF PSA includes evaluations of the potential environmental impacts of constructing and operating the facility at one of five candidate site and for two design options.

  12. Construction of Civil and Public Facilities of Chinese Cities in 2006

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    <正>In 2006, by adopting the Scientific View of Development to guide the urban con-struction, the municipal governments of different levels in China continued to carry out the policies and measures issued by the Central Government con-

  13. Research on the application of PPP model in the Chinese construction and operation of new energy vehicle charging facilities

    Science.gov (United States)

    Zhu, Liping

    2017-05-01

    New energy car charging equipment is the development and popularization of new energy vehicles. It has the nature of quasi-public goods. Due to the large number of construction projects, wide distribution, big investment, it needs huge sums of money. PPP mode is a new financing model and has the inherent driving force to lead the idea the technology and the system innovation. The government and the social subject cooperate on the basis of the spirit of contract thus achieve benefit sharing. This mode effectively improve the operation of new energy vehicle charging facilities operating efficiency

  14. TRI mu P - a radioactive isotope trapping facility under construction at KVI

    CERN Document Server

    Berg, G P; Dermois, O; Harakeh, M N; Hoekstra, R; Jungmann, Klaus; Kopecky, S; Morgenstern, R; Rogachevskiy, A; Timmermans, R; Willmann, L; Wilschut, H W

    2003-01-01

    At the Kernfysisch Versneller Instituut a new facility (TRI mu P) is under development which aims to investigate fundamental interactions using radioactive ions. A spectrum of radioactive isotopes will be produced in inverse-kinematics and fragmentation reactions using heavy-ion beams from the superconducting cyclotron AGOR. The reaction products will be separated from the primary beam in a dual-mode recoil and fragment separator. The beam of isotopes of interest will be transformed into a low-energy, high-quality, bunched beam and, after neutralization, stored in an atom trap. The emphasis will be put on studying the origin of parity violation via beta-nu angular correlations and the search for permanent electric dipole moments of atoms and nuclei. The facility will be open to outside users; suggestions for collaborations to extend the scientific program are encouraged.

  15. Development and construction of a comprehensive set of research diagnostics for the FLARE user facility

    Science.gov (United States)

    Yoo, Jongsoo; Jara-Almonte, J.; Majeski, S.; Frank, S.; Ji, H.; Yamada, M.

    2016-10-01

    FLARE (Facility for Laboratory Reconnection Experiments) will be operated as a flexible user facility, and so a complete set of research diagnostics is under development, including magnetic probe arrays, Langmuir probes, Mach probes, spectroscopic probes, and a laser interferometer. In order to accommodate the various requirements of users, large-scale (1 m), variable resolution (0.5-4 cm) magnetic probes have been designed, and are currently being prototyped. Moreover, a fully fiber-coupled laser interferometer has been designed to measure the line-integrated electron density. This fiber-coupled interferometer system will reduce the complexity of alignment processes and minimize maintenance of the system. Finally, improvements to the electrostatic probes and spectroscopic probes currently used in the Magnetic Reconnection Experiment (MRX) are discussed. The specifications of other subsystems, such as integrators and digitizers, are also presented. This work is supported by DoE Contract No. DE-AC0209CH11466.

  16. Construction of a naturally occurring radioactive material project in the BeAAT hazardous waste facilities.

    Science.gov (United States)

    Abuahmad, H

    2015-06-01

    This paper does not necessarily reflect the views of the International Commission on Radiological Protection. Naturally occurring radioactive material (NORM) is produced during exploration and production operations of subsidiaries of the Abu Dhabi National Oil Company (ADNOC) in the United Arab Emirates, and accumulates in drilling tubulars, plant equipment, and components. These NORM hazardous wastes need to be managed in such a way that they do not damage human health and the environment. The primary radionuclides of concern in the oil and gas industries are radium-226 and radium-228. These radioisotopes are the decay products of uranium and thorium isotopes that are present in subsurface formations from which hydrocarbons are produced. While uranium and thorium are largely immobile, radium is slightly more soluble and may become mobilised in the fluid phases of the formation (International Association of Oil & Gas Producers, 2008). In order to treat and dispose of NORM waste products safely, ADNOC's subsidiary 'TAKREER' is developing a new facility, on behalf of all ADNOC subsidiaries, within the existing Central Environmental Protection Facilities (BeAAT) in Ruwais city. The NORM plant is envisaged to treat, handle, and dispose of NORM waste in the forms of scale, sludge, and contaminated equipment. The NORM treatment facility will cover activities such as decontamination, volume reduction, NORM handling, and concrete immobilisation of NORM waste into packages for designated landfilling. © The International Society for Prosthetics and Orthotics Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Ecological studies related to construction of the Defense Waste Processing Facility on the Savannah River Site. Annual report, FY 1993

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-11-01

    Construction of the Defense Waste Processing Facility (DWPF) on the Savannah River Site (SRS) began during FY-1984. The Savannah River Ecology Laboratory (SREL) has completed 15 years of ecological studies related to the construction of the DWPF complex. Prior to construction, the 600-acre site (S-Area) contained a Carolina bay and the headwaters of a stream. Through the long-term census taking of biota at the DWPF site and Rainbow Bay, SREL has been evaluating the impact of construction on the biota and the effectiveness of mitigation efforts. similarly, the effects of erosion from the DWPF site on the water quality of S-Area peripheral streams are being assessed. This research provides supporting data relevant to the National Environmental Policy Act (NEPA) of 1969, the Endangered Species Act of 1973, Executive orders 11988 (Floodplain Management) and 11990 (Protection of Wetlands), and United States Department of Energy (DOE) Guidelines for Compliance with Floodplain/Wetland Environmental Review Requirements (10 CFR 1022).

  18. Construction safety program for the National Ignition Facility, July 30, 1999

    Energy Technology Data Exchange (ETDEWEB)

    Benjamin, D W

    1999-07-30

    The Construction Safety Program (CSP) for NIF sets forth the responsibilities, guidelines, rules, policies and regulations for all workers involved in the construction, special equipment installation, acceptance testing, and start-up of NIF at LLNL during the construction period of NIF. During this period, all workers are required to implement measures to create a universal awareness which promotes safe practice at the work site, and which will achieve NIF's management objectives in preventing accidents and illnesses. Construction safety for NIF is predicated on everyone performing their jobs in a manner that prevents job-related disabling injuries and illnesses. Integrated Safety Management (ISM) is practiced in the execution of all activities associated with the NIF Project. The seven Principles of ISM are: (1) Line management is responsible for safety. (2) Clear roles and responsibilities are established and maintained. (3) Personnel possess competence commensurate with responsibilities. (4) Resource allocations are balanced, making ES and H a priority in project planning and execution. (5) Safety requirements are identified and implemented. (6) Hazard controls are tailored to the project work. (7) Operations are authorized before work begins.

  19. [Change in pancreatic exocrine function in acute appendicitis].

    Science.gov (United States)

    Ivanov, Iu A

    1979-10-01

    In order to study changes in the functional state of the pancreas 1572 investigations of the blood and urine amylase, atoxylresistant lipase of the blood serum before operation were performed in different postoperative periods in 131 patients with acute appendicitis. The enzyme activity was established to increase, especially in destructive forms of appendicitis and in elderly patients.

  20. Appendicitis Presenting Concurrently with Cecal Arteriovenous Malformation in a Child

    Directory of Open Access Journals (Sweden)

    Sahil P Parikh

    2015-09-01

    Full Text Available Acute appendicitis is a commonly diagnosed surgical problem in the pediatric population. Arterio-venous malformations (AVM of the colonic tract are rarely reported in the pediatric literature. A 13-year old boy who presented with acute appendicitis with concurrent cecal AVM is reported in whom appendectomy was done. Later on radiological investigations AVM was confirmed.

  1. Stratified computed tomography findings improve diagnostic accuracy for appendicitis

    Science.gov (United States)

    Park, Geon; Lee, Sang Chul; Choi, Byung-Jo; Kim, Say-June

    2014-01-01

    AIM: To improve the diagnostic accuracy in patients with symptoms and signs of appendicitis, but without confirmative computed tomography (CT) findings. METHODS: We retrospectively reviewed the database of 224 patients who had been operated on for the suspicion of appendicitis, but whose CT findings were negative or equivocal for appendicitis. The patient population was divided into two groups: a pathologically proven appendicitis group (n = 177) and a non-appendicitis group (n = 47). The CT images of these patients were re-evaluated according to the characteristic CT features as described in the literature. The re-evaluations and baseline characteristics of the two groups were compared. RESULTS: The two groups showed significant differences with respect to appendiceal diameter, and the presence of periappendiceal fat stranding and intraluminal air in the appendix. A larger proportion of patients in the appendicitis group showed distended appendices larger than 6.0 mm (66.3% vs 37.0%; P appendicitis group. Furthermore, the presence of two or more of these factors increased the odds ratio to 6.8 times higher than baseline (95%CI: 3.013-15.454; P appendicitis with equivocal CT findings. PMID:25320531

  2. Thermal-vacuum facility with in-situ mechanical loading. [for testing space construction materials

    Science.gov (United States)

    Tennyson, R. C.; Hansen, J. S.; Holzer, R. P.; Uffen, B.; Mabson, G.

    1978-01-01

    The paper describes a thermal-vacuum space simulator used to assess property changes of fiber-reinforced polymer composite systems. The facility can achieve a vacuum of approximately .0000001 torr with temperatures ranging from -200 to +300 F. Some preliminary experimental results are presented for materials subjected to thermal loading up to 200 F. The tests conducted include the evaluation of matrix modulus and strength, coefficients of thermal expansion, and fracture toughness. Though the experimental program is at an early stage, the data appear to indicate that these parameters are influenced by hard vacuum.

  3. Appendicitis/diverticulitis: minimally invasive surgery.

    Science.gov (United States)

    Mutter, D; Marescaux, J

    2013-01-01

    Complicated intra-abdominal infections such as acute appendicitis and complicated diverticulitis represent both diagnostic and therapeutic challenges. Both diseases, although different in many ways, are caused by the obstruction of a blind pouch leading to inflammation, abscesses, and perforation of surrounding tissues. For many decades, acute appendicitis was managed through a conventional surgical incision in the right iliac fossa. As for other diseases, there is a significant tendency to propose less invasive treatments. For many teams, laparoscopy, which leads to less postoperative pain, a shorter hospital stay, and a quicker recovery, represents the standard of care for appendectomy. For selected cases, a medical approach can be proposed with satisfactory outcomes. Additionally, the management of complicated diverticulitis is also quickly moving towards less invasive procedures than the deleterious '3-phase surgery', which is Hartmann's procedure, followed by reversal protected with a stoma, and finally stoma closure. Benefiting from the evolution of antimicrobial therapy and interventional radiology, many complicated cases classified as Hinchey stage I and Hinchey stage II complicated diverticulitis are now treated medically. CT images allow the identification of patients requiring radiological drainage of localized abscesses or collections over 5 cm in size. Patients with Hinchey stage III sigmoiditis may benefit from an initial laparoscopic exploration allowing, in some cases, a conservative nonresective approach that will prevent laparotomy and stoma. Major resection leading to temporary or definitive stoma is usually indicated for stage IV complications and is required only in exceptional cases. Although a surgical intervention can be the definitive treatment for complicated intra-abdominal infections, multidisciplinary management including radiology, medical treatment, and laparoscopic surgery may limit the severe consequences of an acute surgical

  4. Acute appendicitis in a premature baby

    Energy Technology Data Exchange (ETDEWEB)

    Beluffi, Giampiero; Alberici, Elisa [Department of Radiodiagnosis, Section of Paediatric Radiology, IRCCS Policlinico S. Matteo, Piazzale Golgi 2, 27100 Pavia PV (Italy)

    2002-07-01

    A case of acute appendicitis in a premature baby in whom diagnosis was suggested on plain films of the abdomen is presented. In this baby air in a hollow viscus suspected of being an enlarged appendix was the clue to diagnosis. The diagnostic dilemma of this rare and life-threatening condition in premature babies and newborns is underlined. The relevance of different imaging modalities and of different findings in this age group is discussed. Awareness of this rare condition and possible differential diagnosis in newborns and premature babies is stressed. (orig.)

  5. The construction of the Fiber-SiPM beam monitor system of the R484 and R582 experiments at the RIKEN-RAL muon facility

    Science.gov (United States)

    Bonesini, M.; Bertoni, R.; Chignoli, F.; Mazza, R.; Cervi, T.; de Bari, A.; Menegolli, A.; Prata, M. C.; Rossella, M.; Tortora, L.; Carbone, R.; Mocchiutti, E.; Vacchi, A.; Vallazza, E.; Zampa, G.

    2017-03-01

    The scintillating fiber-SiPM beam monitor detectors, designed to deliver beam informations for the R484 and R582 experiments at the high intensity, low energy pulsed muon beam at the RIKEN-RAL facility, have been successfully constructed and operated. Details on their construction and first performances in beam are reported.

  6. Improving diagnosis of appendicitis. Early autologous leukocyte scanning.

    Science.gov (United States)

    DeLaney, A R; Raviola, C A; Weber, P N; McDonald, P T; Navarro, D A; Jasko, I

    1989-10-01

    A prospective nonrandomized study investigating the accuracy and utility of autologous leukocyte scanning in the diagnosis of apendicitis was performed. One hundred patients in whom the clinical diagnosis of appendicitis was uncertain underwent indium 111 oxyquinoline labelling of autologous leukocytes and underwent scanning 2 hours following reinjection. Of 32 patients with proved appendicitis, three scans revealed normal results (false-negative rate, 0.09). Of 68 patients without appendicitis, three scans had positive results (false-positive rate, 0.03; sensitivity, 0.91; specificity, 0.97; predictive value of positive scan, 0.94; predictive value of negative scan, 0.96; and overall accuracy, 0.95). Scan results altered clinical decisions in 19 patients. In 13 cases, the scan produced images consistent with diagnoses other than appendicitis, expediting appropriate management. Early-imaging111 In oxyquinoline autologous leukocyte scanning is a practical and highly accurate adjunct for diagnosing appendicitis.

  7. Facile fabrication of tissue-engineered constructs using nanopatterned cell sheets and magnetic levitation

    Science.gov (United States)

    Penland, Nisa; Choi, Eunpyo; Perla, Mikael; Park, Jungyul; Kim, Deok-Ho

    2017-02-01

    We report a simple and versatile method for in vitro fabrication of scaffold-free tissue-engineered constructs with predetermined cellular alignment, by combining magnetic cell levitation with thermoresponsive nanofabricated substratum (TNFS) based cell sheet engineering technique. The TNFS based nanotopography provides contact guidance cues for regulation of cellular alignment and enables cell sheet transfer, while magnetic nanoparticles facilitate the magnetic levitation of the cell sheet. The temperature-mediated change in surface wettability of the thermoresponsive poly(N-isopropylacrylamide), substratum enables the spontaneous detachment of cell monolayers, which can then be easily manipulated through use of a ring or disk shaped magnet. Our developed platform could be readily applicable to production of tissue-engineered constructs containing complex physiological structures for the study of tissue structure-function relationships, drug screening, and regenerative medicine.

  8. Design and construction of a Wien velocity filter for AMS facilities

    CERN Document Server

    Catana, D; Enachescu, M; Plostinaru, V D; Vata, I; Rohrer, L

    2001-01-01

    Many experiments in atomic and nuclear physics using accelerated particles require accurate ion beams with respect to their atomic number, mass number and ion charge. These requirements have special important for experiments of accelerated mass spectrometry. Double focussing analyzing magnets perform the mass selection of charged ions. However, the magnetic analyzer cannot distinguish between particles with equal charge and having the same mass-velocity product. A simple way of resolving this degeneracy is to use a Wien velocity filter, WVF, in conjunction with the magnet analyzers. The design and construction of a WVF is presented together with experiments performed to determine the separation power. A velocity separation DELTA v/v = 1/100 was obtained. The design in this separate arrangements of fields is simple and straightforward. The construction can be achieved in a usual workshop. The applications of the WVF are manifold, e.g., AMS, ERDA, RBS, etc. (authors)

  9. Facile fabrication of tissue-engineered constructs using nanopatterned cell sheets and magnetic levitation.

    Science.gov (United States)

    Penland, Nisa; Choi, Eunpyo; Perla, Mikael; Park, Jungyul; Kim, Deok-Ho

    2017-02-17

    We report a simple and versatile method for in vitro fabrication of scaffold-free tissue-engineered constructs with predetermined cellular alignment, by combining magnetic cell levitation with thermoresponsive nanofabricated substratum (TNFS) based cell sheet engineering technique. The TNFS based nanotopography provides contact guidance cues for regulation of cellular alignment and enables cell sheet transfer, while magnetic nanoparticles facilitate the magnetic levitation of the cell sheet. The temperature-mediated change in surface wettability of the thermoresponsive poly(N-isopropylacrylamide), substratum enables the spontaneous detachment of cell monolayers, which can then be easily manipulated through use of a ring or disk shaped magnet. Our developed platform could be readily applicable to production of tissue-engineered constructs containing complex physiological structures for the study of tissue structure-function relationships, drug screening, and regenerative medicine.

  10. Universal Molecular Scaffold for Facile Construction of Multivalent and Multimodal Imaging Probes.

    Science.gov (United States)

    Gai, Yongkang; Xiang, Guangya; Ma, Xiang; Hui, Wenqi; Ouyang, Qin; Sun, Lingyi; Ding, Jiule; Sheng, Jing; Zeng, Dexing

    2016-03-16

    Multivalent and multimodal imaging probes are rapidly emerging as powerful chemical tools for visualizing various biochemical processes. Herein, we described a bifunctional chelator (BFC)-based scaffold that can be used to construct such promising probes concisely. Compared to other reported similar scaffolds, this new BFC scaffold demonstrated two major advantages: (1) significantly simplified synthesis due to the use of this new BFC that can serve as chelator and linker simultaneously; (2) highly efficient synthesis rendered by using either click chemistry and/or total solid-phase synthesis. In addition, the versatile utility of this molecular scaffold has been demonstrated by constructing several multivalent/multimodal imaging probes labeled with various radioisotopes, and the resulting radiotracers demonstrated substantially improved in vivo performance compared to the two individual monomeric counterparts.

  11. Environmental Assessment for Proposed Construction Freight Transfer Facility, Buckley Air Force Base, Colorado

    Science.gov (United States)

    2007-06-01

    removed during the project would be used as fill material or stock piled for use at other locations on Buckley AFB. Implementation of BMPs during...associated with mixed grass prairie are scarlet globe mallow (Spaeralcea coccinea), prickly pear (Opuntia macrohiza), rabbitbrush (Chrysothamnus...minimize potential erosion and sedimentation during the construction phase • Soil removed during the project would be used as fill material or stock

  12. Final Environmental Assessment for the Construction of a Temporary Lodging Facility, Eglin Air Force Base, FL

    Science.gov (United States)

    2012-03-01

    including longleaf pine , would be minimized to the degree feasible. No sensitive species have been documented at any of the alternative sites...will be designed to minimize the loss of trees, particularly longleaf pines . • A gopher tortoise survey is required before construction activities...of trees, including longleaf pine , would be minimized to the degree feasible. No sensitive species have been documented at the site. There

  13. Diagnostic Value of Mean Platelet Volume in Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Turgay Kilic

    2014-12-01

    Full Text Available Aim: The diagnosis of acute appendicitis for patients referred to the emergency department with the complaint of abdominal pain remains challenging. In this study, we investigated the diagnostic value of mean platelet volume in acute appendicitis. Material and Method: This clinical research study was performed retrospectively and included patients referred to the emergency department between January 1 and December 31, 2013, with the complaint of abdominal pain and were then discharged without a specific diagnosis in comparison to patients with a proven diagnosis of acute appendicitis. Control patients were selected using a randomization method from among patients of the same age and gender as acute appendicitis patients. The acute appendicitis group was subdivided into complicated and noncomplicated cases according to the pathology results. The Mann-Whitney U test for continuous variables and the chi-square test for categorical data were used. Results: This clinical research study was performed with 316 acute appendicitis patients and an equal number of control patients; 188 of the patients were male. Among the acute appendicitis patients, 67 presented with complicated acute appendicitis and 249 with noncomplicated acute appendicitis. The median mean platelet volume of the acute appendicitis versus control patients was 8.03 fL (IQR: 1.86; min: 5.53, max: 14.40 and 8.10 fL (IQR: 1.38; min: 5.70, max: 13.90, respectively (p=0.193. The platelet counts in the complicated and noncomplicated groups were 235 K/µL (IQR: 70; min: 116, max: 649 and 261 K/µL (IQR: 87; min: 124, max: 537, respectively (p

  14. Design and construction of models for the National Transonic Facility, part 2

    Science.gov (United States)

    Young, C. P., Jr.

    1985-01-01

    This lecture presents the results of fastener load and retention systems tests which were carried out as a part of the cryogenic models technology development program a the NASA Langley Research Center (LaRC). Various design concepts for the National Transonic Facility (NTF) developmental and production models are discussed. A number of NTF models are described with emphasis on materials used, uniqueness of design and design drivers. Design and fabrication experience is presented in terms of the primary thermal and mechanical considerations required for design as well as fabrication. Cost considerations are addressed in terms of factors influencing costs for NTF models and cost data comparisons which are taken from both NASA Langley and industry experience.

  15. Design and construction of a pre-injector for the Iranian Light Source Facility

    Directory of Open Access Journals (Sweden)

    A Sadeghipanah

    2015-09-01

    Full Text Available Every synchrotron accelerator requires a pre-injector for primary injection of the electrons into the booster ring. The Iranian Light Source Facility (ILSF pre-injector is a 150 MeV S-band linear accelerator with a thermionic cathode RF gun. The design of the pre-injector lattice and its beam dynamics calculation results together with the design of RF gun, alpha magnet, quadrupole magnets and linear accelerator structures are described in this article. The measurement results of the RF gun prototype fabricated in Iran demonstrate a dimension error less than 20 μm and a surface roughness of less than 0.8 μm

  16. Evaluation of scoring systems in predicting acute appendicitis in children.

    Science.gov (United States)

    Macco, Sven; Vrouenraets, Bart C; de Castro, Steve M M

    2016-12-01

    Acute appendicitis can be difficult to diagnose, especially in children. Appendicitis scoring systems have been developed as a diagnostic tool to improve the decision-making process in patients with suspected acute appendicitis. This study evaluates the Appendicitis Inflammatory Response score, Alvarado score, and Pediatric Appendicitis Score in children suspected of acute appendicitis. Data were collected retrospectively. All children younger than 18 years suspected of acute appendicitis who presented to the emergency department between January 2006 and June 2014 were included in this study. Variables were registered to evaluate 3 different appendicitis scoring systems. The diagnostic performance of the 3 scores was analyzed using the area under the receiver-operating curve and by calculating the diagnostic performances at different cut-off points. The present study included 747 consecutive children. There were 399 boys (53%) and 348 girls (47%) with a mean age of 11 years (range, 1-17 years). In total, 269 children (36%) were diagnosed with acute appendicitis. The area under the receiver-operating curve of the Appendicitis Inflammatory Response score was 0.90, the Alvarado score was 0.87, and the Pediatric Appendicitis Score was 0.82 (P Appendicitis Inflammatory Response score were better at predicting an acute appendicitis than that of the Alvarado score and Pediatric Appendicitis Score. In children with a low-risk acute appendicitis, false negative rates of 14% for the Appendicitis Inflammatory Response, 7% for the Alvarado, and 18% for the Pediatric Appendicitis Score were measured. In this study, the Appendicitis Inflammatory Response score had the highest discriminating power and outperformed the Alvarado score and Pediatric Appendicitis Score in predicting acute appendicitis in children. Excluding acute appendicitis safely in children with the scoring systems still remains uncertain. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Diagnosis of Acute Appendicitis by Endoscopic Retrograde Appendicitis Therapy (ERAT): Combination of Colonoscopy and Endoscopic Retrograde Appendicography.

    Science.gov (United States)

    Li, Yingchao; Mi, Chen; Li, Weizhi; She, Junjun

    2016-11-01

    Acute appendicitis is the most common abdominal emergency, but the diagnosis of appendicitis remains a challenge. Endoscopic retrograde appendicitis therapy (ERAT) is a new and minimally invasive procedure for the diagnosis and treatment of acute appendicitis. To investigate the diagnostic value of ERAT for acute appendicitis by the combination of colonoscopy and endoscopic retrograde appendicography (ERA). Twenty-one patients with the diagnosis of suspected uncomplicated acute appendicitis who underwent ERAT between November 2014 and January 2015 were included in this study. The main outcomes, imaging findings of acute appendicitis including colonoscopic direct-vision imaging and fluoroscopic ERA imaging, were retrospectively reviewed. Secondary outcomes included mean operative time, mean hospital stay, rate of complication, rate of appendectomy during follow-up period, and other clinical data. The diagnosis of acute appendicitis was established in 20 patients by positive ERA (5 patients) or colonoscopy (1 patient) alone or both (14 patients). The main colonoscopic imaging findings included mucosal inflammation (15/20, 75 %), appendicoliths (14/20, 70 %), and maturation (5/20, 25 %). The key points of ERA for diagnosing acute appendicitis included radiographic changes of appendix (17/20, 85 %), intraluminal appendicoliths (14/20, 70 %), and perforation (1/20, 5 %). Mean operative time of ERAT was 49.7 min, and mean hospital stay was 3.3 days. No patient converted to emergency appendectomy. Perforation occurred in one patient after appendicoliths removal was not severe and did not require invasive procedures. During at least 1-year follow-up period, only one patient underwent laparoscopic appendectomy. ERAT is a valuable procedure of choice providing a precise yield of diagnostic information for patients with suspected acute appendicitis by combination of colonoscopy and ERA.

  18. What is the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after CT?

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Kyung Mi [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Lee, Kwanseop [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)], E-mail: kwanseop@hallym.or.kr; Kim, Min-Jeong; Yoon, Hoi Soo; Jeon, Eui Yong; Koh, Sung Hye [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Min, Kwangseon [Department of Pathology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Choi, Dongil [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (Korea, Republic of)

    2010-04-15

    The objective of our study was to estimate the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after abdominoplevic CT. A total of 104 patients initially underwent abdominopelvic CT before appendix US due to acute abdominal pain. All CT examinations were evaluated retrospectively for the presence of acute appendicitis. The findings of appendix on CT were classified into five categories (definite appendicitis, probably appendicitis, equivocal CT findings for diagnosis of appendicitis, probably not appendicitis, and normal looking appendix). Appendix US images and their radiologic reports were also evaluated retrospectively. Then, CT and US findings were correlated with clinical or pathologic diagnosis. Three all patients with definite appendicitis initially on CT again showed US findings of appendicitis. In the 32 patients of probably appendicitis on CT, US showed normal looking appendix in seven patients (21.8%, 7 of 32) who improved with medical treatment and discharged. In the 16 patients of equivocal CT findings for diagnosis of appendicitis, US showed appendicitis in seven patients (43.8%, 7 of 16) and normal looking appendix in nine patients. In the 12 patients of probably not appendicitis on CT, US showed acute appendicitis in two patients (16.7%, 2 of 12). In the 41 patients of normal looking appendix on CT, US showed acute appendicitis in five patients (12.2%, 5 of 41). US reevaluation enables us to avoid misdiagnosis of appendicitis on CT and improve diagnostic accuracy of acute appendicitis.

  19. Construction safety program for the National Ignition Facility, July 30, 1999 (NIF-0001374-OC)

    Energy Technology Data Exchange (ETDEWEB)

    Benjamin, D W

    1999-07-30

    These rules apply to all LLNL employees, non-LLNL employees (including contract labor, supplemental labor, vendors, personnel matrixed/assigned from other National Laboratories, participating guests, visitors and students) and contractors/subcontractors. The General Rules-Code of Safe Practices shall be used by management to promote accident prevention through indoctrination, safety and health training and on-the-job application. As a condition for contracts award, all contractors and subcontractors and their employees must certify on Form S and H A-l that they have read and understand, or have been briefed and understand, the National Ignition Facility OCIP Project General Rules-Code of Safe Practices. (An interpreter must brief those employees who do not speak or read English fluently.) In addition, all contractors and subcontractors shall adopt a written General Rules-Code of Safe Practices that relates to their operations. The General Rules-Code of Safe Practices must be posted at a conspicuous location at the job site office or be provided to each supervisory employee who shall have it readily available. Copies of the General Rules-Code of Safe Practices can also be included in employee safety pamphlets.

  20. Role of non-operative management in pediatric appendicitis.

    Science.gov (United States)

    Gonzalez, Dani O; Deans, Katherine J; Minneci, Peter C

    2016-08-01

    Appendectomy is currently considered the standard of care for children with acute appendicitis. Although commonly performed and considered a safe procedure, appendectomy is not without complications. Non-operative management has a role in the treatment of both uncomplicated and complicated appendicitis. In uncomplicated appendicitis, initial non-operative management appears to be safe, with an approximate 1-year success rate of 75%. Compared to surgery, non-operative management is associated with less disability and lower costs, with no increase in the rate of complicated appendicitis. In patients with complicated appendicitis, initial non-operative management with interval appendectomy has been shown to be safe with reported success rates between 66% and 95%. Several studies suggest that initial non-operative management with interval appendectomy may be beneficial in patients with perforated appendicitis with a well-formed abscess or inflammatory mass. Recent data suggest that interval appendectomy may not be necessary after initial non-operative management of complicated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Trends in the Diagnosis and Management of Pediatric Appendicitis.

    Science.gov (United States)

    Hansen, Laura W; Dolgin, Stephen E

    2016-02-01

    • On the basis of class B evidence and consensus, acute appendicitis in children can often be diagnosed clinically with only selective use of imaging. (13)(14)(15)(16) • On the basis of class B evidence and consensus, ultrasonography is the test of choice when acute appendicitis is suspected but is unclear based on history, physical examination, and laboratory results. (17)(18)(19) • On the basis of class B evidence and consensus, the use of computed tomography scan should be limited to cases of suspected complex appendicitis with abscess or when there is clinical suspicion for acute appendicitis but ultrasonography results are not helpful. (16) • On the basis of class C evidence and consensus, children with possible appendicitis ideally should be treated in medical centers that have skilled sonographic personnel. (21) • On the basis of class B evidence and consensus, simple appendicitis should be treated by appendectomy during normal operating hours. Preoperative treatment with intravenous antibiotics and fluids during the overnight hours halts disease progression and allows for the safest surgery with the benefit of a full and rested staff. (24)(25)(26) • On the basis of class B evidence and consensus, complex appendicitis with a well-defined abscess can be treated nonoperatively initially, with the option of an interval appendectomy after recovery from the acute infection. (29)(30) (31)(32)(33)

  2. Lessons Learned from the 200 West Pump and Treatment Facility Construction Project at the US DOE Hanford Site - A Leadership for Energy and Environmental Design (LEED) Gold-Certified Facility

    Energy Technology Data Exchange (ETDEWEB)

    Dorr, Kent A.; Ostrom, Michael J.; Freeman-Pollard, Jhivaun R.

    2013-01-11

    CH2M Hill Plateau Remediation Company (CHPRC) designed, constructed, commissioned, and began operation of the largest groundwater pump and treatment facility in the U.S. Department of Energy’s (DOE) nationwide complex. This one-of-a-kind groundwater pump and treatment facility, located at the Hanford Nuclear Reservation Site (Hanford Site) in Washington State, was built to an accelerated schedule with American Recovery and Reinvestment Act (ARRA) funds. There were many contractual, technical, configuration management, quality, safety, and Leadership in Energy and Environmental Design (LEED) challenges associated with the design, procurement, construction, and commissioning of this $95 million, 52,000 ft groundwater pump and treatment facility to meet DOE’s mission objective of treating contaminated groundwater at the Hanford Site with a new facility by June 28, 2012. The project team’s successful integration of the project’s core values and green energy technology throughout design, procurement, construction, and start-up of this complex, first-of-its-kind Bio Process facility resulted in successful achievement of DOE’s mission objective, as well as attainment of LEED GOLD certification, which makes this Bio Process facility the first non-administrative building in the DOE Office of Environmental Management complex to earn such an award.

  3. Lessons Learned from the 200 West Pump and Treatment Facility Construction Project at the US DOE Hanford Site - A Leadership for Energy and Environmental Design (LEED) Gold-Certified Facility - 13113

    Energy Technology Data Exchange (ETDEWEB)

    Dorr, Kent A.; Freeman-Pollard, Jhivaun R.; Ostrom, Michael J. [CH2M HILL Plateau Remediation Company, P.O. Box 1600, MSIN R4-41, 99352 (United States)

    2013-07-01

    CH2M Hill Plateau Remediation Company (CHPRC) designed, constructed, commissioned, and began operation of the largest groundwater pump and treatment facility in the U.S. Department of Energy's (DOE) nationwide complex. This one-of-a-kind groundwater pump and treatment facility, located at the Hanford Nuclear Reservation Site (Hanford Site) in Washington State, was built to an accelerated schedule with American Recovery and Reinvestment Act (ARRA) funds. There were many contractual, technical, configuration management, quality, safety, and Leadership in Energy and Environmental Design (LEED) challenges associated with the design, procurement, construction, and commissioning of this $95 million, 52,000 ft groundwater pump and treatment facility to meet DOE's mission objective of treating contaminated groundwater at the Hanford Site with a new facility by June 28, 2012. The project team's successful integration of the project's core values and green energy technology throughout design, procurement, construction, and start-up of this complex, first-of-its-kind Bio Process facility resulted in successful achievement of DOE's mission objective, as well as attainment of LEED GOLD certification (Figure 1), which makes this Bio Process facility the first non-administrative building in the DOE Office of Environmental Management complex to earn such an award. (authors)

  4. Overview and diagnosis of acute appendicitis in children.

    Science.gov (United States)

    Glass, Charity C; Rangel, Shawn J

    2016-08-01

    Appendicitis represents the most common abdominal surgical emergency in the pediatric age group. Despite being a relatively common condition, the diagnosis of appendicitis in children can prove to be challenging in many cases. The goal of this article is to review the predictive utility for presenting signs and symptoms, laboratory tests, and imaging studies in the diagnostic work-up of appendicitis. Furthermore, we sought to explore the predictive utility of composite measures based on multiple sources of diagnostic information, as well as the utility of clinical pathways as a means to streamline the diagnostic process. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Livstruende appendicitis forårsaget af Fusobacterium necrophorum

    DEFF Research Database (Denmark)

    Hagen, Trine Langfeldt; Maeda, Yasuko; Lindberg, Jens Aage;

    2014-01-01

    Fusobacterium necrophorum is a well-known cause of Lemierre's syndrome. Recent studies suggest a causative association between F. necrophorum and acute appendicitis. We present a case of a 15-year-old previously healthy girl who presented with acute non-perforated appendicitis, intra......-abdominal abscesses and thrombosis that led to omental necrosis. This resulted in a life-threatening septic shock with the need for prolonged intensive care. We suggest that F. necrophorum identified in pus from the abdomen caused this fulminant variation of appendicitis with findings similar to those seen...

  6. Case report and management of suspected acute appendicitis in pregnancy.

    Science.gov (United States)

    Murariu, Daniel; Tatsuno, Brent; Hirai, Cori-Ann M; Takamori, Ryan

    2011-02-01

    Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed at length, as well as the finer points in treatment of this population.

  7. Engineering and construction projects for oil and gas processing facilities: Contracting, uncertainty and the economics of information

    Energy Technology Data Exchange (ETDEWEB)

    Berends, Kees [Capital Contracting Services, Shell Global Solutions International B.V., The Hague (Netherlands)

    2007-08-15

    The amount of oil and gas processing capacity required to meet demand during the next 20 years is more than twice the amount realised during the last decades. Engineering and Construction contractors (ECs) play a key role in the development and implementation of Large Engineering and Construction Projects (LECPs) for these facilities. We examine the characteristics of LECPs, demand and supply of the contracting market and the strategies traditionally adopted by owners to contract out the development and implementation of these projects to ECs. We demonstrate that these traditional strategies are not longer effective, in the current 'sellers market', to mitigate the oligopolistic economic inefficiencies. As the 'overheating' of the contracting market is expected to continue for a considerable period of time, alternative contracting strategies are required. Contract theory, particularly the economics of information on LECPs, indicates how alternative contracting strategies can be used to overcome economic inefficiencies. The effective use of these alternative strategies requires increased owner involvement and their effectiveness is contingent upon owner competency and ECs acting as the owner's agent rather than its adversary. This will require an organisational and behavioural change process for both owners and ECs. (author)

  8. Missed appendicitis after self-induced abortion.

    Science.gov (United States)

    Punguyire, Damien; Iserson, Victor Kenneth

    2011-01-01

    Female lower abdominal pain poses diagnostic difficulties for clinicians, especially when little more than the history and physical examination are available. A girl presented with constant lower abdominal pain after taking misoprostol for pregnancy termination. She was eventually referred to a rural District Hospital, where a laparotomy demonstrated acute appendicitis. After treating herself for a self-diagnosed pregnancy with illegally provided misoprostol, this patient presented with persistent lower abdominal pain. The differential diagnosis included ectopic pregnancy and all other causes of female abdominal pain. Yet diagnosing two diseases in the same anatomical area at the same time contradicts diagnostic parsimony. System problems in resource-poor areas can limit access to healthcare services and encourage dispensing potentially dangerous medications without clinicians' authorization. It is dangerous to rely on patients' self-diagnoses while neglecting other diagnoses. More than one diagnosis may be needed to explain temporally and anatomically related symptoms.

  9. Schistosomiasis: A Rare Cause of Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Faten Limaiem

    2015-06-01

    Full Text Available Schistosomiasis is a water-borne trematode infestation and is one of the most widespread parasitic diseases in the world. Schistosomiasis can affect any organ, but is rare in the appendix. In this paper, the authors report a new case of appendicular schistosomiasis that was incidentally discovered in a 27-year-old male patient from Mali who underwent appendectomy for acute appendicitis. Appendectomy specimens removed from patients with appendicular schistosomiasis often appear macroscopically normal, but histopathological analysis of these cases confirms the diagnosis by revealing schistosomal eggs. The authors strongly recommend that all appendectomy specimens be examined histopathologically regardless of whether the specimens are macroscopically normal. [J Interdiscipl Histopathol 2015; 3(2.000: 78-80

  10. Massive ovarian edema, due to adjacent appendicitis.

    Science.gov (United States)

    Callen, Andrew L; Illangasekare, Tushani; Poder, Liina

    2017-04-01

    Massive ovarian edema is a benign clinical entity, the imaging findings of which can mimic an adnexal mass or ovarian torsion. In the setting of acute abdominal pain, identifying massive ovarian edema is a key in avoiding potential fertility-threatening surgery in young women. In addition, it is important to consider other contributing pathology when ovarian edema is secondary to another process. We present a case of a young woman presenting with subacute abdominal pain, whose initial workup revealed marked enlarged right ovary. Further imaging, diagnostic tests, and eventually diagnostic laparoscopy revealed that the ovarian enlargement was secondary to subacute appendicitis, rather than a primary adnexal process. We review the classic ultrasound and MRI imaging findings and pitfalls that relate to this diagnosis.

  11. Xanthogranulomatous Appendicitis: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Nikhil Mehrotra

    2017-07-01

    Full Text Available Xanthogranulomatous inflammation is a form of chronic inflammation where the exact eitiology is not known. It is commonly reported in organs like kidney and gall bladder Very few cases of xanthogranulomatous inflammation of appendix have been reported in the literature. We report a case of 30 year female presenting with pain abdomen and fever for which provisional diagnosis of appendicitis was made. Open appendicectomy was performed which on intraoperative examination showed that appendix was adherent to surrounding structures forming a mass. Resection of the mass was done and sent for histopathological examination. Gross examination of the received specimen revealed multiple irregular tissue bits and one tubular tissue bit. Multiple sections studied from resected tissue showed features of xanthogranulomatous inflammation in appendix and periappendicular tissue.

  12. Acute appendicitis in a femoral hernia

    Directory of Open Access Journals (Sweden)

    Zdravković Darko

    2007-01-01

    Full Text Available INTRODUCTION Acute appendicitis in a femoral hernia is an uncommon condition that can be serious. Complications are more frequent if the diagnosis is delayed and surgery is not performed on time. CASE REPORT We present a 71-year-old man with a painful swollen mass. The patient presented with fatigue and loss of appetite, while body temperature was normal. The abdomen was not painful, and peristaltic was normal. All laboratory findings were normal. After anamnesis and physical examination, the presumed diagnosis was incarcerated femoral hernia and the patient was sent to the operating room. Intraoperative findings revealed an incarcerated femoral hernia within a phlegmonous inflammated appendix. Appendectomy and McVay hernioplastics were done. The postoperative course was without complications. CONCLUSION It is very important to bear in mind that right femoral hernia with signs of incarceration and inflammation may contain an acutely inflamed appendix. Delayed diagnosis and misdiagnosis cause greater morbidity and mortality.

  13. Corrosion behaviour of steel rebars embedded in a concrete designed for the construction of an intermediate-level radioactive waste disposal facility

    Science.gov (United States)

    Duffó, G. S.; Arva, E. A.; Schulz, F. M.; Vazquez, D. R.

    2013-07-01

    The National Atomic Energy Commission of the Argentine Republic is developing a nuclear waste disposal management programme that contemplates the design and construction of a facility for the final disposal of intermediate-level radioactive wastes. The repository is based on the use of multiple, independent and redundant barriers. The major components are made in reinforced concrete so, the durability of these structures is an important aspect for the facility integrity. This work presents an investigation performed on an instrumented reinforced concrete prototype specifically designed for this purpose, to study the behaviour of an intermediate level radioactive waste disposal facility from the rebar corrosion point of view. The information obtained will be used for the final design of the facility in order to guarantee a service life more or equal than the foreseen durability for this type of facilities.

  14. Corrosion behaviour of steel rebars embedded in a concrete designed for the construction of an intermediate-level radioactive waste disposal facility

    Directory of Open Access Journals (Sweden)

    Schulz F.M.

    2013-07-01

    Full Text Available The National Atomic Energy Commission of the Argentine Republic is developing a nuclear waste disposal management programme that contemplates the design and construction of a facility for the final disposal of intermediate-level radioactive wastes. The repository is based on the use of multiple, independent and redundant barriers. The major components are made in reinforced concrete so, the durability of these structures is an important aspect for the facility integrity. This work presents an investigation performed on an instrumented reinforced concrete prototype specifically designed for this purpose, to study the behaviour of an intermediate level radioactive waste disposal facility from the rebar corrosion point of view. The information obtained will be used for the final design of the facility in order to guarantee a service life more or equal than the foreseen durability for this type of facilities.

  15. Lessons Learned From The 200 West Pump And Treatment Facility Construction Project At The US DOE Hanford Site - A Leadership For Energy And Environmental Design (LEED) Gold-Certified Facility

    Energy Technology Data Exchange (ETDEWEB)

    Dorr, Kent A. [CH2M HILL Plateau Remediation Company, Richland, WA (United States); Ostrom, Michael J. [CH2M HILL Plateau Remediation Company, Richland, WA (United States); Freeman-Pollard, Jhivaun R. [CH2M HILL Plateau Remediation Company, Richland, WA (United States)

    2012-11-14

    CH2M Hill Plateau Remediation Company (CHPRC) designed, constructed, commissioned, and began operation of the largest groundwater pump and treatment facility in the U.S. Department of Energy's (DOE) nationwide complex. This one-of-a-kind groundwater pump and treatment facility, located at the Hanford Nuclear Reservation Site (Hanford Site) in Washington State, was built in an accelerated manner with American Recovery and Reinvestment Act (ARRA) funds and has attained Leadership in Energy and Environmental Design (LEED) GOLD certification, which makes it the first non-administrative building in the DOE Office of Environmental Management complex to earn such an award. There were many contractual, technical, configuration management, quality, safety, and LEED challenges associated with the design, procurement, construction, and commissioning of this $95 million, 52,000 ft groundwater pump and treatment facility. This paper will present the Project and LEED accomplishments, as well as Lessons Learned by CHPRC when additional ARRA funds were used to accelerate design, procurement, construction, and commissioning of the 200 West Groundwater Pump and Treatment (2W P&T) Facility to meet DOE's mission of treating contaminated groundwater at the Hanford Site with a new facility by June 28, 2012.

  16. Study of 150 cases of acute appendicitis in children

    Directory of Open Access Journals (Sweden)

    Fallahi Gh

    1998-06-01

    Full Text Available Acute appendicitis is the most common condidition, requiring emergency operation in children. Late appendicitis is still a major sours of morbidity and potential mortality. The charts of all pediatric appendectomy patients (150 cases treated between 1367-1373 (Iranian calender in Amir Kabir Medical Center were reviewed. Mean hospital stay was 4.7 days. Mean ages of patients was 8.5 years. Male to female ratio was 1.2/1. Most common symptom was abdominal pain (100% and deep tenderness in right lower quadrant in 94.6%. Mean temprature was 37.2 and leucocytosis (more than 10000 were in the 76.3%. 14 patients had perforated appendicitis and most common pathology was acut supporative appendicitis. Accuracy of diagnosis was 96.6% and post operative pelvic abccess was 2%. Mortality occurred in one case (0.6%

  17. Acute Appendicitis: An Extracolonic Manifestation of Clostridium difficile Colitis

    Directory of Open Access Journals (Sweden)

    Ali Ridha

    2017-01-01

    Full Text Available The current report is the case of a 30-year-old male patient who presented with symptomatology suggestive of appendicitis. However, careful history-taking and laboratory tests led to the diagnosis of Clostridium difficile colitis, resulting in successful nonsurgical management of this patient. Although both appendicitis and C. difficile colitis are common conditions, they are rarely diagnosed concurrently. This is reflected by paucity of literature describing this manifestation. Given this current presentation, the authors contend that the manifestation of extracolonic colitis within the appendix is possibly underdiagnosed or misdiagnosed as an acute appendicitis and thus potentially results in unnecessary surgical intervention. This report reminds physicians to consider the medical approach to managing acute appendicitis given the possibility of underlying C. difficile colitis as the causative factor.

  18. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    DEFF Research Database (Denmark)

    Chabanova, Elizaveta; Balslev, Ingegerd; Achiam, Michael;

    2011-01-01

    PURPOSE: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. MATERIALS...... radiologists and one surgeon independent of each other and compared with surgical and pathological records. RESULTS: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14...... patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate (kappa=0.51) and fair (kappa=0.31) interobserver agreements in the MR diagnosis of acute...

  19. Can fruit seeds and undigested plant residuals cause acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Omer Engin; Mehmet Yildirim; Savas Yakan; Gulnihal Ay Coskun

    2011-01-01

    Objective:To investigate the relation between fruit seeds, plants residuals and appendicitis. Methods: Among cases that underwent appendectomy, the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively. Also, histopathological features, age, sex, and parameters of morbidity and mortality were used. Results: Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%). It was determined that there were appendix inflammation in 2 of the plant residuals cases, while there were obstruction and lymphoid hyperplasia in the appendix lumen of5 cases. No mortality was observed.Conclusions: The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

  20. Caecal diverticulitis presenting as acute appendicitis: a case report

    Directory of Open Access Journals (Sweden)

    Ayantunde Abraham A

    2009-07-01

    Full Text Available Abstract Solitary caecal diverticulum is an uncommon entity and therefore difficult to diagnose except at surgery. Caecal diverticulitis is an infrequent cause of acute abdomen and usually presents in a manner similar to acute appendicitis. It is extremely difficult to differentiate it preoperative from acute appendicitis and such distinction is usually made in the operating room. The optimal management of this clinical condition is still controversial, ranging from conservative treatment with antibiotics to aggressive surgical resections. We report a case of a 61 year old Caucasian who presented with acute onset right iliac fossa pain indistinguishable from acute appendicitis. The true diagnosis of a perforated acute caecal diverticulitis with an abscess mass was only made at operation in the presence of a macroscopically normal appendix. We reviewed the literature to highlight the difficulty of a preoperative diagnosis and the need for a high index of suspicion especially in the older age group presenting in manner similar to acute appendicitis.

  1. Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis

    NARCIS (Netherlands)

    Rossem, C.C. van; Schreinemacher, M.H.; Geloven, A.A. van; Bemelman, W.A.; Goor, H. van; Knaapen, L.

    2016-01-01

    IMPORTANCE: Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE: To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complica

  2. New synthetic strategies for xanthene-dye-appended cyclodextrins.

    Science.gov (United States)

    Malanga, Milo; Darcsi, Andras; Balint, Mihaly; Benkovics, Gabor; Sohajda, Tamas; Beni, Szabolcs

    2016-01-01

    Xanthene dyes can be appended to cyclodextrins via an ester or amide bridge in order to switch the fluorescence on or off. This is made possible through the formation of nonfluorescent lactones or lactams as the fluorophore can reversibly cyclize. In this context we report a green approach for the synthesis of switchable xanthene-dye-appended cyclodextrins based on the coupling agent 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMT-MM). By using 6-monoamino-β-cyclodextrin and commercially available inexpensive dyes, we prepared rhodamine- and fluorescein-appended cyclodextrins. The compounds were characterized by NMR and IR spectroscopy and MS spectrometry, their UV-vis spectra were recorded at various pH, and their purity was determined by capillary electrophoresis. Two potential models for the supramolecular assembly of the xanthene-dye-appended cyclodextrins were developed based on the set of data collected by the extensive NMR characterization.

  3. Underestimated Amoebic Appendicitis among HIV-1-Infected Individuals in Japan

    Science.gov (United States)

    Kobayashi, Taiichiro; Yano, Hideaki; Murata, Yukinori; Igari, Toru; Nakada-Tsukui, Kumiko; Yagita, Kenji; Nozaki, Tomoyoshi; Kaku, Mitsuo; Tsukada, Kunihisa; Gatanaga, Hiroyuki; Kikuchi, Yoshimi; Oka, Shinichi

    2016-01-01

    ABSTRACT Entamoeba histolytica is not a common causative agent of acute appendicitis. However, amoebic appendicitis can sometimes be severe and life threatening, mainly due to a lack of awareness. Also, its frequency, clinical features, and pathogenesis remain unclear. The study subjects were HIV-1-infected individuals who presented with acute appendicitis and later underwent appendectomy at our hospital between 1996 and 2014. Formalin-fixed paraffin-embedded preserved appendix specimens were reexamined by periodic acid-Schiff (PAS) staining and PCR to identify undiagnosed amoebic appendicitis. Appendectomies were performed in 57 patients with acute appendicitis. The seroprevalence of E. histolytica was 33% (14/43) from the available stored sera. Based on the medical records, only 3 cases were clinically diagnosed as amoebic appendicitis, including 2 diagnosed at the time of appendectomy and 1 case diagnosed by rereview of the appendix after the development of postoperative complications. Retrospective analyses using PAS staining and PCR identified 3 and 3 more cases, respectively. Thus, E. histolytica infection was confirmed in 9 cases (15.8%) in the present study. Apart from a significantly higher leukocyte count in E. histolytica-positive patients than in negative patients (median, 13,760 versus 10,385 cells/μl, respectively, P = 0.02), there were no other differences in the clinical features of the PCR-positive and -negative groups. In conclusion, E. histolytica infection was confirmed in 9 (15.8%) of the appendicitis cases. However, only 3, including one diagnosed after intestinal perforation, were diagnosed before the present analyses. These results strongly suggest there is frequently a failure to detect trophozoites in routine examination, resulting in an underestimation of the incidence of amoebic appendicitis. PMID:27847377

  4. An unusual manifestation of acute appendicitis with left flank pain

    Directory of Open Access Journals (Sweden)

    Roland Talanow, MD, PhD

    2008-08-01

    Full Text Available The author presents a case with an unusual presentation of early appendicitis. The patient presented initially with left sided flank pain. Workup for nephrolithiasis, including non-contrast CT of the abdomen and pelvis was negative for renal stones or hydronephrosis. After discharge, the patient presented one week later in the ED with right lower quadrant pain. Contrast enhanced CT of the abdomen revealed perforated appendicitis.

  5. Timely recognition of Amyand's hernia with appendicitis in infants

    Institute of Scientific and Technical Information of China (English)

    Zhen Shen; Shan Zheng

    2015-01-01

    Background: Amyand's hernia with acute appendicitis is rare in infants and is mostly delayed in diagnosis and treatment, resulting in a high morbidity. Methods: We presented two cases of infantile Amyand's hernia with acute appendicitis. Results: Early surgical interventions were performed and both patients recovered without complication. Conclusion: A practical strategy for this entity is to be aware of the rare disease and to perform early surgical exploration for suspected cases.

  6. Acute Appendicitis Complicated by Pylephlebitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Ricardo Castro

    2013-01-01

    Full Text Available Pylephlebitis is defined as septic thrombophlebitis of the portal vein. It is a rare but serious complication of an intraabdominal infection, more commonly diverticulitis and appendicitis. It has an unspecific clinical presentation and the diagnosis is difficult. The authors report a case of a 21-year-old man with acute appendicitis complicated by pylephlebitis. The diagnosis was made with contrast enhanced CT.

  7. Underestimated Amoebic Appendicitis among HIV-1-Infected Individuals in Japan.

    Science.gov (United States)

    Kobayashi, Taiichiro; Watanabe, Koji; Yano, Hideaki; Murata, Yukinori; Igari, Toru; Nakada-Tsukui, Kumiko; Yagita, Kenji; Nozaki, Tomoyoshi; Kaku, Mitsuo; Tsukada, Kunihisa; Gatanaga, Hiroyuki; Kikuchi, Yoshimi; Oka, Shinichi

    2017-01-01

    Entamoeba histolytica is not a common causative agent of acute appendicitis. However, amoebic appendicitis can sometimes be severe and life threatening, mainly due to a lack of awareness. Also, its frequency, clinical features, and pathogenesis remain unclear. The study subjects were HIV-1-infected individuals who presented with acute appendicitis and later underwent appendectomy at our hospital between 1996 and 2014. Formalin-fixed paraffin-embedded preserved appendix specimens were reexamined by periodic acid-Schiff (PAS) staining and PCR to identify undiagnosed amoebic appendicitis. Appendectomies were performed in 57 patients with acute appendicitis. The seroprevalence of E. histolytica was 33% (14/43) from the available stored sera. Based on the medical records, only 3 cases were clinically diagnosed as amoebic appendicitis, including 2 diagnosed at the time of appendectomy and 1 case diagnosed by rereview of the appendix after the development of postoperative complications. Retrospective analyses using PAS staining and PCR identified 3 and 3 more cases, respectively. Thus, E. histolytica infection was confirmed in 9 cases (15.8%) in the present study. Apart from a significantly higher leukocyte count in E. histolytica-positive patients than in negative patients (median, 13,760 versus 10,385 cells/μl, respectively, P = 0.02), there were no other differences in the clinical features of the PCR-positive and -negative groups. In conclusion, E. histolytica infection was confirmed in 9 (15.8%) of the appendicitis cases. However, only 3, including one diagnosed after intestinal perforation, were diagnosed before the present analyses. These results strongly suggest there is frequently a failure to detect trophozoites in routine examination, resulting in an underestimation of the incidence of amoebic appendicitis. Copyright © 2016 Kobayashi et al.

  8. A Rare Complication of Acute Appendicitis: Superior Mesenteric Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hendra Koncoro

    2016-12-01

    Full Text Available Superior mesenteric vein (SMV thrombosis caused by acute appendicitis is quite rare nowadays. These conditions occurs secondary to infection in the region drained by the portal venous system. In this case, we report a successfully treated case of SMV thrombosis and liver abscess associated with appendicitis with antibiotics and anticoagulant.Early diagnosis and prompt treatment are basic to a favorable clinical course.

  9. Value of ultrasonography in the diagnosis of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Seok Ho; Jung, Kun Sik; Kim, Jung Sik; Woo, Seong Ku; Chung, Ki Yong [School of Medicine, Keimyung University, Daegu (Korea, Republic of); Kim, Hee Jin [Fatima Hospital, Daegu (Korea, Republic of)

    1993-03-15

    During a 12-month period high-resolution, real-time ultrasonography (US) with graded compression was performed on 268 consecutive patients with clinically suspected acute appendicitis and its complications. US visualization of a fluid-filled, non-compressed appendix or a decompressed, thick-walled appendix was the primary criterion for a diagnosis of acute appendicitis. The sonographic findings were correlated with surgical-pathologic outcome in 92 cases and with the findings of clinical follow-ups in the remainder. US was found to be accurate in the diagnosis of acute appendicitis and its complication with a sensitivity of 93.3%, a specificity of 98.9%, and an accuracy of 97%. The predictive value of a positive test was 97.7%; that of a negative test was 96.7%. There were two false-positive examinations in patients with a thick-walled appendix or periapperdiceal abscess, which were surgically confirmed as appendiceal adenocarcinoma and perforated cecal diverticulitis respectively. There were six false-negative examinations in patients with a sonographically no-visible appendix, which were confirmed surgically as acute appendicitis (n=5) and perforated appendicitis (n=1). Our results show that high-resolution, real-time US is an accurate imaging modality in the diagnosis of acute appendicitis and the evaluation of its complications.

  10. Acute appendicitis in children: not only surgical treatment.

    Science.gov (United States)

    Caruso, Anna Maria; Pane, Alessandro; Garau, Roberto; Atzori, Pietro; Podda, Marcello; Casuccio, Alessandra; Mascia, Luigi

    2017-03-01

    An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery. Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated. Complicated appendicitis underwent early surgery; uncomplicated appendicitis started conservative treatment with antibiotic. If in the next 24-48h it was worsening, the conservative approach failed and patients underwent late surgery. A total of 362 pediatric patients were included. One hundred sixty-five underwent early appendectomy; 197 patients were at first treated conservatively: of these, 82 were operated within 24-48h for failure. The total percentage of operated patients was 68.2%. An elevated association was found between surgery and ultrasound. Conservative treatment for uncomplicated appendicitis had high percentage of success (58%). Complications in operated patients were infrequent. Our protocol was effective in order to decide which patients treat early surgically and which conservatively; specific red flags (age and onset) can identified patients at most risk of complications or conservative failure. treatment study. II. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. CT following US for possible appendicitis: anatomic coverage

    Energy Technology Data Exchange (ETDEWEB)

    O' Malley, Martin E. [University of Toronto, Princess Margaret Hospital, 3-920, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Alharbi, Fawaz [University of Toronto, Toronto General Hospital, NCSB 1C572, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Qassim University, Department of Medical Imaging, Buraydah, Qassim (Saudi Arabia); Chawla, Tanya P. [University of Toronto, Mount Sinai Hospital, Room 567, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Moshonov, Hadas [University of Toronto, Joint Department of Medical Imaging, Toronto, Ontario (Canada)

    2016-02-15

    To determine superior-inferior anatomic borders for CT following inconclusive/nondiagnostic US for possible appendicitis. Ninety-nine patients with possible appendicitis and inconclusive/nondiagnostic US followed by CT were included in this retrospective study. Two radiologists reviewed CT images and determined superior-inferior anatomic borders required to diagnose or exclude appendicitis and diagnose alternative causes. This ''targeted'' coverage was used to estimate potential reduction in anatomic coverage compared to standard abdominal/pelvic CT. The study group included 83 women and 16 men; mean age 32 (median, 29; range 18-73) years. Final diagnoses were: nonspecific abdominal pain 50/99 (51 %), appendicitis 26/99 (26 %), gynaecological 12/99 (12 %), gastrointestinal 9/99 (10 %), and musculoskeletal 2/99 (2 %). Median dose-length product for standard CT was 890.0 (range, 306.3 - 2493.9) mGy.cm. To confidently diagnose/exclude appendicitis or identify alternative diagnoses, maximum superior-inferior anatomic CT coverage was the superior border of L2-superior border of pubic symphysis, for both reviewers. Targeted CT would reduce anatomic coverage by 30-55 % (mean 39 %, median 40 %) compared to standard CT. When CT is performed for appendicitis following inconclusive/nondiagnostic US, targeted CT from the superior border of L2-superior border of pubic symphysis can be used resulting in significant reduction in exposure to ionizing radiation compared to standard CT. (orig.)

  12. Design and construction of a circulating fluidized bed combustion facility for use in studying the thermal remediation of wastes

    Science.gov (United States)

    Rink, Karl K.; Kozinski, Janusz A.; Lighty, JoAnn S.; Lu, Quing

    1994-08-01

    Fluidized bed combustion systems have been widely applied in the combustion of solid fossil fuels, particularly by the power generation industry. Recently, attention has shifted from the conventional bubbling fluidized bed (BFB) to circulating fluidized bed (CFB) combustion systems. Inherent advantages of CFB combustion such as uniform temperatures, excellent mixing, high combustion efficiencies, and greater fuel flexibility have generated interest in the feasibility of CFB combustion systems applied to the thermal remediation of contaminated soils and sludges. Because it is often difficult to monitor and analyze the combustion phenomena that occurs within a full scale fluidized bed system, the need exists for smaller scale research facilities which permit detailed measurements of temperature, pressure, and chemical specie profiles. This article describes the design, construction, and operation of a pilot-scale fluidized bed facility developed to investigate the thermal remediation characteristics of contaminated soils and sludges. The refractory-lined reactor measures 8 m in height and has an external diameter of 0.6 m. The facility can be operated as a BFB or CFB using a variety of solid fuels including low calorific or high moisture content materials supplemented by natural gas introduced into the fluidized bed through auxiliary fuel injectors. Maximum firing rate of the fluidized bed is approximately 300 kW. Under normal operating conditions, internal wall temperatures are maintained between 1150 and 1350 K over superficial velocities ranging from 0.5 to 4 m/s. Contaminated material can be continuously fed into the fluidized bed or introduced as a single charge at three different locations. The facility is fully instrumented to allow time-resolved measurements of gaseous pollutant species, gas phase temperatures, and internal pressures. The facility has produced reproducible fluidization results which agree well with the work of other researchers. Minimum

  13. Facile Synthesis of Smart Nanocontainers as Key Components for Construction of Self-Healing Coating with Superhydrophobic Surfaces

    Science.gov (United States)

    Liang, Yi; Wang, MingDong; Wang, Cheng; Feng, Jing; Li, JianSheng; Wang, LianJun; Fu, JiaJun

    2016-04-01

    SiO2-imidazoline nanocomposites (SiO2-IMI) owning high loading capacity of corrosion inhibitor, 1-hexadecyl-3-methylimidazolium bromide (HMID), and a special acid/alkali dual-stimuli-accelerated release property have been synthesized via a one-step modified Stöber method. SiO2-IMI were uniformly distributed into the hydrophobic SiO2 sol to construct "host"-"guest" feedback active coating with a superhydrophobic surface (SiO2-IMI@SHSC) on aluminium alloy, AA2024, by dip-coating technique. SiO2-IMI as "guest" components have good compatibility with "host" sol-gel coating, and more importantly, once localized corrosion occurs on the surface of AA2024, SiO2-IMI can simultaneously respond to the increase in environmental pH around corrosive micro-cathodic regions and decrease in pH near micro-anodic regions, promptly releasing HMID to form a compact molecular film on the damaged surface, inhibiting corrosion spread and executing a self-healing function. The scanning vibrating electrode technique (SVET) was applied to illustrate the suppression process of cathodic/anodic corrosion activities. Furthermore, benefiting from the superhydrophobic surface, SiO2-IMI@SHSC remained its protective ability after immersion in 0.5 M NaCl solution for 35 days, which is far superior to the conventional sol-gel coating with the same coating thickness. The facile fabrication method of SiO2-IMI simplifies the construction procedure of SiO2-IMI@SHSC, which have great potential to replace non-environmental chromate conversion coatings for practical use.

  14. Facile Synthesis of Smart Nanocontainers as Key Components for Construction of Self-Healing Coating with Superhydrophobic Surfaces.

    Science.gov (United States)

    Liang, Yi; Wang, MingDong; Wang, Cheng; Feng, Jing; Li, JianSheng; Wang, LianJun; Fu, JiaJun

    2016-12-01

    SiO2-imidazoline nanocomposites (SiO2-IMI) owning high loading capacity of corrosion inhibitor, 1-hexadecyl-3-methylimidazolium bromide (HMID), and a special acid/alkali dual-stimuli-accelerated release property have been synthesized via a one-step modified Stöber method. SiO2-IMI were uniformly distributed into the hydrophobic SiO2 sol to construct "host"-"guest" feedback active coating with a superhydrophobic surface (SiO2-IMI@SHSC) on aluminium alloy, AA2024, by dip-coating technique. SiO2-IMI as "guest" components have good compatibility with "host" sol-gel coating, and more importantly, once localized corrosion occurs on the surface of AA2024, SiO2-IMI can simultaneously respond to the increase in environmental pH around corrosive micro-cathodic regions and decrease in pH near micro-anodic regions, promptly releasing HMID to form a compact molecular film on the damaged surface, inhibiting corrosion spread and executing a self-healing function. The scanning vibrating electrode technique (SVET) was applied to illustrate the suppression process of cathodic/anodic corrosion activities. Furthermore, benefiting from the superhydrophobic surface, SiO2-IMI@SHSC remained its protective ability after immersion in 0.5 M NaCl solution for 35 days, which is far superior to the conventional sol-gel coating with the same coating thickness. The facile fabrication method of SiO2-IMI simplifies the construction procedure of SiO2-IMI@SHSC, which have great potential to replace non-environmental chromate conversion coatings for practical use.

  15. Construction

    Science.gov (United States)

    2002-01-01

    Harbor Deepening Project, Jacksonville, FL Palm Valley Bridge Project, Jacksonville, FL Rotary Club of San Juan, San Juan, PR Tren Urbano Subway...David. What is nanotechnology? What are its implications for construction?, Foresight/CRISP Workshop on Nanotechnology, Royal Society of Arts

  16. Proposed Use of a Constructed Wetland for the Treatment of Metals in the S-04 Outfall of the Defense Waste Processing Facility at the Savannah River Site

    Energy Technology Data Exchange (ETDEWEB)

    Glover, T.

    1999-11-23

    The DWPF is part of an integrated waste treatment system at the SRS to treat wastes containing radioactive contaminants. In the early 1980s the DOE recognized that there would be significant safety and cost advantages associated with immobilizing the radioactive waste in a stable solid form. The Defense Waste Processing Facility was designed and constructed to accomplish this task.

  17. A Facile Protocol for the Construction of Tricyclic Framework Tetrahydrobenzo-4-nitrobenzenesulfonate, 4-methylbenzenesulfonate and [1,8] naphthyridine Substituents from Methyl δ-Lactam

    Directory of Open Access Journals (Sweden)

    Shireen Mohammed

    2015-12-01

    Full Text Available Retraction of: A Facile Protocol for the Construction of Tricyclic Framework Tetrahydrobenzo-4-nitrobenzenesulfonate, 4-methylbenzenesulfonate and [1,8] naphthyridine Substituents from Methyl δ-Lactam/, http://dx.doi.org/10.13005/ojc/310435 by Shireen Mohammed and Maher Khalid as it was published by them without the permission of their supervisor.

  18. Issues related to the construction and operation of a geological disposal facility for nuclear fuel waste in crystalline rock - the Canadian experience

    Energy Technology Data Exchange (ETDEWEB)

    Allan, C.J.; Baumgartner, P.; Ohta, M.M.; Simmons, G.R.; Whitaker, S.H. [Atomic Energy of Canada Ltd., Pinawa, MB (Canada). Whiteshell Labs

    1997-12-31

    This paper covers the overview of the Canadian nuclear fuel waste management program, the general approach to the siting, design, construction, operation and closure of a geological disposal facility, the implementing disposal, and the public involvement in implementing geological disposal of nuclear fuel waste. And two appendices are included. 45 refs., 5 tabs., 10 figs.

  19. Facile construction of 3D graphene/MoS2 composites as advanced electrode materials for supercapacitors

    Science.gov (United States)

    Sun, Tianhua; Li, Zhangpeng; Liu, Xiaohong; Ma, Limin; Wang, Jinqing; Yang, Shengrong

    2016-11-01

    Flower-like molybdenum disulfide (MoS2) microstructures are synthesized based on three-dimensional graphene (3DG) skeleton via a simple and facile one-step hydrothermal method, aiming at constructing series of novel composite electrode materials of 3DG/MoS2 with high electrochemical performances for supercapacitors. The electrochemical properties of the samples are evaluated by cyclic voltammetry and galvanostatic charge/discharge tests. Specifically, the optimal 3DG/MoS2 composite exhibits remarkable performances with a high specific capacitance of 410 F g-1 at a current density of 1 A g-1 and an excellent cycling stability with ca. 80.3% capacitance retention after 10,000 continuous charge-discharge cycles at a high current density of 2 A g-1, making it adaptive for high-performance supercapacitors. The enhanced electrochemical performances can be ascribed to the combination of 3DG and flower-like MoS2, which provides excellent charge transfer network and electrolyte diffusion channels while effectively prevents the collapse, aggregation and morphology change of active materials during charge-discharge process. The results demonstrate that 3DG/MoS2 composite is one of the attractive electrode materials for supercapacitors.

  20. [Diagnostic difficulties in pediatric abdominal pain with potential appendicitis].

    Science.gov (United States)

    Iwańczak, Barbara; Stawarski, Andrzej; Czernik, Jerzy; Bronowickip, Krzysztof; Iwańczak, Franciszek; Pytrus, Tomasz; Klempous, Jan; Godziński, Jan

    2007-01-01

    Pediatric abdominal pain is one of the most common symptom of children brought to attention of primary care physicians and pediatric surgeons. In many children clinical symptoms may be uncharacteristic and may lead to diagnostic difficulties. Clinical analysis of children with right lower quadrant abdominal pain suspected of appendicitis or children with periappendicular mass. The histories of 14 children aged from 18 months to 17 years treated in Pediatric Clinic were analysed. All children were operated because of right lower quadrant abdominal pain or abdominal mass before admission to the Pediatric Clinic or during hospitalization in Pediatric Clinic. Intraoperatively in all children pathologies other than appendicitis were the cause of symptoms. The most often Crohn's disease were recognized (9 children), in 2 cases with concomitant other pathologies (fecal tumor of appendix in one case and with peritoneal abscess after perforation of intestinal wall). Sporadically the inflammation of the mesenterial lymph nodes caused by Yersinia infection suggested appendicitis. In one boy with ulcerative colitis, during exacerbation of the disease appendicitis complicated by rupture and peritonitis was observed. In 18-month old child with right lower quadrant abdominal mass invagination complicated by perforation of the ileum was recognized. In the case of 14-years old boy 6 months after appendectomy we observed mechanical intestinal obstruction complicated by perforation and peritonitis. Carcinoid of the appendix was the cause of abdominal pain in one child. 1. Appendicitis is the most frequent surgical etiology of the right lower quadrant pediatric abdominal pain. 2. Despite new diagnostic imagines there are no definite criteria to recognize appendicitis, in most cases physical examination and very carefull evaluation of abdominal pain are the most important. 3. All children with periappendipected of Crohn's disease. 4. All children with equivocal presentations of

  1. Inflammatory myofibroblastic tumor masquerading as perforated appendicitis

    Directory of Open Access Journals (Sweden)

    Ioanna Mazotas

    2015-11-01

    Full Text Available Inflammatory myofibroblastic tumor (IMT is a rare and histologically benign tumor that most commonly presents in pediatric patients. Abdominal IMTs often present with non-specific symptoms, and therefore they can masquerade as other more common abdominal conditions. This report describes two cases of IMT presenting as perforated appendicitis. Both cases are of young children who presented with over 48 hours of abdominal pain and who had peritonitis on examination. Pre-operative ultrasounds for both patients revealed complex free fluid. Laparoscopic evaluation demonstrated hemoperitoneum, and further exploration revealed mesenteric avulsion with abnormally thickened mesentery. Pathology confirmed IMT arising from the small bowel mesentery in both cases. Both children underwent limited bowel resection and were discharged in stable condition on a course of non-steroidal anti-inflammatory drugs (NSAIDs. Given the association of avulsed bowel to trauma, non-accidental trauma was suspected in both cases and demonstrated in one. Both patients showed complete resolution of tumor on follow-up MRI. The diagnosis of IMT must always be considered when an intra-abdominal mass is encountered as its treatment differs greatly from other neoplasms.

  2. Acute suppurative appendicitis with Blastocystis hominis

    Directory of Open Access Journals (Sweden)

    Poppy M Lintong

    2012-10-01

    Full Text Available Blastocystis hominis (B. hominis is an anaerobic protozoan parasite, which lives in human and animal ’s intestines. It is commonly found in the tropical area. The parasite is low pathogen and its infection causes gastrointestinal disease with diarrhea symptom as reported from many studies. B. hominis is rarely seen in tissue section. The clinical diagnoses are usually confirmed with the microscopic examination of the stool, which can directly detect the parasite through trichrom stain and Kinyoun acid fast technique. We reported a case of 52 years old man with abdominal pain and suspected as perforated appendicitis and tumor of appendix as the differential diagnosis. The macroscopic features of the appendix mass were 7 cm in length and 1.5-2.5 cm in diameter. The cut section showed a widening of the appendix lumen, and the distal part filled with a gelatinous mass. The microscopic examination with HE stain showed the infiltration of PMN inflammatory cells in the muscle layer of the appendix and foci of a number of round structures in the sub mucosal layer known as B. hominis. Some authors reported results from the endoscopy and biopsy examinations that B. hominis does not infiltrate in the intestinal mucosa; nevertheless, in this case we found the infiltration of the parasite towards the mucosal and sub mucosal layers of the appendix.

  3. Solitary caecum diverticulitis mimicking acute appendicitis.

    Science.gov (United States)

    Hot, Semih; Eğin, Seracettin; Gökçek, Berk; Yeşiltaş, Metin; Alemdar, Ali; Akan, Arzu; Karahan, Servet Rüştü

    2015-12-01

    Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.

  4. Non-fecalith-induced appendicitis: etiology, imaging, and pathology.

    Science.gov (United States)

    Swischuk, Leonard E; Chung, Dai H; Hawkins, Hal K; Jadhav, Siddharth P; Radhakrishnan, Ravi

    2015-12-01

    This study aims to document the imaging and pathology findings in non-fecalith-induced appendicitis. We reviewed the imaging and pathologic findings in 40 patients with histologically proven purulent appendicitis seen over a 2-year period. Findings documented were (1) total appendiceal involvement, (2) predominant appendiceal tip involvement, (3) presence of a fecalith, and (4) presence of lymphoid hyperplasia. There were a total of 40 patients, 28 males and 12 females. The age range was 2-18 years with a mean of 11.5 years. Twenty-two (55 %) patients demonstrated classic purulent appendicitis of the whole appendix, 20 (91 %) of these appendices had a fecalith. Eighteen (45 %) patients demonstrated purulent appendicitis confined to or predominately involving the tip of the appendix, and all 18 (100 %) patients demonstrated marked lymphoid hyperplasia. Only two (11 %) of these appendices had a fecalith. Overall, a fecalith was found in only 55 % of our cases, while 45 % demonstrated no fecalith, but rather marked lymphoid hyperplasia. Lymphoid hyperplasia appeared to be the underlying predisposing cause of purulent appendicitis in these cases.

  5. Dengue fever mimicking acute appendicitis: A case report.

    Science.gov (United States)

    McFarlane, M E C; Plummer, J M; Leake, P A; Powell, L; Chand, V; Chung, S; Tulloch, K

    2013-01-01

    Dengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy. A 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus. This unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery. This case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. [Acute appendicitis. Surgical and non-surgical treatment].

    Science.gov (United States)

    Souza-Gallardo, Luis Manuel; Martínez-Ordaz, José Luis

    2017-01-01

    Appendicitis represents a common disease for the surgeon with a relative risk between 7-8%. It was thought that if more time passed between diagnosis and treatment, the risk for complications, such as perforation or abscess formation, was higher; nevertheless; the evolution is variable, making necessary the development of different strategies such as antibiotic use only, interval surgery or endoscopic treatment. The purpose of this study is to make a revision in the management of appendicitis comparing conservative and surgical treatment. It is known that traditional management of appendicitis is appendectomy with a complication rate of 2.5% to 48%. Nowadays, laparoscopy is the approach of choice by many surgeons and there have proposed new invasive techniques such as endoscopic treatment with the use of prosthesis and ambulatory surgery. Antibiotic use is essential in the management of appendicitis. Its use as the only strategy to treat this disease has the purpose of lowering costs and diminishing complications related to surgery or the resection of the organ. We conclude that the ideal management of appendicitis remains controversial and it will depend of the clinical characteristics of each patient and the resources available.

  7. Facile construction of macroporous hybrid monoliths via thiol-methacrylate Michael addition click reaction for capillary liquid chromatography.

    Science.gov (United States)

    Lin, Hui; Ou, Junjie; Liu, Zhongshan; Wang, Hongwei; Dong, Jing; Zou, Hanfa

    2015-01-30

    A facile approach based on thiol-methacrylate Michael addition click reaction was developed for construction of porous hybrid monolithic materials. Three hybrid monoliths were prepared via thiol-methacrylate click polymerization by using methacrylate-polyhedral oligomeric silsesquioxane (POSS) (cage mixture, n=8, 10, 12, POSS-MA) and three multi-thiol crosslinkers, 1,6-hexanedithiol (HDT), trimethylolpropane tris(3-mercaptopropionate) (TPTM) and pentaerythritol tetrakis(3-mercaptopropionate) (PTM), respectively, in the presence of porogenic solvents (n-propanol and PEG 200) and a catalyst (dimethylphenylphosphine, DMPP). The obtained monoliths possessed high thermal and chemical stabilities. Besides, they all exhibited high column efficiencies and excellent separation abilities in capillary liquid chromatography (cLC). The highest column efficiency could reach ca. 195,000N/m for butylbenzene on the monolith prepared with POSS-MA and TPTM (monolith POSS-TPTM) in reversed-phase (RP) mode at 0.64mm/s. Good chromatographic performance were all achieved in the separations of polycyclic aromatic hydrocarbons (PAHs), phenols, anilines, EPA 610 as well as bovine serum albumin (BSA) digest. The high column efficiencies in the range of 51,400-117,000N/m (achieved on the monolith POSS-PTM in RP mode) convincingly demonstrated the high separation abilities of these thiol-methacrylate based hybrid monoliths. All the results demonstrated the feasibility of the phosphines catalyzed thiol-methacrylate Michael addition click reaction in fabrication of monolithic columns with high efficiency for cLC applications. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. More than one-third of successfully nonoperatively treated patients with complicated appendicitis experienced recurrent appendicitis: Is interval appendectomy necessary?

    Science.gov (United States)

    Tanaka, Yujiro; Uchida, Hiroo; Kawashima, Hiroshi; Fujiogi, Michimasa; Suzuki, Keisuke; Takazawa, Shinya; Deie, Kyoichi; Amano, Hizuru; Iwanaka, Tadashi

    2016-12-01

    Although nonoperative treatment (non-OPT) for complicated appendicitis is performed widely, the long-term outcomes and merits of interval appendectomy (IA) need to be evaluated. Between April 2007 and December 2013, all appendicitis patients with well-circumscribed abscess or phlegmon were required to select either laparoscopic surgery (OPT) or non-OPT with optional IA on admission. Optional IA was planned at ≥3months after non-OPT. For non-OPT, intravenous injection of antibiotics was continued until the serum C-reactive protein concentration decreased to appendicitis at recurrence, they visited the hospital earlier than at the initial appendicitis and had less inflammation. Readmission rate or complications in patients undergoing IA were not different compared with those of the patients in the non-IA group, who had recurrence at ≥3months, or with those of patients in the OPT group. Although many patients experienced recurrent appendicitis after successful nonoperative treatment, IA may not be necessary after non-OPT. Prospective comparative study, level II. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Simultaneous acute appendicitis and pseudomembranous colitis in a pediatric patient.

    Science.gov (United States)

    Vidrine, Steven R; Cortina, Chandler; Black, Marissa; Vidrine, Steven B

    2012-01-01

    Acute appendicitis is a common cause for pediatric surgery, with an increasing incidence as this population ages. Pseudomembranous colitis (PMC) from Clostridum difficle is being seen more frequently in pediatric patients, especially after treatment with antibiotics and in those with Hirschsprung's disease. Only three prior cases of appendicitis associated with PMC have been described in the literature, and all of them occurred in adult patients. Here, we describe the first documented pediatric case: a 16-year-old female who developed acute appendicitis while concomitantly being treated for suspected pseudomembranous colitis. We concur with previous authors that there may be an association between these two pathologies; furthermore, this association may not always be clinically apparent and may be both under-diagnosed and under-reported.

  10. Acute neonatal appendicitis: a diagnosis to consider in abdominal sepsis.

    Science.gov (United States)

    Arias-Llorente, R P; Flórez-Díez, P; Oviedo-Gutiérrez, M; Suárez-Rodríguez, M; Costa-Romero, M; Solís-Sánchez, G; García-López, E

    2014-01-01

    Appendicitis in the neonatal period is extremely rare. Its low incidence together with non-specific clinical symptoms often mean the diagnosis is delayed, leading to increased rates of peritonitis and mortality. We report the case of a 33-week premature infant, small for gestational age (1180 g at birth), clinically stable and receiving exclusive enteral feeding, who presented clinical manifestations of necrotizing enterocolitis at 14 days of life. Acute phase reactants were elevated and abdominal radiography showed pneumoperitoneum. Laparotomy revealed acute perforated appendicitis without intestinal involvement and purulent fluid in the peritoneum, for which appendectomy was performed. Neonatal acute appendicitis should be considered in the differential diagnosis of abdominal sepsis since early diagnosis and treatment significantly reduce associated morbidity and mortality.

  11. Laparoscopic management of acute appendicitis in situs inversus

    Directory of Open Access Journals (Sweden)

    Golash Vishwanath

    2006-01-01

    Full Text Available Situs inversus is often detected incidentally in adults during imaging for a acute surgical emergency. We present a case of acute appendicitis in an adult who was previously unaware about his situs anomaly. A laparoscopic approach is helpful to deal with this condition. A 40 year old man was admitted with history of acute left lower abdominal pain, with uncontrolled diabetic keto-acidosis. Clinically, he was diagnosed as acute diverticulitis with localized peritonitis. Subsequent imaging studies and laparoscopy confirmed the diagnosis of situs inversus and acute left- sided appendicitis. He successfully underwent laparoscopic appendectomy. His postoperative recovery was uneventful. Although technically more challenging because of the reverse laparoscopic view of the anatomy, the laparoscopic diagnosis and management of acute appendicitis is indicated in situs inversus.

  12. CT diagnosis of suspected acute appendicitis in adult patients

    Energy Technology Data Exchange (ETDEWEB)

    Yamase, Hiroshi; Sahashi, Kiyomi; Kawai, Masayuki; Kishida, Yoshihiko; Sumida, Kei; Kawamura, Ken-ichi [Gifu Syakaihoken Hospital (Japan)

    1998-06-01

    In order to assess the CT diagnosis of suspected acute appendicitis, we performed abdominal contrasted CT measurements in 77 patients from 20 to 86 years old, and of 50 men and 27 women from June 1993 to June 1996. The surgical findings were compared with the preoperative CT findings. By the preoperative CT imaging, we can know the degree and the position of inflammation in appendix vermiformis and the degree and the spread of periappendicular inflammation in the case of appendicitis, and can make a differential diagnosis of diverticulitis or gynecological diseases from appendicitis. It is important to make a preoperative diagnosis by the objectively excellent abdominal CT imaging and to avoid unnecessary surgery. (K.H.)

  13. Imaging of appendicitis in adults; Bildgebung der Appendizitis beim Erwachsenen

    Energy Technology Data Exchange (ETDEWEB)

    Karul, M.; Berliner, C.; Keller, S.; Yamamura, J. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology; Tsui, T.Y. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of General, Visceral- and Thoracic Surgery

    2014-06-15

    Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2 mm, cross-sectional diameter greater than 6 mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance. (orig.)

  14. Perforation rate in acute appendicitis: association with different risk facotrs

    Directory of Open Access Journals (Sweden)

    B. Khorasani

    2006-08-01

    Full Text Available Background: The early diagnosis of acute appendicitis before progression to gangrene or abscess formation is recognized as important to minimize morbidity from this common disease process. The aim of this study was to assess the value of different risk factors in the diagnosis of perforation. Methods: This descriptive-analytic and retrospective study was conducted to investigate epidemiological characteristics in patients with perforated and non-perforated appendicitis. A series of 1311 patients who were operated on for acute appendicitis between years 1380-1382 in Shahid Beheshti and Yahya-nejad hospitals were reviewed.. Data gathered included age at operation, gender, care sought prior to admission for appendectomy including antibiotic and analgesic therapy, time of presentation in the year, duration of symptoms, signs and symptoms at the time of admission, and the patient’s living area. Results: One hundred twenty one of 1311 patients (9% had perforated appendicitis and 1190 patients (91% had unperforated appendicitis. Presentation and referral in the first 6-month was associated with higher perforation rate. Patients from rural area showed a higher rate of perforations. The perforation rate was significantly higher in elderly patients (>65 year. When the duration of symptoms was more than 12 hours at presentation, the risk of perforation showed a five-fold increase. 30.7% of perforated cases had used antibiotic or sedative before referring to the hospital. Conclusion: Appendiceal perforation continues to be a complication in patients with acute appendicitis and increased in the frequency as the age of the patients increase and the duration of symptoms lengthen. We also found that the perforation rate is higher in patients from rural area and in whom present in the first 6-month of the year, a finding that was not reported so far.

  15. MRI for clinically suspected pediatric appendicitis: an implemented program

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Gustas, Cristy N.; Choudhary, Arabinda K.; Methratta, Sosamma T.; Hulse, Michael A.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Department of Radiology, Mail Code H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Geeting, Glenn [Penn State Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, PA (United States)

    2012-09-15

    Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized. To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis. A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results. Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients. MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation. (orig.)

  16. Appendiceal diverticulitis and acute appendicitis: differences and similarities

    Directory of Open Access Journals (Sweden)

    Irene Lobo-Machín

    2014-08-01

    Full Text Available Introduction: Acute appendiceal diverticulitis is an unusual cause of acute abdomen, considered clinically indistinguishable from acute appendicitis. Material and methods: In a historic cohort study with 27 cases of appendiceal diverticulitis and 54 cases of acute appendicitis, we compared clinical characteristics, diagnostic tests and pathology findings of the two processes. Results: Mean age at presentation was lower in acute appendicitis (37.24 ± 19.98 vs. 54.81 ± 17.55 years, p < 0.001, with significant differences between men (33.33 ± 15.89 vs. 57 ± 18.02 years, p < 0.001 but not between women (41.76 ± 24.87 vs. 50.44 ± 16.69 years, p = 0.34. In the diverticulitis group, 48.15 % had leukocytosis vs. 81.48 % in the appendicitis group (p = 0.02; there was no difference in leukocyte count (13770.37 ± 4382.55 vs. 14279.63 ± 4268.59, p = 0.61. Patients with appendiceal diverticulitis had a higher incidence of appendiceal mucocele (p = 0.01 and a lower proportion of appendiceal gangrene (p = 0.03. There were no differences in appendiceal perforation or ulceration. Symptom duration before emergency department attendance (71.61 ± 85.25 hours vs. 36.84 ± 33.59 hours; Z = -3.1 p = 0.002, duration of surgery (85 ± 40 minutes vs. 60 ± 21 minutes, Z = -3.2, p = 0.001 and the presence of appendicular plastron was higher in patients with diverticulitis vs. appendicitis (8 vs. 5 patients (p = 0.01, Odds ratio 2.2. Conclusions: Appendiceal diverticulitis presents a series of clinical, epidemiological and pathological differences with respect to acute appendicitis. The former shows a more indolent course with delayed diagnosis.

  17. COMPARISON BETWEEN RIPASA AND ALVARADO SCORING IN DIAGNOSING ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Balakrishnan Subramani

    2017-02-01

    Full Text Available BACKGROUND Acute appendicitis is one of the most common cause of acute abdominal pain and emergency appendicectomy is the most common emergency surgery. The diagnosis of appendicitis is confirmed by histopathological examination that is not possible before appendicectomy. The negative exploration remains high in the rate of about 15-30%. 1 Scoring systems based on history, clinical examination and basic investigations are there in aiding the diagnosis of acute appendicitis and decreasing negative exploration. This study compares RIPASA and ALVARADO scoring systems in diagnosing acute appendicitis. 2 MATERIALS AND METHODS A comparative study was done between November 2014 to June 2015. Patients diagnosed as acute appendicitis in Department of General Surgery, Government Royapettah Hospital. 100 of them are to be selected on the basis of nonprobability (purposive sampling method. After considering the inclusion and exclusion criteria, 96 were enrolled into the study. A full history, clinical examination and both scoring systems were done on the patients. RESULTS In 96 patients, 46 patients (48% were male and 50 patients (52% were female. 65 patients underwent emergency appendicectomy based on the clinical decision. The sensitivity and specificity of the RIPASA scoring system was 98.0% and 80.43%, respectively. The sensitivity and specificity of the ALVARADO scoring system was 80.43% and 86.95%, respectively. The PPV (positive predictive value of RIPASA and ALVARADO was 84% and 85%, respectively. The NPP (negative predictive value of RIPASA and ALVARADO was 97% and 71%, respectively. The diagnostic accuracy was 89% for RIPASA and 77% for ALVARADO. CONCLUSION The RIPASA scoring is better than ALVARADO scoring in the diagnosis of acute appendicitis.

  18. Disparities in appendicitis rupture rate among mentally ill patients

    Directory of Open Access Journals (Sweden)

    Bai Ya-Mei

    2007-11-01

    Full Text Available Abstract Background Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency. Our population-based study was to test for any possible association between mental illness and perforated appendicitis. We hypothesized that there are significant disparities in access to timely surgical care between appendicitis patients with and without mental illness, and more specifically, between patients with schizophrenia and those with another major mental illness. Methods Using the National Health Insurance (NHI hospital-discharge data, we compared the likelihood of perforated appendix among 97,589 adults aged 15 and over who were hospitalized for acute appendicitis in Taiwan between the years 1997 to 2001. Among all the patients admitted for appendicitis, the outcome measure was the odds of appendiceal rupture vs. appendicitis that did not result in a ruptured appendix. Results After adjusting for age, gender, ethnicity, socioeconomic status (SES and hospital characteristics, the presence of schizophrenia was associated with a 2.83 times higher risk of having a ruptured appendix (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.20–3.64. However, the presence of affective psychoses (OR, 1.15; 95% CI: 0.77–1.73 or other mental disorders (OR, 1.58; 95% CI: 0.89–2.81 was not a significant predictor for a ruptured appendix. Conclusion These findings suggest that given the fact that the NHI program reduces financial barriers to care for mentally ill patients, they are still at a disadvantage for obtaining timely treatment for their physical diseases. Of patients with a major mental illness, schizophrenic patients may be the most vulnerable ones for obtaining timely surgical care.

  19. Cost and schedule estimate to construct the tunnel and shaft remedial shielding concept, Los Alamos Meson Physics Facility, Los Alamos National Laboratory, Los Alamos, New Mexico. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-11-30

    The report provides an estimate of the cost and associated schedule to construct the tunnel and shaft remedial shielding concept. The cost and schedule estimate is based on a preliminary concept intended to address the potential radiation effects on Line D and Line Facilities in event of a beam spill. The construction approach utilizes careful tunneling methods based on available excavation and ground support technology. The tunneling rates and overall productivity on which the cost and project schedule are estimated are based on conservative assumptions with appropriate contingencies to address the uncertainty associated with geological conditions. The report is intended to provide supplemental information which will assist in assessing the feasibility of the tunnel and shaft concept and justification for future development of this particular aspect of remedial shielding for Line D and Line D Facilities.

  20. Acute leukemic appendicitis in a patient with acute promyelocytic leukemia

    Directory of Open Access Journals (Sweden)

    Hatim Karachiwala

    2012-01-01

    Full Text Available Leukemic and lymphomatous infiltration of the appendix is a rare complication. We present the case of a 31-year-old male with acute promyelocytic leukemia who developed acute abdomen on day 11 of induction chemotherapy with idarubicin and cytarabine. After appropriate work-up, a clinical diagnosis of acute appendicitis was made. Despite severe pancytopenia, he successfully underwent laparoscopic appendectomy. The final pathology revealed leukemic infiltration of the appendix. It is hypothesized that the leukemic infiltration may play a role in the development of acute appendicitis. Further, this case demonstrates the need to maintain a high index of suspicion and prompt surgical intervention for surgical pathologies in neutropenic patients.

  1. Imaging findings of perforative appendicitis: a pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Hopkins, K.L.; Patrick, L.E.; Ball, T.I. [Dept. of Radiology, Children' s Healthcare of Atlanta, Egleston, GA (United States)

    2001-03-01

    Appendicitis is common in children. Early diagnosis depends on recognition of characteristic signs and symptoms: right lower quadrant or periumbilical pain, localized tenderness, fever, and leukocytosis. Because these classic features may be difficult to elicit or masked by other complaints, the incidence of perforative appendicitis in children is high. This paper reviews the imaging sequelae with emphasis on CT and sonography findings. Areas of focus include abdominopelvic abscess, peritonitis, pyelephlebitis, pyelethrombosis, and hepatic abscess. Secondary involvement of the urinary and gastrointestinal tracts is also discussed. (orig.)

  2. Crohn's disease and recurrent appendicitis: A case report

    Institute of Scientific and Technical Information of China (English)

    Ron Shaoul; Yosi Rimar; Aurora Toubi; Jorge Mogilner; Reuven Polak; Michael Jaffe

    2005-01-01

    The clinical diagnosis of classic Crohn's disease (CD)of the small bowel is based on a typical history, tender right lower quadrant fullness or mass, and characteristic radiographic findings of the terminal ileum. Appendicitis may as well present with chronic or recurrent symptoms and this presentation may be confused with CD. We herein describe the case of a young teenage girl with a presumptive diagnosis of CD, who was ultimately diagnosed as having chronic nongranulomatous appendicitis. The literature on the subject is reviewed.

  3. Case report of recurrent acute appendicitis in a residual tip.

    LENUS (Irish Health Repository)

    O'Leary, Donal P

    2010-01-01

    INTRODUCTION: Residual appendicitis involving the stump of the appendix has been well described in the literature in the past. CASE REPORT: We report the case of a 43 year old male with acute onset of abdominal pain who had undergone an appendicectomy ten years previously. Ultrasound revealed the presence of an inflamed tubular structure. Subsequent laparotomy and histology confirmed that this structure was an inflamed residual appendiceal tip. CONCLUSION: Residual tip appendicitis has not been reported in the literature previously and should be considered in the differential diagnosis of localised peritonitis in a patient with a history of a previous open appendicectomy.

  4. Acute appendicitis mistaken as acute rejection in renal transplant recipients.

    Directory of Open Access Journals (Sweden)

    Talwalkar N

    1994-01-01

    Full Text Available Case histories of 2 renal transplant recipients are reported who had presenting features of fever, leukocytosis and pain/tenderness over right iliac fossa and were diagnosed to be due to acute appendicitis rather than more commonly suspected acute rejection episode which has very similar features. Diagnosis of acute appendicitis was suspected on the basis of rectal examination and later confirmed by laparotomy. The purpose of this communication is to emphasize the need for proper diagnosis in patient with such presentation; otherwise wrong treatment may be received.

  5. Oral antibiotics for perforated appendicitis is not recommended

    DEFF Research Database (Denmark)

    Gögenur, Ismail; Rosenberg, Jacob; Alamili, Mahdi

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...... was to give an overview of studies on acute perforated appendicitis with postoperative oral antibiotics. Five studies were found in a database search covering the 1966-2009 period. There is no evidence to support a conversion of the postoperative antibiotic regimen from intravenous to oral administration...

  6. Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases

    Directory of Open Access Journals (Sweden)

    Kurtulus Idris

    2008-04-01

    Full Text Available Abstract Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum.

  7. [Causes of late diagnosis of appendicitis in children].

    Science.gov (United States)

    Zlámal, Z

    1996-07-01

    The author evaluates the case-history of 51 children with perforated appendicitis treated during 1984-1995 at the First Surgical Clinic of the Faculty Hospital Olomouc. The purpose was to find an answer to the problem why in these children the diagnosis was delayed and whose was the fault of the substantial deterioration of the health status. In the evaluation four groups of causal responsibility are differentiated: a very rapid development of appendicitis-parents, arriving late in the surgery-paediatricians-surgeons. The authors discuss circumstances associated with the diagnostic error and delay.

  8. Does breast feeding provide protection against acute appendicitis? A case-control study.

    Science.gov (United States)

    Alves, João Guilherme Bezerra; Figueiroa, José Natal; Barros, Isabela

    2008-10-01

    Breast feeding stimulates a more tolerant lymphoid tissue at the base of the appendix and this could provide protection against acute appendicitis. Two studies reported that children and adolescents with appendicitis were less likely to have been breast fed. In a case-control study of 200 children with histologically confirmed acute appendicitis matched by 200 siblings with the same sex and difference age - up to three-year-old - we found breast feeding in at least the first two months of life and for more than four months provides protection against acute appendicitis. These findings suggesting that breast feeding may possibly give protection against the development of appendicitis.

  9. Supplemental information for a notice of construction for the Fueled Clad Fabrication System, the Radioisotope Power Systems Facility, and the Fuel Assembly Area

    Energy Technology Data Exchange (ETDEWEB)

    1989-08-01

    This ''Notice of Construction'' has been submitted by the US Department of Energy-Richland Operations Office (P.O. Box 550, Richland, Washington 99352), pursuant to WAC 402-80-070, for three new sources of radionuclide emissions at the Hanford Site in Washington State (Figure 1). The three new sources, the Fueled Clad Fabrication System (FCFS) the Radioisotope Power Systems Facility (RPSF) and the Fuel Assembly Area (FAA) will be located in one facility, the Fuels and materials Examination Facility (FMEF) of the 400 Area. The FMEF was originally designed to provide for post- irradiation examination and fabrication of breeder reactor fuels. These FMEF missions were cancelled before the introduction of any fuel materials or any irradiated material. The current plans are to use the facility to fabricate power supplies to be used in space applications and to produce Fast Flux Test Facility (FFTF) fuel and target assemblies. The FCFS and the RPSF will produce materials and assemblies for application in space. The FAA project will produce FFTF fuel and target assemblies. The FCFS and the RPSF will share the same building, stack, and, in certain cases, the same floor space. Given this relationship, to the extent possible, these systems will be dealt with separately. The FAA is a comparatively independent operation though it will share the FMEF complex.

  10. 75 FR 17859 - Grants to States for Construction or Acquisition of State Home Facilities-Update of Authorized Beds

    Science.gov (United States)

    2010-04-08

    ... Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse..., Health facilities, Health professions, Health records, Homeless, Medical and dental schools, Medical devices, Medical research, Mental health programs, Nursing homes, Reporting and recordkeeping requirements...

  11. Sonographic Differentiation of Complicated From Uncomplicated Appendicitis: Implications for Antibiotics-First Therapy.

    Science.gov (United States)

    Xu, Yingding; Jeffrey, R Brooke; Chang, Stephanie T; DiMaio, Michael A; Olcott, Eric W

    2017-02-01

    To evaluate sonographic findings as indicators of complicated versus uncomplicated appendicitis in the setting of known appendicitis, a necessary distinction in deciding whether to proceed with antibiotic therapy or with appendectomy. With Institutional Review Board approval and Health Insurance Portability and Accountability Act compliance, appendiceal sonograms of 119 patients with histopathologically proven appendicitis were retrospectively blindly reviewed to determine the presence or absence of the normally echogenic submucosal layer, the presence of mural hyperemia, periappendiceal fluid, appendicoliths, and hyperechoic periappendiceal fat and to determine the maximum outside diameter. Results were compared with the presence of complicated versus uncomplicated appendicitis on histopathologic examination and assessed by both univariate and mulitvariate logistic regression; confidence intervals (CIs) of proportions were assessed by the exact binomial test. Thirty-two (26.9%) of the 119 patients had complicated appendicitis, including 11 with gangrenous appendicitis without perforation and 21 with gangrenous appendicitis and perforation. Loss of the submucosal layer was the only independent significant indicator of complicated appendicitis in multivariate regression (P appendicitis, being the only finding independently and significantly associated with complicated appendicitis and, additionally, providing both high sensitivity and high specificity. This information may help a physician decide whether to proceed with antibiotic therapy or with appendectomy when treating a patient with appendicitis. © 2016 by the American Institute of Ultrasound in Medicine.

  12. Association between Gastroesophageal Reflux Disease and Appendicitis: A Population-Based Case-Control Study.

    Science.gov (United States)

    Kao, Li-Ting; Tsai, Ming-Chieh; Lin, Herng-Ching; Lee, Cha-Ze

    2016-03-02

    Appendicitis and gastroesophageal reflux disease (GERD) are both prevalent diseases and might share similar pathological mechanisms. The aim of this study was to investigate the association between GERD and appendicitis using a large population-based dataset. This study used administrative claims data from the Taiwan Longitudinal Health Insurance Database 2005. We identified 7113 patients with appendicitis as cases, and 28452 matched patients without appendicitis as controls. This study revealed that GERD was found in 359 (5.05%) cases and 728 (2.56%) controls (p appendicitis were 1.96 (95% CI: 1.56~2.47), 2.36 (95% CI: 1.94~2.88), and 1.71 (95% CI: 1.31~2.22) than controls, respectively. We concluded that patients with appendicitis had higher odds of prior GERD than those without appendicitis regardless of age group.

  13. Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?

    DEFF Research Database (Denmark)

    Andersson, Manne; Rubér, Marie; Ekerfelt, Christina;

    2014-01-01

    , and myeloperoxidase [MPO]) were compared with traditional diagnostic variables included in the Appendicitis Inflammatory Response (AIR) score (right iliac fossa pain, vomiting, rebound tenderness, guarding, white blood cell [WBC] count, proportion neutrophils, C-reactive protein and body temperature) in 432 patients...

  14. Complicated appendicitis: Analysis of risk factors in children

    Directory of Open Access Journals (Sweden)

    Mahavir Singh

    2014-01-01

    Full Text Available Background: Acute appendicitis (AA is the most common surgical emergency in childhood. The risk of rupture is negligible within the first 24 h, climbing to 6% after 36 h from the onset of symptoms. Because of difficulty in accurate diagnosis of AA a significant number of children still are being managed when it is already perforated. There is always a need to make an early diagnosis of AA and to find out the risk factors associated with development of complication in this condition. Patients and Methods: A total of 102 patients with a clinical diagnosis of AA were admitted during the study period. On admission, a good clinical history and proper physical examination was performed. All the eligible patients who finally diagnosed clinically as having AA were planned for emergency open appendectomy. The removed appendix was sent for histopathological examination in all the study subjects. Results: Out of 102 cases, 93 cases were histopathologically appendicitis, rest nine cases showed no evidence of inflammation so the rate of negative appendectomy was around 9%. On histopathology normal appendix was found in nine patients (8.9%, AA in 71 patients (69.6%, complicated appendicitis (CA which includes perforated and gangrenous appendicitis was present in 22 patients (21.5%. Perforations were more common in patients who were younger than 5 years. >60% patients presented with CA when the duration of pain was >72 h. Presence of appendicolith increased the probability of CA.

  15. Torsion of an Epiploic Appendix Pretending as Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Kamran Ahmad Malik

    2010-07-01

    Full Text Available Torsion of an epiploic appendix is a rare surgical entity. Its unusual symptomatology, wide variation in physical findings and the absence of helpful laboratory and radiological studies makes it very difficult to diagnose pre-operatively. This is a report of this rare entity found in a patient upon diagnostic laparoscopy performed for suspected acute appendicitis

  16. Venstresidig appendicitis forårsaget af intestinal malrotation

    DEFF Research Database (Denmark)

    Ilangkovan, Nivethitha; Rindom, Alesia; Mogensen, Christian Backer

    2013-01-01

    Left-sided appendicitis due to malrotation is a rare condition with an atypical presentation. We report a history of a 31-year-old man who had four days of right-sided abdominal pain, moving across lower abdomen and tenderness in both right and left side on examination. A computed tomography...

  17. Acute appendicitis following endoscopic mucosal resection of cecal adenoma.

    Science.gov (United States)

    Nemoto, Yukako; Tokuhisa, Junya; Shimada, Nagasato; Gomi, Tatsuya; Maetani, Iruru

    2015-07-21

    Endoscopic mucosal resection (EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right -lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm(3), a neutrophil count of 14144/mm(3), and a C-reactive protein level of 2.20 mg/dL, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis.

  18. Ileocecocolic Intussusception Induced by Acute Appendicitis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jo, Bang Sil; Kim, Min Jeong; Jang, Kyung Mi; Lee, Hyun; Jeon, Eui Yong; Lee, Kwan Seop; Lee, Yul [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2009-09-15

    Intussusception is a rare disease in adults. Moreover, appendiceal disease is very rarely the leading cause of adult intussusception. We report a case in which ileocecocolic intussusception is secondary to an acute appendicitis in an adult, and describe the radiologic, clinical, and pathologic findings.

  19. Oral antibiotics for perforated appendicitis is not recommended

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this pap...

  20. Recovery and convalescence after laparoscopic surgery for appendicitis

    DEFF Research Database (Denmark)

    Kleif, Jakob; Vilandt, Jesper; Gögenur, Ismail

    2016-01-01

    BACKGROUND: Information about predictors for the duration of convalescence and the overall general wellbeing after laparoscopic surgery for suspected appendicitis is missing in the scientific literature. We aimed to describe and identify predictors for the duration of convalescence and the qualit...

  1. O knowledge, where art thou? Evidence and suspected appendicitis.

    Science.gov (United States)

    Boehnert, Markus U; Zimmermann, Heinz; Exadaktylos, Aristomenis K

    2009-12-01

    Much effort goes into developing and publishing guidelines which physicians fail to implement. We feel that major discrepancies still exist between theory and reality and that the translational approach to this aspect of medical care has not yet established itself. We therefore decided to investigate in an exemplary audit how liberally inappropriate imaging is used in our emergency department (ED) to rule out acute appendicitis. Our electronic medical record ED database 'Qualicare' (http://www.qualidoc.ch) was searched using the 'appendicitis' sub data base. The frequency and accuracy of abdominal imaging was determined in patients with clinically suspected appendicitis on admission over a 5-year period at a university hospital emergency unit. In total, 272 (41.2%) of the 577 patients were male and 305 (46.3%) were female. The attending physicians ordered abdominal X-rays in 133 patients, abdominal ultrasounds in 319, and abdominal computerized tomography (CT) scans in 93 patients. 125 patients underwent more than one imaging procedure. In all, 85/125 patients received a combination of X-rays, ultrasound and CT scanning! Physicians are often insecure about indications for surgery and therefore order useless imaging procedures. The reliability of such procedures in excluding acute appendicitis is limited, which was confirmed by our results. Although evidence-based medicine guidelines exist, they are neglected for many reasons. Future academic efforts should therefore focus more on knowledge translation and the implementation of existing knowledge by heightening awareness, rather than on simply creating new guidelines.

  2. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis.

    Science.gov (United States)

    Di Saverio, Salomone; Birindelli, Arianna; Kelly, Micheal D; Catena, Fausto; Weber, Dieter G; Sartelli, Massimo; Sugrue, Michael; De Moya, Mark; Gomes, Carlos Augusto; Bhangu, Aneel; Agresta, Ferdinando; Moore, Ernest E; Soreide, Kjetil; Griffiths, Ewen; De Castro, Steve; Kashuk, Jeffry; Kluger, Yoram; Leppaniemi, Ari; Ansaloni, Luca; Andersson, Manne; Coccolini, Federico; Coimbra, Raul; Gurusamy, Kurinchi S; Campanile, Fabio Cesare; Biffl, Walter; Chiara, Osvaldo; Moore, Fred; Peitzman, Andrew B; Fraga, Gustavo P; Costa, David; Maier, Ronald V; Rizoli, Sandro; Balogh, Zsolt J; Bendinelli, Cino; Cirocchi, Roberto; Tonini, Valeria; Piccinini, Alice; Tugnoli, Gregorio; Jovine, Elio; Persiani, Roberto; Biondi, Antonio; Scalea, Thomas; Stahel, Philip; Ivatury, Rao; Velmahos, George; Andersson, Roland

    2016-01-01

    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

  3. Necrotizing fasciitis caused by perforated appendicitis: a case report.

    Science.gov (United States)

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.

  4. New synthetic strategies for xanthene-dye-appended cyclodextrins

    Directory of Open Access Journals (Sweden)

    Milo Malanga

    2016-03-01

    Full Text Available Xanthene dyes can be appended to cyclodextrins via an ester or amide bridge in order to switch the fluorescence on or off. This is made possible through the formation of nonfluorescent lactones or lactams as the fluorophore can reversibly cyclize. In this context we report a green approach for the synthesis of switchable xanthene-dye-appended cyclodextrins based on the coupling agent 4-(4,6-dimethoxy-1,3,5-triazin-2-yl-4-methylmorpholinium chloride (DMT-MM. By using 6-monoamino-β-cyclodextrin and commercially available inexpensive dyes, we prepared rhodamine- and fluorescein-appended cyclodextrins. The compounds were characterized by NMR and IR spectroscopy and MS spectrometry, their UV–vis spectra were recorded at various pH, and their purity was determined by capillary electrophoresis. Two potential models for the supramolecular assembly of the xanthene-dye-appended cyclodextrins were developed based on the set of data collected by the extensive NMR characterization.

  5. Laparoscopic appendectomy in complicated appendicitis: Is it safe?

    Directory of Open Access Journals (Sweden)

    Ashraf A Mohamed

    2013-01-01

    Full Text Available Background: Because of lack of good evidence supporting laparoscopic approach for complicated appendicitis, we carried out this study to evaluate efficacy of laparoscopic appendectomy (LA in management of patients with complicated appendicitis. Materials and Methods: This study was carried out in Surgical Department, Minia University, Egypt involving 214 patients underwent appendectomy for complicated appendicitis over three years. 132 patients underwent LA and remaining 82 patients underwent OA. Parameters studied included operating time, return to oral feeding, postoperative pain, wound infection, intra-abdominal abscess, duration of abdominal drainage and hospital stay. Results: There were four conversions, two due to extensive cecal adhesions and two due to friable appendix. LA took longer time to perform (p = 0.0002 but with less use of analgesics (p < 0.0001, shorter hospital stay (p < 0.0001, shorter duration of abdominal drainage (p < 0.0001 and lower incidence of wound infection (p = 0.0005. Nine patients in LA and seven patients in OA group developed intra-abdominal abscess treated successfully with sonographic guided percutaneous drainage. Postoperative ileus was recorded in two patients in LA group and three patients in OA group, chest infection in one patient in OA group, hernia in one patient in LA and fecal fistula was present in one patient in OA. Overall complications were significantly lower in laparoscopy group and managed conservatively with no mortality in either group. Conclusions: LA in complicated appendicitis is feasible and safe with lower incidence of complications than OA and should be the initial choice for all patients with complicated appendicitis.

  6. [Immunotherapy for the treatment of acute appendicitis in children].

    Science.gov (United States)

    Bulanova, A A; Akhanzaripov, Z A

    1994-08-01

    The immune status was studied during the development of the disease in 182 children who were operated on for acute appendicitis. T lymphocytes and their subpopulations circulating in the blood, as well as B lymphocytes, immunoglobulins A, M, G, and immune complexes were determined. The character of changes of these values before the operation and in various postoperative periods were determined. The effect of complex treatment, including T-activin, on the clinical and immunological parameters in children with acute appendicitis was appraised. Analysis of the results showed that a transitory immunodepressive state forms in children with the disease, which is more marked in the destructive form, with normalization of the main values of cell-mediated and humoral immunity by the 7th day after appendectomy. In a complicated course of acute appendicitis the state of immunodeficiency is torpid in character and does not return to normal values even after clinical recovery, i.e. before discharge from the clinic. Inclusion of the immunostimulating agent T-activin into the complex treatment of patients with appendicitis ensures a more rapid involution of the main clinical manifestations of the disease. The therapeutic effect was most pronounced in destructive appendicitis: after 3 days of treatment the pain syndrome was encountered twice less frequently and intestinal paresis more than twice less frequently in these patients, and the term of hospital stay (8.8 +/- 0.4 days) was less shorter than for children of the control group (12.2 +/- 1.9 days) who did not receive T-activin in the therapeutic complex.

  7. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Chabanova, Elizaveta, E-mail: elcha@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Balslev, Ingegerd, E-mail: inbal@heh.regionh.dk [Department of Pathology, Copenhagen University Hospital at Herlev (Denmark); Achiam, Michael, E-mail: micach01@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Nielsen, Yousef W., E-mail: yujwni01@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Adamsen, Sven, E-mail: svad@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Gocht-Jensen, Peter, E-mail: petgoc01@heh.reginh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Brisling, Steffen K., E-mail: stkibr01@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Logager, Vibeke B., E-mail: viloe@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Thomsen, Henrik S., E-mail: heth@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark)

    2011-08-15

    Purpose: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. Materials and methods: The prospective study included 48 consecutive patients (29 female, 19 male, 18-70 years old, mean age = 37.1 years). MRI examination was designed to be comfortable and fast; no contrast was administered. The sequences were performed during quiet respiration. The MRI findings were reviewed by two radiologists and one surgeon independent of each other and compared with surgical and pathological records. Results: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14 patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate ({kappa} = 0.51) and fair ({kappa} = 0.31) interobserver agreements in the MR diagnosis of acute appendicitis were found between the reviewers. Sensitivity, specificity and accuracy values for overall performance of MRI in detecting pelvic abnormalities were 100%, 75% (3 of 4 healthy patients were identified by MRI) and 98%, respectively. Conclusion: Unenhanced fast MRI is feasible as an additional fast screening before the appendectomy. It may prevent unnecessary surgeries. The fast MRI examination can be adequately performed on an MRI unit of broad range of field strengths.

  8. The Alvarado score for predicting acute appendicitis: a systematic review

    Science.gov (United States)

    2011-01-01

    Background The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score. Methods A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children. Results Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at 'ruling out' admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for 'ruling in' appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata. Conclusions The Alvarado score is a useful diagnostic 'rule out' score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk. PMID:22204638

  9. Ecological studies related to construction of the Defense Waste Processing Facility on the Savannah River Site. FY 1989--1990 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Pechmann, J.H.K.; Scott, D.E.; McGregor, J.H.; Estes, R.A.; Chazal, A.C.

    1993-02-01

    The Defense Waste Processing Facility (DWPF) was built on the Savannah River Site (SRS) during the mid-1980`s. The Savannah River Ecology Laboratory (SREL) has completed 12 years of ecological studies related to the construction of the DWPF complex. Prior to construction, the 600-acre site (S-Area) contained a Carolina bay and the headwaters of a stream. Research conducted by the SREL has focused primarily on four questions related to these wetlands: (1) Prior to construction, what fauna and flora were present at the DWPF site and at similar, yet undisturbed, alternative sites? (2) By comparing the Carolina bay at the DWPF site (Sun Bay) with an undisturbed control Carolina bay (Rainbow Bay), what effect is construction having on the organisms that inhabited the DWPF site? (3) By comparing control streams with streams on the periphery of the DWPF site, what effect is construction having on the peripheral streams? (4) How effective have efforts been to lessen the impacts of construction, both with respect to erosion control measures and the construction of ``refuge ponds`` as alternative breeding sites for amphibians that formerly bred at Sun Bay? Through the long-term census-taking of biota at the DWPF site and Rainbow Bay, SREL has begun to evaluate the impact of construction on the biota and the effectiveness of mitigation efforts. Similarly, the effects of erosion from the DWPF site on the water quality of S-Area peripheral streams are being assessed. This research provides supporting data relevant to the National Environmental Policy Act (NEPA) of 1969, the Endangered Species Act of 1973, Executive Orders 11988 (Floodplain Management) and 11990 (Protection of Wetlands), and United States Department of Energy (DOE) Guidelines for Compliance with Floodplain/Wetland Environmental Review Requirements (10CFR1022).

  10. Ecological studies related to the construction of the Defense Waste Processing Facility on the Savannah River Site. Annual report, FY-1991 and FY-1992

    Energy Technology Data Exchange (ETDEWEB)

    Scott, D.E.; Chazel, A.C.; Pechmann, J.H.K.; Estes, R.A.

    1993-06-01

    The Defense Waste Processing Facility (DWPF) was built on the Savannah River Site (SRS) during the mid-1980`s. The Savannah River Ecology Laboratory (SREL) has completed 14 years of ecological studies related to the construction of the DWPF complex. Prior to construction, the 600-acre site (S-Area) contained a Carolina bay and the headwaters of a stream. Research conducted by the SREL has focused primarily on four questions related to these wetlands: (1) Prior to construction, what fauna and flora were present at the DWPF site and at similar, yet undisturbed, alternative sites? (2) By comparing the Carolina bay at the DWPF site (Sun Bay) with an undisturbed control Carolina bay (Rainbow Bay), what effect is construction having on the organisms that inhabited the DWPF site? (3) By comparing control streams with streams on the periphery of the DWPF site, what effect is construction having on the peripheral streams? (4) How effective have efforts been to lessen the impacts of construction, both with respect to erosion control measures and the construction of ``refuge ponds`` as alternative breeding sites for amphibians that formerly bred at Sun Bay? Through the long-term census-taking of biota at the DWPF site and Rainbow Bay, SREL has begun to evaluate the impact of construction on the biota and the effectiveness of mitigation efforts. Similarly, the effects of erosion from the DWPF site on the water quality of S-Area peripheral streams are being assessed. This research provides supporting data relevant to the National Environmental Policy Act (NEPA) of 1969, the Endangered Species Act of 1973, Executive Orders 11988 (Floodplain Management) and 11990 (Protection of Wetlands), and United States Department of Energy (DOE) Guidelines for Compliance with Floodplain/Wetland Environmental Review Requirements (10 CFR 1022).

  11. Environmental Assessment: Proposed Construction of a New Entry Control Facility and Visitors Center Adjacent to the Bell Street Gate

    Science.gov (United States)

    2005-06-01

    Cannon Street, Building 1060 Maxwell AFB, AL 36112 Tel.: 334-953-5260 • 334-3964004 L E C Maxwell Support Division March 17, 2005 Mr. David Rabon ...Facility (ECF) and Visitors Center Maxwell Air Force Base, Alabama Dear Mr. Rabon , The United States Air Force is preparing an Environmental Assessment

  12. 环卫设施建设现状及改进探讨%Discussion of the Construction Status and Improvement of the Sanitation Facilities

    Institute of Scientific and Technical Information of China (English)

    朱红

    2014-01-01

    This article has carried on a thorough analysis on the current status of the development of sanitation facilities in China, and finds the leakage in sanitation work to improve the problems, so as to promote the long-term development of the environmental protection facilities construction.%本文对我国当前的环卫设施的发展现状进行了深入细致地分析,发现环卫工作中的不足,对于其中存在的问题进行了改善,从而促进环保设施建设的长远发展。

  13. Contrast-enhanced power Doppler US in the diagnosis of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Incesu, L.; Yazicioglu, A.K.; Selcuk, M.B.; Ozen, N

    2004-05-01

    Introduction/objective: To determine the value of power Doppler (PD) ultrasonography (US) and contrast-enhanced power Doppler (CEPD) US in the diagnosis of acute appendicitis and the prediction of histopathologic stages. Methods and material: 50 patients with suspected acute appendicitis were evaluated by the same radiologist with PD US and CEPD US. Air micro bubbles stabilized by a granulate of 'galactose and palmitic acid' were used as a contrast medium for sonography with the concentration of 400 mg/ml. PD US and CEPD US results were later correlated with the surgical and histopathologic findings. PD US and CEPD US findings were considered positive for appendicitis; if there was depiction of hyperemia in the wall of the appendix or if there was depiction of prominent peripheral vascularity when compared with normal soft tissues; and negative if both hyperemia and peripheral hyperemia were not prominent. Results and discussions: Of the 50 patients, 35 patients had histopathologically proven acute appendicitis. CEPD US showed prominent hyperemia in the appendiceal vessels or feeding vessels of the inflamed appendix, and resistance index (RI) calculations were easier. There was statistically significant difference between mean RI values of the normal appendix, suppurative appendicitis and gangrenous appendicitis. PD US has accuracy of 80%, sensitivity of 74% and CEPD US has 98%, and 100% in the diagnosis of acute appendicitis. CEPD US identified 100% of suppurative appendicitis and gangrenous appendicitis. Conclusion: CEPD US is a promising method in the diagnosis of acute appendicitis and determination of the inflammation stage.

  14. Fecal loading in the cecum as a new radiological sign of acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Andy Petroianu; Luiz Ronaldo Alberti; Renata Indelicato Zac

    2005-01-01

    AIM: Although the radiological features of acute appendicitis have been well documented, the value of plain radiography has not been fully appreciated. The aim of this study was to determine the frequency of the association of acute appendicitis with images of fecal loading in the cecum.METHODS: Plain abdominal radiographs of 400 patients operated upon for acute appendicitis (n = 100), acute cholecystitis (n = 100), right acute pelvic inflammatory disease (n = 100) and right nephrolithiasis (n = 100)were assessed. The presence of fecal loading was recorded and the sensitivity and specificity of this sign for acute appendicitis were calculated.RESULTS: The presence of fecal loading in the cecum occurred in 97 patients with acute appendicitis, 13 patients with acute cholecystitis, 12 patients with acute inflammatory pelvic disease and 19 patients with nephrolithiasis. The sensitivity of this sign for appendicitis was 97% and its specificity to this disease was 85.3%. Its positive predictive value for appendicitis was 68.7%; however, its negative predictive value for appendicitis was 98.8%.CONCLUSION: The present study suggests that the presence of radiological images of fecal loading in the cecum may be a useful sign of acute appendicitis, and the absence of this sign probably excludes this disease.This is the first description of fecal loading as a radiological sign for acute appendicitis.

  15. Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy

    Science.gov (United States)

    Dalpiaz, Amanda; Gandhi, Jason; Smith, Noel L.; Dagur, Gautam; Schwamb, Richard; Weissbart, Steven J.; Khan, Sardar Ali

    2017-01-01

    Introduction Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods. Methods Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature. Results Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases. Conclusion Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms. PMID:28413377

  16. STUDY OF INTRAOPERATIVELY AND HISTOLOGICALLY NEGATIVE CASES IN CLINICALLY DIAGNOSED CASES OF ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Muralidhar Manga

    2016-07-01

    Full Text Available BACKGROUND Acute appendicitis remains the most common cause of acute abdomen requiring surgical intervention. Diagnosis of appendicitis is done on clinical grounds. The aetiology and pathogenesis of appendicitis are poorly understood. The cause of pain in the cases with clinical diagnosis of acute appendicitis but intraoperatively normal looking appendix remains controversial. The present study aims at determining the cause of pain in these cases by combining routine histopathology, IHC to investigate the status of the enteric nervous system in normal and inflamed appendices. MATERIALS AND METHODS In the present study, 694 patients who underwent appendicectomy with diagnosis of acute appendicitis were included. In 89 cases, there were no signs of inflammation intraoperatively. These appendix specimens were followed by histopathological examination by H&E staining. 69 out of 89 specimens did not have signs of inflammation in histological examination by H&E staining. Cases which are diagnosed as acute appendicitis but histologically negative in H&E staining are taken as study cases. 49 acute appendicitis cases- histologically positive acute appendicitis (HPAA and 20 appendices from right hemicolectomy specimens were taken as controls. All these specimens were subjected to; 1 Routine Haematoxylin & Eosin staining. 2 Toluidine blue stain for mast cell evaluation. 3 Immunohistochemistry by S-100 stain for evaluating size and number of the ganglia. OBSERVATION The mean mast cell count was more in the histologically negative acute appendicitis group when compared to histologically positive acute appendicitis and control group. The mean size and number of the ganglia were more in the histologically negative acute appendicitis group when compared to histologically positive acute appendicitis and control groups. CONCLUSION Neuronal hypertrophy and mast cells may play a role in the pathogenesis of “appendicitis like pain” in patients with

  17. Diagnostic accuracy of fibrinogen to differentiate appendicitis from nonspecific abdominal pain in children.

    Science.gov (United States)

    Prada-Arias, Marcos; Vázquez, José Luis; Salgado-Barreira, Ángel; Gómez-Veiras, Javier; Montero-Sánchez, Margarita; Fernández-Lorenzo, José Ramón

    2017-01-01

    The aim of this study was to assess the diagnostic accuracy of the biomarker fibrinogen (FB), along with the more traditional markers white blood cell count (WBC), absolute neutrophil count (ANC), and C-reactive protein (CRP), to discriminate appendicitis from nonspecific abdominal pain (NSAP) in children. We prospectively evaluated all children aged 5 to 15 years admitted for suspected appendicitis at an academic pediatric emergency department during 2 years. Diagnostic accuracy of FB (prothrombin time-derived method), WBC, ANC, and CRP was assessed by the area under the curve (AUC) of the receiver operating characteristic curve. A total of 275 patients were enrolled in the study (143 NSAP, 100 uncomplicated appendicitis, and 32 complicated appendicitis). WBC and ANC had a moderate diagnostic accuracy for appendicitis vs NSAP (WBC: AUC 0.79, ANC: AUC 0.79). FB and CPR had a poor diagnostic accuracy for appendicitis vs NSAP (FB: AUC 0.63, CRP: AUC 0.64) and a good diagnostic accuracy for complicated vs uncomplicated appendicitis (FB: AUC 0.86, CRP: AUC 0.90). All inflammatory markers had a good diagnostic accuracy for complicated appendicitis vs NSAP. WBC and ANC are useful inflammatory markers to discriminate appendicitis from NSAP. FB and CRP are not very useful to discriminate appendicitis from NSAP, but they discriminate properly complicated from uncomplicated appendicitis and NSAP, with a similar diagnostic accuracy. In a child with suspected appendicitis, a plasma FB level (prothrombin time-derived method) >520 mg/dL is associated to an increased likelihood of complicated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. The Diagnostic Value of D-dimer, Procalcitonin and CRP in Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Bulent Kaya, Baris Sana, Cengiz Eris, Koray Karabulut, Orhan Bat, Riza Kutanis

    2012-01-01

    Full Text Available BACKGROUND: The early diagnosis of acute abdomen is of great importance. To date, several inflammatory markers have been used for the diagnosis of acute abdominal conditions, including acute appendicitis. The aim of this study was to evaluate the diagnostic utility of D-dimer, Procalcitonin (PCT and C-reactive protein (CRP measurements in the acute appendicitis.METHODS: This prospective study was conducted between March 1st, 2010 and July 1st, 2011. In this period, seventy-eight patients were operated with the diagnosis of acute appendicitis, and D-dimer, PCT and CRP levels of the patients were measured. The patients were grouped as phlegmonous appendicitis (Group 1, gangrenous appendicitis (Group 2, perforated appendicitis (Group 3 and negative appendectomy (Group 4 according to the surgical findings and histopathological results.RESULTS: Of 78 patients, 54 (69.2 % were male and 24 (30.8 % were female, and the mean age was 25.4 ± 11.1 years (range, 18 to 69 years. 66 (84.6 % patients had increased leukocyte count (white blood cell count. The PCT values were higher than the upper normal limit in 20 (25.6% patients, followed by D-dimer in 22 (28.2 % patients and CRP in 54 (69.2 % patients. The diagnostic value of leukocyte count and CRP in acute appendicitis was higher than that of the other markers, whereas leukocyte count showed very low specificity. CRP values were higher in perforated appendicitis when compared with the phlegmonous appendicitis (p<0.05. However, PCT and D-dimer showed lower diagnostic values (26% and 31%, respectively.CONCLUSION: An increase in CRP levels alone is not sufficient to make the diagnosis of acute appendicitis. However, CRP levels may differentiate between phlegmonous appendicitis and perforated appendicitis. Due to their low sensitivity and diagnostic value, PCT and D-dimer are not better markers than CRP for the diagnosis of acute appendicitis.

  19. Six Case Studies on Alternative Construction Methods: One-Step ’Turnkey’ Facility Acquisition and Architectural Fabric Structure Technology

    Science.gov (United States)

    1988-05-01

    maintenance building was $102K, and $120K for the general purpose building. The contract was awarded to Silverton Construction Co., El Paso, TX, which...considered as "bids" for the fabric structures. In preparing its bid, Silverton obtained ,bi.e° st..uct.u, price quotes from two manuf-n-curers and chose...concept estimate) versus $37.58 for fabric structures (see Table 3). Construction Documentation Silverton submitted the Roder Building Systems design

  20. Laparoscopic appendectomy in surgical treatment of acute appendicitis

    Directory of Open Access Journals (Sweden)

    G. I. Ohrimenko

    2016-06-01

    Full Text Available Relevance of the topic. At the present time laparoscopic appendectomy has taken its own place at the urgent surgery. In spite of this less is studied in the field of the use of the minimally invasive technologies in the cases of complicated acute appendicitis. The aim of research: to investigate the close results of the patients with acute appendicitis treatment with laparoscopic appendectomy, and to compare them with the open appendectomy results; to estimate the possibilities of laparoscopic appendectomy in the cases of complicated acute appendicitis. Materials and methods. The results of surgical treatment of 146 patients with acute appendicitis were analyzed – 59 patients in the main group, who undergone laparoscopic appendectomy, and 80 patients in the control group, who undergone open surgery. 7 patients who passed through conversion were included in the additional group. Results. The frequency of acute appendicitis complications, which were diagnosed during the operation, in the both groups had no significant distinction (50.8 % in the main group and 47.5% in the control group. But 5 patients with diffuse peritonitis and appendicular abscesses needed a conversion of laparoscopic operation into open one, because of the full sanitation necessity and technique difficulties. In the postoperative period among the patients of main group the suppuration of the wound was observed in 2 (3.4% cases, in the control group – in 10 (12.5%. The average duration of laparoscopic operation was 33.12±2.51 min, open surgery – 66.45±3.33 min. The average hospitalization period in the control group was 6.95±0.2 days and was statistically proved higher than in the main group – 4.72±0.21 days (p≤0.01. Conclusion. Laparoscopic appendectomy can be wide used in the cases of acute appendicitis, including complications, but it can be restricted in the cases of diffuse peritonitis and appendicular abscesses. This minimally invasive surgical operation

  1. Design, construction, and demonstration of a neutron beamline and a neutron imaging facility at a Mark-I TRIGA reactor

    Science.gov (United States)

    Craft, Aaron E.

    The fleet of research and training reactors is aging, and no new research reactors are planned in the United States. Thus, there is a need to expand the capabilities of existing reactors to meet users' needs. While many research reactors have beam port facilities, the original design of the United States Geological Survey TRIGA Reactor (GSTR) did not include beam ports. The MInes NEutron Radiography (MINER) facility developed by this thesis and installed at the GSTR provides new capabilities for both researchers and students at the Colorado School of Mines. The facility consists of a number of components, including a neutron beamline and beamstop, an optical table, an experimental enclosure and associated interlocks, a computer control system, a multi-channel plate imaging detector, and the associated electronics. The neutron beam source location, determined through Monte Carlo modeling, provides the best mixture of high neutron flux, high thermal neutron content, and low gamma radiation content. A Monte Carlo n-Particle (MCNP) model of the neutron beam provides researchers with a tool for designing experiments before placing objects in the neutron beam. Experimental multi-foil activation results, compared to calculated multi-foil activation results, verify the model. The MCNP model predicts a neutron beamline flux of 2.2*106 +/- 6.4*105 n/cm2-s based on a source particle rate determined from the foil activation experiments when the reactor is operating at a power of 950 kWt with the beam shutter fully open. The average cadmium ratio of the beamline is 7.4, and the L/D of the neutron beam is approximately 200+/-10. Radiographs of a sensitivity indicator taken using both the digital detector and the transfer foil method provide one demonstration of the radiographic capabilities of the new facility. Calibration fuel pins manufactured using copper and stainless steel surrogate fuel pellets provide additional specimens for demonstration of the new facility and offer a

  2. The activity of granulocyte alpha-amylase in acute appendicitis.

    Science.gov (United States)

    Zakrzewska, I; Gajda, R

    1994-01-01

    The activity of alpha-amylase was measured in isolated granulocytes, serum and urine of 35 patients with acute appendicitis. The measurements were performed before operation and on the 7th day after operation. Slightly increased activity of alpha-amylase was found in the serum and urine of 15 patients. On the 7th day after operation the activity of this enzyme reached normal value. The activity of granulocyte alpha-amylase was elevated in 22 patients. In 2 of them the increased activity still maintained on the 7th day after operation. Positive correlation between the serum and granulocyte alpha-amylase activities was found. These observations allow to conclude that granulocytes are the source of increased alpha-amylase activity in the serum of patients with acute appendicitis.

  3. Twisting lipoma presenting as appendicitis-a rare presentation.

    Science.gov (United States)

    Sathyakrishna, Basavapatna Ramakrishnaiah; Boggaram, Suryanarayan Giridhar; Jannu, Nagamalleswara Rao

    2014-08-01

    Right iliac fossa (RIF) pain is the most common presenting complaint in the general surgical ward. Though there are several causes for the RIF pain, acute appendicitis is the first and common diagnosis. Here we present one of the rare differential diagnoses of RIF pain in a young female patient with one month history of intermittent right lower abdominal pain. Patient's symptoms and clinical findings indicated acute appendicitis, though ultrasonography didn't show any significant abnormality. Through diagnostic laparoscopy we found that there was torsion of anterior abdominal wall parietal peritoneal pedunculated lipoma located in RIF region. The clinical presentation, examination, investigation, laparoscopic findings and further management is presented in this case report.

  4. IMAGING AS AN AID TO THE DIAGNOSIS OF ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Lionel I Wijesuriya

    2007-01-01

    Full Text Available Acute appendicitis has been known as a disease entity for well over a century but a confident diagnosis before surgeryin all patients suspected of the condition is still not possible. Timely diagnosis is essential to minimise morbidity due topossible perforation of the inflamed organ in the event treatment is delayed; so much so that surgeons often preferredto operate at the slightest suspicion of the diagnosis in the past. This resulted in the removal of many normal appendixes.When the diagnosis of appendicitis is clear from the history and clinical examination, then no further investigation isnecessary and prompt surgical treatment is appropriate. Where there is doubt about the diagnosis however it is advisableto resort to imaging studies such as abdominal ultrasound or computed tomography to clear such suspicions beforesubjecting the patient to an appendicectomy. These studies would also help avoid delays in surgery in deservingpatients.

  5. Duplicate Appendix With Acute Ruptured Appendicitis: A Case Report

    OpenAIRE

    Nazir, Sharique; Bulanov, Alex; Ilyas, Mohammed Iyoob Mohammed; Jabbour, Ibrahim I.; Griffith, Larry

    2015-01-01

    Duplication of the appendix is a rare congenital anomaly that, in adults, is most often found incidentally during surgery for other reasons. Appendicitis in the duplicated appendix is very rare and has been reported less than 10 times in the medical literature. We describe a 33-year-old woman with worsening periumbilical pain, nausea, vomiting, and fever. Physical examination showed localized peritonitis in the right lower quadrant. She had an elevated white blood cell count with neutrophilia...

  6. Appendicitis within Morgagni Hernia and simultaneous Paraesophageal Hernia

    OpenAIRE

    2015-01-01

    Background Morgagni hernia is a congenital diaphragmatic defect that rarely presents with symptomatic findings in adults. The presence of one diaphragmatic defect may decrease the occurrence of a separate diaphragmatic defect. Appendicitis may be a unique presentation of incarcerated bowel in a Morgagni defect. Case presentation Review of recent literature and presentation of a patient with Morgagni defect. Only five cases of simultaneous Morgagni hernia and paraesophageal hernia have been de...

  7. Perforated appendicitis: an underappreciated mimic of intussusception on ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Schmitz, Matthew; Gawande, Rakhee; Vasanawala, Shreyas; Barth, Richard [Lucile Packard Children' s Hospital, Department of Radiology, Stanford University, Stanford, CA (United States)

    2014-05-15

    We encountered multiple cases in which the US appearance of ruptured appendicitis mimicked intussusception, resulting in diagnostic and therapeutic delay and multiple additional imaging studies. To explore the clinical and imaging discriminatory features between the conditions. Initial US images in six children (age 16 months to 8 years; 4 boys, 2 girls) were reviewed independently and by consensus by three pediatric radiologists. These findings were compared and correlated with the original reports and subsequent US, fluoroscopic, and CT images and reports. All initial US studies demonstrated a multiple-ring-like appearance (target sign, most apparent on transverse views) with diagnostic consensus supportive of intussusception. In three cases, US findings were somewhat discrepant with clinical concerns. Subsequently, four of the six children had contrast enemas; two were thought to have partial or complete intussusception reduction. Three had a repeat US examination, with recognition of the correct diagnosis. None of the US examinations demonstrated definite intralesional lymph nodes or mesenteric fat, but central echogenicity caused by debris/appendicolith was misinterpreted as fat. All showed perilesional hyperechogenicity that, in retrospect, represented inflamed fat ''walling off'' of the perforated appendix. There were four CTs, all of which demonstrated a double-ring appearance that correlated with the US target appearance, with inner and outer rings representing the dilated appendix and walled-off appendiceal rupture, respectively. All six children had surgical confirmation of perforated appendicitis. Contained perforated appendicitis can produce US findings closely mimicking intussusception. Clinical correlation and careful multiplanar evaluation should allow for sonographic suspicion of perforated appendicitis, which can be confirmed on CT if necessary. (orig.)

  8. Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety.

    Science.gov (United States)

    Steiner, Zvi; Buklan, Genady; Stackievicz, Rodica; Gutermacher, Michael; Litmanovitz, Ita; Golani, Guy; Arnon, Shmuel

    2017-04-01

    The success rate of conservative treatment for children with uncomplicated appendicitis was prospectively evaluated among 197 children. All who received intravenous antibiotics for 3-5 days, and if symptoms resolved, were discharged home on oral antibiotics for 5 days. Failure rate, symptoms, laboratory signs, and sonographic findings were evaluated for prognostic markers of treatment failure. Children were followed for 18 months. The success rate of conservative treatment was 87%, with shorter hospital stays compared to children who eventually needed surgery (72 [60-84] vs. 84 h [72-126], P = 0.001). Vomiting and/or nausea and intraluminal fluid on sonography were the only prognostic signs of failed treatment (P = 0.028 and P = 0.0001, respectively). After multi-regression analysis, intraluminal fluid was the only prognostic sign for failed treatment (odds ratio = 10.2; 95% CI 3.3-31.8, P = 0.001). Patients who failed conservative treatment were successfully operated without significant morbidity. Pathology findings were compatible with acute or subacute inflammation in 94% of operated AA, with no perforated appendices. When applying rigorous criteria for children with uncomplicated appendicitis, a high success rate can be achieved with conservative treatment. Those who fail conservative treatment have a benign medical course without serious complications. Intraluminal fluid may increase risk for conservative treatment failure. What is Known: • Conservative treatment in uncomplicated acute appendicitis is a reasonable alternative to appendectomy. What is New: • Using rigorous criteria for conservative treatment in uncomplicated acute appendicitis is safe and feasible. • Intraluminal fluid should be considered a contraindication to conservative treatment.

  9. Archaeological Investigations on the San Antonio Terrace, Vandenberg Air Force Base, California, in Connection with MX Facilities Construction.

    Science.gov (United States)

    1984-01-01

    terraces, beaches, streams) precluded such a treatment . Instead, color variability and collection of samples from distinctive beds at particular...Morris (1966), and a number of *damp and hirsute local shellfish collectors were consulted before compiling the list of common shellfish names in...Plumbing, Electri- cal, Construction Material, Fencing, Roofing, Flooring, Paint Interior Furnishings Lighting, Heating, Furniture, Window Treatment

  10. Data Gap Analysis and Damage Case Studies: Risk Analyses from Construction and Demolition Debris Landfills and Recycling Facilities

    Science.gov (United States)

    The report presents an evaluation of construction and demolition (C&D) debris management in the US to update and expand upon the previous set of data to include information on more recent cases of damage and potential impacts and expand the breadth of damages beyond groundwater a...

  11. A Facile Construction of Eudesmanolide Denebutenolide via SmI2-catalyzed Rearrangement of an Enol Ester Epoxide

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    A very convenient construction procedure of the a, b-unsaturated lactone has been carried out in 98% yield. SmI2 (10%) was used as catalyst for rearrangement of an enol ester epoxide of eudesmanolide sesquiterpene. The possible mechanism was also discussed.

  12. A Facile Construction of Eudesmanolide Denebutenolide via SmI2—catalyzed Rearrangement of an Enol Ester Epoxide

    Institute of Scientific and Technical Information of China (English)

    WuJiongXIA; AoChengCAO; 等

    2002-01-01

    A very convenient construction procedure of the α,β-unsaturated lactone has been carried out in 98% yield. SmI2 (10%) was used as catalyst for rearrangement of an enol ester exoxide of eudesmanolide sesquiterpene. The possible mechanism was also discussed.

  13. A stump appendicitis in a child: a case report

    Directory of Open Access Journals (Sweden)

    Jemaï Radhia

    2009-11-01

    Full Text Available Abstract Background Stump appendicitis is a delayed complication of appendectomy. It is rare and few cases reported in the paediatric literature. The authors report on another case in a child and focus on the diagnostic peculiarities of this entity. Case A 9-year-old boy with previous history of open appendectomy was admitted for a right lower quadrant pain with bilious vomiting and fever. Physical examination demonstrated tenderness in the right lower quadrant and guarding over the appendectomy scar. The white blood cell count was 23.500 cells/mm3. Plain abdominal radiograph and ultrasonography revealed fecalith localized in the right iliac fossa. The diagnosis of stump appendicitis was advocated and confirmed at laparotomy. A gangrenous and perforated appendiceal stump was found and completely removed. The post-operative course was uneventful after 18 months follow-up period. Conclusion Stump appendicitis is rare and should be considered in any patient with right lower quadrant pain even if there is a history of appendectomy. Complete removal of the appendix is the only mean to prevent the occurrence of this complication.

  14. An unusual presentation of perforated appendicitis in epigastric region☆

    Science.gov (United States)

    Odabasi, Mehmet; Arslan, Cem; Abuoglu, Hasan; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, M.A. Tolga

    2013-01-01

    INTRODUCTION Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation. PRESENTATION OF CASE A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. DISCUSSION While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. CONCLUSION Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia. PMID:24441442

  15. [Chronic appendicitis due to multiple fecaliths. A case report].

    Science.gov (United States)

    Montiel-Jarquín, Álvaro José; Ramírez-Sánchez, Celso; García-Cano, Eugenio; González-Hernández, Nicolás; Rodríguez-Pérez, Fabiola; Alvarado-Ortega, Ivan

    2016-12-09

    The appendix inflammatory process is the most common cause of chronic abdominal pain in the right lower quadrant. The frequency of appendiceal lumen obstruction by fecalith ranges from 10 to 20%; few cases of obstruction by multiple fecaliths had been reported. Sixty-nine years old male, diabetic and hypertensive in control, he underwent bowel resection 30 years previously. He completed 6 months with intermittent, mild pain in the right lower quadrant abdomen; 14 days prior to admission with increasing pain, nausea, vomiting, constipation, abdominal distension and absence of peristalsis; 12,750 leukocytes, neutrophils 90%; plain abdominal radiography without specific bowel pattern, TAC with 3 dense images in right lower quadrant; exploratory laparotomy was performed and perforated appendix with 3 free fecaliths was found. Histopathological report showed fibrosis and lymphocytic infiltrate in the muscle layer of the cecal appendix consistent with chronic appendicitis. The most common obstruction of the appendix lumen is by a single fecalith. In this case the patient had chronic appendicitis secondary to appendiceal lumen obstruction by multiple fecaliths. Reviewing the international literature any case of chronic appendicitis associated with the presence of multiple fecaliths was found. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  16. [Acute appendicitis: clinico-diagnostic and therapeutic considerations].

    Science.gov (United States)

    Carditello, A; Bartolotta, M; Bonavita, G; Lentini, B; Sturniolo, G

    1985-04-01

    Since january 1970-december 1982, 58 patients underwent emergently appendectomy for acute appendicitis. 31 (53,4 percent) where males; the average age was 21 +/- 2,3 years (M +/- SEM). The duration of symptoms ranged from 1-6 hours (10,3 percent of cases) to over 48 hours, before the hospital admission (15,4 percent of cases). 27 patients (46,5 percent) had a clinical examination at home by a physician. 21 patients (36,4 percent) came to hospital emergency unit without previous physical examination; 10 (17,2 percent) were transferred from other departments. In 6,9 percent of cases was present a perforated appendicitis with peritonitis. During operation, in 50 percent of patients was performed a therapeutic peritoneal lavage. In 63,7 percent of cases multiple drains were placed in peritoneal cavity. In all patients was effected postoperative antibiotic profilaxis. The mortality rate was 3,4 percent. General complications were observed more in patients with perforated appendicitis. This review suggests the following remarcable data: morbidity of this disease is still high; the physical examination is more important than laboratory work (especially in the elderly patients, which are often immunodepressed and in children, with leucocitosis-lack at hospital admission); early surgery is the most important factor to the improvement of prognosis in these cases and the results of surgical treatment are improved by large vertical incisions, peritoneal lavage and application of multiple intracavitary drains.

  17. Xanthogranulomatous appendicitis in interval appendectomy specimens of children

    Directory of Open Access Journals (Sweden)

    Yusuf Hakan Çavuşoğlu

    2016-05-01

    Full Text Available Xanthogranulomatous inflammation is common in interval appendectomy specimens in adults, but it is unusual in children. Histopathologic specimens of interval appendectomy, within an 8-year period, were reevaluated to assess the true incidence. A computer search of the hospital database of all appendectomies was performed between January 2008 and June 2015 to identify all interval appendectomy cases. A total of 2694 patients underwent appendectomies. Of these, 13 were interval appendectomies. After pathologic evaluation, 2 (15.4% of the specimens were reported as xanthogranulomatous appendicitis (XA. Histopathologic examination of these interval appendectomy specimens, granulomas (59%, xanthogranulomatous inflammation (36% and Crohn-like changes (50% were common in adults. However, XA is a particularly rare clinical entity among children. Two cases of XA were reported in children in the English literature. One was a 12-year old boy that underwent interval appendectomy 6 weeks after an episode of acute appendicitis. The other was an 11-year old boy with acute (non-interval appendicitis, but the complete blood count was suggestive of an acute suppurative inflammation. These two cases are the 3rd and 4th cases of XA reported in children in the English literature, and both were managed by interval appendectomy. Thus, XA may be encountered in interval appendectomy specimens and association with IBD has to be ruled out.

  18. Abdominal Pain in the Female Patient: A Case of Concurrent Acute Appendicitis and Ruptured Endometrioma

    Science.gov (United States)

    Louis, Martine A.; Lin, Elizabeth; Baek, Ji Yoon; Andoni, Alda; Wang, Xiao Hui

    2016-01-01

    General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma. PMID:28097032

  19. Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature

    OpenAIRE

    Daisuke Ito; Shojirou Hata; Shimizu Seiichiro; Kaoru Kobayashi; Masanori Teruya; Michio Kaminishi

    2014-01-01

    INTRODUCTION: Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis. PRESENTATION OF CASE: A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom re...

  20. Computed Tomography Diagnosis Utilizing Compressed Image Data: An ROC Analysis Using Acute Appendicitis as a Model

    OpenAIRE

    2002-01-01

    Using receiver-operating characteristic (ROC) methodology, the ability to diagnose acute appendicitis with computed tomography (CT) images displayed at varying levels of lossy compression was evaluated. Nine sequential images over the ileocecal region were obtained from 53 consecutive patients with right lower quadrant pain who were clinically suspected to have acute appendicitis. Thirty were proven surgically to have acute appendicitis, alternative diagnoses confirmed in 23. The image sets w...

  1. Profiles of US and CT imaging features with a high probability of appendicitis

    Science.gov (United States)

    Laméris, W.; van Es, H. W.; ten Hove, W.; Bouma, W. H.; van Leeuwen, M. S.; van Keulen, E. M.; van der Hulst, V. P. M.; Henneman, O. D.; Bossuyt, P. M.; Boermeester, M. A.; Stoker, J.

    2010-01-01

    Objectives To identify and evaluate profiles of US and CT features associated with acute appendicitis. Methods Consecutive patients presenting with acute abdominal pain at the emergency department were invited to participate in this study. All patients underwent US and CT. Imaging features known to be associated with appendicitis, and an imaging diagnosis were prospectively recorded by two independent radiologists. A final diagnosis was assigned after 6 months. Associations between appendiceal imaging features and a final diagnosis of appendicitis were evaluated with logistic regression analysis. Results Appendicitis was assigned to 284 of 942 evaluated patients (30%). All evaluated features were associated with appendicitis. Imaging profiles were created after multivariable logistic regression analysis. Of 147 patients with a thickened appendix, local transducer tenderness and peri-appendiceal fat infiltration on US, 139 (95%) had appendicitis. On CT, 119 patients in whom the appendix was completely visualised, thickened, with peri-appendiceal fat infiltration and appendiceal enhancement, 114 had a final diagnosis of appendicitis (96%). When at least two of these essential features were present on US or CT, sensitivity was 92% (95% CI 89–96%) and 96% (95% CI 93–98%), respectively. Conclusion Most patients with appendicitis can be categorised within a few imaging profiles on US and CT. When two of the essential features are present the diagnosis of appendicitis can be made accurately. PMID:20119730

  2. Profiles of US and CT imaging features with a high probability of appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Randen, A. van; Lameris, W. [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Es, H.W. van [St Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Hove, W. ten; Bouma, W.H. [Gelre Hospitals, Department of Surgery, Apeldoorn (Netherlands); Leeuwen, M.S. van [University Medical Centre, Department of Radiology, Utrecht (Netherlands); Keulen, E.M. van [Tergooi Hospitals, Department of Radiology, Hilversum (Netherlands); Hulst, V.P.M. van der [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Henneman, O.D. [Bronovo Hospital, Department of Radiology, The Hague (Netherlands); Bossuyt, P.M. [University of Amsterdam, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam (Netherlands); Boermeester, M.A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Stoker, J. [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands)

    2010-07-15

    To identify and evaluate profiles of US and CT features associated with acute appendicitis. Consecutive patients presenting with acute abdominal pain at the emergency department were invited to participate in this study. All patients underwent US and CT. Imaging features known to be associated with appendicitis, and an imaging diagnosis were prospectively recorded by two independent radiologists. A final diagnosis was assigned after 6 months. Associations between appendiceal imaging features and a final diagnosis of appendicitis were evaluated with logistic regression analysis. Appendicitis was assigned to 284 of 942 evaluated patients (30%). All evaluated features were associated with appendicitis. Imaging profiles were created after multivariable logistic regression analysis. Of 147 patients with a thickened appendix, local transducer tenderness and peri-appendiceal fat infiltration on US, 139 (95%) had appendicitis. On CT, 119 patients in whom the appendix was completely visualised, thickened, with peri-appendiceal fat infiltration and appendiceal enhancement, 114 had a final diagnosis of appendicitis (96%). When at least two of these essential features were present on US or CT, sensitivity was 92% (95% CI 89-96%) and 96% (95% CI 93-98%), respectively. Most patients with appendicitis can be categorised within a few imaging profiles on US and CT. When two of the essential features are present the diagnosis of appendicitis can be made accurately. (orig.)

  3. A Rare Case: Appendectomy After Connected Stump Appendicitis Perforation of the Cecum

    Directory of Open Access Journals (Sweden)

    Berke Manoglu

    2016-01-01

    Full Text Available Stump appendicitis is a rare complication after appendectomy . Stump appendicitis made of incomplete appendectomy after a rest appendix tissue develops as a result of the inflammation. Admitted to the emergency department with acute abdomen and a history of appendectomy in patients with a history of current pain in the right lower quadrant , especially that of the patient must be evaluated in terms of stump appendicitis. The fact that the earlier story appendectomy patients , causing a delay in diagnosis and increasing the morbidity Cecal perforation was offered an advanced case of delayed depending on the stump appendicitis in this article.

  4. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis.

    Science.gov (United States)

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-03-01

    The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively.We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis.Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach.In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity.

  5. Stump appendicitis is a rare delayed complication of appendectomy: A case report

    Institute of Scientific and Technical Information of China (English)

    Mehmet Uludag; Adnan Isgor; Muzaffer Basak

    2006-01-01

    Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Paying attention to the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy can prevent the delay of diagnosis and treatment. In patients with stump appendicitis,CT scan not only assists in making an accurate preoperative diagnosis but also excludes other etiologies. We report a 47-year old man with preoperatively diagnosed stump appendicitis by CT, who underwent an open appendectomy 20 years ago.

  6. Are acute exacerbations of chronic inflammatory appendicitis triggered by coprostasis and/or coproliths?

    Institute of Scientific and Technical Information of China (English)

    George Sgourakis; Georgios C Sotiropoulos; Ernesto P Molmenti; Charis Eibl; Stylianous Bonticous; Jurgen Moege; Christoph Berchtold

    2008-01-01

    AIM:To examine the role of coprostasis and coproliths in recurrent appendicitis.METHODS:We evaluated four hundred and twentyseven consecutive pathology reports of all appendectomy specimens from January 2003 to December 2004.Findings were categorised as showing acute append icitis,acute recurrent appendicitis,subacute recurrentappendicitis,chronic appendicitis,or appendices without inflammation.All patients had presented with acute right lower quadrant pain.In 94 instances,there was a history of recurrent similar episodes in the past.RESULTS:Of the 427 histology reports,294 were interpreted as showing acute appendicitis,56 acute recurrent appendicitis,34 subacute recurrent appen-dicitis,28chronic appendicitis,and 15 non-inflamed appendices.Coprostasis was observed in 58 patients (13.58%) and the presence of coprolith in 6 (1.4%).Coprostasis,and age,were among the predictors in the final model.CONCLUSION:Coprostasis but not coproliths seems to be a contributing factor to acute exacerbations of chronic inflammatory appendicitis.

  7. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Gyu Chang [Dept. of Radiology, Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of)

    2011-07-15

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p < 0.001). The sensitivity of circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  8. Prospective Evaluation of a Clinical Practice Guideline for Diagnosis of Appendicitis in Children

    Science.gov (United States)

    Santillanes, Genevieve; Simms, Sonia; Gausche-Hill, Marianne; Diament, Michael; Putnam, Brant; Renslo, Richard; Lee, Jumie; Tinger, Elga; Lewis, Roger J.

    2015-01-01

    Objectives The objective was to assess the performance of a clinical practice guideline for evaluation of possible appendicitis in children. The guideline incorporated risk stratification, staged imaging, and early surgical involvement in high-risk cases. Methods The authors prospectively evaluated the clinical guideline in one pediatric emergency department (ED) in a general teaching hospital. Patients were risk-stratified based on history, physical examination findings, and laboratory results. Imaging was ordered selectively based on risk category, with ultrasound (US) as the initial imaging modality. Computed tomography (CT) was ordered if the US was negative or indeterminate. Surgery was consulted before imaging in high-risk patients. Results A total of 475 patients were enrolled. Of those, 193 (41%) had appendicitis. No low-risk patient had appendicitis. Medium-risk patients had a 19% rate of appendicitis, and 83% of high-risk patients had appendicitis. Factors associated with an increased likelihood of appendicitis included decreased bowel sounds; rebound tenderness; and presence of psoas, obturator, or Rovsing’s signs. Of the 475 patients, 276 (58%) were managed without a CT scan. Seventy-one of the 193 (37%) patients with appendicitis went to the operating room without any imaging. The rate of missed appendicitis was 2%, and the rate of negative appendectomy was 1%. Conclusions The clinical practice guideline performed well in a general teaching hospital. Rates of negative appendectomy and missed appendicitis were low and 58% of patients were managed without a CT scan. PMID:22849662

  9. CLINICAL EVALUATION AND ROLE OF USG IN PATIENTS OF ACUTE APPENDICITIS IN A RURAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sandesh

    2014-12-01

    Full Text Available INTRODUCTION: Acute appendicitis is the commonest emergency met in surgical practice. The clinical features sometimes being non-specific and list of differential diagnosis is too long. Diagnosis being particularly difficult in females due to associated gynaecological and obstetric conditions. The aim is to reduce unnecessary laparotomies and incidence of appendiceal perforation which is associated with significant post-operative morbidity. Reported approaches to achieve this objective include emergency laparotomy, Ultrasonography (USG, scoring system, CT scan etc. In peripheral areas USG remains most widely available and preliminary investigative for establishing definitive diagnosis in addition to clinical suspicion. AIM: Clinical evaluation and role of ultrasonography in patients of acute appendicitis in a rural hospital. OBJECTIVES: To study clinical profile of acute appendicitis. Role of USG in diagnosis of acute appendicitis. METHODS: 50 patients of acute abdomen suspected to have acute appendicitis, of all age groups and both sexes, admitted with cardinal features of acute appendicitis like pain in abdomen (Right iliac fossa, vomiting, and fever were included in this study. Patients were studied according to the Proforma. Surgeons made a final clinical diagnosis on the basis of clinical impression and USG information. All the patients diagnosed as acute appendicitis (without any lump formation in RIF were treated surgically and diagnosis was confirmed histopathologically. Acute appendicitis was studied with special reference to clinical findings and ultrasonographic findings. Use of ultrasonography in the diagnosis of acute appendicitis was evaluated. CONCLUSION: USG remains most cost effective, efficient and valuable investigation for acute appendicitis in rural settings. The use of USG in suspected acute appendicitis should be complement to but not replacing clinical assessment.

  10. The Epidemiology of Appendicitis and Appendectomy in South Korea: National Registry Data

    Science.gov (United States)

    Lee, Jung Hun; Park, Young Sun; Choi, Joong Sub

    2010-01-01

    Background Appendicitis is one of the most frequent acute surgical conditions of the abdomen, and appendectomy is one of the most commonly performed operations in the world. However, epidemiological data on appendicitis have not been reported for South Korean or East Asian populations. Methods We analyzed the epidemiological features and lifetime risk of appendicitis and appendectomy in South Korea using data collected for the national health insurance database from 2005 through 2007. Results Appendectomy was performed in 59.70% of inpatients diagnosed with appendicitis. The overall incidences of appendicitis, total appendectomy, and perforated appendectomy were 22.71, 13.56, and 2.91 per 10 000 population per year, respectively. The incidence of appendicitis and appendectomy showed clear seasonality, with a peak in summer. The standardized lifetime risks of appendicitis and appendectomy were constant from 2005 through 2007. A life table model suggests that the lifetime risk of appendicitis is 16.33% for males and 16.34% for females, and that the lifetime risk of appendectomy is 9.89% for males and 9.61% for females. Conclusions As compared to results obtained in research on Western populations, appendicitis and appendectomy had a similar perforation rate and seasonality, but a higher overall incidence, in South Koreans. Between 2005 and 2007, the incidence of appendicitis and appendectomy was constant. Overall, an estimated 15 incidental appendectomies are performed to prevent 1 inpatient with suspected appendicitis, and 26 incidental appendectomies are performed to prevent 1 appendectomy. Incidental appendectomy may have greater preventive value in Koreans. PMID:20023368

  11. The clinical value of pathology tests and imaging study in the diagnosis of acute appendicitis.

    Science.gov (United States)

    Chen, Ko-Chin; Arad, Alon; Chen, Ko-Chien; Storrar, Jonathan; Christy, Andrew G

    2016-10-01

    To explore the diagnostic accuracy of acute appendicitis among different patient groups and evaluate the statistical diagnostic values of common pathology and imaging tests for the diagnosis of acute appendicitis. Proportions of histology-proven appendicitis in different patient groups. Statistical parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic odds ratio (DOR) between the histology-proven appendicitis and abnormal results of U/S, CT, WCC, CRP, bilirubin, pancreatic, and combined test results of WCC and CRP. Our data showed that up to 25.7% of patients underwent appendectomy has normal appendix. Appendicitis is often accurately diagnosed among male patients, up to 90.3% of the time, while misdiagnosis of appendicitis among young females (appendicitis, sensitivity > 90%, and no individual pathology test out of those examined can rival the sensitivity of CT. Nevertheless, by examining the combined results of WCC and CRP, we found that abnormal results in one or both these yields sensitivity similar to CT scans in detecting acute appendicitis, up to 95%. Young female patients have highest risk of being falsely diagnosed with acute appendicitis and hence unnecessary surgery. Bilirubin and lipase exhibit no correlations with acute appendicitis. Combined interpretation of WCC or CRP abnormal results yields competitive sensitivity as CT. Hencewe would suggest that, under the appropriate clinical context, one can use both WCC and CRP as a simple tool to support the diagnosis of appendicitis. If both tests show normal results, we would highly recommend considering alternative diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Can platelet indices be used as predictors of complication in subjects with appendicitis?

    Science.gov (United States)

    Ceylan, Bahadır; Aslan, Turan; Çınar, Ahmet; Ruhkar Kurt, Ayşe; Akkoyunlu, Yasemin

    2016-12-01

    We examined the changes of mean platelet volume (MPV) and platelet distribution width (PDW) in subjects with appendicitis and whether MPV and PDW could be used to predict the development of complication due to appendicitis. The healthy control group, the cases of appendicitis with perforation, and the cases of appendicitis without perforation were compared with regard to MPV and PDW. We determined whether MPV and PDW were independent variables predictive of the development of complication in subjects with appendicitis. This retrospective case-control study included a total of 362 patients (249 of which were male (68.8 %) and 113 were female (31.2 %); median age, 30 [range, 18-84 years]). One hundred and ninety-two subjects (53 %) presented with appendicitis and 170 (47 %) comprised the healthy control group. Sixty-six (18.2 %) of the subjects with appendicitis developed complication. MPVs were lower in subjects of appendicitis without complication compared to the subjects of appendicitis with complication and the control group (MPV, 9.78 ± 0.99 vs. 10.20 ± 1.21 and 10.14 ± 1.03, respectively [p = 0.005]). The PDW levels were not different between the three groups. Independent variables predictive of the presence of complication included increased MPV and time from onset of symptoms to hospital presentation (odds ratio[confidence interval], p-value: 1.507[1.064-2.133], 0.021 and 18.887[5.139-69.410], 0.0001, respectively). Our findings suggested these, MPV values in cases of appendicitis without complication were lower than the cases with complication and healthy control and MPV is a predictor of the development of complication in subjects with appendicitis.

  13. The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies.

    Science.gov (United States)

    Ferris, Mollie; Quan, Samuel; Kaplan, Belle S; Molodecky, Natalie; Ball, Chad G; Chernoff, Greg W; Bhala, Nij; Ghosh, Subrata; Dixon, Elijah; Ng, Siew; Kaplan, Gilaad G

    2017-08-01

    We compared the incidence of appendicitis or appendectomy across the world and evaluated temporal trends. Population-based studies reported the incidence of appendicitis. We searched MEDLINE and EMBASE databases for population-based studies reporting the incidence of appendicitis or appendectomy. Time trends were explored using Poisson regression and reported as annual percent change (APC) with 95% confidence intervals (CI). APC were stratified by time periods and pooled using random effects models. Incidence since 2000 was pooled for regions in the Western world. The search retrieved 10,247 citations with 120 studies reporting on the incidence of appendicitis or appendectomy. During the 21st century the pooled incidence of appendicitis or appendectomy (in per 100,000 person-years) was 100 (95% CI: 91, 110) in Northern America, and the estimated number of cases in 2015 was 378,614. The pooled incidence ranged from 105 in Eastern Europe to 151 in Western Europe. In Western countries, the incidence of appendectomy steadily decreased since 1990 (APC after 1989=-1.54; 95% CI: -2.22, -0.86), whereas the incidence of appendicitis stabilized (APC=-0.36; 95% CI: -0.97, 0.26) for both perforated (APC=0.95; 95% CI: -0.25, 2.17) and nonperforated appendicitis (APC=0.44; 95% CI: -0.84, 1.73). In the 21st century, the incidence of appendicitis or appendectomy is high in newly industrialized countries in Asia (South Korea pooled: 206), the Middle East (Turkey pooled: 160), and Southern America (Chile: 202). Appendicitis is a global disease. The incidence of appendicitis is stable in most Western countries. Data from newly industrialized countries is sparse, but suggests that appendicitis is rising rapidly.

  14. Asian Facilities

    Science.gov (United States)

    Nakahata, M.

    2011-04-01

    Asian underground facilities are reviewed. The YangYang underground Laboratory in Korea and the Kamioka observatory in Japan are operational and several astrophysical experiments are running. Indian Neutrino Observatory(INO) and China JinPing Underground Laboratory (CJPL) are under construction and underground experiments are being prepared. Current activities and future prospects at those underground sites are described.

  15. New construction of an in-drum drying plant in the central decontamination and water treatment facility (ZDW)

    Energy Technology Data Exchange (ETDEWEB)

    Hoffmann, Martin; Koischwitz, Ingmar; Viermann, Jorg [GNS Gesellschaft fur Nuklear-Service mbh, Essen (Germany)

    2013-07-01

    In order to ensure future conditioning of the accumulating radioactive liquid waste during the advancing dismantling of the nuclear power plant Greifswald, GNS provides EWN within the new construction of the ZDW with an in-drum drying plant, including the appropriate infrastructure and media supply. For the in-drum drying plant, GNS has consistently further developed the process of the FAVORIT plant operationally proven for many years. Noteworthy is that for the first time a fully automatic plant of this type has been implemented which requires interventions of the operating personnel only for rounds and for loading and unloading processes of the drum stations. Moreover, components of the vacuum unit were designed according to needs and optimised with regard to installation space and plant engineering. (authors)

  16. Construction of. gamma pi. /sup 0/ spectrometer and photon tagging facility at Bates Linear Accelerator. Final report, July 31, 1979-July 31, 1980

    Energy Technology Data Exchange (ETDEWEB)

    Booth, E.C.

    1981-08-01

    The funds provided under Contract No. DE-AC02-79ER10486 were totally expended for hardware and supplies required by two related devices at the Bates Linear Accelerator. These were a photon tagging facility and a ..gamma pi../sup 0/ spectrometer in Beam Line C of the new South Experimental Hall. Construction was begun in November of 1979 and both systems became fully operational in the summer of 1981. Preliminary data was taken in 1980 with a prototype ..gamma pi../sup 0/ spectrometer will be carried out in the fall of 1981 and spring of 1982. The photon tagging system has been used successfully to calibrate the ..gamma pi../sup 0/ spectrometer for the BU - MIT collaboration and to test a lead glass detector system for Brandeis University.

  17. Issues related to the construction and operation of a geological disposal facility for nuclear fuel waste in crystalline rock - the Canadian experience

    Energy Technology Data Exchange (ETDEWEB)

    Allan, C.J.; Baumgartner, P.; Ohta, M.M.; Simmons, G.R.; Whitaker, S.H

    1997-12-01

    The siting, design, construction, operation, decommissioning, and closure of a geological facility for the disposal of nuclear fuel waste is a complex undertaking that will span many decades. Both technical and social issues must be taken into account simultaneously and many factors must be considered. Based on studies carried out in Canada and elsewhere, it appears that these factors can be accommodated and that geological disposal is both technically and socially feasible. But throughout the different stages of implementing disposal, technical and social issues will continue to arise and these will have to be dealt with successfully if progress is to continue. This paper discusses these issues and a proposed approach for dealing with them. (author)

  18. Pavement Testing Facility

    Data.gov (United States)

    Federal Laboratory Consortium — Comprehensive Environmental and Structural Analyses The ERDC Pavement Testing Facility, located on the ERDC Vicksburg campus, was originally constructed to provide...

  19. Pavement Testing Facility

    Data.gov (United States)

    Federal Laboratory Consortium — Comprehensive Environmental and Structural AnalysesThe ERDC Pavement Testing Facility, located on the ERDC Vicksburg campus, was originally constructed to provide an...

  20. Capabilities, Design, Construction and Commissioning of New Vibration, Acoustic, and Electromagnetic Capabilities Added to the World's Largest Thermal Vacuum Chamber at NASA's Space Power Facility

    Science.gov (United States)

    Motil, Susan M.; Ludwiczak, Damian R.; Carek, Gerald A.; Sorge, Richard N.; Free, James M.; Cikanek, Harry A., III

    2011-01-01

    NASA s human space exploration plans developed under the Exploration System Architecture Studies in 2005 included a Crew Exploration Vehicle launched on an Ares I launch vehicle. The mass of the Crew Exploration Vehicle and trajectory of the Ares I coupled with the need to be able to abort across a large percentage of the trajectory generated unprecedented testing requirements. A future lunar lander added to projected test requirements. In 2006, the basic test plan for Orion was developed. It included several types of environment tests typical of spacecraft development programs. These included thermal-vacuum, electromagnetic interference, mechanical vibration, and acoustic tests. Because of the size of the vehicle and unprecedented acoustics, NASA conducted an extensive assessment of options for testing, and as result, chose to augment the Space Power Facility at NASA Plum Brook Station, of the John H. Glenn Research Center to provide the needed test capabilities. The augmentation included designing and building the World s highest mass capable vibration table, the highest power large acoustic chamber, and adaptation of the existing World s largest thermal vacuum chamber as a reverberant electromagnetic interference test chamber. These augmentations were accomplished from 2007 through early 2011. Acceptance testing began in Spring 2011 and will be completed in the Fall of 2011. This paper provides an overview of the capabilities, design, construction and acceptance of this extraordinary facility.

  1. Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Emily K Smith; Edmund Ek; Daniel Croagh; Lavinia A Spain; Stephen Farrell

    2009-01-01

    We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature.

  2. A scoring system to predict the severity of appendicitis in children

    NARCIS (Netherlands)

    Gorter, Ramon R.; van den Boom, Anne L oes; Heij, Hugo A.; Kneepkens, C. M Frank; Hulsker, Caroline C.; Tenhagen, Mark; Dawson, Imro; van der Lee, Johanna H.

    2016-01-01

    BACKGROUND: It appears that two forms of appendicitis exist. Preoperative distinction between the two is essential to optimize treatment outcome. This study aimed to develop a scoring system to accurately determine the severity of appendicitis in children. MATERIALS AND METHODS: Historical cohort st

  3. The influence of underweight and obesity on the diagnosis and treatment of appendicitis in children

    NARCIS (Netherlands)

    Timmerman, Marjolijn E W; Groen, Henk; Heineman, Erik; Broens, Paul M A

    2016-01-01

    PURPOSE: The impact of lower body mass index (BMI) on appendicitis has never been addressed. We investigated whether different BMIs affect the diagnosis and treatment of appendicitis in children. METHODS: The correlation between BMI and diagnosis accuracy and treatment quality was evaluated by retro

  4. Impact of appendicitis during pregnancy : No delay in accurate diagnosis and treatment

    NARCIS (Netherlands)

    Aggenbach, L.; Zeeman, G. G.; Cantineau, A. E. P.; Gordijn, S. J.; Hofker, H. S.

    2015-01-01

    Background: Acute appendicitis during pregnancy may be associated with serious maternal and/or fetal complications. To date, the optimal clinical approach to the management of pregnant women suspected of having acute appendicitis is subject to debate. The purpose of this retrospective study was to p

  5. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Ho; Choi, Young Hun; Kim, Woo Sun; Cheon, Jung-Eun; Kim, In-One [Seoul National University Hospital, Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    To decrease the negative appendectomy rate in children, knowledge of the misleading imaging findings on US and CT in negative appendicitis cases is important. To evaluate the negative appendectomy rate and describe the imaging findings of US and CT that lead radiologists to misdiagnose acute appendicitis in children. From 2007 to 2013, 374 children operated for suspected appendicitis were proved to either have acute appendicitis (n = 348) or to be negative for appendicitis (n = 26) on pathological reports. Negative appendectomy rates were compared among imaging modalities, age groups and genders. We retrospectively reviewed US and CT findings from negative appendectomy cases. The overall negative appendectomy rate was 7.0% (26/374). There were no statistically significant differences among the subgroups. The most common misleading presentations on US were sonographic tenderness (9/16, 56%) and non-compressibility (9/16, 56%). The most common misleading finding on CT were the presence of an appendicolith or hyperdense feces (5/12, 42%). Periappendiceal fat inflammation was observed in only one case of negative appendicitis on US and on CT. Radiologists can misdiagnose children with equivocal diameters of appendices as having acute appendicitis when sonographic tenderness or non-compressibility is present on US and when an appendicolith or hyperdense feces is noted on CT. The possibility of negative appendicitis should be borne in mind when periappendiceal fat inflammation is absent or minimal in indeterminate cases. (orig.)

  6. Simultaneous Acute Cholecystitis and Acute Appendicitis Treated by a Single Laparoscopic Operation

    Directory of Open Access Journals (Sweden)

    Jonas P. DeMuro

    2012-01-01

    Full Text Available While acute appendicitis and acute cholecystitis are both common, they are only rarely seen simultaneously. The clinical presentation and hospital course of a 45-year-old female with concurrent acute appendicitis and acute cholecystitis is presented. The laparoscopic approach is ideal for dealing with multiple, simultaenous abdominal pathologies.

  7. Simultaneous Acute Cholecystitis and Acute Appendicitis Treated by a Single Laparoscopic Operation

    OpenAIRE

    DeMuro, Jonas P.

    2012-01-01

    While acute appendicitis and acute cholecystitis are both common, they are only rarely seen simultaneously. The clinical presentation and hospital course of a 45-year-old female with concurrent acute appendicitis and acute cholecystitis is presented. The laparoscopic approach is ideal for dealing with multiple, simultaenous abdominal pathologies.

  8. C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study

    Science.gov (United States)

    Yokoyama, Shozo; Takifuji, Katsunari; Hotta, Tsukasa; Matsuda, Kenji; Nasu, Toru; Nakamori, Mikihito; Hirabayashi, Naoki; Kinoshita, Hiroyuki; Yamaue, Hiroki

    2009-01-01

    Background This study is an attempt to clarify the role of C-reactive protein (CRP) as a surgical indication marker for appendicitis. Methods One hundred and fifty patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between May 1, 1999 and September 31, 2007. The correlation between preoperative clinical factors and the actual histological severity, and identify surgical indication markers were assessed by univariate and multivariate analyses. Results Univariate analysis showed that only the CRP level significantly differ between the surgical treatment necessary group (gangrenous appendicitis) and the possible non-surgical treatment group (catarrhalis and phlegmonous appendicitis). Multivariate analysis indicated only the CRP level to be a surgical indication marker for acute appendicitis. The receiver-operating characteristic (ROC) curve indicated that the cutoff value of CRP for surgical indication of appendicitis is 4.95 mg/dl. Conclusion Only the CRP level is consistent with the severity of appendicitis, and considered to be a surgical indication marker for acute appendicitis. PMID:19878592

  9. C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study

    Directory of Open Access Journals (Sweden)

    Nakamori Mikihito

    2009-10-01

    Full Text Available Abstract Background This study is an attempt to clarify the role of C-reactive protein (CRP as a surgical indication marker for appendicitis. Methods One hundred and fifty patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between May 1, 1999 and September 31, 2007. The correlation between preoperative clinical factors and the actual histological severity, and identify surgical indication markers were assessed by univariate and multivariate analyses. Results Univariate analysis showed that only the CRP level significantly differ between the surgical treatment necessary group (gangrenous appendicitis and the possible non-surgical treatment group (catarrhalis and phlegmonous appendicitis. Multivariate analysis indicated only the CRP level to be a surgical indication marker for acute appendicitis. The receiver-operating characteristic (ROC curve indicated that the cutoff value of CRP for surgical indication of appendicitis is 4.95 mg/dl. Conclusion Only the CRP level is consistent with the severity of appendicitis, and considered to be a surgical indication marker for acute appendicitis.

  10. Incarcerated appendicitis in port-site hernia: A rare case report

    Directory of Open Access Journals (Sweden)

    Tamir A. Hassan

    2015-09-01

    Case presentation: We describe a distinctive case of incarcerated appendicitis in port-site hernia following laparoscopic cholecystectomy. Acute appendicitis was pre-operatively CT diagnosed and appendectomy was performed followed by primary repair of the hernia defect. Awareness of atypical presentation and possible complications may raise the clinical suspicion index to ask for early CT.

  11. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications

    Directory of Open Access Journals (Sweden)

    Yueh-Ming Lin

    2012-07-01

    Conclusion: This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.

  12. Ischemia-modified albumin as a predictor of the severity of acute appendicitis.

    Science.gov (United States)

    Kılıç, Murat Özgür; Güldoğan, Cem Emir; Balamir, İlhan; Tez, Mesut

    2017-01-01

    The early prediction of gangrenous/perforated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. Ischemia-modified albumin (IMA) was previously reported as a biomarker of various ischemia-based diseases. Our aim is to determine the predictive value of serum IMA in the severity of acute appendicitis. Sixty-two patients who underwent urgent appendectomy were included in the study. Plasma level of IMA was measured after diagnosis and before treatment. All patients were classified as noncomplicated (acute) appendicitis and complicated (gangrenous/perforated) appendicitis according to histopathological findings, and comparisons were made between the groups. The data of 62 patients with a mean age of 30.1 years were statistically evaluated. The pathological diagnoses were acute appendicitis in 33 (53.2%), and gangrenous/perforated appendicitis in 29 (46.8%) patients. There were significant differences in computed tomography (CT) findings (P = .031) and IMA (P = .012) levels between the groups. A strong positive correlation between IMA levels and CT findings was also found (Spearman ρ = +0.688, P = .003). The IMA can be considered as a novel and useful marker to distinguish gangrenous/perforated appendicitis from noncomplicated appendicitis. The correlation of IMA with CT findings also enhances the predictive value of IMA. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Diabetes increases the risk of an appendectomy in patients with antibiotic treatment of noncomplicated appendicitis.

    Science.gov (United States)

    Tsai, Ming-Chieh; Lin, Herng-Ching; Lee, Cha-Ze

    2017-07-01

    This retrospective cohort study examined whether diabetic patients have a higher risk for recurrent appendicitis during a 1-year follow-up period after successful antibiotic treatment for patients with acute uncomplicated appendicitis than nondiabetic patients using a population-based database. We included 541 appendicitis patients who received antibiotic treatment for acute appendicitis. We individually tracked each patient for a 1-year period to identify those who subsequently underwent an appendectomy during the follow-up period. Cox proportional hazard regressions suggested that the adjusted hazard ratio of an appendectomy during the 1-year follow-up period was 1.75 for appendicitis patients with diabetes than appendicitis patients without diabetes. We found that among females, the adjusted hazard ratio of an appendectomy was 2.18 for acute appendicitis patients with diabetes than their counterparts without diabetes. However, we failed to observe this relationship in males. We demonstrated a relationship between diabetes and a subsequent appendectomy in females who underwent antibiotic treatment for noncomplicated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.

    NARCIS (Netherlands)

    Wijck, K. van; Jong, J.R. de; Heurn, L.W.E. van; Zee, D.C. van der

    2010-01-01

    BACKGROUND: Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different

  15. Impact of appendicitis during pregnancy : No delay in accurate diagnosis and treatment

    NARCIS (Netherlands)

    Aggenbach, L.; Zeeman, G. G.; Cantineau, A. E. P.; Gordijn, S. J.; Hofker, H. S.

    Background: Acute appendicitis during pregnancy may be associated with serious maternal and/or fetal complications. To date, the optimal clinical approach to the management of pregnant women suspected of having acute appendicitis is subject to debate. The purpose of this retrospective study was to

  16. A scoring system to predict the severity of appendicitis in children

    NARCIS (Netherlands)

    Gorter, Ramon R.; van den Boom, Anne L oes; Heij, Hugo A.; Kneepkens, C. M Frank; Hulsker, Caroline C.; Tenhagen, Mark; Dawson, Imro; van der Lee, Johanna H.

    2016-01-01

    BACKGROUND: It appears that two forms of appendicitis exist. Preoperative distinction between the two is essential to optimize treatment outcome. This study aimed to develop a scoring system to accurately determine the severity of appendicitis in children. MATERIALS AND METHODS: Historical cohort

  17. A rare presentation of a common entity: Chronic appendicitis in a patient with back pain

    Directory of Open Access Journals (Sweden)

    Ekene Onwuka

    2017-03-01

    Full Text Available Despite being one of the most common pediatric surgical diseases, some cases of appendicitis are far from straightforward to diagnose. We present here an interesting case of chronic, retrocecal appendicitis in a dancer who presented with isolated back pain.

  18. The influence of underweight and obesity on the diagnosis and treatment of appendicitis in children

    NARCIS (Netherlands)

    Timmerman, Marjolijn E. W.; Groen, Henk; Heineman, Erik; Broens, Paul M. A.

    2016-01-01

    The impact of lower body mass index (BMI) on appendicitis has never been addressed. We investigated whether different BMIs affect the diagnosis and treatment of appendicitis in children. The correlation between BMI and diagnosis accuracy and treatment quality was evaluated by retrospective analysis

  19. Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.

    NARCIS (Netherlands)

    Wijck, K. van; Jong, J.R. de; Heurn, L.W.E. van; Zee, D.C. van der

    2010-01-01

    BACKGROUND: Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different pos

  20. Regional variation in rates of pediatric perforated appendicitis.

    Science.gov (United States)

    Sarda, Samir; Short, Heather L; Hockenberry, Jason M; McCarthy, Ian; Raval, Mehul V

    2017-09-01

    While trends in perforated appendicitis (PA) rates have been studied, regional variability in pediatric admissions for PA remains unknown. A retrospective, cross-sectional analysis of the 2006-2012 Kids' Inpatient Database was conducted to examine variation in PA admission rates by region of the United States and insurance status. PA rates were calculated and reported as per 1000 admissions in accordance with national quality measure specifications. National PA rates per 1000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively. Similarly, all regions demonstrated a statistically significant decrease in PA rates between 2006 and 2009 (p<0.001), where the increase in rates between 2009 and 2012 was only statistically significant in the Midwest [Odds Ratio (OR) 1.07; 95% Confidence Interval (95%CI) 1.03-1.12] and West (OR 1.10; 95% CI 1.07-1.14). The Northeast consistently experienced the lowest PA rates. The odds of PA were highest among uninsured patients (OR 1.35; 95% CI 1.31-1.29). The South had the highest proportion of uninsured children, and these patients had the highest odds of perforation (OR 1.57; 95% CI 1.21-2.02). For children with appendicitis, geographic region and insurance status appear to be associated with perforation upon presentation. Understanding regional variation in pediatric PA rates may inform health policymakers in the constantly evolving insurance coverage landscape. Level III Treatment Study - Retrospective comparative study of appendicitis presentation in children by region of the country. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Granulomatous appendicitis in children: A single institutional experience

    Directory of Open Access Journals (Sweden)

    Kamalesh Pal

    2014-01-01

    Full Text Available Background: Granulomatous appendicitis (GA is a rare entity, mostly mentioned in adults. There have been anecdotal case reports describing GA in the paediatric population. This study was aimed at reviewing the cases of appendectomies to assess the incidence and characteristics of GA in children in a tertiary care University hospital. Materials and Methods: Records of children (<13 years age with biopsy proven granulomatous lesions in the appendectomy specimen, treated during 1991-2011, were analysed. Data regarding demography, clinical presentation, radiological findings, intra-operative finding, histology, diagnosis and follow-up were recorded and descriptively analysed. Results: Twelve out of 1150 (1.04% appendectomies were biopsy proven GA. Male to female ratio was 8:4. Four had Yersinia enterocolitis, two had Crohn′s disease (CD; one isolated Crohn′s Appendicitis, one Ileo-cecal Crohn′ with appendicitis and five were idiopathic. Remaining one case, initially diagnosed as idiopathic GA, developed full blown ileo-cecal CD at 2 nd month post-operative. Age ranged between 4 and 11 years with inflammatory bowel disease (IBD affecting older children and Yersinia, seen in younger children. Majority (10/12 remained asymptomatic at a maximum of 5 years of follow-up. Two patients had recurrent symptoms; one with sub-acute obstruction (2 years follow-up and another with flaring of Crohn′s ileitis (2 months follow-up. Conclusions: GA in children is a rare entity, with incidence of 1.04% and male preponderance in our series. Idiopathic causes were the most common followed by Yersinia enterocolitis and CD. Although majority remained asymptomatic, IBD should be ruled out in case of recurrence of pain or alteration of bowel habit. Therefore, a long-term follow-up (at least for 5 years of idiopathic GA is suggested in children.

  2. [Coexistence of acute appendicitis and dengue fever: A case report].

    Science.gov (United States)

    Osuna-Ramos, Juan Fidel; Silva-Gracia, Carlos; Maya-Vacio, Gerardo Joel; Romero-Utrilla, Alejandra; Ríos-Burgueño, Efrén Rafael; Velarde-Félix, Jesús Salvador

    2017-01-03

    Dengue is the most important human viral disease transmitted by mosquitoes. It can be asymptomatic or it can present in any of its 3clinical forms: Dengue fever, dengue haemorrhagic fever and dengue shock syndrome. However, some atypical manifestations have been reported in surgical emergencies caused by acute appendicitis in patients with dengue fever. We report the case of an 18-year-old Mexican male who presented to the emergency department of the General Hospital of Culiacan, Sinaloa, with symptoms of dengue fever, accompanied by crampy abdominal pain with positive Rovsing and Dunphy signs. Dengue infection was confirmed by a positive NS1 antigen test performed by enzyme-linked immunosorbent assay. An abdominal ultrasound revealed an appendicular process; as the abdominal pain in the right side kept increasing, an open appendectomy was performed. Abundant inflammatory liquid was observed during the surgery, and the pathology laboratory reported an oedematous appendix with fibrinopurulent plaques, which agreed with acute ulcerative appendicitis. The patient was discharged fully recovered without complications during the follow-up period. Acute abdominal pain can be caused in some cases by dengue infection. This can be confusing, which can lead to unnecessary surgical interventions, creating additional morbidities and costs for the patient. This unusual and coincident acute appendicitis with dengue highlights the importance of performing careful clinical studies for appropriate decision making, especially in dengue endemic regions during an outbreak of this disease. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  3. Successful nonsurgical treatment for synchronous acute cholecystitis and acute appendicitis: A case report and review of the literatures

    Directory of Open Access Journals (Sweden)

    Ting-Ying Lee

    2014-01-01

    Full Text Available Acute appendicitis and acute cholecystitis are commonly seen in acute abdominal disease. However, it is rarely described that synchronous acute cholecystitis and acute appendicitis presented. Here, we present a case of 78-year-old male suffered from cholelithiasis with acute cholecystitis synchronized with acute appendicitis treated with nonsurgical management successfully.

  4. MODIFIED ALVARADO SCORE IN CHILDREN WITH DIAGNOSIS OF APPENDICITIS.

    Science.gov (United States)

    Peyvasteh, Mehran; Askarpour, Shahnam; Javaherizadeh, Hazhir; Besharati, Sepideh

    2017-01-01

    Appendicitis is one of the most common abdominal emergency. Some predictive scoring systems are recommended to decrease the rate of negative appendectomy. To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of modified Alvarado score in children who underwent appendectomy. Four hundred children with initial diagnosis of appendicitis were randomly selected from patients who underwent appendectomy. Modified Alvarado score was used for evaluation of the appendicitis, that was confirmed using histology. Of modified Alvarado score components, anorexia; nausea and vomiting and rebound tenderness were significantly more common in children with positive appendectomy in contrast to patients with negative appendectomy. Sensitivity, specificity, positive predictive value, and negative predictive value for modified Alvarado score were: 91.3%; 38.4%; 87.7%; and 51.2% respectively. Alvarado score has high sensitivity but low specificity for diagnosis of acute appendicitis in children. A apendicite é uma das emergências abdominais mais comuns. Alguns sistemas de pontuação preditivos são recomendados para diminuir a taxa de apendicectomia negativa. Avaliar a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo do escore de Alvarado modificado em crianças submetidas à apendicectomia. Quatrocentos crianças com diagnóstico inicial de apendicite foram selecionadas aleatoriamente de pacientes submetidos à apendicectomia. A pontuação de Alvarado modificada foi utilizada para avaliação do quadro, que foi confirmado por meio de histologia. Anorexia; náuseas, vômitos e desconforto abdominal foram significativamente mais comuns em crianças com apendicectomia positiva, em contraste com casos negativos pelo escore de Alvarado modificado. A sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para o escore de Alvarado modificado foram: 91,3%; 38,4%; 87,7%; e 51

  5. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    Energy Technology Data Exchange (ETDEWEB)

    Vyas, Rajashree C.; Sides, Corey; Klein, Deborah J. [University of Rochester Medical Center, Rochester, NY (United States); Reddy, Sireesha Y. [University of Rochester, Obstetrics and Gynecology, Rochester, NY (United States); Santos, Mary C. [University of Rochester, Pediatric Surgery, Rochester, NY (United States)

    2008-09-15

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  6. Acute Appendicitis and Pneumatosis in a Duplicated Appendix With Schistosoma Remnants.

    Science.gov (United States)

    Handra-Luca, Adriana; Bisseret, Damien; Dragoescu, Ema

    2016-02-01

    Appendiceal pneumatosis is rare, reported either in the context of acute appendicitis or enterocolitis. Here, we report the case of an elderly adult in whom the acute appendicitis was associated with pneumatosis and occurred in the context of a malformed appendix with pathogenic organism remnants. A 72-year-old man presented with abdominal pain 3 weeks after posttraumatic dorsolumbar surgery. The computed tomography scan showed acute appendicitis and 2 diverticula. On microscopy, the appendix showed acute appendicitis along with a Cave-Wallbridge type A duplication. In addition, several optically clear spaces were observed in the entire appendiceal wall consistent with pneumatosis of the appendix. Focally, calcified structures suggesting pathogenic organisms such as Schistosoma were noted as well. In conclusion, we report a case of appendiceal pneumatosis occurring in the context of acute appendicitis in a duplicated appendix, with presence of calcified structures suggestive of pathogenic organisms.

  7. Clinical and computed tomography findings of appendiceal diverticulitis vs acute appendicitis

    Science.gov (United States)

    Ito, Daisuke; Miki, Kenji; Seiichiro, Shimizu; Hata, Shojiro; Kobayashi, Kaoru; Teruya, Masanori; Kaminishi, Michio

    2015-01-01

    AIM: To study the clinical features and computed tomography (CT) findings of appendiceal diverticulitis vs acute appendicitis. METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy in our institution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis. RESULTS: Among 451 patients, 44 (9.7%) were diagnosed to have appendiceal diverticulitis and 398 (86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older (59 vs 37 years, P appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix (84% vs 12%, P appendicitis. PMID:25852277

  8. Information Construction of Facility Management of Holding-type Properties%持有型物业运营管理的信息化建设研究

    Institute of Scientific and Technical Information of China (English)

    冯丹; 陆惠民

    2012-01-01

    国内房地产宏观调控的力度不断加大使得开发商们开始调整优化企业资产结构,加大持有物业的比例。本文结合当前房地产企业的发展形势,对把握持有型物业现代运营管理的核心内容进行了阐述,并在此基础上对持有型物业运营管理的信息化建设进行了分析,主要从BIM—FM团队的组建、运营战略的规划以及BIM应用环境的构建三个方面进行详述。%The large intensity of macroeconomic regulation and control of the domestic real estate urges developers to adjust and optimize the structure of corporate assets, thus result in the increasing proportion of holding-type properties. Combined with the current situation of the development of the real estate business, this paper describes the core contents of the facility management of holding-type properties and analyzes the information construction process based on these knowledge identified. Three aspects are detailed concluding the organization of BIM-FM management team, the planning of operation strategies and the construction of BIM application environment.

  9. Polyphenol-Inspired Facile Construction of Smart Assemblies for ATP- and pH-Responsive Tumor MR/Optical Imaging and Photothermal Therapy.

    Science.gov (United States)

    Song, Xiao-Rong; Li, Shi-Hua; Dai, Jiayong; Song, Liang; Huang, Guoming; Lin, Ruhui; Li, Juan; Liu, Gang; Yang, Huang-Hao

    2017-05-01

    Smart assemblies have attracted increased interest in various areas, especially in developing novel stimuli-responsive theranostics. Herein, commercially available, natural tannic acid (TA) and iron oxide nanoparticles (Fe3 O4 NPs) are utilized as models to construct smart magnetic assemblies based on polyphenol-inspired NPs-phenolic self-assembly between NPs and TA. Interestingly, the magnetic assemblies can be specially disassembled by adenosine triphosphate, which shows a stronger affinity to Fe3 O4 NPs than that of TA and partly replaces the surface coordinated TA. The disassembly can further be facilitated by the acidic environment hence causing the remarkable change of the transverse relaxivity and potent "turn-on" of fluorescence (FL) signals. Therefore, the assemblies for specific and sensitive tumor magnetic resonance and FL dual-modal imaging and photothermal therapy after intravenous injection of the assemblies are successfully employed. This work not only provides understandings on the self-assembly between NPs and polyphenols, but also will open new insights for facilely constructing versatile assemblies and extending their biomedical applications. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  10. Diagnosing Appendicitis: Evidence-Based Review of the Diagnostic Approach in 2014

    Science.gov (United States)

    Shogilev, Daniel J.; Duus, Nicolaj; Odom, Stephen R.; Shapiro, Nathan I.

    2014-01-01

    Introduction Acute appendicitis is the most common abdominal emergency requiring emergency surgery. However, the diagnosis is often challenging and the decision to operate, observe or further work-up a patient is often unclear. The utility of clinical scoring systems (namely the Alvarado score), laboratory markers, and the development of novel markers in the diagnosis of appendicitis remains controversial. This article presents an update on the diagnostic approach to appendicitis through an evidence-based review. Methods We performed a broad Medline search of radiological imaging, the Alvarado score, common laboratory markers, and novel markers in patients with suspected appendicitis. Results Computed tomography (CT) is the most accurate mode of imaging for suspected cases of appendicitis, but the associated increase in radiation exposure is problematic. The Alvarado score is a clinical scoring system that is used to predict the likelihood of appendicitis based on signs, symptoms and laboratory data. It can help risk stratify patients with suspected appendicitis and potentially decrease the use of CT imaging in patients with certain Alvarado scores. White blood cell (WBC), C-reactive protein (CRP), granulocyte count and proportion of polymorphonuclear (PMN) cells are frequently elevated in patients with appendicitis, but are insufficient on their own as a diagnostic modality. When multiple markers are used in combination their diagnostic utility is greatly increased. Several novel markers have been proposed to aid in the diagnosis of appendicitis; however, while promising, most are only in the preliminary stages of being studied. Conclusion While CT is the most accurate mode of imaging in suspected appendicitis, the accompanying radiation is a concern. Ultrasound may help in the diagnosis while decreasing the need for CT in certain circumstances. The Alvarado Score has good diagnostic utility at specific cutoff points. Laboratory markers have very limited

  11. Reduced risk of UC in families affected by appendicitis: a Danish national cohort study.

    Science.gov (United States)

    Nyboe Andersen, Nynne; Gørtz, Sanne; Frisch, Morten; Jess, Tine

    2017-08-01

    The possible aetiological link between appendicitis and UC remains unclear. In order to investigate the hereditary component of the association, we studied the risk of UC in family members of individuals with appendicitis. A cohort of 7.1 million individuals was established by linkage of national registers in Denmark with data on kinship and diagnoses of appendicitis and UC. Poisson regression models were used to calculate first hospital contact rate ratios (RR) for UC with 95% CIs between individuals with or without relatives with a history of appendicitis. During 174 million person-years of follow-up between 1977 and 2011, a total of 190 004 cohort members developed appendicitis and 45 202 developed UC. Individuals having a first-degree relative with appendicitis before age 20 years had significantly reduced risk of UC (RR 0.90; 95% CI 0.86 to 0.95); this association was stronger in individuals with a family predisposition to UC (RR 0.66; 95% CI 0.51 to 0.83). Individuals with a first-degree relative diagnosed with appendicitis before age 20 years are at reduced risk of UC, particularly when there is a family predisposition to UC. Our findings question a previously hypothesised direct protective influence of appendicitis on inflammation of the large bowel. Rather, genetic or environmental factors linked to an increased risk of appendicitis while being protective against UC may explain the repeatedly reported reduced relative risk of UC in individuals with a history of appendicitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. Lymphoid Hyperplasia of the Appendix: A Potential Pitfall in the Sonographic Diagnosis of Appendicitis.

    Science.gov (United States)

    Xu, Yingding; Jeffrey, R Brooke; DiMaio, Michael A; Olcott, Eric W

    2016-01-01

    The objective of this study was to test the hypothesis that thickening of the lamina propria, a finding produced by lymphoid hyperplasia, is significantly associated with false-positive sonographic diagnoses of appendicitis in 6- to 8-mm noncompressible appendixes. Sonograms of 119 consecutive patients with suspected appendicitis and 6- to 8-mm noncompressible appendixes were retrospectively blindly evaluated for thickening of the lamina propria (short axis thickness ≥ 1 mm). The reference standard for appendicitis was pathologic analysis of resected specimens. Results were compared with the two-tailed Fisher exact test. Thirty-one patients (26.1%) had a thickened lamina propria and 88 (73.9%) did not. Of the 27 pediatric patients with a thickened lamina propria, five (18.5%) had true-positive and 22 (81.5%) had false-positive sonograms for appendicitis; among the 55 pediatric patients without a thickened lamina propria, 27 (49.1%) had true-positive and 28 (50.9%) had false-positive sonograms for appendicitis (p = 0.009). Similar differences in adult patients were not statistically significant. All five pediatric patients with appendicitis and thickened lamina propria also showed two or more findings of periappendiceal fluid, hyperechoic periappendiceal fat, or mural hyperemia on color Doppler examination, compared with two of 22 similar pediatric patients without appendicitis (p hyperplasia may result in a noncompressible appendix 6-8 mm in diameter and may be misdiagnosed as appendicitis in pediatric patients. True-positive diagnoses of appendicitis can be accurately identified by the presence of at least two additional findings from the group of periappendiceal fluid, hyperechoic periappendiceal fat, and mural hyperemia. Identifying the characteristic sonographic appearance of lymphoid hyperplasia may help prevent false-positive misdiagnoses of appendicitis.

  13. Passive-solar construction handbook

    Energy Technology Data Exchange (ETDEWEB)

    Levy, E.; Evans, D.; Gardstein, C.

    1981-02-01

    Many of the basic elements of passive solar design are reviewed. Passive solar construction is covered according to system type, each system type discussion including a general discussion of the important design and construction issues which apply to the particular system and case studies illustrating designed and built examples of the system type. The three basic types of passive solar systems discussed are direct gain, thermal storage wall, and attached sunspace. Thermal performance and construction information is presented for typical materials used in passive solar collector components, storage components, and control components. Appended are an overview of analysis methods and a technique for estimating performance. (LEW)

  14. Passive solar construction handbook

    Energy Technology Data Exchange (ETDEWEB)

    Levy, E.; Evans, D.; Gardstein, C.

    1981-08-01

    Many of the basic elements of passive solar design are reviewed. The unique design constraints presented in passive homes are introduced and many of the salient issues influencing design decisions are described briefly. Passive solar construction is described for each passive system type: direct gain, thermal storage wall, attached sunspace, thermal storage roof, and convective loop. For each system type, important design and construction issues are discussed and case studies illustrating designed and built examples of the system type are presented. Construction details are given and construction and thermal performance information is given for the materials used in collector components, storage components, and control components. Included are glazing materials, framing systems, caulking and sealants, concrete masonry, concrete, brick, shading, reflectors, and insulators. The Load Collector Ratio method for estimating passive system performance is appended, and other analysis methods are briefly summarized. (LEW)

  15. Treatment of perforated appendicitis in children: what is the cost?

    Science.gov (United States)

    Dennett, Kate V; Tracy, Sarah; Fisher, Sharon; Charron, Gisele; Zurakowski, David; Calvert, Catherine E; Chen, Catherine

    2012-06-01

    We compared direct hospital costs and indirect costs to the family associated with immediate appendectomy or initial nonoperative management for perforated appendicitis in children. From June 2009 through May 2010, 61 prospectively identified families completed a cost diary, documenting the numbers of missed school days for the child and missed employment days for the adult caregiver(s) over the treatment course. Hospital costs were obtained from hospital financial databases. Mann-Whitney U tests and Fisher exact tests were used to compare outcome measures for each treatment strategy. Patients treated by initial nonoperative management had a significantly longer median length of stay (9 days vs 7 days, P = .02) and a significantly greater median total hospital cost per patient ($31,349 vs $21,323, P = .01) when compared with those treated by immediate appendectomy. There was no significant difference in median number of missed school days (9 days vs 10 days, P = .23) or missed employment days for adult caregiver(s) (5 days vs 7 days, P = .18) between treatment strategies. Patients with perforated appendicitis treated by initial nonoperative management had a greater length of stay and a significantly greater total hospital cost but were not burdened by significantly greater indirect costs compared with those treated by immediate appendectomy. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Chronic appendicitis in an atrophic appendix: case report

    Directory of Open Access Journals (Sweden)

    Yeray Trujillo L

    2016-03-01

    Full Text Available Chronic appendicitis is a rare entity characterized by pain in the right iliac Fossa during 2 years of evolution. Some surgeons and pathologists deny the existence of this disease; in contrast, there are studies of different authors that reported findings of chronic appendicitis. Male patient, 71 years- old, with pain in the right iliac Fossa of 2 weeks of evolution which remitted partially throughout his presentation, not associated with nausea, vomiting or anorexia. Physical examination revealed bounce in right iliac Fossa and blood count without Leukocytosis and forms segmented within normal parameters. History of 2 years of similar symptoms with resolution spontaneously. It was decided to carry out exploratory laparotomy; the operative finding was a cecal appendix of 1 cm of length with adherence of its distal part to the abdominal wall, exerting traction. Postoperatively the patient presented mild bloating and complete remission of pain. The pathological anatomy of the operative part was informed as cecal appendix 1 cm of length with chronic inflammation and fibrosis.

  17. Biological assessment of the effects of construction and operation of adepleted uranium hexafluoride conversion facility at the Portsmouth, Ohio,site.

    Energy Technology Data Exchange (ETDEWEB)

    Van Lonkhuyzen, R.

    2005-09-09

    The U.S. Department of Energy (DOE) Depleted Uranium Hexafluoride (DUF{sub 6}) Management Program evaluated alternatives for managing its inventory of DUF{sub 6} and issued the ''Programmatic Environmental Impact Statement for Alternative Strategies for the Long-Term Management and Use of Depleted Uranium Hexafluoride'' (DUF{sub 6} PEIS) in April 1999 (DOE 1999). The DUF{sub 6} inventory is stored in cylinders at three DOE sites: Paducah, Kentucky; Portsmouth, Ohio; and East Tennessee Technology Park (ETTP), near Oak Ridge, Tennessee. In the Record of Decision for the DUF{sub 6} PEIS, DOE stated its decision to promptly convert the DUF{sub 6} inventory to a more stable chemical form. Subsequently, the U.S. Congress passed, and the President signed, the ''2002 Supplemental Appropriations Act for Further Recovery from and Response to Terrorist Attacks on the United States'' (Public Law No. 107-206). This law stipulated in part that, within 30 days of enactment, DOE must award a contract for the design, construction, and operation of a DUF{sub 6} conversion plant at the Department's Paducah, Kentucky, and Portsmouth, Ohio, sites, and for the shipment of DUF{sub 6} cylinders stored at ETTP to the Portsmouth site for conversion. This biological assessment (BA) has been prepared by DOE, pursuant to the National Environmental Policy Act of 1969 and the Endangered Species Act of 1974, to evaluate potential impacts to federally listed species from the construction and operation of a conversion facility at the DOE Portsmouth site. The Indiana bat is known to occur in the area of the Portsmouth site and may potentially occur on the site during spring or summer. Evaluations of the Portsmouth site indicated that most of the site was found to have poor summer habitat for the Indiana bat because of the small size, isolation, and insufficient maturity of the few woodlands on the site. Potential summer habitat for the Indiana bat was

  18. Ultrasonography Manifestation of Acute Appendicitis%急性阑尾炎的超声表现

    Institute of Scientific and Technical Information of China (English)

    刘晓芳

    2016-01-01

    目的:探讨急性阑尾炎的超声表现。方法收集我2014年6月~2014年12月通过超声检查诊断为急性阑尾炎患者66例影像表现进行分析。结果46例患者为急性单纯阑尾炎,急性化脓性阑尾炎10例,急性坏疽性阑尾炎10例。结论超声检查诊断急性阑尾炎精准,方便快捷,无创,能在临床的诊断及手术时提供重要的依据。%Objective To investigate the ultrasonographic features of acute appendicitis.Methods Selected the imaging findings of 66 patients with acute appendicitis who were diagnosed as acute appendicitis by ultrasound examination from June 2014 to December 2014 were collected and analyzed.Results 46 patients with acute simple appendicitis, 10 cases of acute suppurative appendicitis, 10 cases of acute gangrenous appendicitis. Conclusion Ultrasound diagnosis of acute appendicitis is accurate,convenient, non-invasive, can provide an important basis for clinical diagnosis and surgery.

  19. Histopathological Feature of Acute Appendicitis in Kerman-Iran from 1997 to 2003

    Directory of Open Access Journals (Sweden)

    Fatemeh Nabipour

    2005-01-01

    Full Text Available Acute appendicitis is one of the most common surgical conditions that affect about seven percent of the population. The histopathologic stages of appendicitis are important to regarding prognosis. To evaluate pathologic features of appendix after operation, this study was designed. 2753 appendices specimen that had been received to department of pathology of two major hospitals in Kerman-Iran during five years periods were reviewed by two pathologist and classification was performed by followed: Normal, early acute, acute, suppurative or purulent, gangrenous and perforated appendicitis. There were 54.6% males, the average age of patients was 24.9+/-13.3 (mean+/-SD, that 76.6% was under 30 years old. 34.2% of reports were normal histopathologically. The accuracy rate of acute appendicitis was 65.8%. Perforation observed to 0.8%. There was significant difference between sex and stage of development of appendicitis. Seasonal incidence was difference in various histopathology views, significantly. Finally, acute appendicitis was more frequent in men than women and was increase by age specially 19-30 years. Our results showed appendicitis was more frequent and higher in stage at winter.

  20. Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography

    Institute of Scientific and Technical Information of China (English)

    Eugene Mun Wai Ong; Sudhakar Kundapur Venkatesh

    2009-01-01

    Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract. We report a series of four patients with retrocecal appendicitis who presented with acute right upper abdominal pain. The clinical diagnoses at presentation were acute cholecystitis in two patients, pyelonephritis in one, and ureteric colic in one. Ultrasound examination of the abdomen at presentation showed subhepatic collections in two patients and normal findings in the other two. Computed tomography (CT) identified correctly retrocecal appendicitis and inflammation in the retroperitoneum in all cases. In addition, abscesses in the retrocecal space ( n = 2) and subhepatic collections ( n = 2) were also demonstrated. Emergency appendectomy was performed in two patients, interval appendectomy in one, and hemicolectomy in another. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions. Our case series illustrates the usefulness of CT in diagnosing ascending retrocecal appendicitis and its extension, and excluding other in- flammatory conditions that mimic appendicitis.

  1. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy.

    Science.gov (United States)

    Patel, Darshan; Fingard, Jordan; Winters, Sean; Low, Gavin

    2017-07-01

    The purpose of this study was to determine the diagnostic accuracy of MRI for detecting acute appendicitis in pregnancy in a multi-institution study involving general body MR readers with no specific expertise in MR imaging of the pregnant patient. Retrospective review of MRI examinations on PACS in 42 pregnant patients was evaluated for acute right lower quadrant pain. Three fellowship-trained general body radiologists analyzed the MRI examinations in consensus and attempted to localize the appendix, assess for features of appendicitis, and exclude alternative etiologies for the right lower quadrant pain. Of the 42 MRI examinations, the readers noted 6 cases of acute appendicitis, 16 cases of a normal appendix, and 20 cases involving non-visualization of the appendix but where there were no secondary features of acute appendicitis. Based on the surgical data and clinical follow-up, there were 3 true-positive cases, 3 false-positive cases, 34 true-negative cases, and 2 false-negative cases of acute appendicitis on MRI. This yielded an accuracy of 88.1%, sensitivity of 60%, specificity of 91.9%, positive predictive value of 50%, and negative predictive value of 94.4% for the detection of acute appendicitis in the pregnant patient on MRI. Alternative etiologies for the right lower quadrant pain on MRI included torsion of an ovarian dermoid in 1 case and pyelonephritis in 1 case. MRI is an excellent modality for excluding acute appendicitis in pregnant patients presenting with right lower quadrant pain.

  2. Diabetes is associated with perforated appendicitis: evidence from a population-based study.

    Science.gov (United States)

    Wei, Po-Li; Lin, Herng-Ching; Kao, Li-Ting; Chen, Yi-Hua; Lee, Cha-Ze

    2016-10-01

    The purpose of this study was to investigate the relationship between perforated appendicitis and patient with diabetes using a population-based data set. This study used data from the Longitudinal Health Insurance Database 2005 in Taiwan. We identified 4,806 patients hospitalized with acute appendicitis. The independent variable was whether a patient had ever received a diagnosis of diabetes before the index hospitalization. We performed a conditional logistic regression model to explore the odds ratio and its corresponding 95% confidence interval of perforated appendicitis. Rates of perforated appendicitis for patients with and those without diabetes were 46.2% and 28.3%, respectively. A chi-square test revealed that there was a significant difference in rates of perforated appendicitis between patients with and those without diabetes (P appendicitis for patients with diabetes was 1.35 (95% confidence interval = 1.11 to 1.65) compared with patients without diabetes. Our study demonstrated that a history of diabetes is an important factor with regard to the rate of perforated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Floodplain/wetland assessment of the effects of construction and operation ofa depleted uranium hexafluoride conversion facility at the Paducah, Kentucky,site.

    Energy Technology Data Exchange (ETDEWEB)

    Van Lonkhuyzen, R.

    2005-09-09

    The U.S. Department of Energy (DOE) Depleted Uranium Hexafluoride (DUF{sub 6}) Management Program evaluated alternatives for managing its inventory of DUF{sub 6} and issued the ''Programmatic Environmental Impact Statement for Alternative Strategies for the Long-Term Management and Use of Depleted Uranium Hexafluoride'' (DUF{sub 6} PEIS) in April 1999 (DOE 1999). The DUF{sub 6} inventory is stored in cylinders at three DOE sites: Paducah, Kentucky; Portsmouth, Ohio; and East Tennessee Technology Park (ETTP), near Oak Ridge, Tennessee. In the Record of Decision for the DUF{sub 6} PEIS, DOE stated its decision to promptly convert the DUF{sub 6} inventory to a more stable chemical form. Subsequently, the U.S. Congress passed, and the President signed, the ''2002 Supplemental Appropriations Act for Further Recovery from and Response to Terrorist Attacks on the United States'' (Public Law No. 107-206). This law stipulated in part that, within 30 days of enactment, DOE must award a contract for the design, construction, and operation of a DUF{sub 6} conversion plant at the Department's Paducah, Kentucky, and Portsmouth, Ohio, sites, and for the shipment of DUF{sub 6} cylinders stored at ETTP to the Portsmouth site for conversion. This floodplain/wetland assessment has been prepared by DOE, pursuant to Executive Order 11988 (''Floodplain Management''), Executive Order 11990 (Protection of Wetlands), and DOE regulations for implementing these Executive Orders as set forth in Title 10, Part 1022, of the ''Code of Federal Regulations'' (10 CFR Part 1022 [''Compliance with Floodplain and Wetland Environmental Review Requirements'']), to evaluate potential impacts to floodplains and wetlands from the construction and operation of a conversion facility at the DOE Paducah site. Reconstruction of the bridge crossing Bayou Creek would occur within the Bayou Creek 100-year

  4. Volume-outcome relation for acute appendicitis: evidence from a nationwide population-based study.

    Directory of Open Access Journals (Sweden)

    Po-Li Wei

    Full Text Available BACKGROUND: Although procedures like appendectomy have been studied extensively, the relative importance of each surgeon's surgical volume-to-ruptured appendicitis has not been explored. The purpose of this study was to investigate the rate of ruptured appendicitis by surgeon-volume groups as a measure of quality of care for appendicitis by using a nationwide population-based dataset. METHODS: We identified 65,339 first-time hospitalizations with a discharge diagnosis of acute appendicitis (International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM codes 540, 540.0, 540.1 and 540.9 between January 2007 and December 2009. We used "whether or not a patient had a perforated appendicitis" as the outcome measure. A conditional (fixed-effect logistic regression model was performed to explore the odds of perforated appendicitis among surgeon case volume groups. RESULTS: Patients treated by low-volume surgeons had significantly higher morbidity rates than those treated by high-volume (28.1% vs. 26.15, p<0.001 and very-high-volume surgeons (28.1% vs. 21.4%, p<0.001. After adjusting for surgeon practice location, and teaching status of practice hospital, and patient age, gender, and Charlson Comorbidity Index, and hospital acute appendicitis volume, patients treated by low-volume surgeons had significantly higher rates of perforated appendicitis than those treated by medium-volume surgeons (OR = 1.09, p<0.001, high-volume surgeons (OR = 1.16, p<0.001, or very-high-volume surgeons (OR = 1.54, p<0.001. CONCLUSION: Our study suggested that surgeon volume is an important factor with regard to the rate of ruptured appendicitis.

  5. Discovery and validation of urine markers of acute pediatric appendicitis using high accuracy mass spectrometry

    Science.gov (United States)

    Kentsis, Alex; Lin, Yin Yin; Kurek, Kyle; Calicchio, Monica; Wang, Yan Yan; Monigatti, Flavio; Campagne, Fabien; Lee, Richard; Horwitz, Bruce; Steen, Hanno; Bachur, Richard

    2015-01-01

    Study Objective Molecular definition of disease has been changing all aspects of medical practice, from diagnosis and screening to understanding and treatment. Acute appendicitis is among many human conditions that are complicated by the heterogeneity of clinical presentation and shortage of diagnostic markers. Here, we sought to profile the urine of patients with appendicitis with the goal of identifying new diagnostic markers. Methods Candidate markers were identified from the urine of children with histologically proven appendicitis by using high accuracy mass spectrometry proteome profiling. These systemic and local markers were used to assess the probability of appendicitis in a blinded, prospective study of children being evaluated for acute abdominal pain in our emergency department. Tests of performance of the markers were evaluated against the pathologic diagnosis and histologic grade of appendicitis. Results Test performance of 57 identified candidate markers was studied in 67 patients, with median age of 11 years, 37% of whom had appendicitis. Several exhibited favorable diagnostic performance, including calgranulin A (S100-A8), α-1-acid glycoprotein 1 (orosomucoid), and leucine-rich α-2-glycoprotein (LRG), with the ROC AUC and values of 0.84 (95 % CI 0.72-0.95), 0.84 (0.72-0.95), and 0.97 (0.93-1.0), respectively. LRG was enriched in diseased appendices and its abundance correlated with severity of appendicitis. Conclusions High accuracy mass spectrometry urine proteome profiling allowed identification of diagnostic markers of acute appendicitis. Usage of LRG and other identified biomarkers may improve the diagnostic accuracy of clinical evaluations of appendicitis. PMID:19556024

  6. The Reliability of a Standardized Reporting System for the Diagnosis of Appendicitis.

    Science.gov (United States)

    Simianu, Vlad V; Shamitoff, Anna; Hippe, Daniel S; Godwin, Benjamin D; Shriki, Jabi E; Drake, Frederick T; O'Malley, Ryan B; Maximin, Suresh; Bastawrous, Sarah; Moshiri, Mariam; Lee, Jean H; Cuevas, Carlos; Dighe, Manjiri; Flum, David; Bhargava, Puneet

    Computed tomography (CT) is a fast and ubiquitous tool to evaluate intra-abdominal organs and diagnose appendicitis. However, traditional CT reporting does not necessarily capture the degree of uncertainty and indeterminate findings are still common. The purpose of this study was to evaluate the reproducibility of a standardized CT reporting system for appendicitis across a large population and the system's impact on radiologists' certainty in diagnosing appendicitis. Using a previously described standardized reporting system, eight radiologists retrospectively evaluated CT scans, blinded to all clinical information, in a stratified random sample of 237 patients from a larger cohort of patients imaged for possible appendicitis (2010-2014). Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were used to evaluate the diagnostic performance of readers for identifying appendicitis. Two-thirds of these scans were randomly selected to be independently read by a second reader, using the original CT reports to balance the number of positive, negative and indeterminate exams across all readers. Inter-reader agreement was evaluated. There were 113 patients with appendicitis (mean age 38, 67% male). Using the standardized report, radiologists were highly accurate at identifying appendicitis (AUC=0.968, 95%CI confidence interval: 0.95, 0.99. Inter-reader agreement was >80% for most objective findings, and certainty in diagnosing appendicitis was high and reproducible (AUC=0.955 and AUC=0.936 for the first and second readers, respectively). Using a standardized reporting system resulted in high reproducibility of objective CT findings for appendicitis and achieved high diagnostic accuracy in an at-risk population. Predictive tools based on this reporting system may further improve communication about certainty in diagnosis and guide patient management, especially when CT findings are indeterminate. Copyright © 2017 Elsevier Inc. All rights

  7. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study.

    Science.gov (United States)

    Carpenter, Jennifer L; Orth, Robert C; Zhang, Wei; Lopez, Monica E; Mangona, Kate L; Guillerman, R Paul

    2017-03-01

    Purpose To prospectively evaluate the diagnostic performance of ultrasonography (US) for differentiating perforated from nonperforated pediatric appendicitis and to investigate the association between specific US findings and perforation. Materials and Methods This HIPAA-compliant study had institutional review board approval, and the need for informed consent was waived. All abdominal US studies performed for suspected pediatric appendicitis at one institution from July 1, 2013, to July 9, 2014, were examined prospectively. US studies were reported by using a risk-stratified scoring system (where a score of 1 indicated a normal appendix; a score of 2, an incompletely visualized normal appendix; a score of 3, a nonvisualized appendix; a score of 4, equivocal; a score of 5a, nonperforated appendicitis; and a score of 5b, perforated appendicitis). The diagnostic performance of US studies designated 5a and 5b was calculated. The following US findings were correlated with perforation at multivariate analysis: maximum appendiceal diameter, wall thickness, loss of mural stratification, hyperemia, periappendiceal fat inflammation, periappendiceal fluid, lumen contents, and appendicolith presence. The number of symptomatic days prior to presentation was recorded. Surgical diagnosis and clinical follow-up served as reference standards. Results A total of 577 patients with a diagnosis of appendicitis at US met the study criteria (468 with a score of 5a; 109 with a score of 5b). Appendicitis was correctly identified in 573 (99.3%) of 577 patients. US performance in the detection of perforated appendicitis (5b) was as follows: a sensitivity of 44.0% (80 of 182), a specificity of 93.1% (364 of 391), a positive predictive value of 74.8% (80 of 107), and a negative predictive value of 78.1% (364 of 466). Statistically significant associations with perforated appendicitis were longer duration of symptoms (odds ratio [OR] = 1.46, P appendicitis. Several US findings are

  8. Biological assessment of the effects of construction and operation of a depleted uranium hexafluoride conversion facility at the Paducah, Kentucky, site.

    Energy Technology Data Exchange (ETDEWEB)

    Van Lonkhuyzen, R.

    2005-09-09

    The U.S. Department of Energy (DOE) Depleted Uranium Hexafluoride (DUF{sub 6}) Management Program evaluated alternatives for managing its inventory of DUF{sub 6} and issued the ''Programmatic Environmental Impact Statement for Alternative Strategies for the Long-Term Management and Use of Depleted Uranium Hexafluoride'' (DUF{sub 6} PEIS) in April 1999 (DOE 1999). The DUF{sub 6} inventory is stored in cylinders at three DOE sites: Paducah, Kentucky; Portsmouth, Ohio; and East Tennessee Technology Park (ETTP), near Oak Ridge, Tennessee. In the Record of Decision for the DUF{sub 6} PEIS, DOE stated its decision to promptly convert the DUF6 inventory to a more stable chemical form. Subsequently, the U.S. Congress passed, and the President signed, the ''2002 Supplemental Appropriations Act for Further Recovery from and Response to Terrorist Attacks on the United States'' (Public Law No. 107-206). This law stipulated in part that, within 30 days of enactment, DOE must award a contract for the design, construction, and operation of a DUF{sub 6} conversion plant at the Department's Paducah, Kentucky, and Portsmouth, Ohio, sites, and for the shipment of DUF{sub 6} cylinders stored at ETTP to the Portsmouth site for conversion. This biological assessment (BA) has been prepared by DOE, pursuant to the National Environmental Policy Act of 1969 (NEPA) and the Endangered Species Act of 1974, to evaluate potential impacts to federally listed species from the construction and operation of a conversion facility at the DOE Paducah site.

  9. A STUDY ON OPEN VS. LAPAROSCOPIC APPROACH IN ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Savalam Bujjitha

    2016-05-01

    Full Text Available Reginald Fitz in 1986, first described acute appendicitis. Since the acute appendicitis was first described, the pathology remains the most common intra-abdominal condition requiring emergency surgery. The life time risk of having acute appendicitis is about 8%. Traditionally, the treatment of choice has been surgery. Before the only option was the open laparotomical meaning opening the abdominal cavity was the mode of operation. Laparoscopic appendectomy was described by Semm in 1983. This method was new and had its own benefits but this particular procedure has struggled to prove its superiority over the open technique. This is contrast to laparoscopic cholecystectomy which has promptly become the gold standard for gallstone disease despite little scientific challenge. This peculiarity might be because of the fact that the Open Appendectomy was used for centuries with good effect. The particular procedure withstood the test of time for more than a century since its introduction by McBurney unlike cholecystectomy. Open surgery is typically completed using a small right lower quadrant incision between the point joining the lateral one-third and medial two-third of a line drawn from anterior-superior iliac spine and the umbilicus. The postoperative recovery is usually uneventful. The overall mortality of OA is around 0.3% and morbidity about 11%. Despite numerous randomised trials, several meta-analysis and systematic critical reviews, the clear cut winner is unannounced. A sincere effort has been put to understand the different pros and cons of the two methods so that the patient can be benefited. METHODS One Hundred cases were studied in the Department of Surgery, King George Hospital, Visakhapatnam, Andhra Pradesh from 01-09-2015 to 29-02-2016. Out of these, fifty cases underwent open surgery and the rest through laparoscopic surgery. The first group (Open Surgery thus consisted of 50 cases and the second group (laparoscopic consisted of fifty

  10. Typhoid Fever and Acute Appendicitis: A Rare Association Not Yet Fully Formed

    Directory of Open Access Journals (Sweden)

    Daniel J. Sartori

    2017-08-01

    Full Text Available Infections caused by foodborne enteric pathogens including typhoidal and non-typhoidal Salmonella species can mimic symptoms of acute appendicitis. The association between such bacterial pathogens and pathology-proven acute appendicitis has been described, but this link is poorly understood. Here we describe a case of a young man with typhoid fever presenting with histology-proven acute appendicitis requiring urgent appendectomy, and provide a brief review of relevant literature to prompt more widespread recognition of this rare cause of a common surgical emergency.

  11. [Nature of the relation of acute appendicitis morbidity to meteorological and heliogeophysical factors].

    Science.gov (United States)

    Khaavel', A A; Birkenfeldt, R R

    1978-04-01

    The authors analyzed 2009 appendicitis case records for the period from 1964 to 1973. In a sea climate region an evident season distribution of the apendicitis morbidity was found, with the rise of the incidence rate in January, March and April. The rise of the appendicitis incidence rate during the periods of vast fluctuations of air temperature, increase of air humidity and decrease of actual duration of sun radiance was established. The rise of the incidence of acute appendicitis was also noted during the months of a great and extremely great magnetic storms.

  12. MODIFIED ALVARADO SCORING AS A DIAGNOSTIC TOOL IN ACUTE APPENDICITIS- A PROSPECTIVE STUDY

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    V. K. Arun Kumar

    2017-02-01

    Full Text Available BACKGROUND Acute Appendicitis commonest community-acquired intra-abdominal infections. Acute appendicitis and its associated complications are significant source of morbidity and sometimes mortality. The Modified Alvarado Scoring System (MASS has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. Diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting. The aim of the study is to evaluate the efficacy of the modified Alvarado score as a diagnostic tool in Acute Appendicitis, as the diagnosis of appendicitis depends on the onset of symptoms and the subjective interpretation of the physical examination. MATERIALS AND METHODS This was a prospective study carried out in Pondicherry Institute of Medical Science during the period of November 2013 to May 2015. This study was done on 50 patients diagnosed with Acute Appendicitis and admitted in General Surgery. RESULTS In this study, there were a total of 50 patients who were taken up for surgery based on clinical and radiological diagnosis. Our study demonstrates that modified Alvarado score applied to all adult patients of acute appendicitis in adults with a sensitivity of 60% and a specificity of 40% only. Showing it wasn’t efficient in diagnosing acute appendicitis. The positive predictive value shown by our study was 80% which is marginally lower than that explained in literature which reports 87.5%. Negative appendicectomy rate in this study is 12%. CONCLUSION Alvarado score is a non-invasive, safe diagnostic procedure, which is simple, fast reliable and repeatable; it can be used in all conditions, without expensive and complicated supportive diagnostic methods. Alvarado score increases the diagnostic certainty of clinical examination in diagnosis of

  13. The current utility of ultrasound in the diagnosis of acute appendicitis.

    Science.gov (United States)

    Lourenco, Pedro; Brown, Jacquie; Leipsic, Jonathan; Hague, Cameron

    2016-01-01

    The purpose of this study is to evaluate the current performance of ultrasound in the diagnosis of acute appendicitis. Retrospectively, patients who presented to a single institution between 2011 and 2012 were included. Diagnostic accuracy was calculated, with surgery considered gold-standard. Our data demonstrates that US relative to surgery-confirmed appendicitis has a sensitivity and specificity of 48.4% and 97.9%, respectively. The diagnostic accuracy was further increased when there was a low pre-test probability, with a NPV of up to 96.6%. Ultrasound has a strong PPV in the diagnosis of acute appendicitis, and in equivocal cases, the NPV is reliable.

  14. Acute Appendagitis Presenting with Features of Appendicitis: Value of Abdominal CT Evaluation

    Directory of Open Access Journals (Sweden)

    Sukhpreet Dubb

    2008-05-01

    Full Text Available We report a case of acute appendagitis in a patient who presented initially with typical features of acute appendicitis. The diagnosis of acute appendagitis was made on pathognomonic signs on computed tomography (CT scan. Abdominal pain is a common surgical emergency. CT is not always done if there are clear features of acute appendicitis. The rare but important differential diagnosis of acute appendagitis must be borne in mind when dealing with patients with suspected acute appendicitis. A CT scan of the abdomen may avoid unnecessary surgery in these patients.

  15. Asymptomatic early acute appendicitis initiated and diagnosed during colonoscopy: A case report

    Institute of Scientific and Technical Information of China (English)

    Michelle Petro; Anil Minocha

    2005-01-01

    Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of the lumen due to various causes is believed to be the most common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature have only shown a patent appendiceal lumen with pus flowing into the cecum. We present the case of a patient undergoing colonoscopy for colorectal cancer evaluation with no abdominal symptoms. An obstructed, swollen appendix was seen. The process was probably initiated during the colonoscopy, documenting perhaps the earliest stage of acute appendicitis for the first time. Endoscopic, CT and microscopic documentation of the case is also presented.

  16. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

    Directory of Open Access Journals (Sweden)

    Jennings Jason

    2010-01-01

    Full Text Available Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP approach using Polypropylene Mesh (Mesh and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

  17. Phased Construction Completion Report for Building K-1401 of the Remaining Facilities Demolition Project at the East Tennessee Technology Park Oak Ridge, Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    Garland S.

    2008-03-01

    This Phased Construction Completion Report documents the demolition of Bldg. K-1401, Maintenance Building, addressed in the Action Memorandum for the Remaining Facilities Demolition Project at East Tennessee Technology Park, Oak Ridge, Tennessee (DOE 2003a) as a Comprehensive Environmental Response, Compensation, and Liability Act of 1980 non-time-critical removal action. The objectives of the removal action (DOE 2003a) - to eliminate the source of potential contamination, to eliminate the threat of potential future releases, and/or to eliminate the threats to the general public and the environment - were met. The end state of this action is for the slab to remain with all penetrations sealed and grouted or backfilled. The basement and pits remain open. There is residual radiological and polychlorinated biphenyl contamination on the slab and basement. A fixative was applied to the area on the pad contaminated with polychlorinated biphenyls. Interim land-use controls will be maintained until final remediation decisions are made under the Zone 2 Record of Decision (DOE 2005a).

  18. Phased Construction Completion Report for Bldg. K-1401 of the Remaining Facilities Demolition Project at the East Tennessee Technology Park, Oak Ridge, Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    Bechtel Jacobs

    2008-10-01

    This Phased Construction Completion Report documents the demolition of Bldg. K-1401, Maintenance Building, addressed in the Action Memorandum for the Remaining Facilities Demolition Project at East Tennessee Technology Park, Oak Ridge, Tennessee (DOE 2003a) as a Comprehensive Environmental Response, Compensation, and Liability Act of 1980 non-time-critical removal action. The objectives of the removal action (DOE 2003a) - to eliminate the source of potential contamination, to eliminate the threat of potential future releases, and/or to eliminate the threats to the general public and the environment - were met. The end state of this action is for the slab to remain with all penetrations sealed and grouted or backfilled. The basement and pits remain open. There is residual radiological and polychlorinated biphenyl contamination on the slab and basement. A fixative was applied to the area on the pad contaminated with polychlorinated biphenyls. Interim land-use controls will be maintained until final remediation decisions are made under the Zone 2 Record of Decision (DOE 2005a).

  19. Air Dispersion Modeling for the INL Application for a Synthetic Minor Sitewide Air Quality Permit to Construct with a Facility Emission Cap Component

    Energy Technology Data Exchange (ETDEWEB)

    Sondrup, Andrus Jeffrey [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-10-01

    The Department of Energy Idaho Operations Office (DOE-ID) is applying for a synthetic minor, Sitewide, air quality permit to construct (PTC) with a facility emission cap (FEC) component from the Idaho Department of Environmental Quality (DEQ) for Idaho National Laboratory (INL) to limit its potential to emit to less than major facility limits for criteria air pollutants (CAPs) and hazardous air pollutants (HAPs) regulated under the Clean Air Act. This document is supplied as an appendix to the application, Idaho National Laboratory Application for a Synthetic Minor Sitewide Air Quality Permit to Construct with a Facility Emissions Cap Component, hereafter referred to as “permit application” (DOE-ID 2015). Air dispersion modeling was performed as part of the permit application process to demonstrate pollutant emissions from the INL will not cause a violation of any ambient air quality standards. This report documents the modeling methodology and results for the air dispersion impact analysis. All CAPs regulated under Section 109 of the Clean Air Act were modeled with the exception of lead (Pb) and ozone, which are not required to be modeled by DEQ. Modeling was not performed for toxic air pollutants (TAPs) as uncontrolled emissions did not exceed screening emission levels for carcinogenic and non-carcinogenic TAPs. Modeling for CAPs was performed with the EPA approved AERMOD dispersion modeling system (Version 14134) (EPA 2004a) and five years (2000-2004) of meteorological data. The meteorological data set was produced with the companion AERMET model (Version 14134) (EPA 2004b) using surface data from the Idaho Falls airport, and upper-air data from Boise International Airport supplied by DEQ. Onsite meteorological data from the Grid 3 Mesonet tower located near the center of the INL (north of INTEC) and supplied by the local National Oceanic and Atmospheric Administration (NOAA) office was used for surface wind directions and wind speeds. Surface data (i

  20. Macroamylasemia in a patient with acute appendicitis: a case report.

    Science.gov (United States)

    Um, J W; Kim, K H; Kang, M S; Choe, J H; Bae, J W; Hong, Y S; Suh, S O; Kim, Y C; Whang, C W; Kim, S M

    1999-12-01

    Macroamylasemia is a condition of persistent, elevated serum amylase activity with no apparent clinical symptoms of a pancreatic disorder. In Korea, however, no such case has been reported to date. We report a case of a 17-year-old female diagnosed with macroamylasemia and acute appendicitis. One day earlier, she developed epigastric and right lower quadrant abdominal pain. She was characterized by high level of serum amylase, but normal lipase. Amylase isoenzyme analysis demonstrated increased fraction of salivary type and follow-up amylase level was persistently increased. Immunofixation disclosed the macroamylase binding with an immunoglobulin, consisting of IgA and kappa chain. The patient was treated by appendectomy, and the abdominal pain subsided.

  1. Magnetic resonance imaging in pediatric appendicitis: a systematic review.

    Science.gov (United States)

    Moore, Michael M; Kulaylat, Afif N; Hollenbeak, Christopher S; Engbrecht, Brett W; Dillman, Jonathan R; Methratta, Sosamma T

    2016-05-01

    Magnetic resonance imaging for the evaluation of appendicitis in children has rapidly increased recently. This change has been primarily driven by the desire to avoid CT radiation dose. This meta-analysis reviews the diagnostic performance of MRI for pediatric appendicitis and discusses current knowledge of cost-effectiveness. We used a conservative Haldane correction statistical method and found pooled diagnostic parameters including a sensitivity of 96.5% (95% confidence interval [CI]: 94.3-97.8%), specificity of 96.1% (95% CI: 93.5-97.7%), positive predictive value of 92.0% (95% CI: 89.3-94.0%) and negative predictive value of 98.3% (95% CI: 97.3-99.0%), based on 11 studies. Assessment of patient outcomes associated with MRI use at two institutions indicates that time to antibiotics was 4.7 h and 8.2 h, time to appendectomy was 9.1 h and 13.9 h, and negative appendectomy rate was 3.1% and 1.4%, respectively. Alternative diagnoses were present in ~20% of cases, most commonly adnexal cysts and enteritis/colitis. Regarding technique, half-acquisition single-shot fast spin-echo (SSFSE) pulse sequences are crucial. While gadolinium-enhanced T1-weighted pulse sequences might be helpful, any benefit beyond non-contrast MRI has not been confirmed. Balanced steady-state free precession (SSFP) sequences are generally noncontributory. Protocols do not need to exceed five sequences; four-sequence protocols are commonly utilized. Sedation generally is not indicated; patients younger than 5 years might be attempted based on the child's ability to cooperate. A comprehensive pediatric cost-effectiveness analysis that includes both direct and indirect costs is needed.

  2. [Synchronous acute cholecystolithiasis and perforated acute appendicitis. Case report].

    Science.gov (United States)

    Padrón-Arredondo, Guillermo; de Atocha Rosado-Montero, Manuel

    2016-01-01

    Acute appendicitis and acute cholecystitis are among the most common diagnoses that general surgeons operate on. However, it is rarely described in its synchronous form. A 43 year-old woman attending the clinic for right upper quadrant pain of 11 days duration. The patient refers to intermittent radiating pain in the right side, with positive Murphy, tachycardia, and fever. The laboratory results showed white cells 16,200/mm(3), glucose 345 mg/dl, abnormal liver function tests. Acute cholecystitis was reported with ultrasound. A Masson-type incision was made, noting an enlarged pyogenic gallbladder with thickened walls, sub-hepatic abscess of approximately 300 ml, greenish-yellow colour, and foetid. An anterograde subtotal cholecystectomy is performed due to difficulty in identifying elements of Calot triangle due to the inflammatory process, opening it and extracting stones. The right iliac fossa is reviewed, finding a plastron and a sub-serous retrocaecal appendix perforated in its middle third with free fecalith and an abscess in the pelvic cavity. An anterograde appendectomy was performed and the patient progressed satisfactorily, later being discharged due to improvement. In this patient, with a history of recurrent episodes of gallbladder pain and disseminated acute abdominal pain without peritoneal irritation, clinical suspicion was exacerbated cholecystitis with probable empyema of the gallbladder. Open surgery approach for this patient allowed access to both the appendix and gallbladder in order to perform a complete exploration of the abdominal cavity. The synchronous presentation of cholecystolithiasis and complicated appendicitis has not been reported in the literature. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  3. Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis

    Science.gov (United States)

    Dumlu, Ersin Gürkan; Tokaç, Mehmet; Bozkurt, Birkan; Yildirim, Murat Baki; Ergin, Merve; Yalçin, Abdussamed; Kiliç, Mehmet

    2014-01-01

    OBJECTIVES: To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients. METHOD: Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35) and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level) and ischemia-modified albumin. Surgical specimens were also evaluated. RESULTS: The diagnoses were acute appendicitis (n = 37), perforated appendicitis (n = 8), phlegmonous appendicitis (n = 12), perforated+phlegmonous appendicitis (n = 4), or no appendicitis (n = 4). The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004). The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters. CONCLUSIONS: The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis. PMID:25518019

  4. Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts

    Energy Technology Data Exchange (ETDEWEB)

    Sivit, Carlos J. [Departments of Radiology and Pediatrics, Rainbow Babies and Childrens Hospital of the University Hospitals of Cleveland and Case Western Reserve School of Medicine, Euclid Avenue, 11100, 44106-5056, Cleveland, OH (United States)

    2004-06-01

    Acute appendicitis is the most common condition presenting with right lower quadrant pain requiring acute surgical intervention in childhood. The clinical diagnosis of acute appendicitis is often not straightforward and can be challenging. Approximately one-third of children with the condition have atypical clinical findings and are initially managed non-operatively. Complications usually result from perforation and include abscess formation, peritonitis, sepsis, bowel obstruction and death. Cross-sectional imaging with sonography and computed tomography (CT) have proven useful for the evaluation of suspected acute appendicitis in children. The principal advantages of sonography are its lower cost, lack of ionizing radiation, and ability to precisely delineate gynecologic disease. The principal advantages of CT are its operator independency with resultant higher diagnostic accuracy, enhanced delineation of disease extent in perforated appendicitis, and improved patient outcomes including decreased negative laparotomy and perforation rates. (orig.)

  5. Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature

    Directory of Open Access Journals (Sweden)

    Daisuke Ito

    2014-01-01

    CONCLUSION: We report a case of acute amebic appendicitis in a 31-year-old woman and review the ages at presentation, causative factors, treatments, and outcomes of 11 cases reported in Japan between 1995 and 2013.

  6. Synthesis and characterization of dendronized poly(methylsiloxane) with appendent Fréchet-type dendrons

    Institute of Scientific and Technical Information of China (English)

    姜静; 刘宏伟; 赵优良; 陈传福; 习复

    2002-01-01

    A new kind of dendronized poly(methylsiloxane) (3a and 3b) with appendent Fréchet-type poly(aryl ether) dendrons has been synthesized and characterized by GPC, DSC, TGA, fluorescence and UV-Vis spectra.

  7. May Ingestion of Leachate from Decomposed Corpses Cause Appendicitis? A Case Report

    Directory of Open Access Journals (Sweden)

    Maurício Domingues-Ferreira

    2011-01-01

    Full Text Available The general consensus is that appendicitis is basically provoked by fecaliths or lymphoid hyperplasic obstruction. Several studies based on histological diagnosis have not confirmed this hypothesis. On the contrary, obstruction has been proved in only a minority of cases. Diverse infections by parasites, bacteria, fungus, and noninfective agents have been associated with appendicitis in the medical literature. We describe a firefighter, who ingested a small quantity of leachate from decomposing corpses while working and developed enteritis a few hours later, which lasted several days and evolved to appendicitis. This case raises the possibility that the high quantity of bacteria concentration present in the leachate could have provoked enteritis and the subsequent appendicitis due to a direct effect of the bacteria on the appendix.

  8. May Ingestion of Leachate from Decomposed Corpses Cause Appendicitis? A Case Report

    Science.gov (United States)

    Domingues-Ferreira, Maurício; Saddi-Rosa, Pedro; dos Santos, André Luis

    2011-01-01

    The general consensus is that appendicitis is basically provoked by fecaliths or lymphoid hyperplasic obstruction. Several studies based on histological diagnosis have not confirmed this hypothesis. On the contrary, obstruction has been proved in only a minority of cases. Diverse infections by parasites, bacteria, fungus, and noninfective agents have been associated with appendicitis in the medical literature. We describe a firefighter, who ingested a small quantity of leachate from decomposing corpses while working and developed enteritis a few hours later, which lasted several days and evolved to appendicitis. This case raises the possibility that the high quantity of bacteria concentration present in the leachate could have provoked enteritis and the subsequent appendicitis due to a direct effect of the bacteria on the appendix. PMID:21541232

  9. A case of acute appendicitis in a patient with crossed renal ectopia

    Institute of Scientific and Technical Information of China (English)

    Ulvi Meral; Murat Zor; Orhan Ureyen; Nisa Cem Oren; Hilmi Gungor

    2016-01-01

    Crossed renal ectopia is a rare anomaly in urological clinical practice. Patients with this anomaly are usually asymptomatic. Herein, we reported a case of acute appendicitis in a patient with crossed renal ectopia. A 22-year-old man with abdominal pain admitted to the emergency department. His physical examination revealed muscular defense and painful mass at the lower quadrant. Abdominal ultrasonography revealed crossed renal ectopia with no sign of stones and acute appendicitis. Tomography confirmed crossed renal ectopia but not acute appendicitis. On-going clinical symptoms lead to surgical intervention and acute appendicitis diagnosis. The patient was treated with appendectomy with no perioperative complications. Appendectomy is a common surgical procedure in surgical clinical practice. Acute abdominal pain must be managed carefully in patients with unusual anatomy. Also surgeons should be aware of ectopic organs in surgical procedures, to avoid iatrogenic intraoperative injuries.

  10. The diagnostic value of a panel of serological markers in acute appendicitis

    DEFF Research Database (Denmark)

    Farooqui, W; Pommergaard, H-C; Burcharth, J

    2015-01-01

    markers could increase the prognostic accuracy of diagnosing non-perforated and perforated appendicitis. MATERIAL AND METHODS: Demographic data, histological findings, blood tests, and clinical symptoms were collected on all patients who underwent a diagnostic laparoscopy, a laparoscopic appendectomy...

  11. A novel fully conjugated phenanthroline-appended phthalocyanine: synthesis and characterisation.

    Science.gov (United States)

    Rusanova, Julia; Pilkington, Melanie; Decurtins, Silvio

    2002-10-07

    The synthetic route to a new fully conjugated phenanthroline appended phthalocyanine is described. This compound has been fully characterised by elemental analysis, UV-VIS, IR, MS and 1H NMR spectroscopy.

  12. Appendicitis-like clinical image elicited by Enterobius vermicularis: case report and review of the literature.

    Science.gov (United States)

    Vleeschouwers, W; Hofman, Ph; Gillardin, J P; Meert, V; Van Slycke, S

    2013-01-01

    A 17-year-old female patient presented with the clinical features of an acute appendicitis. During laparoscopic exploration a macroscopically normal appendix was found. Since there were no intra-abdominal abnormalities found, the appendix was resected. Anatomopathology demonstrated Enterobius vermicularis, a pinworm infecting only humans, and mostly living in the caecum. This parasite is responsible for possibly the most common helminthic infection in the developed world. Its role in the pathogenesis of acute appendicitis is controversial, but more recent studies indicate a stronger association between enterobiasis and appendicitis. Often, enterobius mimics appendicitis by obstructing the lumen of the appendix, thereby causing appendiceal colic. This case report stresses the importance of microscopic examination of all appendectomy resection specimens. In case of enterobius infestation, systemic therapy of patient and family is necessary.

  13. A comparison between modified Alvarado score and RIPASA score in the diagnosis of acute appendicitis.

    Science.gov (United States)

    Singla, Anand; Singla, Satpaul; Singh, Mohinder; Singla, Deeksha

    2016-12-01

    Acute appendicitis is a common but elusive surgical condition and remains a diagnostic dilemma. It has many clinical mimickers and diagnosis is primarily made on clinical grounds, leading to the evolution of clinical scoring systems for pin pointing the right diagnosis. The modified Alvarado and RIPASA scoring systems are two important scoring systems, for diagnosis of acute appendicitis. We prospectively compared the two scoring systems for diagnosing acute appendicitis in 50 patients presenting with right iliac fossa pain. The RIPASA score correctly classified 88 % of patients with histologically confirmed acute appendicitis compared with 48.0 % with modified Alvarado score, indicating that RIPASA score is more superior to Modified Alvarado score in our clinical settings.

  14. De Garengeot’s Hernia; Acute Appendicitis In An Incarcerated Femoral Hernia

    Directory of Open Access Journals (Sweden)

    Kokoszka Maciej

    2015-07-01

    Full Text Available Acute appendicitis and incarcerated femoral hernia belong to relatively well known surgical diseases with regard to diagnostic workup and treatment. de Garengeot’s hernia is an entity involving concurrent occurrence of both the above mentioned problems.

  15. Flower-like supramolecular self-assembly of phosphonic acid appended naphthalene diimide and melamine

    Science.gov (United States)

    Bhosale, Rajesh S.; Al Kobaisi, Mohammad; Bhosale, Sidhanath V.; Bhargava, Suresh; Bhosale, Sheshanath V.

    2015-09-01

    Diverse supramolecular assemblies ranging from nanometres to micrometers of small aromatic π-conjugated functional molecules have attracted enormous research interest in light of their applications in optoelectronics, chemosensors, nanotechnology, biotechnology and biomedicines. Here we study the mechanism of the formation of a flower-shaped supramolecular structure of phosphonic acid appended naphthalene diimide with melamine. The flower-shaped assembly formation was visualised by scanning electron microscope (SEM) and transmission electron microscopy (TEM) imaging, furthermore, XRD and DLS used to determined mode of aggregation. Characteristically, phosphonic acid-substituted at imide position of NDIs possess two important properties resulting in the formation of controlled flower-like nanostructures: (i) the aromatic core of the NDI which is designed to optimize the dispersive interactions (π-π stacking and van der Waals interactions) between the cores within a construct and (ii) phosphonic acid of NDI interact with malamine through molecular recognition i.e. strong hydrogen-bonding (H-bonding). We believe such arrangements prevent crystallization and favour the directional growth of flower-like nanostructure in 3D fashion. These works demonstrate that complex self-assembly can indeed be attained through hierarchical non-covalent interactions of two components. Furthermore, flower-like structures built from molecular recognition by these molecules indicate their potential in other fields if combined with other chemical entities.

  16. A fluorescent sensing membrane for iodine based on intramolecular excitation energy transfer of anthryl appended porphyrin

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    A single anthryl appended meso-tetraphenylporphyrin (TPP) dyad has been synthesized and applied in fluorescence sensing of iodine based on the intramolecular excitation energy transfer. The molecular recognition of the sensor is based on the interaction of iodine with inner anthracene moiety of the dyad, while the signal reporter for the recognition process is the TPP fluorescence quenching. Because the emission spectrum of anthracene is largely overlapped with the Soret band absorption of TPP, intramolecular excitation energy transfer interaction occurs between the donor, anthracene and acceptor, TPP. This energy transfer leads to TPP fluorescence emission by excitation of anthracene. The sensor was constructed by immobilizing the dyad in a plasticized poly(vinyl chloride) (PVC) membrane. The sensing membrane shows higher sensitivity compared to the sensors by using anthracene, TPP, or a mixture of anthracene and TPP as sensing materials. Under the optimum conditions, iodine in a sample solution can be determined from 2.04 to 23.6 mmol·L-1 with a detection limit of 33 nmol·L-1. The sensing membrane shows satisfactory response characteristics including good reproducibility, reversibility and stability, as well as the short response time of less than 60 s. Except for Cr2O72- and MnO4-, other common metal ions and anions in foodstuff do not interfere with iodine determination. The proposed method was applied in the determination of iodine in table salt samples. The results agree well with those obtained by other methods.

  17. A fluorescent sensing membrane for iodine based on intramolecular excitation energy transfer of anthryl appended porphyrin

    Institute of Scientific and Technical Information of China (English)

    LONG LiPing; YOU MingXu; WANG Hao; WANG YongXiang; YANG RongHua

    2009-01-01

    A single anthryl appended meso-tetraphenylporphyrin (TPP) dyed has been synthesized and applied in fluorescence sensing of iodine based on the intramolecular excitation energy transfer. The molecular recognition of the sensor is based on the interaction of iodine with inner anthracene moiety of the dyad, while the signal reporter for the recognition process is the TPP fluorescence quenching. Because the emission spectrum of anthracene is largely overlapped with the Soret band absorption of TPP, in-tremolecular excitation energy transfer interaction occurs between the donor, anthracene and acceptor, TPP. This energy transfer leads to TPP fluorescence emission by excitation of anthracene. The sensor was constructed by immobilizing the dyad in a plasticized poly(vinyl chloride) (PVC) membrane. The sensing membrane shows higher sensitivity compared to the sensors by using anthracene, TPP, or a mixture of anthracene and TPP as sensing materials. Under the optimum conditions, iodine in a sample membrane shows satisfactory response characteristics including good reproducibility, reversibility end stability, as well as the short response time of less than 60 s. Except for Cr2O2-7 and MnO-4, other common metal ions and anions in foodstuff do not interfere with iodine determination. The proposed method was applied in the determination of iodine in table salt samples. The results agree well with those obtained by other methods.

  18. Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Danielle I. Miano

    2015-12-01

    Full Text Available Introduction: Acute appendicitis in children is a clinical diagnosis, which often requires preoperative confirmation with either ultrasound (US or computed tomography (CT studies. CTs expose children to radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric population with appropriate clinical follow up and serial exam may be an effective diagnostic modality for many children without incurring the risk of radiation. The objective of the study was to compare the rate of appendiceal rupture and negative appendectomies between children with and without abdominal CTs; and to evaluate the same outcomes for children with and without USs to determine if there were any associations between imaging modalities and outcomes. Methods: We conducted a retrospective chart review including emergency department (ED and inpatient records from 1/1/2009–2/31/2010 and included patients with suspected acute appendicitis. Results: 1,493 children, aged less than one year to 20 years, were identified in the ED with suspected appendicitis. These patients presented with abdominal pain who had either a surgical consult or an abdominal imaging study to evaluate for appendicitis, or were transferred from an outside hospital or primary care physician office with the stated suspicion of acute appendicitis. Of these patients, 739 were sent home following evaluation in the ED and did not return within the subsequent two weeks and were therefore presumed not to have appendicitis. A total of 754 were admitted and form the study population, of which 20% received a CT, 53% US, and 8% received both. Of these 57%, 95% CI [53.5,60.5] had pathology-proven appendicitis. Appendicitis rates were similar for children with a CT (57%, 95% CI [49.6,64.4] compared to those without (57%, 95% CI [52.9,61.0]. Children with perforation were similar between those with a CT (18%, 95% CI [12.3,23.7] and those without (13%, 95% CI [10.3,15.7]. The proportion of

  19. Inflammatory stricture of the right ureter following perforated appendicitis: The first Indian report.

    Science.gov (United States)

    Rajkumar, Janavikula Sankaran; Ganesh, Deepa; Rajkumar, Anirudh

    2016-01-01

    Perforated appendicitis leading to inflammatory stricture of the right ureter is a rarity. We present this fairly uncommon case of a patient who developed a stricture of the right ureter secondary to an ongoing inflammatory process in the peritoneum and retroperitoneum. A perforated appendicitis was operated upon, and on follow-up the mild hydronephrosis had worsened. Stenting of the right ureter completely solved the problem.

  20. Limits and advantages of abdominal ultrasonography in children with acute appendicitis syndrome

    Directory of Open Access Journals (Sweden)

    Valentina Pastore

    2014-01-01

    Full Text Available Background: Graded compression ultrasonography (US has become the most popular technique used in suspected appendicitis and in our prospective study, we have evaluated its contribution to the diagnosis of acute appendicitis during the period 2010-2013. Materials and Methods: Four hundred and eighty children underwent urgent abdominal suspected of having acute appendicitis. Patients were divided into operated groups; (220 patients and non-operated (260 patients the final diagnosis was established on histopathological findings in the first group and on the phone interview in the second one. US was the sole imaging modality in all the non-operated patients and in 203 out of 220 operated ones. Seven children in the operated group underwent CT, while a second US was performed in 10 patients. Results: Acute appendicitis was confirmed in 188 operated patients while no one in the non-operated group returned to the hospital or was operated for appendicitis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79%, 78%, 95%, 39% and 79%, respectively. Negative appendectomy and perforation rates were 14% and 8%. Seventeen children in the operated group required a second diagnostic imaging: 7 CTs and 10 USs. All the seven CTs were consistent with appendicitis and 6 out of 10 USs showed ecographic signs of appendicitis. Conclusion: Our results support routine US in all the children with suspected appendicitis because it helps in reducing negative appendectomy and perforation rate. Moreover, a negative US does not justify a subsequent and immediate CT because clinical re-evaluation and a second US can clarify the diagnosis.

  1. Isolated submucosal lipomatosis of appendix mimicking acute appendicitis: computed tomography findings

    Directory of Open Access Journals (Sweden)

    Şükrü Şanlı

    2014-03-01

    Full Text Available Acute appendicitis is one of the more common surgical emergencies, and it is one of the most common causes of acute abdominal pain. Intestinal lipomatosis is a rare condition particularly the isolated form of lipomatosis of the appendix which may mimic or present as an acute appendicitis, that frequently requires the surgical exploration.In this paper, we report computed tomography findings of a case wıth isolated form of submucosal lipomatosis of appendix.

  2. Inflammatory stricture of the right ureter following perforated appendicitis: The first Indian report

    Directory of Open Access Journals (Sweden)

    Janavikula Sankaran Rajkumar

    2016-01-01

    Full Text Available Perforated appendicitis leading to inflammatory stricture of the right ureter is a rarity. We present this fairly uncommon case of a patient who developed a stricture of the right ureter secondary to an ongoing inflammatory process in the peritoneum and retroperitoneum. A perforated appendicitis was operated upon, and on follow-up the mild hydronephrosis had worsened. Stenting of the right ureter completely solved the problem.

  3. Computed tomography findings mimicking appendicitis as a manifestation of colorectal cancer☆

    Science.gov (United States)

    Watchorn, Richard E.; Poder, Liina; Wang, Zhen J.; Yeh, Benjamin M.; Webb, Emily M.; Coakley, Fergus V.

    2009-01-01

    The primary computed tomography (CT) signs of appendicitis can also be seen with other inflammatory or neoplastic processes. We report on two cases in which appendiceal dilatation and peri-appendiceal fluid or stranding were the dominant imaging manifestations of colorectal carcinoma in the ascending colon. This study highlights the need to closely examine the ascending colon in patients with a suspected CT diagnosis of acute appendicitis, since these findings may be secondary to an inconspicuous colorectal carcinoma. PMID:19857802

  4. Co-infection with Enterobius vermicularis and Taenia saginata mimicking acute appendicitis.

    Science.gov (United States)

    Saravi, Kasra H; Fakhar, Mahdi; Nematian, Javad; Ghasemi, Maryam

    2016-01-01

    In this report, we describe an unusual case of verminous appendicitis due to Enterobius vermicularis and Taenia saginata in a 29-year-old woman from Iran. The histopathological examinations and parasitological descriptions of both worms found in the appendix lumen are discussed. The removed appendix exhibited the macroscopic and microscopic features of acute appendicitis. Antihelminthic therapy was initiated with single doses of praziquantel for the taeniasis and mebendazole for the enterobiasis, and the patient was discharged.

  5. The Association Between Barium Examination and Subsequent Appendicitis: A Nationwide Population-Based Study.

    Science.gov (United States)

    Li, Hao-Ming; Yeh, Lee-Ren; Huang, Ying-Kai; Lin, Cheng-Li; Kao, Chia-Hung

    2017-01-01

    The incidence and association between appendicitis and barium examination (BE) remain unclear. Such potential risk may be omitted. We conducted a longitudinal, nationwide, population-based cohort study to investigate the association between BE and appendicitis risk. From the Taiwan National Health Insurance Research Database, a total of 24,885 patients who underwent BE between January 1, 2000 and December 31, 2010 were enrolled in a BE cohort; an additional 98,384 subjects without BE exposure were selected as a non-BE cohort, matched by age, sex, and index date. The cumulative incidences of subsequent appendicitis in the BE and non-BE cohorts were assessed using the Kaplan-Meier curves and log-rank test. Cox proportional hazards regression analyses were employed to calculate the appendicitis risk between the groups. The cumulative incidence of appendicitis was higher in the BE cohort than in the non-BE cohort (P = .001). The overall incidence rates of appendicitis for the BE and non-BE cohorts were 1.19 and 0.80 per 1000 person-years, respectively. After adjustment for sex, age, and comorbidities, the risk of appendicitis was higher in the BE cohort (adjusted hazard ratio = 1.46, 95% confidence interval = 1.23-1.73) compared with the non-BE cohort, especially in the first 2 months (adjusted hazard ratio = 9.72, 95% confidence interval = 4.65-20.3). BE was associated with an increased, time-dependent appendicitis risk. Clinicians should be aware of this potential risk to avoid delayed diagnoses. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. The utility of acoustic radiation force impulse imaging in diagnosing acute appendicitis and staging its severity

    Science.gov (United States)

    Göya, Cemil; Hamidi, Cihad; Okur, Mehmet Hanifi; İçer, Mustafa; Oğuz, Abdullah; Hattapoğlu, Salih; Çetinçakmak, Mehmet Güli; Teke, Memik

    2014-01-01

    PURPOSE The aim of this study was to investigate the feasibility of using acoustic radiation force impulse (ARFI) imaging to diagnose acute appendicitis. METHODS Abdominal ultrasonography (US) and ARFI imaging were performed in 53 patients that presented with right lower quadrant pain, and the results were compared with those obtained in 52 healthy subjects. Qualitative evaluation of the patients was conducted by Virtual Touch™ tissue imaging (VTI), while quantitative evaluation was performed by Virtual Touch™ tissue quantification (VTQ) measuring the shear wave velocity (SWV). The severity of appendix inflammation was observed and rated using ARFI imaging in patients diagnosed with acute appendicitis. Alvarado scores were determined for all patients presenting with right lower quadrant pain. All patients diagnosed with appendicitis received appendectomies. The sensitivity and specificity of ARFI imaging relative to US was determined upon confirming the diagnosis of acute appendicitis via histopathological analysis. RESULTS The Alvarado score had a sensitivity and specificity of 70.8% and 20%, respectively, in detecting acute appendicitis. Abdominal US had 83.3% sensitivity and 80% specificity, while ARFI imaging had 100% sensitivity and 98% specificity, in diagnosing acute appendicitis. The median SWV value was 1.11 m/s (range, 0.6–1.56 m/s) for healthy appendix and 3.07 m/s (range, 1.37–4.78 m/s) for acute appendicitis. CONCLUSION ARFI imaging may be useful in guiding the clinical management of acute appendicitis, by helping its diagnosis and determining the severity of appendix inflammation. PMID:25323836

  7. Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams.

    Science.gov (United States)

    Telesmanich, Morgan E; Orth, Robert C; Zhang, Wei; Lopez, Monica E; Carpenter, Jennifer L; Mahmood, Nadia; Jadhav, Siddharth P; Guillerman, R Paul

    2016-10-01

    Ultrasound (US) is the preferred imaging modality for evaluating suspected pediatric appendicitis. However, borderline appendiceal enlargement or questionable inflammatory changes can confound interpretation and lead to equivocal exams. The purpose of this study was to determine which findings on equivocal US exams are most predictive of appendicitis. All US exams performed for suspected pediatric appendicitis from July 1, 2013, through July 9, 2014, were initially interpreted using a risk-stratified scoring system. Two blinded pediatric radiologists independently reviewed US exams designated as equivocal and recorded the following findings: increased wall thickness, loss of mural stratification, peri-appendiceal fat inflammation, peri-appendiceal fluid, appendicolith and maximum appendiceal diameter. A third pediatric radiologist resolved discrepancies. US features were correlated with the final diagnosis via multivariate analysis. During the study period, 162/3,750 (4.3%) children had US exams initially interpreted as equivocal (mean age 9.8 +/- 3.8 years). Five outpatients were lost to follow-up. Forty-eight of the remaining 157 (30.6%) children had an operative diagnosis of appendicitis. Findings significantly associated with appendicitis were loss of mural stratification (odds ratio [OR] = 6.7, P=0.035), peri-appendiceal fat inflammation (OR = 10.0, Pappendicitis, the difference was not statistically significant. Loss of mural stratification, peri-appendiceal fat inflammation and an appendicolith are significant predictors of appendicitis in children with otherwise equivocal US exams. While maximum appendiceal diameter is not statistically associated with appendicitis in our study, mean appendiceal diameter of 6.7 mm in those without appendicitis suggests that the customary upper normal limit of 6 mm is too sensitive.

  8. Contrast-Enhanced Abdominal MRI for Suspected Appendicitis: How We Do It

    Science.gov (United States)

    Kinner, Sonja; Repplinger, Michael D.; Pickhardt, Perry J.; Reeder, Scott B.

    2017-01-01

    OBJECTIVE The purpose of this article is to describe our approach to contrast-enhanced abdominal MRI in patients with nontraumatic abdominal pain and suspected appendicitis. We aim to share our experience on the advantages, pearls, and pitfalls of MRI in this clinical setting, in comparison with CT and ultrasound. CONCLUSION We present some typical cases of appendicitis and alternative diagnoses in patients presenting with acute nontraumatic abdominal pain. PMID:27065072

  9. Appendicitis in children less than five years old: A challenge for the general practitioner

    OpenAIRE

    Marzuillo, Pierluigi; Germani, Claudio; Baruch S. Krauss; Barbi, Egidio

    2015-01-01

    Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5...

  10. Round ligament lipoma mimicking acute appendicitis in a 24-week pregnant female: a case report.

    Science.gov (United States)

    Miller, T J; Paulk, D G

    2013-04-01

    An exhaustive search of the literature using the Pub Med database revealed no reports of round ligament lipomas mimicking acute appendicitis in pregnant patients. There are relatively few articles on round ligament lipomas and even less on round ligament lipomas during pregnancy. This case report is on a 27-year-old 24-week pregnant female who presented with signs and symptoms similar to acute appendicitis who in fact had a large right pelvic round ligament lipoma that was causing her pain.

  11. A Rare Case of Neonatal Complicated Appendicitis in a Child with Patau’s Syndrome

    OpenAIRE

    Valentina Pastore; Fabio Bartoli

    2014-01-01

    Neonatal appendicitis is a rare condition with high mortality rate. Signs and symptoms are often nonspecific, imaging modalities are not always diagnostic, and preoperative diagnosis is difficult with subsequent delay and complications. Its pathophysiology may be different from appendicitis in older children and comorbidities can be found. We report a case of a female neonate with Patau’s syndrome, intestinal malrotation, and Fallot tetralogy in whom perforated appendix, probably occurring du...

  12. Ultrasound Findings of Lymphoid Hyperplasia of the Appendix in Children: Differentiation from Acute Appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bong Jae; Seo, Jung Wook; Lee, Byung Hoon [Inje University Ilsan Paik Hospital, Koyang (Korea, Republic of)

    2009-12-15

    To evaluate the ultrasound (US) findings that can help differentiate lymphoid hyperplasia in the appendix from acute appendicitis. A total of 1230 patients (below 20 years old) suspected of having appendicitis received an appendectomy between November, 1999, and March, 2008, with US findings in 27 patients with pathologically proven lymphoid hyperplasia of the appendix. Of 167 patients that received an appendectomy from January, 2007, to December, 2007, 52 patients with acute appendicitis were retrospectively reviewed as a control group. Retrospective review of US images was performed by two radiologists who were blinded to the pathologic results. The review was based on 12 ultrasonographic criteria derived from reports on the diagnostic findings of the appendicitis. Compared with acute appendicitis, lymphoid hyperplasia in appendix had a smaller diameter (7.14{+-}1.22 mm vs 9.37{+-}1.80 mm, p < 0.001) and less wall thickening(1.38{+-}0.36 mm vs 1.74 {+-} 0.56 mm, p =0.001). Periappendicular inflammation (p < 0.001), intraluminal air (p = 0.006), round shape in transverse scan (p = 0.002),increased blood flow on color Doppler US (p = 0.03) were also different. US is a useful modality to differentiate lymphoid hyperplasia in the appendix from acute appendicitis

  13. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Inci, Ercan; Hocaoglu, Elif; Aydin, Sibel; Bayramoglu, Sibel; Cimilli, Tan [Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul (Turkey); Kilickesmez, Ozgur [Yeditepe University, School of Medicine, Department of Radiology, Istanbul (Turkey)

    2011-04-15

    To evaluate the value of diffusion-weighted MRI (DWI) in the diagnosis of acute appendicitis. 119 patients with acute appendicitis and 50 controls were enrolled in this prospective study. DWI was obtained with b factors 0, 500 and 1000 s/mm{sup 2} and were assessed with a visual scoring system by two radiologists followed by quantitative evaluation of the DW images and ADC maps. Histopathology revealed appendicitis in 79/92 patients (78%) who had undergone surgery. On visual evaluation, except for one patient with histopathologically proven appendicitis all inflamed appendixes were hyperintense on DWI (98.7%). Quantitative evaluation with DW signal intensities and ADC values revealed a significant difference with normal and inflamed appendixes (p < 0.001). The best discriminative parameter was signal intensity (b 500). With a cut-off value of 56 for the signal intensity the ratio had a sensitivity of 99% and a specificity of 97%. The cut-off ADC value at 1.66 mm{sup 2}/s had a sensitivity of 97% and a specificity of 99%. DWI is a valuable technique for the diagnosis of acute appendicitis with both qualitative and quantitative evaluation. DWI increases the conspicuity of the inflamed appendix. We recommend using DWI to diagnose acute appendicitis. (orig.)

  14. Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Platon, Alexandra; Jlassi, Helmi; Becker, Christoph D.; Poletti, Pierre-Alexandre [University Hospital of Geneva, Department of Radiology, Geneva 14 (Switzerland); Rutschmann, Olivier T. [University Hospital of Geneva, Emergency Center, Geneva (Switzerland); Verdun, Francis R. [University Institute for Radiation Physics, Lausanne (Switzerland); Gervaz, Pascal [University Hospital of Geneva, Clinic of Digestive Surgery, Geneva (Switzerland)

    2009-02-15

    The aim of this study was to evaluate a low-dose CT with oral contrast medium (LDCT) for the diagnosis of acute appendicitis and compare its performance with standard-dose i.v. contrast-enhanced CT (standard CT) according to patients' BMIs. Eighty-six consecutive patients admitted with suspicion of acute appendicitis underwent LDCT (30 mAs), followed by standard CT (180 mAs). Both examinations were reviewed by two experienced radiologists for direct and indirect signs of appendicitis. Clinical and surgical follow-up was considered as the reference standard. Appendicitis was confirmed by surgery in 37 (43%) of the 86 patients. Twenty-nine (34%) patients eventually had an alternative discharge diagnosis to explain their abdominal pain. Clinical and biological follow-up was uneventful in 20 (23%) patients. LDCT and standard CT had the same sensitivity (100%, 33/33) and specificity (98%, 45/46) to diagnose appendicitis in patients with a body mass index (BMI) {>=} 18.5. In slim patients (BMI < 18.5), sensitivity to diagnose appendicitis was 50% (2/4) for LDCT and 100% (4/4) for standard CT, while specificity was identical for both techniques (67%, 2/3). LDCT may play a role in the diagnostic workup of patients with a BMI {>=} 18.5. (orig.)

  15. Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.

    Science.gov (United States)

    Lotti, Marco

    2017-06-01

    Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. Between June and July 2016, two patients were readmitted and operated for failure of nonoperative treatment with antibiotics. A video is presented, which focuses on the different anatomic presentation and technical challenges between prompt and second date laparoscopic appendectomy. When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Volume-Outcome Relation for Acute Appendicitis: Evidence from a Nationwide Population-Based Study

    Science.gov (United States)

    Wei, Po-Li; Liu, Shih-Ping; Keller, Joseph J.; Lin, Herng-Ching

    2012-01-01

    Background Although procedures like appendectomy have been studied extensively, the relative importance of each surgeon's surgical volume-to-ruptured appendicitis has not been explored. The purpose of this study was to investigate the rate of ruptured appendicitis by surgeon-volume groups as a measure of quality of care for appendicitis by using a nationwide population-based dataset. Methods We identified 65,339 first-time hospitalizations with a discharge diagnosis of acute appendicitis (International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes 540, 540.0, 540.1 and 540.9) between January 2007 and December 2009. We used “whether or not a patient had a perforated appendicitis” as the outcome measure. A conditional (fixed-effect) logistic regression model was performed to explore the odds of perforated appendicitis among surgeon case volume groups. Results Patients treated by low-volume surgeons had significantly higher morbidity rates than those treated by high-volume (28.1% vs. 26.15, pappendicitis volume, patients treated by low-volume surgeons had significantly higher rates of perforated appendicitis than those treated by medium-volume surgeons (OR = 1.09, pappendicitis. PMID:23300703

  17. Assessment of serum endothelin-1 levels in rat appendicitis model and the effects of bosentan.

    Science.gov (United States)

    Sarsu, S B; Sahin, K; Kilincaslan, H; Mirapoglu, S L; Buyukpınarbasili, N; Duz, M E; Aydogdu, I

    2017-04-01

    In this study, the diagnostic value of serum endothelin-1 (ET-1) levels and the therapeutic effects of bosentan have been investigated in an experimental appendicitis rat model. Twenty-one male Sprague-Dawley rats were chosen for the study. The rats were allocated into three groups as follows: Group 1 (control, n = 7), Group 2 (appendicitis, n = 7), and Group 3 (bosentan treatment, n = 7). At the 6th hour of the experiment, Groups 1 and 2 received 2 ml saline, and group 3 received 30 mg/kg bosentan intraperitoneally. At the 24th postoperative hour, all rats were sacrificed and evaluated histopathologically to score the severity of appendicitis. The plasma malondialdehyde, reduced and total glutathione levels, serum, and appendiceal tissue ET-1 levels were evaluated. In this study, we found that the ET-1 levels were significantly increased with appendicitis (p = 0.018). The administration of bosentan can statistically significantly both decrease the histopathologic injury in the inflamed appendix and increase the serum total glutathione levels (p = 0.002). The increase in plasma ET-1 levels may have a diagnostic value of acute appendicitis. We believe that manifestations that occur during the acute phase of appendicitis may be reduced with the administration of bosentan, which may also help prevent complications.

  18. Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children.

    Science.gov (United States)

    Partain, Kristin N; Patel, Adarsh; Travers, Curtis; McCracken, Courtney E; Loewen, Jonathan; Braithwaite, Kiery; Heiss, Kurt F; Raval, Mehul V

    2016-10-01

    Ultrasound (US) is the preferred imaging modality for evaluating appendicitis. Our purpose was to determine if including secondary signs (SS) improve diagnostic accuracy in equivocal US studies. Retrospective review identified 825 children presenting with concern for appendicitis and with a right lower quadrant (RLQ) US. Regression models identified which SS were associated with appendicitis. Test characteristics were demonstrated. 530 patients (64%) had equivocal US reports. Of 114 (22%) patients with equivocal US undergoing CT, those with SS were more likely to have appendicitis (48.6% vs 14.6%, pappendicitis (61.0% vs 33.6%, pappendicitis included fluid collection (adjusted odds ratio (OR) 13.3, 95% confidence interval (CI) 2.1-82.8), hyperemia (OR=2.0, 95%CI 1.5-95.5), free fluid (OR=9.8, 95%CI 3.8-25.4), and appendicolith (OR=7.9, 95%CI 1.7-37.2). Wall thickness, bowel peristalsis, and echogenic fat were not associated with appendicitis. Equivocal US that included hyperemia, a fluid collection, or an appendicolith had 96% specificity and 88% accuracy. Use of SS in RLQ US assists in the diagnostic accuracy of appendicitis. SS may guide clinicians and reduce unnecessary CT and admissions. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. A rare case of perforated "sub-hepatic appendicitis" - a challenging differential diagnosis of acute abdomen based on the combination of appendicitis and maldescent of the caecum.

    Science.gov (United States)

    Chiapponi, Costanza; Jannasch, Olof; Petersen, Manuela; Lessel, Wiebke; Bruns, Christiane; Meyer, Frank

    2017-01-01

    Unusual locations of the appendix vermiformis can result in delay in appropriate diagnosis and treatment of appendicitis. So an inflamed appendix in a sub-hepatic caecum caused by caecal maldescent for example can mimic cholecystitis, the pain being localized in the right upper quadrant. Here, we present a case of perforated sub-hepatic appendicitis with peritonitis, requiring open ileocaecal resection. Review of the existing literature has demonstrated that this pathology is uncommon, yet not so rare as one might presume. In conclusion, surgeons should be aware of this possibility in the diagnostic and therapeutic management of acute abdomen. Copyright © 2016. Published by Elsevier GmbH.

  20. Pre-reserving and Pre-burying Construction Management of Expressway Traffic Engineering Facility%高速公路交通工程设施预留预埋建设管理

    Institute of Scientific and Technical Information of China (English)

    彭洪涛; 王晨

    2012-01-01

      Pre-reserving and pre-burying of highway traffic engineering facilities usually constructed synchronously with the highway main body engineering, however, the traffic engineering equipment installation and cable laying construction project are relatively lag behind. Combined with the actual construction of highway, problems existing in traffic engineering facilities pre-reserving and pre-burying construction and their reasons were analyzed, and from angle of highway construction management corresponding proposals on design, construction and supervision etc. were put forward.%  高速公路交通工程设施预留预埋通常随公路主体工程同步施工,而交通工程设备安装及线缆敷设等施工项目在时间上相对滞后,文章结合高速公路实际建设情况,对交通工程设施预留预埋施工存在的问题及原因进行了分析,并从从高速公路建设管理角度对设计、施工、监理等环节提出相应建议。

  1. 电动汽车充电设施建设方案浅谈%On Construction Schemes of Electric Vehicle Charging Facilities

    Institute of Scientific and Technical Information of China (English)

    张巍伟

    2015-01-01

    With the deepening of global energy crisis and the prevalence of air pollution and climate warming,the devel-opment and application of new energy are receivingmore and more attention. Governments and automobile makers have realized that energy saving and emission-reduction are the direction of future automotive technology and the development of electric vehicles is the best way to solve the problems. China has attached great importance on the development of electric vehicles,and has issued a series of policies and worked out many standards to support and standardize the industry. How-ever,the popularization of electric vehicles still has a long way to go. This paper discusses construction schemes of electric vehicle charging facilities from the aspects of charging stations and charging piles.%随着全球能源危机的不断加深,大气污染、气候变暖等危害的加剧,新能源的发展与应用越来越受到关注,各国政府及汽车企业普遍认识到节能和减排是未来汽车技术发展的方向,发展电动汽车将是解决上述难题的最佳途径.我国高度重视电动汽车的发展,相继出台了一系列政策标准来扶持和规范电动汽车的发展,但要实现电动汽车大面积普及还需要很长的时间.分别从充电站与充电桩两方面论述了电动汽车充电设施的建设方案.

  2. Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: Comparison with Alvarado scoring system and histopathological results

    Energy Technology Data Exchange (ETDEWEB)

    Inci, Ercan, E-mail: ercan_inci@mynet.com [Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Incirli-Bakirkoy, Istanbul (Turkey); Hocaoglu, Elif; Aydin, Sibel; Palabiyik, Figen; Cimilli, Tan [Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Incirli-Bakirkoy, Istanbul (Turkey); Turhan, Ahmet Nuray; Ayguen, Ersan [Department of Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul (Turkey)

    2011-11-15

    Purpose: The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results. Materials and methods: The study included 85 consecutive patients (mean age, 26.5 {+-} 11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores. The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings. Results: Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively. Conclusions: MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.

  3. Enterobius Vermicularis infection of the appendix as a cause of acute appendicitis in a Greek adolescent: a case report

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    Efraimidou, Eleni; Gatopoulou, Anthia; Stamos, Charilaos; Lirantzopoulos, Nikolaos; Kouklakis, George

    2008-01-01

    Gastrointestinal infection due to Enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection. The simple presence of E. vermicularis in the appendix usually produces symptoms of acute appendicitis. The association of this parasitic infestation with acute appendicitis varies from 0.2%–41.8% worldwide. We present a case of a 15 year old female with enterobiasis of appendix presented with clinical features of acute appendicitis. The appendix was surgicall...

  4. Diagnosing Appendicitis: Evidence-Based Review of the Diagnostic Approach in 2014

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    Daniel J. Shogilev

    2014-11-01

    Full Text Available Introduction: Acute appendicitis is the most common abdominal emergency requiring emergency surgery. However, the diagnosis is often challenging and the decision to operate, observe or further work-up a patient is often unclear. The utility of clinical scoring systems (namely the Alvarado score, laboratory markers, and the development of novel markers in the diagnosis of appendicitis remains controversial. This article presents an update on the diagnostic approach to appendicitis through an evidence-based review. Methods: We performed a broad Medline search of radiological imaging, the Alvarado score, common laboratory markers, and novel markers in patients with suspected appendicitis. Results: Computed tomography (CT is the most accurate mode of imaging for suspected cases of appendicitis, but the associated increase in radiation exposure is problematic. The Alvarado score is a clinical scoring system that is used to predict the likelihood of appendicitis based on signs, symptoms and laboratory data. It can help risk stratify patients with suspected appendicitis and potentially decrease the use of CT imaging in patients with certain Alvarado scores. White blood cell (WBC, C-reactive protein (CRP, granulocyte count and proportion of polymorphonuclear (PMN cells are frequently elevated in patients with appendicitis, but are insufficient on their own as a diagnostic modality. When multiple markers are used in combination their diagnostic utility is greatly increased. Several novel markers have been proposed to aid in the diagnosis of appendicitis; however, while promising, most are only in the preliminary stages of being studied. Conclusion: While CT is the most accurate mode of imaging in suspected appendicitis, the accompanying radiation is a concern. Ultrasound may help in the diagnosis while decreasing the need for CT in certain circumstances. The Alvarado Score has good diagnostic utility at specific cutoff points. Laboratory markers have

  5. Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children.

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    Serres, Stephanie K; Cameron, Danielle B; Glass, Charity C; Graham, Dionne A; Zurakowski, David; Karki, Mahima; Anandalwar, Seema P; Rangel, Shawn J

    2017-08-01

    Management of appendicitis as an urgent rather than emergency procedure has become an increasingly common practice in children. Controversy remains as to whether this practice is associated with increased risk of complicated appendicitis and adverse events. To examine the association between time to appendectomy (TTA) and risk of complicated appendicitis and postoperative complications. In this retrospective cohort study using the Pediatric National Surgical Quality Improvement Program appendectomy pilot database, 2429 children younger than 18 years who underwent appendectomy within 24 hours of presentation at 23 children's hospitals from January 1, 2013, through December 31, 2014, were studied. The main exposure was TTA, defined as the time from emergency department presentation to appendectomy. Patients were further categorized into early and late TTA groups based on whether their TTA was shorter or longer than their hospital's median TTA. Exposures were defined in this manner to compare rates of complicated appendicitis within a time frame sensitive to each hospital's existing infrastructure and diagnostic practices. The primary outcome was complicated appendicitis documented at operation. The association between treatment delay and complicated appendicitis was examined across all hospitals by using TTA as a continuous variable and at the level of individual hospitals by using TTA as a categorical variable comparing outcomes between late and early TTA groups. Secondary outcomes included length of stay (LOS) and postoperative complications (incisional and organ space infections, percutaneous drainage procedures, unplanned reoperation, and hospital revisits). Of the 6767 patients who met the inclusion criteria, 2429 were included in the analysis (median age, 10 years; interquartile range, 8-13 years; 1467 [60.4%] male). Median hospital TTA was 7.4 hours (range, 5.0-19.2 hours), and 574 patients (23.6%) were diagnosed with complicated appendicitis (range, 5

  6. Synthesis, computational modeling, and properties of benzo-appended BODIPYs.

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    Uppal, Timsy; Hu, Xiaoke; Fronczek, Frank R; Maschek, Stephanie; Bobadova-Parvanova, Petia; Vicente, M Graça H

    2012-03-26

    A series of new functionalized mono- and dibenzo-appended BODIPY dyes were synthesized from a common tetrahydroisoindole precursor following two different synthetic routes. Route A involved the assembly of the BODIPY core prior to aromatization, while in Route B the aromatization step was performed first. In general, Route A gave higher yields of the target dibenzo-BODIPYs, due to the ease of aromatization of the BODIPYs compared with the corresponding dipyrromethenes, probably due to their higher stability under the oxidative conditions (2,3-dichloro-5,6-dicyano-1,4-benzoquinone in refluxing toluene). However, due to the slow oxidation of highly electron-deficient BODIPY 3 c bearing a meso-C(6)F(5) group, dibenzo-BODIPY 4 c was obtained, in 35 % overall from dipyrromethane, only by Route B. Computational calculations performed at the 6-31G(d,p) level are in agreement with the experimental results, showing similar relative energies for all reaction intermediates in both routes. In addition, BODIPY 3 c had the highest molecular electrostatic potential (MEPN), confirming its high electron deficiency and consequent resistance toward oxidation. X-ray analyses of eight BODIPYs and several intermediates show that benzannulation further enhances the planarity of these systems. The π-extended BODIPYs show strong red-shifted absorptions and emissions, about 50-60 nm per benzoannulated ring, at 589-658 and 596-680 nm, respectively. In particular, db-BODIPY 4 c bearing a meso-C(6)F(5) group showed the longest λ(max) of absorption and emission, along with the lowest fluorescence quantum yield (0.31 in CH(2)Cl(2)); on the other hand monobenzo-BODIPY 8 showed the highest quantum yield (0.99) of this series. Cellular investigations using human carcinoma HEp2 cells revealed high plasma membrane permeability for all dibenzo-BODIPYs, low dark- and photo-cytotoxicities and intracellular localization in the cell endoplasmic reticulum, in addition to other

  7. A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

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    Cobben, Lodewijk [Medisch Centrum Haaglanden, Department of Radiology, Leidschendam (Netherlands); Groot, Ingrid [Medisch Centrum Haaglanden, Department of Surgery, Leidschendam (Netherlands); Kingma, Lucas; Coerkamp, Emile; Puylaert, Julien [Medisch Centrum Haaglanden, Department of Radiology, Den Haag (Netherlands); Blickman, Johan [Universitair Medisch Centrum St Radboud, Department of Radiology, Geert Grooteplein 10, GA, Nijmegen (Netherlands)

    2009-05-15

    To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes. The imaging results were recorded separately and subsequently correlated with clinical, radiological and histopathological follow-up. The effect of imaging strategies in patients suspected of appendicitis on hospital resources was calculated. Sixty-two of the 138 patients had a histopathologically proven appendicitis. MRI determined appendicitis in 63 patients, with one examination being false positive. The resulting sensitivity and specificity were 100% and 99%, respectively. MRI showed an alternative diagnosis in 41 of the 75 remaining patients. In 22 of the remaining 34 patients, a normal appendix was depicted with MRI. In two patients, where MRI showed no appendicitis, an alternative diagnosis or normal appendix, an unnecessary appendectomy was performed. The overall effect of using MRI in patients suspected of appendicitis on the use of hospital resources could have been a net saving between EUR 55,746 and EUR 72,534. MRI has a high accuracy in detecting and excluding appendicitis, an alternative diagnosis or showing the normal appendix, and can be a valuable and cost-effective tool in the workup of patients clinically suspected of having appendicitis. (orig.)

  8. EVALUATION OF HYPERBILIRUBINAEMIA AS A NEW DIAGNOSTIC MARKER FOR ACUTE APPENDICITIS AND ITS ROLE IN THE PREDICTION OF APPENDICULAR PERFORATION

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    Lalit Kumar Regar

    2016-07-01

    Full Text Available BACKGROUND There are various investigations recommended to diagnose acute appendicitis; however, till date there is no confirmatory laboratory marker to diagnose preoperatively acute appendicitis & appendicular perforation. The purpose of study is to evaluate hyperbilirubinaemia as a new diagnostic marker for acute appendicitis and its role in the prediction of appendicular perforation. Preoperative assessment of serum bilirubin appears to be a promising new laboratory marker for diagnosing acute appendicitis & have a predictive potential for the diagnosis of appendicular perforation. METHODS A prospective analytical study of 100 cases comprising of a non-randomised cohort. RESULTS Hyperbilirubinaemia was found in most of the patients diagnosed with acute appendicitis (68.23% or appendicular perforation (73.33%. The mean total bilirubin level in patients diagnosed with acute appendicitis was 1.34 mg% while in patients diagnosed with appendicular perforation was 2.12 mg%. CONCLUSIONS Preoperative assessment of serum bilirubin should be routinely performed in cases of acute appendicitis as it can help in diagnosis of acute appendicitis as well as also serve as an important maker of acute gangrenous appendicitis.

  9. Does elevated urinary 5-hydroxyindole acetic acid level predict acute appendicitis in children?

    Science.gov (United States)

    Bosak Versic, Ana; Glavan, Nedeljka; Bukvic, Nado; Tomasic, Zlatko; Nikolic, Harry

    2016-12-01

    Acute appendicitis is the most common abdominal surgical emergency in children, and appendectomy is the most frequent acute abdominal operation. Prompt diagnosis and surgical treatment are required to reduce the risk of perforation and prevent complications, especially in small children. Enterochromaffin cells that contain large amounts of serotonin are mostly located in the distal appendix. Serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) could therefore be a marker for acute appendicitis. We tested urinary 5-HIAA concentrations in spot urine samples from children with acute appendicitis. We enrolled 93 patients who underwent surgery for suspicion of acute appendicitis. The diagnosis was made intraoperatively and confirmed histopathologically. Additionally, urine samples from 102 healthy children were collected as controls. Their 5-HIAA was measured using high-performance liquid chromatography. Acute appendicitis was diagnosed in 81 patients, whereas there were other explanations for abdominal pain in the remaining 12 patients in the non-appendicitis group. The control group comprised 102 healthy children. Considering the median of all measured 5-HIAA values as the cut-off, we analysed the proportions of patients with elevated values in all the groups. Our analysis showed that statistically there was no significant difference in the distribution of percentages among the groups. The area under the curve for 5-HIAA was 0.55 (95% CI 0.47 to 0.62) with sensitivity and specificity 60.4% and 48.9%, respectively. Urine 5-HIAA concentration measured in spot samples is not a reliable method for diagnosing acute appendicitis in children. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Routine Ultrasound and Limited Computed Tomography for the Diagnosis of Acute Appendicitis

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    Wiersma, Fraukje; Bakker, Rutger F. R.; Merkus, Jos W. S.; Breslau, Paul J.; Hamming, Jaap F.

    2010-01-01

    Background Acute appendicitis continues to be a challenging diagnosis. Preoperative radiological imaging using ultrasound (US) or computed tomography (CT) has gained popularity as it may offer a more accurate diagnosis than classic clinical evaluation. The optimal implementation of these diagnostic modalities has yet to be established. The aim of the present study was to investigate a diagnostic pathway that uses routine US, limited CT, and clinical re-evaluation for patients with acute appendicitis. Methods A prospective analysis was performed of all patients presenting with acute abdominal pain at the emergency department from June 2005 until July 2006 using a structured diagnosis and management flowchart. Daily practice was mimicked, while ensuring a valid assessment of clinical and radiological diagnostic accuracies and the effect they had on patient management. Results A total of 802 patients were included in this analysis. Additional radiological imaging was performed in 96.3% of patients with suspected appendicitis (n = 164). Use of CT was kept to a minimum (17.9%), with a US:CT ratio of approximately 6:1. Positive and negative predictive values for the clinical diagnosis of appendicitis were 63 and 98%, respectively; for US 94 and 97%, respectively; and for CT 100 and 100%, respectively. The negative appendicitis rate was 3.3%, the perforation rate was 23.5%, and the missed perforated appendicitis rate was 3.4%. No (diagnostic) laparoscopies were performed. Conclusions A diagnostic pathway using routine US, limited CT, and clinical re-evaluation for patients with acute abdominal pain can provide excellent results for the diagnosis and treatment of appendicitis. PMID:20582544

  11. Single-port laparoscopic surgery in acute appendicitis: retrospective comparative analysis for 618 patients.

    Science.gov (United States)

    Kang, Byung Mo; Hwang, Ji Woong; Ryu, Byoung Yoon

    2016-11-01

    Transumbilical single-port laparoscopic appendectomy (SPLA) is a promising procedure that features less pain, faster recovery of postoperative bowel function and superior cosmetic results. We performed a retrospective comparative analysis of SPLA versus conventional laparoscopic surgery (CLA) to evaluate the safety and efficacy in acute appendicitis. From December 2008 to November 2013, laparoscopic surgery was performed on 636 patients with acute appendicitis at the Department of Surgery, Chuncheon Sacred Heart Hospital. Under approval of Institutional Review Board, data concerning baseline characteristics, operative outcomes, postoperative complications and postoperative functional recovery were compared between both procedures. After exclusion of 18 patients, 618 patients treated for acute appendicitis were included. SPLA was performed in 375 patients and CLA in 243 patients. Complicated appendicitis was more prevalent in the CLA group (26.3 %) than in the SPLA group (17.1 %) (p = 0.005). There was no difference between groups in operation time (p = 0.235), postoperative duration of hospital stay (p = 0.672) and readmission rate (p = 0.688). The rate of postoperative complications was similar in both groups (10.7 % in SPLA vs. 11.1 % in CLA, p = 0.862). In subgroup analysis of complicated appendicitis, more patients needed conversion to open surgery in the SPLA group (15.6 vs. 1.6 %, p = 0.005). In uncomplicated appendicitis, SPLA can be performed safely and efficiently. However, more selective indication for SPLA should be applied in cases of complicated appendicitis because of the greater risk of open conversion.

  12. Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments.

    Science.gov (United States)

    Fullerton, Katherine; Depinet, Holly; Iyer, Sujit; Hall, Matt; Herr, Sandra; Morton, Inge; Lee, Timothy; Melzer-Lange, Marlene

    2017-04-01

    Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (PED). Although many professional organizations recommend decreasing use of computed tomography (CT) and choosing ultrasound as first-line imaging for pediatric appendicitis, significant variability persists in imaging utilization. This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital-level characteristics associated with the likelihood of ultrasound as the first imaging modality. This was a multicenter (seven children's hospitals) retrospective investigation. Data from chart review of 160 consecutive patients aged 3-18 years diagnosed with appendicitis from each site were compared with a survey of site medical directors regarding hospital resource availability, usual practices, and departmental-level demographics. In the diagnostic evaluation of 1,090 children with appendicitis, CT scan was performed first for 22.4% of patients, with a range across PEDs of 3.1% to 83.8%. Ultrasound was performed for 54.0% of patients with a range of 2.5% to 96.9%. The only hospital-level factor significantly associated with ultrasound as the first imaging modality was 24-hour availability of in-house ultrasound (odds ratio = 29.2, 95% confidence interval = 1.2-691.8). Across children's hospitals, significant practice variation exists regarding diagnostic imaging in the evaluation of patients with appendicitis. Variation in hospital-level resources may impact the diagnostic evaluation of patients with appendicitis. Availability of 24-hour in-house ultrasound significantly increases the likelihood of ultrasound as first imaging and decreases CT scans. Hospitals aiming to increase the use of ultrasound should consider adding 24-hour in-house coverage. © 2017 by the Society for Academic Emergency Medicine.

  13. A3 Altitude Test Facility

    Science.gov (United States)

    Dulreix, Lionel J.

    2009-01-01

    This slide presentation shows drawings, diagrams and photographs of the A3 Altitude Test Facility. It includes a review of the A3 Facility requirements, and drawings of the various sections of the facility including Engine Deck and Superstructure, Test Cell and Thrust Takeout, Structure and Altitude Support Systems, Chemical Steam generators, and the subscale diffuser. There are also pictures of the construction site, and the facility under construction. A Diagram of the A3 Steam system schematic is also shown

  14. Optimizing imaging in suspected appendicitis (OPTIMAP-study: A multicenter diagnostic accuracy study of MRI in patients with suspected acute appendicitis. Study Protocol

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    Bossuyt Patrick MM

    2010-10-01

    Full Text Available Abstract Background In patients with clinically suspected appendicitis, imaging is needed to substantiate the clinical diagnosis. Imaging accuracy of ultrasonography (US is suboptimal, while the most accurate technique (CT is associated with cancer related deaths through exposure to ionizing radiation. MRI is a potential replacement, without associated ionizing radiation and no need for contrast medium administration. If MRI is proven to be sufficiently accurate, it could be introduced in the diagnostic pathway of patients with suspected appendicitis, increasing diagnostic accuracy and improving clinical outcomes, without the risk of radiation induced cancer or iodinated contrast medium-related drawbacks. The multicenter OPTIMAP study was designed to estimate the diagnostic accuracy of MRI in patients with suspected acute appendicitis in the general population. Methods/Design Eligible for this study are consecutive patients presenting with clinically suspected appendicitis at the emergency department in six centers. All patients will undergo imaging according to the Dutch guideline for acute appendicitis: initial ultrasonography in all and subsequent CT whenever US does not confirm acute appendicitis. Then MRI is performed in all patients, but the results are not used for patient management. A final diagnosis assigned by an expert panel, based on all available information including 3-months follow-up, except MRI findings, is used as the reference standard in estimating accuracy. We will calculate the sensitivity, specificity, predictive values and inter-observer agreement of MRI, and aim to include 230 patients. Patient acceptance and total imaging costs will also be evaluated. Discussion If MRI is found to be sufficiently accurate, it could replace CT in some or all patients. This will limit or obviate the ionizing radiation exposure associated risk of cancer induction and contrast medium induced nephropathy with CT, preventing the burden and

  15. Ambient Ozone Concentrations and the Risk of Perforated and Nonperforated Appendicitis: A Multicity Case-Crossover Study

    Science.gov (United States)

    Tanyingoh, Divine; Dixon, Elijah; Johnson, Markey; Wheeler, Amanda J.; Myers, Robert P.; Bertazzon, Stefania; Saini, Vineet; Madsen, Karen; Ghosh, Subrata; Villeneuve, Paul J.

    2013-01-01

    Background: Environmental determinants of appendicitis are poorly understood. Past work suggests that air pollution may increase the risk of appendicitis. Objectives: We investigated whether ambient ground-level ozone (O3) concentrations were associated with appendicitis and whether these associations varied between perforated and nonperforated appendicitis. Methods: We based this time-stratified case-crossover study on 35,811 patients hospitalized with appendicitis from 2004 to 2008 in 12 Canadian cities. Data from a national network of fixed-site monitors were used to calculate daily maximum O3 concentrations for each city. Conditional logistic regression was used to estimate city-specific odds ratios (ORs) relative to an interquartile range (IQR) increase in O3 adjusted for temperature and relative humidity. A random-effects meta-analysis was used to derive a pooled risk estimate. Stratified analyses were used to estimate associations separately for perforated and nonperforated appendicitis. Results: Overall, a 16-ppb increase in the 7-day cumulative average daily maximum O3 concentration was associated with all appendicitis cases across the 12 cities (pooled OR = 1.07; 95% CI: 1.02, 1.13). The association was stronger among patients presenting with perforated appendicitis for the 7-day average (pooled OR = 1.22; 95% CI: 1.09, 1.36) when compared with the corresponding estimate for nonperforated appendicitis [7-day average (pooled OR = 1.02, 95% CI: 0.95, 1.09)]. Heterogeneity was not statistically significant across cities for either perforated or nonperforated appendicitis (p > 0.20). Conclusions: Higher levels of ambient O3 exposure may increase the risk of perforated appendicitis. PMID:23842601

  16. Non-Complicated Acute Appendicitis in Adults Treated Successfully by Conservative Treatment without Recurrences.

    Science.gov (United States)

    Charalampopoulos, Anestis; Dimopoulos, Ioannis; Koliakos, Nikolaos; Kopanakis, Konstantinos; And, Theodoros Liakakos

    2017-01-01

    Backround: Surgical treatment of appendicitis remains the standard treatment, but many cases respond conservatively. Our purpose was the clarification of the clinical, laboratory and imaging characteristics of uncomplicated cases undergoing successful conservative treatment without recurrence. Methods: 105 adult patients (66 female, 39 male) with non-complicated acute appendicitis. Symptom duration, clinical abdominal examination, body temperature, inflammatory markers, imaging studies results and in-hospital treatment were recorded. No patient had a previous episode of appendicitis. Results: Duration of symptoms was 2 hours-3 days. Abdominal examination was compatible with appendicitis and findings were localized in the lower right quadrat. The majority (85.7%) had no or low fever ( 37.4 C). All had leukocytosis (range: 10.000-22.900 WBC/L, mean 14.370'+-2.900 WBC/L), 3 patients 20.000 WBC/L. All had CRP 3.36 mg/L (mean 46.8'+-40.5 mg/L), and 3 150 mg/L. U/S was performed on 95 patients (combined with transvaginal U/S in 19 females) with positive findings of acute appendicitis in 91 (91/95, 95.7%). When faced with inconclusive findings, CT was performed (13 patients) and MRI on one pregnant. In-hospital conservative treatment lasted 1-10 days, overstay was 1-2 days following clinic-laboratory regression. Outpatient, antibiotic treatment followed discharge in 27 patients. Conclusions: Young patients with non-complicated acute appendicitis and short symptom duration, without rare etiologic pathologies, are candidates for conservative treatment. Diagnosis of non-complicated acute appendicitis is based on combining clinical signs, positive inflammatory markers and imaging studies, excluding complicated cases, generalized peritonitis and sepsis. The inflammation seems self-limited, while the role of anti-inflammatory drugs remains obscure. AA = Acute Appendicitis, un-AA = Uncomplicated AA, cAA = Complicated Acute Appendicitis, WBC = White Blood Cells, CRP = C

  17. Evaluation of Tc-99m leukocyte scan in the diagnosis of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Butler, J.A.; Marcus, C.S.; Henneman, P.L.; Inkelis, S.H.; Wilson, S.E.

    1987-05-01

    A new /sup 99m/Tc Microlite leukocyte scan was performed in 38 patients to assess its value in the diagnosis of acute appendicitis. Autologous leukocytes are labeled with /sup 99m/Tc by inducing phagocytosis of /sup 99m/Tc albumin microcolloid particles. The advantages of this test over the standard indium-111 scan include superior imaging capability, a marked reduction (greater than 75%) in the radiation dose, and performance of the test including labeling, in less than 3 hr. Imaging is performed at 5-90 min postinjection of labeled cells. There were 19 male and 19 female patients with ages ranging from 10 to 80 years, in whom the diagnosis of appendicitis was indeterminate on clinical examination. Of the 13 of the 38 patients (34%) who came to surgery 12 had acute appendicitis. The WBC scan correctly identified 10 of the 12 cases of appendicitis. There were two false-negative studies. In the nonoperative group of 25 patients admitted for observation, 21 studies were reported as negative and four identified other sites of inflammation. All patients with a negative study have remained asymptomatic on follow-up. With a sensitivity of 83% (10/12) and a specificity of 100% (26/26) the /sup 99m/Tc leukocyte scan provides a rapid and highly accurate method for diagnosis of appendicitis in this preliminary study of patients with equivocal clinical exams.

  18. Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature

    Science.gov (United States)

    Ito, Daisuke; Hata, Shojirou; Seiichiro, Shimizu; Kobayashi, Kaoru; Teruya, Masanori; Kaminishi, Michio

    2014-01-01

    INTRODUCTION Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis. PRESENTATION OF CASE A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom resolution, we performed a pathologic examination of the appendix again that revealed multiple Entamoeba histolytica trophozoites; the serum amebic antibody was positive. She was treated postoperatively with metronidazole for amebiasis and discharged on postoperative day 12. DISCUSSION The mortality rate and frequency of severe postoperative intraabdominal complications were higher in the Japanese literature (1995–2013) (25% and 33%, respectively) than in other developed countries (3.3% and 19.4%, respectively). Japan is a low-risk area for amebiasis; many physicians fail to consider amebiasis in the differential diagnosis of acute abdomen. It is important to conduct further examinations, including those for amebiasis, when appendectomy does not resolve acute appendicitis. CONCLUSION We report a case of acute amebic appendicitis in a 31-year-old woman and review the ages at presentation, causative factors, treatments, and outcomes of 11 cases reported in Japan between 1995 and 2013. PMID:25460473

  19. Fibromatosis of the cecum presenting with acute appendicitis: a case report

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    Toydemir T

    2011-12-01

    Full Text Available Toygar Toydemir1, Gökhan Ertuğrul21Istanbul Surgery Hospital, Department of General Surgery, Nisantasi-Istanbul, 2Atatürk State Hospital, Department of General Surgery, Düzce, TurkeyAbstract: Although acute appendicitis is a common clinical condition in general surgical practice, <1% of them are associated with malignancies. Appendiceal carcinoids make up most of those malignancies and acute appendicitis cases associated with benign cecal neoplasias are very uncommon. In this study, a 25-year-old female patient who presented with distinct acute appendicitis symptoms is reported. The patient was operated on via open technique. Exploration revealed an appendix with advanced edema and hyperemia. While the cecum was observed to be normal, a solid mass of 2.5 cm diameter was palpated in the appendiceal base. Following the ileocecal resection, histopathological examination revealed the mass as a fibromatosis. The goals of this report are to remind health care professionals that some very rare etiologies may be involved in acute appendicitis diagnosis and treatment, and to underscore the place of laparoscopic approach and preoperative computed tomography in this disease.Keywords: acute appendicitis, fibromatosis, laparoscopy, preoperative computed tomography

  20. Acute appendicitis in preschoolers: a study of two different populations of children

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    Sivridis Efthimios

    2011-07-01

    Full Text Available Abstract Objective To assess the incidence and the risk factors implicated in acute appendicitis in preschoolers in our region. Methods Over a 7-year period, 352 children underwent appendectomy for suspected acute appendicitis. Of these, data for 23 children were excluded because no inflammation of the appendix was found on subsequent histology. Of the remaining 329, 82 were ≤ 5 years old (i.e., preschool children and 247 were 5-14 years old. These two groups of children were further divided according to their religion into Muslims and Christian Orthodox: 43 of the children aged ≤ 5 years were Muslims and 39 were Christian Orthodox. A household questionnaire was designed to collect data concerning age, gender, type of residence area, living conditions, vegetable consumption, and family history of surgery for acute appendicitis as preschool children. The removed appendices were also assessed histologically for the amount of lymphoid tissue. Results Acute appendicitis of preschoolers developed more frequently in Muslims (39.4% than in Christians (17.7%; p p p > 0.05. Conclusions In our region, the percentage of preschool-aged Muslim children with acute appendicitis was remarkably high. One possible explanation for this finding could be the higher amount of lymphoid tissue in the wall of the appendix in Muslim preschool children together with their low standard of hygiene.

  1. Assessment of Urinary-5-Hydroxyindolacetic Acid as A Diagnostic Parameter in Early Detection of Acute Appendicitis

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    Zuhair B Kamal

    2017-04-01

    Full Text Available Background: Acute appendicitis is the most common abdominal surgical emergency especially in children and young adults. The diagnosis of appendicitis is difficult because half the cases are incorrectly identified. Serotonin was defined as a good diagnostic marker for many inflammations including appendicitis and it is metabolite into 5-hydroxyindolacetic acid (5-HIAA to be excreted in urine. 5-HIAA is suggested to be of diagnostic importance in the detection of this disease. The aim of this study was to evaluate the diagnostic importance of urinary-5-HIAA as an added parameter to Alvarado score. Methods: Seventy patients (35 females and 35 males with acute appendicitis (35 were mild and 35 severe-perforated and gangrenous were included in this study and 70 healthy individuals were taken as a control group. Urinary-5-HIAA was estimated in all patients and control group using ELISA method. Results: Sensitivity for the mild group is 94.2%, specificity 100% and diagnostic accuracy is 97.4%, while the sensitivity for the severe group is 37%. It was found that there is a highly significant difference between mild and control groups (P<0.05. The diagnostic accuracy for the mild group is 97.4% and for the severe is 68.5%. Conclusion: We conclude that urinary-5-HIAA is a high sensitive test for early detection of acute appendicitis.

  2. Identical appended series of points as invariants in the collocal general-colinear fields

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    Krasić Sonja

    2003-01-01

    Full Text Available In order to bring the collocal collinear fields from the general into the perspective position, it is required to determine the identical appended series of points. Because of the properties depending on the projectivity that is given by the four appended points (straight lines the appended identical series of the points and types are ranked among the invariants of general-collinear and perspectively-collinear fields. The procedure of determination of appended identical series of points is comprised of the following: in the set of ∞1 of perspectively similar series in one field (whose center of perspective is a point on the vanishing line, find those that are identical to all the series in the set ∞1 of perspective identical series of points in the other field (whose center of perspective is the point on the infinitely distant straight line. In the procedure, one begins from the appended similar methods obtained by the general method. The procedure is simplified by the introduction of the specially given similar series of points.

  3. Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis.

    Science.gov (United States)

    Platon, Alexandra; Jlassi, Helmi; Rutschmann, Olivier T; Becker, Christoph D; Verdun, Francis R; Gervaz, Pascal; Poletti, Pierre-Alexandre

    2009-02-01

    The aim of this study was to evaluate a low-dose CT with oral contrast medium (LDCT) for the diagnosis of acute appendicitis and compare its performance with standard-dose i.v. contrast-enhanced CT (standard CT) according to patients' BMIs. Eighty-six consecutive patients admitted with suspicion of acute appendicitis underwent LDCT (30 mAs), followed by standard CT (180 mAs). Both examinations were reviewed by two experienced radiologists for direct and indirect signs of appendicitis. Clinical and surgical follow-up was considered as the reference standard. Appendicitis was confirmed by surgery in 37 (43%) of the 86 patients. Twenty-nine (34%) patients eventually had an alternative discharge diagnosis to explain their abdominal pain. Clinical and biological follow-up was uneventful in 20 (23%) patients. LDCT and standard CT had the same sensitivity (100%, 33/33) and specificity (98%, 45/46) to diagnose appendicitis in patients with a body mass index (BMI) >or= 18.5. In slim patients (BMIor= 18.5.

  4. Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature.

    Science.gov (United States)

    Ito, Daisuke; Hata, Shojirou; Seiichiro, Shimizu; Kobayashi, Kaoru; Teruya, Masanori; Kaminishi, Michio

    2014-01-01

    Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis. A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom resolution, we performed a pathologic examination of the appendix again that revealed multiple Entamoeba histolytica trophozoites; the serum amebic antibody was positive. She was treated postoperatively with metronidazole for amebiasis and discharged on postoperative day 12. The mortality rate and frequency of severe postoperative intraabdominal complications were higher in the Japanese literature (1995-2013) (25% and 33%, respectively) than in other developed countries (3.3% and 19.4%, respectively). Japan is a low-risk area for amebiasis; many physicians fail to consider amebiasis in the differential diagnosis of acute abdomen. It is important to conduct further examinations, including those for amebiasis, when appendectomy does not resolve acute appendicitis. We report a case of acute amebic appendicitis in a 31-year-old woman and review the ages at presentation, causative factors, treatments, and outcomes of 11 cases reported in Japan between 1995 and 2013. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. ACUTE APPENDICITIS SECONDARY TO ENTEROBIUS VERMICULARIS INFESTATION IN A YOUNG FEMALE: A CASE REPORT

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    Kumar Premjeet

    2014-05-01

    Full Text Available Gastrointestinal infection due to enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection. The simple presence of enterobius vermicularis in the appendix usually produces symptoms of acute appendicitis. Acute appendicitis due to enterobius vermicularis is very rare, affecting mostly children. The association of this parasitic infestation with acute appendicitis varies from 0.2%–41.8% worldwide. Whether pinworms cause inflammation of the appendix or just appendiceal colic has been a matter of controversy. We present a case of an 18 year old female with enterobiasis of appendix presented with clinical features of acute appendicitis. The appendix was surgically removed and the specimen was pathologically diagnosed to contain of enterobius vermicularis in non-inflamed and histologically mild mononuclear cell infiltrated appendix. One should keep in mind that the clinical signs of intestinal parasite infection may mimic acute appendicitis, although rare. A careful evaluation of symptoms such as pruritus ani, or eosinophilia on laboratory examination, could prevent unnecessary appendectomies.

  6. Lack of utility of measuring serum bilirubin concentration in distinguishing perforation status of pediatric appendicitis.

    Science.gov (United States)

    Bonadio, William; Bruno, Santina; Attaway, David; Dharmar, Logesh; Tam, Derek; Homel, Peter

    2017-06-01

    Pediatric appendicitis is a common, potentially serious condition. Determining perforation status is crucial to planning effective management. Determine the efficacy of serum total bilirubin concentration [STBC] in distinguishing perforation status in children with appendicitis. Retrospective review of 257 cases of appendicitis who received abdominal CT scan and measurement of STBC. There were 109 with perforation vs 148 without perforation. Although elevated STBC was significantly more common in those with [36%] vs without perforation [22%], the mean difference in elevated values between groups [0.1mg/dL] was clinically insignificant. Higher degrees of hyperbilirubinemia [>2mg/dL] were rarely encountered [5%]. Predictive values for elevated STBC in distinguishing perforation outcome were imprecise [sensitivity 38.5%, specificity 78.4%, PPV 56.8%, NPV 63.4%]. ROC curve analysis of multiple clinical and other laboratory factors for predicting perforation status was unenhanced by adding the STBC variable. Specific analysis of those with perforated appendicitis and percutaneously-drained intra-abdominal abscess which was culture-positive for Escherichia coli showed an identical rate of STBC elevation compared to all with perforation. The routine measurement of STBC does not accurately distinguish perforation status in children with appendicitis, nor discern infecting organism in those with perforation and intra-abdominal abscess. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis.

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    Horvath, P; Lange, J; Bachmann, R; Struller, F; Königsrainer, A; Zdichavsky, M

    2017-01-01

    Laparoscopic appendectomy is now the treatment of choice in uncomplicated appendicitis. To date its importance in the treatment of complicated appendicitis is not clearly defined. From January 2005 to June 2013 a total of 1762 patients underwent appendectomy for the suspected diagnosis of appendicitis at our institution. Of these patients 1516 suffered from complicated appendicitis and were enrolled. In total 926 (61 %) underwent open appendectomy (OA) and 590 (39 %) underwent laparoscopic appendectomy (LA). The following parameters were retrospectively analyzed: age, sex, operative times, histology, length of hospital stay, 30-day morbidity focusing on occurrence of surgical site infections, intraabdominal abscess formation, postoperative ileus and appendiceal stump insufficiency, conversion rate, use of endoloops and endostapler. A statistically significant difference in operative time was observed between the laparoscopic and the open group (64.5 vs. 60 min; p = 0.002). Median length of hospitalization was significantly shorter in the laparoscopic group (p appendicitis is a safe and feasible procedure. Surgeons should be aware of a potentially higher incidence of intraabdominal abscess formation following LA. Use of endobags , inversion of the appendiceal stump and carefully conducted local irrigation of the abdomen in a supine position may reduce the incidence of abscess formation.

  8. Appendicitis presenting as the first manifestation of colorectal carcinoma: a 13-year retrospective study.

    Science.gov (United States)

    Shine, Rebecca J; Zarifeh, Abigail; Frampton, Chris; Rossaak, Jeremy

    2017-07-21

    Appendicitis in older adults may present as the first sign of underlying colorectal cancer. We aim to determine whether there was a difference in the rate of diagnosis of colorectal carcinoma for patients ≥45 years following a presentation with appendicitis, compared with New Zealand standardised rates. Retrospective study of patients ≥45 years with a confirmed diagnosis of appendicitis from 2003 to 2015 inclusive. The rate of colorectal carcinoma diagnosed during the 36-month follow-up period was calculated and compared to standardised rates, as per the New Zealand cancer registry. Six hundred and twenty-nine patients were included for analysis, 15 had a diagnosis of colorectal cancer in the follow-up period. Patients ≥45 years had a 6.3-fold (CI 3.6-10.2) increased risk of colorectal carcinoma than predicted given the population demographics. Those patients aged between 45-60 years had a 17-fold (95% CI 8-32.2) increased standardised risk ratio. This is the first study of its kind conducted in Australasia. This study found patients ≥45 years who present with appendicitis have significantly increased risk of underlying colorectal cancer. Until further research is conducted the authors recommend clinicians consider colonic investigation for older adults following a diagnosis of appendicitis.

  9. Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation?

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    Yılmaz, Eyüp Murat; Kapçı, Mücahit; Çelik, Sebahattin; Manoğlu, Berke; Avcil, Mücahit; Karacan, Erkan

    2017-01-01

    Acute appendicitis is one of the most common causes of abdominal pain seen in surgical clinics. Although it can be easily diagnosed, the picture may be confusing, particularly in premenopausal women and the elderly. The present study is an evaluation of 2 of the current scoring systems with respect to accurate diagnosis of the disease and indication of inflammation severity. A total of 105 patients diagnosed with acute appendicitis were included in the study. Subsequent to Alvarado and Ohmann scoring, ultrasonography image was obtained and appendectomy was performed. A unique intraoperative severity scoring system was used to measure severity of inflammation and to compare Alvarado and Ohmann scoring system results to assess accuracy of predictive value for acute appendicitis. Moderate positive correlation was found between Alvarado score and Ohmann score (r=0.508; pappendicitis based on histopathological results was statistically significant (p=0.027), while rate of Ohmann score was not statistically significant (p=0.807). Correlation between both scores and grading of inflammation performed during the operation was weak, but statistical significance was observed between Alvarado scoring system and intraoperative severity scoring (r=0.30; p=0.002). No statistical difference was observed between Ohmann scoring and intraoperative severity scoring (r=0.09; p=0.384). Alvarado score is better able to predict acute appendicitis and provide an idea of severity of inflammation. Ohmann score is more useful to provide guidance and eliminate acute appendicitis from consideration when conditions are more uncertain and obscured.

  10. Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Thieme, Mai E.; Valdehueza, Zaldy D.; Wiarda, Bart M. [Medical Centre Alkmaar, Department of Radiology, Alkmaar (Netherlands); Leeuwenburgh, Marjolein M.N. [Academic Medical Centre Amsterdam, Department of Radiology, Amsterdam (Netherlands); Academic Medical Centre Amsterdam, Department of Surgery, Amsterdam (Netherlands); Bouman, Donald E. [Medical Spectrum Twente, Department of Radiology, Enschede (Netherlands); Bruin, Ivar G.J.M. de; Schreurs, W.H.; Houdijk, Alexander P.J. [Medical Centre Alkmaar, Department of Surgery, Alkmaar (Netherlands); Stoker, Jaap [Academic Medical Centre Amsterdam, Department of Radiology, Amsterdam (Netherlands)

    2014-03-15

    To compare magnetic resonance imaging (MRI) and ultrasound in children with suspected appendicitis. In a single-centre diagnostic accuracy study, children with suspected appendicitis were prospectively identified at the emergency department. All underwent abdominal ultrasound and MRI within 2 h, with the reader blinded to other imaging findings. An expert panel established the final diagnosis after 3 months. We evaluated the diagnostic accuracy of three imaging strategies: ultrasound only, conditional MRI after negative or inconclusive ultrasound, and MRI only. Significance between sensitivity and specificity was calculated using McNemar's test statistic. Between April and December 2009 we included 104 consecutive children (47 male, mean age 12). According to the expert panel, 58 patients had appendicitis. The sensitivity of MRI only and conditional MRI was 100 % (95 % confidence interval 92-100), that of ultrasound was significantly lower (76 %; 63-85, P < 0.001). Specificity was comparable among the three investigated strategies; ultrasound only 89 % (77-95), conditional MRI 80 % (67-89), MRI only 89 % (77-95) (P values 0.13, 0.13 and 1.00). In children with suspected appendicitis, strategies with MRI (MRI only, conditional MRI) had a higher sensitivity for appendicitis compared with a strategy with ultrasound only, while specificity was comparable. (orig.)

  11. BIBLIOGRAPHY OF FACILITIES INFORMATION.

    Science.gov (United States)

    American Association of Junior Colleges, Washington, DC.

    PERSONNEL OF THE FACILITIES INFORMATION SERVICE OF THE AMERICAN ASSOCIATION OF JUNIOR COLLEGES COMPILED THIS LISTING OF BOOKS, ARTICLES, MONOGRAPHS, AND OTHER PRINTED MATERIALS RELEVANT TO JUNIOR COLLEGE FACILITIES PLANNING, DESIGN, AND CONSTRUCTION. IN ADDITION TO A "GENERAL" CATEGORY, REFERENCES ARE GROUPED UNDER HEADINGS OF AUDITORIUMS, COLLEGE…

  12. Application of system directions, facilities and methods of individualization preparation of sportsmen in playing types of sport in structural circannual loop of preparation constructs

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    Kozina Zh.l.

    2010-08-01

    Full Text Available Basic directions conception of individualization of training process are presented in playing types of sport. Distributing of facilities is rotined in individual programs of preparation of sportsmen. Depending on a leading factor and period of individual dynamics of playing effectiveness correlation of facilities varies. On development of leading factors 60-80% is taken to time, on development of backward - 20-40%. In every micro cycle 30% taken time on individual preparation of players.

  13. Report on the symposium and workshop on the 5 MWt solar thermal test facility

    Energy Technology Data Exchange (ETDEWEB)

    1976-01-01

    Design concepts and applications for the 5 MWt Solar Thermal Test Facility at Albuquerque are discussed in 43 papers. Session topics include central receivers, solar collectors, solar energy storage, high temperature materials and chemistry. A program overview and individual contractor reports for the test facility project are included, along with reports on conference workshop sessions and users group recommendations. A list of conference attendees is appended. Separate abstracts are prepared for 39 papers.

  14. The influence of age, duration of symptoms and duration of operation on outcome after appendicitis in children

    DEFF Research Database (Denmark)

    Bech-Larsen, Sandra Julia; Lalla, Marianna; Thorup, Jørgen Mogens

    2013-01-01

    The aim of the study was to evaluate the impact of any perioperative parameters on the outcome of treatment for appendicitis.......The aim of the study was to evaluate the impact of any perioperative parameters on the outcome of treatment for appendicitis....

  15. Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age.

    Science.gov (United States)

    Luckmann, R

    1989-05-01

    In 1984, 24,794 appendectomies and abscess drainage procedures were performed for acute appendicitis in California hospitals. Analysis of hospital discharge abstracts revealed age- and sex-specific incidence rates and in-hospital case fatality rates for acute appendicitis lower than previously reported. In persons aged 60 years and older, the case fatality rate for nonperforating appendicitis with appendectomy was 0.7% and for perforating appendicitis and abscess 2.4%. Surgery was delayed beyond the day of admission in 21% of persons aged 40-59 years, 29% of persons aged 60-79 years, and 47% of persons aged 80 years and over. The proportion of cases with perforation increased from 22% to 75% between ages 20 and 80 years. The population incidence of perforating appendicitis changed little after age 20 years, while the incidence of nonperforating cases declined sharply. The high proportion of appendicitis cases with perforation among the elderly may be due to the decreased incidence of nonperforating appendicitis in the elderly and not to a greater propensity for perforation, as previously proposed. Most elderly in California receive timely surgery for appendicitis and tolerate it better than previously reported. Diminished tolerance for intra-abdominal infection may be the primary determinant of the increase in case fatality with age.

  16. The influence of age, duration of symptoms and duration of operation on outcome after appendicitis in children

    DEFF Research Database (Denmark)

    Bech-Larsen, Sandra Julia; Lalla, Marianna; Thorup, Jørgen Mogens

    2013-01-01

    The aim of the study was to evaluate the impact of any perioperative parameters on the outcome of treatment for appendicitis.......The aim of the study was to evaluate the impact of any perioperative parameters on the outcome of treatment for appendicitis....

  17. The platelet indices in pediatric patients with acute appendicitis

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    Yunus Yilmaz

    2015-06-01

    Full Text Available Background: The diagnosis of Acute Appendicitis (AA remains a problem in pediatric population. It has been suggested that Mean Platelet Volume (MPV is lower in the patients with AA. The purpose of this study was to investigate the diagnostic value of platelet indices in pediatric AA cases. Methods: A retrospective case-controlled study was designed: 224 subjects were included in this study. All patients had been operated on in division of pediatric surgery at the Kars Government Hospital with the preliminary diagnosis of AA. 204 and 20 of these patients were pathologically diagnosed as AA (group 1 and normal appendix vermiformis (group 2, respectively. Platelet indices had been studied in the biochemistry laboratory of the hospital, before the surgery. Results: In group 1, platelet count, mean platelet volume, plateletcrit and platelet distribution width were 305 +/- 94x103/ and micro;L; 7.37 +/- 0.90 fL; 0,220 +/- 0.057 % and 16.3 +/- 0.5%, respectively. In group 2, platelet count, mean platelet volume, plateletcrit and platelet distribution width were 283 +/- 85 103/ and micro;L; 7.60 +/- 1.24 fL; 0.208 +/- 0.045 % and 16.4 +/- 0.7%, respectively. There was no statistically significant difference between the groups studied with regard to platelet indices (P>0.05. Conclusions: Our study showed that platelet indices have no diagnostic value in the diagnosis of AA at pediatric age group. [Int J Res Med Sci 2015; 3(6.000: 1388-1391

  18. Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center.

    Science.gov (United States)

    Repplinger, Michael D; Weber, Andrew C; Pickhardt, Perry J; Rajamanickam, Victoria P; Svenson, James E; Ehlenbach, William J; Westergaard, Ryan P; Reeder, Scott B; Jacobs, Elizabeth A

    2016-09-01

    To quantify the trends in imaging use for the diagnosis of appendicitis. A retrospective study covering a 22-year period was conducted at an academic medical center. Patients were identified by International Classification of Diseases-9 diagnosis code for appendicitis. Medical record data extraction of these patients included imaging test used (ultrasound, CT, or MRI), gender, age, and body mass index (BMI). The proportion of patients undergoing each scan was calculated by year. Regression analysis was performed to determine whether age, gender, or BMI affected imaging choice. The study included a total of 2,108 patients, including 967 (43.5%) females and 599 (27%) children (imaging used for the diagnosis of appendicitis decreased over time (P medical center, CT use increased more than 20-fold. However, no statistically significant trend was found for increased use of ultrasound or MRI. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  19. Acute primary haemorrhagic omental torsion mimicking perforated appendicitis: an unorthodox surgical paradox.

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    Rehman, Abdul

    2014-08-01

    Acute primary haemorrhagic omental torsion is an atypical and deceptive cause of acute abdomen that could closely mimic a myriad of intra-abdominal catastrophes, especially perforated appendicitis. The author reports a 30 years man who had presented with gradually worsening right-sided abdominal pain of 2 days duration. Laboratory work-up and abdominal radiographs were inconclusive. Abdominal sonography detected presence of free fluid in the pelvic cul-de-sac. Based on clinical and sonographic findings, presumptive diagnosis of perforated appendicitis was made and the patient was explored through extended Rockey-Davis incision. About 500 - 700 ml of dark-coloured blood (haemoperitoneum) was present in the peritoneal cavity and the pelvis secondary to acute haemorrhagic omental torsion. The appendix was grossly normal. Omentectomy and prophylactic appendicectomy resulted in uneventful recovery of the patient. Acute primary omental torsion is an uncommon pathology that must be kept in mind during differential diagnosis of acute abdomen, especially acute or perforated appendicitis.

  20. Clinical significance of elevated serum and urine amylase levels in patients with appendicitis.

    Science.gov (United States)

    Swensson, E E; Maull, K I

    1981-12-01

    During the 45 month period beginning January 1977, 251 patients with a pathologically confirmed diagnosis of acute appendicitis underwent celiotomy at the Medical College of Virginia Hospital. A preoperative serum or urine amylase determination was recorded in 155 of the patients (62 percent). Of this group, 15 patients (10 percent) had elevation of serum amylase or 2 hour urine amylase. Hyperamylasemia or hyperamylasuria directly led to misdiagnosis or treatment delay in 5 of the 15 patients. Appendiceal rupture occurred in three patients, two of whom had prolonged (greater than 1 month) hospitalizations directly attributable to the misdiagnosis. As a result of this study, we conclude that (1) acute appendicitis and elevated amylase levels may occur concurrently, (2) hyperamylasemia or hyperamylasuria should not dissuade the surgeon from early operation if other clinical features suggest appendicitis, and (3) abdominal pain and elevation of amylase level define significant intraabdominal disease, not specifically pancreatic disease.