PubMed · 12352857
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Katherine A Atassi. 2002. Action stat. Appendicitis.. https://doi.org/10.1097/00152193-200208000-00074
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We report a patient who presented with a purpuric rash and polyarthritis, but IgA deposits were not found in the skin. Abdominal pain and renal disease first emerged 1 and 2 weeks, respectively, after presentation, to reveal the classic tetrad of Henoch-Schönlein purpura. Our patient emphasises the need for careful follow-up in patients with cutaneous vasculitis, as they may develop systemic manifestations, of which renal involvement, particularly, may be asymptomatic.
Recurrent right lower quadrant (RLQ) abdominal pain is often difficult to diagnose and treat. We reviewed our experience with diagnostic laparoscopy with planned appendectomy for children with unexplained RLQ pain. This procedure was performed when the cause of atypical RLQ pain could not be diagnosed by comprehensive medical and radiological evaluation. Outcome data was obtained at office visits and by telephone. From 1997 to 2000, 30 children (22 female) presented with unexplained RLQ pain. Ages ranged from 5 to 16 years (mean 11 years). Symptoms had been present from 6 days to 2 years (median 6 weeks). Gross and/or histological appendiceal abnormalities were found in 26 children (87%). Incidental findings included patent processus vaginalis in one and adnexal cysts in six. Two complications occurred: pelvic fluid collection and umbilical suture reaction. At initial follow-up, 29 patients (97%) were pain-free. Long-term follow-up was continued through 2002. At a median of 19 months (range 2-47 months), 25 of 28 patients (89%) reported no recurrence of their original pain. Our results confirm that the appendix is an important source of unexplained recurrent RLQ pain in children. Diagnostic laparoscopy with planned appendectomy is highly effective and should be considered an integral step in the management of these patients.
INTRODUCTION: Transnasal gastroscopy (TNG) is the result of ongoing improvements in endoscopic device development. These ultrathin endoscopes are planned to improve patient satisfaction with the endoscopic procedure. AIM: The aim of the current study was to prospectively evaluate the performance and patient acceptance of transnasal gastroscopy. PATIENTS AND METHODS: Sixty-three consecutive patients (40 males, 23 females, mean age 58.5 years) referred for routine upper gastrointestinal endoscopy to our tertiary care referral centre were assigned to one of three groups: first time transnasal gastroscopy (group 1, TNG), first time transoral gastroscopy (group 2, TOG) and transnasal gastroscopy after a previous unsedated transoral gastroscopy (group 3). All examinations were performed without intravenous sedation. Patients answered a standardised questionnaire immediately following the examination. RESULTS: The three groups of patients did not differ in age, gender or reason for gastroscopy. Investigations performed using transnasal technique were significantly shorter (TNG 8.9 min and 9.2 min vs. TOG 11.9 min, p = 0.011 and p = 0.026, respectively) than those performed in transoral technique. Nosebleeding, albeit not clinically significant, and the urge to wretch were significantly more common in the transnasal technique group (p > 0.001). Patient acceptance tended to score higher in the transnasal technique groups, however not statistically higher. A greater number of patients from group 3 (TNG after previous TOG) would prefer a repeat exam via the transnasal route. CONCLUSIONS: Transnasal gastroscopy represents a possible alternative to the conventional transoral technique. TNG entails less subjective patient discomfort, and patients experienced in both techniques prefer the transnasal route. Shorter examination times and lack of intravenous sedation result in several benefits: no sedation-related complications, shorter post-procedure observation times, and subsequently shorter time off work for patients.