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Ultrasonographic findings in diseases of the appendix.

Ultrasonographic findings in patients with diseases of the appendix, including acute appendicitis, suspected appendiceal abscess, and palpable right-lower-quadrant abdominal mass, are described. An appendiceal abscess may manifest as a cystic mass, a mixed solid and cystic mass, or a hypoechoic solid mass. An appendiceal calculus within an abscess can be recognized as a hyperechoic structure with acoustic shadowing. On ultrasonography, acute appendicitis in female patients may mimic tubo-ovarian disease. Ultrasonographic features of isolated Crohn's disease of the appendix and mucocele of the appendix are also described.

Abscess

Arterial vascularization of the vermiform appendix in human fetus.

In 50 human fetuses of the crown-rump length ranging from 88 mm to 185 mm (12 to 20 weeks), the variability of the arterial vascularization of the vermiform appendix was investigated using the injection method. 3 vascularization types were distinguished on the basis of the size and number of the supplying arteries. The obtained results were compared with those reported by other authors who studied vermiform appendix vascularization in adults. In most cases the vermiform appendix is supplied by single ramus arising from ileocolic artery.

Appendix

Motor response to electric spatial stimulation of isolated intact and inflamed human appendix.

The smooth muscle responses to electric stimulation of intact, slightly or severely inflamed, isolated human appendix strips were studied. No changes were noted in the motility of the not inflamed and slightly inflamed appendices, (simple appendicitis), the preparations responded to nervous stimulation with contractions of the same size. The smooth muscle contractions were blocked by atropine, and enhanced by physostigmine, which proves the cholinergic nature of the innervation. The severe inflammation (acute phlegmonous appendicitis) reduced also the contraction and relaxation of the appendix strips. With the advancement of the inflammatory process, the decreased motility of the appendix can play an in vivo role in the rapid progress of the process.

Appendicitis

[Goblet cell carcinoid of the vermiform appendix].

The goblet-cell-carcinoid of the appendix vermiformis lies somewhat between the carcinoid and the adenocarcinoma of the appendix concerning the biological behaviour and the histological characteristics. Referring an own well documented case (76 are well known in the available literature) the importance of the very conscientiously managed histological examination of each appendix specimen is emphasized with regard to the 5-year-survival of 73%.

Appendectomy

[A carcinoma of the cecum arising from the orifice of the appendix: a case report].

Reported is the case of a 50-year-old man who was admitted to hospital because of an abdominal pain. A barium enema revealed the shade of a distended, unfilled appendix that had reversed itself on the cecum and the ascending colon, the latter showing compression from the exterior. Further, a colonoscopic examination uncovered a flat, nodular tumor of the cecum that had elevated at the orifice of the vermiform appendix, and 67Ga scintigraphy indicated the uptake at the lower right abdomen. A resected specimen of the tumor showed proliferation in the cecal mucosa at the orifice of the appendix, causing an appendiceal abscess, and the histopathological findings revealed an adenocarcinoma of the cecal mucosa but no malignant transformation of the appendiceal mucosa.

Adenocarcinoma

Crohn's disease of the appendix.

Crohn's disease limited to the appendix is uncommon. The disease may mimic acute appendicitis with fever, leukocytosis, right lower quadrant pain, and occasionally a palpable mass. When Crohn's disease affects the appendix, it typically has a longer clinical period in which the patient has symptoms than do most cases of acute appendicitis. The most common preoperative diagnoses are acute appendicitis and appendiceal abscess. A review of the literature is presented along with our experience in three additional cases of Crohn's disease limited to the appendix. We suggest that Crohn's disease be included in the preoperative differential diagnosis and that extensive intraoperative examination of the gastrointestinal tract be made in any case of suspected appendicitis that has had a protracted preoperative course.

Adolescent

Neuromas of the appendix. A light-microscopic, immunohistochemical and electron-microscopic study of 20 cases.

The neural origin and even the existence of appendiceal neuromas have been questioned. We have studied 20 examples, 7 discovered during a prospective examination of 26 consecutive routine appendectomy specimens (for an incidence of 27%), 2 selected from random cases, and 11 discovered in a retrospective review of 11 randomly selected cases of appendices diagnosed as "fibrous obliteration." By light-microscopy, appendiceal neuromas appear as a loose proliferation of spindle cells usually in a myxoid background, frequently with entrapped fat and connective tissue and infiltrated by eosinophils. Seventeen were located centrally in the appendix without nodule formation. One was central with nodularity and two were confined to the mucosa. The spindle cells were positive for S-100 protein and neuron-specific enolase in all cases. In 12, serotonin positive cells entrapped in the proliferation were present. In 5 of 11 cases with apparent uninvolved appendix present in the specimen, the number of serotonin cells in the crypts was greater than in normal appendix controls. Two appendiceal neuromas contained somatostatin positive cells. Stains for vasoactive intestinal polypeptide, substance P, neurotensin, bombesin and gastrin were negative. Ultrastructural examination of one case confirmed the presence of a mixture of Schwann cells and cells containing neurosecretory granules. We conclude that appendiceal neuroma is a rather common entity, and that most cases of so-called fibrous obliteration actually represent appendiceal neuroma.

Adolescent

The position of the vermiform appendix in Nigerians with a review of the literature.

This is a study of the positions of the appendix in 548 Nigerians 447 of whom were autopsies or cadavers while the rest (101) were appendicectomy patients. Overall, the retrocaecal appendix was the commonest because of its very high frequency in the surgical material. The pelvic appendix as distinct from the retrocaecal or retrocolic was the commonest in the nonsurgical cases and it also had an increasing frequency with age. When previous reports were reviewed, the retrocaecal position was moderately infrequent in blacks compared to causasians.

Adolescent

["Cecal appendix with pellets"].

A case is presented of caecal appendix with birdshots, in a 38 years-old male patient, with a clinical picture of biliary pathology. An elongated and "heavy" caecal appendix was palpated during cholecystectomy and removed. The pathological study showed the presence of 99 ammunitions or lead birdshots in the appendicular lumen, with a diameter of 1-5 mm, without histologic evidence of active appendicitis. The patient was fond of hunting wild animals and is used to eat them pickled. Pertinent literature is revised and works are commented in relation to the incidence of different foreign bodies in the appendix lumen, clinical picture and complications.

Adult

Blood lead levels in patients with lead shot retained in the appendix.

Seven patients with one or two lead shots retained in the appendix were identified by radiography. For each case, two sex- and age-matched control patients without lead shot in the appendix were found. None of the 7 patients with lead shot in the appendix had blood lead levels (median 0.55 mumol/l) approaching the toxic levels, but they averaged almost twice the levels of the controls (median 0.29 mumol/l). Thus, lead shots may add to individual lead exposures, and blood lead analysis should be performed, at least when more than a few lead shots are present.

Appendix

[Endocrinocytes of the appendix in the human fetus].

At light and electron microscopic level endocrine cells of the human embryos (9-31-week-old) appendices have been studied. They appear in the human embryo appendix on the 11th week of development for the first time. Amount of the endocrine cells in the field of vision increases significantly on the 17th-24th and does not change on the 25th-31st weeks. Basing on certain morphological criteria, presence of EC-cells and those resembling S- or I-cells is demonstrated in the human embryo appendix. Thus, already during the embryonal period there are cells in the appendix, main function of which is to produce biogenic amines and peptide hormones, participating in local regulation of homeostasis.

Appendix

Transient gas-filled appendix developing during excretory urography.

Gas-filled appendix is well recognized in association with appendicitis, and in acute abdominal conditions associated with bowel distension. 3 patients who developed gas-filled appendix in the course of excretory urography are reported. The phenomenom is thought to result from the reported property of ionic contrast materials to produce anticholinesterase activity and histamine release, either or both of which could produce increased bowel tone and consequent displacement of cecal gas into the appendix.

Adolescent

Crohn's disease of the appendix, manifested as acute appendicitis with postoperative fistula.

Two cases are reported of Crohn's disease localized to the appendix and manifested as acute appendicitis; after appendectomy a fistula developed. In none of 18 patients with Crohn's disease reported by other authors, where the appendix was the primary site, did a fistula develop postoperatively. When the appendix is the primary site of Crohn's disease the presence of mild inflammation of adjacent organs such as the terminal ileum may be mistakenly attributed to ordinary appendicitis. If, at exploratory laparotomy performed on a tentative diagnosis of appendicitis, Crohn's disease is suspected in the adjacent intestine, it is proposed that appendectomy should be followed by at least 10 days of total parenteral nutrition to minimize the risk of a fistula developing.

Acute Disease

[Histochemical characteristics of the secretory elements of the vermiform appendix following surgical trauma, circulatory hypoxia and immunization].

Histochemical methods were applied to determination of salomycin, dermatansulfate, keratosulfate and neutral mucopolysaccharides in the goblet cells of rabbit appendix. Sialomycin and neutral mucopolysaccharides were found in the glands. Immunization with human gamma globulin was followed in the productive phase of immunogenesis by a rise of the secretory activity of the mucosa of the appendix. An increase of the mucus formation in the appendix occurred after laparatomy and during the initial period of experimental appendicitis. However, surgical trauma caused an opposite effect against the background of increased functional activity of the secretory elements of the immunized animals, and during experimental appendicitis no activation of mucus formation was seen. The influence of the abovementioned factors on the secretory activity of the mucous membrane was accompanied by qualitative changes in the synthesized mucus.

Animals

[Development of the mucosa and differentiation of the lymphocytes of the vermiform appendix of the human fetus].

One hundred and twenty-two appendices have been obtained from 12-30-week-old human fetuses and studied histologically (90) and immune-morphologically (32). Lymphoid follicles in the organ appear on the 17th week. Character of the epithelial and the reticular tissue structure in the area of the cupola including the lymphoid follicle have been studied. T- and B-lymphocytes have been stated to be present in the appendix of a 17-week-old fetus. As the fetus is further developing, the number of lymphocytes in the appendix increases: the amount of T-lymphocytes is practically constant, and that of B-lymphocytes increases. Direction of the lymphocytes migration out of the follicle is demonstrated. The lymphoid formations of the appendix are necessary for certain local protective reactions and already in the fetus they begin to participate in the general system of the organism's immunogenesis.

Appendix

The position, length and arterial supply of vermiform appendix.

The arterial blood supply, position and length of appendix were studied in 100 Indian (Uttar Pradesh region) cadavers. In 39% more than one appendicular artery was demonstrated. The retrocaecal and retrocolic positions of the appendix were by far the commonest (58%). Incidence of postilial position was also fairly common (10%). The average length of the appendix was found to be 9.5 cm in the male and 8.7 cm in the female. The prevalence of the retrocaecal and retrocolic positions may partly explain the incidences of appendicitis.

Adolescent

Endoscopic removal of an intussuscepted appendix mimicking a polyp--an endoscopic hazard.

A 55-yr-old white woman with a polypoid filling defect in the caput cecum, on barium enema examination, had endoscopic removal of this mass. This was immediately recognized macroscopically to be an intussuscepted appendix. This case is only the second naturally inverting appendix to be removed endoscopically, and it was complicated 18 h later by local peritonitis which was heralded by acute right lower quadrant pain. Laparotomy revealed a cleanly transected base of appendix and cecal adhesions representing previous chronic inflammatory disease. Endoscopists should consider this diagnosis in all cases of mass lesions of the caput cecum. It is imperative to retrieve such lesions if polypectomy is performed, as the macroscopic diagnosis is then evident. Once the diagnosis is established, immediate surgery is advised rather than watchful waiting.

Appendix

Participation of follicle associated epithelium (fae), macrophages, and plasma cells in the function of appendix.

Rabbit appendix was studied by correlated scanning and transmission electron microscopy and light microscopy, taking advantage of luminal bacteria as naturally occurring markers for following antigen uptake. The three-dimensional relationship of lymphoid follicles to other structures was revealed clearly. The smooth luminal surface of the appendix is interrupted by stomata each leading to a recessed interval between the dome epithelium covering the apical pole of each follicle and the goblet cell-rich epithelium forming a cupola on the opposing surface. Bacteria abound in this recess. They are taken up by follicle associated epithelial (FAE) cells which comprise part of the dome epithelium. Intraepithelial macrophages phagocytize the bacteria. Bacteria-laden macrophages are numerous in the dome area of the follicle and in the germinal center. Large lymphatic sinuses surrounding the follicles are well visualized following stimulation of fluid movement. Plasma cells are located within the dome epithelial layer and immediately beneath it. Plasma cells may be concentrated along the base of epithelial cells, with the absence of a basal lamina indicating an absence of the molecular selection which it would normally provide. The appendix, like Peyer's patches, takes up antigens, processes them, and gives evidence of reaction to them locally, with the secretions from plasma cells possibly modulating antigen entry.

Animals