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. Computed tomography showed acute ruptured appendicitis. Diagnostic laparoscopy showed 2 appendices attached via separate bases to a single cecum with no other concurrent anomalies. Both appendices were removed laparoscopically. Histopathology confirmed normal appendiceal tissue in one and severe acute transmural appendicitis in the other. Awareness of appendiceal duplication and a thorough intraoperative inspection are critical to assess the presence of significant associated anomalies and avoid life-threatening complications.
Background: Colorectal cancer is the third most common cancer diagnosed and the second most common cause of cancer death in the United States. For the past two decades, colorectal cancer survival has significantly improved. Although overall colorectal cancer survival has improved, there is limited survival data from inner city patients treated at safety net community hospitals The aim of this study is to analyze post-surgery survival in a community hospital with a high African American (AA) population. Methods: This is a retrospective analysis of prospectively collected data from The Brooklyn Hospital Center's cancer registry, from 1997 to 2010. Of the 1068 registry patients, 275 were excluded leaving 793 (AA n=619, white n=174) for analysis. The study was divided into two time periods: 1997–2004 and 2005–2010. Statistical analyses were performed by SPSS and Epi info software. Chi square and Fisher's exact test, one-way ANOVA analysis are used for the baseline characteristics. Kaplan–Meier survival probabilities are calculated and multivariate Cox proportional hazards models were applied to estimate hazard ratios (HR) with 95% confidence intervals (95% CI). Results: The average age at diagnosis is 67.46±13.23 in 1997–2004 periods and 66.73±12.34 in 2005–2010; there was no significant difference. Significant differences are presented in histological grade as well as pathology stages with high percentage of high grade differential and advanced pathologies in 1997–2004 period and high percentage of low grade differential and early pathology stages in 2005–2010 period with p <0.001 and <0.001 respectively. There is no significant difference in percentage of people who received surgery for these two periods. However, the percentage of people receiving chemotherapy increased in the latter time period. Most common procedure performed was a hemicolectomy. The number of hemicolectomies increased in the later time period (54.2% versus 44.7%, p<0.001). Kaplan Meier survival analysis: post-surgery survival probability significantly improved when comparing 1997–2004 vs 2005–2010 periods (Log-rank p<0.001) with a 5 year survival probability of 55.06% in the 1997–2004 period and 71.2% in the 2005–2010 period. Cox regression hazard ratio is 1.65. This post-surgery survival improvement is not associated with histological grade, site of tumor, but associated with pathology stages and number of lymph nodes removed. Our data demonstrates an improved survival rate in the later time period. This improvement is associated with lower tumor grade differential and early pathologic staging suggesting earlier detection. These data points indicate that minority patients treated in safety net hospitals can achieve superior outcomes. These outcomes are probably related to improvements in patient care delivery and overall cancer awareness. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A54.
Background: Racial disparities and gender differences in the prevalence and mortality of colorectal cancer have been reported. African Americans (AA) have the highest incidence and worst prognosis of colorectal cancer amongst ethnic groups. Men also have a younger age at diagnosis than women along with a poorer prognosis. It is uncertain whether differences persist when patients are of similar biological status at diagnosis, and they have equal opportunity to receive surgery. The aim of this study is to investigate post-surgery survival between AAs and Whites as well as between men and women in the setting of a community hospital in which a majority of the population is AA. Methods: This is a retrospective analysis of data from The Brooklyn Hospital Center's cancer registry from 1997 to 2010. Of all of 1068 registered patients, 806 (75.46%) are AA, 243 (22.75%) are White and 19 (1.8%) are Asian. 445 are male and 623 are female. Among all of the subjects, 817 (76.5%) underwent surgery. Among the 817 surgical patients, 619 are African American, 174 are White, and 34 are Asian (not included in the data analysis). 330 are men, and 403 are women (exclude Asian). Statistical analyses were done by SPSS and Epi info software. Chi square test, Fisher's exact test, and one-way ANOVA analysis are used for the baseline characteristics. Kaplan–Meier survival probabilities are calculated and multivariate Cox proportional hazards models were applied to estimate hazard ratios (HR) with 95% confidence intervals (95% CI). Results: The average age at diagnosis is 67.62±13.23 in AAs and 69.54±14.25 in Whites with no significant difference. Average age at diagnosis in men is 65.81±11.78 and in women is 68.09±13.5 (P=0.014). There is significant difference in location of the presenting tumor; AAs right sided colon cancer in AAs is 40.87% as compared with Whites in whom right sided colon cancer occurs 30.46% of the time. 50.57% of Whites have colorectal cancer located in rectosigmoid region vs. only 38.93% of AAs (p=0.002). There was no significant difference in tumor location between men and women. No significant difference existed in the distribution of histological grade (p=0.19), pathologic stages (p=0.82), people who received surgery, and percentage of patients who received chemotherapy between ethnic groups as well as between gender groups. Hemicolectomy is the most common procedure performed. Significant difference for the distribution of the surgery types was present with 51.4% of AAs receiving hemicolectomy vs. 39.1% of Whites (p=0.022). Also, a significant difference in surgery type was measured between genders with 47% of men receiving hemicolectomy versus 49.9% of women (p=0.044). Kaplan Meier survival analysis: no significant differences presented between these two ethnic groups (Log-rank p=0.2958) with regards to the 5 years survival probability; 5 year survival in AAs is 61.07% and in Whites is 57.36 %. There was a significant difference between men and women in 5 year survival with Log rank p=0.035 and a 5-year survival probability for men of 54.38% vs. 64.24% for women with Cox hazard ratio 1.248. Conclusions: Much attention has been paid to racial disparities and gender differences for the past two decades. Our study shows that AAs are younger at diagnosis and are more likely to present with proximal tumors than Whites, but there is no significant difference in survival between these two ethnic groups post-surgery. Based on similar biological background and with equal opportunity to receive surgery, the racial disparity is diminished perhaps even ameliorated. However, a gender difference is present in our data analysis even when taking into account no difference in the biological characteristics. Men have a younger age at diagnosis and a poorer prognosis. As some studies state, that gender difference may be attributed to hormone levels. Further study is needed to uncover the underlying mechanisms. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A86.
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