Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data—the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.
Background and Objectives: Acute abdominal pain in children has been noticed to be a primary reason to seek medical attention in multisystem inflammatory disorder (MIS-C), which can prevail separately or together with acute appendicitis. Our aim was to distinguish regular appendicitis cases from MIS-C and to suggest the best clinical and laboratory criteria for it. Materials and methods: Cases of patients, admitted to the Pediatric Surgery Department over a six-month period in 2021, were retrospectively analyzed. Confirmed MIS-C or acute appendicitis cases were selected. MIS-C cases were either separate/with no found inflammation in the appendix or together with acute appendicitis. Acute appendicitis cases were either regular cases or with a positive COVID-19 test. Four groups were formed and compared: A-acute appendicitis, B-MIS-C with acute appendicitis, C-MIS-C only and D-acute appendicitis with COVID-19. Results: A total of 76 cases were overall analyzed: A-36, B-6, C-29 and D-5. The most significant differences were found in duration of disease A—1.4 days, B—4.5 days, C—4 days, D—4 days (p < 0.0001), C reactive protein (CRP) values A-19.3 mg/L B-112.5 m/L, C-143.8 mg/L and D-141 mg/L (p < 0.0001), presence of febrile fever A-13.9%, B-66.7%, C-96.6% and D-40% (p < 0.0001) and other system involvement: A 0%, B 100%, C 100% and D 20%. A combination of these factors was entered into a ROC curve and was found to have a possibility to predict MIS-C in our analyzed cases (with or without acute appendicitis) with an AUC = 0.983, p < 0.0001, sensitivity of 94.3% and specificity of 92.7% when at least three criteria were met. Conclusions: MIS-C could be suspected even when clinical data and performed tests suggest acute appendicitis especially when at least three out of four signs are present: CRP > 55.8 mg, symptoms last 3 days or longer, febrile fever is present, and any kind of other system involvement is noticed, especially with a known prior recent COVID-19 contact, infection or a positive COVID-19 antibody IgG test.
Aim. To predict rapidly progressive appendicitis using routinely performed tests. Methods. We have analysed patients’ records from the Paediatric Surgery departments in two hospitals with acute appendicitis for a 19year period. The early uncomplicated appendicitis (A1) group was compared to the late uncomplicated – or resolving appendicitis (A2) group. Also, the early complicated – or as we called it rapidly progressive appendicitis (B1) group was compared to the late complicated appendicitis (B2) group. Results. A2 in comparison to A1 showed a lower median white blood cell count 12.3×109/l, neutrophil 74.6 % and neutrophiltolymphocyte ratio (NLR) 4.3, p < 0.0001 but a higher CRP 20 mg/l, p < 0.0001. B1 showed a higher median Basophil count 0.068×109/l, p < 0.0001, but a lower CRP 17 mg/l, p = 0.003 than B2. Conclusions. A higher basophil count and CRP may suggest a rapidly progressive appendicitis, while a lower White blood cell count, neutrophil percentage and NLR may predict resolving appendicitis.
Galvos smegenų kaverninė malformacija (KM, kavernoma, kaverninė angioma, kaverninė hemangioma) -tai įgimtas krauja gyslinis darinys, sudarytas iš kompaktiškai išsidėsčiusio išsiplėtusių kapiliarų rezginio, kuriame nėra smegenų parenchimos. Dažnai kavernomų simptomatikos pasireiškimas susijęs su pakraujavimu. Tačiau kavernomos gali būti besimptomės, jos nu statomos atsitiktinai. Kasmetinis kamieno kavernomų pakraujavimo dažnis -nuo 2,3 % iki 4,1 %.Todėl dauguma sunkių ži dinių tampa neurochirurgijos centrų tikslu. Giliai esančių bei kamieno židinių chirurgija yra ne tokia sėkminga. Kavernomų simptomatika priklauso nuo židinio lokalizacijos. Apie 80 % atvejų kavernomos yra viršdangtinės. Dažniausiai pažeidžiamos kaktinė bei smilkininė skiltys, požievinė zona. Būdingiausi simptomai yra epilepsija ir traukuliai. Šie simptomai yra susiję su kaverninės malformacijos pakraujavimu. Renkantis chirurginį gydymą svarbu įvertinti židinio anatomiją ir lokalizaciją atlikus magnetinio rezonanso tomografiją (MRT). Radikalus kavernomos chirurginis pašalinimas yra vienintelis veiksmingas gydymo metodas.MRT yra jautriausias ir specifiškiausias kavernomų diagnostikos metodas. Mažas kavernomas rutininiu MRT gali būti sunku diagnozuoti. Reikšminiai žodžiai: Galvos smegenų kaverninė malformacija, kavernoma, kaverninė angioma, kaverninė hemangioma Cerebral cavernous malformations (CCM) are lowflow vascular lesions in eloquent locations. Their presentation is often marked with symptomatic hemorrhages. Annual brainstem CM rate of hemorrhage is from 2.3% to 4.1%. Surgery for deepseated or brainstem lesions is less successful and is associated with an early morbidity rate of roughly 30-70% and a mortality rate of 2%. Signs and symptoms of CCM depends on localization in the brain. Approximately 80% of cases are supratentorial caverno mas. The most frequent injuring zones are frontal, temporal lobes and subcortical region. The most common symptoms are epilepsy and seizures. Also it can effect motor fibers which are situated in the cerebellum branch. Statistically approximately 40% all of CCM are asymptomatic and found accidentally when radiological investigations are taken.
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