Background: Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan. Patients and methods: This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months. Results: 90 patients were evaluated, 54 (60%) patients were female and 36 (40%) patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6%) patients and failed in 22 (24.4%) patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients), appendicular abscess (3 patients) and appendicular mass (4 patients). Conclusion: Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery. Highlights:

Intralobar pulmonary sequestration is a rare malformation that predisposes to recurrent respiratory infections. It is difficult to diagnose unless a more extensive directed investigation (to the vasculature and pulmonary parenchyma) is take on. Failure to diagnose and treat this condition can lead to recurrent pneumonia and fatal hemoptysis. Most cases are diagnosed before the age of 20 years. In this report, we present an extremely rare case of elderly woman with initial diagnosis of intralobar sequestration, and to our knowledge, this case represents the oldest diagnosed patient in the literature.

BackgroundIron overload is a risk factor affecting all patients with thalassemia intermedia (TI). We aimed to determine whether there is a relationship of serum ferritin (SF) and alanine aminotransferase (ALT) with liver iron concentration (LIC) determined by R2 magnetic resonance imaging (R2-MRI), to estimate the most relevant degree of iron overload and best time to chelate in patients with TI.MethodsIn this cross-sectional study, 119 patients with TI (mean age years) were randomly selected and compared with 120 patients who had a diagnosis of thalassemia major (TM). Correlations of LIC, as determined by R2-MRI, with SF and ALT levels, were assessed in all participants. A P-value <0.05 was considered statistically significant.ResultsSF and LIC levels were lower in patients with TI than in those with TM; only ferritin values were significant. We found a statistically significant relationship between SF and LIC, with cut-off estimates of SF in patients with TI who had splenectomy and those who entered puberty spontaneously (916 and 940 ng/mL, respectively) with LIC >5 mg Fe/g dry weight (P<0.0001). A significant relationship was also found for patients with TI who had elevated ALT level (63.5 U/L), of 3.15 times the upper normal laboratory limit, using a cut-off for LIC ≥5 mg Fe/g dry weight.ConclusionWe determined the cut-off values for ALT and SF indicating the best time to start iron chelation therapy in patients with TI, and found significant correlations among iron overload, SF, and ALT.

No abstract

Pericallosal lipomas are rare congenital malformative lesions occurring in the interhemispheric fissure closely related to the corpus callosum which is usually abnormal. Pericallosal lipomas may extend into either or both lateral ventricles and appearing as lipomas of choroid plexus in the absence of corpus callosum. I observed this in an interesting case, and, as this is uncommon, I reporting it in order to increase awareness about this unusual presentation and to review briefly criteria of its pathogenesis & diagnosis.