Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis.

c A S E R E P O R t SAn enteric fistula that occurs in an open abdomen is called an enteroatmospheric fistula (EAF) and is the most challenging complication for a surgical team to deal with. The treatment of EAF requires a multidisciplinary approach. First of all, sepsis has to be managed. Any fluid, electrolyte and metabolic disorders need to be corrected. Oral intake must be stopped and total parenteral nutrition introduced. The control and drainage of the effluent from the fistula is a separate issue. Since there are no fixed algorithms for the treatment of EAF, surgeons need to develop their own, often highly unconventional solutions. We present the case of a 24-year-old man who developed enteroatmospheric fistula after laparotomy and relaparotomy due to acute necrotic pancreatitis. Both the laparostomy and the fistula were successfully managed using modified negative pressure wound therapy. The literature regarding this issue was also reviewed.

Abstract-Introduction: Venous leg ulcers (VLU) occur in 1% of the adult population and are associated with chronic disability, diminished quality of life and high health-care costs. Treatment is often slow, difficult and recurrence is high because of inappropriate conditions of the wound bed.Patients and Methods: This study involves 14 patients with chronic venous ulcers larger than 100 cm 2 treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalized tissues and partial stripping of an insufficient great saphenous vein in the first operation. After adequate haemostasis, NPWT kit was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Dressing impregnated with neutral triglycerides and silver ions was used as a first layer and the black polyurethane NPWT foam was applied over it. The pain assessment was performed for 7 patients using 10 cm visual analog scale (VAS).Results: The mean number of NPWT dressing changes prior to grafting was 5.8. The mean number of NPWT foam changes was 2.8 after skin grafting. We accomplished complete healing of 92% of applied skin grafts surface. One patient had recurrence of venous ulcers in the follow-up period. Moreover, one patient required regrafting.Conclusions: The application of NPWT provides quick wound-bed preparation and high graft take in venous ulcer treatment.

Patients with diabetes mellitus are at increased risk of angiopathy, neuropathy and infection compared with healthy individuals and that may lead to foot disorders. Treatment is difficult challenging and if it is not successful it often run to lower limbs amputations.We present case report of 63 years old man after amputation of big toe and part of metatarsus due to diabetic foot syndrome, successfully treated with negative pressure wound therapy in combination with silver dressing. The literature regarding this issue was also reviewed.