Radiation arteritis is not an uncommon clinical situation, given that almost 50% of patients with cancer receive radiotherapy in the course of treatment. Radiation effects are non-specific, and late radiation tissue injury presentation can be very variable. However, radiation arteritis has some unique clinical and radiological features, with consequent special therapeutic considerations. Iliac radiation arteritis may be accompanied by radiation-associated iliac vein disease and small vessel disease. Therefore, diagnostic and therapeutic plans should be directed toward all possible late radiation effects as relevant. Despite the complexity of the disease process and diagnostic challenges, treatment can be very straightforward if adequately planned. Otherwise, limb loss and/or life-threatening complications can rapidly ensue. This article highlights the natural history of radiation arteritis, with a particular emphasis on the iliac segment, and discusses the risk potentials of this condition, given that limb loss may be multifactorial, not merely because of the iliac arterial flow interruption. The main lines of management are also briefly discussed.
Aim There is significant variation in management of acute appendicitis across the UK. Despite advancements in imaging modalities, acute appendicitis is still a clinical diagnosis. The primary aim of this study was to determine the negative appendectomy rate (NAR) and secondary aim was to look for the imaging results and hospital readmission rate in case of a normal appendix. Method It is a retrospective analysis of all the patients admitted with a suspicion of acute appendicitis from Jan 2018 to April 2019. For data collection hospital medical record was used. Information about patient demographic details, blood results, outcome, operative findings, and histology of appendix if removed, was collected. For Patients having negative appendectomy, hospital admission rate was calculated. Results Total 517 patients were admitted with suspected acute appendicitis and only 45.6% (n = 236) patients underwent surgery. Females=52.1%, Males 47.9%. Mean age was 31 years. NAR was 10.6% (n = 25). (Females= 9.3%, Males=1.3%), 8.4% female patients were below 35 years of age. Patients were divided into 3 groups (Normal appendix NA, Uncomplicated appendicitis UA, complicated appendicitis CA). There was a statistically significant difference in inflammatory markers between the groups. In NA group 17/25 patients underwent prior imaging and imaging suggested acute appendicitis in 7/17 patients. Post NA hospital readmission rate was 20%, all of them were females, and gynecology opinion was sought in all of them. Conclusions The negative appendectomy rate is at 10.6%, comparable to national database. It is more common in young females due to a range of differential diagnoses.
Aim Acute appendicitis (AA) is usually a clinical diagnosis and surgical intervention is typically a preferred choice to avoid potentially lethal complications like perforation and purulent peritonitis. Intra-abdominal inflammation can lead to hepatic cholestasis due to cytokine release, which can reflect as rise in bilirubin alone or in combination with other liver enzymes. The aim of this study was to evaluate hyperbilirubinemia as a predictor of complicated acute appendicitis (CA). Method A retrospective analysis of all the patients who underwent surgery for AA in a district general hospital in the UK from Jan 2018 to April 2019. All the patients underwent admission blood tests including White cell count (WCC), C- reactive proteins (CRP), and liver function tests (LFTs). For data collection hospital medical record was used. Complicated appendicitis (CA) was defined as Gangrenous, or perforated appendix wall, abscess formation, or generalized peritonitis. Results In total 236 patients underwent appendectomy. On histology 25 patients (10.6%) had normal appendix (NA). Furthermore, 161 patients (68.2%) had uncomplicated appendicitis (UA) and 50 patients (21.2%) had complicated appendicitis (CA). Serum Bilirubin (SB) was found to be statistically significantly raised in patients with CA (p value=0.0001) when compared with NA group. Overall sensitivity of SB, CRP and WCC for AA was(15.17%, 79.90%, and 57.82% respectively) and specificity was(100%, 36.36% and 68% respectively). Conclusions SB had low sensitivity and high specificity as compared to CRP and WCC for AA. Raised serum bilirubin levels can be considered as one of the supportive markers of complicated appendicitis.
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