BACKGROUND AND AIMS: This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test. PATIENTS AND METHODS: 717 patients were operated on for appendicitis by six different surgeons. Initial clinical and laboratory examination were evaluated in relation to the intraoperative and the pathological appreciation of the appendiceal inflammation. RESULTS: 598 patients were found to have appendicitis, 34 a different condition, 41 had both appendicitis and an additional condition and 44 no pathology. 6% of the laparotomies and 11% of the appendectomies were unnecessary. The severity of the inflammation correlated significantly with periumbilical pain, pain migrating to right lower quadrant, loss of appetite, fever, rebound tenderness, local rigidity, polymorphonuclear predominance on deferential, polymorhonucleosis and leukocytosis. Leukocytosis was less frequent in aged patients. All the six surgeons were found to be equally reliable, although they all underestimated the setting compared to the pathologists. Patients with a long duration of symptoms had milder forms of inflammation and increased percentage of unanticipated abdominal conditions. CONCLUSIONS: Appendicitis can be reliably diagnosed clinically without employment of adjunct tests. These can be reserved for equivocal cases.

The authors report the case of a 2-year-old girl with pulmonary cystic adenomatoid malformation type II who presented with a mass on the lower lobe of the left lung. Resection and histological examination revealed pleomorphic rhabdomyosarcoma. Chemotherapy and radiotherapy followed the operation and the girl is alive and in perfect condition 10 years after the operation. The literature on primary rhabdomyosarcoma of the lung in children is reviewed.

SUMMARY: A 71-year-old diabetic patient underwent right pneumonectomy with wide mediastinal lymph node dissection for lung cancer (right upper lobe). Postoperatively he developed pleura empyema that was successfully treated - drainage and Eloesser window, followed by adjuvant radiotherapy. Two months later he developed an esophagopleural fistula. Due to the patient's physical condition primary repair of the esophageal rupture was considered a high-risk operation. Stenting was also considered as inappropriate due to the existing contamination. Bypassing with the use of the stomach as conduit was preferred due to its simplicity compared to the colon. In order to avoid mediastinum after the postradiation alterations and because of the Eloesser window we adopted a presternal subcutaneous position. Twenty-eight months after the by pass procedure the patient is in good health being able to eat and drink, has gained weight and shows no evidence of malignancy. Presternal gastric esophageal bypass has never been reported as a treatment for esophagopleural fistula. This case report indicates its possible successful use in this debilitating setting, although more experience is needed.

The purpose of this study was to examine the usefulness and validity of contrast enhanced-spiral computerized tomography in assessing blunt abdominal trauma. 257 patients were admitted in a general hospital over a period of five years and were examined with computed tomography. Two-dimension reconstruction and delayed imaging were used when appropriate. 169 patients underwent a laparotomy, while 88 were treated conservatively. Scans were true positive for intraabdominal damage in 212 patients depicting chiefly splenic, liver, renal, urinary bladder, and mesenteric/intestinal injuries (41%, 18%, 6.6%, 6.6%, and 13.7% respectively). True negative examinations amounted up to 35. 10 non-specific examinations displayed the existence of hemoperitoneum but not the actual damage itself, therefore they were considered false negative. No false positive examination existed. Overall sensitivity was 95%, specificity 100%, positive predictive value 100% and negative predictive value 78%. In conclusion spiral computed tomography is a valuable examination in blunt abdominal trauma as it facilitates diagnosis of intraabdominal damage, assists in defining treatment and occasionally allows foretelling the outcome.

For 5 years (January 1998 to November 2002) our department has applied the Marlex Mesh Perfix Plug hernioplasty. This article demonstrates the experience gained in operative and postoperative aspects, costs, and outcome along with the results of a follow-up analysis. Altogether, 801 patients (749 males, 52 females) were operated on Sixty-four males had bilateral groin hernias, so the total number of hernioplasties amounted to 865. A total of 19 hernias were recurrent, 297 were direct, 545 were indirect or scrotal (or both) 21 were femoral, and 2 were Spigelian. Fifty-three operations were performed on an emergency basis. Preoperative routine use of antibiotics was minimized throughout the years. Operating time fluctuated from 20 to 25 min (30-40 minutes for recurrent hernias), and the postoperative hospital stay was 28 hours (6-72) hours. The complication rate was 5% and the recurrence rate less than 1%. Early patient mobilization and return to everyday activities (1-2 weeks) was encouraged. The follow-up of 95% of the patient population lasted 12 to 60 months and was performed at 1 week, 1 month, 1 year, and yearly thereafter. The technique demonstrates less overall postoperative pain, discomfort, and complications combined with a remarkably low recurrence rate. The rapid rehabilitation with great patient comfort and decreased operating room time, resulting in lower financial costs, have led us nowadays to repair all types of inguinal hernias, femoral and recurrent ones, using this technique.

Visceral involvement in acute non-lymphocytic leukemia (ANLL) seldom precedes hematological manifestation. We report on a patient with M4 - ANLL presenting with acute abdomen without any evidence of blood disorder. Laparotomy revealed only ileal wall oedema. Postoperative clinical deterioration led to a second-look operation combined with intraoperative endoscopy. Biopsied tissues were diffusely infiltrated by blasts characterised as HLA-DR (+), PGM1 (50% +), MPO (50% +) and CD 34 (-). Bone marrow reconfirmed these findings and showed positivity for CD4 (44%), CD11b (50%), CD11c (42%), CD13 (33%), CD34 (32%), and CD56 (54%). Chemotherapy achieved a complete but short remission. Relapse occurred 7 months later. Immediately after consolidation chemotherapy the profoundly immunosuppressed patient passed away after a lower respiratory tract infection. We discuss the contrast between histology and short disease duration, the unusual presentation and the bad prognosis, and attempt to correlate the clinical course with the coexpression of markers.