Acute perforated appendicitis in childhood; analysis of management,including the use of hypothermia

The increasing millions of people with chronic disease constitute the greatest challenge to American medicine today. It is only during the very few years just past that any comprehensive answer to this challenge has been initiated. To physicians the most pressing needs in the total care of the chronically ill are:1. Research in the care of the chronically ill as well as in the specific diseases causing chronic illness.2. Coordination of all the services available in our communities.3. Recognition by physicians of responsibility for the care of the chronically ill person, himself, as well as for treatment of his disease.     

Peripheral arteriosclerosis; present concepts of management

Three hundred patients with clinical manifestations of ischemia due to peripheral arteriosclerosis were studied. An accurate demonstration of the extent of the arterial occlusive process by means of aortography was of major importance in determining therapy and prognosis. The results from thromboendarterectomy to restore the arterial lumen in cases of segmental thrombosis or stenosis greatly exceeded those obtained from other methods of therapy for peripheral arteriosclerosis. The indications for and the limitations of lumbar sympathectomy as a palliative procedure are described. Medical treatment, except for the use of specific protective measures, was of little value in altering either the symptoms or prognosis.     

Acute appendicitis in a chimpanzee (Pan troglodytes)

BACKGROUND: A 7-year old, female chimpanzee (Pan troglodytes) developed acute abdominal pain and anorexia. An irregular, mineral opacity was identified in the caudal right quadrant of the abdomen on radiographs and computed tomography scan, which appeared to be in the region of the cecal appendage. RESULTS AND CONCLUSIONS: A diagnosis of acute appendicitis was made based on clinical signs, abnormal haematology findings, and consultation with a human radiologist. Exploratory laparotomy was performed and the cecal appendage was removed. On histologic examination, the mucosal epithelium contained eosinophilic and neutrophilic inflammation. The inflammation extended through the tunica muscularis to the serosal surface and adjacent mesentery. The histologic findings were consistent with acute appendicitis in humans. The chimpanzee recovered well from surgery with immediate improvement in clinical signs and no post-operative complications.     

Past and present concepts in flow cytometry: a European perspective

The development of flow cytometric instrumentation, methods and research concepts in Europe has been a continuous driving force for the general scientific advancement in this area over the years. This review addresses early European concepts of continuing interest with regard to instrumentation, data analysis, clinical and eperimental DNA analysis, cell function and microbiology at their worldwide first appearence while flow cytometric immunology and immunophenotyping will be covered separately. Flow cytometry represents an efficient approach to the enormous complexity of molecular cell architecture and cell function by the analysis of apparent molecular cell phenotypes in heterogeneous cell samples. The present merger of flow and image cytometry into the method independent cytomics discipline increases the potential of cell analysis very significantly. It opens the way for predictive medicine as well as for predictive cytopathology and predictive cytology in everyday clinical and medical practice. Current progress is driven by joint advances in molecular fluorescence technologies and instrument development. This complements the analysis of genome sequence information in an efficient way.     

Acute appendicitis in nine British towns.

The incidence of acute appendicitis was compared among residents in nine towns in England and Wales, the towns having been chosen so that three were in the north, three in the central latitude band, and three in the south. Each group of three towns comprised one with "better,'' one with "intermediate,'' and one with "worse'' socioeconomic conditions. The data were derived from hospital records for the years 1974-7. Hospital discharge rates for acute appendicitis were higher in the three northern towns in both sexes and all age groups. There was no consistent variation with the socioeconomic state of the towns. The distribution of appendicitis in the nine towns differed from that of other "diseases of Western civilisation'' and so weighs against the hypothesis of similar dietary influences in the aetiology of acute appendicitis and these other diseases. These findings are being followed up by dietary surveys in the towns.     

Acute appendicitis and ileal perforation with a toothpick treated by laparoscopy

A 69-year-old man underwent an emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration showed inflamed appendix and perforation of terminal ileum with a swallowed part of the wooden toothpick. The treatment consisted of typical laparoscopic appendectomy and laparoscopic removal of the foreign body, followed by laparoscopic closure of the perforation site and lavage of the abdominal cavity. The postoperative course was uneventful and the patient was discharged from the hospital on day 3 after the operation.     

Acute appendicitis and bathrooms in three samples of British children

The occurrence of appendicectomy in three national samples of British children was analysed in relation to household amenities, crowding in the home, and social class. The risk of having the operation depended on the amenities present in the home, in particular whether or not there was a bathroom. This risk was independent of social class.The findings support a relation between acute appendicitis and Western hygiene, which would explain the geographical distribution of the disease and its changing incidence over time. In the developing world, where children grow up in conditions of poor hygiene, there may be outbreaks of appendicitis when housing improves.     

Localizational concepts in epilepsy: past, present and future

The clinical seizure pattern, particularly the initial phenomena, plus the EEG, when satisfactory recording of the seizure onset can be achieved, determine the primary localization of epileptic phenomena. The EEG has also demonstrated, by the presence of interictal epileptiform spike discharges, the presence of a second-order localization of epileptic phenomena, namely, the location and extent of cortex adjacent to the site of origin of the neuronal seizure discharge that is recruited into action in a clinical epileptic seizure. Experience with cortical resection in the treatment of focal epilepsy has demonstrated the importance of a third-order localization of epileptic phenomena, namely, how much of the potentially epileptogenic cortex must be excised in order to produce a satisfactory reduction of the seizure tendency.     

Acute hemiplegia of childhood.

Acute hemiplegia of obscure cause occurred in 28 children: 13 had had prolonged seizures and a high temperature (considered to have been the direct cause of the brain damage); 5 had had brief seizures, a lower temperature and a depressed level of consciousness; and 10 had a nonfebrile onset of hemiplegia and were found to have vascular abnormalities. Most of the first group were retarded and epileptic at long-term follow-up, as were about half of the second group, whereas children in the third group were of normal intelligence and epilepsy was uncommon among them. Hemiplegia persisted at follow-up in most of the children in each group, the proportion being at least in the third group; if cerebral angiography had demonstrated carotid stenosis or occlusion there was usually poor recovery from the hemiplegia. Bilateral changes on plain skull films or pneumoencephalograms were associated with mental retardation. Failure to control prolonged seizures accompanied by a high temperature predisposes to brain damage; therefore, early and vigorous management is essential.     

A review of some present molecular and submolecular physical concepts in biology

Increasing attention is being directed towards understanding cellular processes at the molecular and submolecular levels. This article describes some of the physical concepts, such as proton transport in membrane pores and at protein-water interfaces, tunnelling processes, electronic conduction and induction effects in membrane-associated protein structures, that are currently being investigated and developed in the study of such functions as energy transduction and the passive and active transport of ions in cell membranes.