Conservative management of acute appendicitis (AA) is gradually being adopted as a valuable therapeutic choice in the treatment of selected patients with AA. This approach is based on the results of many recent studie...Conservative management of acute appendicitis (AA) is gradually being adopted as a valuable therapeutic choice in the treatment of selected patients with AA. This approach is based on the results of many recent studies indicating that it is a valuable and effective alternative to routine emergency appendectomy. Existing data do not support routine interval appendectomy following successful conservative management of AA; indeed, the risk of recurrence is low. Moreover, recurrences usually exhibit a milder clinical course compared to the first episode of AA. The role of routine interval appendectomy is also questioned recently, even in patients with AA complicated by plastron or localized abscess formation. Surgical judgment is required to avoid misdiagnosis when selecting a conservative approach in patients with a presumed “appendiceal” mass.展开更多
The ability of box turtles to close their shell as an antipredation adaptation and the potential impact of the anterior and posterior lobes of the plastron on the closing force and closing time remain relatively unexp...The ability of box turtles to close their shell as an antipredation adaptation and the potential impact of the anterior and posterior lobes of the plastron on the closing force and closing time remain relatively unexplored.Here,keeled(Cuora mouhotii)and flowerback(C.galbinifrons)box turtles,whose shell cannot and can be completely closed,respectively,were studied.Anterior and posterior closing forces were measured using a force transducer,and the closing time was recorded.The anterior closing force in both turtle species was substantially greater than the posterior closing force,reaching approximately 4-fold in adults.Moreover,the anterior closing time in adults was significantly longer than the posterior closing time.This closing force difference can be attributed to the substantially smaller anterior plastron lobe than the posterior lobe in the two species.Additionally,the anterior and posterior closing forces in both species positively correlated with body weight and showed no relationship with the length of the bridge and hinge.Interspecies comparison showed that the anterior and posterior closing forces were significantly greater(approximately 2–4-fold)in flowerback box turtle than in keeled box turtles,regardless of age,and the closure time was significantly longer in adult flowerback box turtles than in adult keeled box turtles.Although the closing forces in both species showed negative allometry,the increase rate was significantly higher in flowerback box turtle than in keeled box turtle.The closing forces in both species were observed to be approximately 4-fold stronger in adults than in juveniles.No sexual dimorphism concerning the anterior and posterior closing forces was observed in either species.In summary,this is the first study to comparatively evaluate the anterior and posterior closing ability of box turtles,demonstrating that age,weight,plastron shape,and the degree of shell closure are important factors affecting closing ability.展开更多
<strong>Purpose:</strong> To assess the epidemiological, clinical and therapeutic aspects of acute appendicitis at the Koutiala Reference Health Centre. <strong>Methods:</strong> This was a pro...<strong>Purpose:</strong> To assess the epidemiological, clinical and therapeutic aspects of acute appendicitis at the Koutiala Reference Health Centre. <strong>Methods:</strong> This was a prospective study conducted in the general surgery department of the Koutiala Reference Health Centre. Patient records admitted for simple and complicated appendicitis during the period from August 1, 2017 to August 31, 2018 have been collected. Patients operated on for simple and complicated acute appendicitis were included in the study. Patients who did not have surgery were excluded. <strong>Results:</strong> We collected records of 62 patients who had surgery for simple and complicated acute appendicitis. They accounted for 11.9% of surgical procedures (n-520) and 27.3% (n-227) of surgical emergencies. The average age was 33.1 years-15.7. Men were in the majority with 72.5%. Simple acute appendicitis accounted for 56.4% of cases (n-35) and complicated appendicitis 43.6% of cases (these were 16 cases of appendicular peritonitis, 09 cases of appendicular abscess and 02 cases of appendicular plastron). Therapeutically, appendectomy was performed in 58 patients. In 4 patients the appendix was completely necrotized. The average length of hospitalization was 3.3 days-0.8 for single acute appendicites and 6 days-2.7 for complicated appendicites. Postoperative morbidity of complicated appendicitis was 6.4% (no. 4) and mortality was zero. <strong>Conclusion:</strong> Simple acute appendicitis is more common. Laparotomy remains the only way at present. Postoperative morbidity is high in complicated appendicitis and mortality is zero.展开更多
文摘Conservative management of acute appendicitis (AA) is gradually being adopted as a valuable therapeutic choice in the treatment of selected patients with AA. This approach is based on the results of many recent studies indicating that it is a valuable and effective alternative to routine emergency appendectomy. Existing data do not support routine interval appendectomy following successful conservative management of AA; indeed, the risk of recurrence is low. Moreover, recurrences usually exhibit a milder clinical course compared to the first episode of AA. The role of routine interval appendectomy is also questioned recently, even in patients with AA complicated by plastron or localized abscess formation. Surgical judgment is required to avoid misdiagnosis when selecting a conservative approach in patients with a presumed “appendiceal” mass.
基金supported by the National Natural Science Foundation of China(32170532 and 31772486)。
文摘The ability of box turtles to close their shell as an antipredation adaptation and the potential impact of the anterior and posterior lobes of the plastron on the closing force and closing time remain relatively unexplored.Here,keeled(Cuora mouhotii)and flowerback(C.galbinifrons)box turtles,whose shell cannot and can be completely closed,respectively,were studied.Anterior and posterior closing forces were measured using a force transducer,and the closing time was recorded.The anterior closing force in both turtle species was substantially greater than the posterior closing force,reaching approximately 4-fold in adults.Moreover,the anterior closing time in adults was significantly longer than the posterior closing time.This closing force difference can be attributed to the substantially smaller anterior plastron lobe than the posterior lobe in the two species.Additionally,the anterior and posterior closing forces in both species positively correlated with body weight and showed no relationship with the length of the bridge and hinge.Interspecies comparison showed that the anterior and posterior closing forces were significantly greater(approximately 2–4-fold)in flowerback box turtle than in keeled box turtles,regardless of age,and the closure time was significantly longer in adult flowerback box turtles than in adult keeled box turtles.Although the closing forces in both species showed negative allometry,the increase rate was significantly higher in flowerback box turtle than in keeled box turtle.The closing forces in both species were observed to be approximately 4-fold stronger in adults than in juveniles.No sexual dimorphism concerning the anterior and posterior closing forces was observed in either species.In summary,this is the first study to comparatively evaluate the anterior and posterior closing ability of box turtles,demonstrating that age,weight,plastron shape,and the degree of shell closure are important factors affecting closing ability.
文摘<strong>Purpose:</strong> To assess the epidemiological, clinical and therapeutic aspects of acute appendicitis at the Koutiala Reference Health Centre. <strong>Methods:</strong> This was a prospective study conducted in the general surgery department of the Koutiala Reference Health Centre. Patient records admitted for simple and complicated appendicitis during the period from August 1, 2017 to August 31, 2018 have been collected. Patients operated on for simple and complicated acute appendicitis were included in the study. Patients who did not have surgery were excluded. <strong>Results:</strong> We collected records of 62 patients who had surgery for simple and complicated acute appendicitis. They accounted for 11.9% of surgical procedures (n-520) and 27.3% (n-227) of surgical emergencies. The average age was 33.1 years-15.7. Men were in the majority with 72.5%. Simple acute appendicitis accounted for 56.4% of cases (n-35) and complicated appendicitis 43.6% of cases (these were 16 cases of appendicular peritonitis, 09 cases of appendicular abscess and 02 cases of appendicular plastron). Therapeutically, appendectomy was performed in 58 patients. In 4 patients the appendix was completely necrotized. The average length of hospitalization was 3.3 days-0.8 for single acute appendicites and 6 days-2.7 for complicated appendicites. Postoperative morbidity of complicated appendicitis was 6.4% (no. 4) and mortality was zero. <strong>Conclusion:</strong> Simple acute appendicitis is more common. Laparotomy remains the only way at present. Postoperative morbidity is high in complicated appendicitis and mortality is zero.
