fibrin and Intestinal-Perforation

Diagnostic laparoscopy is the ultimate diagnostic tool to evaluate the appendix. Still, according to the literature, this strategy results in a negative appendectomy rate of approximately 12-18 % and associated morbidity. Laparoscopic criteria for determining appendicitis are lacking. The goal of this study is to define clear and reliable criteria for appendicitis during diagnostic laparoscopy that eventually may safely reduce the negative appendectomy rate.. From December 2009 through April 2011, 134 patients were included and analysed in a single-centre prospective pilot study. Intraoperatively, the appendix was evaluated by the surgeon according to nine criteria for appendicitis. The operating surgeon decided whether it should be removed or not. Immediately after the operation the surgeon had to complete a questionnaire on nine criteria for appendicitis. All removed appendices were examined by a pathologist. In case the appendix was not removed, the clinical postoperative course was decisive for the (missed) presence of appendicitis.. In 109 cases an inflamed appendix was removed; in 25 patients the appendix was normal, 3 of which had been removed. After univariate analysis and clinical judgement six variables were included in the Laparoscopic APPendicitis score (LAPP score). In this study, use of the LAPP score would have led to a positive predictive value of 99 % and a negative predictive value of 100 %.. This study presents the LAPP score. The LAPP score is an easily applicable score that can be used by surgeons to evaluate the appendix during diagnostic laparoscopy. The score has high positive and negative predictive value. The LAPP score needs to be validated in a multicentre validation study.

Topics: Adolescent; Adult; Appendectomy; Appendicitis; Appendix; False Positive Reactions; Female; Fibrin; Humans; Intestinal Perforation; Laparoscopy; Male; Mesentery; Necrosis; Pilot Projects; Predictive Value of Tests; Prospective Studies; Severity of Illness Index; Suppuration; Surveys and Questionnaires; Unnecessary Procedures; Young Adult

Topics: Female; Fibrin; Foreign Bodies; Gastrostomy; Humans; Intestinal Perforation; Male; Middle Aged; Peritoneal Cavity; Stomach

The possible injurious effects of abdominal intrauterine devices (IUDs), including Cu-IUDs, inert IUDs, and "closed' IUDs, were evaluated in an experimental study. Pigs and dogs were used as they have, respectively, a propensity to form adhesions and a pronounced tendency to develop serious peritonitis. The reactions expected in humans might be intermediate to those found in these two kinds of experimental animals. The results of this study indicate that an inert or copper-bearing IUD usually remains in its initial position in the abdominal cavity, encapsulated by adhesions. The risk of strangulation of the intestine by a "closed' IUD seems minimal.

Topics: Animals; Dogs; Female; Fibrin; Hysterosalpingography; Intestinal Perforation; Intrauterine Devices; Intrauterine Devices, Copper; Laparotomy; Pregnancy; Swine; Tissue Adhesions; Uterine Perforation; Uterine Rupture