Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085693 (acute appendicitis)
 3,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Four cases of carcinoid tumors of the vermiform appendix are reported. Clinical presentation in 3 cases was suggestive of acute appendicitis and they were submitted to appendicectomy. The carcinoid tumor was discovered by the pathologist on specimen of appendix. The tumors's size, less than 2 cm, the absence of serosal involvement and lymphatics invasion suggested that simple appendicectomy was a satisfactory treatment for such patients. Occasionally clinical presentation of appendiceal carcinoid is characterized by symptoms of intestinal obstruction or intussusception, palpable mass, bleeding. In the fourth patient, that had symptoms consistent with ileal occlusion, we found at laparotomy a bulky tumor of the base of appendix infiltrating and obstructing the cecum and right colon, without liver metastases. A right hemicolectomy with end-to-end anastomosis was performed. Aggressive behaviour of this tumor was also revealed by the single pulmonary metastasis, finding very uncommon in carcinoid of appendix. This patient died postoperatively, at 25th day, of septic abdominal complications, secondary to anastomotic leak. The former patients at clinical and radiological (CT scan) follow-up performed at 3, 12, 36 months respectively, are still alive and disease free.
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PMID:[Carcinoid of the appendix. Observations on 4 cases]. 978 Jun 37

A case of a young male operated on for acute appendicitis due to a carcinoid of the base is reported. Since the tumor was infiltrating the resection margin of the appendix, the patient was later treated with a right hemicolectomy. Carcinoid tumor is unusual, but can be encountered several times during the career of a surgeon (1/200-300 appendicectomy). The tumor is more frequent in women (2-4:1), located at the tip of the appendix (62-78%) and has a diameter less than 1 cm in 70-95% of cases. It is more frequently diagnosed incidentally after an operation for acute appendicitis and occasionally during other procedures (colectomy, cholecystectomy, salpingectomy). Liver metastases are rare (< 2%), related to the dimension of the primitive tumor (21-100% when > 2 cm) and can cause a "carcinoid syndrome": flush, diarrhea bronchoconstriction, cardiac valve disease. Diagnosis is made by the pathologist and staging by conventional radiologic procedures (TAC, US), dosage of neuroendocrine mediators such as 24 hours urinary 5-HIAA. Nowadays 111In-octreotide scintigraphy (SRS) has an 86% sensitivity to detect the carcinoid and is useful for staging and for planning a surgical intervention. Simple appendectomy is adequate treatment for appendiceal carcinoids less than 1 cm in diameter. Adequate treatment for tumors greater than 2 cm is right hemicolectomy. A point of controversy is what to do for tumors in the 1 to 2 cm range. It seems that appendectomy alone is sufficient except in those cases when mesoappendiceal invasion is identified. When surgical margins after appendectomy are not free of tumor, additional surgery seems warranted. Carcinoid tumor of the appendix has a good prognosis with a 5-year-survival rate, of 85.9-100%. When liver metastases are encountered octreotide can relieve symptoms and sometimes the progression of the disease.
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PMID:[Carcinoid of the appendix. A case report]. 1083 90

Twelve patients operated for gastrointestinal carcinoid tumors are analyzed retrospectively. Clinically four of the cases (33%) were with signs of bowel obstruction, 4 (33%)--with signs of acute appendicitis, 3 (25%)--with signs of gastric outlet obstruction, and one (9%) with a picture of perforative peritonitis. Carcinoid syndrome was observed in two cases (17%). Five of the tumors (42%) were localized in the small intestine, 4 (33%)--in the appendix and 3 (25%)--in the duodenum. Small bowel resection was performed in 5 cases (42%), appendectomy--in 4 (33%), hemiresection of the duodenum--in 2 (17%) and duodenotomy with excision of the tumor and pyloroplasty--in one. In 2 cases liver metastases were found, and in one--multiple (3) tumors in the gut.
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PMID:[Gastrointestinal carcinoid tumors--a retrospective analysis of 12 cases]. 1570 44

Carcinoids of the appendix represent a separate class of tumours with characteristics that vary between benign (adenomas) and malignant (carcinomas) neoplasias. A recent nomenclature identifies them as diffuse neuroendocrine system (DNS) and/or, parallely, as neuroendocrine tumours (NET): the gastroenteric tract is the site of about 64.3% of carcinoids, followed by the respiratory tract with 25.3%. Among the gastrointestinals, tumour of the small intestine is the one with the highest incidence with 28.5%, followed by the appendix with 4.77%, the rectum with 13.6% and the stomach with 4.6%. Carcinoid of the colon has an incidence of 8.62%, with the caecum which alone represents 34.5% of colic localisations. The 3 cases described are an example of the behavioural unpredictability of intestinal carcinoids. The first case is that of a female patient in whom the primary tumour was only discovered after liver metastasis was documented. The second case regards a girl who, at admission, presented a picture of acute abdomen with the symptomatological characteristics of acute appendicitis. She was submitted to an appendicectomy. Subsequent investigations carried out in the postoperative period documented the presence of liver metastasis at the V and VI liver segments. The last case, similar to the second from certain points of view, shows the need to carry out a right hemicolectomy with removal of locoregional lymphnodes in the event of an appendicular carcinoid >2 cm. Both laboratory and instrumental examinations contribute to the diagnosis of intestinal carcinoid. The main laboratory examinations are based on the measurement of serotonin and urinary 5-hydroxy-indolacetic acid. First level instrumental examinations for the diagnosis of intestinal carcinoid are represented by CT with and without contrast medium, diagnostic endoscopy and, to better highlight the presence of locoregional metastases, scintigraphy with octreotide and PET. An alternative treatment of liver metastases other than surgery is most certainly chemoembolisation. This latter treatment has also proved very effective as a neoadjuvant treatment for liver metastases before subjecting the patient to liver resection. Treatment with somatostatin, on the other hand, proved effective in controlling tumour secretion, so attenuating the inconveniences of carcinoid syndrome.
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PMID:Carcinoid of the vermiform appendix. Description of three clinical cases and review of the literature. 1685 10