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Background: Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. Methods: A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. Results: Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. Conclusion: Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence. Contexte : L'appendicite aigue demeure la plus frequente cause de l'abdomen aigu chez les jeunes adultes et dans la plupart des centres, la base du traitement repose sur l'appendicectomie. Toutefois, le traitement des autres processus inflammatoires intra-abdominaux, comme la diverticulite, consiste initialement en une prise en charge conservatrice par antibiotherapie. Cette etude avait pour but de determiner le role des antibiotiques dans la prise en charge de l'appendicite aigue et de verifier si l'appendicectomie reste la norme therapeutique. Methodes : Une interrogation des publications dans MEDLINE et la Collaboration Cochrane a permis de recenser des etudes publiees entre 1999 et 2009 et nous avons passe en revue tous les articles pertinents. Nous avons soumis les articles a un examen critique en appliquant les outils d'evaluation de la Public Health Resource Unit (2006). Resultats : Notre recherche a retrouve 41 articles, et nous avons retenu 13 articles a partir des criteres specifies. Tous, meme s'ils posaient des questions pertinentes et etablissaient le role de l'antibiotherapie comme etape de transition avant la chirurgie, ont echoue a demontrer de facon adequate leurs conclusions selon lesquelles les antibiotiques pourraient etre utilises en traitement definitif de l'appendicite aigue. Conclusion : Si l'on se fie aux preuves actuelles, l'appendicectomie reste la norme therapeutique privilegiee pour le traitement de l'appendice aigue., Acute appendicitis is inflammation of the vermiform appendix and remains the most common cause of the acute abdomen in young adults. The mainstay of treatment in most centres is an [...]

In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment. [ABSTRACT FROM AUTHOR]

Background: Alcohol-related admissions (ARA) represent a significant burden on hospital resources. The study objectives were to assess alcohol-related acute surgical admissions to a District General Hospital over a 5-year period, to determine the cost of these admissions and to consider strategies to affect future admission rates. Methods: A prospective observational study was completed from October 2007 to March 2008. A daily review of acute surgical admissions determined whether alcohol was a factor for patients admitted. Data recorded included patient demographics, clinical presentation, investigations and final outcomes. This data was then compared with a previously completed prospective study between November 2002 and March 2003. Results: Overall emergency surgical admissions during the study period were 1,125 (10.4%) compared to 838 (11.02%) in 2002. There was a 1.1% reduction in ARA from 9.5% (80/838) in 2002 to 8.4% (94/1,125) in 2007. The majority of ARA were male (82.8%) and 59.8% of ARA were under 40 years of age. ARA secondary to road traffic collisions (RTC) were reduced in 2007 compared to 2002 (12.5% to 8.5%). However, head injuries (30.0% to 48.9%) and pancreatitis (3.8% to 19.1%) secondary to alcohol had increased (p=0.27). 79.3% of admissions occurred out of hours. Although use of plain x-rays had decreased (70% to 54.3%, p=0.018), CT imaging (11.3% to 20.2%, p=0.67) and upper GI endoscopy had increased (2.5% to 7.4%, p=0.82). Blood alcohol levels increased with 83.0% of patients in 2007 compared to 60.9% in 2002 admitted with a level greater than 151mg/100mls (p=0.10). The overall cost of ARA over one year was calculated at £341,796. Conclusion: Alcohol-related admissions have reduced at this District General Hospital. However, despite recent government initiatives it still remains unclear how these factors affected ARA, as blood alcohol levels, alcohol-related head injuries and pancreatitis admissions all increased. Our findings highlight the relevance of the implementation of an inpatient alcohol policy combined with the availability of an alcohol liaison nurse in all acute surgical units. [ABSTRACT FROM AUTHOR]

Circulating tumor cells (CTCs) have potential as diagnostic, prognostic, and predictive biomarkers in solid tumors. Despite Food and Drug Administration (FDA) approval of CTC devices in various cancers, the rarity and heterogeneity of CTCs in lung cancer make them technically challenging to isolate and analyze, hindering their clinical integration. Establishing a consensus through comparative analysis of different CTC systems is warranted. This study aimed to evaluate seven different CTC enrichment methods across five technologies using a standardized spike‐in protocol: the CellMag™ (EpCAM‐dependent enrichment), EasySep™ and RosetteSep™ (blood cell depletion), and the Parsortix® PR1 and the new design Parsortix® Prototype (PP) (size‐ and deformability‐based enrichment). The Parsortix® systems were also evaluated for any differences in recovery rates between cell harvest versus in‐cassette staining. Healthy donor blood (5 mL) was spiked with 100 fluorescently labeled EpCAMhigh H1975 cells, processed through each system, and the isolation efficiency was calculated. The CellMag™ had the highest recovery rate (70 ± 14%), followed by Parsortix® PR1 in‐cassette staining, while the EasySep™ had the lowest recovery (18 ± 8%). Additional spike‐in experiments were performed with EpCAMmoderate A549 and EpCAMlow H1299 cells using the CellMag™ and Parsortix® PR1 in‐cassette staining. The recovery rate of CellMag™ significantly reduced to 35 ± 14% with A549 cells and 1 ± 1% with H1299 cells. However, the Parsortix® PR1 in‐cassette staining showed cell phenotype‐independent and consistent recovery rates among all lung cancer cell lines: H1975 (49 ± 2%), A549 (47 ± 10%), and H1299 (52 ± 10%). Furthermore, we demonstrated that the Parsortix® PR1 in‐cassette staining method is capable of isolating heterogeneous single CTCs and cell clusters from patient samples. The Parsortix® PR1 in‐cassette staining, capable of isolating different phenotypes of CTCs as either single cells or cell clusters with consistent recovery rates, is considered optimal for CTC enrichment for lung cancer, albeit needing further optimization and validation. [ABSTRACT FROM AUTHOR]

The incidence of human epidermal growth factor receptor 2 (Her-2) mutations in lung adenocarcinoma is approximately 3%; however, its significance in the management of these lung cancers remains under investigation. We describe an incidental but unique opportunity to evaluate the response to treatment with herceptin in a patient with bilateral synchronous lung primaries in conjunction with breast carcinoma. Interval imaging following surgical resection of the squamous cell carcinoma while on herceptin treatment delineated the radiological regression of the Her-2 positive lung adenocarcinoma. We feel that this case highlights the potential role for herceptin treatment in Her-2 positive lung adenocarcinomas and demonstrates the importance of screening for these mutations. [ABSTRACT FROM AUTHOR]

A response by Andrea Cariati and colleagues to a letter to the editor about their article related to the management of acute appendicitis which was published in a previous issue is presented.

The article describes the clinical case of a 72-year-old man who was found to have a tracheal septum. The patient was diagnosed with severe mitral regurgitation and was admitted for mitral valve repair. Finding a tracheal septum during a pre-operative posterior-anterior chest X-ray, the patient's surgery was postponed. Further examination on the patient revealed that the septum was a pleural junctional line. The surgery was administered uneventful.