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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The vermiform (worm-shaped) appendix is a blind-ending tube varying in length (commonly 6–9 cm) which opens into the posteromedial wall of the caecum, where the taeniae coli converge. The appendix is an intraperitoneal structure and therefore has its own short mesentery, the mesoappendix. Within the mesentery lies the appendicular artery, a branch of the ileocolic artery which arises from the SMA.
The vermiform appendix
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The importance of the vermiform appendix in surgery results primarily from its propensity for inflammation, which results in the clinical syndrome known as acute appendicitis. Acute appendicitis is the most common cause of an ‘acute abdomen' in young adults and, as such, the associated symptoms and signs have become a paradigm for clinical teaching. Appendicitis is sufficiently common that appendicectomy (termed appendectomy in North America) is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Advances in modern radiographic imaging have improved diagnostic accuracy; however, the diagnosis of appendicitis remains essentially clinical, requiring a mixture of observation, clinical acumen and surgical science and as such it remains an enigmatic challenge and a reminder of the art of surgical diagnosis. Although much more uncommon, the appendix also has a propensity to the formation of tumours which, despite humble and innocuous beginnings, may disseminate widely with dramatic clinical consequences.
The obstacle of war
Published in Théodore H MacDonald, Removing the Barriers to Global Health Equity, 2018
One obvious way out of the fact that no amount of religious or philosophical quibbling seems to prevent wars, suggests that the tendency for organised group conflict is a sort of ‘relict psychological pattern’, that once in the distant past it had served some evolutionary advantage, but has since become not only useless, but an actual threat. There are many physiological and anatomical parallels with this, such as the possession of a vermiform appendix, which no longer serves a useful purpose to omnivorous humans. Clearly, as we have evolved, we have become much more efficient and technologically efficient in fighting one another and, at some point, war became of negative evolutionary value. The tipping point might have been the invention of gunpowder, or maybe even the invention of the crossbow. Nuclear warfare has made feasible the idea of war vanishing altogether, as have other destructive refinements such as bacteriological warfare.
The ‘worm’ in our brain. An anatomical, historical, and philological study on the vermis cerebelli
Published in Journal of the History of the Neurosciences, 2023
In their annotations to this translation, Kitchell and Resnick (1999) argued for a twofold worm: One “of vermiform shape … which to some degree resembles flesh,” equivalent to the choroid plexus of the third ventricle; the second one identified as “the vermiform object,” different from the former. For me, this reading is incorrect. First, the Latin text (and even the English one) does not allow any separation: vermiculare istud (“this vermiform object”) is still the same pars vermicularis formae (“a part of vermiform shape”), mentioned in the first line, as well as hoc corpus (“this body”), and is not a separate one. Second, Kitchell and Resnick translated pars vermicularis formae correctly as “part of vermiform shape” but added in footnote 882 the meaning of vermis as given by Fonahn in his dictionary (“the choroid plexus of the third cerebral ventricle,” 1922, No. 3555). Fonahn drew solely on the description of the vermis by Mondino, who wrote his Anothomia in 1316, and seemed to think that all worms must be identical. He did not consider Galen or other sources.
De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases
Published in Acta Chirurgica Belgica, 2022
Michail Chatzikonstantinou, Mohamed Toeima, Tao Ding, Almas Qazi, Niall Aston
Acute presentation of an incarcerated femoral hernia constitutes a surgical emergency. Incarceration and strangulation are more common in female patients aged 65 and over. Herniation of the vermiform appendix is not common and difficult to detect preoperatively. CT of the abdomen and pelvis is the most common investigation and the investigation of choice in clinical uncertainty. The procedure of a repair of a De Garengeot’s hernia varies, depending on the clinical expertise of the operating surgeon. There are various surgical approaches described in the literature. The majority of published cases underwent an open procedure via an inguinal or infra-inguinal incision. In case of difficulty accessing the base of the appendix a second incision had to be made. The intraoperative findings are in favor of acute appendicitis, and, thus, the hernia was repaired with sutures. The surgical incision is based upon the surgeon’s preference and experience.
Brief Commentary on the Article “Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis”
Published in Journal of Investigative Surgery, 2019
Appendicitis has always remained the major subgroup among patients suspected of acute abdomen in emergency departments all over the world. Due to the potential catastrophic events that might ensue if left unattended, surgical removal of the vermiform appendix is the ideal treatment in a case of diagnosed appendicitis. However, there are a large number of clinical conditions which can mimic the clinical features of acute appendicitis, especially in the paediatric population. To diagnose a case of acute abdomen as appendicitis requires astute clinical examination skills as well as an array of investigations in the form of blood counts and imaging modalities like Ultrasonography and Computed Tomography(CT). In spite of all the preoperative investigations, a significant percentage of people(as high as 10%) who undergo emergency appendicectomy still turn up negative histology.1 Also, the adverse effects associated with CT scan preclude its routine prescription in all suspected cases, especially in the younger population. Over the years, clinicians have been on the hunt for the right blood marker that can differentiate a case of acute appendicitis from other causes of acute abdomen which don't mandate surgical treatment.