The obstacle of war
Théodore H MacDonald in 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 vermiform appendix
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
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.
Appendicitis
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Deviations from these commonly associated physical findings usually are related to the anatomic position of the inflamed appendix. The common anatomic locations of the appendix include: paracolic (the appendix lies in the right paracolic gutter lateral to the cecum), retrocecal (the appendix lies posterior to the cecum and may be partially or totally extraperitoneal), preileal (the appendix is anterior to the terminal ileum), postileal (the appendix is posterior to the ileum), promontoric (the tip of the appendix lies in the vicinity of the sacral promontory), pelvic (the tip of the appendix lies in or toward the pelvis), and subcecal (the appendix lies inferior to the cecum) [11]. Wakeley [12] performed a postmortem analysis of 10,000 cases and described the frequency of the location of the appendix as follows: retrocecal, 65.3%; pelvic, 31%; subcecal, 2.3%; preileal, 1%; and right paracolic and postileal, 0.4%. When the appendix occupies an unusual location the diagnosis of appendicitis can be more difficult and may contribute to delays in presentation, diagnosis, and treatment.
Cellulolytic bacteria in the large intestine of mammals
Published in Gut Microbes, 2022
Alicia Froidurot, Véronique Julliand
The large intestine of mammals (Figure 3) is a fermenter in which environmental conditions are favorable to microbial activity. It is the part of the digestive tract that follows the small intestine and begins at the cecum and includes the appendix (humans only), colon, rectum, and anus.32 The large intestine contains a minority of microorganisms that are able to degrade cellulose, including bacteria, and certain anaerobic eukaryotes (fungi and protozoa).16,33 In contrast, the abundance of microorganisms growing on soluble polysaccharides resulting from the “primary” cellulose degradation is high.16,34 In the present review, cellulolytic bacteria were focused. Despite their small quantity, cellulolytic bacteria play a crucial role, i.e., a “keystone” role, in this process, as their absence would, e.g., greatly decrease the degradation and utilization of an important substrate, thus affecting the remainder of the microbial community.33
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.
Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis
Published in Journal of Investigative Surgery, 2019
Ali Aygun, Burak Katipoglu, Melih Ïmamoglu, Selim Demir, Metin Yadigaroglu, Ozgur Tatli, Selim Yurtsever, Arif Usta, Ahmet Mentese, Suha Turkmen
Medical history, clinical presentation, and physical examination provide essential information for diagnosing AA.1 Today's surgeons also employ additional screening and imaging techniques prior to diagnosis because of the high rate of negative results obtained after laparotomy and the increase in malpractice cases filed by unhappy patients. In our study, although biochemical blood tests were performed on patients who had been admitted to the ED with right-lower quadrant abdominal pain and were suspected of AA, we employed an imaging method for our final diagnosis. Among the 42 patients who were diagnosed with AA and operated on given our clinical findings and radiological evaluations, three were found with normal appendix vermiformis tissue during postoperative histopathological evaluation. Therefore, AA may present with atypical clinical and physical manifestations, which means it cannot be diagnosed via increases in PTX3 levels or other infective parameter values alone. We recommend the use of additional imaging methods to achieve a final diagnosis of AA in patients presenting with right-lower quadrant abdominal pain, especially since, despite the availability of several diagnostic tests, laparotomy continues to produce negative results among patients pre-diagnosed with AA.
Related Knowledge Centers
- Abdomen
- Small Intestine
- Large Intestine
- Cecum
- Prenatal Development
- Vermiform
- Vestigiality
- Gut Microbiota
- Quadrants & Regions of Abdomen
- Iliac Fossa