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Introduction: Primary appendiceal adenocarcinoma is rare (less than 250 cases described in the literature). In this article a case of appendiceal carcinoma with peritoneal seeding is reported. Case: The patient is a 38 years old man presented with pain, tenderness and rebound in the lower quadrant of the abdomen. These findings suggested acute appendicitis. Emergency laparotomy showed inflamed appendix, without adhesion to the surrounding tissue or perforation. Appendectomy was performed. The histologic diagnosis revealed a moderately differentiated appendiceal adenocarcinoma. The tumour had infiltrated up to serouca of the appendix. The patient was reffered to oncology center but due to refusing of patient for further evaluation, six months later he was admitted with dyspnea, abdominal pain and prorusion. Clinical examination and diagnostic work ups showed massive exudative ascites. The patient was admitted to the oncology ward of Vali-e-Asr hospital with the diagnosis of appendiceal adenocarcinoma with peritoneal involvement. Conclusion: In case of acute appendicitis, the possibility of appendiceal adenocarcinoma should be considered

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Background: Nowadays, the use of inflammatory biomarkers in the diagnosis of appendicitis is on the rise. On the other hand, the role of oxygen free radicals in various inflammatory states has been verified. Noticing the high prevalence of negative appendectomy (9.3-22.2%), the aim of this study was to investigate the level of blood total antioxidant capacity (TAC) as a biomarker for early diagnosis of acute appendicitis. Materials and Methods: In this prospective analytical trial, over a one-year period, 407 patients, with preoperative diagnosis of acute appendicitis who had undergone operation, were studied. After measuring the TAC level, data were analyzed through the analytic ROC curve and parametric mean comparison tests. Results: Of all the patients, 298 were identified with appendicitis. TAC levels in adult female and male groups were respectively 663.9±164.75 and 752.58±167.37 µm/L which revealed a significant difference (p<0.0001). Also, in children, the mean of TAC level in perforated appendicitis sub-group was significantly greater than those in gangrenous and suppurative groups. Conclusion: TAC level can be used as a predictive factor for the diagnosis of perforated appendicitis in children however, it cannot be used as a biomarker for the diagnosis of appendicitis. Because of the significant difference existing between the level of TAC in male and female patients, further studies are suggested to investigate the level of inflammatory biomarkers with respect to menstrual cycle in women.

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Background: Diagnosis of acute appendicitis is one of the challenges that surgeons face in the emergency ward. Although Alvarado score has been recommended in the diagnosis of acute appendicitis, this criterion has some limitations in terms of age, sex, and race. The aim of this study was to evaluate the effectiveness of Alvarado score in the diagnosis of acute appendicitis based on the age and gender. Materials and Methods: In this cross-sectional study, 407 patients who underwent operation with the preoperative diagnosis of acute appendicitis from June 2008 to August 2009 were included in the study. The patients’ data were recorded by the investigators. The data were compared by parametric tests. The sensitivity and specificity were determined by the optimal cut-off point on ROC curve using MedCalc software version 10.2.0.0. Results: The optimal cut-off point for women was lower than men (6 and 7, respectively). The rate of negative appendectomy in the group with Alvarado scores 9 and 10 was 11.8%, while the negative appendectomy rate in the other two groups with Alvarado scores 7 and 8 and 5 and 6 were 29.9% and 52.8%, respectively. Conclusion: The diagnostic value of Alvarado score of 8 and less in physical examination is lower than the abdominal tenderness exam alone. Also, the cut-off point for the diagnosis of acute appendicitis in women should be considered lower than that in men. On the other hand, the cut-off point in adolescents and children is higher than adults.

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Background: Several studies have demonstrated that the levels of inflammatory markers in healthy women are under the influence of menstrual cycle changes. The aim of this study was to compare blood levels of inflammatory markers in women with appendicitis in different phases of menstrual cycle. Materials and Methods: In this case-control study, 70 female and 12 male patients with appendicitis, and 61 healthy women were enrolled based on inclusion and exclusion criteria. Inflammatory markers, such as leukocyte count, CRP, ESR, and TNF-α were measured and compared using student t-test and one-way ANOVA based on different phases of menstrual cycle. Results: There were no significant changes in the ESR, CRP, and TNF-α concentrations and the number of peripheral blood leukocytes in different phases of the menstrual cycle in women with appendicitis. The mean number of leukocytes and CRP concentrations were significantly higher in patients with appendicitis compared with the control group. Conclusion: The findings show that there are not significant differences in the inflammatory markers in women with appendicitis during the different phases of menstrual cycles. It seems that day to day variation of sexual hormones in the menstrual cycle have led to very different conclusions about the change of inflammatory markers in different phases of menstrual cycle. Therefore, studies investigating inflammatory markers in women with acute appendicitis based on day of menstrual cycle, time of sampling in the day, and severity of appendicitis are suggested.