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ABSTRACT: Addis et al. [5] described the epidemiology of appendicitis in the United States from 1970 to 1984. He reported that while overall incidence decreased, the highest incidence of appendicitis occurred in 10- to 19-y-olds. This study examines if the incidence of appendicitis and mean age of diagnosis has changed, and whether demographics are related to the frequency of admissions and incidence rate of acute appendicitis (AA).
Study questions were assessed using the Nationwide Inpatient Sample (NIS) discharge data and US Census data from 1993-2008. Operatively managed, uncomplicated, and complex cases of AA were included. Incidental appendectomy and right hemicolectomy were excluded. Descriptive, ANOVA, χ(2), and test of proportion statistics were used to evaluate frequency of admissions, incidence rate, and demographic changes in appendicitis.
The annual rate of AA increased from 7.62 to 9.38 per 10,000 between 1993 and 2008. The highest frequency of AA was found in the 10-19 y age group, however occurrence in this group decreased by 4.6%. Persons between ages 30 and 69 y old experienced an increase of AA by 6.3%. AA rates remained higher in males. Hispanics, Asians, and Native Americans saw a rise in the frequency of AA, while the frequencies among Whites and Blacks decreased.
While AA is most common in persons 10- to 19-y old, the mean age at diagnosis has increased over time. Minorities are experiencing an increase in the frequency of appendicitis. The changing demographics of the US plays a role in the current epidemiology of appendicitis, but is not solely responsible for the change observed.
Journal of Surgical Research 08/2011; 175(2):185-90. · 2.25 Impact Factor
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ABSTRACT: Laparoscopic appendectomy (LA) has become more acceptable for the treatment of appendicitis over the last decade; however, its cost benefit compared to open appendectomy (OA) remains under debate. The purpose of this study is to evaluate the utilization of LA and its cost effectiveness based on total hospital charges stratified by complexity of disease and complications compared to OA.
Nationwide Inpatient Sample data from 1998 to 2008 with the principal diagnosis of appendicitis were included. Appendicitis cases were divided by simple and complex (peritonitis or abscess) and subdivided by OA, LA, and lap converted to open (CONV). Total charges (2008 value), length of stay (LOS), and complications were assessed by disease presentation and operative approach.
Between 1998 and 2008, 1,561,518 (54.3%) OA, 1,231,643 (42.8%) LA, and 84,662 (2.9%) CONV appendectomies were performed. LA had shorter LOS (2 d) than OA (3 d) and CONV (5 d) (P<0.001). CONV (7.4%) cases had more complications than OA (3.7%) and LA (2.6%). LA ($19,978) and CONV ($28,103) are costlier than OA ($15,714) based on normalized cost for simple and complex diseases (P<0.001).
LA is more prevalent but its cost is higher in both simple and complex cases. Cost and complications increase if the case is converted to open. OA remains the most cost effective approach for patients with acute appendicitis.
Journal of Surgical Research 07/2011; 171(2):e161-8. · 2.25 Impact Factor
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ABSTRACT: Use of large allografts in the diaphyseal region can be complicated by nonunion of the host bone to the allograft. Increasing the contact area at this interface can help prevent this from happening. This study investigated the resulting contact area with use of end-cutting reamers to prepare the interface of host and allograft bone in the daiphyseal region, as compared with hand preparation using a sagittal saw. Using a sawbone model, it was demonstrated that the end-cutting reamers produced a significantly greater contact area, compared with hand-cutting techniques.
The Journal of Arthroplasty 11/2005; 20(7):939-40. · 2.38 Impact Factor
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ABSTRACT: Malignant glomus tumor (MGT) is a rare, recently described neoplasm that recapitulates the appearance of the modified smooth cells of the normal glomus body. We report a case of MGT of the hand of a 48-year-old woman. Magnetic resonance imaging (MRI) showed a 2.8-cm, well circumscribed, enhancing mass on the volar aspect of the thenar region of the right hand in immediate continuity with the ulnar artery and nerve. Computed tomography scan (CT-Scan) of the chest was normal. Histologic evaluation revealed a multilobular lesion with prominent branching capillary vasculature and perivascular arrangement of sheets of tumor cells. The tumor cells were round, relatively uniform in size with distinct cell borders and perinuclear cytoplasmic clearing. They were of intermediate to high nuclear grade and showed significant mitotic activity. A wide local excision with negative margins was performed. Multiple lung metastases were evident at 8-month follow-up. To date, forty-five cases of MGT of skin and soft issue have been reported in the literature. Twelve of the forty-five cases developed metastasis. In this report, we emphasize the differential diagnosis of MGT in the skin and deep soft tissue.
American Journal of Dermatopathology 11/2005; 27(5):428-31. · 1.20 Impact Factor
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ABSTRACT: The aim of the study was to obtain information regarding the prevalence, structure, student characteristics and outcomes of formal decelerated medical education programs. A 13-item survey was mailed to all US medical schools examining characteristics of decelerated curricular programs. Responses were received from 77 schools (62% response). Some 24 (31%) indicated a formal decelerated option; 13 (57%) decelerate the first year while four (17%) decelerate year 1 or year 2. Participants may be selected before matriculation or after difficulty in 14 (61%) programs while four (17%) select only after encountering difficulty. Students may unilaterally choose deceleration in 10 (43%); 4.3% (0.1-12) of total matriculants were decelerated. The proportion of decelerated students identified as underrepresented minority (URM) was 37% (0-100), representing 10.5% (0-43) of total URM enrollment. Twelve (52%) programs do not provide unique support beyond deceleration. Standards for advancement are identical for decelerated and regular students in 17 schools (81%). In total, 10% (0-100) of decelerated students were dismissed within the last five years, representing 24% (0-90) of all dismissals. Few schools provided grade point average (GPA) or Medical College Admissions Test (MCAT) data but the limited responses indicate that many decelerated students are at risk for academic difficulty. It is concluded that decelerated curricular options are available at a significant number of US medical schools. Decelerated students comprise a small proportion of total enrollment but URM matriculants represent a disproportionate share of participants. Decelerated programs appear to be successful as measured by dismissal rates if one accepts attrition which exceeds that for regular MD students. Variation in dismissal rates is difficult to interpret given the lack of GPA and MCAT data. One half of all programs offer no additional support activities beyond deceleration. More data are needed to determine the relative contribution of deceleration vs. other support measures to the advancement of students at academic risk.
Medical Teacher 10/2004; 26(6):510-3. · 1.22 Impact Factor
