Schwartz: Apendicele ...mic dar rau, prosti dar multi

"The relationship of the base of the appendix to the cecum remains constant, whereas the tip can be found in a retrocecal, pelvic, subcecal, preileal, or right pericolic position."
"Relatia de baza apendice-cec ramane constanta , desi exista tipuri de apendice cu situare retrocecala, pelvica, subcecala, preileala sau pozitie dreapta preicolica (pozitie inalta cecala)." (pg. 1381)

"The three taenia coli converge at the junction of the cecum with the appendix and can be a useful landmark to identify the appendix. The appendix can vary in length from less than 1 to greater than 30 cm;"
"A treia tenie colica converge spre jonctiunea cecoapendiculara si poate fi folosita ca punct de identificare a apendicelui. Apendicele poate varia ca lungime de la 1-30 cm;" (pg. 1381)


"Multi ani apendicele a fost considerat ca un organ rudimentar cu functie necunoscuta." ... sunt convinsa ca s-au adunat toti medicii si au zis hai sa consideram ca apendicele are functie necunoscuta!

"Although the first successful appendectomy was reported in 1736, it was not until 1886 that Reginald Fitz helped establish the role of surgical removal of the inflamed appendix as curative therapy for this disease, which was once thought to be fatal."
"Desi prima apendicectomie a fost datata in 1736, a trebuit sa treaca o vreme pana cand, in 1886, Reiginald Fitz a stabilit rolul indepartarii chirurgicale a apendicelui inflamat ca tratament al bolii, care nu o data s-a dovedit a fi fatal." (pg 1381) etc...asta e un adevar care trebuie recunoscut...multe tratamente se dovedesc a fi fatale :P

"A decline from 100 cases per 100,000 population to 52 cases per 100,000 population was demonstrated over a study period from 1975 to 1991. This degree of change does not seem to be explained by improved diagnosis, and the explanation for this phenomenon remains elusive."
"O scadere de la 100 de cazuri la 100000 de indivizi, la 52 de cazuri la 100 de indivizi a fost demonstrata printru-un studiu efectuat in perioada 1975-1991. Aceasta scadere nu pare a fi explicata prin cresterea ratei diagnosticarii bolii, explicarea fenomenului ramanand incerta." (pg. 1381) ... cresterea ratei diagnosticarii unei boli nu poate decat sa duca la cresterea incidentei ( prin cresterea numarului de cazuri raportate)...deci ce zic ei aici e complet stupid...din engleza se intelege ca e vorba de imbunatatirea diagnosticului, adica in prezent diagnosticul are acuratete mai mare, deci vor fi mai putine diagnositce false de apendicita...

"The rate of normal appendectomy averages 16 percent, with females comprising 68 percent of those patients found to have a normal appendix at exploration."
...si poetul continua: "Rata apendicectomiilor normale, in medie de 16%, din care un procent de 68% sunt de sex feminin, a depistat prezenta unui apendice normal la explorare." (pg. 1381)... ce misto ca 68% din apendicetocmiile normale sunt de sex feminin si a demonstrat un apendice normal la explorare...

"Obstruction of the lumen is the dominant causal factor in acute appendicitis. Fecaliths are the usual cause of appendiceal obstruction. Less common are hypertrophy of lymphoid tissue; inspissated barium from previous x-ray studies; vegetable and fruit seeds; and intestinal worms, particularly ascarids."
"Cauze de obstructie mai putin comune sunt: hipertrofia tesutului limfoid, bariul neeliminat in urma explorarilor radiologice ale tractului digestiv, samburii de fructe si legume, viermii intestinali, in special ascarizi." (pg. 1381) ... cand am facut eu apendicita cred ca samburii de la morcovii pe care ii mancasem au fost de vina ...

"The probable sequence of events following occlusion of the lumen is as follows. A closed-loop obstruction is produced by the proximal block, and continuing normal secretion of the appendiceal mucosa rapidly produces distention."
"Succesiunea probabila a evenimentelor ce au drept consecinta obstructia lumenului este prezentata in continuare. Obstructia se produce prin blocarea proximala cu continuarea secretiei normale a mucoasei apendiculare, care produce o distensie rapida a apendicelui. " (pg 1382) :)))))

"The human being is one of the few animals with an appendix capable of secreting at pressures high enough to lead to gangrene and perforation."
"Fiinta umana este una dintre cele cateva vietuitoare cu un apendice capabil de a secreta, la presiuni crescute, suficient pentru a determina fenomene de gangrena si perforatie apendiculara." (pg. 1382)

"Distention stimulates nerve endings of visceral afferent pain fibers, producing vague, dull, diffuse pain in the midabdomen or lower epigastrium. Peristalsis is also stimulated by the rather sudden distention, so that some cramping may be superimposed on the visceral pain early in the course of appendicitis."
"Distensia stimuleaza terminatiile nervoase viscerale aferente fibrelor senzitive producand dureri vagi, surde si difuze in etajul abdominal mediu si in epigastrul inferior (hipogastru). Peristaltismul este stimulat prin distensie brusca, asa cum crampele pot accentua durerea viscerala initiala in cursul apendicitei." (pg. 1382) ... nu stiu ce scoala de medicina a facut cine a tradus, dar epigastrul inferior nu este hipogastru ci e doar partea inferioara a epigastrului... si cum stim cu totii durerea in apendicita debuteaza in epigastru si/sau periomblical iar apoi se localizeaza in fosa iliaca dreapta.

"As progressive distention encroaches on the arteriolar pressure, the area with the poorest blood supply suffers most: ellipsoidal infarcts develop in the antimesenteric border. As distention, bacterial invasion, compromise of vascular supply, and infarction progress, perforation occurs, usually through one of the infarcted areas on the antimesenteric border."
"Prin distensie progresiva ce influenteaza presiunea arteriolara, aria cu aport sanguin redus sufera cele mai multe modificari- infarcte elipsoidale dezvoltate pe marginea antimezenterica. Datorita distensiei, invaziei bacteriene, compromiterii aportului vascular, si infarctelor progresive, perforatia intereseaza de obicei una dintre ariile infarctizate la nivelul marginii antimezenterice." (pg. 1382)

"Abdominal pain is the prime symptom of acute appendicitis."
"Durerea abdominala este primul simptom in apendicita acuta. " (pg. 1832)
... este important de mentionat ca putin mai jos pe pagina se poate citi: "Succesiunea aparitiei simptomelor are o mare semnificatie in stabilirea diagnosticului diferential. La peste 95% dintre pacientii cu apendicita acuta, anorexia este primul simptom, urmat de durere abdominala si voma (in cazul in care aceasta apare)."

"Most patients give a history of obstipation from before the onset of abdominal pain, and many feel that defecation would relieve their abdominal pain."
"Majoritatea pacientilor au un istoric de constipatie anterior durerii abdominale, multi simtind defecatia ca o usurare a durerii abdominale." (pg. 1382) ...

"Physical findings are determined principally by the anatomic position of the inflamed appendix as well as by whether the organ has already ruptured when the patient is first examined."
"Investigatiile medicale sunt determinate in principal de pozitia anatomica a apendicelui inflamat, la fel de bine ca in cazul in care organul s-a perforat la prima examinare a pacientului. " (pg 1382)

"Patients with appendicitis usually prefer to lie supine, with the thighs, particularly the right thigh, drawn up, because any motion increases pain."
"Pacientii cu apendicita prefera pozitia in supinatie cu piciorul drept flectat, deocarece orice alta miscare la accentueaza durerea. " (pg. 1382) ...super tare imginea asta cu piciorul flectat... tot e bine ca nu au halucele flectat... iar "pozitia in supinatie" putea fi inlocuita cu decubit dorsal, ca poate cine citeste pricepe ca pacientul sta cu piciorul drept in supinatie si flectat :)

"The classic right lower quadrant physical signs are present when the inflamed appendix lies in the anterior position."
"Semnele fizice la nivelul fosei iliace drepte sunt prezente in cazul in care pozitia apendicelui inflamat este anterioara." (pg. 1382)

"Tenderness is often maximal at or near the point described by McBurney as being “located exactly between an inch and a half and two inches from the anterior spinous process of the ileum on a straight line drawn from that process to the umbilicus.” Direct rebound tenderness is usually present, and referred or indirect rebound tenderness is frequently present, and the tenderness is felt maximally in the right lower quadrant, indicating peritoneal irritation."
"Sensibilitatea abdominala este maxima in punctul McBurney localizat la intersectia treimii externe cu cele doua treimi interne ale liniei ce uneste spina iliaca antero-superioara dreapta cu ombilicul. Apararea musculara la durere este prezenta atat direct cat si indirect, sensibilitatea dureroasa maxima localizata la nivelul fosei iliace drepte indicand iritatie peritoneala. " (pg. 1382)... daca traducatorul a vrut sa precizeze ca punctul McBurney se afla la unirea a 1/3 laterale cu 2/3 mediale pe linia care uneste spina il antero sup cu ombilicul, lucru foarte bun dealtfel, nu a putut sa treaca asta la nota editorului?

"Muscular resistance to palpation of the abdominal wall roughly parallels the severity of the inflammatory process. Early in the disease, resistance, if present, consists mainly of voluntary guarding. As peritoneal irritation progresses, muscle spasm increases and becomes largely involuntary—true reflex rigidity as opposed to voluntary guarding."
"Rezistenta musculara la palparea peretelui abdominal creste paralel cu severitatea procesului inflamator. In faza precoce a bolii, rezistenta abdominala, daca este prezenta, se manifesta sub forma apararii musculare voluntare. Daca iritatia peritoneala progreseaza, spasmul muscular creste si devine involuntar ( o adevarata rigiditate reflexa care se opune contractiei voluntare)." (pg. 1383)

"With a retrocecal appendix, the anterior abdominal findings are less striking, and tenderness may be most marked in the flank."
"In apendicele situat retrocecal, semnele de la nivelul peretelui abdominal, anterior sunt mai putin acute, sensibilitatea fiind mai accentuata pe flancuri. " (pg. 1383)

"The test is performed by having patients lie on their left side; the examiner then slowly extends the right thigh, thus stretching the iliopsoas muscle."
"Testul se realizeaza prin pozitionarea pacientului in decubit lateral stang; examinatorul extinde incet membrul pelvin drept al pacientului, aceasta determinand extensia muschiului iliopsoas." (pg. 1383)

"Laboratory Findings"
"Analiza de laborator" (subtitlu pg. 1383)

" A chest x-ray is sometimes indicated to rule out referred pain from a right lower lobe pneumonic process."
"Radiografia toracica este uneori indicata pentru excluderea unui proces pneumonic localizat la nivelul lobului pulmonar inferior drept, care ar putea cauza durerea." (pg. 1383)

"A scan is considered positive if a noncompressible appendix 6 mm or greater in the anteroposterior direction is demonstrated."
"Testul este considerat pozitiv daca diametrul anteroposterior al apendicelui necomprimat este de 6 mm sau mai mult. " (pg. 1383)

"Sonography has definite limitations and results are user-dependent."
"Ecografia are o serie de limite nete si rezultatele sunt dependente de experienta celui care o efectueaza." (pg. 1383)

"or if the appendix is perforated and therefore compressible."
"sau in caz de perforatie apendiculara cand este comprimat." (pg. 1383)

"Laparoscopy is probably most useful for the evaluation of females with lower abdominal complaints, since appendectomy is performed on a normal appendix in as many as 30 to 40 percent of such patients."
"Ea e probabil mai utila in evaluarea femeilor cu dureri abdominale inferioare, din momentul in care apendictectomiile practicate pe apendici normali au depasit 30-40%" (pg. 1383)

"This is because clinical manifestations are not specific for a given disease but are specific for disturbance of a physiologic function or functions."
"aceasta deoarece manifestarile clinice nu sunt specifice pentru boala data, dar sunt specifice pentru perturbarile fiziologice si functionale." (pg. 1383)

"Accuracy of preoperative diagnosis should be about 85 percent.If it is consistently less, some unnecessary operations are probably being done, and a more rigorous preoperative differential diagnosis is in order."
"Acuratetea diagnosticului preoperator ar putea fi in jur de 85%. Daca este semnificativ mai redusa e binevenit un diagnostic preoperator mai riguros." (pg. 1384)

"The Haller group has shown, however, that this is not invariably true."
"Haller si colaboratorii au demonstrat valabilitatea acestei teorii. " (pg. 1384) ... chestie care te face sa te intrebi cum au ajuns la concluzia asta avand in vedere rezultatele studiului lor...

"There are a few conditions in which operation is contraindicated, but in general the disease processes that are confused with appendicitis are also surgical problems or, if not, are not made worse by surgical intervention. The more frequent error is to make a preoperative diagnosis of acute appendicitis only to find some other condition (or nothing) at operation; much less frequently, acute appendicitis is found after a preoperative diagnosis of another condition. The most common erroneous preoperative diagnoses—accounting for more than 75 percent—in descending order of frequency are acute mesenteric lymphadenitis, no organic pathologic condition, acute pelvic inflammatory disease, twisted ovarian cyst or ruptured graafian follicle, and acute gastroenteritis."
"Exista cateva situatii in care operatia este contraindicata, dar, in general, afectiunile care sunt confundate cu apendicita sunt chirurgicale, sau daca nu, totusi nu este gresit sa intervenim chirurgical. Cea mai frecventa confuzie este de a stabili diagnosticul preoperator de apendicita acuta doar pe baza catorva factori sau in absenta acestora si de a interveni chirurgical. Mult mai putin frecvent exista alte cauze ce stabilesc diagnosticul preoperator de apendicita acuta. Cel mai comun diagnostic preoperator eronat (peste 75% din cazuri) este limfadenita acuta mezenterica fara prezenta unei leziuni organice, urmat in ordinea descrescatoare a frecventei de boala inflamatorie acuta pelvina, chistul ovarian bilateral, ruptura foliculului Graff si gastroenterita acuta." (pg. 1385)

"Observation for several hours is in order if the diagnosis of mesenteric adenitis seems likely, since mesenteric adenitis is a self-limited disease, but if the differentiation remains in doubt, immediate operation is the only safe course."
"Supravegherea pacientului timp de cateva ore este binevenita, daca diagnosticul pare a fi de adenita mezenterica, deoarece este o afectiune autolimitata, dar daca avem indoieli in privinta diagnosticului, este de preferat a se interveni chirurgical de urgenta, aceasta fiind singura cale de salvare a pacientului." (pg. 1385)

"Typhoid fever is now a rare disease. This probably accounts for the frequency of missed diagnosis—it is rarely seen and rarely thought of."
"Febra tifoida este o afectiune rara in prezent, probabil, ca urmare a erorilor de diagnostic- boala putin studiata si rar intalnita. " (pg. 1385)

"Meckel's Diverticulitis"
"Diverticulul Meckel" (subtitlu pg.1385)

"Preoperative differentiation is academic and unnecessary"
"Diagnosticul preoperator este teoretic si inutil" (pg. 1385) ... putea fi gasita o exprimare mai buna...cred...

"Diarrhea and the infrequency of anorexia, nausea, and vomiting favor a diagnosis of enteritis"
"Diareea si starile anorexice, greata si voma, fara a fi frecvente, favorizeaza sustinerea diagnosticului de enterita" (pg. 1385)

"In an appreciable percentage of patients with chronic regional enteritis, the diagnosis has been first made at the time of operation for presumed acute appendicitis. Acute ileitis should be distinguished from Crohn's disease."
"Intr-un procent apreciabil de pacienti cu enterite cronice regionale, diagnosticul s-a stabilit intraoperator, intervenindu-se pentru suspiciunea de apendicita acuta. Ileitele acute ar putea fi diferentiate de boala Crohn." (pg. 1385)

"Perforated peptic ulcer closely simulates appendicitis..."
"Ulcerul peptic perforat inchis simuleaza apendicita..." (pg. 1385) ---- asta cu ulcerul perforat inchis a fost in grile la rez

"Extensive diagnostic studies in an attempt to make a preoperative differentiation are not warranted."
"Studii diagnostice extinse ca durata , in incercarea de realizare a diagnosticului preoperator, nu ofera nici o garantie in acest sens." (pg. 1385)

"Epiploic appendagitis probably results from infarction of the appendage(s) secondary to torsion."
" Ciucurii epiploicii rezulta probabil din infarctizarea acestora secundar torsiunii." (pg. 1385)
...ar fi tare o intrebare de genul "din ce rezulta ciucurii epiploici?"...

"Localized tenderness over the site is usual and is often marked on rebound but without rigidity." ... adica carevasazica Bloomberg pozitiv, fara abdomen de lemn
"Apararea locala este obisnuita si deseori marcata de o rezistenta abdominala, dar fara rigiditate. " (pg. 1386) ... aaaaaaaaaaaaaaaa!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

"Human infection with Yersinia enterocolitica or Y. pseudotuberculosis is probably transmitted through food contaminated by feces or urine."
"Infectia cu Yersinia enterocolitica sau Yersinia pseudotuberculosis este transmisa prin alimente contaminate, urina si fecale infectate." (pg. 1386)

"Not uncommonly, ovulation results in the spill of sufficient blood and follicular fluid to produce brief, mild lower abdominal pain."
"Ovulatia se asociaza cu revarsarea de sange si lichid folicular si determina o durere in etajul abdominal inferior de durata si intensitate redusa." ...cartile se fac din carti zicea cineva... si, desi sunt cam rea, nu pot sa nu ma intreb "licenta poetica" atat de des uilizata de acest traducator (despre care am putea crede ca e medic-vezi McBurney-) o fi o deformatie"profesionala"?

"Since this pain occurs at the midpoint of the menstrual cycle, it is often called mittelschmerz."
"Cand aceasta durere apare la jumatatea ciclului menstrual se numeste mittelschmertz." (pag. 1386)... pana la urma poate nu o fi medic, ca nu vad cum un medic ar putea da de inteles ca durerea cauzata de ruptura foliculului de Graff ar putea sa apara altcandva decat la jumatatea ciclului (ciclurile patologice neregulate sunt de regula anovulatorii).

"Diseases not mentioned in the previous sections that occur in patients of all ages and both sexes and that must be considered in the differential diagnosis of appendicitis are foreign body perforations of the bowel; closed-loop intestinal obstruction;..."
"Bolile care nu au fost mentionate mai sus, care intereseaza pacientii indiferent de varsta si sex si care trebuie luate in considerare in diagnosticul diferential al apendicitei acute sunt diferite de perforatiile intestinale: sindromul ocluziv intestinal, ...." (pg. 1386)

"Stabilirea diagnosticului de apendicita acuta la tineri este chiar mai dificil decat la adulti." (pg. 1386)...iar tinerii despre care e vorba este mai degraba copii...dar se intelege mai jos cand zice " incapacitatea de a obtine o anamneza corecta, pe baza datelor rezultate de la ambii parinti si medici, si frecventa crescuta a afectiunilor gastrointestinale in copilarie sunt factori care contribuie la dificultatea stabilirii unui diagnostic corect" Iata si cum este aceasta fraza in engleza: "The inability of young children to give an accurate history, diagnostic delays by both parents and physicians, and the frequency of gastrointestinal upset in children are all contributing factors." ...

"As fetal gestation progresses, the diagnosis of appendicitis becomes more difficult as the appendix is displaced laterally and superiorly."
"Pe masura dezvoltarii sarcinii, diagnosticul apendicitei devine mai dificil daca apendicele e plasat lateral si superior."

"Abdominal pain and tenderness will be present, although rebound and guarding are less frequent due to laxity of the abdominal wall. Elevation of the white blood cell count above the normal pregnancy levels of 15,000 to 20,000/mm 3 with a predominance of polymorphonuclea cells is usually present."
"Durerea abdominala si apararea musculara sunt prezente desi rezistenta abdominala este mai putin frecventa datorita laxitatii peretelui muscular. Cresterea leucocitelor este normala in sarcina pana la valori de 15.000-20.000/mm3 cu o predominenta a polimorfonuclearelor." (pg. 1387) ... din cate stiu eu rezistenta abdominala se poate manifesta ca aparare musculara sau contractura, in fuctie de intensitatea iritati peritoneale (iar cand apare rigiditatea, ca parca zicea mai sus... pacientul nu prea mai are nevoie de chirurg...)...oricum, ce zice unul, ce traduce celalalt... daca tot Schwartul in romana e asa cred ca nu ar trebui sa se mai numeasca Schwartz...

"Although the clinical presentation of appendicitis in patients who have AIDS or are HIV-positive does not differ significantly from patients without AIDS or HIV infection, the leukocytosis usually noted in acute appendicitis may not be present."
"Tabloul clinic al apendicitei la pacientii cu SIDA sau infectati HIV nu difera semnificativ de cel al apendicitei la persoanele sanatoase, cu exceptia leucocitozei care poatre lipsi in primul caz." (pg. 1387) 1. leucocitoza nu e parte a tabloului clinic ci paraclinic 2. e interesant ca o persoana sanatoasa poate avea simptome de apendicita

"O data luata decizia operatorie..." si putin mai jos "O data identificat apendicele..." (pg. 1387)

"For more severe infection..."
"Pentru cele mai severe infectii..." (pg. 1387)

"The mucosa is frequently obliterated to avoid the development of a mucocele."
"Mucoasa este frecvent afectata de procesul inflamator, dezvoltand un mucocel." (pg. 1387)

"The peritoneal cavity is irrigated and the wound closed in layers."
"Cavitatea peritoneala este inundata iar, prin mecanisme de aparare locala, procesul patologic este blocat." (pg. 1387) :))))))))))))))))))))))))))))))))))))) ...si se si potriveste in text ca nuca in perete...

"If appendicitis is not found, a methodical search for an alternative diagnosis must be performed."
"Daca nu se depisteaza apendicita, trebuie efectuata o investigatie metodica a organismului pentru depistarea unui alt diagnostic." (pg. 1387) ... chiar se poate sa investighezi metodic organismul in timpul unei laparotomii...?

"Peritoneal fluid should be sent for Gram's stain and culture."
"Lichidul peritoneal ar trebui trimis pentru lame si insamantari pe medii de cultura pentru germeni Grami." (pg. 1388) ... culturi pt germeni Grami/Gram :)))))))))))))))))

"For properly trained personnel, laparoscopic appendectomy may be appropriate for most cases of appendicitis, with a conversion rate of approximately 10 percent, mostly in patients with ruptured appendices."
"Pentru antrenamentul personal apendicectomia laparoscopica poate fi facuta in cele mai multe cazuri de apendicita, cu o rata de conversie de 10% la pacientii cu perforatii apendiculare." (pg. 1388) :/ :| :| :|

"The mesoappendix is divided with a stapling device or by using electrocautery for dissection and clips or a ligating loop to secure the appendiceal artery. Division of the mesoappendix
should be done as close to the appendix as possible."
"Mezoapendicele este sectionat cu pensa in carlig (Hook) sau folosind electrocauterul pentru disectie si clipuri sau ligatura in bucla pentru protectia arterei apendiculare. Sectionarea mezoapendicelui ar trebui facuta ca o inchidere a apendicelui pe cat posibil. " (pg. 1389) ... sa-ntelegem de aici ca e medic?

"Intestinal obstruction, initially paralytic but sometimes progressing to mechanical obstruction, may occur with slowly resolving peritonitis with loculated abscesses and exuberant adhesion formation."
"Ocluzia intestinala, initial paralitica, uneori progresand spre obstructie mecanica, poate induce cu usurinta o peritonita cu abcese loculare sau formare de aderente." (pg. 1390)