In addition we also found that the noncastrated

In addition, we also found that the noncastrated male rats with cirrhosis of the liver showed a significant decrease in mortality (63.0% vs. 33.3%) following the immune-enhancing diet. A slightly lower mortality in nonoophorectomized female rats with a cirrhotic liver was found after feeding them with an immune-enhancing diet (69.6% vs. 52.1%). Castrated male rats with a cirrhotic liver showed a similar mortality (75%) following an immune-enhancing diet, and cirrhotic oophorectomized female rats showed significantly lower mortality after an immune-enhancing diet (87.5% vs. 55%). Immunonutrition was more beneficial for male rats than female rats with a cirrhotic liver following sepsis. Although orchiectomy was not found to be more advantageous for the normal male rats in sepsis, immunonutrition seemed to be as important as sex hormones for female rats in sepsis.
Conclusion
Introduction Appendiceal diverticulosis is a rare disease and a diagnosis of the disease is easily missed. Only one case has been reported in Taiwan. The clinical presentations of acute appendicitis and appendiceal diverticulum disease are extremely similar; however, a number of differences can be observed. Most cases of appendiceal diverticular disease are incidentally identified during an operation or pathological examination. Diagnosing appendiceal diverticulosis preoperatively is difficult. In this retrospective study, we present 10 cases of appendiceal diverticulosis. We analyzed the clinical features, laboratory data, and pathological findings of each case. We also compared the clinical manifestations of typical acute appendicitis and appendiceal diverticulitis to help identify the differences.
Materials and methods We retrospectively reviewed the medical records of patients who had undergone an appendectomy at a local hospital (Ton Yen General Hospital, Taiwan) from June 2004 to May 2012. Ten patients with appendiceal diverticulosis were documented. The clinical presentations were recorded and included pain location, duration, the number of admissions before the operation, and days of hospitalization. The patients\' imaging data, whether they had a preoperative fever, and laboratory data were reviewed. The laboratory data included a white blood cell count, neutrophil percentage, and C-reactive protein (CRP) level. For the pathological examination, two transverse sections of the proximal cut end, the middle portion, and one longitudinal section of the tip of the gli protein (including the distal portion) were obtained as the standard sampling procedure. When one protruding pouch was detected, additional transverse sections were taken. Fig. 1 is a photograph of one patient\'s appendiceal diverticula. The appendiceal diverticula were microscopically categorized as congenital or acquired diverticula.
Results In our hospital (TYGH), the incidence of appendiceal diverticulosis was 0.88% (10/1131) in the appendectomy specimens. The patients consisted of eight men and two women. The mean age of the patients was 39.2 years and ranged from 22 years to 71 years. Tables 1 and 2 list the patients\' clinical presentation and laboratory data, respectively. The patients\' white blood cell (WBC) count ranged from 9860 /μL to 23,790/μL. The neutrophil percentages ranged between 60% and 85%. The C-reactive protein (CRP) values ranged from 0.02 mg/dL to 17.86 mg/dL. The duration of hospitalization ranged from 2 days to 6 days. Three patients developed a preoperative fever (i.e., a body temperature of 38°C or greater). All patients who experienced a fever had perforated diverticulitis. One patient (Case 9) who presented with a normal appendix and diverticulum had a high CRP level; however, his WBC count was not elevated and he did not develop a fever. In the 10 appendices, all diverticula were acquired without the muscularis propria. Eight patients (Cases 1–7 and 9) presented with acute appendicitis and diverticulitis. The diverticular lumens contained mucus, pus, or fecaliths. Three patients (Cases 2, 6, and 7) exhibited dilated appendiceal lumens that were filled with mucus (i.e., mucoceles). Five appendiceal lumens contained feces, and five contained pus. In the inflammatory foci, the mucosa showed reactive epithelial proliferation with pseudostratification of epithelial cells, increased mitotic activity, and distortion of the glandular architecture. Patients 1 and 9 presented with marked inflammation, epithelial regenerative atypia, and small foci of adenomatous change with mild dysplasia. Patient 8 had a normal appendix with mild periappendicitis and a single noninflamed diverticulum with an undilated appendiceal cavity. This diverticulum contained a fecalith and was located in the middle portion of the appendix. There was a small focus containing a hyperplastic polyp over the appendiceal mucosa; it measured 1 mm. Patient 10 had a normal appendix and acute diverticulitis in one of two diverticula. A fecalith in the appendiceal lumen and adipocyte infiltration in the appendiceal submucosa were also present. Perforation occurred in 70% (7/10) of the patients. The patients with multiple diverticula had higher perforation rates than patients with a single diverticulum (75% [6/8] patients vs. 50% [1/2] patients). The perforation rate however was not correlated with the diverticular size. Table 3 lists the pathological findings of the 10 patients.