Operative versus non-operative management in the care of patients with complicated appendicitis.

Background: The approach to complicated appendicitis is unclear. We have sought to determine factors which may persuade surgeons to non-operative management and whether such treatment affects outcome.

Methods: All adult patients admitted over a five-year period 2009-2014 with a diagnosis of appendicitis were reviewed.

Tumor necrosis factor-α in liver ischemia/reperfusion injury.

The pathophysiology of hepatic ischemia/reperfusion injury (IRI) includes a number of complex and diverse mechanisms involving interactions between hepatocytes, Kupffer cells, neutrophils, macrophages, sinusoidal endothelial cells, and platelets. Tumor Necrosis Factor-α (TNF-α), a cytokine produced by numerous cell types in response to inflammatory stimuli, is a well-known mediator during ischemia/reperfusion (IR) that plays a central role in injury to hepatocytes. TNF-α has a multifactorial effect in hepatic IRI because of the many interactions between TNF-α and reactive oxygen species, nitric oxide, adhesion molecules, and various cytokines and chemokines.