Geriatric Acute Perforated Appendicitis
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A geriatric man was admitted to the hospital with left-sided chest pain and subsequently had a full cardiac evaluation by a cardiologist. The workup revealed no cardiac abnormalities, and the patient was discharged on the second hospital day. He returned within 48 hours for recurrence of the left-sided chest pain and the interval development of epigastric and left upper quadrant abdominal pain. He was admitted to the hospital for evaluation and serial examinations. Mild diffuse abdominal tenderness developed overnight, and computed tomography of the abdomen revealed a perforated appendix with suppuration. An appendectomy was done immediately. The diagnosis of appendicitis in the geriatric patient is occasionally difficult because of atypical and sometimes misleading physical findings.Keywords:
Epigastric pain
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Meat tenderness
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Steaks from 58 beef carcasses were used to determine the effects of antemortem injections of proteolytic enzyme in increasing tenderness and/or in reducing tenderness variability among bullock carcasses. Sensory panel ratings indicated that steaks from the carcasses of treated bullocks did not differ significantly from steaks from treated steer carcasses in tenderness or overall satisfaction, but were significantly more tender and satisfactory overall than steaks from untreated bullocks. Variation in tenderness scores within the group of steaks from treated bullocks was reduced to a level more nearly comparable to that of steaks from treated steers. Since antemortem injections of papain increased tenderness and reduced the variability in tenderness among steaks from bullock carcasses, such treatment could be used to more effectively merchandise beef from young bulls.
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Forty patients with tension headache and 40 healthy comparable control persons were palpated by the same "blinded" observer. Tenderness in 10 pericranial muscles on each side was rated on a four-point scale. A Total Tenderness Score was calculated for each individual by adding the scores from all palpated areas. Headache patients had significantly higher scores than controls and also significantly higher tenderness in each point separately. Median normal values and confidence limits for tenderness are given. Among 23 patients with daily headache a correlation was found between headache intensity and Total Tenderness Score. It is likely that the pathologic tenderness in patients with tension headache is the source of nociception, but pain mechanisms are more complex, as evidenced by discrepancy between tenderness and pain in some patients. Pathologic tenderness should be a contributing criterion to the diagnosis of tension headache (muscle contraction headache).
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The improvement in meat tenderness during post storage of carcasses were mainly caused by calpain. The main content of this paper were: the mechanism of tenderness of calpain,tenderness modeling of post mortem,effect of calcium chloride on the tenderness and influencing factor of calpain activity.
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This study was conducted to determine whether modification of early-postmortem muscle pH and(or) control of postmortem aging time could be used to improve tenderness of strip loin (longissimus, LM), top sirloin (GM), and top round (SM) steaks. Muscle pH, at 1.5 and 3 h postmortem, was modified using three 60-Hz electrical stimulation (ES) treatments (240 V, 35 V, or combined use of 240 and 35 V). Vacuum-packaged sections of the LM, GM, and SM were aged for 6, 12, 18, or 24 d postmortem. Use of ES increased rate of postmortem muscle pH decline and decreased shear force of LM steaks but had no effect on tenderness of GM or SM steaks. Reducing 3-h pH of the LM reduced variability in LM shear force but had little effect on tenderness of GM or SM steaks. However, lower values for 24-h pH of the LM were associated with increased tenderness of all three cuts. Tenderness of all cuts also improved as length of the postmortem aging period was increased. For LM and SM steaks, the greatest improvements in tenderness were achieved by 12 d; however, tenderness of GM steaks continued to increase up to 24 d postmortem.
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Longissimus muscle
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To evaluate the effect of hyoscine on pain and tenderness, rebound tenderness and appendicitis patients before surgery and this study can be considered as the first study investigated the efficacy of hyoscine on pain, tenderness, and rebound tenderness in patients with appendicitis.In this single-group, prospective interventional study (before-after) according to inclusion and exclusion criteria, 70 patients with pain in the right lower abdomen and typical symptoms of appendicitis were evaluated and after surgery, diagnostic accuracy was examined by pathologic results. The pain was evaluated before and after administration of hyoscine by numerical and verbal examination. Tenderness and rebound tenderness were also determined.The mean age of patients was 26.81±7.66. Totally, 42 patients (60%) had reduction in pain, 50 patients (71% percent) had reduction in tenderness, and 39 (55%) had reduction in rebound tenderness after treatment with the drug. A statistically significant reduction of pain and tenderness, rebound tenderness was observed in all of men after administration of hyoscine (p<0.001) but in women, the reduction of severity of tender results was only significant (p=0.002). Data analysis in women and men together showed the significant reduction of pain, tenderness, and rebound tenderness (p<0.001).According to the results, hyoscine can reduce pain, tenderness, and rebound tenderness. So, it seems that hyoscine is a good candidate for patients with appendicitis.IRCT2015111825123N1.
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SUMMARY As an introduction to a long‐term investigation of meat tenderness, seven series of comparisons were made between sensory and objective evaluations of the tenderness of roasted lamb rib‐loins. Using a tenderometer based on that of Volodkevich, high coefficients of correlation (0.68‐0.94) were found despite the occasional occurrence of large variations in tenderness within single muscles and the detection of slight panel fluctuation in three of the more prolonged series. Sensory assessment of tenderness was shown to be more nearly linearly related to either the reciprocal or the square root of shear force than to shear force itself.
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