Acute appendicitis remains one of the most common surgical emergencies worldwide; however, its presentation, diagnosis, and management in elderly patients differ considerably from those in younger populations. Elderly individuals frequently exhibit atypical clinical manifestations, delayed presentation, multiple comorbidities, and reduced physiological reserve, all of which contribute to higher rates of perforation, postoperative complications, prolonged hospitalization, and mortality. Advances in diagnostic imaging, minimally invasive surgery, perioperative care, and risk stratification have significantly improved outcomes in this population. The role of non-operative management with antibiotics remains controversial, particularly given concerns regarding recurrence, missed neoplasms, and delayed definitive treatment. This review examines current evidence regarding the treatment options and outcomes of acute appendicitis in the elderly. Emphasis is placed on the role of non-operative treatment and appendectomy in the management of acute appendicitis in the elderly. We will also look at the role of laparoscopic appendectomy in the management of acute appendicitis in the elderly. Understanding the unique characteristics of appendicitis in elderly patients is essential for improving diagnostic accuracy, reducing complications, and optimizing clinical outcomes.

Background: Angiomyolipoma (AML) is a benign mesenchymal neoplasm belonging to the family of perivascular epithelioid cell tumors (PEComas). While most AMLs arise in the kidney, extra-renal occurrences are exceptionally rare. Fat-poor variants may pose significant diagnostic challenges because of their resemblance to malignant mesenchymal neoplasms. Case Presentation: We report the case of a 58-year-old woman presenting with progressive abdominal enlargement. Imaging revealed a giant retroperitoneal mass measuring approximately 40 cm, radiologically suggestive of sarcoma. Preoperative biopsies yielded discordant diagnoses, including dedifferentiated liposarcoma and spindle-cell neoplasm with smooth muscle differentiation. Complete surgical excision was performed. Histological examination demonstrated a predominantly smooth muscle proliferation lacking atypia, necrosis, or increased mitotic activity. Extensive sampling identified focal mature adipose tissue and dysmorphic blood vessels. Immunohistochemistry showed positivity for smooth muscle actin, desmin, HMB-45, and Melan-A, confirming the diagnosis of fat-poor extra-renal retroperitoneal angiomyolipoma. Conclusion: Extra-renal angiomyolipoma is an uncommon benign neoplasm that may mimic retroperitoneal sarcoma clinically, radiologically, and histologically. Adequate sampling and appropriate immunohistochemical investigations are essential for accurate diagnosis and prevention of overtreatment.

Lennox–Gastaut syndrome (LGS) is a severe developmental epileptic encephalopathy that presents anesthetic challenges because of refractory epilepsy, multiple antiepileptic medications. We report the anesthetic management of a 7-year-old boy with LGS who underwent elective tracheostomy for progressive upper airway obstruction. Preoperative evaluation revealed micrognathia, retrognathia, and dynamic upper airway obstruction, suggesting a potentially difficult airway. Antiepileptic medications were continued throughout the perioperative period, and general anesthesia was induced after preoxygenation with a HFNC (high-flow nasal cannula). Tracheal intubation was successfully performed using a McGrath MAC video laryngoscope, and anesthesia was maintained uneventfully with sevoflurane and remifentanil without perioperative seizure-related or airway complications. The patient recovered without anesthetic complications. This case highlights the importance of careful perioperative planning, including appropriate seizure management and airway preparation, for the safe administration of general anesthesia in pediatric patients with LGS.

Low-grade oncocytic tumor (LOT) of the kidney has recently emerged as a distinct diagnostic entity among eosinophilic renal neoplasms. Due to its notably slow clinical progression and "mismatch" immunoprofile (CK7+/CD117-), LOT must be differentiated from renal oncocytoma and chromophobe renal cell carcinoma (chRCC). In this report, we discuss the case of a 69-year-old male patient who presented with a solid enhancing mass in the right kidney, clinically suspected to be renal cell carcinoma. A right radical nephrectomy was performed, and histological and immunohistochemical features were consistent with LOT.

Sinonasal metastases from prostatic adenocarcinoma are exceptional and may represent a major diagnostic challenge, particularly in the presence of neuroendocrine differentiation. Ethmoidal involvement is especially rare and may mimic a primary sinonasal malignancy clinically, radiologically, and histologically. We report the case of an elderly man presenting with sinonasal symptoms related to a destructive ethmoidal mass. Histopathological examination revealed an infiltrative malignant proliferation composed of irregular glandular structures associated with a focal neuroendocrine component arranged in solid nests and trabeculae. Tumor cells displayed enlarged nuclei with conspicuous nucleoli. Immunohistochemically, tumor cells were negative for CK7 and CK20, while Prostein expression supported a prostatic origin. Synaptophysin and chromogranin were positive within the neuroendocrine component. Subsequent prostate biopsies confirmed the diagnosis of prostatic adenocarcinoma with neuroendocrine differentiation. This case highlights the importance of integrating morphology, immunohistochemistry, and clinicoradiological findings when evaluating unusual sinonasal tumors. Metastatic prostate carcinoma should be considered in destructive sinonasal lesions occurring in elderly men, even in the absence of a known prostatic malignancy.

Antenatal care (ANC) is important care or attention given to a pregnant mother to ensure safety of the mother and child from time of conception to delivery. Antenatal care is the medical attention, monitoring, education, and support given to a pregnant woman from conception until the onset of labor. However, certain factors may hinder the smooth take up of the ANC. Therefore, barriers to antenatal booking are factors that delay or prevent pregnant women from registering for antenatal care (ANC), especially within the first trimester in rural areas. These barriers are usually interconnected. This study aimed to Assesse the Barriers to Early Antenatal Booking Among Women of Reproductive Age in Rural Areas of South-South, Nigeria. This was a cross-sectional study involving 250 pregnant women. Participants’ age is between 18 to 47 years. A well-structured questionnaire was administered to participants. The study lasted for a period of 3 months. Statistical analysis was done using SPSS version 25.0 and p < 0.05 was significant. The results revealed that 76% of the pregnant women are not aware that antenatal care should start in the first trimester of pregnancy, 72% are not aware that early antenatal booking helps detect pregnancy complication, 76% are prevented from early ANC booking due to cost, 68% is due to lack of money, 80% had low level of education, 80% prefer traditional birth attendants, poor roads, long waiting time, cultural belief, and permission from husband. The study revealed that educational and awareness barriers, sociocultural barriers, geographical and transportation barriers, socioeconomic barriers, health system–related barriers, psychosocial factors, pregnancy-related factors are major barriers to early ANC booking in rural areas.

We present the case of a 33 year old patient who has been followed since the age of 16 for autosomal dominant spondyloepiphyseal dysplasia (SED), in an evocative familial context (his sister has the same clinical picture). The disease began in adolescence with disabling mechanical pain in the hips and knees, with a walking distance limited to 500 metres. Clinical examination showed bilateral knee flexion contracture, generalised stiffness of the hips, shoulders, elbows, wrists and fingers, girdle muscle wasting, and a BMI of 16 (47 kg for 1.67 m). The patient walks with a cane. Symptomatic treatment combining analgesics, NSAIDs and physiotherapy was initiated. The article details the diagnostic arguments, indications for bilateral hip arthroplasty, anaesthetic precautions and the role of genetic counselling. Medium term outcome was favourable, with improvement in pain and walking distance after total hip replacement.