<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1405-0099</journal-id>
<journal-title><![CDATA[Cirujano general]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. gen]]></abbrev-journal-title>
<issn>1405-0099</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Cirugía General A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1405-00992016000300149</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Errores en el diagnóstico de apendicitis aguda en ancianos. Estudio de un caso clínico y revisión de la literatura]]></article-title>
<article-title xml:lang="en"><![CDATA[Diagnostic errors in acute appendicitis in the elderly. Study of a clinical case and revision of the literature]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Herrera Chabert]]></surname>
<given-names><![CDATA[Leopoldo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Joffe Fraind]]></surname>
<given-names><![CDATA[Jacobo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Llamas Prieto]]></surname>
<given-names><![CDATA[Luis Enrique]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital San Javier Departamento de Gastrocirugía ]]></institution>
<addr-line><![CDATA[Guadalajara Jalisco]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2016</year>
</pub-date>
<volume>38</volume>
<numero>3</numero>
<fpage>149</fpage>
<lpage>157</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S1405-00992016000300149&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S1405-00992016000300149&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S1405-00992016000300149&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción: Por más de seis décadas, la apendicitis aguda en pacientes longevos continúa teniendo errores diagnósticos, lo que resulta en la demora de un diagnóstico oportuno y un retraso en la cirugía. La apendicitis del anciano se caracteriza por un retardo en el diagnóstico y tratamiento de índole multifactorial. El hallazgo habitual durante la cirugía es un apéndice perforado con peritonitis regional o generalizada. La muerte en estos individuos es secundaria a sepsis abdominal por siembra bacteriana de origen intestinal. El curso postoperatorio en un anciano con un proceso inflamatorio mínimo en el apéndice cecal, como el que se describe, es habitualmente benigno al controlarse oportunamente la contaminación peritoneal. Si una comorbilidad no interviene en el postoperatorio, el egreso hospitalario es rápido.  Caso clínico:  En el caso que se presenta, el apéndice tuvo un aspecto normal, como se muestra en la fotografía. Nosotros decidimos resecarlo por ausencia de otras anormalidades en la cavidad abdominal. En el estudio histopatológico se describieron cambios inflamatorios confinados a mucosa y submucosa. No hubo perforación. Estas modificaciones pudieron ser secundarias a una severa hipoperfusión por el estado de la mujer.  Conclusiones:  Resulta peligroso concluir que &#8220;aunque macroscópicamente se aprecie normal el apéndice cecal en sujetos longevos, sería muy razonable extirparlo&#8221; para evitar un desenlace como el del caso que se presenta.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction: For more than six decades, acute appendicitis in the aged remains a difficult diagnosis that results in a delay in an appropriate treatment. Appendicitis in the elderly is characterized by a delay in the diagnosis and treatment of multifactorial nature. The usual finding during surgery is an appendix with regional or widespread peritonitis. Death in these patients is secondary to abdominal sepsis by bacterial seeding of intestinal origin. The postoperative course in an old person with a minimal inflammatory process in the cecal appendix, such as the one described in this case, is usually benign if there is an appropriate control of peritoneal contamination. If comorbidity does not intervene in the postoperative period, hospital discharge is rapid.  Case report: In the case that is presented, the cecal appendix was normal, as shown in the picture. We decided to resect it because of the absence of other abnormalities in the abdominal cavity. The histopathological study described inflammatory changes confined to the mucosa and submucosa. There was no perforation. These changes might have been secondary to a severe hypoperfusion due to the state of the patient.  Conclusions: It is dangerous to conclude that &#8220;although the cecal appendix in older patients might seem normal, it would be very reasonable to remove it&#8221; to avoid an outcome like that of the case presented.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Apendicitis del anciano]]></kwd>
<kwd lng="es"><![CDATA[error en el diagnóstico]]></kwd>
<kwd lng="es"><![CDATA[diagnóstico oportuno y pronta cirugía]]></kwd>
<kwd lng="en"><![CDATA[Appendicitis in the aged]]></kwd>
<kwd lng="en"><![CDATA[difficult diagnosis]]></kwd>
<kwd lng="en"><![CDATA[early diagnosis and surgical treatment]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peltokallio]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Jauhiainen]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute appendicitis in the aged patient. Study of 300 cases after the age of 60]]></article-title>
<source><![CDATA[Arch Surg]]></source>
<year>1970</year>
<volume>100</volume>
<page-range>140-3</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Søreide]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Appendicitis -a study of incidence, death rates and consumption of hospital resources]]></article-title>
<source><![CDATA[Postgrad Med J]]></source>
<year>1984</year>
<volume>60</volume>
<page-range>341-5</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Horattas]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Haught]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Managing appendicitis in the elderly patient]]></article-title>
<source><![CDATA[AORN J]]></source>
<year>1992</year>
<volume>55</volume>
<page-range>1282-5</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Horattas]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Guyton]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
<name>
<surname><![CDATA[Wu]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A reappraisal of appendicitis in the elderly]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1990</year>
<volume>160</volume>
<page-range>282-5</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Franz]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Norman]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Fabri]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Increased morbidity of appendicitis with advancing age]]></article-title>
<source><![CDATA[Am Surg]]></source>
<year>1995</year>
<volume>61</volume>
<page-range>40-4</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peltokallio]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Tykkä]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evolution of the age distribution and mortality of acute appendicitis]]></article-title>
<source><![CDATA[Arch Surg]]></source>
<year>1981</year>
<volume>116</volume>
<page-range>153-6</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lau]]></surname>
<given-names><![CDATA[WY]]></given-names>
</name>
<name>
<surname><![CDATA[Fan]]></surname>
<given-names><![CDATA[ST]]></given-names>
</name>
<name>
<surname><![CDATA[Yiu]]></surname>
<given-names><![CDATA[TF]]></given-names>
</name>
<name>
<surname><![CDATA[Chu]]></surname>
<given-names><![CDATA[KW]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute appendicitis in the elderly]]></article-title>
<source><![CDATA[Surg Gynecol Obstet]]></source>
<year>1985</year>
<volume>161</volume>
<page-range>157-60</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Leigh]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Simmons]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Norman]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection]]></article-title>
<source><![CDATA[J Clin Pathol]]></source>
<year>1974</year>
<volume>27</volume>
<page-range>997-1000</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Smithy]]></surname>
<given-names><![CDATA[WB]]></given-names>
</name>
<name>
<surname><![CDATA[Wexner]]></surname>
<given-names><![CDATA[SD]]></given-names>
</name>
<name>
<surname><![CDATA[Dailey]]></surname>
<given-names><![CDATA[TH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The diagnosis and treatment of acute appendicitis in the aged]]></article-title>
<source><![CDATA[Dis Colon Rectum]]></source>
<year>1986</year>
<volume>29</volume>
<page-range>170-3</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[McCaig]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
<name>
<surname><![CDATA[Nawar]]></surname>
<given-names><![CDATA[EN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[National hospital ambulatory medical care survey: 2004 emergency department summary. Advance date from vital and health statistics]]></article-title>
<source><![CDATA[Adv Data]]></source>
<year>2006</year>
<volume>372</volume>
<page-range>1-29</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wilber]]></surname>
<given-names><![CDATA[ST]]></given-names>
</name>
<name>
<surname><![CDATA[Gerson]]></surname>
<given-names><![CDATA[LW]]></given-names>
</name>
<name>
<surname><![CDATA[Terrell]]></surname>
<given-names><![CDATA[KM]]></given-names>
</name>
<name>
<surname><![CDATA[Carpenter]]></surname>
<given-names><![CDATA[CR]]></given-names>
</name>
<name>
<surname><![CDATA[Shah]]></surname>
<given-names><![CDATA[MN]]></given-names>
</name>
<name>
<surname><![CDATA[Heard]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system]]></article-title>
<source><![CDATA[Acad Emerg Med]]></source>
<year>2006</year>
<volume>13</volume>
<page-range>1345-51</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wofford]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Schwartz]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Timerding]]></surname>
<given-names><![CDATA[BL]]></given-names>
</name>
<name>
<surname><![CDATA[Folmar]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Ellis]]></surname>
<given-names><![CDATA[SD]]></given-names>
</name>
<name>
<surname><![CDATA[Messick]]></surname>
<given-names><![CDATA[CH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Emergency department utilization by the elderly: analysis of the National Hospital Ambulatory Medical Care Survey]]></article-title>
<source><![CDATA[Acad Emerg Med]]></source>
<year>1996</year>
<volume>3</volume>
<page-range>694-9</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[McNamara]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
<name>
<surname><![CDATA[Rousseau]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Sanders]]></surname>
<given-names><![CDATA[AB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Geriatric emergency medicine: a survey of practicing emergency physicians]]></article-title>
<source><![CDATA[Ann Emerg Med]]></source>
<year>1992</year>
<volume>212</volume>
<page-range>796-801</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Coro&#351;]]></surname>
<given-names><![CDATA[MF]]></given-names>
</name>
<name>
<surname><![CDATA[Copotoiu]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Copotoiu]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Ioni&#355;&#259;]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Dobre]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Sorlea]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical emergencies in elderly]]></article-title>
<source><![CDATA[Chirurgia (Bucur)]]></source>
<year>2008</year>
<volume>103</volume>
<page-range>283-90</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De Dombal]]></surname>
<given-names><![CDATA[FT]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute abdominal pain in the elderly]]></article-title>
<source><![CDATA[J Clin Gastroenterol]]></source>
<year>1994</year>
<volume>19</volume>
<page-range>331-5</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ongrádi]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Stercz]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Kövesdi]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Vértes]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Immunosenescence and vaccination of the elderly II. New strategies to restore age-related immune impairment]]></article-title>
<source><![CDATA[Acta Microbiol Immunol Hung]]></source>
<year>2009</year>
<volume>56</volume>
<page-range>301-12</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cusi]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Martorelli]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Di Genova]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Terrosi]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Campoccia]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Correale]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Age related changes in T cell mediated immune response and effector memory to Respiratory Syncytial Virus (RSV) in healthy subjects]]></article-title>
<source><![CDATA[Immun Ageing]]></source>
<year>2010</year>
<volume>7</volume>
<page-range>14</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Grubeck-Loebenstein]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fading immune protection in old age: vaccination in the elderly]]></article-title>
<source><![CDATA[J Comp Pathol]]></source>
<year>2010</year>
<volume>142</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>S116-9</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zhou]]></surname>
<given-names><![CDATA[XJ]]></given-names>
</name>
<name>
<surname><![CDATA[Saxena]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Liu]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Vaziri]]></surname>
<given-names><![CDATA[ND]]></given-names>
</name>
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[FG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Renal senescence in 2008: progress and challenges]]></article-title>
<source><![CDATA[Int Urol Nephrol]]></source>
<year>2008</year>
<volume>40</volume>
<page-range>823-39</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cotreau]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[von Moltke]]></surname>
<given-names><![CDATA[LL]]></given-names>
</name>
<name>
<surname><![CDATA[Greenblatt]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The influence of age and sex on the clearance of cytochrome P450 3A substrates]]></article-title>
<source><![CDATA[Clin Pharmacokinet]]></source>
<year>2005</year>
<volume>44</volume>
<page-range>33-60</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Radley]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Keighley]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Radley]]></surname>
<given-names><![CDATA[SC]]></given-names>
</name>
<name>
<surname><![CDATA[Mann]]></surname>
<given-names><![CDATA[CH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bowel dysfunction following hysterectomy]]></article-title>
<source><![CDATA[Br J Obstet Gynaecol]]></source>
<year>1999</year>
<volume>106</volume>
<page-range>1120-5</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bhutto]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Morley]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The clinical significance of gastrointestinal changes with aging]]></article-title>
<source><![CDATA[Curr Opin Clin Nutr Metab Care]]></source>
<year>2008</year>
<volume>11</volume>
<page-range>651-60</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wickremaratchi]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Llewelyn]]></surname>
<given-names><![CDATA[JG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effects of ageing on touch]]></article-title>
<source><![CDATA[Postgrad Med J]]></source>
<year>2006</year>
<volume>82</volume>
<page-range>301-4</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hilton]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Iman]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Burke]]></surname>
<given-names><![CDATA[GJ]]></given-names>
</name>
<name>
<surname><![CDATA[Moore]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[O&#8217;Mara]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Signorini]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study]]></article-title>
<source><![CDATA[Am J Gastroenterol]]></source>
<year>2001</year>
<volume>96</volume>
<page-range>380-4</page-range></nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kamin]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<name>
<surname><![CDATA[Nowicki]]></surname>
<given-names><![CDATA[TA]]></given-names>
</name>
<name>
<surname><![CDATA[Courtney]]></surname>
<given-names><![CDATA[DS]]></given-names>
</name>
<name>
<surname><![CDATA[Powers]]></surname>
<given-names><![CDATA[RD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pearls and pitfalls in the emergency department evaluation of abdominal pain]]></article-title>
<source><![CDATA[Emerg Med Clin North Am]]></source>
<year>2003</year>
<volume>21</volume>
<page-range>61-vi</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Stroman]]></surname>
<given-names><![CDATA[DL]]></given-names>
</name>
<name>
<surname><![CDATA[Bayouth]]></surname>
<given-names><![CDATA[CV]]></given-names>
</name>
<name>
<surname><![CDATA[Kuhn]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Westmoreland]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Jones]]></surname>
<given-names><![CDATA[RC]]></given-names>
</name>
<name>
<surname><![CDATA[Fisher]]></surname>
<given-names><![CDATA[TL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The role of computed tomography in the diagnosis of acute appendicitis]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1999</year>
<volume>178</volume>
<page-range>485-9</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rao]]></surname>
<given-names><![CDATA[PM]]></given-names>
</name>
<name>
<surname><![CDATA[Rhea]]></surname>
<given-names><![CDATA[JT]]></given-names>
</name>
<name>
<surname><![CDATA[Novelline]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<name>
<surname><![CDATA[Mostafavi]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<name>
<surname><![CDATA[McCabe]]></surname>
<given-names><![CDATA[CJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effect of computed tomography of the appendix on treatment of patients and use of hospital resources]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>1998</year>
<volume>338</volume>
<page-range>141-6</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wolff]]></surname>
<given-names><![CDATA[WL]]></given-names>
</name>
<name>
<surname><![CDATA[Hindman]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute appendicitis in the aged]]></article-title>
<source><![CDATA[Br J Sur]]></source>
<year>1976</year>
<volume>63</volume>
<page-range>956-60</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Goldenberg]]></surname>
<given-names><![CDATA[IS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute appendicitis in the aged]]></article-title>
<source><![CDATA[Geriatrics]]></source>
<year>1955</year>
<volume>10</volume>
<page-range>324-7</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hubbell]]></surname>
<given-names><![CDATA[DS]]></given-names>
</name>
<name>
<surname><![CDATA[Barton]]></surname>
<given-names><![CDATA[WK]]></given-names>
</name>
<name>
<surname><![CDATA[Solomon]]></surname>
<given-names><![CDATA[OD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Appendicitis in older people]]></article-title>
<source><![CDATA[Surg Gynecol Obstet]]></source>
<year>1960</year>
<volume>110</volume>
<page-range>289-92</page-range></nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Coran]]></surname>
<given-names><![CDATA[AG]]></given-names>
</name>
<name>
<surname><![CDATA[Wheeler]]></surname>
<given-names><![CDATA[HB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Early perforation in appendicitis after age 60]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>1966</year>
<volume>197</volume>
<page-range>745-8</page-range></nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Albano]]></surname>
<given-names><![CDATA[WA]]></given-names>
</name>
<name>
<surname><![CDATA[Zielinski]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Organ]]></surname>
<given-names><![CDATA[CH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Is appendicitis in the aged really different?]]></article-title>
<source><![CDATA[Geriatrics]]></source>
<year>1975</year>
<volume>30</volume>
<page-range>81-8</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Freund]]></surname>
<given-names><![CDATA[HR]]></given-names>
</name>
<name>
<surname><![CDATA[Rubinstein]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Appendicitis in the aged. Is it really different?]]></article-title>
<source><![CDATA[Am Surg]]></source>
<year>1984</year>
<volume>50</volume>
<page-range>573-6</page-range></nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Owens]]></surname>
<given-names><![CDATA[BJ]]></given-names>
</name>
<name>
<surname><![CDATA[Hamit]]></surname>
<given-names><![CDATA[HF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Appendicitis in the elderly]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>1978</year>
<volume>187</volume>
<page-range>392-6</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Blake]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Lynn]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Emergency abdominal surgery in the aged]]></article-title>
<source><![CDATA[Br J Surg]]></source>
<year>1976</year>
<volume>63</volume>
<page-range>956-60</page-range></nlm-citation>
</ref>
<ref id="B36">
<label>36</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pieper]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Kager]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Näsman]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute appendicitis: a clinical study of 1018 cases of emergency appendectomy]]></article-title>
<source><![CDATA[Acta Chir Scand]]></source>
<year>1982</year>
<volume>148</volume>
<page-range>51-62</page-range></nlm-citation>
</ref>
<ref id="B37">
<label>37</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Horattas]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Guyton]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
<name>
<surname><![CDATA[Wu]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A reappraisal of appendicitis in the elderly]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1990</year>
<volume>160</volume>
<page-range>291-3</page-range></nlm-citation>
</ref>
<ref id="B38">
<label>38</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lukmann]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Incidence and case fatality rates for acute appendicitis in California. A population-base study of effects of age]]></article-title>
<source><![CDATA[Am J Epidermiol]]></source>
<year>1989</year>
<volume>129</volume>
<page-range>905-18</page-range></nlm-citation>
</ref>
<ref id="B39">
<label>39</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Paajanen]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Kettunen]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Kostianen]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Emergency appendicitis in patients over 80 years old]]></article-title>
<source><![CDATA[Am Surg]]></source>
<year>1994</year>
<volume>60</volume>
<page-range>950-3</page-range></nlm-citation>
</ref>
<ref id="B40">
<label>40</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Franz]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Norman]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Fabri]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Increased morbidity of appendicitis with advancing age]]></article-title>
<source><![CDATA[Am Surg]]></source>
<year>1995</year>
<volume>61</volume>
<page-range>40-4</page-range></nlm-citation>
</ref>
<ref id="B41">
<label>41</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rub]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Margel]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Soffer]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Kluger]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Appendicitis in the elderly: what has changed?]]></article-title>
<source><![CDATA[Isr Med Assoc J]]></source>
<year>2000</year>
<volume>2</volume>
<page-range>220-3</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
