The association of Enterobius vermicularis infestation with acute appendicitis varies from 0.2-41.8% worldwide. Our purpose was to determine the significance of Enterobius-associated appendicitis by retrospective review of appendectomies performed during a 5-year period at a major children's hospital. The Surgical Pathology database at Children's Hospital, Columbus, Ohio, was reviewed for appendiceal specimens found to have Enterobius infestation. Corresponding patient charts were evaluated for age, gender, presenting symptoms, laboratory data, operative findings, and clinical course. Of the 1,549 appendectomies performed from January 1998 through January 2003, 21 specimens (1.4%) were found to contain Enterobius vermicularis. Fifteen of the appendectomies were performed for symptoms of acute appendicitis; the remaining six were incidental appendectomies in conjunction with other operations. The mean age was 8.9 years. Ten patients were male; 11 were female. Of the 15 symptomatic children, nine presented with fever >99.0 degrees F, and 11 had a WBC count >10,000. Intra-operative appearance of the appendix ranged from normal to perforation. Pathologic evaluation showed neutrophil or eosinophil infiltration in 15 of the 21 specimens. Enterobius infestation is an uncommon cause of acute appendicitis in children in the United States. It may be associated with acute appendicitis, "chronic appendicitis," ruptured appendicitis, or with no significant clinical symptoms.

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With the realization that simple thyroid procedures had a very low rate of complication and that patients often seemed well enough to go home from the recovery room, we began performing them in an ambulatory surgery setting. We review here 134 consecutive thyroid procedures performed at Columbia Presbyterian Medical Center between July 1987 and July 1989. Patients undergoing reoperation, neck dissection, sternal splits, or other concomitant procedures were excluded. There were 105 women and 29 men with an average age of 47 years. Fifty percent of the operations were performed for benign disease, although the most common diagnosis was papillary cancer (44%). Twenty-one operations (16%) were performed under local anesthesia. Most patients underwent surgery in our ambulatory surgery unit and 76 were discharged the day of surgery. Of these patients, 21 underwent total thyroidectomy, 13 subtotal thyroidectomy, and 42 simple thyroid lobectomy. Of the 58 patients who were admitted, 53 were discharged on the day following surgery. The average length of stay was 0.49 days. Extensive pre- and postoperative teaching was given regarding the signs and symptoms associated with the complications of thyroid surgery. All patients were felt to be reliable and capable of understanding the procedure and of complying with the postoperative plans. Postoperative complications included 8 patients (6%) with transient hypocalcemia and 1 patient (0.75%) with permanent unilateral recurrent laryngeal nerve paralysis. All complications occurred in patients who underwent total thyroidectomies. No patient had a postoperative complication requiring reoperation or readmission. We conclude that by using specific selection criteria, thyroid lobectomies and subtotal thyroidectomies can be performed safely in an ambulatory surgery setting without increase in morbidity or mortality.