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Sample records for acute leukemic appendicitis

  1. Acute Myeloid Leukemia Presenting as Acute Appendicitis

    Sherri Rauenzahn

    2013-01-01

    Full Text Available Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days.

  2. Imaging diagnosis of acute appendicitis

    The nontraumatic acute abdomen is one of the most common presentation to the emergency room, with appendicitis being one of the most common causes of the acute abdomen. Up to 30 % of patients suspected of having acute appendicitis will present with atypical signs and symptoms. There are many conditions that imitate acute appendicitis. The percentage of unnecessary appendectomies that result from a clinical false-positive diagnosis of appendicitis. The use of computed tomography (CT) before planned surgery has decreased the negative appendicectomy rate for patients with suspected acute appendicitis. Recognition of the typical and atypical CT signs of appendicitis is important to optimize the diagnosis yield of the examination. Visualization of an appendix with normal characteristics is the most important finding to exclude appendicitis. (author)

  3. Ultrasonographic diagnosis of acute appendicitis

    Acute appendicitis is the most common surgical disease of acute abdomen, But the diagnosis of acute appendicitis is often difficult, and not in frequently, operation for appendicitis is performed only to find a normal appendix. Various radiological examinations have been proposed to improve diagnostic accuracy of appendicitis. The purpose of this study was to improve the diagnostic accuracy of appendicitis, and to decline negative exploration. High resolution real time ultrasonographical examination using graded compression was performed in 57 consecutive patients who were clinically suspected of appendicitis. Autors analysed ultrasonographical, surgical, and clinical follow up findings. The results were are follows: 1. Ultrasonographical finding of acute appendicitis was visualization of appendix as a tubular structure with one bline end, or target phenomenon. 2. Hypoechoic area over the appendix was thought to be a sign of periappendiceal abscess. 3. The sensitivity of US diagnosis of acute appendicitis in this study was 92.8% with a specificity of 93.1%. The overall accuracy was 93.0%. 4. In control group of 50 individuals, the abnormal appendix was not visualized. 5. In cases of clinically suspected appendicitis, the US evaluation with graded compression technique is very accurate and effective examination.

  4. Radiologic diagnosis of acute appendicitis

    Sixty-six cases of acute appendicitis were proved by surgery during the period from May 1969 to May 1971. The present study was designated to elucidate the findings of roentgen examination in acute appendicitis. The results obtained were summarized as follows: 1. Over 90 percent of cases of acute appendicitis showed significant radiographic findings. 2. Distension and fluid level in cecum and terminal ileum were disclosed approximately 75 percent of cases. It believe diagnostically significant in acute appendicitis. 3. About 10 percent of cases were found extra-alimentary free air. 4. The roentgen findings of the fluid interposed between colonic contents and frank stripesin the right lower quadrant was another interesting findings to suspect acute appendicitis

  5. Echography in appendicitis acute diagnosis

    Over an 18-month period, high resolution ultrasound was used to assess 220 patients with doubtful clinical diagnosis of acute appendicitis. The ultrasonographic findings were correlated with the surgical results and the pathological results in 115 cases, and with clinical follow-up in the rest. This technique has been found to be effective in the diagnosis of acute appendicitis, with a sensitivity of 90.4%, and similar specificity and reliability (90.2%). The positive predictive value of the test was 89% and the negative predictive value, 91%. The ultrasonographic criteria applied for the diagnosis of acute appendicitis was the detection of an understood appendix measuring over 6 mm. All cases with perforation were correctly diagnosed as acute appendicitis. The observation of an accumulation of fluid pooled in DIF in patients with ultrasonographic findings suggestive of appendicitis points to a diagnosis of perforation or complicated (gangrenous) appendicitis. A relationship between complicated appendicitis and the detection of appendicoliths within the enlarged appendix was also observed. The results obtained demonstrate that high resolution ultrasound is indicated in the diagnosis of acute appendicitis in all cases in which the clinical findings are doubtful

  6. Amebiasis presenting as acute appendicitis.

    Andrade, Javier E; Mederos, Raul; Rivero, Haidy; Sendzischew, Morgan A; Soaita, Mauela; Robinson, Morton J; Sendzischew, Harry; Danielpour, Payman

    2007-11-01

    Amebiasis presenting as acute appendicitis is extremely rare. The case of a 38-year-old Hispanic man who presented to the hospital with symptoms and signs suggestive of acute appendicitis is reported. He underwent laparoscopic appendectomy and the pathologic examination of the appendix revealed multiple trophozoites of Entamoeba histolytica. The patient was treated postoperatively with metronidazole for amebiasis, and follow-up stool studies showed no sign of residual infection. The patient has remained asymptomatic. PMID:17984748

  7. Ultrasonographic findings of acute appendicitis

    For the evaluation of acute appendicitis, many diagnostic methods, such as physical examination, laboratory findings, plain abdomen and barium enema have been widely used. But the overall accuracy was ranged from 50% to 84% and negative appendectomy rate was reported between 5% and 35%. In these days, high resolution ultrasonography is well known to be a good imaging modality in evaluation of acute appendicitis and its complications. Using high resolution ultrasonography, 138 patients with right lower quadrant abdominal pain were examined for 16 months. The results were compared to post-operative findings and clinical follow up study. The results were as follows: 1. The sex distribution of cases were 58 males and 80 females, and most common in the third decade (33.3%). 2. The positive ultrasonographic findings were in 69 cases (50%), those were simple appendicitis without complication in 46 cases (66.7%), acute appendicitis with periappendicitis in 9 cases (13.0%), acute appendicitis with abscess in 6 cases (8.7%), acute appendicitis with appendicolith in 4 cases (5.8%) and perforated appendicitis in 4 cases (16%). 3. The ultrasonographic findings of normal appendix were in 69 cases (50%), those were nonvisualization of appendix in 62 cases (91.3%) and visualization of normal appendix with single thin echogenic wall in 6 cases (8.7%). 4. In the 50 cases of control group, the visualization of normal appendix on ultrasonography were in 8 cases (16%). 5. The overall accuracy was 95.7% with 97.1% of sensitivity and 94.4% of specificity

  8. Ultrasonography for the acute appendicitis

    The authors analysed ultrasonography (US) findings in patients with clinical signs of acute appendicitis during a recent 7-months period. The comparative analysis between US findings and surgical-pathologic findings was performed in 193 cases who underwent surgery. There were 52 cases with a sonographically non-visible appendix whose symptoms spontaneously resolved. The inflamed appendix was visualized by high-resolution, real-time US according to the graded-compression method described by Puylaert. The following results noted: 1. Sonographically visualized 136 cases were the target-appearance appendix in 47 cases, the fluid-filled appendix in 66 cases and the irregular marginated mixed echogenic mass-like density with surrounding fluid collection in 23 cases. The appendix was not visualized by US in 109 cases. 2. Appendicitis perforation was predictable in 21 cases of 24 cases. 3. Acute appendicitis was 24 cases (59%) among 41 cases who were sonographically visualized with appendiceal wall thickening less than 3mm and 77 cases (81%) among 95 cases with wall thickening more than 3mm. 4. When the results in women were analyzed separately (n=176), the sensitivity was 86%, the specificity was 76% and the accuracy was 80%. In women, US was helpful for the differential diagnosis between acute appendicitis and other gynecologic disease. 5. In men (n=69), the sensitivity was 88%, the specificity was 67% and the accuracy was 81%. 6. The overall sensitivity was 87%, the specificity was 75% and accuracy was 80% (n=245). Graded-compression US is the examination of choice in the patients with clinical signs of acute appendicitis, particularly in women

  9. Diagnosis of acute appendicitis with MSCT

    Objective: To analyze the CT appearance of acute appendicitis and investigate diagnostic value of MSCT on acute appendicitis. Methods: The type and CT appearance of 15 cases with acute appendicitis proved by surgery and histopathology or clinic was analyzed retrospectively. Multi-stages scanning was carried out on the whole abdomen with 16 row CT. Post processing techniques including MPR, CPR and MIP were performed to observe the lesions. Results: There were 3 acute suppurative appendicitis, 12 acute gangrene and perforative appendicitis and appendiceal abscess. Complication occurred in 10 cases with gangrene and perforative appendix or appendix molten. The complication included 4 pelvic abscess, 3 intra-abdminal abscess, 1 combined pelvic and intra-abdominal abscess, 4 conglutination bowel obstruction, 1 ureteritis stegnosis and 1 abdominal wall fistulae. The exact ratio of CT diagnosis on acute suppurative appendicitis and appendiceal abscess reached 93.3% preoperatively. It is difficult to distinguish between acute suppurative appendicitis and acute gangrenous appendicitis without perforation. Conclusion: The MSCT appearance of acute appendicitis was marked and of important value on diagnosis of acute appendicitis. (authors)

  10. Simultaneous acute appendicitis with right testicular torsion

    Tanveer Akhtar

    2012-01-01

    Full Text Available We present a child with both acute appendicitis and torsion of the right testis presenting at the same time. Testicular torsion possibly occurring due to vomiting in acute appendicitis so far has not been reported in the literature.

  11. Acute Appendicitis in Infants. A Case Report

    Sergio Luis González López

    2013-04-01

    Full Text Available Acute appendicitis is more common in school-age children, but it rarely occurs in infants. The younger the patient, the fastest the course of the disease. In addition, there are greater risks of complications. A case of a nine-month-old infant, admitted to the pediatric hospital with fever and diarrhea, is presented. After several tests, he underwent surgery. Peritonitis caused by acute gangrenous appendicitis was diagnosed. While the patient was in the intensive care unit, he suffered a septic shock and acute multiple organ failure. As a result, he died 24 hours later. The biopsy confirmed the diagnosis of acute gangrenous appendicitis. Acute appendicitis is a disease that must be considered by doctors who treat infants with fever, diarrhea and abdominal pain related to irritability. Thus, an early diagnosis of the disease as well as the implementation of an appropriate surgical treatment can be performed.

  12. Diagnosis of acute appendicitis using ultrasonography

    It is well known that acute appendicitis is the most common cause of emergency operation of the abdomen. The mortality rate of acute appendicitis has considerably declined during the past decades, but the diagnostic accuracy is still 70 to 82%, and moreover 54 to 65% in the young women. Various radiologic examinations have been proposed to improve diagnostic accuracy. Scout films of the abdomen and barium examinations have all proved to be of some value but are not generally employed. The purpose of this study was to improve the diagnostic accuracy and to make early diagnosis of acute appendicitis using ultrasonography. High resolution real time ultrasonography was performed in 39 patients with clinically suspected acute appendicitis at the department of Radiology, St. Mary's Hospital, Catholic University Medical College from May to July 1987. Ultrasonographic findings, operative findings and results of clinical follow-up of acute appendicitis were analyzed and correlated. The results were as follows: 1. Ultrasonographic finding of acute appendicitis was visualization of appendix with thickened wall and distended lumen. In the acute appendicitis the thickness of wall was 4.5 ± 2.02mm (2 to 10mm) and even in 84.6%. The diameter of distended lumen was 6.58 ± 2.33mm (3 to 10mm). 2. Anechoic area over the appendix was thought to be a sign of periappendiceal abscess. 3. Although no echolucency was demonstrated around the appendix, perforation of appendix should be suspected when thickening of the appendiceal wall was asymmetrical and eccentric without luminal distension. 4. Ultrasonography had an 88.9% sensitivity, an 89.5% specificity and an 89.2% accuracy. 5. Ultrasonography is felt to be very accurate and effective method in the diagnosis of acute appendicitis

  13. Scan role in diagnosing acute appendicitis

    Massimo Summa

    2006-12-01

    Full Text Available Acute appendicitis is one of the commonest surgical diseases. It can rapidly progress to severe complications, like perforation and peritonitis. Consequently, surgeons often prefer to operate as soon as there is, clinically, a probable diagnosis, even if such a decision results in the ablation of up to 30% of normal appendixes. Many diagnostic methods have been proposed with the aim of decreasing the number of appendectomies in patients without appendicitis: ultrasonography, computed tomography, magnetic resonance imaging, laparoscopy. In particular, ultrasonography has the advantage of being less expensive, widely available, and non-invasive; furthermore, it has demonstrated a diagnostic accuracy of 70-95%. However, its use needs further evaluation with respect to the best way to integrate it with clinical and laboratory data, in order to correctly identify a patient with suspected acute appendicitis. The aim of our study is to show our experience with ultrasonographic diagnosis of acute appendicitis, acquired by surgeons with specific sonographic expertise.

  14. Evidence for eosinophil degranulation in acute appendicitis

    Santosh G

    2008-04-01

    Full Text Available Finding of increased numbers of eosinophils in the muscle in cases of acute appendicitis has led to the hypothesis that it may have an allergic origin. This study aimed to measure the eosinophil degranulation resulting in a rise in the serum of eosinophil granule proteins that would be expected in such cases. The levels of serum eosinophil cationic protein (ECP measured by chemiluminescence assay in acute appendicitis were compared, with those of appropriate controls. Mean (95% CI serum ECP (µg/L levels were: acute appendicitis 45.3 (27.7-63.0; normal appendix 22.7 (16.0-29.3; asthma 24.2 (4.6-43.8; and healthy volunteers 13.2 (8.3-18.1. In cases of acute appendicitis, there is an inverse relationship between duration of symptoms and serum ECP. However, this was not statistically significant. Significant local eosinophil activation and degranulation occurs in acute appendicitis, enough to cause a rise in serum levels of eosinophil chemotactic protein

  15. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis.

    Emmanuel, Andrew

    2011-04-01

    No reliably specific marker for acute appendicitis has been identified. Although recent studies have shown hyperbilirubinaemia to be a useful predictor of appendiceal perforation, they did not focus on the value of bilirubin as a marker for acute appendicitis. The aim of this study was to determine the value of hyperbilirubinaemia as a marker for acute appendicitis.

  16. Imaging Acute Appendicitis: State of the Art

    Diana Gaitini

    2011-01-01

    Full Text Available The goal of this review is to present the state of the art in imaging tests for the diagnosis of acute appendicitis. Relevant publications regarding performance and advantages/disadvantages of imaging modalities for the diagnosis of appendicitis in different clinical situations were reviewed. Articles were extracted from a computerized database (MEDLINE with the following activated limits: Humans, English, core clinical journals, and published in the last five years. Reference lists of relevant studies were checked manually to identify additional, related articles. Ultrasound (US examination should be the first imaging test performed, particularly among the pediatric and young adult populations, who represent the main targets for appendicitis, as well as in pregnant patients. A positive US examination for appendicitis or an alternative diagnosis of possible gastrointestinal or urological origin, or a negative US, either showing a normal appendix or presenting low clinical suspicion of appendicitis, should lead to a final diagnosis. A negative or indeterminate examination with a strong clinical suspicion of appendicitis should be followed by a computed tomography (CT scan or alternatively, a magnetic resonanace imaging (MRI scan in a pregnant patient. A second US examination in a patient with persistent symptoms, especially if the first one was performed by a less experienced imaging professional, is a valid alternative to a CT.

  17. Acute appendicitis mistaken as acute rejection in renal transplant recipients.

    Talwalkar N; Javali D; Venkatesh K; Iyer S; Venkatesh M; Joshi U

    1994-01-01

    Case histories of 2 renal transplant recipients are reported who had presenting features of fever, leukocytosis and pain/tenderness over right iliac fossa and were diagnosed to be due to acute appendicitis rather than more commonly suspected acute rejection episode which has very similar features. Diagnosis of acute appendicitis was suspected on the basis of rectal examination and later confirmed by laparotomy. The purpose of this communication is to emphasize the need for proper diagnosis in...

  18. Usefulness of computed tomography in diagnosis of acute appendicitis

    The usefulness of computed tomography (CT) in the diagnosis of acute appendicitis was studied. CT was performed in 32 patients who were suspected to have acute appendicitis. Direct findings (abnormal appendix) were seen in 24 patients and suggestive findings were seen in 16 patients. Acute appendicitis was diagnosed in 25 patients with the help of CT findings, and the other seven patients was no found in acute appendicitis by CT. The diagnosis of appendicitis was made histopathologically in 21 cases. The benefits of CT in the diagnosis of acute appendicitis were high correct diagnosis rate, avoidance of unnecessary appendectomy, demonstration of abscess and perforated appendicitis, demonstration of retrocecal appendix, and selection of anesthesia method. The demerits were radiating of X-rays and expensive cost. If was concluded that CT is a useful aid in the diagnosis of acute appendicitis. (author)

  19. Simultaneous acute appendicitis and ectopic pregnancy

    Ankouz Amal; Ousadden Abdelmalek; Majdoub Karim; Chouaib Ali; Maazaz Khalid; Taleb Khalid

    2009-01-01

    The acute abdomen in pregnancy is a surgical emergency. Ectopic pregnancy and appendicitis are two causes of acute abdomen in pregnancy. Difficulties in correctly identifying the cause of the pain can be hazardous to the patient and care needs to be taken in obtaining a prompt and accurate diagnosis enabling the most appropriate management. The case presented here underlies the pathogenesis of the simultaneous existence of these two conditions in a patient.

  20. Acute appendicitis in pregnancy: literature review

    Antônio Henriques de Franca Neto

    2015-04-01

    Full Text Available Introduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms “acute appendicitis” and “pregnancy”, in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. Results: the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. Discussion: clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. Conclusion: the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial.

  1. Acute amebic appendicitis: Report of a rare case

    Singh Naorem

    2010-10-01

    Full Text Available Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. We report a case of amebic appendicitis presenting with fever, severe pain in the right lower quadrant of the abdomen and rebound tenderness. Lab investigations revealed neutrophilic leukocytosis. The patient underwent appendectomy. Histopathological examination revealed numerous Entameba histolytica trophozoites in the mucosa of the appendix. Acute appendicitis of amebic origin does not appear frequently. Appendicular amebiasis can give the clinical features of acute appendicitis and should be treated accordingly.

  2. Acute appendicitis mistaken as acute rejection in renal transplant recipients.

    Talwalkar N

    1994-01-01

    Full Text Available Case histories of 2 renal transplant recipients are reported who had presenting features of fever, leukocytosis and pain/tenderness over right iliac fossa and were diagnosed to be due to acute appendicitis rather than more commonly suspected acute rejection episode which has very similar features. Diagnosis of acute appendicitis was suspected on the basis of rectal examination and later confirmed by laparotomy. The purpose of this communication is to emphasize the need for proper diagnosis in patient with such presentation; otherwise wrong treatment may be received.

  3. Diagnosis of acute appendicitis: Current criteria

    INTRODUCTION: The aim of present paper was to identify some features related to preoperative diagnosis of acute appendicitis, according the selected variables, as well as to establish comparisons with findings from other authors. METHODS: We made a prospective, descriptive and observational study of 560 patients operated on and discharged with the histopathology diagnosis of acute appendicitis. Patients were seen in General Surgery Service of the 'Saturnino Lora' Teaching Provincial Hospital of Santiago de Cuba during year 2006. RESULTS: Among the more significant results were the predominance of young males with a mean age of 25,2 years, and the preponderance of the clinical diagnosis. Mean time of preoperative course was greater in men, and there was a predominance of gangrenous and perforated varieties, although the primacy was for the suppurative appendicitis. In the deceased ones the more severe pathologic histology ways were detected, and these were elderlies presenting with atypical clinical manifestations of disease. CONCLUSIONS: Clinical method has nowadays is of capital significance, since thorough it is possible early to diagnose this so common urgency, and to reduce the preoperative course time, whose length is cause of a unnecessary morbidity and mortality. (author)

  4. Acute appendicitis in a premature baby

    Beluffi, Giampiero; Alberici, Elisa [Department of Radiodiagnosis, Section of Paediatric Radiology, IRCCS Policlinico S. Matteo, Piazzale Golgi 2, 27100 Pavia PV (Italy)

    2002-07-01

    A case of acute appendicitis in a premature baby in whom diagnosis was suggested on plain films of the abdomen is presented. In this baby air in a hollow viscus suspected of being an enlarged appendix was the clue to diagnosis. The diagnostic dilemma of this rare and life-threatening condition in premature babies and newborns is underlined. The relevance of different imaging modalities and of different findings in this age group is discussed. Awareness of this rare condition and possible differential diagnosis in newborns and premature babies is stressed. (orig.)

  5. Accuracy of Ultrasonography in Diagnosing Acute Appendicitis

    Parisa Javidi Parsijani; Nima Pourhabibi Zarandi; Shahram Paydar; Hamidreza Abbasi; Shahram Bolandparvaz

    2013-01-01

    Objectives: To evaluate the accuracy of sonography in diagnosing acute appendicitis in patients with Alvarado score 4–7.Methods: This is a retrospective cross-sectional study being performed in Namazee hospital affiliated with Shiraz University of Medical sciences during a one year period from 9/2007 to 9/2008. We evaluated all patients with Alvarado score 4-7 and divided them in two groups: those with Ultrasound study prior to surgery and those without any imaging modalities for diagnosis of...

  6. [BACTERIOLOGICAL ASPECTS OF AN ACUTE APPENDICITIS].

    Zhuchenko, O P

    2016-03-01

    Peculiarities of microflora in the appendix mucosa and abdominal exudate in different morphological forms of an acute appendicitis (AA) were studied up. In accordance to the bacteriological investigations data, anaerobic, and aerobic microorganisms in AA were revealed in a monoculture and in association, more frequently--obligate anaer- obes (bacteroids) with E. coli--in 82 (80.39%) observations, staphylococcus--in 52 (50.98%), fecal streptococcus--in 19 (18.63%). With progression of inflammatory process and destructive changes in the appendix wall the quantity of bacteroids and enterobacteria have had enhanced, while the quantity of lacto- and bifidumflora-- reduced. PMID:27514082

  7. Acute appendicitis in a premature baby

    A case of acute appendicitis in a premature baby in whom diagnosis was suggested on plain films of the abdomen is presented. In this baby air in a hollow viscus suspected of being an enlarged appendix was the clue to diagnosis. The diagnostic dilemma of this rare and life-threatening condition in premature babies and newborns is underlined. The relevance of different imaging modalities and of different findings in this age group is discussed. Awareness of this rare condition and possible differential diagnosis in newborns and premature babies is stressed. (orig.)

  8. Two Cases of Omental Torsion Mimicking Acute Appendicitis

    Feeroz Alam Khan; Naeem Liaqat; Sajid Hameed Dar; Asif Iqbal Sandhu; Sajid Nayyer

    2014-01-01

    Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel’s diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion.

  9. Two Cases of Omental Torsion Mimicking Acute Appendicitis

    Feeroz Alam Khan

    2014-02-01

    Full Text Available Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel’s diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion.

  10. Two Cases of Omental Torsion Mimicking Acute Appendicitis

    Liaqat, Naeem; Dar, Sajid Hameed; Sandhu, Asif Iqbal; Nayyer, Sajid

    2014-01-01

    Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel’s diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion. PMID:24834389

  11. Septic Mesenteric Venous Thrombophlebitis: A Rare Complication of Acute Appendicitis

    Stylianos Kykalos

    2011-01-01

    Full Text Available Mesenteric venous thrombophlebitis represents a very rare complication of acute appendicitis. Based on the findings of a 45-year-old patient with mesenteric venous thrombophlebitis due to acute appendicitis, we herein describe the diagnostic difficulties and therapeutic options in this uncommon disease. The treatment in our case consisted of simple appendectomy and perioperative anticoagulation therapy.

  12. Unusual computed tomography findings and complications in acute appendicitis

    The objective of this article is to describe and illustrate unusual computed tomography (CT) findings in patients with acute appendicitis. We reviewed the charts of 200 patients with clinical suspicion of acute appendicitis who were submitted to abdominal CT before surgery. Patients with unusual presentation or complications were selected for illustrating the main CT findings. Unusual complications of acute appendicitis were related to anomalous position of the appendix, contiguity to intraperitoneal organs such as the liver, gall bladder, annexes and the bladder and continuous use of anti inflammatory or antibiotics during the diagnostic process. We concluded that CT is a useful diagnostic tool in patients with complicated or unusual presentation acute appendicitis. The first step towards diagnosis in these cases i to have in mind the hypothesis of appendicitis in patients with acute abdominal pain. (author)

  13. [Anaerobic-aerobic infection in acute appendicitis].

    Mamchich, V I; Ulitovskiĭ, I V; Savich, E I; Znamenskiĭ, V A; Beliaeva, O A

    1998-01-01

    362 patients with acute appendicitis (AA) were examined. For microbiological diagnosis of aerobic and anaerobic nonclostridial microflora we used complex accelerated methods (including evaluation of gram-negative microorganisms in comparison with tinctorial-fermentative method of differential staining according to oxygen sensitivity of catalasopositive together with aerobic and cathalasonegative anaerobic microorganisms) as well as complete bacteriologic examination with determination of sensitivity of the above microorganism to antimicrobial remedies. High rate of aerobic-anaerobic microbial associations and substantial identity of microflora from appendicis and exudate from abdominal cavity was revealed, which evidenced the leading role of endogenous microorganisms in etiology and pathogenesis of AA and peritonitis i. e. autoinfection. In patients with destructive forms of AA, complicated by peritonitis it is recommended to use the accelerated method of examination of pathologic material as well as the complete scheme of examination with the identification of the isolated microorganisms and the correction of antibiotic treatment. PMID:9511291

  14. Acute appendicitis caused by acute myeloid leukemia

    Zhang, Shanxiang; Chen, Shaoxiong

    2014-01-01

    Key Clinical Message A case of appendiceal involvement by acute myeloid leukemia (AML) in an adult with recent history of AML transformed from myelodysplastic syndrome (MDS) was presented. Being aware of this rare presentation in particular in a patient with history of MDS and/or AML is important for prompt clinical diagnosis and management.

  15. [Change in pancreatic exocrine function in acute appendicitis].

    Ivanov, Iu A

    1979-10-01

    In order to study changes in the functional state of the pancreas 1572 investigations of the blood and urine amylase, atoxylresistant lipase of the blood serum before operation were performed in different postoperative periods in 131 patients with acute appendicitis. The enzyme activity was established to increase, especially in destructive forms of appendicitis and in elderly patients. PMID:505800

  16. MRI features associated with acute appendicitis

    To identify MRI features associated with appendicitis. Features expected to be associated with appendicitis were recorded in consensus by two expert radiologists on 223 abdominal MRIs in patients with suspected appendicitis. Nine MRI features were studied: appendix diameter >7 mm, appendicolith, peri-appendiceal fat infiltration, peri-appendiceal fluid, absence of gas in the appendix, appendiceal wall destruction, restricted diffusion of the appendiceal wall, lumen or focal fluid collections. Appendicitis was assigned as the final diagnosis in 117/223 patients. Associations between imaging features and appendicitis were evaluated with logistic regression analysis. All investigated features were significantly associated with appendicitis in univariate analysis. Combinations of two and three features were associated with a probability of appendicitis of 88 % and 92 %, respectively. In patients without any of the nine features, appendicitis was present in 2 % of cases. After multivariate analysis, only an appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall were significantly associated with appendicitis. The probability of appendicitis was 96 % in their presence and 2 % in their absence. An appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall have the strongest association with appendicitis on MRI. (orig.)

  17. MRI features associated with acute appendicitis

    Leeuwenburgh, Marjolein M.N. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Academic Medical Center, Department of Radiology (G1-223.1), Amsterdam (Netherlands); Jensch, Sebastiaan [Sint Lucas Andreas Hospital, Department of Radiology, Amsterdam (Netherlands); Gratama, Jan W.C. [Gelre Hospitals, Department of Radiology, Apeldoorn (Netherlands); Spilt, Aart [Kennemer Gasthuis, Department of Radiology, Haarlem (Netherlands); Wiarda, Bart M. [Alkmaar Medical Center, Department of Radiology, Alkmaar (Netherlands); Es, H.W. van [Sint Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Cobben, Lodewijk P.J. [Haaglanden Medical Center, Department of Radiology, Leidschendam (Netherlands); Bossuyt, Patrick M.M. [University of Amsterdam, Department of Clinical Epidemiology, Academic Medical Center, Amsterdam (Netherlands); Boermeester, Marja A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Collaboration: on behalf of the OPTIMAP study group

    2014-01-15

    To identify MRI features associated with appendicitis. Features expected to be associated with appendicitis were recorded in consensus by two expert radiologists on 223 abdominal MRIs in patients with suspected appendicitis. Nine MRI features were studied: appendix diameter >7 mm, appendicolith, peri-appendiceal fat infiltration, peri-appendiceal fluid, absence of gas in the appendix, appendiceal wall destruction, restricted diffusion of the appendiceal wall, lumen or focal fluid collections. Appendicitis was assigned as the final diagnosis in 117/223 patients. Associations between imaging features and appendicitis were evaluated with logistic regression analysis. All investigated features were significantly associated with appendicitis in univariate analysis. Combinations of two and three features were associated with a probability of appendicitis of 88 % and 92 %, respectively. In patients without any of the nine features, appendicitis was present in 2 % of cases. After multivariate analysis, only an appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall were significantly associated with appendicitis. The probability of appendicitis was 96 % in their presence and 2 % in their absence. An appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall have the strongest association with appendicitis on MRI. (orig.)

  18. Endometrial decidualization: a rare cause of acute appendicitis during pregnancy.

    Murphy, Skyle J; Kaur, Anupinder; Wullschleger, Martin E

    2016-01-01

    Appendicular endometriosis is a rare and poorly understood pathology that affects women in their reproductive years. In the gravid woman, ectopic endometrial tissue undergoes decidualization. This physiological process can result in acute appendicitis in exceptional cases. Here we describe a patient in her second trimester of pregnancy who presented with right iliac fossa pain and clinical, laboratory and imaging findings consistent with acute appendicitis. A laparoscopic appendectomy was performed with intraoperative findings suspicious for malignancy. Histological analysis made the surprising diagnosis of decidualized endometriosis causing luminal constriction resulting in acute appendicitis. We also detail the challenging diagnostic and management issues faced by clinicians in such cases. PMID:27106612

  19. Value of noncontrast spiral CT for suspected acute appendicitis

    To assess the diagnostic accuracy and clinical efficacy of noncontrast spiral CT in patients with suspected acute appendicitis. Over a six-month period, 100 patients with suspected acute appendicitis were prospectively evaluated with noncontrast spiral CT. All scans were obtained from the lower body of L3 to the symphysis pubis, with 5mm or 10mm collimation and pitch of 1 or 1.5, and without intravenous or oral contrast material. Diagnosis was established by means of surgical or clinical follow-up. Prospective diagnosis based on CT findings was compared with surgical results and clinical follow-up. Acute appendicitis was confirmed in 47 of 100 patients. On the basis of the Ct findings, SI patients were prospectively interpreted as positive for appendicitis, but in six the diagnosis was false-positive. Two of the 47 with acute appendicitis were prospectively interpreted as normal. The preoperative diagnosis of acute appendicitis was, thus, 45 true-positive, 47 true-negative, six false-positive and two false-negative yielding a sensitivity of 96%, a specificity of 89%, an accuracy of 92%, a positive predictive value of 88%, and a negative predictive value of 96%. Using CT, an alternative diagnosis was established in 14 patients. Noncontrast spiral CT is a useful technique for diagnosing acute appendicitis. =20

  20. Right Hydronephrosis as a Complication of Acute Appendicitis

    Okur, Selahattin Koray; Koca, Yavuz Savaş; Yıldız, İhsan; Barut, İbrahim

    2016-01-01

    Introduction. Acute appendicitis is the most common cause of acute abdomen, but atypical appendicitis may lead to delayed diagnosis and related complications. In this report, we present a very rare case of acute appendicitis causing right hydronephrosis. Case Report. A 54-year-old male patient who had been receiving antibiotic therapy due to the diagnosis of urinary tract infection for the last one week but had no clinical improvement was admitted to the emergency service. Abdominal computed tomography (CT) showed right hydronephrosis and a pelvic abscess. After appendectomy and abscess drainage had been performed, hydronephrosis was completely recovered. Discussion. The use of appendicitis scoring systems, abdominal ultrasonography (USG), abdominal CT, and diagnostic laparoscopy can be useful for the diagnostic process in patients presenting with acute abdomen. In our patient, we considered that the surgical treatment was delayed since the symptoms of acute appendicitis were suppressed by the antibiotic therapy that was being administered due to the complaints including symptoms of urinary tract infections. Conclusion. Atypical appendicitis may cause a delay in the diagnosis of acute appendicitis and thus may lead to serious complications such as right hydronephrosis, prolonged hospital stay, increased morbidity and mortality, and increased antibiotic resistance. PMID:27069699

  1. Right Hydronephrosis as a Complication of Acute Appendicitis.

    Okur, Selahattin Koray; Koca, Yavuz Savaş; Yıldız, İhsan; Barut, İbrahim

    2016-01-01

    Introduction. Acute appendicitis is the most common cause of acute abdomen, but atypical appendicitis may lead to delayed diagnosis and related complications. In this report, we present a very rare case of acute appendicitis causing right hydronephrosis. Case Report. A 54-year-old male patient who had been receiving antibiotic therapy due to the diagnosis of urinary tract infection for the last one week but had no clinical improvement was admitted to the emergency service. Abdominal computed tomography (CT) showed right hydronephrosis and a pelvic abscess. After appendectomy and abscess drainage had been performed, hydronephrosis was completely recovered. Discussion. The use of appendicitis scoring systems, abdominal ultrasonography (USG), abdominal CT, and diagnostic laparoscopy can be useful for the diagnostic process in patients presenting with acute abdomen. In our patient, we considered that the surgical treatment was delayed since the symptoms of acute appendicitis were suppressed by the antibiotic therapy that was being administered due to the complaints including symptoms of urinary tract infections. Conclusion. Atypical appendicitis may cause a delay in the diagnosis of acute appendicitis and thus may lead to serious complications such as right hydronephrosis, prolonged hospital stay, increased morbidity and mortality, and increased antibiotic resistance. PMID:27069699

  2. Appendicitis

    ... Safe Recipes En Español Making a Change – Your Personal Plan Hot Topics ... What's in this article? What Is Appendicitis? Symptoms of Appendicitis Development and Duration of Appendicitis When to Call the ...

  3. Appendicitis

    ... function. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure, problems with ... to pass gas Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical ...

  4. Complications of acute appendicitis: a review of 120 cases

    To find out the frequency of complications of acute appendicitis. Patients and Methods: A retrospective study was conducted at surgical unit-I and III, Chandka Medical College Hospital, Larkana. Case records of patients who were admitted with complications of appendicitis from June 2004 to May 2007 were examined and data analysed. Most common complications of appendicitis were appendicular mass (38.3%) followed by appendicular perforation and peritonitis (37.5%), appendicular abscess (10%), gangrene of appendix (11.6%) and intestinal obstruction (2.5%). Majority (66.6 %) of the cases were operated while 33:3% were treated by conservative measures. Appendicular mass and perforation were the main complications of untreated acute appendicitis. Complications of appendicitis usually result due to delay in diagnosis and treatment. (author)

  5. Solitary caecum diverticulitis mimicking acute appendicitis.

    Hot, Semih; Eğin, Seracettin; Gökçek, Berk; Yeşiltaş, Metin; Alemdar, Ali; Akan, Arzu; Karahan, Servet Rüştü

    2015-12-01

    Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room. PMID:27054646

  6. Acute appendicitis in unenhanced spiral CT: Diagnostic luxury or benefit?

    Purpose: To evaluate the diagnostic accuracy of thin collimated unenhanced spiral-CT in patients with clinically suspected acute appendicitis and to determine the impact on patient management and overall costs. Method: Unenhanced focussed appendiceal spiral-CT was performed in 56 patients (23 women and 33 men) with clinically suspected acute appendicitis. Scans were obtained from the L4 level to the symphysis pubis using 5 mm collimation, 7.5 mm table feed (pitch 1.5) and 4 mm increment without i.v., oral, or rectal contrast material. Prospective diagnoses based on CT findings were compared with surgical (and histopathological) results and clinical follow-up. The effect of spiral-CT on patient management and clinical pressources was assessed. Results: 29 patients (10 women and 19 men) underwent appendectomy. Unenhanced spiral-CT was an accurate impaging technique for the initial examination of patients with suspected acute appendicitis with a sensitivity of 95.4% and a specificity 100%, an accuracy of 98.2%, a positive predictive value of 100%, and a negative predictive value of 97.1%. In 27 patients with no evidence of acute appendicitis, an alternative diagnosis could be made in 24 patients by unenhanced spiral-CT. Conclusion: Unenhanced spiral-CT is an accurate test to diagnose or to exclude acute appendicitis. Routine appendiceal spiral-CT can improve medical care and reduce the overall costs for patients suspected of having acute appendicitis. (orig.)

  7. Laparoscopic management of acute appendicitis in situs inversus

    Golash Vishwanath

    2006-01-01

    Full Text Available Situs inversus is often detected incidentally in adults during imaging for a acute surgical emergency. We present a case of acute appendicitis in an adult who was previously unaware about his situs anomaly. A laparoscopic approach is helpful to deal with this condition. A 40 year old man was admitted with history of acute left lower abdominal pain, with uncontrolled diabetic keto-acidosis. Clinically, he was diagnosed as acute diverticulitis with localized peritonitis. Subsequent imaging studies and laparoscopy confirmed the diagnosis of situs inversus and acute left- sided appendicitis. He successfully underwent laparoscopic appendectomy. His postoperative recovery was uneventful. Although technically more challenging because of the reverse laparoscopic view of the anatomy, the laparoscopic diagnosis and management of acute appendicitis is indicated in situs inversus.

  8. Value of ultrasonography in the diagnosis of acute appendicitis

    During a 12-month period high-resolution, real-time ultrasonography (US) with graded compression was performed on 268 consecutive patients with clinically suspected acute appendicitis and its complications. US visualization of a fluid-filled, non-compressed appendix or a decompressed, thick-walled appendix was the primary criterion for a diagnosis of acute appendicitis. The sonographic findings were correlated with surgical-pathologic outcome in 92 cases and with the findings of clinical follow-ups in the remainder. US was found to be accurate in the diagnosis of acute appendicitis and its complication with a sensitivity of 93.3%, a specificity of 98.9%, and an accuracy of 97%. The predictive value of a positive test was 97.7%; that of a negative test was 96.7%. There were two false-positive examinations in patients with a thick-walled appendix or periapperdiceal abscess, which were surgically confirmed as appendiceal adenocarcinoma and perforated cecal diverticulitis respectively. There were six false-negative examinations in patients with a sonographically no-visible appendix, which were confirmed surgically as acute appendicitis (n=5) and perforated appendicitis (n=1). Our results show that high-resolution, real-time US is an accurate imaging modality in the diagnosis of acute appendicitis and the evaluation of its complications

  9. Acute appendicitis: most common clinical presentation and causative microorganism

    Objective: To determine the most common clinical presentation and causative microorganism for acute appendicitis. Study Design: Descriptive. Place and duration of study: Department of Surgery, Combined Military Hospital Multan, from June 2002 to May 2004. Patients and Methods: Clinical features of all the patients, older than 5 years of age diagnosed with acute appendicitis were recorded. Patients presented with other pathology which mimic acute appendicitis were excluded from the study. Surgery was done under general anaesthesia. Appendices of all the patient as well as pus swabs from abdominal cavity were sent to the laboratory for histopathology and microbiological cultures to confirm the diagnoses of acute appendicitis and causative organism. Results: The mean age of 75 subjects was 32.56 +- 11.93 years. The most common symptom was pain in right iliac fossa (80 % cases) and the most common physical sign was tenderness (92% cases). Some of the patients(9.3%) had a histologically normal appendix. Maximum isolates on culture were E. coli. Conclusion: The most common presentation of acute appendicitis was pain in right iliac fossa while the most sensitive sign was tenderness. Proper history and sharp clinical examination is the key to diagnosis. The most frequent organism of appendicitis was Escherichia Coli. (author)

  10. Acute appendicitis: position paper, WSES, 2013.

    Agresta, Ferdinando; Ansaloni, Luca; Catena, Fausto; Verza, Luca Andrea; Prando, Daniela

    2014-01-01

    Appendectomy is one of the most frequently performed operative procedures in general surgery departments of every size and category. Laparoscopic Appendectomy - LA - as compared to Open Appendectomy - OA - was very controversial at first but has found increasing acceptance all over the World, although the percentage of its acceptance is different in the various single National setting. Various meta-analyses and Cochrane reviews have compared LA with OA and different technical details. Furthermore, new surgical methods have recently emerged, namely, the single-port/incision laparoscopic appendectomy and NOTES technique. Their distribution among the hospitals, however, is unclear. Using laparoscopic mini-instruments with trocars of 2-3.5 mm diameter is proposed as a reliable alternative due to less postoperative pain and improved aesthetics. How to proceed in case of an inconspicuous appendix during a procedure planned as an appendectomy remains controversial despite existing study results. But the main question still is: operate or not operate an acute appendicitis, in the meaning of an attempt of a conservative antibiotic therapy. Therefore, we have done a literature survey on the performance of appendectomies and their technical details as well as the management of the intraoperative finding of an inconspicuous appendix in order to write down - under the light of the latest evidence - a position paper. PMID:24708651

  11. Acute cytomegalovirus infections in leukemic mice.

    Mayo, D. R.; Rapp, F

    1980-01-01

    Mice infected with 2 x 10(3) plaque-forming units of mouse cytomegalovirus (MCMV) 3 days after receiving 300 to 400 spleen focus-forming units of Friend leukemia virus developed a more severe MCMV infection than did normal animals. Increased severity was demonstrated by the increased amounts of MCMV recoverable from the salivary glands of leukemic mice 1 to 5 weeks postinfection. In addition, the difference in the number of virus isolations from the kidneys, spleens, livers, and lungs of anim...

  12. The diagnostic value of barium enema in acute appendicitis

    Acute appendicitis is the most common acute surgical condition of the abdomen. When the clinical presentation is atypical, barium enema has proven to be safe and useful in confirming the diagnosis and reducing the negative surgical exploration. However, the performance of barium enema in acute appendicitis has known contraindication primarily because of fear of leakage by perforation of the inflamed appendix. This study using barium enema as a diagnostic aid in acute appendicitis with atypical clinical presentation was performed to further support the previously noted efficacy and safety of this procedure. The results were as followings: 1. In case of acute appendicitis with atypical clinical presentation, the use of barium enema as a diagnostic aid increased the accuracy of diagnosis and decreased the negative surgical exploration. In women between 11 to 50 years old age, especially, it played important role differentiating appendicitis from nonsurgical acute abdomen. 2. The results of the study were 92.31% in sensitivity, 7.69% in false positive, 6.9% in false negative, and 10.26% in negative appendectomy. 3. None of case of leakage of barium by perforation of the inflamed appendix was noted, therefore, barium enema was thought to be safe as a diagnostic aid in acute appendicitis. 4. A simple partial or non filling of appendix without other associated positive finding could not exclude appendicitis, therefore, close clinical observation was necessary. 5. The positive findings of barium enema and their sensitivity were as followings: 1. Non filling of appendix: 90% 2. Partial filling of appendix: 91.7% 3. Displacement or a local impression on terminal ileum: 100%

  13. Ultrasound signs of acute appendicitis in children - clinical application

    Background. Acute appendicitis is a leading cause of the abdominal pain in children that need an urgent surgical treatment. Neither of individually clinical variables doesn't have a real discriminational nor predictive strength to be used as the only diagnostic test. A goal of this study is to define ultrasound criteria of the acute appendicitis by appointing of ultrasound parameters for this pathological condition, determine the relation between ultrasound signs and pathohistological finding, determine the connection of several ultrasound signs with a degree of the inflammation of the acute appendicitis. Methods. In the prospective study with an ultrasound method we examine 50 patients with clinical signs of the acute abdomen. In these patients, the sonographic diagnosis is confirmed by the surgical finding, in fact with a pathohistological diagnosis. A basic, positive sonograph finding of the acute appendicitis was the identification of tubular, noncompresive, aperistaltic bowel which demonstrates a connection with coecum and blind terminal. In our work we analysed the lasting of the symptoms until the hospital intervention in patients stratified according to the pathohistological finding. We used ultrasound equipment- Toshiba Sonolayer with convex 3.75 MHz and linear 8 MHz probes. Results. From 8 ultrasound signs of the acute appendicitis, only an anterior-posterior (AP) diameter of appendices, FAT (width of periappendicular fat tissue) and a peristaltic absence are positive ultrasound signs of the acute appendicitis. Appendicitis phlegmonosa is the most common pathohistological finding in our study (44%). Perforate gangrenous appendicitis and gangrenous appendicitis are represented in more than half of patients (30% + 22%), which suggests a long period of persisting symptoms until a hospital treatment. A statistic analysis shows a great possibility for using values of AP diameter, width of periapendicular fat tissue, just like the values of mural thickness in

  14. Study of 150 cases of acute appendicitis in children

    Fallahi Gh

    1998-06-01

    Full Text Available Acute appendicitis is the most common condidition, requiring emergency operation in children. Late appendicitis is still a major sours of morbidity and potential mortality. The charts of all pediatric appendectomy patients (150 cases treated between 1367-1373 (Iranian calender in Amir Kabir Medical Center were reviewed. Mean hospital stay was 4.7 days. Mean ages of patients was 8.5 years. Male to female ratio was 1.2/1. Most common symptom was abdominal pain (100% and deep tenderness in right lower quadrant in 94.6%. Mean temprature was 37.2 and leucocytosis (more than 10000 were in the 76.3%. 14 patients had perforated appendicitis and most common pathology was acut supporative appendicitis. Accuracy of diagnosis was 96.6% and post operative pelvic abccess was 2%. Mortality occurred in one case (0.6%

  15. Hydatidosis as a cause of acute appendicitis: a case report

    Hajizadeh, Maryam; Ahmadpour, Ehsan; Sadat, Amir Taher Eftekhar; Spotin, Adel

    2013-01-01

    Acute appendicitis is considered the most common cause of emergency surgery in children and young adults. The association between parasitic infections and appendicitis has been widely investigated. Hydatidosis, a zoonotic helminthic disease caused by the larval stage of the Echinococcus granulosus, may cause illness in intermediate hosts, generally human and herbivorous animals. This disease is considered hyper endemic in northwest of Iran and is a serious public health problem. Hydatidosis p...

  16. Diagnostic value of procalcitonin for acute complicated appendicitis

    Yamashita, Hiromasa; YUASA, NORIHIRO; TAKEUCHI, EIJI; Goto, Yasutomo; Miyake, Hideo; Miyata, Kanji; Kato, Hideki; Ito, Masafumi

    2016-01-01

    ABSTRACT A rapid and reliable test for detection of complicated appendicitis would be useful when deciding whether emergency surgery is required. We investigated the clinical usefulness of procalcitonin for identifying acute complicated appendicitis. We retrospectively analyzed 63 patients aged ≥15 years who underwent appendectomy without receiving antibiotics before admission and had preoperative data on the plasma procalcitonin level (PCT), body temperature (BT), white blood cell count (WBC...

  17. What is the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after CT?

    The objective of our study was to estimate the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after abdominoplevic CT. A total of 104 patients initially underwent abdominopelvic CT before appendix US due to acute abdominal pain. All CT examinations were evaluated retrospectively for the presence of acute appendicitis. The findings of appendix on CT were classified into five categories (definite appendicitis, probably appendicitis, equivocal CT findings for diagnosis of appendicitis, probably not appendicitis, and normal looking appendix). Appendix US images and their radiologic reports were also evaluated retrospectively. Then, CT and US findings were correlated with clinical or pathologic diagnosis. Three all patients with definite appendicitis initially on CT again showed US findings of appendicitis. In the 32 patients of probably appendicitis on CT, US showed normal looking appendix in seven patients (21.8%, 7 of 32) who improved with medical treatment and discharged. In the 16 patients of equivocal CT findings for diagnosis of appendicitis, US showed appendicitis in seven patients (43.8%, 7 of 16) and normal looking appendix in nine patients. In the 12 patients of probably not appendicitis on CT, US showed acute appendicitis in two patients (16.7%, 2 of 12). In the 41 patients of normal looking appendix on CT, US showed acute appendicitis in five patients (12.2%, 5 of 41). US reevaluation enables us to avoid misdiagnosis of appendicitis on CT and improve diagnostic accuracy of acute appendicitis.

  18. What is the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after CT?

    Jang, Kyung Mi [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Lee, Kwanseop [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)], E-mail: kwanseop@hallym.or.kr; Kim, Min-Jeong; Yoon, Hoi Soo; Jeon, Eui Yong; Koh, Sung Hye [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Min, Kwangseon [Department of Pathology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Choi, Dongil [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (Korea, Republic of)

    2010-04-15

    The objective of our study was to estimate the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after abdominoplevic CT. A total of 104 patients initially underwent abdominopelvic CT before appendix US due to acute abdominal pain. All CT examinations were evaluated retrospectively for the presence of acute appendicitis. The findings of appendix on CT were classified into five categories (definite appendicitis, probably appendicitis, equivocal CT findings for diagnosis of appendicitis, probably not appendicitis, and normal looking appendix). Appendix US images and their radiologic reports were also evaluated retrospectively. Then, CT and US findings were correlated with clinical or pathologic diagnosis. Three all patients with definite appendicitis initially on CT again showed US findings of appendicitis. In the 32 patients of probably appendicitis on CT, US showed normal looking appendix in seven patients (21.8%, 7 of 32) who improved with medical treatment and discharged. In the 16 patients of equivocal CT findings for diagnosis of appendicitis, US showed appendicitis in seven patients (43.8%, 7 of 16) and normal looking appendix in nine patients. In the 12 patients of probably not appendicitis on CT, US showed acute appendicitis in two patients (16.7%, 2 of 12). In the 41 patients of normal looking appendix on CT, US showed acute appendicitis in five patients (12.2%, 5 of 41). US reevaluation enables us to avoid misdiagnosis of appendicitis on CT and improve diagnostic accuracy of acute appendicitis.

  19. Acute Appendicitis Together with Chylous Ascites: Is It a Coincidence?

    Sami Akbulut

    2010-01-01

    Full Text Available Acute chylous ascites is a rarely seen clinical picture, therefore, examination findings are often confused with acute appendicitis. To the best of our knowledge, there is no publication to date showing the occurrence of them together. This study presents the treatment plan for a 25-year-old male patient with both acute chylous ascites and appendicitis. Surgical findings were retrocaecal appendicitis, evident lymphangiectasia in the proximal segment of jejunum, and approximately 3 lt of chylous fluid. An appendectomy was performed and drainage was applied. Low-fat total parenteral nutrition (TPN and octreotide treatment were administered for 7 days postoperatively. We also present a general review of some studies on chylous ascites, which have been published in the English language medical literature since 1910.

  20. CT scan for suspected acute appendicitis

    Widlus, David M.

    2012-01-01

    Appendicitis is common with a 7% lifetime risk for an individual in the United States. Mean age at diagnosis is 22 years old. While frequently clinically obvious, by 2006, more than 90% of patients diagnosed with appendicitis had a CT scan of the abdomen and pelvis performed. Use of CT scans has allowed a decrease in false-negative rate at appendectomy to under 10% from a rate of approximately 20% before routine use of CT scan. In addition, the rate of perforation has decreased from nearly 30...

  1. Surpass sound the value applying in diagnosing in the acute appendicitis

    Objective: Discuss the value applying in surpassing sound examining the diagnose in the acute appendicitis. Method: Acoustic images carry out retrospect nature analysis On being over after 168 example acute appendicitis of operation pathological mechanism verification. Result: Acute appendicitis's surpass sound diagnosing coincidence rate being 89.9%(151/168). Conclusion: Surpass sound examining that the diagnose to the acute appendicitis has important value. (authors)

  2. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    Chabanova, Elizaveta; Balslev, Ingegerd; Achiam, Michael;

    2011-01-01

    AND METHODS: The prospective study included 48 consecutive patients (29 female, 19 male, 18-70 years old, mean age=37.1 years). MRI examination was designed to be comfortable and fast; no contrast was administered. The sequences were performed during quiet respiration. The MRI findings were reviewed......PURPOSE: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. MATERIALS...... symptoms and 14 patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate (kappa=0.51) and fair (kappa=0.31) interobserver agreements in the MR...

  3. Validity of samul's paediatric appendicitis score (pas) in the diagnosis of acute appendicitis in children

    Objective: To validate the paediatric appendicitis score for the diagnosis of acute appendicitis in children using histopathology as a gold standard. Study Design: Case control study. Place and Duration of Study: Military Hospital (MH) and Combined Military Hospital (CMH) Rawalpindi, Pakistan from Dec 2009 to Jul 2010. Patients and Methods: Eighty five children 1-7year old who came to our tertiary surgical department with the chief complaint of abdominal pain of less than 7 days duration were included in the study. Paediatric appendicitis score (PAS) components including fever > 380 C, anorexia, nausea/vomiting, cough/percussion/hopping tenderness, right-lower-quadrant tenderness, migration of pain, leukocytosis > 10,000 (109/1) and polymorphonuclear - neutrophilia > 7500 (109/1) were assessed and recorded on admission, but the sum was not calculated until later and the score did not play any role in the management of the patient. The diagnosis of appendicitis was made by the trainees and consultants clinically and with the aid of routine sonography of abdomen. After appendicetomies, resected specimens were sent for histopathological examination. Pre-operative PAS, histopathology report of resected appendix were endorsed on patient's performa. A two by two table was used to determine sensitivity, specificity, positive and negative predictive values and diagnostic efficacy of PAS. Results: Sensitivity of PAS was 92.16%, specificity 88.23%, positive predictive value 92.16%, negative predictive value 88.23% and the diagnostic efficacy 90.59%. Conclusion: PAS is a highly sensitive test with fair degree of specificity in diagnosing acute appendicitis in children and its routine usage may improve the diagnostic accuracy. (author)

  4. Torsion of an Epiploic Appendix Pretending as Acute Appendicitis

    Kamran Ahmad Malik

    2010-07-01

    Full Text Available Torsion of an epiploic appendix is a rare surgical entity. Its unusual symptomatology, wide variation in physical findings and the absence of helpful laboratory and radiological studies makes it very difficult to diagnose pre-operatively. This is a report of this rare entity found in a patient upon diagnostic laparoscopy performed for suspected acute appendicitis

  5. Ileocecocolic Intussusception Induced by Acute Appendicitis: A Case Report

    Jo, Bang Sil; Kim, Min Jeong; Jang, Kyung Mi; Lee, Hyun; Jeon, Eui Yong; Lee, Kwan Seop; Lee, Yul [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2009-09-15

    Intussusception is a rare disease in adults. Moreover, appendiceal disease is very rarely the leading cause of adult intussusception. We report a case in which ileocecocolic intussusception is secondary to an acute appendicitis in an adult, and describe the radiologic, clinical, and pathologic findings.

  6. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    Chabanova, Elizaveta; Balslev, Ingegerd; Achiam, Michael;

    2011-01-01

    by two radiologists and one surgeon independent of each other and compared with surgical and pathological records. RESULTS: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical...

  7. Perforation rate in acute appendicitis: association with different risk facotrs

    B. Khorasani

    2006-08-01

    Full Text Available Background: The early diagnosis of acute appendicitis before progression to gangrene or abscess formation is recognized as important to minimize morbidity from this common disease process. The aim of this study was to assess the value of different risk factors in the diagnosis of perforation. Methods: This descriptive-analytic and retrospective study was conducted to investigate epidemiological characteristics in patients with perforated and non-perforated appendicitis. A series of 1311 patients who were operated on for acute appendicitis between years 1380-1382 in Shahid Beheshti and Yahya-nejad hospitals were reviewed.. Data gathered included age at operation, gender, care sought prior to admission for appendectomy including antibiotic and analgesic therapy, time of presentation in the year, duration of symptoms, signs and symptoms at the time of admission, and the patient’s living area. Results: One hundred twenty one of 1311 patients (9% had perforated appendicitis and 1190 patients (91% had unperforated appendicitis. Presentation and referral in the first 6-month was associated with higher perforation rate. Patients from rural area showed a higher rate of perforations. The perforation rate was significantly higher in elderly patients (>65 year. When the duration of symptoms was more than 12 hours at presentation, the risk of perforation showed a five-fold increase. 30.7% of perforated cases had used antibiotic or sedative before referring to the hospital. Conclusion: Appendiceal perforation continues to be a complication in patients with acute appendicitis and increased in the frequency as the age of the patients increase and the duration of symptoms lengthen. We also found that the perforation rate is higher in patients from rural area and in whom present in the first 6-month of the year, a finding that was not reported so far.

  8. The impact of ultrasound in suspected acute appendicitis

    Aims: To evaluate prospectively the impact of an appendix ultrasound (US) service on the clinical management of patients presenting with suspected acute appendicitis. Materials and methods: The referring clinician completed a proforma for patients presenting with suspected acute appendicitis. Two visual analogue scales assessed clinical suspicion before and after knowledge of laboratory results. The clinician also indicated if they intended to operate had US been unavailable. During a 3-year period, 327 patients were examined by graded-compression US and diagnosed 'positive' or 'negative' for acute appendicitis. Findings were correlated with histopathology results. The referring clinician completed a retrospective audit questionnaire to assess user satisfaction. Results: Clinical suspicion was altered by knowledge of laboratory results. The decision to operate if US had been unavailable, was 'yes' in 70 cases (group A), 'no' in 231 (group B), and incomplete in 26 (group C). In group A, 31 patients (44.3%) had a negative US and 25 avoided surgery. US identified 39 cases of appendicitis and 37 appendicectomies confirmed appendicitis in 34 cases. In group B, 72 (31.2%) patients had a positive US and 66 appendicectomies confirmed 51 cases of appendicitis. The sensitivity of US was 94.7% in group A, 93.3% in group B and 93.8% overall. Specificity was 90.6% in group A, 91.2% in group B and 91.3% overall. US findings were contrary to intended surgical management in 103 cases. Management was altered in 97 cases (32.2%), with a positive outcome in 85 (28.2%). The referrers found US of appendix very useful in planning appropriate management. Conclusion: US of the appendix increases diagnostic accuracy, alters management and is more sensitive and specific than clinical impression, either alone, or in conjunction with laboratory results

  9. Faecal loading in the cecum as a new radiological sign of acute appendicitis

    Purpose: Although the radiological features of acute appendicitis have been well documented, the value of the plain radiography has not been fully appreciated. The aim of this study was to determine the frequency of the association of acute appendicitis and images of faecal loading in the cecum. Methods: Plain abdominal radiographs of 100 consecutive adult patients operated on acute appendicitis were assessed. The presence of faecal loading was registered. Results: The presence of faecal loading in the cecum occurred in 97 of the cases of acute appendicitis. Conclusion: This study seems to demonstrate that the presence of radiological images of faecal loading in the cecum may be a useful sign of acute appendicitis

  10. Sonographic study about differential diagnosis between acute appendicitis and non-appendicitis in appendices of borderline diameter

    To find out the sonographic criteria which can be effectively used to differentiate acute appendicitis from non-appendicitis in patients with appendices with borderline diameter(5-8 mm). Sixteen patients diagnosed as acute appendicitis, another 16 patients diagnosed as non-appendicitis were included in this study. They complained of RLQ pain and their appendices measured 5-8 mm in diameter on sonogram. Features such as appendiceal wall thickness, presence or absence of air in appendiceal lumen, movability of tip of the appendix, compressibility of the appendix were evaluated on gray-scale sonogram and thereafter, presence or absence of color flow in the wall of the appendix was evaluated on color Doppler sonogram. Thickness of appendiceal wall is 2.98 ± 0.77 mm in acute appendicitis group and 1.73 ± 0.44 mm in non-appendicitis group (p<0.05). When 2.5 mm thickness of appendiceal wall is applied for diagnosis of acute appendicitis, sensitivity is 81.3%, specificity is 87.5% and accuracy is 84.4%. With absence of air in appendiceal lumen, sensitivity is 93.8%, specificity is 68.8% and accuracy is 81.3%. With absence of movability of appendiceal tip, sensitivity is 87.5%, specificity is 50% and accuracy is 68.8%. With absence of compressibility of the appendix, sensitivity is 100%, specificity is 31.3% and accuracy is 65.6%. With color flow in appendiceal wall, sensitivity is 81.3%, specificity is 62.5% and accuracy is 71.9%. The above mentioned criteria show statistically significant difference between acute appendicitis and non-appendicitis groups (p<0.05). When the diameter of the appendix measures 5-8 mm on sonogram, evaluation of thickness of appendiceal wall, air in appendiceal lumen, movability of tip, compressibility and color flow in the wall will be helpful to diagnose the acute appendicitis with confidence.

  11. Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases

    Kurtulus Idris

    2008-04-01

    Full Text Available Abstract Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum.

  12. Case report of recurrent acute appendicitis in a residual tip.

    O'Leary, Donal P

    2010-01-01

    INTRODUCTION: Residual appendicitis involving the stump of the appendix has been well described in the literature in the past. CASE REPORT: We report the case of a 43 year old male with acute onset of abdominal pain who had undergone an appendicectomy ten years previously. Ultrasound revealed the presence of an inflamed tubular structure. Subsequent laparotomy and histology confirmed that this structure was an inflamed residual appendiceal tip. CONCLUSION: Residual tip appendicitis has not been reported in the literature previously and should be considered in the differential diagnosis of localised peritonitis in a patient with a history of a previous open appendicectomy.

  13. Clinical research. Acute appendicitis in children. Review of 324 operated cases

    A retrospective review was made of 324 operated cases of acute appendicitis for sixteen years from 1989 to 2005. For seven years from 1999 to 2005, an additional review was made of 63 cases where patients visited our department on suspicion of acute appendicitis and received medical treatment without operation. Cases of hospitalization on suspicion of appendicitis averaged 18 a year for 1999 to 2005, with half these being appendicitis or peritonitis due to perforated appendicitis. The number of cases by age groups for those with acute appendicitis reached 25 per year in 1997 but fell off from 1998 onwards. Out of the total 324 cases, 179 were boys, 145 were girls, and there were 188 cases of acute appendicitis and 136 cases of perforated appendicitis. There were 23 cases of catarrhal appendicitis, with three cases out of the 63 cases overall of the last seven years. There were 66 cases for ages 0 to 6, 168 cases for ages 7 to 11, and 90 cases for ages 12 to 20, the peak age group being 7 to 11. Perforated appendicitis occurred in 65.2% of cases involving infants under six, which is relatively high compared to the 36.0% of the over seven age grouping. There were 112 cases of fecalith out of the 324 overall cases, 24.5% of acute appendicitis cases and 48.5% of perforated appendicitis cases. Over the last seven years ultrasound examination made visible the inflamed appendix in 41 cases of 46 (89.1%) for acute appendicitis and in 16 cases of 17 (94.1%) for perforated appendicitis. CT scans were used in five cases of acute appendicitis/perforated appendicitis out of the 324 overall cases. Five of the 63 cases of surgical operations from 1999 to 2005 involved surgery made after diagnosis of acute appendicitis after follow-up hospitalization. Types of operations involved 11 cases of laparoscopic appendectomy, the remaining 313 operations involving classical open appendectomy. (author)

  14. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    Chabanova, Elizaveta, E-mail: elcha@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Balslev, Ingegerd, E-mail: inbal@heh.regionh.dk [Department of Pathology, Copenhagen University Hospital at Herlev (Denmark); Achiam, Michael, E-mail: micach01@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Nielsen, Yousef W., E-mail: yujwni01@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Adamsen, Sven, E-mail: svad@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Gocht-Jensen, Peter, E-mail: petgoc01@heh.reginh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Brisling, Steffen K., E-mail: stkibr01@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Logager, Vibeke B., E-mail: viloe@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Thomsen, Henrik S., E-mail: heth@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark)

    2011-08-15

    Purpose: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. Materials and methods: The prospective study included 48 consecutive patients (29 female, 19 male, 18-70 years old, mean age = 37.1 years). MRI examination was designed to be comfortable and fast; no contrast was administered. The sequences were performed during quiet respiration. The MRI findings were reviewed by two radiologists and one surgeon independent of each other and compared with surgical and pathological records. Results: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14 patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate ({kappa} = 0.51) and fair ({kappa} = 0.31) interobserver agreements in the MR diagnosis of acute appendicitis were found between the reviewers. Sensitivity, specificity and accuracy values for overall performance of MRI in detecting pelvic abnormalities were 100%, 75% (3 of 4 healthy patients were identified by MRI) and 98%, respectively. Conclusion: Unenhanced fast MRI is feasible as an additional fast screening before the appendectomy. It may prevent unnecessary surgeries. The fast MRI examination can be adequately performed on an MRI unit of broad range of field strengths.

  15. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    Purpose: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. Materials and methods: The prospective study included 48 consecutive patients (29 female, 19 male, 18-70 years old, mean age = 37.1 years). MRI examination was designed to be comfortable and fast; no contrast was administered. The sequences were performed during quiet respiration. The MRI findings were reviewed by two radiologists and one surgeon independent of each other and compared with surgical and pathological records. Results: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14 patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate (κ = 0.51) and fair (κ = 0.31) interobserver agreements in the MR diagnosis of acute appendicitis were found between the reviewers. Sensitivity, specificity and accuracy values for overall performance of MRI in detecting pelvic abnormalities were 100%, 75% (3 of 4 healthy patients were identified by MRI) and 98%, respectively. Conclusion: Unenhanced fast MRI is feasible as an additional fast screening before the appendectomy. It may prevent unnecessary surgeries. The fast MRI examination can be adequately performed on an MRI unit of broad range of field strengths.

  16. High-Resolution Ultrasonography (US) of Appendiceal Specimens: Differentiation of Acute Non-perforated Appendicitis from Perforated Appendicitis

    To analyze surgical specimens from patients with acute non-perforated and perforated appendicitis using high-resolution ultrasonography (US), and to correlate the US features with the pathologic findings. One hundred and six surgical appendix specimens obtained from patients with suspected acute appendicitis were evaluated. The following US features were evaluated for differentiating acute non-perforated appendicitis from perforated appendicitis: circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, the sum of opposing walls ≥ 9 mm and the presence of appendicoliths. The sensitivity and specificity of the US findings for diagnosing perforated appendicitis were determined. All US features were detected significantly more often in the perforated appendicitis group of specimens. The disruption of the serosal layer was the most significant independent predictor of perforation (p < .001). The sensitivity for circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, wall thickness ≥ 9 mm, and the presence of appendicoliths individually was 84.6%, 69.2%, 61.5%, 73.1% and 46.2%, respectively. The specificity for all of these findings was 86.3%, 98.7%, 95.0%, 85.0% and 85.0%, respectively. High-resolution US of appendiceal specimens was very useful for differentiating acute non-perforated from perforated appendicitis

  17. Fecal loading in the cecum as a new radiological sign of acute appendicitis

    Andy Petroianu; Luiz Ronaldo Alberti; Renata Indelicato Zac

    2005-01-01

    AIM: Although the radiological features of acute appendicitis have been well documented, the value of plain radiography has not been fully appreciated. The aim of this study was to determine the frequency of the association of acute appendicitis with images of fecal loading in the cecum.METHODS: Plain abdominal radiographs of 400 patients operated upon for acute appendicitis (n = 100), acute cholecystitis (n = 100), right acute pelvic inflammatory disease (n = 100) and right nephrolithiasis (n = 100)were assessed. The presence of fecal loading was recorded and the sensitivity and specificity of this sign for acute appendicitis were calculated.RESULTS: The presence of fecal loading in the cecum occurred in 97 patients with acute appendicitis, 13 patients with acute cholecystitis, 12 patients with acute inflammatory pelvic disease and 19 patients with nephrolithiasis. The sensitivity of this sign for appendicitis was 97% and its specificity to this disease was 85.3%. Its positive predictive value for appendicitis was 68.7%; however, its negative predictive value for appendicitis was 98.8%.CONCLUSION: The present study suggests that the presence of radiological images of fecal loading in the cecum may be a useful sign of acute appendicitis, and the absence of this sign probably excludes this disease.This is the first description of fecal loading as a radiological sign for acute appendicitis.

  18. Acute appendicitis complicated by mass formation occurring simultaneously with serologically proven dengue fever: a case report

    Senanayake, Manouri P; Samarasinghe, Malik

    2014-01-01

    Introduction Acute abdomen and acute appendicitis are unusual clinical presentations that occur in dengue infection–caused illness. Lymphoid hyperplasia and mesenteric adenitis are possible explanations, although vasculitis in the pathology of dengue infection has not been reported. Authors of previous case reports have described mimicking of acute appendicitis discovered upon surgical treatment. Dengue virus has not been proven to cause acute appendicitis. Case presentation We report a case ...

  19. Acute appendicitis: computed tomography findings - an iconographic essay

    Acute appendicitis is the most important cause of abdominal pain requiring surgical intervention in the Western world. The early diagnosis of this disease is of paramount relevance for minimizing its morbidity. Imaging methods have represented a huge progress in the diagnosis of this entity, which used to be based essentially on clinical history, physical examination and laboratory tests results, considering that 20% to 33% of patients present with atypical symptoms. Diagnostic difficulty is higher in children, the elderly, and women in childbearing age. The main imaging methods for evaluation of acute appendicitis are ultrasound and computed tomography. The present study is aimed at describing the disease physiopathology, commenting main computed tomography technical aspects, demonstrating and illustrating tomographic findings, and describing main differential diagnoses. (author)

  20. The activity of granulocyte alpha-amylase in acute appendicitis.

    Zakrzewska, I; Gajda, R

    1994-01-01

    The activity of alpha-amylase was measured in isolated granulocytes, serum and urine of 35 patients with acute appendicitis. The measurements were performed before operation and on the 7th day after operation. Slightly increased activity of alpha-amylase was found in the serum and urine of 15 patients. On the 7th day after operation the activity of this enzyme reached normal value. The activity of granulocyte alpha-amylase was elevated in 22 patients. In 2 of them the increased activity still maintained on the 7th day after operation. Positive correlation between the serum and granulocyte alpha-amylase activities was found. These observations allow to conclude that granulocytes are the source of increased alpha-amylase activity in the serum of patients with acute appendicitis. PMID:7497089

  1. Issues in Management of Acute Appendicitis in Pregnancy

    Sivalingam Nalliah; Lionel Wijesuriya; Subramani Venugopal

    2011-01-01

    Acute appendicitis is an infrequent yet the commonestsurgical emergency in pregnancy occurring in about1:1500 pregnancies. The classical abdominal pain in theright lower quadrant of the abdomen is the only reliableclinical sign. Delay in diagnosis is attributed to presenceof symptoms commonly seen in pregnancy like nauseaand vomiting and difficulty in localizing abdominal paindue to displacement of the appendix with advancinggestation. Perforated appendix and generalizedperitonitis impacts ad...

  2. The platelet indices in pediatric patients with acute appendicitis

    Yunus Yilmaz; Fatih Kara; Musa Gumusdere; Hasan Arslan; Sefer Ustebay

    2015-01-01

    Background: The diagnosis of Acute Appendicitis (AA) remains a problem in pediatric population. It has been suggested that Mean Platelet Volume (MPV) is lower in the patients with AA. The purpose of this study was to investigate the diagnostic value of platelet indices in pediatric AA cases. Methods: A retrospective case-controlled study was designed: 224 subjects were included in this study. All patients had been operated on in division of pediatric surgery at the Kars Government Hospita...

  3. Macroamylasemia in a patient with acute appendicitis: a case report.

    Um, J. W.; Kim, K.H.; Kang, M. S.; Choe, J. H.; Bae, J. W.; Hong, Y S; Suh, S O; Kim, Y C; Whang, C. W.; Kim, S. M.

    1999-01-01

    Macroamylasemia is a condition of persistent, elevated serum amylase activity with no apparent clinical symptoms of a pancreatic disorder. In Korea, however, no such case has been reported to date. We report a case of a 17-year-old female diagnosed with macroamylasemia and acute appendicitis. One day earlier, she developed epigastric and right lower quadrant abdominal pain. She was characterized by high level of serum amylase, but normal lipase. Amylase isoenzyme analysis demonstrated increas...

  4. Comparison of helical computed tomography and ultrasonography in diagnosis of acute appendicitis

    The objective of study is to compare the diagnostic accuracy of helical computed tomography and ultrasonography in acute appendicitis using histopathology as gold standard. Thirty cases of clinically suspected acute appendicitis were included in the study selected on non probability convenience sampling technique. Computed tomography and graded compression ultrasonography of right lower quadrant of abdomen were conducted and results compared with histopathological findings. Amongst 30 patients who underwent computed tomography and graded compression ultrasonography examinations of right lower quadrant for diagnosis of acute appendicitis, on computed tomography 19 were diagnosed with acute appendicitis, 10 were diagnosed as not having the disease and 01 patient diagnosed as not having appendicitis on computed tomography did not improve clinically, was operated upon and histopathology proved it as acute appendicitis. While on graded compression ultrasonography 15 were diagnosed with acute appendicitis, 11 were diagnosed as not having the disease and 04 patients diagnosed as not having appendicitis on ultrasonography, did not improve clinically, were operated upon and histopathology proved it as acute appendicitis. This showed that CT scan has sensitivity of 95%, specificity 100%, positive predictive value 100%, negative predictive value 90.91% and overall accuracy of 96.67% while ultrasonography has sensitivity of 78.9%, specificity 100%, positive predictive value 100%, negative predictive value 73.33% and overall accuracy of 86.67%. We concluded that Helical computed tomography is highly accurate in diagnosing acute appendicitis as compared to ultrasonography and it helps to reduce negative appendectomy rate. (author)

  5. [New ways in the surgery of acute appendicitis?].

    Magdeburg, R; Kähler, G

    2013-06-01

    Acute appendicitis is still one of the most common abdominal emergencies necessitating operative treatment. For the past century, the conventional management of appendicitis has been open appendectomy. Since the introduction of laparoscopic appendectomy, it has been performed with increased frequency. Clinical trials evaluating outcomes comparing open appendectomy with laparoscopic appendectomy indicate that laparoscopic appendectomy is associated with lower complication rate and lower mortality and is to be considered the procedure of choice for patients with suspected acute appendicitis. Ever since Kalloo's first report on transgastric peritoneoscopy in a porcine model in 2004, this dramatic surgical revolution has prompted many surgeons and endoscopists to study this new technique. This complex technique involves breaching the wall of a hollow organ to gain access into the peritoneum: Natural Orifice Translumenal Endoscopic Surgery (NOTES). In recent years, several NOTES experiments have been carried out in animal models and even on humans, including appendectomy. NOTES may help to reduce surgical pain and shorten recovery time. The concept of NOTES has generated intensive interest in the medical community as well as in the group of patients. Although the novel procedure is still far from being mature and many technical problems have to be overcome and more clinical studies have to be done before its widespread application in human appendectomy, NOTES is a promising procedure for the future. PMID:23325519

  6. Retroperitoneal Leiomyosarcoma Mimicking Acute Appendicitis: Laparoscopic Management

    Agresta, Ferdinando; De Simone, Paolo; Michelet, Ivan; Bedin, Natalino

    2003-01-01

    Background: Retroperitoneal leiomyosarcomas (RLMS) are a challenging clinical entity. The vast majority of patients are operated on when tumors are advanced. We report herein a case of RLMS, mimicking acute appendiceal disease and treated successfully via laparoscopy. Methods: A 37-year-old woman, para 1, was admitted to our department for right lower quadrant abdominal pain, fever, and leukocytosis. She had no changes in gastrointestinal and urologic function. A physical examination revealed...

  7. Changes in the epidemiology of acute appendicitis and appendectomy in Danish children 1996-2004

    Andersen, S B; Paerregaard, A; Larsen, K

    2009-01-01

    PURPOSE: Aim of the study was to describe changes in the epidemiology of acute appendicitis in Danish children between 0-19 years of age for the period 1996-2004. METHODS: The study was based on discharge diagnoses taken from the Danish National Patient Registry of all 28 274 patients with a...... diagnosis of acute uncomplicated or complicated appendicitis, and/or a registered procedure code of appendectomy. These data were computed together with data on the background population, and incidences were calculated. RESULTS: A significant decrease in the incidence of acute uncomplicated appendicitis was...... found for all age groups (range, 13-36%). The decrease was present for both sexes, but most prominent in girls. The incidence of complicated acute appendicitis decreased by 10%. CONCLUSION: The incidence of acute appendicitis is declining. The incidence of uncomplicated appendicitis appears to be...

  8. The Diagnostic Value of D-dimer, Procalcitonin and CRP in Acute Appendicitis

    Bulent Kaya, Baris Sana, Cengiz Eris, Koray Karabulut, Orhan Bat, Riza Kutanis

    2012-01-01

    Full Text Available BACKGROUND: The early diagnosis of acute abdomen is of great importance. To date, several inflammatory markers have been used for the diagnosis of acute abdominal conditions, including acute appendicitis. The aim of this study was to evaluate the diagnostic utility of D-dimer, Procalcitonin (PCT and C-reactive protein (CRP measurements in the acute appendicitis.METHODS: This prospective study was conducted between March 1st, 2010 and July 1st, 2011. In this period, seventy-eight patients were operated with the diagnosis of acute appendicitis, and D-dimer, PCT and CRP levels of the patients were measured. The patients were grouped as phlegmonous appendicitis (Group 1, gangrenous appendicitis (Group 2, perforated appendicitis (Group 3 and negative appendectomy (Group 4 according to the surgical findings and histopathological results.RESULTS: Of 78 patients, 54 (69.2 % were male and 24 (30.8 % were female, and the mean age was 25.4 ± 11.1 years (range, 18 to 69 years. 66 (84.6 % patients had increased leukocyte count (white blood cell count. The PCT values were higher than the upper normal limit in 20 (25.6% patients, followed by D-dimer in 22 (28.2 % patients and CRP in 54 (69.2 % patients. The diagnostic value of leukocyte count and CRP in acute appendicitis was higher than that of the other markers, whereas leukocyte count showed very low specificity. CRP values were higher in perforated appendicitis when compared with the phlegmonous appendicitis (p<0.05. However, PCT and D-dimer showed lower diagnostic values (26% and 31%, respectively.CONCLUSION: An increase in CRP levels alone is not sufficient to make the diagnosis of acute appendicitis. However, CRP levels may differentiate between phlegmonous appendicitis and perforated appendicitis. Due to their low sensitivity and diagnostic value, PCT and D-dimer are not better markers than CRP for the diagnosis of acute appendicitis.

  9. Contrast-enhanced power Doppler US in the diagnosis of acute appendicitis

    Introduction/objective: To determine the value of power Doppler (PD) ultrasonography (US) and contrast-enhanced power Doppler (CEPD) US in the diagnosis of acute appendicitis and the prediction of histopathologic stages. Methods and material: 50 patients with suspected acute appendicitis were evaluated by the same radiologist with PD US and CEPD US. Air micro bubbles stabilized by a granulate of 'galactose and palmitic acid' were used as a contrast medium for sonography with the concentration of 400 mg/ml. PD US and CEPD US results were later correlated with the surgical and histopathologic findings. PD US and CEPD US findings were considered positive for appendicitis; if there was depiction of hyperemia in the wall of the appendix or if there was depiction of prominent peripheral vascularity when compared with normal soft tissues; and negative if both hyperemia and peripheral hyperemia were not prominent. Results and discussions: Of the 50 patients, 35 patients had histopathologically proven acute appendicitis. CEPD US showed prominent hyperemia in the appendiceal vessels or feeding vessels of the inflamed appendix, and resistance index (RI) calculations were easier. There was statistically significant difference between mean RI values of the normal appendix, suppurative appendicitis and gangrenous appendicitis. PD US has accuracy of 80%, sensitivity of 74% and CEPD US has 98%, and 100% in the diagnosis of acute appendicitis. CEPD US identified 100% of suppurative appendicitis and gangrenous appendicitis. Conclusion: CEPD US is a promising method in the diagnosis of acute appendicitis and determination of the inflammation stage

  10. Retrospective evaluation of acute appendicitis incorrectly diagnosed on CT

    The purpose of our study was to retrospectively evaluate the CT images of patients suffering with surgically proven appendicitis to determine the causes of missed diagnoses. We reviewed the pathology reports of the patients with surgically proven appendicitis from two hospitals during a 3-year period. Thirty-seven such cases with a misdiagnosis were identified and they served as our misdiagnosed group (17 females and 20 males, mean age: 58 years, age range 15-68 years). These were cases that were misdiagnosed on preoperative abdominal CT. All 57 patients in the control group (30 females and 27 males, mean age: 44 years, age range: 21-78 years) had undergone laparotomy for acute appendicitis and they had been correctly diagnosed preoperatively on CT. Two abdominal radiologists evaluated the following items from all 94 CT examinations: 1) an abnormal appendix, 2) periappendiceal fat inflammation, 3) pericecal extraluminal fluid, 4) pericecal extraluminal air, 5) appendicolith, 6) cecal wall thickening, 7) small bowel dilatation, and 8) the pericecal fat content. Statistical analysis was performed using a Chi-squared test and Fisher's exact test. Any abnormal appendix was not visualized, even retrospectively, in 27 (73%) of the 37 patients from the misdiagnosed group, whereas it was not visualized in 13 (23%) of the 57 patients in the control group (ρ = 0.001). Of the patients who had been misdiagnosed, inflammation of the pericecal fat was observed in 21 patients (57%) as compared to 50 (88%) patients in the control group (ρ =0.001). Pericecal fluid and air were noted in 15 (41%) and 9 (24%) patients, respectively, in the misdiagnosed group and in 19 (33%) and 14 (25%) patients, respectively, in the control group, (ρ = 0.477 and ρ =0.901, respectively). Appendicolith was found in 3 (8%) misdiagnosed subjects and in 10 (18%) of the controls (ρ = 0.001). Focal cecal wall thickening was noted in 14 (38%) misdiagnosed patients and in 28 (49%) control patients (

  11. Clinical impact of leukemic blast heterogeneity at diagnosis in cytogenetic intermediate-risk acute myeloid leukemia

    Hoffmann, Marianne Hutchings; Klausen, Tobias Wirenfeldt; Boegsted, Martin;

    2012-01-01

    Individual cellular heterogeneity within the acute myeloid leukemia (AML) bone marrow samples can be observed by multi parametric flow cytometry analysis (MFC) indicating that immunophenotypic screening for leukemic blast subsets may have prognostic impact.......Individual cellular heterogeneity within the acute myeloid leukemia (AML) bone marrow samples can be observed by multi parametric flow cytometry analysis (MFC) indicating that immunophenotypic screening for leukemic blast subsets may have prognostic impact....

  12. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  13. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    Choi, Gyu Chang [Dept. of Radiology, Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of)

    2011-07-15

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p < 0.001). The sensitivity of circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  14. Diagnostic value of procalcitonin for acute complicated appendicitis

    Yamashita, Hiromasa; Yuasa, Norihiro; Takeuchi, Eiji; Goto, Yasutomo; Miyake, Hideo; Miyata, Kanji; Kato, Hideki; Ito, Masafumi

    2016-01-01

    ABSTRACT A rapid and reliable test for detection of complicated appendicitis would be useful when deciding whether emergency surgery is required. We investigated the clinical usefulness of procalcitonin for identifying acute complicated appendicitis. We retrospectively analyzed 63 patients aged ≥15 years who underwent appendectomy without receiving antibiotics before admission and had preoperative data on the plasma procalcitonin level (PCT), body temperature (BT), white blood cell count (WBC), neutrophil / lymphocyte ratio (N/L ratio), and C-reactive protein level (CRP). Patients were classified into 3 groups: group A (inflammatory cell infiltration of the appendix with intact mural architecture), group B (inflammatory cell infiltration with destruction of mural architecture, but without abscess or perforation), and group C (macroscopic abscess and/or perforation). For identifying destruction of mural architecture, the diagnostic accuracy of PCT was similar to that of BT or CRP. However, the diagnostic accuracy of PCT was highest among the five inflammatory indices for identifying abscess and/or perforation, with the positive predictive value of PCT for abscess and/or perforation being higher than that of CRP (73% vs. 48%). Univariate analysis of the predictors of abscess and/or perforation revealed that a plasma PCT level ≥0.46 ng/mL had the highest odds ratio (30.3 [95% confidence interval: 6.5–140.5] versus PCT <0.46 ng/mL). These findings indicate that procalcitonin is a useful marker of acute appendicitis with abscess and/or perforation. PMID:27019529

  15. Appendicular mass complicating acute appendicitis in a patient with dengue fever.

    Low, Y N; Cheong, B M K

    2016-04-01

    Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis. PMID:27326951

  16. Issues in Management of Acute Appendicitis in Pregnancy

    Sivalingam Nalliah

    2011-06-01

    Full Text Available Acute appendicitis is an infrequent yet the commonestsurgical emergency in pregnancy occurring in about1:1500 pregnancies. The classical abdominal pain in theright lower quadrant of the abdomen is the only reliableclinical sign. Delay in diagnosis is attributed to presenceof symptoms commonly seen in pregnancy like nauseaand vomiting and difficulty in localizing abdominal paindue to displacement of the appendix with advancinggestation. Perforated appendix and generalizedperitonitis impacts adversely on pregnancy contributingto increases in miscarriage, pre-term delivery, fetalloss and even maternal mortality. Imaging studieslike abdominal ultrasonogram, helical computerizedtomography and magnetic imaging have been utilizedto complement clinical suspicion and decrease ‘negativeappendectomies’ but robust data on their routine use isawaited. Although the laparoscopic approach is a usefuldiagnostic and therapeutic tool in early pregnancy, itsuse as the primary approach for appendicectomy inpregnancy requires further evaluation as increases inthe incidence of fetal loss of 5.6% has been reportedcompared to 3.1% in open access surgery.

  17. Macroamylasemia in a patient with acute appendicitis: a case report.

    Um, J W; Kim, K H; Kang, M S; Choe, J H; Bae, J W; Hong, Y S; Suh, S O; Kim, Y C; Whang, C W; Kim, S M

    1999-12-01

    Macroamylasemia is a condition of persistent, elevated serum amylase activity with no apparent clinical symptoms of a pancreatic disorder. In Korea, however, no such case has been reported to date. We report a case of a 17-year-old female diagnosed with macroamylasemia and acute appendicitis. One day earlier, she developed epigastric and right lower quadrant abdominal pain. She was characterized by high level of serum amylase, but normal lipase. Amylase isoenzyme analysis demonstrated increased fraction of salivary type and follow-up amylase level was persistently increased. Immunofixation disclosed the macroamylase binding with an immunoglobulin, consisting of IgA and kappa chain. The patient was treated by appendectomy, and the abdominal pain subsided. PMID:10642949

  18. Acute appendicitis in a 14-year-old boy with familial Mediterranean fever

    Yoshihiko Sakurai; Takaaki Murata; Hirohisa Hirata; Takeshi Morita

    2015-01-01

    Familial Mediterranean fever (FMF) is one manifestation of a heritable periodic fever syndrome that is characterized by recurrent attacks of febrile polyserositis, most frequently peritonitis. An FMF abdominal attack is often misdiagnosed as acute appendicitis, a more common cause of an acute abdomen. We report a 14-year-old boy with FMF who developed acute appendicitis during his follow-up. The patient had a several-year history of abdominal pain episodes, and was initially admitted for an a...

  19. Synchronous presentation of acute acalculous cholecystitis and appendicitis: a case report

    Sahebally, Shaheel M

    2011-11-14

    Abstract Introduction Acute acalculous cholecystitis is traditionally associated with elderly or critically ill patients. Case presentation We present the case of an otherwise healthy 23-year-old Caucasian man who presented with acute right-sided abdominal pain. An ultrasound examination revealed evidence of acute acalculous cholecystitis. A laparoscopy was undertaken and the dual pathologies of acute acalculous cholecystitis and acute appendicitis were discovered and a laparoscopic cholecystectomy and appendectomy were performed. Conclusion Acute acalculous cholecystitis is a rare clinical entity in young, healthy patients and this report describes the unusual association of acute acalculous cholecystitis and appendicitis. A single stage combined laparoscopic appendectomy and cholecystectomy is an effective treatment modality.

  20. Sonography of acute appendicitis in pregnant women: diagnostic accuracy by the stage of gestation

    To evaluate the diagnostic accuracy of a diagnosis of acute appendicitis in pregnant women according to the trimester. A retrospective review was performed on 103 pregnant women who underwent sonography with clinically suspected acute appendicitis. The sonographic technique used involved either the graded compression or a non-compression method. All the sonograms were obtained after changing the patient's position and identifying the diseased appendix. The criterion for a sonographic diagnosis of acute appendicitis was the visualization of a non-compressible appendix with a maximal diameter ≥ 6 mm. The sonographic findings were correlated with the surgical findings and clinical follow-up. Acute appendicitis was confirmed by both the surgical and pathological findings in 48 out of 103 pregnant women. Ultrasound established the diagnosis in 34 of the 48 patients with proven appendicitis. There were false-positives in 2 patients and false-negatives in 14 patients. Among the 55 patients who had a normal appendix, 30 patients improved at the clinical follow-up and 25 patients had other intra-abdominal disorders. The diagnostic accuracy of the ultrasound was 94% in the first trimester, 81% in the second trimester, and 76% in the third trimester. The overall accuracy was found to be 84%, with a 71% sensitivity and a 96% specificity. No significant difference was found in the diagnostic accuracy of the ultrasound according to the trimester in which the acute appendicitis occurred. Therefore, regardless of the stage of gestation, sonography is a valuable procedure for diagnosing acute appendicitis

  1. Extramedullary Acute Myeloid Leukemia (AML: Leukemic Pleural Effusion, Case Report and Review of the Literature

    NaveenPemmaraju

    2014-06-01

    Full Text Available Objective and Importance: Malignant pleural effusions occur in the setting of both solid and hematologic malignancies. Pleural effusion caused by leukemic infiltration is an unusual extramedullary manifestation of acute myeloid leukemia (AML with fewer than 20 cases reported.1-11 We report a case of pericardial and pleural effusions in a patient with AML and review the literature. Clinical presentation: In this case, a 55 year old man with previous history of myeloproliferative neoplasm (MPN experienced transformation AML, heralded by appearance of leukemic pleural effusions. The patient was identified to have leukemic pleural effusion based upon extended cytogenetic analysis of the pleural fluid, as morphologic analysis alone was insufficient. Intervention: The patient was treated with hypomethylator-based and intensive chemotherapy strategies, both of which maintained resolution of the effusions in the remission setting. Conclusion: Due to the rarity of diagnosis of leukemic pleural effusions, both cytogenetic and fluorescence in situ hybridization (FISH testing are recommended. Futhermore, systemic chemotherapy directed at the AML can lead to complete resolution of leukemic pleural effusions. Objective and ImportancePleural effusion caused by leukemic infiltration is an unusual extramedullary manifestation of acute myeloid leukemia (AML, but may be more common than previously thought. Fewer than 20 cases have been reported.1-11 We report a case of pericardial and pleural effusions in a patient with AML and review the literature.

  2. The US findings of acute nonperforated and perforated appendicitis in children

    To analyse and interpret different sonographic findings in acute nonperforated and appendicitis. In 46 cases of acute appendicitis in children(26 girls, 20 boys) proven by surgery, sonographic findings were reviewed retrospectively. The findings of nonperforated and perforated appendicitis were analysed, focusing on the size, shape and echogenicity of the appendix, echo patterns of periappendiceal abscesses, mesenteric lymphadenopathy, and the prevalence of appendicolith. A noncompressible distended appendix was present in 18 of 21 patients with nonperforated appendicitis and in 13 of 25 patients with perforation. In 18 patients with nonperforated appendicitis, the average diameter of distended appendix was 8.6 mm ; target appearance was noted in 16 patients and loss of echogenic submucosa in two. In 13 patients with perforated appendicitis, the average diameter of appendix was 9.1 mm ; target appearance was noted in four patients and loss of echogenic submucosa in nine. Periappendiceal abscesses were present in 21 of 25 cases of perforated appendicitis, and the echogenicity of abscesses was mixed in 12 patients, hypoechogenic in eight, and hyperechogenic in one. Mesenteric lymphadenopathy was present in two of 21 patients with nonperforated appendicitis and in four of 25 with perforation. Appendicolith was detected on sonography in three of 25 patients with perforated appendicitis, but was found in seven patients during surgery. One patients with perforated appendicitis also had right side hydronephrosis. Sonographically false-negative results were obtained in six cases. A sonographic examination was useful to differenciate perforated and nonperforated appendicitis in children. Loss of echogenic submucosa in the distended appendix and periappendiceal abscess formation were important findings in diagnosis of perforated appendicitis

  3. Histopathological Feature of Acute Appendicitis in Kerman-Iran from 1997 to 2003

    Fatemeh Nabipour

    2005-01-01

    Full Text Available Acute appendicitis is one of the most common surgical conditions that affect about seven percent of the population. The histopathologic stages of appendicitis are important to regarding prognosis. To evaluate pathologic features of appendix after operation, this study was designed. 2753 appendices specimen that had been received to department of pathology of two major hospitals in Kerman-Iran during five years periods were reviewed by two pathologist and classification was performed by followed: Normal, early acute, acute, suppurative or purulent, gangrenous and perforated appendicitis. There were 54.6% males, the average age of patients was 24.9+/-13.3 (mean+/-SD, that 76.6% was under 30 years old. 34.2% of reports were normal histopathologically. The accuracy rate of acute appendicitis was 65.8%. Perforation observed to 0.8%. There was significant difference between sex and stage of development of appendicitis. Seasonal incidence was difference in various histopathology views, significantly. Finally, acute appendicitis was more frequent in men than women and was increase by age specially 19-30 years. Our results showed appendicitis was more frequent and higher in stage at winter.

  4. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases

    To decrease the negative appendectomy rate in children, knowledge of the misleading imaging findings on US and CT in negative appendicitis cases is important. To evaluate the negative appendectomy rate and describe the imaging findings of US and CT that lead radiologists to misdiagnose acute appendicitis in children. From 2007 to 2013, 374 children operated for suspected appendicitis were proved to either have acute appendicitis (n = 348) or to be negative for appendicitis (n = 26) on pathological reports. Negative appendectomy rates were compared among imaging modalities, age groups and genders. We retrospectively reviewed US and CT findings from negative appendectomy cases. The overall negative appendectomy rate was 7.0% (26/374). There were no statistically significant differences among the subgroups. The most common misleading presentations on US were sonographic tenderness (9/16, 56%) and non-compressibility (9/16, 56%). The most common misleading finding on CT were the presence of an appendicolith or hyperdense feces (5/12, 42%). Periappendiceal fat inflammation was observed in only one case of negative appendicitis on US and on CT. Radiologists can misdiagnose children with equivocal diameters of appendices as having acute appendicitis when sonographic tenderness or non-compressibility is present on US and when an appendicolith or hyperdense feces is noted on CT. The possibility of negative appendicitis should be borne in mind when periappendiceal fat inflammation is absent or minimal in indeterminate cases. (orig.)

  5. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases

    Kim, Seong Ho; Choi, Young Hun; Kim, Woo Sun; Cheon, Jung-Eun; Kim, In-One [Seoul National University Hospital, Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    To decrease the negative appendectomy rate in children, knowledge of the misleading imaging findings on US and CT in negative appendicitis cases is important. To evaluate the negative appendectomy rate and describe the imaging findings of US and CT that lead radiologists to misdiagnose acute appendicitis in children. From 2007 to 2013, 374 children operated for suspected appendicitis were proved to either have acute appendicitis (n = 348) or to be negative for appendicitis (n = 26) on pathological reports. Negative appendectomy rates were compared among imaging modalities, age groups and genders. We retrospectively reviewed US and CT findings from negative appendectomy cases. The overall negative appendectomy rate was 7.0% (26/374). There were no statistically significant differences among the subgroups. The most common misleading presentations on US were sonographic tenderness (9/16, 56%) and non-compressibility (9/16, 56%). The most common misleading finding on CT were the presence of an appendicolith or hyperdense feces (5/12, 42%). Periappendiceal fat inflammation was observed in only one case of negative appendicitis on US and on CT. Radiologists can misdiagnose children with equivocal diameters of appendices as having acute appendicitis when sonographic tenderness or non-compressibility is present on US and when an appendicolith or hyperdense feces is noted on CT. The possibility of negative appendicitis should be borne in mind when periappendiceal fat inflammation is absent or minimal in indeterminate cases. (orig.)

  6. Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature

    Daisuke Ito

    2014-01-01

    CONCLUSION: We report a case of acute amebic appendicitis in a 31-year-old woman and review the ages at presentation, causative factors, treatments, and outcomes of 11 cases reported in Japan between 1995 and 2013.

  7. EVALUATION OF MODIFIED ALVARADO SCORE IN PREOPERATIVE DIAGNOSIS OF ACUTE APPENDICITIS

    Ramachandra

    2013-11-01

    Full Text Available ABSTRACT: BACKGROUND AND OBJECTIVES: Decision making in case of acute appendicitis may be difficult, especiall y for junior surgeon. Radiological investigations do not appear to be helpful sometime. A decision to operate based on clinical suspicion alone can lead to removal of normal appendix in 15 - 30% cases. In some studies Modified Alvarado Scoring System (MASS was helpful in minimizing unnecessary appendectomies. The present study aims to evaluate the efficiency of Modified Alvarado scoring in preoperative diagnosis of acute appendicitis.

  8. Acute appendicitis in preschoolers: a study of two different populations of children

    Sivridis Efthimios; Tripsianis Gregorios; Kambouri Katerina; Giatromanolaki Alexandra; Gardikis Stefanos; Vaos George

    2011-01-01

    Abstract Objective To assess the incidence and the risk factors implicated in acute appendicitis in preschoolers in our region. Methods Over a 7-year period, 352 children underwent appendectomy for suspected acute appendicitis. Of these, data for 23 children were excluded because no inflammation of the appendix was found on subsequent histology. Of the remaining 329, 82 were ≤ 5 years old (i.e., preschool children) and 247 were 5-14 years old. These two groups of children were further divided...

  9. A study of preoperative diagnosis using abdominal computed tomography in acute appendicitis

    To evaluate the usefulness of computed tomography (CT) in differential diagnosis and decisions for operative indications in patients with acute appendicitis, CT was done in 45 patients diagnosed with acute appendicitis. CT was retrospectively analyzed for the following findings: enlarged appendix, hazy periappendiceal density, increased enhancement of the appendiceal wall, deficiency of the appendiceal wall, appendiceal stones, abscess, and ascites. Surgery was conducted 28 patients, of whom 25 were pathologically diagnosed with gangrenous or phlegmonous appendicitis. Seventeen improved without surgery, i.e., 9 with acute appendicitis, 7 with diverticulitis of the colon, and 1 with pelvic peritonitis. Except for 3 with severe abscess, enlarged appendix, hazy periappendiceal density, and increased enhancement of the appendiceal wall were observed in 22 with phlegmonous or gangrenous appendicitis. In 25 with phlegmonous or gangrenous appendicitis, appendiceal stones were observed in 32% and abscess or ascites in 60%. Sensitivity, specificity, and accuracy in CT diagnosis images were 100%, 80%, and 96%. CT findings thus provide useful information in differential diagnosis and decisions on operative indication in patients with acute appendicitis. (author)

  10. Enhanced multidetector-row computed tomography (MDCT) in the diagnosis of acute appendicitis and its severity

    The purpose of this study was to examine the accuracy of enhanced multidetector-row computed tomography (MDCT) in diagnosing acute appendicitis and its severity. Contrast-enhanced MD-CT 3.5 mm thick images of 23 control patients (A), and 64 patients with surgically proven acute appendicitis including 8 catarrhal (B), 28 phiegmonous (C), and 28 gangrenous (D) appendicitis patients were respectively analyzed. The number of observed major computed tomography (CT) findings for each patient group were as follows: enlarged (≥6 mm in maximum diameter) appendix (A: 5, B: 8, C: 28, D: 28), enhancement of the appendiceal wall; hyper (A: 3, B: 8, C: 27, D: 20), iso (A: 15, B: 0, C: 1, D: 2), hypo (A-C: 0, D: 4), and patched (A-C: 0, D: 2) enhancement, appendicolith (A, B: 0, C: 7, D: 13), dirty fat sign (A: 3, B: 1, C: 21, D: 28), localized ascites (A: 2, B: 0, C: 2, D: 11), and abscess formation (A-C: 0, D: 5). From the combinations of these findings, we could differentiate acute appendicitis from the control normal appendix with an accuracy of 99% and could diagnose the severity of acute appendicitis with accuracies of 92% for catarrhal appendicitis, 84% for phlegmonous appendicitis, and 92% for gangrenous appendicitis. We could also visually reconstruct the entire forms and positions of the appendices from the successive CT findings because of the high-resolution thin-slice MDCT images. MDCT is highly accurate in the diagnosis of acute appendicitis and its severity. (author)

  11. Ultrasonography with a hand-held device for the diagnosis of acute appendicitis

    The purpose of this study was to evaluate the accuracy of ultrasonography (US) with a hand-held device for the diagnosis of acute appendicitis in the emergency room. US with a hand-held device was performed by the first author in 33 patients suspected of having appendicitis in the emergency room. From these 33 patients, 24 who subsequently underwent computed tomography (CT) or surgery were included in this study. The accuracy of US with the hand-held device for the diagnosis of acute appendicitis was evaluated based on the findings of CT or surgery. CT and surgery were performed in 22 and 12 patients, respectively. Final diagnoses were acute appendicitis (n=18), terminal ileitis (n=2), pelvic inflammatory disease (n=2), diverticulitis (n=1), and ureterolithiasis (n=1). The US yielded a sensitivity of 78% and a positive predictive value of 100%. The shortest distance between the abdominal wall and the appendix measured on CT was less than 40 mm in 11 patients. In ten (91%) of the 11 patients US with the hand-held device showed the swollen appendix. US with a hand-held device is potentially useful in the positive identification of acute appendicitis, but further investigation is needed to prove its utility in the routine diagnosis of acute appendicitis. (author)

  12. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis.

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-03-01

    The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively.We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis.Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age <18, a (CCI) <2, medical center admission, and a longer time to recurrence were correlated with using laparoscopy to treat recurrence. Neither type of appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach.In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

  13. LEUKEMIC PLEURAL EFF USION AS INITIAL MAN IFESTATION OF ACUTE MYELOID LEUKEMIA: A RARE CASE REPORT

    Rajeev Kumar; Kanchan; Shaila; Shilpa

    2015-01-01

    Leukemic effusion is an uncommon presentation of Acute Myeloid leukemia with only isolated reports in literature. We report a case of 45 years old female who presented with unilateral pleural effusion and was diagnosed with haematological malignancy on pleural fluid cytology which revealed presence of myeloblasts. Subsequent, peripheral blood smear...

  14. Kinetics of indium-111-labeled leukemic cells in patients with acute non-lymphocytic leukemia

    The kinetics of autologous leukemic cells labeled with In-111 oxine were studied in 5 patients with acute myeloblastic leukemia (AML) and one patient with acute premyelocytic leukemia (APL), and kinetics of OKM1 monoclonal antibody-treated leukemic cells were studied in one patient with acute monoblastic leukemia (AMoL). Recoveries of 33.7 +- 23.3%(range, 22.0 to 48.1%) were achieved at 10min after injection of In-111 oxine labeled leukemic cells in AML and APL patients. However, in a patient with AMoL recovery of 12.3% was only achieved at 10min after injection of OKM1-treated leukemic cells. Clearance of the activity from blood was rapid up to one in all patients. The clearance curve of the activity in 5 AML patients showed a hump or a plateau from one to 5hr after injection of labeled leukemic cells. In APL patient and AMoL patient, however, this hump or plateau was not noted. In AML and APL patients the activity over the spleen was higher than that of over the liver at from 30min to 3hr after and showed a plateau or gradual rising thereafter. In a patient with AMoL, the hepatic activity was higher than the splenic activity at 30min after, but thereafter the latter became higher than the former. Liver activity curves showed transient fall at 3hr after and then gradual uprising in all patients. In a patient with APL, high activity was noted over the kidneys. This rose to a maximum after 3hr and then decreased rapidly. Since In-111 oxine stays firmly attached to the cells in spite of the possibility of radiation damage in a long-term survey, it seems an ideal label for studying leukemic cell kinetics

  15. Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan

    Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800 k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation. (orig.)

  16. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

    Xharra Shefki; Gashi-Luci Lumturije; Xharra Kumrije; Veselaj Fahredin; Bicaj Besnik; Sada Fatos; Krasniqi Avdyl

    2012-01-01

    Abstract Background Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging investigation. The aim of the study is to analyze the role of C-reactive protein (CRP), white blood count (WBC) and Neutrophil percentage (NP) in improving the accuracy of diagnosis of acute appendicitis and to compare it with the intraoperative assessment and histopathology findings. Materials...

  17. No Circadian Variation in Surgeons' Ability to Diagnose Acute Appendicitis

    Jørgensen, Anders Bech; Amirian, Ilda; Watt, Sara Kehlet;

    2015-01-01

    patients were included. There were no age limitations or selection in sex. RESULTS: There was no significant difference in the ability to diagnose appendicitis in day-evening hours vs night hours (p = 0.391), nor was any significant difference found on weekdays (Monday-Thursday) vs weekends (Friday...... imaging had no effect on the ability to diagnose appendicitis. Male sex showed a higher probability of the diagnosis being appendicitis compared with other or no pathology (odds ratio: 3.094; p < 0.001). Age between 40 and 80 years was significantly associated with a higher probability of the diagnosis...

  18. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis

    To evaluate the value of diffusion-weighted MRI (DWI) in the diagnosis of acute appendicitis. 119 patients with acute appendicitis and 50 controls were enrolled in this prospective study. DWI was obtained with b factors 0, 500 and 1000 s/mm2 and were assessed with a visual scoring system by two radiologists followed by quantitative evaluation of the DW images and ADC maps. Histopathology revealed appendicitis in 79/92 patients (78%) who had undergone surgery. On visual evaluation, except for one patient with histopathologically proven appendicitis all inflamed appendixes were hyperintense on DWI (98.7%). Quantitative evaluation with DW signal intensities and ADC values revealed a significant difference with normal and inflamed appendixes (p 2/s had a sensitivity of 97% and a specificity of 99%. DWI is a valuable technique for the diagnosis of acute appendicitis with both qualitative and quantitative evaluation. DWI increases the conspicuity of the inflamed appendix. We recommend using DWI to diagnose acute appendicitis. (orig.)

  19. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis

    Inci, Ercan; Hocaoglu, Elif; Aydin, Sibel; Bayramoglu, Sibel; Cimilli, Tan [Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul (Turkey); Kilickesmez, Ozgur [Yeditepe University, School of Medicine, Department of Radiology, Istanbul (Turkey)

    2011-04-15

    To evaluate the value of diffusion-weighted MRI (DWI) in the diagnosis of acute appendicitis. 119 patients with acute appendicitis and 50 controls were enrolled in this prospective study. DWI was obtained with b factors 0, 500 and 1000 s/mm{sup 2} and were assessed with a visual scoring system by two radiologists followed by quantitative evaluation of the DW images and ADC maps. Histopathology revealed appendicitis in 79/92 patients (78%) who had undergone surgery. On visual evaluation, except for one patient with histopathologically proven appendicitis all inflamed appendixes were hyperintense on DWI (98.7%). Quantitative evaluation with DW signal intensities and ADC values revealed a significant difference with normal and inflamed appendixes (p < 0.001). The best discriminative parameter was signal intensity (b 500). With a cut-off value of 56 for the signal intensity the ratio had a sensitivity of 99% and a specificity of 97%. The cut-off ADC value at 1.66 mm{sup 2}/s had a sensitivity of 97% and a specificity of 99%. DWI is a valuable technique for the diagnosis of acute appendicitis with both qualitative and quantitative evaluation. DWI increases the conspicuity of the inflamed appendix. We recommend using DWI to diagnose acute appendicitis. (orig.)

  20. Ultrasound Findings of Lymphoid Hyperplasia of the Appendix in Children: Differentiation from Acute Appendicitis

    Kim, Bong Jae; Seo, Jung Wook; Lee, Byung Hoon [Inje University Ilsan Paik Hospital, Koyang (Korea, Republic of)

    2009-12-15

    To evaluate the ultrasound (US) findings that can help differentiate lymphoid hyperplasia in the appendix from acute appendicitis. A total of 1230 patients (below 20 years old) suspected of having appendicitis received an appendectomy between November, 1999, and March, 2008, with US findings in 27 patients with pathologically proven lymphoid hyperplasia of the appendix. Of 167 patients that received an appendectomy from January, 2007, to December, 2007, 52 patients with acute appendicitis were retrospectively reviewed as a control group. Retrospective review of US images was performed by two radiologists who were blinded to the pathologic results. The review was based on 12 ultrasonographic criteria derived from reports on the diagnostic findings of the appendicitis. Compared with acute appendicitis, lymphoid hyperplasia in appendix had a smaller diameter (7.14{+-}1.22 mm vs 9.37{+-}1.80 mm, p < 0.001) and less wall thickening(1.38{+-}0.36 mm vs 1.74 {+-} 0.56 mm, p =0.001). Periappendicular inflammation (p < 0.001), intraluminal air (p = 0.006), round shape in transverse scan (p = 0.002),increased blood flow on color Doppler US (p = 0.03) were also different. US is a useful modality to differentiate lymphoid hyperplasia in the appendix from acute appendicitis

  1. Ultrasound Findings of Lymphoid Hyperplasia of the Appendix in Children: Differentiation from Acute Appendicitis

    To evaluate the ultrasound (US) findings that can help differentiate lymphoid hyperplasia in the appendix from acute appendicitis. A total of 1230 patients (below 20 years old) suspected of having appendicitis received an appendectomy between November, 1999, and March, 2008, with US findings in 27 patients with pathologically proven lymphoid hyperplasia of the appendix. Of 167 patients that received an appendectomy from January, 2007, to December, 2007, 52 patients with acute appendicitis were retrospectively reviewed as a control group. Retrospective review of US images was performed by two radiologists who were blinded to the pathologic results. The review was based on 12 ultrasonographic criteria derived from reports on the diagnostic findings of the appendicitis. Compared with acute appendicitis, lymphoid hyperplasia in appendix had a smaller diameter (7.14±1.22 mm vs 9.37±1.80 mm, p < 0.001) and less wall thickening(1.38±0.36 mm vs 1.74 ± 0.56 mm, p =0.001). Periappendicular inflammation (p < 0.001), intraluminal air (p = 0.006), round shape in transverse scan (p = 0.002),increased blood flow on color Doppler US (p = 0.03) were also different. US is a useful modality to differentiate lymphoid hyperplasia in the appendix from acute appendicitis

  2. An evidence for adhesion-mediated acquisition of acute myeloid leukemic stem cell-like immaturities

    Funayama, Keiji; Shimane, Miyuki; Nomura, Hitoshi [Department of Integrative Bioscience and Biomedical Engineering, Waseda University, 4-3-1 Ohkubo, Shinjuku-ku, Tokyo 169-8555 (Japan); Asano, Shigetaka, E-mail: asgtkmd@waseda.jp [Department of Integrative Bioscience and Biomedical Engineering, Waseda University, 4-3-1 Ohkubo, Shinjuku-ku, Tokyo 169-8555 (Japan)

    2010-02-12

    For long-term survival in vitro and in vivo of acute myeloid leukemia cells, their adhesion to bone marrow stromal cells is indispensable. However, it is still unknown if these events are uniquely induced by the leukemic stem cells. Here we show that TF-1 human leukemia cells, once they have formed a cobblestone area by adhering to mouse bone marrow-derived MS-5 cells, can acquire some leukemic stem cell like properties in association with a change in the CD44 isoform-expression pattern and with an increase in a set of related microRNAs. These findings strongly suggest that at least some leukemia cells can acquire leukemic stem cell like properties in an adhesion-mediated stochastic fashion.

  3. The Use of Delta Neutrophil Index and Myeloperoxidase Index for Predicting Acute Complicated Appendicitis in Children

    Kim, Oh Hyun; Cha, Yong Sung; Hwang, Sung Oh; Jang, Ji Young; Choi, Eun Hee; Kim, Hyung Il; Cha, KyoungChul; Kim, Hyun; Lee, Kang Hyun

    2016-01-01

    Background In children with acute appendicitis, 30% to 75% present with a complication, such as perforation, and the early diagnosis of complications is known to improve outcomes. Serum delta neutrophil index (DNI) and myeloperoxidase index (MPXI) are new inflammatory markers, and thus, in the present study, the authors evaluated the predictive values of these two markers for the presence of a complication in children with acute appendicitis. Methods This retrospective observational study was conducted on 105 consecutive children (<12 years old) with acute appendicitis treated over a 31-month period. DNI, MPXI, C-reactive protein (CRP), and white blood cells (WBCs) were measured in an emergency department and investigated with respect to their abilities to predict the presence of acute complicated appendicitis. Results Twenty-nine of the 105 patients (median age, 9 years) were allocated to the complicated group (27.6%) and 76 to the non-complicated group (72.4%). Median serum DNI and CRP were significantly higher in the complicated group [0% vs. 2.2%, p<0.001 and 0.65 mg/dL vs. 8.0 mg/dL, p<0.001], but median MPXI was not (p = 0.316). Area under curve (AUC) for the ability of serum DNI and CRP to predict the presence of acute complicated appendicitis were 0.738 and 0.840, respectively. Multiple logistic regression analyses showed initial CRP [odds ratio 1.301, 95% confidence interval (1.092–1.549), p = 0.003] significantly predicted the presence of a complication. The optimal cutoff for serum CRP was 4.0 mg/dL (sensitivity 69%, specificity 83%, AUC 0.840). Conclusions Although serum DNI values were significantly higher in children with acute complicated appendicitis, no evidence was obtained to support the notion that serum DNI or serum MPXI aid the differentiation of acute complicated and non-complicated appendicitis in the ED setting. PMID:26859663

  4. Usefulness of measurement of the outer appendiceal diameter on abdominal computer tomography in the diagnosis of acute appendicitis

    The purpose of this study was to evaluate the accuracy of our computer tomography (CT)-based protocol and the usefulness of measurement of the outer appendiceal diameter on CT in the diagnosis of acute appendicitis. Two-hundred thirty-nine consecutive patients with clinical diagnoses of acute appendicitis during the period from January 2002 to Jun 2004 were evaluated. The CT criterion of acute appendicitis was the outer appendiceal diameter of 6 mm or more, and/or other associated inflammatory changes. The histological criterion of acute appendicitis was the presentation of polymorphic granulocytes throughout the appendiceal wall. Of 239 patients, 235 underwent CT examination. Among 222 patients with appendectomy, 205 had histologically proven acute appendicitis. Of 200 patients who had the outer appendiceal diameter of 6 mm or more on CT, 193 had histologically proven acute appendicitis. The positive predictive value for diagnosing acute appendicitis was 92.3% in the surgery group, and 96.5% in the group that the outer appendiceal diameter was 6 mm or more on CT. The recurrence rate of acute appendicitis diagnosed by CT following conservative therapy was 35.3%, and was high (50%) in the group with the appendiceal diameter of at least 10 mm. CT is useful in the diagnosis for acute appendicitis. (author)

  5. The findings and usefulness of CT for the diagnosis of acute appendicitis

    CT findings were inspected retrospectively in 48 patients (age: 16-82, 25 males, 23 females) with acute appendicitis before surgery. A slice thickness was 10 mm or 5 mm and a slice distance was 10 mm. Scan was started following the rapid intravenous injection of 100 ml of non-ionic iodine contrast medium. Abnormality of appendix was confirmed in 40 cases (83%), and appendicolithiasis in 13 cases (27%). High density of fatty tissue by periappendicular inflammation or edema was recognized in 46 cases (96%). Periappendicular abscess or ascites was in 23 cases (48%). Phlegmonous or gangrenous appendicitis should be considered when appendix of 10 mm or more, abscess, ascites or appendicolithiasis was recognized. Diagnosis ability of CT in appendicitis was 96%. CT is useful for diagnosis of acute appendicitis and estimation of severity. (K.H.)

  6. Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?

    Andersson, Manne; Rubér, Marie; Ekerfelt, Christina; Hallgren, Hanna Björnsson; Olaison, Per Olov Gunnar; Andersson, Roland E

    2014-01-01

    BACKGROUND: The diagnosis of appendicitis is difficult and resource consuming. New inflammatory markers have been proposed for the diagnosis of appendicitis, but their utility in combination with traditional diagnostic variables has not been tested. Our objective is to explore the potential of new...... inflammatory markers for improving the diagnosis of appendicitis.METHODS: The diagnostic properties of the six most promising out of 21 new inflammatory markers (interleukin [IL]-6, chemokine ligand [CXCL]-8, chemokine C-C motif ligand [CCL]-2, serum amyloid A [SAA], matrix metalloproteinase [MMP]-9, and...... myeloperoxidase [MPO]) were compared with traditional diagnostic variables included in the Appendicitis Inflammatory Response (AIR) score (right iliac fossa pain, vomiting, rebound tenderness, guarding, white blood cell [WBC] count, proportion neutrophils, C-reactive protein and body temperature) in 432 patients...

  7. An unusual manifestation of acute appendicitis with left flank pain

    Roland Talanow, MD, PhD

    2008-08-01

    Full Text Available The author presents a case with an unusual presentation of early appendicitis. The patient presented initially with left sided flank pain. Workup for nephrolithiasis, including non-contrast CT of the abdomen and pelvis was negative for renal stones or hydronephrosis. After discharge, the patient presented one week later in the ED with right lower quadrant pain. Contrast enhanced CT of the abdomen revealed perforated appendicitis.

  8. The role of the cytokines and cell-adhesion molecules on the immunopathology of acute appendicitis

    To study the local expression of the proinflammatory cytokine such as interferon gamma and anti-inflammatory cytokine like interleukin-10 (IL-10) and their role in cell adhesion molecules (CAM) expression on the surface of endothelial cell at the site of inflammation in acute appendicitis. The local expression of these cytokines and CAM was correlated with clinical findings to shed light on their role in the pathogenesis of acute appendicitis. Thirty-five patients with acute appendicitis and 6 apparently normal appendices were removed incidentally from individuals presented with problems other than appendicitis, were included in this prospective study. They were attendant of the emergency room in Al-Khadhumiyah Teaching Hospital in Baghdad, from October 2003 to September 2004. Cell adhesion molecules (intracellular adhesion molecule-1 [ICAM-l], ICAM-3 and vascular cell adhesion molecule-1 [VCAM-1]) were detected by immunohistochemistry while IL-10 and interferon gamma were detected by in situ hybridization. The specimens were classified into 5 groups; early acute appendicitis, phlegmonous appendicitis, ulcero-phlegmonousappendicitis, and gangrenous appendicitis, and the fifth group included specimens that showed no histopathological changes, defined as histologically normal appendix. Intracellular adhesion molecule-1, VCAM-I, IL-10 and interferon gamma were expressed weakly in the control group, while ICAM-3 was not detected in the control group. The average score for ICAM-I, VCAM-1 and the percentage of cells expressing IL-l0 and interferon gamma were significantly higher in the patient groups when compared with the control group. Intracellular adhesion molecule-3 was expressed in the patient group. The kinetics of CAM expression were tightly correlated to the balance between IL-10 and interferon gamma especially after 12.5 hours from the first symptoms experienced by the patients. The interferon gamma was the main player and the most significant factor that leads

  9. Co-infection with Enterobius vermicularis and Taenia saginata mimicking acute appendicitis.

    Saravi, Kasra H; Fakhar, Mahdi; Nematian, Javad; Ghasemi, Maryam

    2016-01-01

    In this report, we describe an unusual case of verminous appendicitis due to Enterobius vermicularis and Taenia saginata in a 29-year-old woman from Iran. The histopathological examinations and parasitological descriptions of both worms found in the appendix lumen are discussed. The removed appendix exhibited the macroscopic and microscopic features of acute appendicitis. Antihelminthic therapy was initiated with single doses of praziquantel for the taeniasis and mebendazole for the enterobiasis, and the patient was discharged. PMID:26754203

  10. Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis

    Ersin Gürkan Dumlu

    2014-12-01

    Full Text Available OBJECTIVES: To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients. METHOD: Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35 and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level and ischemia-modified albumin. Surgical specimens were also evaluated. RESULTS: The diagnoses were acute appendicitis (n = 37, perforated appendicitis (n = 8, phlegmonous appendicitis (n = 12, perforated+phlegmonous appendicitis (n = 4, or no appendicitis (n = 4. The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004. The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters. CONCLUSIONS: The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis.

  11. The platelet indices in pediatric patients with acute appendicitis

    Yunus Yilmaz

    2015-06-01

    Full Text Available Background: The diagnosis of Acute Appendicitis (AA remains a problem in pediatric population. It has been suggested that Mean Platelet Volume (MPV is lower in the patients with AA. The purpose of this study was to investigate the diagnostic value of platelet indices in pediatric AA cases. Methods: A retrospective case-controlled study was designed: 224 subjects were included in this study. All patients had been operated on in division of pediatric surgery at the Kars Government Hospital with the preliminary diagnosis of AA. 204 and 20 of these patients were pathologically diagnosed as AA (group 1 and normal appendix vermiformis (group 2, respectively. Platelet indices had been studied in the biochemistry laboratory of the hospital, before the surgery. Results: In group 1, platelet count, mean platelet volume, plateletcrit and platelet distribution width were 305 +/- 94x103/ and micro;L; 7.37 +/- 0.90 fL; 0,220 +/- 0.057 % and 16.3 +/- 0.5%, respectively. In group 2, platelet count, mean platelet volume, plateletcrit and platelet distribution width were 283 +/- 85 103/ and micro;L; 7.60 +/- 1.24 fL; 0.208 +/- 0.045 % and 16.4 +/- 0.7%, respectively. There was no statistically significant difference between the groups studied with regard to platelet indices (P>0.05. Conclusions: Our study showed that platelet indices have no diagnostic value in the diagnosis of AA at pediatric age group. [Int J Res Med Sci 2015; 3(6.000: 1388-1391

  12. Ultrasonography in the diagnosis of acute appendicitis. A study of 226 cases

    To determine the clinical value of ultrasound in the diagnosis of acute appendicitis. Graded-compression ultrasound was performed in 226 patients with atypical or unclear clinical signs of appendicitis. Twenty-three patients were excluded from study because of an inconclusive examination due to inadequate compression. Appendicitis was considered to be present when the appendix was non compressible and measured over 6 mn in anteroposterior diameter or the patient presented an abscess in right iliac fossa. The findings were confirmed by pathological study of surgically resected tissue or by clinical follow-up. The operative features and the predictive capacity of ultrasound in the diagnosis of acute appendicitis were calculated. In 98 cases, acute appendicitis was confirmed intraoperatively. In 103, this diagnosis was ruled out by the clinical course or intraoperative findings. Ninety-four patients presented ultrasonographic signs compatible with appendiceal inflammation. The sensitivity of ultrasound in the diagnosis of these doubtful cases of appendicitis was, 93.9%; the specificity, 98.1%; reliability, 96%; positive value, 9%; negative predictive value, 94.5%, and the positive probability rate, 49.3%. Our results indicate that high-resolution ultrasonography is indicated in all cases in which the clinical diagnosis of appendiceal inflammation id doubtful. (Author) 64 refs

  13. Acute appendicitis: sensitivity, specificity and diagnostic accuracy of thin-section contrast-enhanced CT findings

    To assess the sensitivity, specificity, and diagnostic accuracy of individual contrast-enhanced helical CT findings of acute appendicitis. We retrospectively reviewed the appendiceal helical CT scans, obtained after intravenous contrast administration (abdomen; 7-mm collimation, abdominopelvic junction; 5-mm collimation), of 50 patients with surgically proven acute appendicitis and 112 with alternative diagnoses. The following parameters were analysed by three radiologists: enlarged appendix (>6 mm in diameter), appendiceal wall thickening, appendiceal wall enhancement, no identification of the appendix, appendicolith(s), (appendiceal) intraluminal air, abscess, lymphadenopathy, terminal ileal wall thickening, focal cecal apical thickening, focal colonic wall thickening, and segmental colonic wall thickening. The CT findings of acute appendicitis that statistically distinguished it from alternative diagnoses were an enlarged appendix (sensitivity; 92%, specificity; 93%, diagnostic accuracy; 93%), appendiceal wall thickening (for these three parameters: 68%, 96% and 88%, respectively), periappendiceal fat stranding (90%, 79%, 82%), appendiceal wall enhancement (72%, 86%, 82%), appendicolith (16%, 100%, 74%), and focal cecal apical thickening (14%, 100%, 74%) (for each, p<0305). On thin-section contrast-enhanced helical CT, an enlarged appendix and periappendiceal fat stranding were found in 90% or more patients with acute appendicitis. Appendiceal wall thickening and enhancement were alearly demonstrated and significant findings for diagnosis. Less common but specific findings include appendicolith, focal cecal apical thickening and intramural air, can also help us establish a diagnosis of acute appendicitis

  14. Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. A meta-analysis

    Acute appendicitis is the most common acute surgical condition of the abdomen. Computed tomography (CT) and Ultrasonography (US) can reduce the rate of complications and unnecessary appendectomies, in addition, they can establish an alternative diagnosis. We carried out a systematic review to evaluate the evidence relating radiological imaging (US and CT scan) and early detection of acute appendicitis in patients presenting with equivocal findings, and to provide recommendations to use radiological imaging (US and CT scan) in diagnosing acute appendicitis as part of the initial clinical assessment of the patients presenting with equivocal findings to reduce complications and unnecessary appendectomies. We used the MEDLINE to search for articles published from 1966 to December 2005 that related to radiological imaging of acute appendicitis; additional articles were identified from the bibliographies of review articles. Selection criteria were used to limit the analysis to prospective studies with more than 100 patients involved in each study as a study group. Forty-five studies fulfilling our inclusion and exclusion criteria were extracted, and 13,046 patients were included. Although the CT scan was more sensitive than US in diagnosing patients with equivocal appendicitis (93.4% [95% CI 92.1-94.6] versus 83.7% [95% CI 82.3-85.0]), either diagnostic study should be used as part of the initial assessment of the patients presenting with equivocal findings. (author)

  15. ACUTE APPENDICITIS SECONDARY TO ENTEROBIUS VERMICULARIS INFESTATION IN A YOUNG FEMALE: A CASE REPORT

    Kumar Premjeet

    2014-05-01

    Full Text Available Gastrointestinal infection due to enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection. The simple presence of enterobius vermicularis in the appendix usually produces symptoms of acute appendicitis. Acute appendicitis due to enterobius vermicularis is very rare, affecting mostly children. The association of this parasitic infestation with acute appendicitis varies from 0.2%–41.8% worldwide. Whether pinworms cause inflammation of the appendix or just appendiceal colic has been a matter of controversy. We present a case of an 18 year old female with enterobiasis of appendix presented with clinical features of acute appendicitis. The appendix was surgically removed and the specimen was pathologically diagnosed to contain of enterobius vermicularis in non-inflamed and histologically mild mononuclear cell infiltrated appendix. One should keep in mind that the clinical signs of intestinal parasite infection may mimic acute appendicitis, although rare. A careful evaluation of symptoms such as pruritus ani, or eosinophilia on laboratory examination, could prevent unnecessary appendectomies.

  16. Acute appendicitis in preschoolers: a study of two different populations of children

    Sivridis Efthimios

    2011-07-01

    Full Text Available Abstract Objective To assess the incidence and the risk factors implicated in acute appendicitis in preschoolers in our region. Methods Over a 7-year period, 352 children underwent appendectomy for suspected acute appendicitis. Of these, data for 23 children were excluded because no inflammation of the appendix was found on subsequent histology. Of the remaining 329, 82 were ≤ 5 years old (i.e., preschool children and 247 were 5-14 years old. These two groups of children were further divided according to their religion into Muslims and Christian Orthodox: 43 of the children aged ≤ 5 years were Muslims and 39 were Christian Orthodox. A household questionnaire was designed to collect data concerning age, gender, type of residence area, living conditions, vegetable consumption, and family history of surgery for acute appendicitis as preschool children. The removed appendices were also assessed histologically for the amount of lymphoid tissue. Results Acute appendicitis of preschoolers developed more frequently in Muslims (39.4% than in Christians (17.7%; p p p > 0.05. Conclusions In our region, the percentage of preschool-aged Muslim children with acute appendicitis was remarkably high. One possible explanation for this finding could be the higher amount of lymphoid tissue in the wall of the appendix in Muslim preschool children together with their low standard of hygiene.

  17. Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis

    Danielle I. Miano

    2015-12-01

    Full Text Available Introduction: Acute appendicitis in children is a clinical diagnosis, which often requires preoperative confirmation with either ultrasound (US or computed tomography (CT studies. CTs expose children to radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric population with appropriate clinical follow up and serial exam may be an effective diagnostic modality for many children without incurring the risk of radiation. The objective of the study was to compare the rate of appendiceal rupture and negative appendectomies between children with and without abdominal CTs; and to evaluate the same outcomes for children with and without USs to determine if there were any associations between imaging modalities and outcomes. Methods: We conducted a retrospective chart review including emergency department (ED and inpatient records from 1/1/2009–2/31/2010 and included patients with suspected acute appendicitis. Results: 1,493 children, aged less than one year to 20 years, were identified in the ED with suspected appendicitis. These patients presented with abdominal pain who had either a surgical consult or an abdominal imaging study to evaluate for appendicitis, or were transferred from an outside hospital or primary care physician office with the stated suspicion of acute appendicitis. Of these patients, 739 were sent home following evaluation in the ED and did not return within the subsequent two weeks and were therefore presumed not to have appendicitis. A total of 754 were admitted and form the study population, of which 20% received a CT, 53% US, and 8% received both. Of these 57%, 95% CI [53.5,60.5] had pathology-proven appendicitis. Appendicitis rates were similar for children with a CT (57%, 95% CI [49.6,64.4] compared to those without (57%, 95% CI [52.9,61.0]. Children with perforation were similar between those with a CT (18%, 95% CI [12.3,23.7] and those without (13%, 95% CI [10.3,15.7]. The proportion of

  18. Studies on CT findings and operation findings for acute appendicitis in children

    Pediatric CT findings of acute appendicitis were reviewed retrospectively. The subjects were 29 patients (15 boys and 14 girls with an average age of 8.2 years), consisting of 17 with necrotic, 8 with phlegmonous inflammatory, and 4 with catarrhal appendicitis. CT findings were compared with the degree of inflammation. CT revealed abscess in 64.7%, 12.5%, and 0% for necrotic, phlegmonous inflammatory, and catarrhal types, respectively, and 41.4% for all types. An enlarged appendicitis was shown on CT in 86.2% (25/29). Fecalithes were shown on CT in 67.7% (19/29), which was associated with necrotic and phlegmonous inflammatory types, but not with catarrhal type. The other CT findings included thickened paramesocolon of the right lower abdomen, undefined wall of the inner side of the cecum. Inflammation was relatively slight in cases of catarrhal appendicitis, Nine patients less than 5 years of age had phlegmonous inflammatory or necrotic appendicitis. CT allowed definitive diagnosis of appendicitis in 2 of 3 patients with necrotic type. Ct was considered to be very useful in the diagnosis of appendicitis. (N.K.)

  19. Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis

    Platon, Alexandra; Jlassi, Helmi; Becker, Christoph D.; Poletti, Pierre-Alexandre [University Hospital of Geneva, Department of Radiology, Geneva 14 (Switzerland); Rutschmann, Olivier T. [University Hospital of Geneva, Emergency Center, Geneva (Switzerland); Verdun, Francis R. [University Institute for Radiation Physics, Lausanne (Switzerland); Gervaz, Pascal [University Hospital of Geneva, Clinic of Digestive Surgery, Geneva (Switzerland)

    2009-02-15

    The aim of this study was to evaluate a low-dose CT with oral contrast medium (LDCT) for the diagnosis of acute appendicitis and compare its performance with standard-dose i.v. contrast-enhanced CT (standard CT) according to patients' BMIs. Eighty-six consecutive patients admitted with suspicion of acute appendicitis underwent LDCT (30 mAs), followed by standard CT (180 mAs). Both examinations were reviewed by two experienced radiologists for direct and indirect signs of appendicitis. Clinical and surgical follow-up was considered as the reference standard. Appendicitis was confirmed by surgery in 37 (43%) of the 86 patients. Twenty-nine (34%) patients eventually had an alternative discharge diagnosis to explain their abdominal pain. Clinical and biological follow-up was uneventful in 20 (23%) patients. LDCT and standard CT had the same sensitivity (100%, 33/33) and specificity (98%, 45/46) to diagnose appendicitis in patients with a body mass index (BMI) {>=} 18.5. In slim patients (BMI < 18.5), sensitivity to diagnose appendicitis was 50% (2/4) for LDCT and 100% (4/4) for standard CT, while specificity was identical for both techniques (67%, 2/3). LDCT may play a role in the diagnostic workup of patients with a BMI {>=} 18.5. (orig.)

  20. Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis

    The aim of this study was to evaluate a low-dose CT with oral contrast medium (LDCT) for the diagnosis of acute appendicitis and compare its performance with standard-dose i.v. contrast-enhanced CT (standard CT) according to patients' BMIs. Eighty-six consecutive patients admitted with suspicion of acute appendicitis underwent LDCT (30 mAs), followed by standard CT (180 mAs). Both examinations were reviewed by two experienced radiologists for direct and indirect signs of appendicitis. Clinical and surgical follow-up was considered as the reference standard. Appendicitis was confirmed by surgery in 37 (43%) of the 86 patients. Twenty-nine (34%) patients eventually had an alternative discharge diagnosis to explain their abdominal pain. Clinical and biological follow-up was uneventful in 20 (23%) patients. LDCT and standard CT had the same sensitivity (100%, 33/33) and specificity (98%, 45/46) to diagnose appendicitis in patients with a body mass index (BMI) ≥ 18.5. In slim patients (BMI < 18.5), sensitivity to diagnose appendicitis was 50% (2/4) for LDCT and 100% (4/4) for standard CT, while specificity was identical for both techniques (67%, 2/3). LDCT may play a role in the diagnostic workup of patients with a BMI ≥ 18.5. (orig.)

  1. Value of multi-slice spiral CT MPVR reconstruction in the diagnosis of acute appendicitis

    Objective: To investigate the value of multi-slice spiral CT MPVR reconstruction in the diagnosis of acute appendicitis. Methods: A total of 39 patients with clinically suspected acute appendicitis underwent surgery from February, 2002 to September, 2003. They were prospectively examined before surgery with routine CT scanning and MPVR reconstruction spiral CT. 31 cases of appendicitis were confirmed after appendectomy. CT scans and surgery-pathology reports were evaluated on a five-grade scale from hyperemic-edematous appendix to abscess (normal appendix: 0 grade). Results: The results of spiral CT MPVR reconstruction were compared with the surgical and pathologic findings at appendectomy, yielding an accuracy of 87.2%, sensitivity of 90.3%, specificity of 75%, positive predictive value of 93.3%, and negative predictive value of 66.7%, respectively. Results of routine CT yielded an accuracy of 38.5%, sensitivity of 38.7%, specificity of 37.5%, positive predictive value of 70.6%, and negative predictive value of 13.6%, respectively. MPVR reconstruction signs of 28 patients with acute appendicitis included enlarged appendix ( > 6 mm) (96.4%), appendicoliths (26.7%), caecal apical thickening (36.7%), periappendiceal inflammation (71.4%), and abscess (10.7%). Conclusion: The use of spiral CT MPVR reconstruction in patients with equivocal clinical presentation suspected of having acute appendicitis can lead to a significant improvement in the preoperative diagnosis and maybe a decrease in surgical-pathologic severity of appendiceal disease. (authors)

  2. Mucosal invasion by fusobacteria is a common feature of acute appendicitis in Germany, Russia, and China

    Alexander Swidsinski

    2012-01-01

    Full Text Available Background/Aim: To investigate the geographic occurrence of mucosa-invading Fusobacteria in acute appendicitis. Patients and Methods: Carnoy- and formalin-fixated appendices from Germany, Russia, and China were comparatively investigated. Bacteria were detected using fluorescent in situ hybridization. Cecal biopsies from patients with inflammatory bowel disease and other conditions were used as disease controls. Results: Fusobacteria represented mainly by Fusobacterium nucleatum were the major invasive component in bacterial infiltrates in acute appendicitis but were completely absent in controls. The occurrence of invasive Fusobacteria in Germany, Russia, and China was the same. The detection rate in Carnoy-fixated material was 70-71% and in formalin-fixated material was 30-36%. Conclusions: Acute appendicitis is a polymicrobial infectious disease in which F. nucleatum and other Fusobacteria play a key role.

  3. Is urinary 5-HIAA determination a valuable method in diagnosis of acute appendicitis in children?

    Ozel S

    2006-01-01

    Full Text Available The aim of the study is to investigate the significance of spot urine 5-hydroxyindoleacetic acid (5-HIAA levels in patients admitted with the suspicion of acute appendicitis. Seventy-one patients with the mean age of 9.4±2.9 years, who were admitted to our pediatric surgery clinic between August 2002 and March 2004 with the complaints of abdominal pain were evaluated prospectively. Additionally spot urine samples were collected from 34 healthy children for control. 5-HIAA was detected from the urine samples in all children with high-performance liquid chromatography (HPLC method. The results were analyzed with one way analysis of variance (ANOVA, post hoc Tukey HSD test and receiver operating characteristic (ROC curve. After the clinical follow-up appendicitis was detected in 40 patients and abdominal pain was found to be due to causes other than appendicitis in 31 patients. Results were found to be correlative with the final diagnosis in all patients. The mean 5-HIAA levels were 2.5±1.8 µmol/dl in healthy children, whereas 9±5 µmol/dl in nonappendicitis and 18.9±17.8 µmol/dl in appendicitis patients, respectively. The difference between the patients with acute appendicitis and the other two groups were statistically significant ( P = 0.001. For a value of 8.9 µmol/dl, this test was found to be 70% sensitive and 67% specific according to the ROC curve. 5-HIAA significantly rises in pediatric acute appendicitis. However, due to high values of SD and relatively low sensitivity and specificity, this test seems to have limited diagnostic power as a single parameter in childhood acute appendicitis.

  4. Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: Comparison with Alvarado scoring system and histopathological results

    Inci, Ercan, E-mail: ercan_inci@mynet.com [Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Incirli-Bakirkoy, Istanbul (Turkey); Hocaoglu, Elif; Aydin, Sibel; Palabiyik, Figen; Cimilli, Tan [Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Incirli-Bakirkoy, Istanbul (Turkey); Turhan, Ahmet Nuray; Ayguen, Ersan [Department of Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul (Turkey)

    2011-11-15

    Purpose: The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results. Materials and methods: The study included 85 consecutive patients (mean age, 26.5 {+-} 11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores. The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings. Results: Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively. Conclusions: MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.

  5. Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: Comparison with Alvarado scoring system and histopathological results

    Purpose: The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results. Materials and methods: The study included 85 consecutive patients (mean age, 26.5 ± 11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores. The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings. Results: Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively. Conclusions: MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.

  6. Primary signet ring cell carcinoma of the appendix mimicking acute appendicitis

    Primary signet ring cell carcinoma of the appendix is a very rare neoplasm that usually presents with signs and symptoms of acute appendicitis and in particular with a right lower abdominal pain. Preoperative imaging detection of appendiceal adenocarcinoma has an important value because it may result in an appropriate surgical procedure. We report a rare case of primary signet ring cell carcinoma of the vermiform appendix in an 80-year-old man who was misdiagnosed on computed tomography (CT) scan as acute appendicitis

  7. Unusual computed tomography findings and complications in acute appendicitis; Aspectos tomograficos incomuns da apendicite aguda e suas complicacoes

    Palacio, Glaucia Andrade e Silva; D' Ippolito, Giuseppe [Hospital Sao Luiz, Sao Paulo, SP (Brazil). Setor de Diagnostico por Imagem]. E-mail: glauciapalacio@uol.com.br; Bianco, Fabio Davolio [Hospital Sao Luiz, Sao Paulo, SP (Brazil). Setor de Tomografia Computadorizada e Ressonancia Magnetica; Domenicis Junior, Osvaldo de [CURA Imagem e Diagnostico, Sao Paulo, SP (Brazil)

    2003-07-01

    The objective of this article is to describe and illustrate unusual computed tomography (CT) findings in patients with acute appendicitis. We reviewed the charts of 200 patients with clinical suspicion of acute appendicitis who were submitted to abdominal CT before surgery. Patients with unusual presentation or complications were selected for illustrating the main CT findings. Unusual complications of acute appendicitis were related to anomalous position of the appendix, contiguity to intraperitoneal organs such as the liver, gall bladder, annexes and the bladder and continuous use of anti inflammatory or antibiotics during the diagnostic process. We concluded that CT is a useful diagnostic tool in patients with complicated or unusual presentation acute appendicitis. The first step towards diagnosis in these cases i to have in mind the hypothesis of appendicitis in patients with acute abdominal pain. (author)

  8. The Most Useful Findings for Diagnosing Acute Appendicitis on Contrast-Enhanced Helical CT

    Purpose: To evaluate the most useful findings to look for in diagnosing acute appendicitis on contrast-enhanced helical CT. Material and Methods: Appendiceal helical CT scans with intravenous contrast administration (abdomen, 7-mm collimation; abdominopelvic junction, 5-mm collimation) of 71 patients with surgically proven acute appendicitis and 167 patients with alternative diagnoses were reviewed retrospectively. Three radiologists analyzed the following parameters: enlarged appendix (>6 mm in diameter), appendiceal wall thickening, appendiceal wall enhancement, no identification of the appendix, appendicolith(s), appendiceal intraluminal air, intramural air, extraluminal air, periappendiceal fat stranding, extraluminal fluid, phlegmon, abscess, lymphadenopathy, segmental terminal ileal wall thickening, focal cecal apical thickening, focal colonic wall thickening, and segmental colonic wall thickening. The features that best distinguished appendicitis from alternative diagnoses were selected with stepwise logistic regression analysis. Results: Nine CT findings distinguished acute appendicitis from alternative diagnoses (P < 0.05): enlarged appendix (R = 0.739), appendiceal wall thickening (R = 0.525), periappendiceal fat stranding (R = 0.414), appendiceal wall enhancement (R = 0.404), focal cecal apical thickening (R 0.171), appendicolith(s) (R = 0.157), extraluminal air (R = 0.050), intramural air (R = 0.043), and phlegmon (R = 0.030). Enlarged appendix (sensitivity, 93%; specificity, 92%), appendiceal wall thickening (sensitivity, 66%; specificity, 96%), periappendiceal fat stranding (sensitivity, 87%; specificity, 74%), and appendiceal wall enhancement (sensitivity, 75%; specificity, 85%) showed the statistically most significant association with acute appendicitis. Conclusion: On 5-mm-section contrast-enhanced helical CT examinations, enlarged appendix, appendiceal wall thickening, periappendiceal fat stranding, and appendiceal wall enhancement were the most

  9. An Imaging Diagnostic Protocol in Children with Clinically Suspected Acute Appendicitis.

    Epifanio, Matias; Antonio de Medeiros Lima, Marco; Corrêa, Patricia; Baldisserotto, Matteo

    2016-05-01

    The objective of the present study is to evaluate a new diagnostic strategy using clinical findings followed by ultrasound (US) and, in selected cases, MRI. This study included 166 children presenting signs and symptoms suggesting acute appendicitis. Cases classified as suggesting appendicitis according to clinical exams had to be referred to surgery, whereas the other cases were discharged. Unclear cases were evaluated using US. If the US results were considered inconclusive, patients underwent MRI. Of the 166 patients, 78 (47%) had acute appendicitis and 88 (53%) had other diseases. The strategy under study had a sensitivity of 96 per cent, specificity of 100 per cent, positive predictive value of 100 per cent, negative predictive value of 97 per cent, and accuracy of 98 per cent. Eight patients remained undiagnosed and underwent MRI. After MRI two girls presented normal appendixes and were discharged. One girl had an enlarged appendix on MRI and appendicitis could have been confirmed by surgery. In the other five patients, no other sign of the disease was detected by MRI such as an inflammatory mass, free fluid or an abscess in the right iliac fossa. All of them were discharged after clinical observation. In the vast majority of cases the correct diagnosis was reached by clinical and US examinations. When clinical assessment and US findings were inconclusive, MRI was useful to detect normal and abnormal appendixes and valuable to rule out other abdominal pathologies that mimic appendicitis. PMID:27215717

  10. Evaluation of Tc-99m leukocyte scan in the diagnosis of acute appendicitis

    A new /sup 99m/Tc Microlite leukocyte scan was performed in 38 patients to assess its value in the diagnosis of acute appendicitis. Autologous leukocytes are labeled with /sup 99m/Tc by inducing phagocytosis of /sup 99m/Tc albumin microcolloid particles. The advantages of this test over the standard indium-111 scan include superior imaging capability, a marked reduction (greater than 75%) in the radiation dose, and performance of the test including labeling, in less than 3 hr. Imaging is performed at 5-90 min postinjection of labeled cells. There were 19 male and 19 female patients with ages ranging from 10 to 80 years, in whom the diagnosis of appendicitis was indeterminate on clinical examination. Of the 13 of the 38 patients (34%) who came to surgery 12 had acute appendicitis. The WBC scan correctly identified 10 of the 12 cases of appendicitis. There were two false-negative studies. In the nonoperative group of 25 patients admitted for observation, 21 studies were reported as negative and four identified other sites of inflammation. All patients with a negative study have remained asymptomatic on follow-up. With a sensitivity of 83% (10/12) and a specificity of 100% (26/26) the /sup 99m/Tc leukocyte scan provides a rapid and highly accurate method for diagnosis of appendicitis in this preliminary study of patients with equivocal clinical exams

  11. LEUKEMIC PLEURAL EFF USION AS INITIAL MAN IFESTATION OF ACUTE MYELOID LEUKEMIA: A RARE CASE REPORT

    Rajeev Kumar

    2015-06-01

    Full Text Available Leukemic effusion is an uncommon presentation of Acute Myeloid leukemia with only isolated reports in literature. We report a case of 45 years old female who presented with unilateral pleural effusion and was diagnosed with haematological malignancy on pleural fluid cytology which revealed presence of myeloblasts. Subsequent, peripheral blood smear and bone marrow examination confirmed the diagnosis of Acute Myeloid Leukemia (AML M1. This case report highlights the uncommon presentation of AML as well as utility of meticulous examination of effusion fluids for diagnosing unsuspected malignancies.

  12. The impact of diagnostic delay on the course of acute appendicitis

    V.C. Cappendijk; F.W.J. Hazebroek (Frans)

    2000-01-01

    textabstractBACKGROUND: The diagnosis of acute appendicitis is often delayed, which may complicate the further course of the disease. AIMS: To review appendectomy cases in order to determine the incidence of diagnostic delay, the underlying factors, and impact on the co

  13. Mesenteric teratoma associated with acute perforated appendicitis in a 2-year-old girl

    Jihoon Jang

    2016-07-01

    Full Text Available Mesenteric teratoma is a rare tumor, with few cases reported in the literature. Because mesenteric teratomas have no specific signs or symptoms, their clinical manifestations depend on their size and location. This report describes a mesenteric teratoma associated with acute perforated appendicitis in a 2-year-old girl who presented with abdominal pain and high grade fever.

  14. Utility of abdominal ultrasonography in acute painful tables of right iliac Fossa with appendicitis acute suspicion. Maciel Hospital Experience

    Acute appendicitis is one of the most frequent causes of consultation and of indication of emergency laparotomy in most western countries. Despite its diagnostic being based mainly on clinical examination, there is a certain percentage of patients whose clinical presentation is atypical. In these cases image methods such as the abdominal ultrasound are particularly useful as diagnostic auxiliaries.The objective of this work is to compare the echographic with the Anatomopathological diagnosis in 80 patients who consulted the Hospital Maciel emergency service with episodes of acute appendicitis

  15. The role of radiolabeled leukocyte imaging in the management of patients with acute appendicitis

    Acute appendicitis is a clinical challenging surgical disease particularly difficult to diagnosis in women and children. An atypical presentation of acute appendicitis is a major factor leading to delay in diagnosis and unnecessary surgery. Delay in diagnosis is associated with morbidity from perforation, abscess and prolonged hospitalization. The routine use of adjunctive imaging studies has not improved the diagnostic accuracy for acute appendicitis nor has impacted clinical outcome. 99mTc HMPAO-labeled leukocyte imaging is one diagnostic imaging test that has the potential of altering the clinical management of acute appendicitis. 99mTc HMPAO-labeled leukocyte imaging is highly sensitive for detecting even small inflammatory processes in the abdomen because of high target to background and early rapid uptake at sites of inflammation. The paper studies the use of99mTc HMPAO-labeled leukocyte for diagnosis and management of suspected acute appendicitis in 124 patients with an atypical clinical presentation. Emergent imaging was performed immediately following injection of labeled leukocytes and continued until positive or through 2 hours if negative. The scan correctly and rapidly detected acute appendicitis in 50 of 51 patients with a surgical confirmation for a sensitivity of 98%. The specificity was 82% leading to an overall accuracy of 90%. The high negative predicted value of 98% allowed early discharge from the emergency department. The negative exploratory laparotomy rate wae 4% in this patient population compared to 9% in a similar population of patients who were not scanned. These data have been confirmed now in over 600 patients scanned in that department. The main drawbacks of 99mTc HMPAO-labeled leukocyte imaging are the requirement of blood handling and a delay in diagnosis because of 2-hours preparation time prior to imaging. There are new radiopharmaceuticals on the horizon which have the potential of replacing 99mTc HMPAO-labeled leukocyte imaging

  16. Hyperbilirubinaemia a predictive factor for complicated acute appendicitis: a study in a tertiary care hospital

    Objective: To study the role of hyperbilirubinaemia as a predictive factor for appendiceal perforation in acute appendicitis. Methods: The prospective, descriptive study was conducted at the Abbasi Shaheed Hospital and the Karachi Medical and Dental College, Karachi, from January 2010 to June 2012. It comprised all patients coming to the surgical outpatient department and emergency department with pain in the right iliac fossa with duration less than seven days. They were clinically assessed for signs and symptoms of acute appendicitis and relevant tests were conducted. Patients were diagnosed as a case of acute appendicitis on the basis of clinical and ultrasound findings, and were prepared for appendicectomy. Per-operative findings were recorded and specimens were sent for histopathology to confirm the diagnosis. SPSS version 10 was used to analyse the data. Results: Of the 71 patients, 37 (52.10%) were male and 34 (47.90%) were female. The age range was 3-57 years, and most of the patients (n=33; 46.5%) were between 11 and 20 years. Besides, 63 (89%) patients had pain in the right iliac fossa of less than four-days duration, while 8 (11%) had pain of longer duration. Total leukocyte count was found to be elevated in 33 (46.5%) patients, while total serum bilirubin was elevated in 41 (57.70%). Ultrasound of abdomen showed 9 (12.70%) patients having normal appearance of appendix and 59 (83.30%) had inflamed appendix. Four (5.60%) patients had no signs of inflammation on naked eye appearance per operatively. Histopathology of appendix showed 10 (14.10%) patients had non-inflammatory appendix. Conclusion: Patients with signs and symptoms of acute appendicitis and a raised total serum bilirubin level indicated a complication of acute appendicitis requiring an early intervention to prevent peritonitis and septicaemia. A raised serum bilirubin level is a good indicator of complicated acute appendicitis, and should be included in the assessment of patients with

  17. Selection of nonessential intravenous contrast enhanced-computed tomography for diagnosing acute appendicitis

    Since computed tomography (CT) has made acute appendicitis increasingly easy to diagnose correctly, intravenous contrast-enhanced CT (IV-CT) is increasingly used for this diagnosis. The purpose of this study is to clarify an indication of IV-CT and to eliminate unnecessary IV-CT. We studied whether IV-CT is necessary in all patients suspected of acute appendicitis, given the interval between onset and clinical diagnosis. IV-CT was performed in patient who had right lower quadrant abdominal pain or who had no pain but physical findings at right lower quadrant abdomen. We reviewed detailed medical records of 171 consecutive patients who underwent IV-CT followed by appendectomy within 24 hr. We compared Blumberg's sign, muscle guarding, body temperature, white blood cell count, and C reaction protein, dividing patients into 3 groups-half a day, in which the interval between onset and initial diagnosis was shorter than half a day; 1-day, in which the interval was longer than half a day but shorter than 1 day; and multiple-day, in which the interval exceeded 1 day. We also analyzed IV-CT findings for the abnormal appendix and the number of positive individual CT findings including abnormal appendix, calcified appendicolith, ascites, cecal wall thickening, and dilated intestines. Muscle guarding was significantly common in the patients who had appendicitis among 1-day and multiple-day patients. In IV-CT, enlarged appendix was observed more frequently in those with appendicitis in all 3 groups. Positive individual CT findings were detected more often in multiple-day patients who had appendicitis. We found no significant difference among the other items. A patient diagnosed clinically later than half a day after onset and having muscle guarding should be strongly suspected having acute appendicitis, indicating that IV-CT is not needed in such patients. (author)

  18. Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

    Carmine Noviello

    2015-01-01

    Full Text Available Transumbilical laparoscopic-assisted appendectomy (TULAA is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA. All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years. Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results.

  19. Total leucocyte count, C-reactive protein and neutrophil count: Diagnostic Aid in acute appendicitis

    Shafi Sheikh

    2009-01-01

    Full Text Available Background/Aim: Acute appendicitis is one of the most common acute intraabdominal affections seen in surgical departments, which can be treated easily if an accurate diagnosis is made in time. Otherwise, delay in diagnosis and treatment can lead to diffuse peritonitis. Materials and Methods: A study was conducted on 110 patients who were operated for acute appendicitis to determine the role and predictive value of the total leucocyte count (TLC, C-reactive protein (CRP and percentage of neutrophil count in the diagnosis of acute appendicitis. Preoperative TLC, CRP and percentage of neutrophil count were determined and were compared with the results of the histopathology of the removed appendix. Results: Of all the patients studied, 92 had histopathologically positive appendicitis. The TLC was found to be significantly high in 90 patients who proved to have acute appendicitis, whereas CRP was high in only 88 patients and neutrophil percentage was raised in 91; four had a normal CRP level. Thus, TLC had a sensitivity, specificity and positive predictive value of 97.82%, 55.55% and 91.8%, respectively. CRP had a sensitivity, specificity and positive predictive value of 95.6%, 77.77% and 95.6% respectively. Percentage of neutrophil count had a sensitivity, specificity and positive predictive value of 98.9%, 38.88% and 89.21%, respectively. When used in combination, there was a marked improvement in the specificity and the positive predictive value to 88.04% and 98.7%, respectively. Conclusion: The inflammatory markers, i.e., TLC, CRP and neutrophil count can be helpful in the diagnosis when measured together as this increases their specificity and positive predictive value.

  20. Case report of idiopathic cecal perforation presenting as acute appendicitis on ultrasound

    Calista Harbaugh

    2016-08-01

    Full Text Available Cecal perforation is an uncommon phenomenon in a pediatric population. It has been linked to a number of underlying medical conditions, which may result in focal inflammation or relative ischemia including hematologic malignancy, infection, and inflammatory bowel disease. We present an otherwise healthy 16-year-old male diagnosed with acute uncomplicated appendicitis on ultrasound, who was found to have cecal perforation with normal appendix intraoperatively, ultimately requiring ileocectomy. With this report, we aim to present the numerous pathophysiologic etiologies of cecal perforation, and to promote a comprehensive differential diagnosis despite the clinical and radiologic findings consistent with uncomplicated appendicitis.

  1. Interleukin 6 and lipopolysaccharide binding protein - markers of inflammation in acute appendicitis.

    Brănescu, C; Serban, D; Dascălu, A M; Oprescu, S M; Savlovschi, C

    2013-01-01

    The rate of incidence of acute appendicitis is 12% in the case of male patients and 25% in case of women, which represents about 7% of the world population. The appendectomy rate has remained constant (i.e. 10 out of 10,000 patients per year). Appendicitis most often occurs in patients aged between 11-40 years, on the threshold between the third and fourth decades, the average age being 31.3 years. Since the first appendectomy performed by Claudius Amyand (1681/6 -1740), on December, 6th, 1735 to our days, i.e., 270 years later, time has confirmed the efficiency of both the therapy method and the surgical solution. The surgical cure in case of acute appendicitis has proved to be acceptable within the most widely practised techniques in general surgery. The variety of clinical forms has reached all age ranges, which in its turn has resulted in a large number of semiotic signs. In the case of acute appendicitis, interdisciplinarity has allowed the transfer of concept and methodology transfer among many areas of expertise, aimed at a better, minute understanding of the inflammatory event itself. Acute appendicitis illustrates inflammation development at digestive level and provides for a diagnostic and paraclinical exploration which continually upgrades. The recent inclusion in the studies of the Lipopolysaccharide binding protein (LBP)- type inflammation markers has laid the foundation of the latter's documented presence in the case of acute appendicitis-related inflammation. Proof of the correlation between the histopathological, clinical and evolutive forms can be found by identifying and quantifying these inflammation markers. The importance of studying inflammation markers allows us to conduct studies going beyond the prognosis of the various stages in which these markers were identified. The present article shows the results of a 1-year monitoring of the inflammation markers' values for Interleukin-6 and Lipopolysaccharide binding protein (LBP)-types, both pre

  2. A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis

    Son Chang Sik; Jang Byoung Kuk; Seo Suk Tae; Kim Min Soo; Kim Yoon Nyun

    2012-01-01

    Abstract Background The aim of this study is to develop a simple and reliable hybrid decision support model by combining statistical analysis and decision tree algorithms to ensure high accuracy of early diagnosis in patients with suspected acute appendicitis and to identify useful decision rules. Methods We enrolled 326 patients who attended an emergency medical center complaining mainly of acute abdominal pain. Statistical analysis approaches were used as a feature selection process in the ...

  3. Comparison of outcomes of laparoscopic intracorporeal knotting technique in patients with complicated and noncomplicated acute appendicitis

    Ay, Nurettin; Dinç, Bulent; Alp, Vahhac; Kaya, Şafak; Sevük, Utkan

    2015-01-01

    Background and aim In our study we aimed to compare laparoscopic intracorporeal knotting technique (base of the appendix was ligated with 20 cm of 2.0 silk) in patients with complicated acute appendicitis (CAA) and noncomplicated acute appendicitis. Patients and methods Ninety patients (female/male: 40/50, age ranging from 16 to 60 years, median age and interquartile range [IQR]: 25 [20; 32] years) who underwent laparoscopic appendectomy were included in the study. The patients were evaluated for the type of acute appendicitis, duration of operation, duration of hospital stay, and postoperative complications. Results The number of cases diagnosed as CAA was 28 (31.1%), and the number of noncomplicated cases was 62 (68.9%). We found that there was no significant difference in postoperative complication rates between complicated and noncomplicated appendicitis cases. Incision site infection was seen in seven cases (7.8%) and ileus was seen in two cases (2.2%). Bleeding, intra-abdominal abscess, and appendix stump leakage were not observed in any of the cases. Median and IQR duration of operation were 42 (35; 52) minutes and median and IQR duration of hospital stay were detected as 2 (1; 2) (range 1–10) days. Conclusion Laparoscopic intracorporeal knotting technique may be a safe, effective, and reliable technique as the materials needed for closing the appendix stumps are easily available for both CAA cases and noncomplicated cases. PMID:26316765

  4. Influence of delays on perforation risk in adults with acute appendicitis.

    Kearney, D

    2012-02-03

    PURPOSE: This study analyzed whether prehospital or in-hospital delay was the more significant influence on perforation rates for acute appendicitis and whether any clinical feature designated patients requiring higher surgical priority. METHODS: A retrospective analysis was conducted over one year at a tertiary referral hospital without a dedicated emergency surgical theater. Admission notes, theater logbook, and the Hospital Inpatient Enquiry system were reviewed to identify the characteristics and clinical course of patients aged greater than 16 years who were operated upon for histologically confirmed acute appendicitis. RESULTS: One hundred and fifteen patients were studied. The overall perforation rate was 17 percent. The mean duration of symptoms prior to hospital presentation was 38.1 hours with the mean in-hospital waiting time prior to operation being 23.4 hours. Although body temperature on presentation was significantly greater in patients found to have perforated appendicitis (P < 0.05), only patient heart rate at presentation and overall duration of symptoms, but not in-hospital waiting time, independently predicted perforation by stepwise linear regression modeling. CONCLUSION: In-hospital delay was not an independent predictor of perforation in adults with acute appendicitis although delays may contribute if patients are left to wait unduly. Tachycardia at presentation may be a quantifiable feature of those more likely to have perforation and who should be given higher surgical priority.

  5. Causes of delayed presentation of acute appendicitis and its impact on morbidity and mortality

    Background: Acute appendicitis is one of the commonest abdominal emergencies and appendectomy. is one of the commonest emergency procedures performed all over the world. The study was done with an objective to evaluate the different causative factors for delayed presentation of appendicitis. Method: This cross-sectional study was carried out in the Surgical C unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 20th June 2013 to 19th June 2014. A total of 130 patients presented with appendicitis in OPDs or emergency department. Detailed history, general physical and systemic examination especially abdominal examination was done along with investigations. Results: It was found that 23.08 percentage of complicated appendicitis presentation is due to missed diagnosis by physicians, 30.77 percentage is due to missed diagnosis by non-doctors, 23.08 percentage is due to conservative management at DHQ hospitals by surgeons, and 23.08 percentage presented late because of self-medication at home. Conclusion: All patients with pain Right iliac fossa, there should be suspected of appendicitis. Proper workup should be done to exclude it. If kept on conservative management then regular monitoring of vitals with laboratory investigations should be done. (author)

  6. Comparison of outcomes of laparoscopic intracorporeal knotting technique in patients with complicated and noncomplicated acute appendicitis

    Ay N

    2015-08-01

    Full Text Available Nurettin Ay,1 Bulent Dinç,2 Vahhac Alp,1 Şafak Kaya,3 Utkan Sevük4 1Department of General Surgery, Diyarbakir Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey; 2Department of General Surgery, Ataturk State Hospital, Antalya, Turkey; 3Department of Infectious Disease, Diyarbakir Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey; 4Department of Cardiovascular Surgery, Diyarbakir Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey Background and aim: In our study we aimed to compare laparoscopic intracorporeal knotting technique (base of the appendix was ligated with 20 cm of 2.0 silk in patients with complicated acute appendicitis (CAA and noncomplicated acute appendicitis. Patients and methods: Ninety patients (female/male: 40/50, age ranging from 16 to 60 years, median age and interquartile range [IQR]: 25 [20; 32] years who underwent laparoscopic appendectomy were included in the study. The patients were evaluated for the type of acute appendicitis, duration of operation, duration of hospital stay, and postoperative complications. Results: The number of cases diagnosed as CAA was 28 (31.1%, and the number of noncomplicated cases was 62 (68.9%. We found that there was no significant difference in postoperative complication rates between complicated and noncomplicated appendicitis cases. Incision site infection was seen in seven cases (7.8% and ileus was seen in two cases (2.2%. Bleeding, intra-abdominal abscess, and appendix stump leakage were not observed in any of the cases. Median and IQR duration of operation were 42 (35; 52 minutes and median and IQR duration of hospital stay were detected as 2 (1; 2 (range 1–10 days. Conclusion: Laparoscopic intracorporeal knotting technique may be a safe, effective, and reliable technique as the materials needed for closing the appendix stumps are easily available for both CAA cases and noncomplicated cases. Keywords: laparoscopic intracorporeal knotting

  7. A study of the usefulness of CT in diagnosis of diverticulitis of the right colon and acute appendicitis

    It is difficult to differentiate between diverticulitis of the right colon and acute appendicitis based on pathological and hematological findings. This study was designed to investigate the usefulness of CT in differentiation between the both diseases and indications of operation. Eight cases of right colon diverticulitis and 39 cases of acute appendicitis undergone abdominal plain CT scan before surgery were enrolled in the study. As for diverticulitis cases, diverticulum was visualized on abdominal CT scan in seven (87.5%) out of the eight cases. Of 39 cases of acute appendicitis, the appendix vermiformis was able to be visualized on abdominal CT scan in 26 (66.7%) cases. Some correlations between CT findings and postoperative pathological diagnosis of appendicitis were observed. A comparison was made on acute appendicitis cases by dividing them into two groups; namely, the non-surgery group comprising of cases pathologically diagnosed as non-inflammatory and catarrhal' and the surgery group comprising of cases diagnosed as 'phlegmonous and gangrenous' after surgery. Statistically significant difference was noted between both groups in two factors, whole-circumferential thickening of the appendiceal wall and fading panniculus adiposus around the appendix. It is concluded that abdominal CT scan is useful for differential diagnosis between right colon diverticulitis and acute appendicitis, and further that CT diagnosis of acute appendicitis well reflects the severity of the disease and contribute to decide indication of operation. (author)

  8. Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes

    Reem Hassan Bassiouny

    2014-09-01

    Conclusion: Using a systematic pattern approach MDCT has proved to be an extremely useful noninvasive method for evaluation of patients with acute RLQP, allowing diagnosis and management of not only the most common conditions such as appendicitis but also less common conditions.

  9. BACTERIAL PATTERN OF APPENDIX IN ACUTE AND CHRONIC APPENDICITIS WITH ITS CLINICAL CORRELATION

    Surajit

    2016-02-01

    Full Text Available BACKGROUND Acute appendicitis is a common, sometimes confusing and often treacherous cause of acute abdomen at all ages. The only way to reduce morbidity and to prevent mortality is to perform appendicectomy before perforation or gangrene occurs. As appendicectomy is a very common practice, it is essential to know in detail the various etiological factors that precipitate appendicitis. Bacterial invasion being a very common cause makes it imperative that we have a clear picture of the bacterial pattern of appendix in acute and recurrent appendicitis and to correlate this with clinical findings. A proper idea of bacterial flora of appendix thus helps us not only to prevent postoperative complication, but also to impart effective conservative treatment by pinpointing sensitive drugs. AIMS AND OBJECTIVES Knowledge of bacterial flora of appendix also has socio-economic benefits through low rates of post-operative complications, reduced hospital stay and also reduced indiscriminate use of multiple costly drugs. The aim of this study is to establish the bacterial profile in acute as well as recurrent appendicitis and to correlate the findings with the severity of the disease. MATERIALS AND METHODS This study was conducted on 90 patients irrespective of age and sex who attended the emergency and OPD during the course of the work with symptoms suggestive of appendicitis. Following appendicectomy, each of the specimens was cut into two pieces. One was sent for histopathological examination and other was sent for bacterial culture. RESULT The commonest bacteria isolated were Escherichia coli in 67.78% cases, which is a facultative anaerobe and it was closely accompanied by Klebsiella species in 47.78% cases. Other isolates that were recorded included Staphylococcus aureus in 3.33% cases with Pseudomonas aeruginosa and Proteus species in 2.22% cases each. Mixed infections were seen in phlegmonous, gangrenous and perforative appendicitis. Bacteroides

  10. Is it possible to make a useful scoring system for the diagnosis of acute appendicitis?

    We conducted a prospective study of 561 patients hospitalized with abdominal pain suggestive of acute appendicitis. History, signs, symptoms, leukocytosis and CT findings were analyzed for sensitivity and specificity. The result of a multivariate analysis of these factors revealed five factors which were found to be useful in making the diagnosis of acute appendicitis, as follows: age; CT findings (distended appendix, appendicolith, periappendiceal inflammatory changes); and the inflammatory changes around the ascending colon (negative finding). Based on this weighting, we devised a practical diagnostic score that may help in excluding catarrhal appendicitis and diagnosing only phlegmonous and gangrenous appendicitis for operation. As a result, the sensitivity and specificity were only 77.2% and 75.6%, respectively. The actual comprehensive diagnostic sensitivity and specificity of 88% and 88.7%, respectively, were 10% greater than the sensitivity and specificity by the scoring system. This difference was equivalent to the overall judgment based on the experience of the surgeons, and appeared impossible to fill by the diagnostic score with statistical analysis. (author)

  11. Evaluation of the Appendix Base Location in Acute Appendicitis Using Sonography and its Clinical Significance

    The purpose of this study is to investigate the location of appendiceal base using sonography in acute appendicitis and the usefulness of the appendiceal base marking in deciding the incision site of appendectomy. We performed appendix sonography in 813 patients and 381 patients were diagnosed as acute appendicitis. During sonography, we marked the base of the appendix on the skin of the patients' abdomen. After appendiceal base marking, we measured the distance from McBurney's point to the appendiceal base. The marking was used as the guide for incision site for appendectomy by the surgeon. Among 381 patients, we excluded 78 patients due to non visualization of the cecoappendiceal junction (n = 6), pregnancy appendicitis (n = 2), false positive appendicitis (n = 3) and no reply from the surgeon (n = 67). So we investigated 303 patients prospectively. After operation, we asked the surgeon whether the appendiceal base marking was helpful for appendectomy or not. The base of the appendix at McBurney's point were 31%, lying within 2 cm from McBurney's point were 20%, within 5 cm were 28%, more than 5 cm were 21%. For the usefulness of appendiceal base marking, 95% showed good correlation with marking and surgical incision, and 5% revealed poor correlation. The base of the appendix was located in diverse areas of the abdomen, although most frequent in the McBurney's point and within 2 cm from the McBurney's point. Appendiceal base marking on the skin of the abdomen after diagnosis of acute appendicitis could be an useful method to guide the surgeon for decision of surgical incision site

  12. Evaluation of the Appendix Base Location in Acute Appendicitis Using Sonography and its Clinical Significance

    Lee, Kwan Seop; Kim, Min Jeong; Ko, Eun Young; Hong, Myung Sun; Jeon, Eui Yong; Hwang, Hee Sung; Lee, In Jae; Yang, Ik; Lee, Eil Seong; Lee, Bong Hwa [Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    2005-12-15

    The purpose of this study is to investigate the location of appendiceal base using sonography in acute appendicitis and the usefulness of the appendiceal base marking in deciding the incision site of appendectomy. We performed appendix sonography in 813 patients and 381 patients were diagnosed as acute appendicitis. During sonography, we marked the base of the appendix on the skin of the patients' abdomen. After appendiceal base marking, we measured the distance from McBurney's point to the appendiceal base. The marking was used as the guide for incision site for appendectomy by the surgeon. Among 381 patients, we excluded 78 patients due to non visualization of the cecoappendiceal junction (n = 6), pregnancy appendicitis (n = 2), false positive appendicitis (n = 3) and no reply from the surgeon (n = 67). So we investigated 303 patients prospectively. After operation, we asked the surgeon whether the appendiceal base marking was helpful for appendectomy or not. The base of the appendix at McBurney's point were 31%, lying within 2 cm from McBurney's point were 20%, within 5 cm were 28%, more than 5 cm were 21%. For the usefulness of appendiceal base marking, 95% showed good correlation with marking and surgical incision, and 5% revealed poor correlation. The base of the appendix was located in diverse areas of the abdomen, although most frequent in the McBurney's point and within 2 cm from the McBurney's point. Appendiceal base marking on the skin of the abdomen after diagnosis of acute appendicitis could be an useful method to guide the surgeon for decision of surgical incision site

  13. Acute appendicitis secondary to Enterobius vermicularis infection in a middle-aged man: a case report

    Panidis Stavros

    2011-11-01

    Full Text Available Abstract Introduction Acute appendicitis due to Enterobius vermicularis is very rare, affecting mostly children. Whether pinworms cause inflammation of the appendix or just appendiceal colic has been a matter of controversy. Case presentation A Caucasian 52-year-old man was referred to our Emergency Department with acute abdominal pain in his right lower quadrant. The physical and laboratory examination revealed right iliac fossa tenderness and leukocytosis with neutrophilia. An open appendectomy was performed. The pathological examination showed the lumen containing pinworms. Two oral doses of mebendazole were administered postoperatively. The follow-up to date was without incident and he was free of symptoms one year after the operation. Conclusion The finding of E. vermicularis in appendectomy pathological specimens is infrequent. Parasitic infections rarely cause acute appendicitis, especially in adults. One should keep in mind that the clinical signs of intestinal parasite infection may mimic acute appendicitis, although rare. A careful evaluation of symptoms such as pruritus ani, or eosinophilia on laboratory examination, could prevent unnecessary appendectomies.

  14. Acute Appendicitis in a Man Undergoing Therapy for Mantle Cell Lymphoma

    Michael Linden

    2012-01-01

    Full Text Available A 71-year-old man was diagnosed with an aggressive mantle cell lymphoma and was started on six cycles of R-CHOP chemotherapy. Approximately two weeks after starting his first cycle of chemotherapy, he complained of severe right lower quadrant abdominal pain, and an abdominal CT scan demonstrated an enlarged appendix with evidence of contained perforation. The man underwent open appendectomy for acute appendicitis and recovered. The appendectomy specimen was submitted for routine pathological analysis. There was histologic evidence of perforation in association with an inflammatory infiltrate with fibrin adhered to the serosal surface; scattered small lymphoid aggregates were present on the mucosal surface. Although the lymphoid aggregates in the submucosa and lamina propria were rather unremarkable by routine histologic examination, immunohistochemistry revealed the lymphocytes to be predominantly Cyclin D1-overexpressing B cells. To our knowledge, this is the first reported case of acute appendicitis in association with appendiceal involvement by mantle cell lymphoma.

  15. Tubercular tubo-ovarian cystic mass mimicking acute appendicitis: a case report

    Arikanoglu Zulfu; Akbulut Sami; Basbug Murat

    2011-01-01

    Abstract Introduction Female genital tuberculosis is a rare form of extrapulmonary tuberculosis. It is an asymptomatic disease usually diagnosed during the search for causes of infertility. However, it can present with a number of abdominopelvic symptoms. Herein we report a case of tubo-ovarian tuberculosis mimicking acute appendicitis. Case presentation A 17-year-old single Turkish woman presented to our hospital with complaints of right lower quadrant abdominal pain, nausea, and vomiting. H...

  16. Acute appendicitis presenting with abdominal wall and right groin abscess: A case report

    Mustafa Yildiz; Ahmet Sevki Karakayali; Saadet Ozer; Hilal Ozer; Aydin Demir; Bugra Kaptanoglu

    2007-01-01

    We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.

  17. Teníase: uma causa rara de apendicite aguda Taeniasis: a rare cause of acute appendicitis

    Fábio Vieira Teixeira

    2008-02-01

    Full Text Available Acute appendicitis is the most common surgical condition of acute abdomen. Approximately 7 percent of the population will have appendicitis during their lifetime, with the peak incidence occurring between 10 through 30 years-old. Obstruction of the appendix lumen with subsequent bacterial infection initiates the pathophysiological sequence of acute appendicitis. Obstruction may have multiple causes, including fecalith, lymphoid hyperplasia (related to viral illnesses, including upper respiratory infection, mononucleosis, and gastroenteritis, foreign bodies, carcinoid tumor, and parasites. In Asia, Africa and Latin America, Enterobius vermicularis has been reported as the main parasite that causes appendix obstruction. Rarely, Taenia sp., has been pointed as a cause of parasitic appendicitis. We reported a 30 years-old patient clinically diagnosed with acute appendicitis. The appendectomy was performed through a McBurney incision. The patient's convalescence was uneventful, and he was discharged from hospital 48 hours after operation. Histological examination of the appendix showed acute appendicitis, and it was found a parasite (Taenia sp. lying inside of the appendix lumen at a transverse section. He has received 10 mg/Kg weight of praziquantel for taeniasis treatment.

  18. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient

    Michael J Forster; Jacob A Akoh

    2008-01-01

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

  19. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient.

    Forster, Michael-J; Akoh, Jacob-A

    2008-03-21

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen. PMID:18350613

  20. Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings

    Tamburrini, Stefania [Universita' di Napoli ' ' Federico II' ' , Dip. Sc. Biomorfologiche e Funzionali, Naples (Italy); UCSD Medical Center, Department of Radiology, San Diego, CA (United States); Brunetti, Arturo [Universita' di Napoli ' ' Federico II' ' , Dip. Sc. Biomorfologiche e Funzionali, Naples (Italy); Brown, Michele; Sirlin, Claude; Casola, Giovanna [UCSD Medical Center, Department of Radiology, San Diego, CA (United States)

    2007-08-15

    The purposes of this study were to determine the (1) frequency with which nonenhanced computed tomography (CT) (NECT) permits conclusive diagnosis of acute appendicitis, (2) accuracy of NECT when findings are conclusive, and (3) overall accuracy of a CT protocol consisting of NECT with selective use of contrast. Five hundred and thirty-six patients underwent a NECT protocol with selective use of contrast. Diagnostic accuracy was then determined separately for (1) patients with conclusive initial NECT, (2) patients with inconclusive initial NECT, and (3) all patients. NECT was conclusive on initial interpretation in 404/536 patients and inconclusive in 132/536. Of 132 inconclusive studies, 126 were repeated with contrast (intravenous, oral or rectal). Sensitivity, specificity, and positive and negative predictive value for diagnosis of acute appendicitis were (1) 90%, 96.0%, 84.8%, and 97.4% in patients with conclusive NECT (n = 404); (2) 95.6%, 92.3%, 73%, and 99% in patients with inconclusive NECT followed by repeat CT with contrast; and (3) 91.3%, 95%, 82%, and 98% in all patients. The initial diagnosis of appendicitis may be made by NECT in 75% of patients, with contrast administration reserved for inconclusive NECT studies. (orig.)

  1. Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings

    The purposes of this study were to determine the (1) frequency with which nonenhanced computed tomography (CT) (NECT) permits conclusive diagnosis of acute appendicitis, (2) accuracy of NECT when findings are conclusive, and (3) overall accuracy of a CT protocol consisting of NECT with selective use of contrast. Five hundred and thirty-six patients underwent a NECT protocol with selective use of contrast. Diagnostic accuracy was then determined separately for (1) patients with conclusive initial NECT, (2) patients with inconclusive initial NECT, and (3) all patients. NECT was conclusive on initial interpretation in 404/536 patients and inconclusive in 132/536. Of 132 inconclusive studies, 126 were repeated with contrast (intravenous, oral or rectal). Sensitivity, specificity, and positive and negative predictive value for diagnosis of acute appendicitis were (1) 90%, 96.0%, 84.8%, and 97.4% in patients with conclusive NECT (n = 404); (2) 95.6%, 92.3%, 73%, and 99% in patients with inconclusive NECT followed by repeat CT with contrast; and (3) 91.3%, 95%, 82%, and 98% in all patients. The initial diagnosis of appendicitis may be made by NECT in 75% of patients, with contrast administration reserved for inconclusive NECT studies. (orig.)

  2. Impact of the use of contrast-enhancement multidetector CT for acute appendicitis: a prospective comparison with the Alvarado score

    To determine the diagnostic performance of contrast-enhanced multidetector CT (MDCT) and the Alvarado score for acute appendicitis. MDCT and determination of the Alvarado score were prospectively performed in 282 patients with 146 pathologically proven cases of acute appendicitis and 136 pathologically proven or clinically diagnosed cases of non-acute appendicitis. To compare the diagnostic performance of MDCT and the Alvarado score, the patients were subdivided according to age and sex, and receiver operating characteristics (ROC) analysis and Spearman rank correlation were performed. ROC analysis revealed that the optimal cut off value of the CT appendicitis grades was 2 in all patients, resulting in a sensitivity of 96.6% and a specificity of 94.9%. The optimal cut off values of the Alvarado score was different according to age and sex, resulting in a sensitivity of 85.6% and a specificity of 48.5%. There was a significant correlation between the CT appendicitis grades and the surgical-pathological grades (r = 0.496, ρ < .0001). However, no significant correlation was observed between the Alvarado score and the surgical-pathological grades. Contrast-enhanced MDCT has a higher diagnostic accuracy and significant correlation with pathological findings than those of the Alvarado score in patients with acute appendicitis

  3. The efficacy of unenhanced MR imaging for the diagnosis of acute appendicitis: a performance comparison versus abdominal ultrasonography

    To evaluate the efficacy of unenhanced MR imaging compared to the diagnostic accuracy, advantage, and limitations of abdominal ultrasonography in the diagnosis of acute appendicitis. The study included 40 patients suspected of having acute appendicitis and who were subjected to an unenhanced MR image, as well as an abdominal ultrasonography. A T1 FLASH in an axial image, a chemical shift-selective fat suppressed T2 HASTE in an axial image, as well as a T2 HASTE in an axial and coronal image were obtained as unenhanced MR images. The diagnosis was established based on a surgical or clinical follow-up of the unenhanced MR results, which were then statistically compared to the ultrasonographic results. The surgical or clinical follow-up results revealed that 25 patients were positively diagnosed with appendicitis. Of these, 7 patients had symptoms of acute appendicitis with no pathologic diagnoses, whereas the 8 remaining patients were diagnosed with another condition. The sensitivity and accuracy of the unenhanced MR imaging was 92% and 90%, compared to ultrasonography which was 68% and 72.5% accurate, respectively. The differences in sensitivity and accuracy between the two methods were found to be statistically significant (ρ < 0.05, chi-square test). Based on these results, unenhanced MR imaging was superior to sonography for the diagnosis of appendicitis. Unenhanced MR imaging may be a useful modality for the diagnosis of acute appendicitis, especially for suboptimal or nondiagnostic sonographies, as well as patients that are particularity sensitive to radiation exposure

  4. A Patient with an Unusual Cause Right Lower Quadrant Pain and Vomiting: Pyelonephritis of an Ectopic Right Kidney Masquerading as Acute Appendicitis

    Michele N. Lossius

    2009-01-01

    Full Text Available An adolescent female presented with one day of abdominal pain and clinical findings of acute appendicitis. CT scan revealed an ectopic right kidney with changes of acute pyelonephritis. This paper underscores the importance of imaging the right pelvis prior to surgical intervention in suspected cases of acute appendicitis in children.

  5. Reassessment of CT images to improve diagnostic accuracy in patients with suspected acute appendicitis and an equivocal preoperative CT interpretation

    To identify CT features that discriminate individuals with and without acute appendicitis in patients with equivocal CT findings, and to assess whether knowledge of these findings improves diagnostic accuracy. 53 patients that underwent appendectomy with an indeterminate preoperative CT interpretation were selected and allocated to an acute appendicitis group or a non-appendicitis group. The 53 CT examinations were reviewed by two radiologists in consensus to identify CT findings that could aid in the discrimination of those with and without appendicitis. In addition, two additional radiologists were then requested to evaluate independently the 53 CT examinations using a 4-point scale, both before and after being informed of the potentially discriminating criteria. CT findings found to be significantly different in the two groups were; the presence of appendiceal wall enhancement, intraluminal air in appendix, a coexistent inflammatory lesion, and appendiceal wall thickening (P < 0.05). Areas under the curves of reviewers 1 and 2 significantly increased from 0.516 and 0.706 to 0.677 and 0.841, respectively, when reviewers were told which CT variables were significant (P = 0.0193 and P = 0.0397, respectively). Knowledge of the identified CT findings was found to improve diagnostic accuracy for acute appendicitis in patients with equivocal CT findings. circle Numerous patients with clinically equivocal appendicitis do not have acute appendicitis circle Computed tomography (CT) helps to reduce the negative appendectomy rate circle CT is not always infallible and may also demonstrate indeterminate findings circle However knowledge of significant CT variables can further reduce negative appendectomy rate circle An equivocal CT interpretation of appendicitis should be reassessed with this knowledge. (orig.)

  6. Reassessment of CT images to improve diagnostic accuracy in patients with suspected acute appendicitis and an equivocal preoperative CT interpretation

    Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won [Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of); Park, Seong Jin [Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of)

    2012-06-15

    To identify CT features that discriminate individuals with and without acute appendicitis in patients with equivocal CT findings, and to assess whether knowledge of these findings improves diagnostic accuracy. 53 patients that underwent appendectomy with an indeterminate preoperative CT interpretation were selected and allocated to an acute appendicitis group or a non-appendicitis group. The 53 CT examinations were reviewed by two radiologists in consensus to identify CT findings that could aid in the discrimination of those with and without appendicitis. In addition, two additional radiologists were then requested to evaluate independently the 53 CT examinations using a 4-point scale, both before and after being informed of the potentially discriminating criteria. CT findings found to be significantly different in the two groups were; the presence of appendiceal wall enhancement, intraluminal air in appendix, a coexistent inflammatory lesion, and appendiceal wall thickening (P < 0.05). Areas under the curves of reviewers 1 and 2 significantly increased from 0.516 and 0.706 to 0.677 and 0.841, respectively, when reviewers were told which CT variables were significant (P = 0.0193 and P = 0.0397, respectively). Knowledge of the identified CT findings was found to improve diagnostic accuracy for acute appendicitis in patients with equivocal CT findings. circle Numerous patients with clinically equivocal appendicitis do not have acute appendicitis circle Computed tomography (CT) helps to reduce the negative appendectomy rate circle CT is not always infallible and may also demonstrate indeterminate findings circle However knowledge of significant CT variables can further reduce negative appendectomy rate circle An equivocal CT interpretation of appendicitis should be reassessed with this knowledge. (orig.)

  7. Identification of hepatic niche harboring human acute lymphoblastic leukemic cells via the SDF-1/CXCR4 axis.

    Itaru Kato

    Full Text Available In acute lymphoblastic leukemia (ALL patients, the bone marrow niche is widely known to be an important element of treatment response and relapse. Furthermore, a characteristic liver pathology observed in ALL patients implies that the hepatic microenvironment provides an extramedullary niche for leukemic cells. However, it remains unclear whether the liver actually provides a specific niche. The mechanism underlying this pathology is also poorly understood. Here, to answer these questions, we reconstituted the histopathology of leukemic liver by using patients-derived primary ALL cells into NOD/SCID/Yc (null mice. The liver pathology in this model was similar to that observed in the patients. By using this model, we clearly demonstrated that bile duct epithelial cells form a hepatic niche that supports infiltration and proliferation of ALL cells in the liver. Furthermore, we showed that functions of the niche are maintained by the SDF-1/CXCR4 axis, proposing a novel therapeutic approach targeting the extramedullary niche by inhibition of the SDF-1/CXCR4 axis. In conclusion, we demonstrated that the liver dissemination of leukemia is not due to nonselective infiltration, but rather systematic invasion and proliferation of leukemic cells in hepatic niche. Although the contribution of SDF-1/CXCR4 axis is reported in some cancer cells or leukemic niches such as bone marrow, we demonstrated that this axis works even in the extramedullary niche of leukemic cells. Our findings form the basis for therapeutic approaches that target the extramedullary niche by inhibiting the SDF-1/CXCR4 axis.

  8. 急性阑尾炎的CT诊断%CT FINDINGS IN ACUTE APPENDICITIS

    吴俊凤; 潘旭民; 陈慧妙; 李秀芳

    2014-01-01

    目的:研究急性阑尾炎的典型CT表现。方法收集45例经手术病理证实的急性阑尾炎病例,回顾性分析其表现特征。结果45例中CT诊断为急性阑尾炎可能1例(2.22%);急性阑尾炎8例(17.78%);急性阑尾炎并阑尾周围炎14例(31.11%);急性阑尾炎并穿孔5例(11.11%);阑尾脓肿13例(28.89%);阑尾炎性肿块4例(8.89%)。急性阑尾炎的CT直接征象为阑尾肿大增粗(直径>6mm)、阑尾壁增厚和阑尾石,间接征象有阑尾-盲肠周围脂肪内条索影等。临床诊断为急性阑尾炎可能4例;急性阑尾炎21例;阑尾炎包块16例;另有4例因右上腹痛而拟诊胆囊炎。主要CT表现:①阑尾肿胀,管壁增厚,可呈不同密度分层的“同心圆”样结构;阑尾边缘模糊,密度近似甚至高于邻近肌肉;②阑尾管腔内可见积液、粪石和气体;③阑尾系膜肿胀,周围脂肪组织密度升高;④阑尾穿孔,周围形成脓肿;⑤相邻盲肠壁可有增厚,末端呈尖角样改变;右侧肾筋膜和侧锥筋膜增厚;⑥小肠低位梗阻、肝脓肿等并发症。CT所显示的阑尾形态及其周围组织的改变,与手术和病理所见一致。结论急性阑尾炎有典型CT表现。CT检查可准确显示阑尾本身和周围组织改变及其合并症,为临床的诊治提供有价值的信息。CT对急性阑尾炎的诊断特别是对临床表现不甚典型的阑尾炎及其并发症的诊断,具有很高准确率。%Objective To investigate CT characteristics of acute appendicitis and to find the significance of CT findings in acute appendicitis .Methods A total of of 45 patients with acute appendicitis confirmed by CT were included in this study ,in which 21 male patients and 24 female patients were included and the av-erage age was 48 years old with the range from 38y to 65y .The clinical and CT data were analyzed retro

  9. Comparative analysis between single incision and conventional laparoscopic appendectomy for acute appendicitis

    Sreeram Sateesh

    2014-08-01

    Full Text Available Appendicitis is an acute inflammatory condition of appendix. Since it is a surgical emergency, needs early diagnosis and treatment strategies which include clinical examination, followed by Laboratory investigations and Imaging studies. The scoring systems like Alvarado score have been considered for better diagnosis. In most studies surgery has been reported as the best modality of treatment. Several studies clearly mentioned the impact of various surgical procedures which include Open appendectomy (OA, Conventional laparoscopic appendectomy (CLA and Single incision laparoscopic appendectomy (SILA. Hence, the present study is carried in an aim to assess and compare the merits and demerits between the surgical procedures Like SILA and CLA. The patients were randomly selected from the surgical department (NMCH who presented with acute pain abdomen and diagnosed as acute appendicitis. 50 patients were enrolled in the study after fulfilling the inclusion and exclusion criteria. The various demographic variables have been studied between the surgical procedures to demonstrate their impact, which include wound infection rate, pain scores at 24 and 48hrs, the amount of time period for surgery in minutes, patient satisfaction scores and post-operative stay tenure at the hospital in days. The laparoscopic hand instruments used in both techniques are similar, except covidien port which was reused in SILA, following gas sterilization to reduce the cost. Findings reveal that the pain score was significantly lower in SILA than CLA group. The procedure time is comparatively more in SILA than CLA group. Patients had significant satisfaction score in SILA measured at 6 weeks after appendectomy. However the post operative stay, wound infection rate was almost similar in both the groups. There was no conversion to open Appendectomy performed in either of these groups. Results also clearly suggest that the SILA procedure is the safe, alternative and effective

  10. The usefulness of enhanced computed tomography imaging in the diagnosis and evaluation of the severity of acute appendicitis

    To evaluate the usefulness of computed tomography (CT) in the diagnosis of acute appendicitis and the decision for an appropriate operative approach, CT was performed in addition to the clinical and laboratory findings in 42 patients suspected of having acute appendicitis. As for CT findings, surgical intervention was considered in principle in patients with enlargement of the appendix over 10 mm, enhanced appendiceal wall, appendicolith, abscess, ascites, deficiency of appendiceal wall, or hazy periappendicular densities. The maximal diameter of resected specimen was also measured. Surgery was conducted in 23 patients, and 19 of them had phlegmonous/gangrenous appendicitis. The remaining 19 patients were treated without surgery. Enhanced appendiceal wall and hazy periappendicular densities were detected in all patients with phlegmonous/gangrenous appendicitis, and deficiency of the appendiceal wall, appendicolith, and abscess/ascites were seen in 79%, 42% and 58%, respectively. The maximal diameter of phlegmonous/gangrenous appendix was 11.8 mm, and was significantly larger than that of the appendix with normal or catarrhal appendicitis. The correlation coefficient of the maximal diameter of the appendix between resected specimen and the appendix as measured with CT was 0.65. The specificity, sensitivity, and accuracy of the preoperative diagnosis including CT were 75%, 97%, and 90%, respectively. Preoperative diagnosis including CT is useful to identify acute appendicitis, to evaluate the severity of disease, and to decide the surgical indication. (author)

  11. The value of pancreatic stone protein in predicting acute appendicitis in patients presenting at the emergency department with abdominal pain

    Tschuor Christoph

    2012-10-01

    Full Text Available Abstract Background Pancreatic Stone Protein (PSP is a protein naturally produced mainly in the pancreas and the gut. There is evidence from experimental and clinical trials that blood PSP levels rise in the presence of inflammation or infection. However, it is not known whether PSP is superior to other established blood tests (e.g. White Blood Count, Neutrophils or C - reactive protein in predicting appendicitis in patients presenting with abdominal pain and a clinical suspicion of appendicitis at the emergency room. Methods/design The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. 245 patients will be prospectively recruited. Interim analysis will be performed once 123 patients are recruited. The primary endpoint of the study concerns the diagnostic accuracy of PSP in predicting acute appendicitis and therefore the evidence of appendicitis on the histopathological specimen after appendectomy. Discussion The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. Trial registration ClinicalTrials.gov: NCT01610193; Institution Ethical Board Approval ID: KEKZH- Nr. 2011–0501

  12. Comparison of two surgical techniques; simple ligation and ligation with invagination of appendicular stump in appendicectomy for acute appendicitis

    Appendicitis is an important differential diagnosis in patients with right lower quadrant pain. Acute appendicitis is the common emergency encountered round the globe. It is the cause of an acute surgical abdomen, and it remains one of the most challenging diagnoses in the emergency department. Appendicectomy is the accepted therapy for acute appendicitis. To compare the technique of simple ligation and ligation with burial of the stump during appendicectomy for acute appendicitis. Subjects and Methods: Eighty cases of acute appendicitis were analysed for this study. They were randomly allocated to the two surgical procedures such as simple ligation (Group I) and ligation with invagination (Group II) of appendicular stump in appendicectomy. The clinical variables were statistically evaluated. The frequency of postoperative ileus was more in group II (22.5%, and 5%) during first 48 and 72 hours respectively as compared to group I, P 0.05). Simple ligation of stump during appendicectomy is a better and safe procedure as compared to the invagination of stump because there is less incidence of postoperative complications such as postoperative paralytic ileus and wound infection. (author)

  13. Usefulness of the inner hypoechoic band of the vermiform appendix as ultrasonographic criteria for the diagnosis of acute appendicitis in children

    We wanted to evaluate the usefulness of the inner hypoechoic band in pediatric appendices as an ultrasonographic criterion to exclude or confirm acute appendicitis. Among the 169 consecutive children with right lower abdominal pain, the 149 appendices depicted on US were prospectively evaluated for an inner hypoechoic band in the appendiceal walls. The sensitivity, specificity, positive and negative predictive values and accuracy were assessed for loss of the inner hypoechoic band as a diagnostic criterion for acute appendicitis. The appendices in 12 (25%) patients with acute appendicitis show entire inner hypoechoic bands and those in 36 patient (75%) did not. The appendices in 97 (96%) patients without acute appendicitis showed entire inner hypoechoic bands, an those in 4 (4%) did not. The loss of inner hypoechoic band confirmed acute appendicitis with a sensitivity of 75%, a specificity of 96%, positive and negative predictive values of 89% and 90%, respectively, and an accuracy of 89%. The thickness of the inner hypoechoic band in patients without appendicitis was significantly higher than that in patients with appendicitis (ρ = 0.03). The visualization of entire thickened inner hypoechoic band in the appendiceal wall helps to rule out acute appendicitis. However, the loss of the inner hypoechoic band is suggestive of acute appendicitis

  14. Torsion of a giant pedunculated liver hemangioma mimicking acute appendicitis: a case report

    Sari Serkan

    2010-01-01

    Full Text Available Abstract Hemangiomas are the most common benign neoplasms affecting the liver. They occur at all ages. Most cases are asymptomatic and do not require any treatment. Rarely, hemangiomas can be pedunculated. İf they undergo torsion and infarction, they become symptomatic. Herein; we report the case of a 31 year old male presenting with features of acute appendicitis: continuous right iliac fossa pain, rebound, guarding tenderness at McBurney' s point, nausea, anorexia, shifted white blood cell count and a Mantrels score of 6. At laparotomy a normal appendix was observed and a torsioned pedinculated liver hemangioma turned out to be the cause.

  15. Acute appendicitis in a young adult with midgut malrotation: a case report

    Bider, K.; Kaim, A.; Wiesner, W.; Bongartz, G. [Dept. of Radiology University Hospital Basel (Switzerland)

    2001-07-01

    Midgut malrotation is defined as a developmental anomaly that may cause atypical clinical symptoms in relatively common intestinal disorders due to altered anatomy. A 27-year-old woman presented with acute left-sided abdominal pain. Underlying type Ia malrotation prevented the correct clinical diagnosis of perforated, ulcerated appendicitis. Cross-sectional imaging demonstrated all the typical signs of this type of malrotation, i.e., right-sided duodenojejunal junction, left positioned cecum and ascending colon, inverted position of the superior mesenteric vessels, and hypoplasia of the uncinate process of pancreas, and surgical treatment was initiated. (orig.)

  16. Localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis

    Ju Won Chyung

    2013-01-01

    Full Text Available A 61-year-old male was admitted to our hospital due to right lower abdominal pain and watery diarrhea for 3 d. Beginning 3 wk before he arrived in our hospital, he took 3rd-generation cephalosporin (cefixime for 2 wk due to chronic left ear otitis media. Colonoscopic examination revealed yellowish patches of ulcerations and swelling covered with thick serosanguineous exudate in the cecum and ascending colon. After 7 d of oral metronidazole treatment, his symptoms completely disappeared. We report a case of localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis associated with cefixime.

  17. Localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis.

    Chyung, Ju Won; Shin, Dong Gue

    2013-05-27

    A 61-year-old male was admitted to our hospital due to right lower abdominal pain and watery diarrhea for 3 d. Beginning 3 wk before he arrived in our hospital, he took 3(rd)-generation cephalosporin (cefixime) for 2 wk due to chronic left ear otitis media. Colonoscopic examination revealed yellowish patches of ulcerations and swelling covered with thick serosanguineous exudate in the cecum and ascending colon. After 7 d of oral metronidazole treatment, his symptoms completely disappeared. We report a case of localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis associated with cefixime. PMID:23710293

  18. Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis

    Iterative reconstruction technique has been proposed as a means of reducing patient radiation dose in pediatric CT. Yet, the effect of such reductions on diagnostic accuracy has not been thoroughly evaluated. This study compares accuracy of diagnosing pediatric acute appendicitis using contrast-enhanced abdominopelvic CT scans performed with traditional pediatric weight-based protocols and filtered back projection reconstruction vs. a filtered back projection/iterative reconstruction technique blend with reduced volume CT dose index (CTDIvol). Results of pediatric contrast-enhanced abdominopelvic CT scans done for pain and/or suspected appendicitis were reviewed in two groups: A, 192 scans performed with the hospital's established weight-based CT protocols and filtered back projection reconstruction; B, 194 scans performed with iterative reconstruction technique and reduced CTDIvol. Reduced CTDIvol was achieved primarily by reductions in effective tube current-time product (mAseff) and tube peak kilovoltage (kVp). CT interpretation was correlated with clinical follow-up and/or surgical pathology. CTDIvol, size-specific dose estimates (SSDE) and performance characteristics of the two CT techniques were then compared. Between groups A and B, mean CTDIvol was reduced by 45%, and mean SSDE was reduced by 46%. Sensitivity, specificity and diagnostic accuracy were 96%, 97% and 96% in group A vs. 100%, 99% and 99% in group B. Accuracy in diagnosing pediatric acute appendicitis was maintained in contrast-enhanced abdominopelvic CT scans that incorporated iterative reconstruction technique, despite reductions in mean CTDIvol and SSDE by nearly half as compared to the hospital's traditional weight-based protocols. (orig.)

  19. Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis

    Didier, Ryne A. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Vajtai, Petra L. [Oregon Health and Science University, Department of Pediatrics, Portland, OR (United States); Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Hopkins, Katharine L. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Oregon Health and Science University, Department of Pediatrics, Portland, OR (United States)

    2014-07-05

    Iterative reconstruction technique has been proposed as a means of reducing patient radiation dose in pediatric CT. Yet, the effect of such reductions on diagnostic accuracy has not been thoroughly evaluated. This study compares accuracy of diagnosing pediatric acute appendicitis using contrast-enhanced abdominopelvic CT scans performed with traditional pediatric weight-based protocols and filtered back projection reconstruction vs. a filtered back projection/iterative reconstruction technique blend with reduced volume CT dose index (CTDI{sub vol}). Results of pediatric contrast-enhanced abdominopelvic CT scans done for pain and/or suspected appendicitis were reviewed in two groups: A, 192 scans performed with the hospital's established weight-based CT protocols and filtered back projection reconstruction; B, 194 scans performed with iterative reconstruction technique and reduced CTDI{sub vol}. Reduced CTDI{sub vol} was achieved primarily by reductions in effective tube current-time product (mAs{sub eff}) and tube peak kilovoltage (kVp). CT interpretation was correlated with clinical follow-up and/or surgical pathology. CTDI{sub vol}, size-specific dose estimates (SSDE) and performance characteristics of the two CT techniques were then compared. Between groups A and B, mean CTDI{sub vol} was reduced by 45%, and mean SSDE was reduced by 46%. Sensitivity, specificity and diagnostic accuracy were 96%, 97% and 96% in group A vs. 100%, 99% and 99% in group B. Accuracy in diagnosing pediatric acute appendicitis was maintained in contrast-enhanced abdominopelvic CT scans that incorporated iterative reconstruction technique, despite reductions in mean CTDI{sub vol} and SSDE by nearly half as compared to the hospital's traditional weight-based protocols. (orig.)

  20. Cytomegalovirus immune reconstitution inflammatory syndrome manifesting as acute appendicitis in an HIV-infected patient

    Faldetta, Kimberly F; Kattakuzhy, Sarah; Wang, Hao-Wei; Sereti, Irini; Sheikh, Virginia

    2014-01-01

    Background Appendicitis occurs with increased frequency in HIV infected compared to HIV uninfected persons. CMV-related appendicitis specifically presents with typical appendicitis symptoms including surgical abdomen, fever and leukocytosis and may have a more severe course with higher mortality than other types of infective appendicitis. We report the first case of CMV appendicitis as a manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS). Case presentation The patient was a 3...

  1. Can Clinical Findings Prevent Negative Laparotomy in Parasitosis Mimicking Acute Appendicitis?

    Musa Zorlu

    2016-01-01

    Full Text Available Objectives. Rates of negative laparotomy (NL for acute appendicitis have been reported as 15% and parasitosis contributed to 2%. This study was planned to reduce the rates of NL by preoperative determination of parasitosis. Methods. In retrospective examination of 2730 appendectomy specimens in Hitit University Department of General Surgery between 2008 and 2012, 55 patients were determined with parasitosis and compared with 102 age-matched randomly selected patients with lymphoid hyperplasia. Results. The parasite group comprised 63.6% females with a mean age of 15.1 years. The number of patients in the parasitosis group increased from city centre to rural areas of towns and villages (p2.2% was determined as a diagnostic value. Conclusion. It is important to determine parasitosis to prevent NL. When acute appendicitis is considered for young patients living in rural areas, the observation of high eosinophil together with negative sonographic findings should bring Enterobius vermicularis parasitosis to mind and thereby should prevent NL.

  2. Non-surgical contraindication for acute appendicitis with secondary thrombocytopenia: a case report.

    Zhang, Hai-Hong; Gu, Guo-Li; Zhang, Xiang-Yang; Fan, Qin; Wang, Xin-Yan; Wei, Xue-Ming

    2015-03-01

    A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases. Blood routine test showed a leukocyte count of 22.74 × 10(9)/L, with 91.4% neutrophils, and a platelet count of 4 × 10(9)/L before admission. The case question was whether the team should proceed with surgery. Obviously, a differential diagnosis is essential before making such a decision. Acute appendicitis was easily diagnosed based on clinical findings, including migrating abdominal pain, a leukocyte count of 22.74 × 10(9)/L and the result of abdominal computed tomography scan. However, it was not clear whether the severe thrombocytopenia was primary or secondary. So smear of peripheral blood and aspiration of bone marrow were ordered to exclude hematological diseases. Neither of the tests indicated obvious pathological hematological changes. There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen. Therefore, operative intervention may be a unique clinical scenario in acute severe appendicitis patients with secondary thrombocytopenia. PMID:25759558

  3. Tubercular tubo-ovarian cystic mass mimicking acute appendicitis: a case report

    Arikanoglu Zulfu

    2011-08-01

    Full Text Available Abstract Introduction Female genital tuberculosis is a rare form of extrapulmonary tuberculosis. It is an asymptomatic disease usually diagnosed during the search for causes of infertility. However, it can present with a number of abdominopelvic symptoms. Herein we report a case of tubo-ovarian tuberculosis mimicking acute appendicitis. Case presentation A 17-year-old single Turkish woman presented to our hospital with complaints of right lower quadrant abdominal pain, nausea, and vomiting. Her physical examination findings, ultrasonogram, and leukocyte count were consistent with acute appendicitis. A cystic mass (15 cm × 6 cm was detected on the right tubo-ovarian structure by laparotomy. The mass was excised while the tubo-ovarian structures were preserved and the need for an appendectomy was avoided. No microbiological evaluation was performed. The histopathological examination of the cystic mass revealed a granuloma with central caseating necrosis surrounded by epithelioid histiocytes. The patient was treated with anti-tuberculosis therapy for six months. No recurrence was observed during a 10-month follow-up period. Conclusion Genital tuberculosis should be considered in the differential diagnosis of right lower quadrant pain in women who live in tuberculosis-endemic regions.

  4. Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

    Amanda Jensen

    2016-04-01

    Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

  5. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

    Unenhanced MRI has emerged as a useful tool for diagnosing pediatric acute appendicitis. The use of contrast-enhanced MRI for diagnosing pediatric appendicitis has not been documented. The purpose of this study is to examine the diagnostic performance of contrast-enhanced MRI for acute appendicitis and alternative entities in the pediatric population presenting with acute abdominal pain. A retrospective review was conducted of 364 consecutive pediatric patients undergoing contrast-enhanced MRI for the evaluation of possible appendicitis at a single institution between November 2012 and September 2013. There were 132 cases of pathologically confirmed appendicitis out of 364 pediatric patients (36.3%) included in the study. Overall sensitivity and specificity were 96.2% (95% CI [91.4-98.4%]) and 95.7% (95% CI [92.3-97.6%]), respectively. Positive predictive value and negative predictive value were 92.7% (95% CI [86.6-96.3%]) and 97.8% (95% CI [94.7-99.1%]), respectively. The appendix was visualized in 243 cases (66.8%). Imaging confirmed alternative diagnoses in 75 patients, including most commonly colitis, enteritis or terminal ileitis (n = 25, 6.9%), adnexal cysts (n = 25, 6.9%) and mesenteric adenitis (n = 7, 1.9%). Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population. (orig.)

  6. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

    Koning, Jeffrey L. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Naheedy, John H.; Kruk, Peter G. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Rady Children' s Hospital, Department of Radiology, San Diego, CA (United States)

    2014-08-15

    Unenhanced MRI has emerged as a useful tool for diagnosing pediatric acute appendicitis. The use of contrast-enhanced MRI for diagnosing pediatric appendicitis has not been documented. The purpose of this study is to examine the diagnostic performance of contrast-enhanced MRI for acute appendicitis and alternative entities in the pediatric population presenting with acute abdominal pain. A retrospective review was conducted of 364 consecutive pediatric patients undergoing contrast-enhanced MRI for the evaluation of possible appendicitis at a single institution between November 2012 and September 2013. There were 132 cases of pathologically confirmed appendicitis out of 364 pediatric patients (36.3%) included in the study. Overall sensitivity and specificity were 96.2% (95% CI [91.4-98.4%]) and 95.7% (95% CI [92.3-97.6%]), respectively. Positive predictive value and negative predictive value were 92.7% (95% CI [86.6-96.3%]) and 97.8% (95% CI [94.7-99.1%]), respectively. The appendix was visualized in 243 cases (66.8%). Imaging confirmed alternative diagnoses in 75 patients, including most commonly colitis, enteritis or terminal ileitis (n = 25, 6.9%), adnexal cysts (n = 25, 6.9%) and mesenteric adenitis (n = 7, 1.9%). Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population. (orig.)

  7. 5-azacytidine enhances the anti-leukemic activity of lintuzumab (SGN-33) in preclinical models of acute myeloid leukemia

    Sutherland, May Kung; Yu, Changpu; Anderson, Martha; Zeng, Weiping; van Rooijen, Nico; Sievers, Eric L; Grewal, Iqbal S; Law, Che-Leung

    2010-01-01

    Despite therapeutic advances, the poor prognoses for acute myeloid leukemia (AML) and intermediate and high-risk myelodysplastic syndromes (MDS) point to the need for better treatment options. AML and MDS cells express the myeloid marker CD33, making it amenable to CD33-targeted therapy. Lintuzumab (SGN-33), a humanized monoclonal anti-CD33 antibody undergoing clinical evaluation, induced meaningful responses in a Phase 1 clinical trial and demonstrated anti-leukemic activity in preclinical m...

  8. Alvarado score: A valuable clinical tool for diagnosis of acute appendicitis –a retros-pective study

    Swagata Brahmachari1 and Ashwini B. Jajee2

    2013-08-01

    Full Text Available Appendicitis is a common surgical emergency and diagnosis is still a great challenge. Accurate diagnosis and timely intervention re-duces morbidity and mortality. The present study was conducted to evaluate Alvarado scoring system for diagnosis of acute appen-dicitis in Indian set up. The study was carried out on 200 patients admitted in Surgery ward between January 2009 and December 2010 with right lower quadrant abdominal pain. Alvarado score was calculated and all patients were divided in three groups. Mean age of presentation was 29.12 years and male to female ratio was 1.27:1. Higher the Alvarado score, more is the sensitivity. So pa-tients having score 7 or above had sensitivity of 66%. We con-clude that Alvarado score is unique since it incorporates signs, symptoms and laboratory findings of suspicious patients. Alvarado score can be utilized safely for diagnosis of acute appendicitis.

  9. A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis

    Son Chang Sik

    2012-03-01

    Full Text Available Abstract Background The aim of this study is to develop a simple and reliable hybrid decision support model by combining statistical analysis and decision tree algorithms to ensure high accuracy of early diagnosis in patients with suspected acute appendicitis and to identify useful decision rules. Methods We enrolled 326 patients who attended an emergency medical center complaining mainly of acute abdominal pain. Statistical analysis approaches were used as a feature selection process in the design of decision support models, including the Chi-square test, Fisher's exact test, the Mann-Whitney U-test (p Results Of 55 variables, two subsets were found to be indispensable for early diagnostic knowledge discovery in acute appendicitis. The two subsets were as follows: (1 lymphocytes, urine glucose, total bilirubin, total amylase, chloride, red blood cell, neutrophils, eosinophils, white blood cell, complaints, basophils, glucose, monocytes, activated partial thromboplastin time, urine ketone, and direct bilirubin in the univariate analysis-based model; and (2 neutrophils, complaints, total bilirubin, urine glucose, and lipase in the multivariate analysis-based model. The experimental results showed that the model with univariate analysis (80.2%, 82.4%, 78.3%, 76.8%, 83.5%, and 80.3% outperformed models using multivariate analysis (71.6%, 69.3%, 73.7%, 69.7%, 73.3%, and 71.5% with entry and removal criteria of 0.01 and 0.05; 73.5%, 66.0%, 80.0%, 74.3%, 72.9%, and 73.0% with entry and removal criteria of 0.05 and 0.10 in terms of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under ROC curve, during a 10-fold cross validation. A statistically significant difference was detected in the pairwise comparison of ROC curves (p p Conclusions The decision model developed in this study can be applied as an aid in the initial decision making of clinicians to increase vigilance in cases of suspected acute

  10. Ripasa score: a new diagnostic score for diagnosis of acute appendicitis

    Objective: To determine the usefulness of RIPASA score for the diagnosis of acute appendicitis using histopathology as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Kohat, from September 2011 to March 2012. Methodology: A total of 267 patients were included in this study. RIPASA score was assessed. The diagnosis of appendicitis was made clinically aided by routine sonography of abdomen. After appendicectomies, resected appendices were sent for histopathological examination. The 15 parameters and the scores generated were age (less than 40 years = 1 point; greater than 40 years = 0.5 point), gender (male = 1 point; female = 0.5 point), Right Iliac Fossa (RIF) pain (0.5 point), migration of pain to RIF (0.5 point), nausea and vomiting (1 point), anorexia (1 point), duration of symptoms (less than 48 hours = 1 point; more than 48 hours = 0.5 point), RIF tenderness (1 point), guarding (2 points), rebound tenderness (1 point), Rovsing's sign (2 points), fever (1 point), raised white cell count (1 point), negative urinalysis (1 point) and foreign national registration identity card (1 point). The optimal cut-off threshold score from the ROC was 7.5. Sensitivity analysis was done. Results: Out of 267 patients, 156 (58.4%) were male while remaining 111 patients (41.6%) were female with mean age of 23.5 +- 9.1 years. Sensitivity of RIPASA score was 96.7%, specificity 93.0%, diagnostic accuracy was 95.1%, positive predictive value was 94.8% and negative predictive value was 95.54%. Conclusion: RIPASA score at a cut-off total score of 7.5 was a useful tool to diagnose appendicitis, in equivocal cases of pain. (author)

  11. Protective mitochondrial transfer from bone marrow stromal cells to acute myeloid leukemic cells during chemotherapy.

    Moschoi, Ruxanda; Imbert, Véronique; Nebout, Marielle; Chiche, Johanna; Mary, Didier; Prebet, Thomas; Saland, Estelle; Castellano, Rémy; Pouyet, Laurent; Collette, Yves; Vey, Norbert; Chabannon, Christian; Recher, Christian; Sarry, Jean-Emmanuel; Alcor, Damien; Peyron, Jean-François; Griessinger, Emmanuel

    2016-07-14

    Here we demonstrate that in a niche-like coculture system, cells from both primary and cultured acute myeloid leukemia (AML) sources take up functional mitochondria from murine or human bone marrow stromal cells. Using different molecular and imaging approaches, we show that AML cells can increase their mitochondrial mass up to 14%. After coculture, recipient AML cells showed a 1.5-fold increase in mitochondrial adenosine triphosphate production and were less prone to mitochondrial depolarization after chemotherapy, displaying a higher survival. This unidirectional transfer enhanced by some chemotherapeutic agents required cell-cell contacts and proceeded through an endocytic pathway. Transfer was greater in AML blasts compared with normal cord blood CD34(+) cells. Finally, we demonstrate that mitochondrial transfer was observed in vivo in an NSG immunodeficient mouse xenograft model and also occurred in human leukemia initiating cells and progenitors. As mitochondrial transfer provides a clear survival advantage following chemotherapy and a higher leukemic long-term culture initiating cell potential, targeting mitochondrial transfer could represent a future therapeutic target for AML treatment. PMID:27257182

  12. C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis

    Tind, Sofie; Lassen, Annmarie Touborg; Zimmermann-Nielsen, Erik;

    2015-01-01

    INTRODUCTION: Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities...... leucocyte counts did not influence clinical decision-making....

  13. Evaluation of modified Alvarado score in the diagnosis of acute appendicitis

    Abhinandan B. Vandakudri

    2016-01-01

    Results: The result of the study showed that high scores in men and children (7-9 had a sensitivity of 92.3% and 83.3% respectively, whereas in females it had a sensitivity of 72.7%. The score (5-6 in males and females had a sensitivity of 57% and 50% respectively. Conclusions: The high scores in modified Alvarado score is dependable aid in the early diagnosis of acute appendicitis in men and children but it's not true as far as women are considered. Ultrasonography of abdomen is a useful tool in avoiding negative appendicectomy rates particularly in females. [Int J Res Med Sci 2016; 4(1.000: 84-88

  14. Suppurative appendicitis presenting as acute scrotum confounded by a testicular appendage

    Shumon, Syed; Bennett, John; Lawson, Geoffrey; Small, Peter

    2016-01-01

    Patients presenting with testicular pain and swelling mandate an urgent urology review and scrotal exploration to prevent testicle loss due to torsion. Other pathology masquerading as torsion is extremely rare but can occur. We present one such case. A 14-year-old male presented with a 1-day history of right testicular swelling and tenderness. He was apyrexial and denied any other symptoms. Blood tests demonstrated raised inflammatory markers. He had lower left-sided abdominal tenderness with a swollen, erythematous right hemiscrotum. During an urgent scrotal exploration for testicular torsion, a purulent hydrocele with a patent process vaginalis was noted, but no torsion. Post-operative abdominal pain mandated a general surgical review and subsequent appendicectomy. The patient made a full recovery. Acute suppurative appendicitis presenting as a urological emergency is extremely rare. To make a correct diagnosis and prevent multiple surgeries, a joint urological and general surgical assessment with a high index of suspicion is required. PMID:26966225

  15. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

    Xharra Shefki

    2012-08-01

    Full Text Available Abstract Background Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging investigation. The aim of the study is to analyze the role of C-reactive protein (CRP, white blood count (WBC and Neutrophil percentage (NP in improving the accuracy of diagnosis of acute appendicitis and to compare it with the intraoperative assessment and histopathology findings. Materials and methods This investigation was a prospective double blinded clinical study. The study was done on 173 patients surgically treated for acute appendicitis. The WBC, NP, and measurement of CRP were randomly collected pre-operatively from all involved patients. Macroscopic assessment was made from the operation. Appendectomy and a histopathology examination were performed on all patients. Gross description was compared with histopathology results and then correlated with CRP, WBC, and NP. Results The observational accuracy was 87,3%, as compared to histopathological accuracy which was 85.5% with a total of 173 patients that were operated on. The histopathology showed 25 (14.5% patients had normal appendices, and 148 (85.5% patients had acutely inflamed, gangrenous, or perforated appendicitis. 52% were male and 48% were female, with the age ranging from 5 to 59 with a median of 19.7. The gangrenous type was the most frequent (52.6%. The WBC was altered in 77.5% of the cases, NP in 72.3%, and C-reactive protein in 76.9% cases. In those with positive appendicitis, the CRP and WBC values were elevated in 126 patients (72.8%, whereas NP was higher than 75% in 117 patients (67.6%. Out of 106 patients with triple positive tests, 101 (95.2% had appendicitis. The sensitivity, specificity, and positive predictive values of the 3 tests in combination were 95.3%, 72.2%, and 95.3%, respectively. Conclusion The raised value of the CRP was directly related to the severity of

  16. Diagnosis and Treatment of Mucinous Appendiceal Neoplasm Presented as Acute Appendicitis

    Kehagias, Ioannis; Markopoulos, Georgios; Papandreou, Thanasis; Kraniotis, Pantelis

    2016-01-01

    Appendiceal mucocele is a rare cause of acute abdomen. Mucinous appendiceal neoplasms represent 0.2–0.7% of all appendix specimens. The aim of this study is to report a case of a mucinous appendiceal neoplasm presented as acute appendicitis, discussing the clinical and surgical approach in the emergency setting. A 72-year-old female patient was admitted to the emergency department with a clinical examination indicative of acute abdomen. The patient underwent abdominal computed tomography scan which revealed a cystic lesion in the right iliac fossa measuring 8.3 × 5.2 × 4.1 cm, with calcified walls, and a mean density indicative of high protein content. The patient was taken to the operating room and a right hemicolectomy was performed. The postoperative course was unremarkable. The histopathological examination revealed a low-grade mucinous appendiceal neoplasm with negative regional lymph nodes. Ultrasound and CT are useful in diagnosing appendiceal mucocele and synchronous cancers in the emergency setting. The initial operation should include appendectomy and resection of the appendicular mesenteric fat along with any fluid collection for cytologic examination. During urgent appendectomy it is important to consider every mucocele as malignant in order to avoid iatrogenic perforation causing pseudomyxoma peritonei. Although laparotomy is recommended, the laparoscopic approach is not contraindicated. PMID:27066284

  17. Enhanced CT in the diagnosis of acute appendicitis to evaluate the severity of disease. Comparison of CT findings and histological diagnosis

    To assess the potential of CT in evaluating the histological severity of acute appendicitis in comparison with surgical and pathological findings. The CT images of 75 patients with surgically proven appendicitis, including 10 cases of catarrhal, 34 of phlegmonous, and 31 of gangrenous appendicitis, were retrospectively analyzed for the following five CT findings: hazy periappendiceal densities, enlarged appendix, increased enhancement of the appendiceal wall, increased enhancement of the periappendiceal intestinal wall, and deficiency of the appendiceal wall. By comparing all the CT findings and the pathological severity of appendicitis (catarrhal, phlegmonous, and gangrenous), the prevalence of the five CT findings was calculated for each pathological category. Abnormal CT findings were noted in only one case of catarrhal appendicitis. Increased enhancement of the appendiceal wall was observed in all 29 cases of phlegmonous appendicitis (100%), but in only 66.7% (18 cases) of gangrenous appendicitis. Deficiency of the appendiceal wall was more frequently observed in gangrenous (19/27, 70.4%) than phlegmonous appendicitis (4/29, 13.8%). Findings of enhanced CT provide useful information in evaluating the pathological severity of acute appendicitis. (author)

  18. Usefulness of computed tomography in patients with right inferior abdominal quadrant pain: acute appendicitis and its alternative diagnosis

    Purpose: To review the tomography findings of the acute appendicitis, their complications and alternative diagnosis. To value the use of helicoidal computed tomography (HCT) in the diagnosis of acute appendicitis and in the study of patients with right inferior abdominal quadrant (RIQ) pain and acute abdomen, for diagnosis and eventual complications, in order to decide treatment. Materials and method: For five months, the populations included in this retrospectively study were all patients delivered for presenting with RIQ pain for a HCT exam. These exams were made with oral and intravenous contrasts, when there were not contraindications. The HCT results were correlated with clinical follow up, surgery and histopathologic exams. Results: Over a total of 100 patients studied, 53 presented tomographic diagnosis of appendicitis, 22 of which presented perforation signs; 27 showed an alternative diagnosis (ovaries follicles, ureteral litiasis, tiphlitis, diverticulitis, colitis, salpingitis), 18 patients did not present tomographic findings to support the clinical symptoms and 2 presented indeterminated results. These data represented a sensibility of 100%, specificity of 95,7%, positive predictive value (PPV) of 96,2% and negative predictive value (NPV) of 100% for the tomography diagnosis of acute appendicitis and a sensibility of 100%, specificity of 81,8%, PPV of 95,1% and NPV of 100% for the tomography diagnosis of the different etiology in patient with right inferior acute abdomen. Conclusion: HCT is extremely useful in the study of patients with acute abdomen with origin in the RIQ, not only to make a diagnosis, but also to evaluate the complications, so as to decide proper treatment. (authors)

  19. A SURVEY ON FREQUENCY OF ACUTE APPENDICITIS IN (15-70 YEARS DURING 1418-1420 (LUNAR

    A DAVOUDABADI

    2003-12-01

    Full Text Available History and Objective: Since acute appendicitis occur as a surgical emergency and should be operated as soon as possible, our experiences showed some fluctuations of appendicitis in Various mouth. We Performed this study to define the frequency of it in 1418 - 1420. Material and Method: Affected Patients In all ages, and aged from 15 - 70 years old which tolerated fasting were enrolled in this study Age. sex and the number of operated patient in each month were considered. Results: Total number of docummended appendicitis Were 414 - 423 - 407 for the years of 1418, 1419 and 1420 respectively. The ratio of M/F=1.2:1 and total frequency was 110/100000.ln the Moharram and Shawal of 1418-20 the number of patients were 49-48-46 and 54-47-47 respectively, which was higher than other months Rmadan had the least frequent patients in these years (20-25-17 there was no significant difference in the number of patient among other months. Conclusion: The frequency of acute appendicitis is decreaed in Ramadan significantly which was most likely due to the fasting and diatary states of the ptients althouqh other nivestigation is rocommended.

  20. NF-κB in T-cell Acute Lymphoblastic Leukemia: Oncogenic Functions in Leukemic and in Microenvironmental Cells

    Santos, Nuno R. dos, E-mail: nrsantos@ualg.pt; Ghezzo, Marinella N.; Silva, Ricardo C. da; Fernandes, Mónica T. [IBB-Institute for Biotechnology and Bioengineering, Centre for Molecular and Structural Biomedicine (CBME), University of Algarve, Campus de Gambelas, 8005-139 Faro (Portugal)

    2010-11-05

    Two main NF-κB signaling pathways, canonical and noncanonical, performing distinct functions in organisms have been characterized. Identification of mutations in genes encoding components of these NF-κB signaling pathways in lymphoid malignancies confirmed their key role in leukemogenesis. T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy of thymocytes that despite significant therapeutic advances can still be fatal. Although mutations in NF-κB genes have not been reported in T-ALL, NF-κB constitutive activation in human T-ALL and in acute T-cell leukemia mouse models has been observed. Although these studies revealed activation of members of both canonical and noncanonical NF-κB pathways in acute T-cell leukemia, only inhibition of canonical NF-κB signaling was shown to impair leukemic T cell growth. Besides playing an important pro-oncogenic role in leukemic T cells, NF-κB signaling also appears to modulate T-cell leukemogenesis through its action in microenvironmental stromal cells. This article reviews recent data on the role of these transcription factors in T-ALL and pinpoints further research crucial to determine the value of NF-κB inhibition as a means to treat T-ALL.

  1. A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone.

    Kim, Changsun; Kang, Bossng; Choi, Hyuk Joong; Park, Joon Bum

    2015-08-01

    We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination. PMID:25700617

  2. Primary appendiceal lymphoma presenting as suspected perforated acute appendicitis: clinical, sonography and CT findings with pathologic correlation

    Guo, Jingjing; Wu, Gang; Chen, Xiaojun; Li, Xiaodong

    2014-01-01

    The gastrointestinal tract is the most common site for extranodal involvement by non-Hodgkin’s lymphoma. However, primary appendiceal lymphomas presenting as perforated acute appendicitis are very rare: they occur in only 0.015% of all gastrointestinal lymphoma cases. The management of this condition is still controversial, and a multimodality approach (e.g., surgery, radiation therapy, and chemotherapy) is the optimal treatment. In these cases, appendiceal non-Hodgkin’s lymphomas typically m...

  3. Spontaneous intra-peritoneal bleeding secondary to warfarin, presenting as an acute appendicitis: a case report and review of literature

    Shah Dharmendra K; Kumar Vikas; Sagar Jayesh; Bhatnagar Ashok

    2006-01-01

    Abstract Background Warfarin is a coumarin anti-coagulant, used widely for the therapeutic and prophylactic anticoagulation. Although, it is considered as a life saving medicine, it is associated with the significant adverse effects including intra-abdominal bleeding, which have been very well documented in literature. However, the presentation of warfarin induced intra-peritoneal bleeding as an acute appendicitis has not been reported in English literature. We report this rare, spontaneous i...

  4. Avaliação ultra-sonográfica da apendicite aguda Ultrasonographic evaluation of acute appendicitis

    Orlando Jorge Martins Torres

    2001-02-01

    Full Text Available OBJETIVO: A apendicite aguda é a mais comum urgência cirúrgica abdominal. Na tentativa de aumentar a acurácia diagnóstica a ultra-sonografia abdominal tem sido observada como método sensível e específico. O presente estudo tem por objetivo avaliar a ultra-sonografia do abdome no diagnóstico de apendicite aguda. MÉTODO: Um total de 138 pacientes submetidos a tratamento cirúrgico com suspeita diagnóstica admitidos no Hospital Municipal Djalma Marques foi estudado no período de janeiro de 1997 a dezembro de 1998. Todos os exames foram realizados na mesma instituição e havia 87 pacientes do sexo masculino (63,0% e 51 do sexo feminino (37,0% com idade variando de 11 a 81 anos (média de 28,4 anos. RESULTADOS: Dos 134 casos com diagnóstico comprovado cirurgicamente, o estudo ultra-sonográfico foi positivo em 114 (sensibilidade de 85,0%. O apêndice foi visualizado como imagem longitudinal ou transversal maior do que 7mm em 75 dos 114 achados positivos (65,8%. CONCLUSÕES: Os autores concluem que a ultra-sonografia abdominal é um instrumento valioso no diagnóstico de apendicite aguda.BACKGROUND: Acute appendicitis is the most common disease leading to emergency abdominal surgery. Many diagnostic tools have been evaluated. Abdominal ultrasonography is sensitive and specific which increase diagnostic accuracy in acute appendicitis. The aim of the present study is to evaluate the abdominal ultrasonography in the diagnosis of acute appendicitis. METHOD: A total of 138 patients underwent surgical treatment for suspected appendicitis admitted to the Hospital Municipal Djalma Marques from January 1997 to December 1998. All abdominal ultrasonography examinations were performed at same hospital. There were 87 male (63.0% and 51 female (37.0%, and their ages ranged from 11 to 81 years (mean 28.4 years. RESULTS: Of the 134 patients with proved appendicitis at surgery the ultrasonographic diagnosis was positive in 114 (sensitivity of 85.0%. The

  5. Assessment of effectiveness of ultrasonography in diagnosis of acute appendicitis: Correlation with level of initial clinical diagnostic confidence

    To evaluate effectiveness of ultrasonography (US) in the diagnosis of acute appendicitis by comparing with initial level of clinical diagnostic confidence. Graded compression US of one hundred forty eight with clinically suspected of acute appendicitis were prospectively evaluated. General surgeons classified patients into three groups bases on the clinical probability before US examination: group 1 as cases with low probability (75%). Two radiologists performed US examination. Statistical significance of ultrasonographic results in each group was assessed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of sonography for all patients were 91.3%, 97%, 97.3%, 90.4%, and 93.9% respectively. Those of group 1 were 100%, 95.5%, 84.6%, 100%, and 96.4%, and those of group 2, 95.8%, 100%, 100%, 95%, and 97.7% while those of group 3, 86.4%, 100%, 100%, 50%, and 88%. There was no statistical difference in each parameter among three groups. The accuracy and NPV in group 3 was significantly higher than those in groups with the low and intermediate probability (group 1 and 2). Ultrasonography in the diagnosis of acute appendicitis is an useful and reliable method, especially in case of low clinical diagnostic confidence.

  6. Assessment of effectiveness of ultrasonography in diagnosis of acute appendicitis: Correlation with level of initial clinical diagnostic confidence

    Song, Soon Young; Koo, Ja Hong; Lee, Eun Ja; Lee, Jong In; Jung, Jin Ho; Kim, Jin Young; Oh, Hwa Eun [Kwandong University College of Medicine, Myongji Hospital, Goyang (Korea, Republic of); Moon, Won Jin [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Sam Soo; Heon, Han [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)

    2002-09-15

    To evaluate effectiveness of ultrasonography (US) in the diagnosis of acute appendicitis by comparing with initial level of clinical diagnostic confidence. Graded compression US of one hundred forty eight with clinically suspected of acute appendicitis were prospectively evaluated. General surgeons classified patients into three groups bases on the clinical probability before US examination: group 1 as cases with low probability (<25%), group 2 as cases with an intermediate probability (25-75%) and group 3 as cases with a high probability (>75%). Two radiologists performed US examination. Statistical significance of ultrasonographic results in each group was assessed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of sonography for all patients were 91.3%, 97%, 97.3%, 90.4%, and 93.9% respectively. Those of group 1 were 100%, 95.5%, 84.6%, 100%, and 96.4%, and those of group 2, 95.8%, 100%, 100%, 95%, and 97.7% while those of group 3, 86.4%, 100%, 100%, 50%, and 88%. There was no statistical difference in each parameter among three groups. The accuracy and NPV in group 3 was significantly higher than those in groups with the low and intermediate probability (group 1 and 2). Ultrasonography in the diagnosis of acute appendicitis is an useful and reliable method, especially in case of low clinical diagnostic confidence.

  7. The diagnostic value of a panel of serological markers in acute appendicitis

    Farooqui, W; Pommergaard, H-C; Burcharth, J; Eriksen, J R

    2015-01-01

    BACKGROUND: Appendicitis is a frequent reason for hospital admissions. Elevated C-reactive protein, white blood cell count, and serum bilirubin have been suggested as individual markers for appendicitis and appendiceal perforation. The aim of this study was to analyze if a combination of serologic...... markers could increase the prognostic accuracy of diagnosing non-perforated and perforated appendicitis. MATERIAL AND METHODS: Demographic data, histological findings, blood tests, and clinical symptoms were collected on all patients who underwent a diagnostic laparoscopy, a laparoscopic appendectomy, or...... conventional (open) appendectomy between May 2009 and May 2012 from a surgical department. The patients were grouped into those with either perforated appendicitis, non-perforated appendicitis, or differential diagnosis. Univariate and multivariate models were used to identify which markers were useful in...

  8. Suspected acute appendicitis in female patients: Trends in diagnosis in emergency department in a University Hospital in Western region of Saudi Arabia

    Objective was to determine the negative appendectomy rate; utilization, accuracy of Alvarado scale, ultrasound (US), computed tomography (CT) in diagnosis of acute appendicitis. Hospital records of 124 female patients admitted for suspicious of acute appendicitis from January 2003-January 2004 to the Emergency Department (ED) at King Abdul-Aziz University Hospital Jeddah, Saudi Arabia were reviewed retrospectively. We reviewed the age of patients, clinical presentation, Alvarado scale, US, CT, histopathalogical diagnosis of appendicular specimen. A total of 124 female patients aged 6-64 years were presented to ED with right iliac fossa pain. Of the total, 103 patients have appendectomies (83.1%), 21 (16.9%) patients underwent conservative treatment. Prevalence of advanced appendicitis was 13.7% and negative appendectomy rate was 27.2%. Accuracy rate of appendicitis with Alvarado scale 67.7%, US was 57.9% CT was 66.7%. Postoperative correlation was found between advanced cases and Alvarado scale (r=0.338), and hospital stay duration (r=0.250, p<0.01). Clinical findings and experiments remain of major importance in appendicitis-diagnosis. When appendicitis appears with atypical presentations, it remains a clinical challenge. In such cases, laboratory and imaging investigation may be useful in establishing a correct diagnosis. Alvarado scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis especially for junior surgeons. (author)

  9. Comparative study between patients with acute appendicitis treated in primary care units and in emergency hospitals

    Thiago de Paula Bon

    2014-10-01

    Full Text Available Objective: To retrospectively analyze the relationship of time of care, combined with possible post-appendectomy complications, with the promptness of transfer of patients seen in Emergency Care Units (UPA to the emergency hospital.Methods: We analyzed patients with preoperative diagnosis of acute appendicitis undergoing appendectomy from January to July 2012. Patients were divided into two groups according to the site of the first care. Group A included patients who received initial care directly in the emergency department of the Lourenço Jorge County Hospital (HMLJ and group B consisted of patients seen in the UPA and forwarded to HMLJ to undergo surgical treatment.Results: the average time between initial treatment and surgery in group A was 29 hours (SD = 21.95 and 54 hours in group B (SD = 54.5. Considering the onset of symptoms, the patients in group A were operated on average 67 hours after (SD = 42.55, while group B, 90 hours (SD = 59.58. After the operation, patients in group A were hospitalized, on average, for 94 hours (SD = 73.53 and group B, 129 hours (SD = 193.42.Conclusion: there was no significant difference in the time elapsed between the onset of symptoms, initial treatment and early surgical treatment, or time elapsed between surgery and discharge.

  10. Lessons to be learned: a case study approach--acute appendicitis masquerading as macroamylasaemia.

    Ganesh, Muniappan; Salam, Imroz

    2008-05-01

    Macroamylasaemia is a condition in which serum amylase is elevated in the presence of a low to normal urinary amylase and normal renal function. It is rare but can masquerade as other clinical disorders. Discussed here is a case report of a patient who presented initially with abdominal pain (later recognized as being due to gangrenous appendicitis) and in whom there was a very high serum amylase level, leading to an erroneous initial diagnosis and management as acute pancreatitis. The CT scan of the abdomen was normal without any evidence of pancreatitis. Subsequently, the renal amylase:creatinine clearance ratio (C(am)/C(cr)) was found to be low, being characteristic and diagnostic of macroamylasaemia; the latter was, in turn, the cause for the elevated serum amylase level. The underlying macroamylasaemia had thus masqueraded as pancreatitis. The patient underwent appendicectomy and hence made an excellent recovery. It is vitally important to recognize this condition in order to avoid both an incorrect diagnosis and inappropriate treatment/management. PMID:18595630

  11. Informative content of clinical symptoms of acute appendicitis in different terms of pregnancy

    Kutovoy A.B.

    2015-09-01

    Full Text Available With the purpose to evaluate diagnostic efficacy of some clinical symptoms of acute appendicitis 75 women in different terms of pregnancy were examined. Informative content of such symptoms as Kocher- Volkovich, Rovsing, Bartomje - Michelson, Sitkovsky, Gabay, Brendo, Michelson, Ivanov was studied. Pain syndrome was fixed in all examined women. Pain localization was various and depended on the pregnancy term. During the I trimester of pregnancy the most often pain was manifestated in epigastrium and right lower quadrant, rarely in other abdomen regions. In the II trimester in majority of cases pain occurred in right lower quadrant. During III trimester pain prevailed in right upper quadrant of abdomen. Analyzing informative component of researching symptoms there was noted significant decrease (р<0,05; р<0,01; р<0,001 of their diagnostic value with growth of pregnancy term. Therefore Kocher – Volkovich and Rovsing symptoms were the most informative in the I trimester of pregnancy. Diagnostic efficacy of Brendo(67,3%, Michelson(55,7%, Ivanov(59,6% symptoms was higher than that of Kocher – Volkovich (36,5%, Rovsing (28,8%, Sitkovsky (51,9%, Bartomje – Michelson (55,7% symptoms, their value was diminishing together with increase of pregnancy terms.

  12. Endothelial Fas-Ligand in Inflammatory Bowel Diseases and in Acute Appendicitis.

    Kokkonen, Tuomo S; Karttunen, Tuomo J

    2015-12-01

    Fas-mediated induction of apoptosis is a major factor in the selection of lymphocytes and downregulation of immunological processes. In the present study, we have assessed endothelial Fas-ligand (FasL) expression in normal human ileum, appendix, and colon, and compared the expression levels with that in inflammatory bowel disease and in acute appendicitis. In a normal appendix, endothelial FasL levels were constant in almost half of the mucosal vessels; but, in the normal ileum and colon, endothelial FasL was practically restricted to areas in close proximity to lymphatic follicles, and was expressed mainly in the submucosal aspect of the follicles in the vessels with high endothelium. In samples from subjects with either Crohn's disease or ulcerative colitis, the extent of endothelial FasL expression was elevated in the submucosa and associated with an elevated number of lymphoid follicles. In inflammatory bowel disease, ulcers and areas with a high density of mononuclear cells expressing FasL also showed an elevated density of blood vessels with endothelial FasL expression. Although the function of endothelial FasL remains unclear, such a specific expression pattern suggests that endothelial FasL expression has a role in the regulation of lymphocyte access to the peripheral lymphoid tissues, including the intestinal mucosa. PMID:26374830

  13. Rectal contrast-enhanced computed tomography in the diagnosis of acute appendicitis

    To assess the efficacy and utility of computed tomography (CT) in the diagnosis of appendicitis, and to evaluate the reliability of CT findings in right iliac fossa in the confirmation or exclusion of this diagnosis. Over a one-year period, 152 patients presenting clinical signs of appendicitis underwent CT scans. The images were reviewed by two radiologists who considered whether the appendix was normal or enlarged and the existence of other signs of appendicitis for the purpose of determining whether or not the patient presented appendicitis. The definitive diagnoses were established by surgery or by clinical follow-up. The sensitivity of CT for the diagnosis of appendicitis was 81.8%, the specificity was 95.3%, the positive predictive value was 93.1%, the negative predictive value was 87.2% and the reliability was 89.9%. The signs of appendicitis observed were: appendicoliths (sensitivity 30.3% and specificity 98.8%), fluid collections (sensitivity 19.7%, specificity 96.5%), cecal enlargement (sensitivity 21.2%, specificity 97.7%), inflammation of pericecal fat (sensitivity 72.7%, specificity 90.7%), fascial thickening (sensitivity 48.5%, specificity 91.9%) and an appendix measuring more than 6 mm (sensitivity 78.8%, specificity 94.3%). Adenopathy and free peritoneal fluid were not significantly related to appendicitis. The presence of a normal appendix filled with air or contrast material had an elevated negative predictive value with respect to appendicitis. In 35 of the 94 cases with negative CT scans, the images suggested alternative diagnoses. CT is a highly reliable diagnostic method for appendicitis. The observation of an appendix filled with air or contrast material has an elevated negative predictive value. The presence of appendicoliths has an elevated positive predictive value. (Author) 29 refs

  14. Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

    Samuel H.F. Lam

    2014-11-01

    Full Text Available Introduction: Appendicitis is a common condition presenting to the emergency department (ED. Increasingly emergency physicians (EP are using bedside ultrasound (BUS as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis. Methods: Patients four years of age and older presenting to the ED with suspected appendicitis were eligible for enrollment. After informed consent was obtained, BUS was performed on the subjects by trained EPs who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis.They then recorded elements of clinical history, physical examination, white blood cell count (WBC with polymophonuclear percentage (PMN, and BUS findings on a data form. We ascertained subject outcomes by a combination of medical record review and telephone follow-up. Results: A total of 125 subjects consented for the study, and 116 had adequate image data for final analysis. Prevalence of appendicitis was 40%. Mean age of the subjects was 20.2 years, and 51% were male. BUS was 100% sensitive (95% CI 87-100% and 32% specific (95% CI 14-57% for detection of appendicitis, with a positive predictive value of 72% (95% CI 56-84%, and a negative predictive value of 100% (95% CI 52-100%. Assuming all non-diagnostic studies were negative would yield a sensitivity of 72% and specificity of 81%. Subjects with appendicitis had a significantly higher occurrence of anorexia, nausea, vomiting, and a higher WBC and PMN count when compared to those without appendicitis. Their BUS studies were significantly more likely to result in visualization of the appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid, visualization of the appendix tip, and sonographic Mcburney’s sign (p6mm, appendix wall thickness >2mm, periappendiceal fluid were

  15. The validity and reliability of iridology in the diagnosis of previous acute appendicitis as evi-denced by appendectomy

    L. Frank

    2013-01-01

    Full Text Available Iridology is defined as a photographic science that identifies pathological and functional changes within organs via biomicroscopic iris assessment for aberrant lines, spots, and discolourations. According to iridology, the iris does not reflect changes  during  anaesthesia,  due  to  the  drugs inhibitory  effects  on  nerves  impulses,  and  in cases of organ removal, it reflects the pre-surgical condition.The profession of Homoeopathy is frequently associated with iridology and in a recent survey (2009  investigating  the  perceptions  of  Masters of  Technology  graduates  in  Homoeopathy  of University of Johannesburg, iridology was highly regarded as a potential additional skill requirement for assessing the health status of the patient.This  study  investigated  the  reliability  of iridology  in  the  diagnosis  of  previous  acute appendicitis, as evidenced by appendectomy. A total of 60 participants took part in the study. Thirty of the 60 participants had an appendectomy due to acute appendicitis, and 30 had had no prior history  of  appendicitis.  Each  participant’s  right iris  was  documented  by  photography  with  the use  of  a  non-mydriatic  retinal  camera  that  was reset for photographing the iris. The photographs were then randomized by an external person and no identifying data made available to the three raters.  The  raters  included  the  researcher,  who had little experience in iridology and two highly experienced  practising  iridologists.  Data  was obtained  from  the  analyses  of  the  photographs wherein  the  presence  or  absence  of  lesions (implying acute appendicitis was indicated by the raters. None of the three raters was able to show a significant  success  rate  in  identifying  correctly the  people  with  a  previous  history  of  acute appendicitis and resultant appendectomies

  16. ALVARADO’S ACUTE APPENDICITIS SCORE FOR ALGORITHM, ADMISSION AND APPENDICECTOMY

    Kiran Kumar

    2014-03-01

    Full Text Available Appendicitis is a most common abdominal surgical emergency, clinically mimicked by other pathologies. Even with modern imaging, at times diagnosis is challenging. Several scorings are available to predict pre-operative diagnosis.

  17. Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT

    Poletti, Pierre-Alexandre; Platon, Alexandra [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland); University Hospital of Geneva, Emergency Center, Geneva (Switzerland); Perrot, Thomas de; Becker, Christoph D. [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland); Sarasin, Francois; Rutschmann, Olivier [University Hospital of Geneva, Emergency Center, Geneva (Switzerland); Andereggen, Elisabeth [University Hospital of Geneva, Emergency Center, Geneva (Switzerland); University Hospital of Geneva, Department of Surgery, Geneva (Switzerland); Dupuis-Lozeron, Elise; Perneger, Thomas [University Hospital of Geneva, Division of Clinical Epidemiology, Geneva (Switzerland); Gervaz, Pascal [University Hospital of Geneva, Department of Surgery, Geneva (Switzerland)

    2011-12-15

    To evaluate an algorithm integrating ultrasound and low-dose unenhanced CT with oral contrast medium (LDCT) in the assessment of acute appendicitis, to reduce the need of conventional CT. Ultrasound was performed upon admission in 183 consecutive adult patients (111 women, 72 men, mean age 32) with suspicion of acute appendicitis and a BMI between 18.5 and 30 (step 1). No further examination was recommended when ultrasound was positive for appendicitis, negative with low clinical suspicion, or demonstrated an alternative diagnosis. All other patients underwent LDCT (30 mAs) (step 2). Standard intravenously enhanced CT (180 mAs) was performed after indeterminate LDCT (step 3). No further imaging was recommended after ultrasound in 84 (46%) patients; LDCT was obtained in 99 (54%). LDCT was positive or negative for appendicitis in 81 (82%) of these 99 patients, indeterminate in 18 (18%) who underwent standard CT. Eighty-six (47%) of the 183 patients had a surgically proven appendicitis. The sensitivity and specificity of the algorithm were 98.8% and 96.9%. The proposed algorithm achieved high sensitivity and specificity for detection of acute appendicitis, while reducing the need for standard CT and thus limiting exposition to radiation and to intravenous contrast media. (orig.)

  18. Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT

    To evaluate an algorithm integrating ultrasound and low-dose unenhanced CT with oral contrast medium (LDCT) in the assessment of acute appendicitis, to reduce the need of conventional CT. Ultrasound was performed upon admission in 183 consecutive adult patients (111 women, 72 men, mean age 32) with suspicion of acute appendicitis and a BMI between 18.5 and 30 (step 1). No further examination was recommended when ultrasound was positive for appendicitis, negative with low clinical suspicion, or demonstrated an alternative diagnosis. All other patients underwent LDCT (30 mAs) (step 2). Standard intravenously enhanced CT (180 mAs) was performed after indeterminate LDCT (step 3). No further imaging was recommended after ultrasound in 84 (46%) patients; LDCT was obtained in 99 (54%). LDCT was positive or negative for appendicitis in 81 (82%) of these 99 patients, indeterminate in 18 (18%) who underwent standard CT. Eighty-six (47%) of the 183 patients had a surgically proven appendicitis. The sensitivity and specificity of the algorithm were 98.8% and 96.9%. The proposed algorithm achieved high sensitivity and specificity for detection of acute appendicitis, while reducing the need for standard CT and thus limiting exposition to radiation and to intravenous contrast media. (orig.)

  19. Accuracy of Unenhanced MR Imaging in the Detection of Acute Appendicitis: Single-Institution Clinical Performance Review.

    Petkovska, Iva; Martin, Diego R; Covington, Matthew F; Urbina, Shannon; Duke, Eugene; Daye, Z John; Stolz, Lori A; Keim, Samuel M; Costello, James R; Chundru, Surya; Arif-Tiwari, Hina; Gilbertson-Dahdal, Dorothy; Gries, Lynn; Kalb, Bobby

    2016-05-01

    Purpose To determine the accuracy of unenhanced magnetic resonance (MR) imaging in the detection of acute appendicitis in patients younger than 50 years who present to the emergency department with right lower quadrant (RLQ) pain. Materials and Methods The institutional review board approved this retrospective study of 403 patients from August 1, 2012, to July 30, 2014, and waived the informed consent requirement. A cross-department strategy was instituted to use MR imaging as the primary diagnostic modality in patients aged 3-49 years who presented to the emergency department with RLQ pain. All MR examinations were performed with a 1.5- or 3.0-T system. Images were acquired without breath holding by using multiplanar half-Fourier single-shot T2-weighted imaging without and with spectral adiabatic inversion recovery fat suppression without oral or intravenous contrast material. MR imaging room time was measured for each patient. Prospective image interpretations from clinical records were reviewed to document acute appendicitis or other causes of abdominal pain. Final clinical outcomes were determined by using (a) surgical results (n = 77), (b) telephone follow-up combined with review of the patient's medical records (n = 291), or (c) consensus expert panel assessment if no follow-up data were available (n = 35). Logistic regression analysis was performed to evaluate the sensitivity and specificity of MR imaging in the detection of acute appendicitis, and corresponding 95% confidence intervals were determined. Results Of the 403 patients, 67 had MR imaging findings that were positive for acute appendicitis, and 336 had negative findings. MR imaging had a sensitivity of 97.0% (65 of 67) and a specificity of 99.4% (334 of 336). The mean total room time was 14 minutes (range, 8-62 minutes). An alternate diagnosis was offered in 173 (51.5%) of 336 patients. Conclusion MR imaging is a highly sensitive and specific test in the evaluation of patients younger than 50 years

  20. Improving the false-negative rate of CT in acute appendicitis-Reassessment of CT images by body imaging radiologists: A blinded prospective study

    Poortman, Pieter [Department of Surgery, St Elisabeth Hospital, Tilburg (Netherlands)], E-mail: ppoortman@wlz.nl; Lohle, Paul N.M. [Department of Surgery, St Elisabeth Hospital, Tilburg (Netherlands)], E-mail: plohle@elisabeth.nl; Schoemaker, Cees M. [Department of Surgery, St Elisabeth Hospital, Tilburg (Netherlands)], E-mail: mcschoemaker@elisabeth.nl; Cuesta, Miguel A. [Department of Surgery, VU Medical Centre, Amsterdam (Netherlands)], E-mail: ma.cuesta@vumc.nl; Oostvogel, Henk J.M. [Department of Surgery, St Elisabeth Hospital, Tilburg (Netherlands)], E-mail: h.oostvogel@elisabeth.nl; Lange-de Klerk, Elly S.M. de [Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam (Netherlands)], E-mail: esm.delange@vumc.nl; Hamming, Jaap F. [Department of Surgery, Leiden University Medical Centre (Netherlands)], E-mail: j.f.hamming@lumc.nl

    2010-04-15

    Purpose: To compare the accuracy of computed tomography (CT) analyzed by individual radiology staff members and body imaging radiologists in a non-academic teaching hospital for the diagnosis of acute appendicitis. Patients and methods: In a prospective study 199 patients with suspected acute appendicitis were examined with unenhanced CT. CT images were pre-operatively analyzed by one of the 12 members of the radiology staff. In a later stage two body imaging radiologist reassessed all CT images without knowledge of the surgical findings and without knowledge of the primary CT diagnosis. The results, independently reported, were correlated with surgical and histopathologic findings. Results: In 132 patients (66%) acute appendicitis was found at surgery, in 67 patients (34%) a normal appendix was found. The sensitivity of the primary CT analysis and of the reassessment was 76% and 88%, respectively; the specificity was 84% and 87%; the positive predictive value was 90% and 93%; the negative predictive value was 64% and 78%; and the accuracy was 78% and 87%. Conclusion: Reassessment of CT images for acute appendicitis by body imaging radiologists results in a significant improvement of sensitivity, negative predictive value and accuracy. To prevent false-negative interpretation of CT images in acute appendicitis the expertise of the attending radiologist should be considered.

  1. [Leukemic neutrophilic dermatosis].

    Török, L; Kirschner, A; Gurzó, M; Krenács, L

    1999-03-28

    A case of a 67 year-old female patient with acute myeloid leukemia is presented. As the first manifestation of the disease, the patient had symptoms of Sweet's syndrome, later signs of gangrenous pyoderma have developed. This transient form is termed as a "leukemic neutrophilic dermatosis". The authors focus on the important diagnostic and prognostic value of this entity. PMID:10349319

  2. Comparison of ultrasonographic finding in men and women suspected of acute appendicitis: Usefulness and limitation of measurement of the outer diameter of the vermiform appendix

    To evaluate the usefulness and limitations of measurement of the outer diameter of the vermiform appendix in men and women patients suspected of acute appendicitis on ultrasonography (US). Retrospectively, the review of the outer diameter of the appendix measured in 197 adult patients, 70 men and 127 women (age ranged from 16 to 83 years), suspected of acute appendicitis on sustained-compression US was done. The measured outer diameters were categorized into two groups according to the patient's sex, and relationships between categoric variables were analyzed by calculating sensitivity, specificity, positive and negative predictive values and accuracy. Data analyses were performed using MedCalc for windows version 7.1.0.1. The outer appendiceal diameters in men ranged between 3.2 and 15 mm, while those in women, between 3.4 and 17 mm. The diameters of acute inflamed appendices ranged from 6 to 17 mm. In men, a diameter equal to or larger than 6 mm was confirmed as acute appendicitis with the sensitivity, specificity and positive and negative predictive values of 100%, 57.6%, 70.2% and 100%, respectively. Meanwhile, in women, a diameter of ≥ 6 mm was confirmed as acute appendicitis with the sensitivity, specificity and positive and negative predictive values of 98%, 55.8%, 68.9% and 96.5%, respectively. The accuracy in women (67.7%) was lower than in men(75.7%), but no statistically significant difference (p=0.395) was seen between men and women. The outer appendiceal diameter of ≥ 6 mm as a sign of acute appendicitis provides a high sensitivity and negative predictive values. This diagnostic criterion is more useful in excluding acute appendicitis than confirming it. There was no statistically significant difference in the accuracy between men and women.

  3. Acute appendicitis during pregnancy:analysis of 23 cases%妊娠期合并急性阑尾炎23例诊治分析

    赵智毅; 王晓亮

    2013-01-01

    Objective To explore diagnosis and treatment of acute appendicitis during pregnancy. Methods The clinic data of 23 pregnant women with acute appendicitis from June 2004 to June 2012 were retrospectively analyzed. Results 21 cases underwent operation and 2 cases were given conservative treatment. Four cases were acute simple appendicitis, 15 cases acute suppurative appendicitis and 2 cases acute gangrenous appendicitis with pathological examination after surgery. Of them, 1 case suffered from surgical wound infection after surgery. Conclusion For acute appendicitis during pregnancy which is harmful to pregnant women and fetus, it is critical to carry out surgery as soon as possible after diagnosis was made.%目的 探讨妊娠期急性阑尾炎的诊断及治疗方案.方法回顾性分析我院2004年6月至2012年6月收治的妊娠期急性阑尾炎23例的临床资料.结果 手术治疗21例,保守治疗2例;术后病理检查:单纯性阑尾炎4例,化脓性阑尾炎15例,坏疽性阑尾炎2例;切口感染1例.结论 妊娠期急性阑尾炎对孕妇及胎儿都会产生不利影响,明确诊断后,应尽早手术治疗.

  4. 5-azacytidine enhances the anti-leukemic activity of lintuzumab (SGN-33) in preclinical models of acute myeloid leukemia

    Yu, Changpu; Anderson, Martha; Zeng, Weiping; van Rooijen, Nico; Sievers, Eric L; Grewal, Iqbal S; Law, Che-Leung

    2010-01-01

    Despite therapeutic advances, the poor prognoses for acute myeloid leukemia (AML) and intermediate and high-risk myelodysplastic syndromes (MDS) point to the need for better treatment options. AML and MDS cells express the myeloid marker CD33, making it amenable to CD33-targeted therapy. Lintuzumab (SGN-33), a humanized monoclonal anti-CD33 antibody undergoing clinical evaluation, induced meaningful responses in a Phase 1 clinical trial and demonstrated anti-leukemic activity in preclinical models. Recently, it was reported that 5-azacytidine (Vidaza™) prolonged the overall survival of a group of high risk MDS and AML patients. To determine whether the combination of lintuzumab and 5-azacytidine would be beneficial, a mouse xenograft model of disseminated AML was used to evaluate the combination. There was a significant reduction in tumor burden and an increase in overall survival in mice treated with lintuzumab and 5-azacytidine. The effects were greater than that obtained with either agent alone. As the in vivo anti-leukemic activity of lintuzumab was dependent upon the presence of mouse effector cells including macrophages and neutrophils, in vitro effector function assays were used to assess the impact of 5-azacytidine on lintuzumab activity. The results show that 5-azacytidine significantly enhanced the ability of lintuzumab to promote tumor cell killing through antibody-dependent cellular cytotoxicity (ADCC) and phagocytic (ADCP) activities. These results suggest that lintuzumab and 5-azacytidine act in concert to promote tumor cell killing. Additionally, these findings provide the rationale to evaluate this combination in the clinic. PMID:20495353

  5. Comparison and Efficacy of LigaSure and Rubber Band Ligature in Closing the Inflamed Cecal Stump in a Rat Model of Acute Appendicitis

    Chun-Chieh Yeh; Chia-Ing Jan; Horng-Ren Yang; Po-Han Huang; Long-Bin Jeng; Wen-Pang Su; Hui-Chen Chen

    2015-01-01

    Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A) and 7 days (Group B) after cecal resection, respectively. The cecal stumps were closed by silk ligature (S), 5 mm LigaSure (L), or rubber band (R). Seven days after cecal resection, th...

  6. Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis

    Jahn, H; Mathiesen, F K; Neckelmann, K;

    1997-01-01

    accuracy of 76%, specificity of 58%, and negative appendicectomy rate of 36%. 193 Patients underwent diagnostic US conducted by the radiologist on call of whom 123 were operated on, 78 for histologically proven appendicitis. US had a diagnostic accuracy of 72%, sensitivity of 49%, and specificity of 88...

  7. Reliability of diagnostic imaging techniques in suspected acute appendicitis: proposed diagnostic protocol

    To study the utility of ultrasound and computed tomography (CT) in case of suspected appendicitis. To determine the diagnostic yield in terms of different clinical contexts and patient characteristics. to assess the costs and benefits of introducing these techniques and propose a protocol for their use. Negative appendectomies, complications and length of hospital stay in a group of 152 patients with suspected appendicitis who underwent ultrasound and CT were compared with those of 180 patients who underwent appendectomy during the same time period, but had not been selected for the first group: these patients costs for each group were calculated. In the first group, the diagnostic value of the clinical signs was also evaluated. The reliability of the clinical signs was limited, while the results with ultrasound and CT were excellent. The incidence of negative appendectomy was 9.6% in the study group and 12.2% in the control group. Moreover, there were fewer complications and a shorter hospital stay in the first group. Among men, however, the rate of negative appendectomy was lower in the control group. The cost of using ultrasound and CT in the management of appendicitis was only slightly higher than that of the control group. Although ultrasound and CT are not necessary in cases in which the probability of appendicitis is low or in men presenting clear clinical evidence, the use of these techniques is indicated in the remaining cases in which appendicitis is suspected. In children, ultrasound is the technique of choice. In all other patients, if negative results are obtained with one of the two techniques, the other should be performed. (Author) 49 refs

  8. Comparison of ultrasonography and computed tomography in the diagnosis of acute appendicitis

    The compare the efficacy of ultrasonography and computed tomography (CT) in cases of suspected appendicitis. To study to what extent age, sex and habits of the patients, as well as the clinical context, influence the diagnostic yield of these two technique. Over a one-year period, 152 patients underwent ultrasonography and CT because of the clinical suspicion of appendicitis. The studies were carried out independently, and the results of each in terms of the presence or absence of appendicitis were unknown to the specialists performing the other. The final diagnoses were established by surgical treatment or clinical follow-up. The sensitivity of CT for the diagnosis of appendicitis was 82%, the specificity was 95%, the positive predictive value was 93%, the negative predictive value was 87% and the reliability was 90%. Ultrasonography has a sensitivity of 83%, a specificity of 97%, a positive predictive value of 95%, a negative predictive value of 88% and a reliability of 91%. Ultrasound was more efficient in patients in which there was a high clinical suspicion and in children, while the results with CT were better in patients in which the clinical diagnosis was less clear. The incidence of false negatives and positives was higher with ultrasound, while CT was more frequently able to identify a normal appendix. Sex and habits had no influence on the respective efficacies, although the performance of ultrasound was simplified in thin patients and that of CT in obese individuals. Ultrasonography and CT are highly reliable in cases of suspected appendicitis, especially when this diagnosis is conformed. Ultrasound is recommended as the technique of choice in children and in patients in which the clinical suspicion is strong. The yield of CT is somewhat greater when the clinical signs and symptoms are less clear. However, the efficacy of both techniques ultimately depends on the expertise of the specialist who interprets them. (Author) 62 refs

  9. Descriptive analysis of sonographic findings, surgical and pathological in patients with acute appendicitis in the Hospital San Juan de Dios in the year 2010

    The Hospital San Juan de Dios has found without studies correlating the ultrasound findings, with the pathology of acute appendicitis by surgery and histological analysis, especially that meets in the same study the utility of ultrasound in the diagnosis. For that reason, the ultrasonographic findings, pathological and surgical of patients with appendiceal pathology are described in the Servicio de Radiologia of Hospital San Juan de Dios in the year 2010. A revision of 324 dossiers in patients with positive biopsy is performed; however, 23% have result without alterations by ultrasound. The female sex has obtained the largest number of diagnosis by ultrasound. The age group for both sexes is found between 21-30 years. The most common transoperative finding has been grade I appendicitis and no perforated appendicitis have prevailed regarding biopsies reported in the pathology service. The validity of ultrasonography is determined to aid in decision making in pathology of acute appendicitis in the emergency room and avoid or reduce complications that can lead a diagnostic doubt, this will inform the surgeon the possible findings when the surgical intervention. Additionally, the diagnosis of acute appendicitis may be discarded when are encountered other pathologies such as ovarian cysts, kidney stones, among others, avoiding unnecessary surgeries. The costs to the institution are reduced by decreasing the hospital stay and the use of operating rooms

  10. Torsion of a lipoma of parietal peritoneum: a rare case mimicking acute appendicitis

    Shrestha, Binod Bade; Karmacharya, Mikesh

    2014-01-01

    Lipomas are found most often on the torso, neck, upper thighs, upper arms and armpits; they can also occur almost anywhere in the body. Parietal peritoneum lipoma is a rare intraoperative finding during abdominal surgery. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. So far only one case has been reported.

  11. Improving the diagnosis of acute appendicitis in children with atypical clinical findings using the technetium-99m hexamethylpropylene amine oxime-labelled white-blood-cell abdomen scan

    Heading AbstractBackground. Diagnosing acute appendicitis in children with equivocal signs and symptoms may be difficult. The usual approach is hospital observation and frequent re-examination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy.Objective. To assess and compare the value of the technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled white-blood-cell (WBC) abdomen scan in the diagnosis of acute appendicitis in children with atypical clinical presentation.Patients and methods. Fifty children with acute right lower quadrant abdominal pain and possible acute appendicitis, but atypical findings were included. After IV injection of 99mTc-HMPAO-labelled WBCs, serial anterior abdomen scans were obtained using a gamma camera.Results. Thirty-three children underwent surgery, while 17 children were managed conservatively and were followed up for at least 1 month. Four children had false-positive results and one child had a false-negative scan result. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the scan to diagnose acute appendicitis in children with atypical findings was 96.7, 80.0, 90.0, 87.8 and 94.1%, respectively.Conclusions. The 99mTc-HMPAO WBC abdomen scan is a potential tool for diagnosing acute appendicitis in children with atypical clinical findings. The high sensitivity and negative predictive value allows early discharge from the emergency department to avoid costly observation in hospital and potentially unnecessary surgery in those patients with negative scans. (orig.)

  12. Diagnosis of acute appendicitis in the community hospital: validity and usefulness of sonography

    To compare the accuracy of initial clinical diagnosis with that of ultrasonography (US) in diagnosing appendicitis and to determine its effect on the care of patients in a community hospital. One hundred and fifty patients with suspected appendicitis were prospectively examined with US. Prior to this, they had been divided into three groups on the basis of clinical judgement regarding diagnosis and their treatment plan ; Group 1 : high suspicion (probability > 75%)-urgent surgery indicated ; Group 2 : equivocal (probability 25-75%)-in hospital for observation, Group 3 : very unlikely (probability < 25%)-discharge without further testing. In order to determine the validity of these groupings, we calculated the sensitivity, specificity, and accuracy of sonographic examination, and the likelihood ratios of initial clinical diagnosis. US revealed a sensitivity of 92%, specificity of 90%, positive predictive value of 95%, negative predictive value of 85% and overall accuracy of 91%. The initial clinical impression showed a sensitivity of 70%, specificity of 82%, positive predictive value of 89%, negative predictive value of 58%, and overall accuracy of 74%. Among 79 patients in the high clinical risk category(Group 1), the sensitivity, specificity and accuracy of US were 96%, 89%, and 95%, respectively. Among 71 patients in the low- and intermediate- clinical categories(Groups 2 and 3), the sensitivity, specificity, and accuracy of US were 83%, 90%, and 87%. The likelihood ratios were 3.9 in Group 1, 0.52 in Group 2, and 0.15 in Group 3. In 32 of 150 patients(21%), the findings of US led to changes in the proposed management plan. The overall accuracy of US in the diagnosis of appendicitis was statistically superior to that of the clinician's initial impression(p < 0.05). In addition, US played an important role in making decisions regarding the treatment plan

  13. A case-control study of acute appendicitis and diet in children.

    Nelson, M.; Morris, J; Barker, D J; Simmonds, S

    1986-01-01

    The diets of 53 Southampton children who had had appendicitis were compared with those of two sets of age-sex matched controls using a seven-day weighed food record. One set of controls comprised classmates of the cases; the other was a random sample of all schoolchildren in the city. The cases weighed less and were shorter in height; they had lower intakes of energy, all the main nutrients and water. The differences in weight and water intake were statistically significant. Low water intake ...

  14. Apendicite aguda: achados na tomografia computadorizada - ensaio iconográfico Acute appendicitis: computed tomography findings - an iconographic essay

    Marcelo Eustáquio Montandon Júnior

    2007-06-01

    Full Text Available A apendicite aguda é a causa mais comum de dor abdominal aguda que requer intervenção cirúrgica no mundo ocidental. O diagnóstico precoce é essencial para minimizar a morbidade da doença. O uso dos métodos de imagem significou grande avanço no diagnóstico desta entidade, até então avaliada apenas com base na história clínica, exame físico e dados laboratoriais, haja vista que 20% a 33% dos pacientes apresentam sintomas atípicos. O diagnóstico é mais difícil nas crianças, nos idosos e nas mulheres em idade fértil. Os principais métodos de imagem para sua avaliação são a ultra-sonografia e a tomografia computadorizada. Os objetivos deste trabalho são: descrever a fisiopatologia da doença, comentar os principais aspectos técnicos da tomografia computadorizada, demonstrar e ilustrar os achados tomográficos e citar os principais diagnósticos diferenciais.Acute appendicitis is the most important cause of abdominal pain requiring surgical intervention in the Western world. The early diagnosis of this disease is of paramount relevance for minimizing its morbidity. Imaging methods have represented a huge progress in the diagnosis of this entity, which used to be based essentially on clinical history, physical examination and laboratory tests results, considering that 20% to 33% of patients present with atypical symptoms. Diagnostic difficulty is higher in children, the elderly, and women in childbearing age. The main imaging methods for evaluation of acute appendicitis are ultrasound and computed tomography. The present study is aimed at describing the disease physiopathology, commenting main computed tomography technical aspects, demonstrating and illustrating tomographic findings, and describing main differential diagnoses.

  15. Added value of coronal reformations for duty radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis

    To assess the added value of coronal reformation for radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis. Contrast-enhanced CT was performed using 16-detector-row scanners in 110 patients, 46 of whom had appendicitis. Transverse (5-mm thickness, 4-mm increment), coronal (5-mm thickness, 4-mm increment), and combined transverse and coronal sections were interpreted by four radiologists, two surgeons and two emergency physicians. The area under the receiver operating characteristic curve (Az value), sensitivity, specificity, (McNemar test), diagnostic confidence and appendiceal visualization (Wilcoxon signed rank test) were compared. For radiologists, the additional coronal sections tended to increase the Az value (0.972 vs 0.986, ρ=0.076) and pooled sensitivity (92% [95% CI: 88,96] vs. 96% [93,99]), and enhanced appendiceal visualization in true-positive cases (ρ= 0.031). For non-radiologists, no such enhancement was observed, and the confidence for excluding acute appendicitis declined (ρ=0.013). Coronal sections alone were inferior to transverse sections for diagnostic confidence as well as appendiceal visualization for each reader group studied (ρ<0.05). The added value of coronal reformation is more apparent for radiologists compared to referring physicians or surgeons in the CT diagnosis of acute appendicitis

  16. Normal and Leukemic Hematopoiesis

    Vercauteren, Suzanne Maria

    2004-01-01

    Acute Myeloid Leukemia (AML) is a clonal myeloproliferative disease characterized by an uncontrolled proliferation and block in differentiation of myeloid committed blood cells in the bone marrow. Despite the lack of mature cells derived from the leukemic clone in the majority of AML patients, AML cells are heterogenous in phenotype and functional ability. AML progenitors capable of initiating the leukemia in immunocompromised mice and generating clonogenic cells after long-term culture in vi...

  17. Comparison of imaging strategies with conditional versus immediate contrast-enhanced computed tomography in patients with clinical suspicion of acute appendicitis

    To compare the diagnostic accuracy of conditional computed tomography (CT), i.e. CT when initial ultrasound findings are negative or inconclusive, and immediate CT for patients with suspected appendicitis. Data were collected within a prospective diagnostic accuracy study on imaging in adults with acute abdominal pain. All patients underwent ultrasound and CT, read by different observers who were blinded from the other modality. Only patients with clinical suspicion of appendicitis were included. An expert panel assigned a final diagnosis to each patient after 6 months of follow-up (clinical reference standard). A total of 422 patients were included with final diagnosis appendicitis in 251 (60 %). For 199 patients (47 %), ultrasound findings were inconclusive or negative. Conditional CT imaging correctly identified 241 of 251 (96 %) appendicitis cases (95 %CI, 92 % to 98 %), versus 238 (95 %) with immediate CT (95 %CI, 91 % to 97 %). The specificity of conditional CT imaging was lower: 77 % (95 %CI, 70 % to 83 %) versus 87 % for immediate CT (95 %CI, 81 % to 91 %). A conditional CT strategy correctly identifies as many patients with appendicitis as an immediate CT strategy, and can halve the number of CTs needed. However, conditional CT imaging results in more false positives. (orig.)

  18. Comparison of imaging strategies with conditional versus immediate contrast-enhanced computed tomography in patients with clinical suspicion of acute appendicitis

    Atema, J.J.; Gans, S.L.; Boermeester, M.A. [Academic Medical Centre, Department of Surgery (G4-142), Amsterdam (Netherlands); Randen, A. van; Stoker, J. [Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Lameris, W. [Academic Medical Centre, Department of Surgery (G4-142), Amsterdam (Netherlands); Spaarne Hospital, Department of Surgery, Hoofddorp (Netherlands); Es, H.W. van; Heesewijk, J.P.M. van [St Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Ramshorst, B. van [St Antonius Hospital, Department of Surgery, Nieuwegein (Netherlands); Bouma, W.H. [Gelre Hospital, Department of Surgery, Apeldoorn (Netherlands); Hove, W. ten [Gelre Hospital, Department of Radiology, Apeldoorn (Netherlands); Keulen, E.M. van [Tergooi Hospital, Department of Radiology, Hilversum (Netherlands); Dijkgraaf, M.G.W. [Academic Medical Centre, Clinical Research Unit, Amsterdam (Netherlands); Bossuyt, P.M.M. [Academic Medical Center, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam (Netherlands)

    2015-08-15

    To compare the diagnostic accuracy of conditional computed tomography (CT), i.e. CT when initial ultrasound findings are negative or inconclusive, and immediate CT for patients with suspected appendicitis. Data were collected within a prospective diagnostic accuracy study on imaging in adults with acute abdominal pain. All patients underwent ultrasound and CT, read by different observers who were blinded from the other modality. Only patients with clinical suspicion of appendicitis were included. An expert panel assigned a final diagnosis to each patient after 6 months of follow-up (clinical reference standard). A total of 422 patients were included with final diagnosis appendicitis in 251 (60 %). For 199 patients (47 %), ultrasound findings were inconclusive or negative. Conditional CT imaging correctly identified 241 of 251 (96 %) appendicitis cases (95 %CI, 92 % to 98 %), versus 238 (95 %) with immediate CT (95 %CI, 91 % to 97 %). The specificity of conditional CT imaging was lower: 77 % (95 %CI, 70 % to 83 %) versus 87 % for immediate CT (95 %CI, 81 % to 91 %). A conditional CT strategy correctly identifies as many patients with appendicitis as an immediate CT strategy, and can halve the number of CTs needed. However, conditional CT imaging results in more false positives. (orig.)

  19. The value of 99mTc-HMPAO labelled white blood cell scintigraphy in acute appendicitis patients with an equivocal clinical presentation

    Various imaging studies can be performed in the evaluation of patients with a clinical presentation equivocal for acute appendicitis. One of these studies is technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled white blood cell (WBC) scintigraphy. The aim of this study was to evaluate the accuracy and clinical value of 99mTc-HMPAO WBC scintigraphy in the aforementioned group of patients. Forty-one patients who had acute right lower quadrant abdominal pain with a clinical presentation equivocal for acute appendicitis were included in the study. The anterior abdomen and pelvis were imaged up to 4 h after the injection of 125-300 MBq 99mTc-HMPAO WBCs and the results were immediately reported to the surgeon before a decision was taken on whether to perform laparotomy. Diagnostic accuracy was established by the intra-operative findings and the histopathology in operated patients. In non-operated patients, absence of abdominal symptoms 1 month after scintigraphy and/or identification of another cause of abdominal pain was used to rule out acute appendicitis. There were 16 patients with positive scintigraphy and 81% of these patients were positive within 2 h post injection. There were no false-positive or false-negative results. We operated on 17 (41.4%) patients, and only one patient (5.9%) underwent unnecessary laparotomy. We conclude that 99mTc-HMPAO WBC scintigraphy is a rapid, highly accurate method for the exclusion of acute appendicitis and that its use can lower the unnecessarily high laparotomy rate in patients with an equivocal clinical presentation. (orig.)

  20. Type C virus particles produced in human T-cell lines derived from acute lymphoblastic leukemia and a leukemic T-lymphoid malignancy.

    Oda,Takuzo

    1983-12-01

    Full Text Available Electron microscopy of four human T-cell lines revealed the production of type C virus particles in two T-cell lines: one derived from acute lymphoblastic leukemia and the other from a leukemic T-lymphoid malignancy. Virus particles isolated from these cells had reverse transcriptase activity and the major internal structural protein of 30,000 daltons (p30. The indirect immunofluorescence test of these virus-producing cells with sera of patients with adult T-cell leukemia (ATL was negative. The data indicate that these retroviruses are different from adult T-cell leukemia virus (ATLV.

  1. Type C virus particles produced in human T-cell lines derived from acute lymphoblastic leukemia and a leukemic T-lymphoid malignancy.

    Oda, Takuzo; Watanabe,Sekiko; Nakamura,Takashi

    1983-01-01

    Electron microscopy of four human T-cell lines revealed the production of type C virus particles in two T-cell lines: one derived from acute lymphoblastic leukemia and the other from a leukemic T-lymphoid malignancy. Virus particles isolated from these cells had reverse transcriptase activity and the major internal structural protein of 30,000 daltons (p30). The indirect immunofluorescence test of these virus-producing cells with sera of patients with adult T-cell leukemia (ATL) was negative....

  2. Primary ovarian leiomyoma associated with endometriotic cyst presenting with symptoms of acute appendicitis: a case report

    Puljiz Zvonimir

    2009-07-01

    Full Text Available Abstract Background Ovarian leiomyoma is a rare benign tumor that accounts for 0.5 to 1% of all benign ovarian tumors. It probably arises from smooth muscle cells in the ovarian hilar blood vessels but there are other possible origins including cells in the ovarian ligament, smooth muscle cells or multipotential cells in the ovarian stroma, undifferentiated germ cells, or cortical smooth muscle metaplasia. Additionally, smooth muscle metaplasia of endometriotic stroma, smooth muscle present in mature cystic teratomas, and smooth muscle in the walls of mucinous cystic tumor may explain their occurrence in the ovary in some cases. Case presentation A 31-year-old woman was admitted to our surgical emergency service with a one-day history of appendicitis-like symptoms. Upon laparotomy, there was a solid, oval left-sided ovarian tumor located behind the uterus. The tumor was sent to the pathology department. A diagnosis of primary ovarian leiomyoma associated with an endometriotic cyst was established. Conclusion The origin of ovarian leiomyoma is still unresolved. In our case, the tumor probably arose from smooth muscle cells derived from myofibroblasts that originate from metaplastic ovarian stromal cells present in the rim of the endometriotic cyst. Despite its rarity, ovarian leiomyoma should be considered in the differential diagnosis of ovarian spindle cell tumors. Appropriate diagnosis may require additional immunohistochemical analysis in some cases.

  3. Comparison and efficacy of LigaSure and rubber band ligature in closing the inflamed cecal stump in a rat model of acute appendicitis.

    Yeh, Chun-Chieh; Jan, Chia-Ing; Yang, Horng-Ren; Huang, Po-Han; Jeng, Long-Bin; Su, Wen-Pang; Chen, Hui-Chen

    2015-01-01

    Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A) and 7 days (Group B) after cecal resection, respectively. The cecal stumps were closed by silk ligature (S), 5 mm LigaSure (L), or rubber band (R). Seven days after cecal resection, the LigaSure (BL) and silk subgroups (BS) had significantly less intra-abdominal adhesion and better laparotomy wound healing than rubber band subgroup (BR). The initial bursting pressure at cecal stump was comparable among the three methods; along with tissue healing process, both BL and BS provided a higher bursting pressure than BR 7 days after appendectomy. BL subgroup had more abundant hydroxyproline deposition than BS and BR subgroup. Furthermore, serum TNF-α in BR group kept persistently increasing along with time after cecal resection. Thus, the finding that LigaSure but not rubber band is safe in sealing off the inflamed cecal stump in rat model of acute appendicitis suggests the possibility of applying LigaSure for appendectomy via single port procedure or natural orifice transluminal endoscopic surgery (NOTES). PMID:25699264

  4. Comparison and Efficacy of LigaSure and Rubber Band Ligature in Closing the Inflamed Cecal Stump in a Rat Model of Acute Appendicitis

    Chun-Chieh Yeh

    2015-01-01

    Full Text Available Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A and 7 days (Group B after cecal resection, respectively. The cecal stumps were closed by silk ligature (S, 5 mm LigaSure (L, or rubber band (R. Seven days after cecal resection, the LigaSure (BL and silk subgroups (BS had significantly less intra-abdominal adhesion and better laparotomy wound healing than rubber band subgroup (BR. The initial bursting pressure at cecal stump was comparable among the three methods; along with tissue healing process, both BL and BS provided a higher bursting pressure than BR 7 days after appendectomy. BL subgroup had more abundant hydroxyproline deposition than BS and BR subgroup. Furthermore, serum TNF-α in BR group kept persistently increasing along with time after cecal resection. Thus, the finding that LigaSure but not rubber band is safe in sealing off the inflamed cecal stump in rat model of acute appendicitis suggests the possibility of applying LigaSure for appendectomy via single port procedure or natural orifice transluminal endoscopic surgery (NOTES.

  5. Apoptosis Susceptibility Prolongs the Lack of Memory B Cells in Acute Leukemic Patients After Allogeneic Hematopoietic Stem Cell Transplantation.

    Mensen, Angela; Oh, Youngseong; Becker, Sonya C; Hemmati, Philipp G; Jehn, Christian; Westermann, Jörg; Szyska, Martin; Göldner, Henning; Dörken, Bernd; Scheibenbogen, Carmen; Arnold, Renate; Na, Il-Kang

    2015-11-01

    Long-term survival after allogeneic hematopoietic stem cell transplantation requires intact immunosurveillance, which is hampered by lymphoid organ damage associated with conditioning therapy, graft-versus-host disease, and immunosuppression. Our study aimed to identify the mechanisms contributing to sustained low memory B cell numbers after transplantation. Peripheral B and T cell subset recovery and functional marker expression were investigated in 35 acute leukemic patients up to 1 year after transplantation. Apoptosis of B cells after CD40/TLR-9, CD40/BCR, and CD40/BCR/TLR-9-dependent stimulation and drug efflux capacity were analyzed. One half of the patients suffered from infections after day 180. All patients had strongly diminished CD27(+) memory B cells despite already normalized total B cell numbers and fully recovered CD27(-)IgD(-) memory B cells, putatively of extra-follicular origin. Circulating memory follicular helper T cells were reduced in the majority of patients as well. Naïve B cells exhibited a decreased expression of CXCR5, which mediates follicular B cell entry. Additionally, a lower HLA-DR expression was found on naïve B cells, impairing antigen presentation. Upon CD40/TLR-9-dependent activation, B cells underwent significantly increased apoptosis paralleled by an aberrant up-regulation of Fas-L on activated T cells and Fas on resting B cells. Significantly increased B cell apoptosis was also observed after CD40/BCR and CD40/BCR/TLR-9-dependent activation. Drug efflux capacity of naïve B cells was diminished in cyclosporin A-treated patients, additionally contributing to an apoptosis-prone phenotype. We conclude that B cell survival and migration and T cell communication defects are contributing candidates for an impaired germinal center formation of memory B cells after allogeneic hematopoietic stem cell transplantation. Follow-up studies should evaluate effectiveness of revaccinations on the cellular level and should

  6. Leukemic cell kinetics in peripheral blood, 2

    The in vivo kinetics of autologous leukemic cells labeled in vitro with indium-111-oxine was studied in 10 patients with acute non-lymphocytic leukemia (ANLL), consisting of 7 patients with acute myeloblastic leukemia (AML), 2 with acute myelomonocytic leukemia (AMML) and 1 with acute monocytic leukemia (AMoL). Leukemic cell disappearance curves showed a single exponential line. The half tims of disappearance (T1/2) in AML was 18.6 +- 8.3 hours (mean +- s.d.), and was longer than that of normal neutrophils. In AMML and AMoL, T1/2 was 11.5 +- 1.4 hours, and tended to be shorter than that in AML (p < 0.1). Total blood leukemic cell pool (TBLCP) size correlated with blood leukemic cell count (LC) (Y = 1.11 + 2.01X, r = 0.95). The ratio of marginal (MLCP) to circulating leukemic cell pool (CLCP) size was 2.38 +- 0.99 in AML. There was no significant correlation between leukemic cell turnover rate (LCTR) and TBLCP size. As for organ distribution, labeled leukemic cells passed immediately through lungs, are then accumulated markedly in the spleen and liver in that order. Initial pulmonary radioactivity was observed in only one of the AMML patients. Only in AMoL, hepatic radioactivity 30 minutes after the injection surpassed splenic radioactivity. Accumulation of radioactivity in the bone marrow was observed in 6 out of 8 patients studied. Radioactivity of the leukemic cells isolated from the bone marrow in 4 patients was larger than that expected from mixing of peripheral blood leukemic cells, suggesting that a portion of blood leukemic cells returned to the bone marrow. (author)

  7. Laser and Non-Coherent Light Effect on Peripheral Blood Normal and Acute Lymphoblastic Leukemic Cells by Using Different Types of Photosensitizers

    El Batanouny, Mohamed H.; Khorshid, Amira M.; Arsanyos, Sonya F.; Shaheen, Hesham M.; Abdel Wahab, Nahed; Amin, Sherif N.; El Rouby, Mahmoud N.; Morsy, Mona I.

    2010-04-01

    Photodynamic therapy (PDT) is a novel treatment modality of cancer and non-cancerous conditions that are generally characterized by an overgrowth of unwanted or abnormal cells. Irradiation of photosensitizer loaded cells or tissues leads via the photochemical reactions of excited photosensitizer molecules to the production of singlet oxygen and free radicals, which initiate cell death. Many types of compounds have been tested as photosensitizers, such as methylene blue (MB) and photopherin seemed to be very promising. This study involved 26 cases of acute lymphoblastic leukemia and 15 normal volunteers as a control group. The cell viability was measured by Light microscope and flowcytometer. Mode of cell death was detected by flowcytometer and electron microscope in selected cases. The viability percentage of normal peripheral blood mononuclear cells (PBMC) incubated with methylene blue (MB) alone or combined with photo irradiation with diode laser (as measured by light microscope) was significantly lower than that of untreated cases either measured after 1 hour (p<0.001) or 24 hours (p<0.001) post incubation. There was a significantly lower viability percentage of normal cells incubated with MB and photoirradiated with diode laser compared to normal cells treated with MB alone for either measured after 1 hour (p<0.001) or 24 hours (p<0.001) post incubation. The decrease in viability was more enhanced with increasing the incubation time. For normal cells incubated with photopherin either for 1/2 an hour or 1 hour, there was a weak cytotoxic effect compared to the effect on untreated cells. There was a significant decrease in viability percentage of cells incubated with photopherin either for 1/2 an hour or 1 hour and photoirradiated with He:Ne laser compared to normal untreated cells. The decrease in the cell viability percentage was significantly lower with the use of PDT (photopherin and He:Ne laser ) compared to either photopherin alone or He:Ne laser alone. The

  8. A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial

    Paajanen Hannu

    2013-02-01

    Full Text Available Abstract Background Although the standard treatment of acute appendicitis (AA consists of an early appendectomy, there has recently been both an interest and an increase in the use of antibiotic therapy as the primary treatment for uncomplicated AA. However, the use of antibiotic therapy in the treatment of uncomplicated AA is still controversial. Methods/design The APPAC trial is a randomized prospective controlled, open label, non-inferiority multicenter trial designed to compare antibiotic therapy (ertapenem with emergency appendectomy in the treatment of uncomplicated AA. The primary endpoint of the study is the success of the randomized treatment. In the antibiotic treatment arm successful treatment is defined as being discharged from the hospital without the need for surgical intervention and no recurrent appendicitis during a minimum follow-up of one-year (treatment efficacy. Treatment efficacy in the operative treatment arm is defined as successful appendectomy evaluated to be 100%. Secondary endpoints are post-intervention complications, overall morbidity and mortality, the length of hospital stay and sick leave, treatment costs and pain scores (VAS, visual analoque scale. A maximum of 610 adult patients (aged 18–60 years with a CT scan confirmed uncomplicated AA will be enrolled from six hospitals and randomized by a closed envelope method in a 1:1 ratio either to undergo emergency appendectomy or to receive ertapenem (1 g per day for three days continued by oral levofloxacin (500 mg per day plus metronidazole (1.5 g per day for seven days. Follow-up by a telephone interview will be at 1 week, 2 months and 1, 3, 5 and 10 years; the primary and secondary endpoints of the trial will be evaluated at each time point. Discussion The APPAC trial aims to provide level I evidence to support the hypothesis that approximately 75–85% of patients with uncomplicated AA can be treated with effective antibiotic therapy avoiding unnecessary

  9. Acute Appendicitis in Infancy:A Report of 84 Cases%婴幼儿急性阑尾炎(附84例分析)

    宋育麟; 江泽熙; 余浠临; 鲁建生

    1982-01-01

    Acute appendicitis in infancy is not uncommon.Misdiagnosis is frequent as infants are unable to state their symptoms or cooperate with the physicians at examination.Of the 84 infant patients reported here,28(33.3%) had perforated appendices.It is essential to differentiate gastroenteritis from appendicitis so as to reach a correct diagnosis as early as possible.This report reviews our experience with acute appendicitis in infants for the past 10 years.%@@ 当前外科技术虽已进展至心血管、器官移植及胎儿外科时代,但小儿,特别是婴幼儿急性阑尾炎的诊断,仍为临床工作中的重要实际问题.我院自1972年~1981年底共收治3岁以下急性阑尾炎84例,占同期小儿阑尾炎1809例的4.64%.44例入院时延误诊断,占52.4%.穿孔者28例,占33.3%.本文就诊断及治疗问题进行讨论.

  10. Appendicitis as a complication of colonoscopy

    AA Sheikh; Watt, J.; M Tee; CR Selvasekar

    2010-01-01

    Acute appendicitis is an extremely rare complication of colonoscopy, with no reports in the British literature. Here we discuss a case report of a patient who developed acute appendicitis 24 hours following a normal diagnostic colonoscopy. This case report highlights the rarity of this life threatening complication and discusses its aetiology.

  11. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient

    Forster, Michael J.; Akoh, Jacob A.

    2008-01-01

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed th...

  12. Imaging of acute appendicitis in children: EU versus U.S.... or US versus CT? A North American perspective

    Frush, Donald P. [Duke University Medical Center, McGovern-Davison Children' s Health Center, Division of Pediatric Radiology, Department of Radiology, Box 3808 DUMC, Durham, NC (United States); Frush, Karen S. [Duke University Health System, Duke University Medical Center, Division of Pediatric Emergency Medicine, Department of Pediatrics, Durham, NC (United States); Oldham, Keith T. [Children' s Hospital of Wisconsin, Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI (United States)

    2009-05-15

    The timing, type, and technique of imaging evaluation of suspected appendicitis in children are all debated. This debate is both local and international. The fact is that choices in imaging evaluation will depend on both local and national influences, which are reasonable and to be expected. There still is a responsibility, though, for those involved with evaluation of patients with possible appendicitis to come to agreement about an appropriate diagnostic pathway that considers standards of care and available resources. (orig.)

  13. Imaging of acute appendicitis in children: EU versus U.S.... or US versus CT? A North American perspective

    The timing, type, and technique of imaging evaluation of suspected appendicitis in children are all debated. This debate is both local and international. The fact is that choices in imaging evaluation will depend on both local and national influences, which are reasonable and to be expected. There still is a responsibility, though, for those involved with evaluation of patients with possible appendicitis to come to agreement about an appropriate diagnostic pathway that considers standards of care and available resources. (orig.)

  14. The surface molecular signature of leukemic cells is associated with NPM1 mutations and FLT3 -ITD in patients with de novo acute myeloid leukemia.

    Su, Long; Gao, Su-Jun; Li, Wei; Tan, Ye-Hui; Cui, Jiu-Wei; Han, Wei

    2014-01-01

    Certain molecular mutations are associated with signs of cell morphology and differentiation in acute myeloid leukemia (AML). However, only limited data are available for the detailed analysis of such correlations. In this study, AML patients were classified into 4 subsets according to CD34, HLA-DR and CD11c expression levels. Significantly low CD34 antigen expression was observed in nucleophosmin (NPM1)-mutated patients and in those with FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD). No correlations were observed among NPM1 mutations, FLT3-ITD and monocytic morphology in patients without CD34 expression. Both NPM1 mutations and FLT3-ITD were absent in cluster IIb patients (CD34(+)CD11c(-)). The associations among NPM1 mutations, FLT3-ITD and the surface molecular signature of leukemic cells may offer beneficial information about the pathogenesis of AML. PMID:24192815

  15. INCIDENCE, RISK FACTORS AND COMPLICATIONS OF ACUTE PERFORATED AND NON - PERFORATED APPENDICITIS IN A RURAL SETUP OF ANDHRA PRADESH

    Anil Kumar

    2015-05-01

    Full Text Available Appendicitis is one of the most common surgical emergencies. The incidence of appendicitis and chances of complication in the form of perforation are dependent on both the patients and non - patient factors . There are various studies conducted to address this problem, but there are no studies conducted to look in to the incidence of appendicitis in east Godavari district of Andhra Pradesh. Our study was aimed to bridge thi s gap. METHOD S AND MATERIALS: this was a retrospective study, patient data from 2009 - 2014 was analyzed and the age, distance from hospital, educational and socioeconomic background of the patients was collected. The duration between first appearance of sy mptoms and hospitalization was recorded. The incidence of post - op complication was also recorded. RESULTS: T he incidence of perforation was 15% in our study population, most of the patients were from low socioeconomic group and having income less than 5000 /month. The middle age group between 30 - 40 years was commonly affected by the appendicitis. The time laps between appearance of symptoms and hospitalization was found to be a predominant factor in the perforation. Surgical site infection was most common co mplication in the patients treated. CONCLUSION: T he incidence of perforation is still high and the time laps between first appearance of symptoms and hospitalization is a major determinant of perforation or complication in the appendicitis.

  16. Infantile perforated appendicitis: A forgotten diagnosis

    Katherine W. Gonzalez

    2015-04-01

    Full Text Available Acute appendicitis in the infant is a rare surgical diagnosis despite its frequency in older patients. The clinical presentation is often vague and can be misleading. We present the successful diagnosis and treatment of a 3 month old female with perforated appendicitis.

  17. Post-colonoscopy appendicitis: a rare entity

    Vipul D Yagnik; Yagnik, Bhargav D.

    2012-01-01

    A 35-year-old woman was admitted to the surgical ward complaining of right-sided lower abdominal pain. She had undergone colonoscopy a week previously. She was diagnosed with acute appendicitis following colonoscopy and laparoscopic appendectomy was performed via the 2-port technique. Post colonoscopy appendicitis is very rare with 14 cases reported since 1988.

  18. A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos.

    Kim, Changsun; Cha, Hyunmin; Kang, Bo Seung; Choi, Hyuk Joong; Lim, Tae Ho; Oh, Jaehoon

    2016-06-01

    Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)-50 with an ejection fraction (EF) of ≥50 s and 50 with EF machine and using a smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer's interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949-0.986) and 0.963 (0.945-0.982) (P = 0.548) for echocardiography and 0.972 (0.954-0.989) and 0.966 (0.947-0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography. PMID:26620200

  19. 急性阑尾炎术后切口感染的防治%Prevention of wound infection after acute appendicitis

    张崇广; 王文江

    2016-01-01

    目的:探讨综合措施预防急性阑尾炎术后切口感染的效果。方法选取2008年1月~2014年12月我院接受急性阑尾炎手术患者363例作为研究对象,从术前刷手、皮肤消毒等到术中操作以及术后围手术期处理的各个环节进行回顾性分析。结果本组患者仅发生切口感染3例,感染发生率为0.8%。结论采取综合方法预防阑尾术后切口感染,明显降低切口感染率,效果满意。%Objective To explore effective comprehensive measures of acute appendicitis postoperative infection prevention.Methods 363 cases of acute appendicitis from preoperative surgical scrub,skin disinfection until surgery operations and all aspects of perioperative treatment were analyzed retrospectively.Results Wound infection occurred in this group only three cases,the infection rate was 0.8%.Conclusion We take an integrated approach to the prevention of wound infection after appendectomy,signiifcantly reduced wound infection rate,results were satisfactory.

  20. Appendicitis (For Parents)

    ... Caring for Your Child All About Food Allergies Appendicitis KidsHealth > For Parents > Appendicitis Print A A A ... the easier it will be to treat. About Appendicitis The appendix is a small finger-like organ ...

  1. Paradigm Shifts in the Treatment of Appendicitis.

    Mak, Grace Zee; Loeff, Deborah S

    2016-07-01

    Acute appendicitis is the most common cause of emergent surgery in children. Historically, surgical dogma dictated emergent appendectomy due to concern for impending perforation. Recently, however, there has been a paradigm shift in both the understanding of its pathophysiology as well as its treatment to more nonoperative management. No longer is it considered a spectrum from uncomplicated appendicitis inevitably progressing to complicated appendicitis over time. Rather, uncomplicated and complicated appendicitis are now considered two distinct pathophysiologic entities. This change requires not only educating the patients and their families but also the general practitioners who will be managing treatment expectations and caring for patients long term. In this article, we review the pathophysiology of appendicitis, including the differentiation between uncomplicated and complicated appendicitis, as well as the new treatment paradigms. [Pediatr Ann. 2016;45(7):e235-e240.]. PMID:27403670

  2. Leukemic meningitis involving the cauda equina: a case report

    The CNS involvement by leukemia may either be meningeal or parenchymal, although meningeal infiltration of leukemic cells, known as leukemic meningitis is more common. We report a case of leukemic meningitis involving the cauda equina in a patient with an acute lymphoblastic crisis which transformed from the chronic phase of chronic myeloid leukemia. An MR image revealed diffuse enlargement and peripheral ring enhancement of the nerve roots of the cauda equina

  3. Leukemic meningitis involving the cauda equina: a case report

    Lee, Dong Hyun; Kim, Ho Kyun; Lee, Young Hwan [School of Medicine, Catholic University of Daegu, Daegu (Korea, Republic of)

    2008-07-15

    The CNS involvement by leukemia may either be meningeal or parenchymal, although meningeal infiltration of leukemic cells, known as leukemic meningitis is more common. We report a case of leukemic meningitis involving the cauda equina in a patient with an acute lymphoblastic crisis which transformed from the chronic phase of chronic myeloid leukemia. An MR image revealed diffuse enlargement and peripheral ring enhancement of the nerve roots of the cauda equina.

  4. Subhepatically located appendicitis due to adhesions: a case report

    Ting Joseph YS

    2008-10-01

    Full Text Available Abstract Introduction Acute appendicitis occurs frequently and is a major indication for acute abdominal surgery. Subhepatic appendicitis has rarely been reported and is more difficult to diagnose. Case presentation A 71-year-old man with multiple medical comorbidities presented with undifferentiated right abdominal pain. Diagnostic difficulty was encountered due to subhepatic mal-location of the appendix and subsequently atypical presentation for acute appendicitis. Conclusion Subhepatic anatomical location of the appendix makes it more difficult to diagnose acute appendicitis at any age, including in older adults.

  5. Apendicite aguda: análise institucional no manejo peri-operatório Acute appendicitis: institutional evaluation in the peri-operative managment

    Orli Franzon

    2009-06-01

    avançado o estágio de evolução da apendicite, maior a prevalência de complicações.BACKGROUND: Acute appendicitis is one of the most common cause of acute abdomen and is responsible for high morbidity. Correct diagnosis remains a challenge, thus accurate perioperative assessment is important in planning surgical therapy. AIM: To evaluate institutional findings in perioperative workup, operative approach and adverse outcomes in patients who underwent open surgical intervention for acute appendicitis. METHOD: A prospective chart was performed of 88 adults patients undergoing open appendectomy. Variables compared were imaging methods and laboratory evaluation, pathologic findings and early complications. Statistical analysis was performed by SPSS 8.0 and EpiInfo6.0. RESULTS: Thirty patients underwent ultrassonography (56,7% females and five computorized tomography (all women. The differencial white cell count was directly related to more advanced phases regarding increased of "stabs", segmented and eosinophyls/lymphocytes decrease (P>0,005. Sixty (67% patients used antibiotic therapy and 38,33% of them had perforated appendicitis. Was found 23,8% of complications, 11,4% was wound infections and patients with perforated appendicitis. CONCLUSION: Females demand more imaging methods. The differencial white cell count in complicated appendicitis has an increment in less mature neutrophils and reduction of the eosinophils and lymphocytes. Advanced phases has increase risk of early complications mainly superficial wound infections and shows more prevalence in using.

  6. Appendicitis associated with a strangulated Littre's hernia

    Quail, Jacob F; Romeo C. Ignacio

    2015-01-01

    A 12 year-old boy presented with right lower abdominal and groin pain. Intraoperatively, he was found to have acute appendicitis associated with a strangulated Meckel's diverticulum, or Littre's hernia. Both the appendix and Meckel's diverticulum were resected laparoscopically while the inguinal hernia was repaired four months later. We present an uncommon finding of a strangulated Littre's hernia discovered concurrently with acute appendicitis. The presentation, management and review of the ...

  7. Nova imagem radiográfica de apendicite aguda: acúmulo fecal no ceco New radiographic sign of acute appendicitis: fecal loading in the cecum

    Andy Petroianu

    2006-08-01

    Full Text Available OBJETIVO: Apesar das características radiográficas da apendicite aguda estarem bem documentadas, o valor da radiografia simples de abdome ainda não foi completamente estudado. Nesse sentido, o objetivo do presente trabalho foi verificar um novo sinal radiográfico caracterizado pela imagem de acúmulo fecal no ceco. MÉTODO: Foram estudados prospectivamente 170 pacientes consecutivos, de ambos os sexos, internados com abdome agudo e dor localizada no flanco direito, distribuídos em dois grupos: Grupo 1 (n = 100 - portadores de apendicite aguda, submetidos a um estudo radiográfico do abdome antes do tratamento cirúrgico, Grupo 2 (n = 70 - submetidos a dois estudos radiográficos do abdome:antes da operação e outro no dia seguinte à cirurgia. Todas as radiografias foram simples, em incidência ântero-posterior. RESULTADOS: A presença do sinal de acúmulo fecal no ceco esteve presente em 97 (97% pacientes do Grupo 1 e em 68 (97,14% pacientes do Grupo 2. No pós-operatório, dos 68 pacientes que apresentaram o sinal radiográfico, esse desapareceu em 66 casos. A sensibilidade do sinal radiográfico para apendicite aguda foi de 97,05 %. CONCLUSÕES: A imagem radiográfica de acúmulo fecal no ceco associa-se a apendicite aguda. Essa imagem geralmente desaparece após o apêndice cecal ser removido.BACKGROUND: Although the radiographic characteristics of acute appendicitis have been well documented, the value of plain abdominal radiograph has not been completely studied. Therefore, the purpose of this investigation was to verify a new radiographic sign: the presence of fecal loading in the cecum. METHODS: One hundred seventy consecutive patients of both sexes have been studied prospectively. They were admitted to the hospital due to acute abdominal pain localized in the right flank. The patients were divided in two groups: Group 1 (n = 100 - diagnosed clinically as acute appendicitis and submitted to an abdominal radiographic study a few

  8. 9-O-acetylated sialic acids differentiating normal haematopoietic precursors from leukemic stem cells with high aldehyde dehydrogenase activity in children with acute lymphoblastic leukaemia.

    Chowdhury, Suchandra; Chandra, Sarmila; Mandal, Chitra

    2014-10-01

    Childhood acute lymphoblastic leukaemia (ALL) originates from mutations in haematopoietic progenitor cells (HPCs). For high-risk patients, treated with intensified post-remission chemotherapy, haematopoietic stem cell (HSC) transplantation is considered. Autologous HSC transplantation needs improvisation till date. Previous studies established enhanced disease-associated expression of 9-O-acetylated sialoglycoproteins (Neu5,9Ac2-GPs) on lymphoblasts of these patients at diagnosis, followed by its decrease with clinical remission and reappearance with relapse. Based on this differential expression of Neu5,9Ac2-GPs, identification of a normal HPC population was targeted from patients at diagnosis. This study identifies two distinct haematopoietic progenitor populations from bone marrow of diagnostic ALL patients, exploring the differential expression of Neu5,9Ac2-GPs with stem cell (CD34, CD90, CD117, CD133), haematopoietic (CD45), lineage-commitment (CD38) antigens and cytosolic aldehyde dehydrogenase (ALDH). Normal haematopoietic progenitor cells (ALDH(+)SSC(lo)CD45(hi)Neu5,9Ac2 -GPs(lo)CD34(+)CD38(-)CD90(+)CD117(+)CD133(+)) differentiated into morphologically different, lineage-specific colonies, being crucial for autologous HSC transplantation while leukemic stem cells (ALDH(+)SSC(lo)CD45(lo)Neu5,9Ac2 -GPs(hi)CD34(+)CD38(+)CD90(-)CD117(-)CD133(-)) lacking this ability can be potential targets for minimal residual disease detection and drug-targeted immunotherapy. PMID:25283637

  9. Apendicite aguda isquêmica em coelhos: novo modelo com estudo histopatológico Acute ischaemic appendicitis in rabbits: new model with histopathological study

    Fernando Costa Nunes

    2005-10-01

    Full Text Available OBJETIVOS: Avaliar a isquemia parcial ou total, através da ligadura com fio inabsorvível dos vasos do mesoapêndice do apêndice vermiforme de coelhos, bem como a obstrução mecânica, através da ligadura com fio inabsorvível da base do apêndice vermiforme, a 1 cm do ceco. Avaliar a histologia do apêndice ( normal e acometido . Estudar a flora bacteriana residente no apêndice vermiforme ( normal e acometido e do exsudato peritoneal. MÉTODOS: Foram utilizados 72 coelhos ( "Oryctogalus cuniculos" , machos da linhagem Nova Zelândia, com peso médio de 3,000 gramas. Foram divididos em grupos: piloto ( A , flora bacteriana ( B , controle ( H e experimento ( C, D, E, F e G com períodos de observação de 96 horas e 192 horas. Fez-se a ligadura dos vasos do mesoapêndice, com fio inabsorvível nos grupos ( D, E, F e G e da base do apêndice vermiforme a 1 cm do ceco, no grupo ( C . No grupo experimento (D,E,F e G foi praticado o modelo isquêmico. No grupo experimento ( C foi realizada a obstrução mecânica e no grupo controle ( H foi feita somente a simulação da cirurgia. RESULTADOS: No grupo controle ( H , não ocorreu apendicite aguda. No grupo experimento ( C,D,E,F, e G ocorreu apendicite aguda. CONCLUSÃO: O procedimento utilizado causa apendicite aguda com alterações anatomopatológicas distintas. A bactéria residente encontrada na flora fisiológica do suco entérico do apêndice vermiforme e no exsudato peritoneal foi a Escherichia coli.PURPOSE: To evaluate partial or total ischemia, through ligature with an unabsorbed thread of vessels from the vermiform appendix of rabbits, as well as the mechanical obstruction, through ligature with an unabsorbed thread at the basis of the vermiform appendix, at 1 cm from the cecum, of the acute appendicitis disease. To evaluate the histology of the appendix ( normal and affected . To study the bacterium flora resident in the vermiform appendix (normal and affected and the exudates

  10. A videolaparoscopia na apendicite aguda na mulher em idade fértil The videolaparoscopy in acute appendicitis in woman of childbearing age

    Cláudio de Oliveira Chiari Campolina

    1998-02-01

    Full Text Available O diagnóstico de apendicite aguda na mulher em idade fértil é um desafio para o cirurgião devido ao alto índice de explorações cirúrgicas negativas. O objetivo deste trabalho foi estabelecer um índice de probabilidade diagnóstica e o valor da videolaparoscopia nestes casos. Foram analisadas, prospectivamente, 34 mulheres em idade fértil referendadas para o serviço com diagnóstico de apendicite aguda. As pacientes foram submetidas à videolaparoscopia de urgência, e o tratamento cirúrgico, quando indicado, foi realizado por videolaparoscopia sempre que possível. Entre as 34 pacientes, 17 apresentaram apendicite aguda à videolaparoscopia, sendo que 15 delas foram operadas por esta via. As 17 pacientes que apresentaram outro diagnóstico à videolaparoscopia não necessitaram de qualquer tratamento cirúrgico em 13 casos, sendo que quatro pacientes foram submetidas a operação por via aberta. O quadro clínico foi medido por um índice de probabilidade para apendicite aguda, e os resultados videolaparoscópicos foram relacionados a este índice. A conclusão é que a videolaparoscopia é um instrumento importante na abordagem propedêutica e terapêutica do abdome agudo da mulher em idade fértil, possibilitando uma maior precisão diagnóstica nestes casos e evitando laparotomias não terapêuticas.In fertile women the diagnosis of acute appendicitis is a challenge for the surgeon. A negative surgical exploration of the abdomen is not uncommon. The purpose of our study was two fold: to stablish a probability diagnostic index of acute abdomenfor fertile women and the value of the videolaparoscopy of the abdomen for the diagnosis and therapeutic in this group of patients. Thirty-four women with clinical and laboratory data suggesting acute appendicitis were divided into three groups according to the probability of having the disease: high, medium and low probability. Following that, all thirty-four patients were submitted to

  11. Indium-111 leukocyte imaging in appendicitis

    Indium-111-labeled leukocyte scintigraphy was applied to the diagnosis of acute appendicitis. Thirty-two patients observed in the hospital for possible appendicitis were prospectively studied. Scanning was done 2 hr after radiopharmaceutical injection. Thirteen scans were positive for acute appendicitis, and all but one were confirmed at laparotomy. In addition, two cases of colitis and two cases of peritonitis were detected. Of 15 negative studies, 11 had a benign course. Four patients with negative studies had laparotomy; two were found to have appendicitis and two had a normal appendix. Of 14 proven cases of appendicitis, 12 scans were positive for appendicitis with one false-positive scan, providing a sensitivity of 86%. Specificity was 93%: all negative cases except one had negative scans. Overall accuracy was 91% (29 of 32), comparing favorably with the accepted false-positive laparotomy rate of 25%. Use of In-111-labeled leukocyte scintigraphy serves to reduce the false-positive laparotomy rate and to shorten the clinical observation time in patients with acute appendicitis

  12. Antibiotika som primær behandling af appendicitis

    Hupfeld, Line; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

    2014-01-01

    Acute appendicitis has traditionally been treated surgically. Conservative approach with antibiotic treatment has been suggested as an alternative to the surgical procedure. The available studies on surgery versus antibiotics may indicate the safe use of conservative treatment for uncomplicated...... appendicitis, but the available studies are typically of low quality. Thus, further studies are needed to clarify the role of conservative treatment, and in the meantime appendectomy remains the standard treatment for acute appendicitis....

  13. 超声在急性阑尾炎临床诊断和分型中的临床意义%Clinical Signi.cance of Ultrasound in Acute Appendicitis Diagnosis and Pathological Typing

    盛建超

    2012-01-01

    Objective To study the significance of ultrasound in acute appendicitis diagnosis and pathological typing.Methods A retrospective review of 168 cases of emergency patients with acute abdomen with operation in the years April 2010 ~ November 2011 was done with comparison between preoperative ultrasonography diagnosis results and postoperative pathological examination results.Results Simple appendicitis ultrasound diagnostic accuracy rate was 97.1%,suppurative appendicitis accuracy rate was 95.2%,gangrenous appendicitis ultrasound accuracy rate was 100%,the overall diagnostic accuracy rate was 97.1%.Appendiceal ultrasonography of appendicitis group shows that the appendiceal diameter,length,wall thickness were higher than that of non-acute-appendicitis patients(P < 0.01).Conclusion Ultrasonography on acute appendicitis diagnosis accuracy rate is very high,which has important diagnostic value,and should be preferred as auxiliary diagnostic method.%目的 探讨超声在急性阑尾炎诊断及病理分型中的作用和意义.方法 回顾2010年4月~2011 年11月急诊就诊的急腹症患者168例,均进行手术治疗,比较术前超声检查诊断结果 与术后病理检查结果 的差异.结果 单纯性阑尾炎超声诊断准确率为97.1%,化脓性阑尾炎准确率为95.2%,坏疽性阑尾炎准确率为100%,超声总的诊断准确率为97.1%;阑尾炎组的阑尾超声结果 显示其阑尾直径、长度、管壁厚度均高于非阑尾炎急腹症患者(P<0.01).结论 超声检查对急性阑尾炎诊断准确率很高,具有重要的诊断价值,应作为首选辅助诊断方法.

  14. NF-κB in T-cell Acute Lymphoblastic Leukemia: Oncogenic Functions in Leukemic and in Microenvironmental Cells

    Fernandes, Mónica T.; dos Santos, Nuno R.; da Silva, Ricardo C.; Marinella N. Ghezzo

    2010-01-01

    Two main NF-κB signaling pathways, canonical and noncanonical, performing distinct functions in organisms have been characterized. Identification of mutations in genes encoding components of these NF-κB signaling pathways in lymphoid malignancies confirmed their key role in leukemogenesis. T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy of thymocytes that despite significant therapeutic advances can still be fatal. Although mutations in NF-κB genes have not been report...

  15. Normal and leukemic stem cells

    Pelicci, P G

    2012-01-01

    Studies on hematopoietic stem cells have provided several critical insights in the biology of stem cells in general; as mature blood cells are generally short lived, stem cells are in fact required to guarantee, throughout the life of an organism, the replenishment of differentiated blood cells by the generation of multi-lineage progenitors and precursors committed to individual hematopoietic lineages. Similarly, acute myeloid leukemia has been considered as a model system to study cancer stem cells. This presentation illustrates some recent results obtained by our group with regard to both normal and leukemic stem cells.

  16. Incidência comparativa da apendicite aguda em população miscigenada, de acordo com a cor da pele Comparative incidence of acute appendicitis in a mixed population, related to the skin color

    Andy Petroianu

    2004-03-01

    Full Text Available RACIONAL: Apendicite aguda é uma emergência cirúrgica muito comum, mas sua etiopatogenia ainda permanece incompreendida. OBJETIVO: Avaliar aspectos epidemiológicos da apendicite aguda relacionados à cor da pele, sexo e idade. MÉTODOS: Foram estudados 500 pacientes operados de apendicite aguda e outros 500 doentes aleatórios tratados por diferentes doenças no Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG. Avaliaram-se sexo, idade e cor da pele. Os resultados foram comparados por meio do teste qui-quadrado. RESULTADOS: Significativa prevalência de pacientes leucodérmicos (73,8% foi verificada nessas séries. Não houve predominância por sexo. O número de homens leucodérmicos com apendicite aguda foi significativamente maior do que homens leucodérmicos do grupo-controle. A incidência de melanodérmicos com apendicite foi significativamente menor do que a de pacientes negros do grupo-controle. A idade média da apendicite aguda foi de 23,2 anos para os pacientes leucodérmicos e de 32,3 anos para os melanodérmicos. CONCLUSÕES: Foi nítida a relação entre apendicite aguda com a cor branca da pele.BACKGROUND: Acute appendicitis is a very common surgical emergency, but its etiology and pathology remain incompletely understood. OBJECTIVE: To elucidate epidemiological aspects of acute appendicitis related to skin color, gender and age. METHODS: Five-hundred patients operated on for acute appendicitis, and other 500 patients treated for different diseases and considered as a control group were studied at "Hospital das Clínicas", Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. Gender, age and skin color were investigated. The results were compared by chi-square test. RESULTS: There was no prevalence related to gender. A significant prevalence of white patients (73.8% was verified in this series. The number of white men with appendicitis was significantly higher than white men in the

  17. Appendicitis in Teens

    ... Issues Listen Español Text Size Email Print Share Appendicitis in Teens Page Content Article Body Early adolescence ... it has no known function. Symptoms that Suggest Appendicitis may Include: Persistent abdominal pain that migrates from ...

  18. Imagem radiográfica de acúmulo fecal no ceco, como sinal diagnóstico de apendicite aguda Radiographic image of fecal loading in the cecum as a diagnostic sign of acute appendicitis

    Andy Petroianu

    2007-08-01

    Full Text Available OBJETIVO: Apesar de os achados radiográficos de apendicite aguda serem bem documentados, o valor da radiografia simples ainda não foi completamente determinado. O objetivo do presente estudo foi estabelecer a freqüência da associação de apendicite aguda a um sinal radiográfico caracterizado por imagem de acúmulo fecal ocupando todo o ceco. MATERIAIS E MÉTODOS: Foram realizadas radiografias simples de abdome de 100 pacientes consecutivos com apendicite aguda, comprovada por operação e exame anatomopatológico. Pesquisou-se, nas radiografias, a presença de imagem de acúmulo fecal no ceco, caracterizada por hipotransparência ocupando todo o ceco e, eventualmente, também o cólon ascendente. RESULTADOS: A imagem de acúmulo fecal no ceco foi encontrada em 97% dos doentes, independentemente de idade, sexo, cor da pele ou estádio da apendicite. CONCLUSÃO: Este estudo sugere que a presença de imagem radiográfica de acúmulo fecal no ceco pode ser um sinal útil no diagnóstico de apendicite aguda.OBJECTIVE: Although the radiological features of acute appendicitis are well documented, the value of the plain radiography has not been fully appreciated yet. The present study was aimed at determining the frequency of association between acute appendicitis and a radiological sign characterized as an image of fecal loading in the whole cecum. MATERIALS AND METHODS: Plain abdominal radiographs of 100 consecutive adult patients with acute appendicitis proved by surgery and histology were assessed. The presence of fecal loading characterized by hypotransparency in the whole cecum, and sometimes also in the ascending colon, was observed. RESULTS: The image of fecal loading in the cecum was found in 97% of cases of acute appendicitis, independently of age, gender, skin color or stage of appendicitis. CONCLUSION: The present study suggests that the presence of radiological images of fecal loading in the cecum may be a useful sign for the

  19. Apendicite aguda isquêmica em coelhos: um novo modelo com estudo histopatológico Acute ischaemic appendicitis in rabbits: new model with histopathological study

    Fernando Costa Nunes

    2004-06-01

    Full Text Available OBJETIVO: Avaliar a isquemia parcial ou total do apêndice vermiforme de coelhos, através da ligadura com fio inabsorvível dos vasos do meso apêndice bem como a obstrução mecânica, através da ligadura com fio inabsorvível da base do apêndice a 1 cm do ceco, na patogênese da apendicite aguda. Avaliar a histologia do apêndice (normal e acometido. Estudar a flora bacteriana residente no apêndice vermiforme (normal e acometido e do exsudato peritoneal. MÉTODO: Foram utilizados 72 coelhos (Oryctogalus cuniculos, machos, da linhagem Nova Zelândia, com peso médio de 3.000 gramas. Foram divididos em grupos: piloto (A, flora bacteriana (B, controle (H e experimento (C, D, E, F e G com períodos de observação de 96 horas e 192 horas. Fez-se a ligadura dos vasos do meso apêndice com fio inabsorvível nos grupos (D, E, F e G e da base do apêndice vermiforme a 1 cm do ceco, no grupo (C. No grupo experimento (D, E, F e G foi praticado o modelo isquêmico. No grupo experimento (C foi realizada a obstrução mec��nica e no grupo controle (H foi feita somente a simulação da cirurgia. RESULTADOS: Ocorreu apendicite aguda no grupo experimento (C,D,E,F, e G. CONCLUSÕES: O método utilizado causa apendicite aguda com alterações anatomopatológicas distintas. A bactéria residente encontrada na flora fisiológica do suco entérico do apêndice vermiforme e no exsudato peritoneal foi Escherichia coli.BACKGROUND: To evaluate partial or total ischemia, through ligature with an unabsorbed thread of vessels from the vermiform appendix of rabbits, as well as the mechanical obstruction, through ligature with an unabsorbed thread at the basis of the vermiform appendix, at 1 cm from the cecum, in the pathogenesis of acute appendicitis. To evaluate the histology of the appendix (normal and affected. To study the resident bacterium flora in the appendix (normal and affected and the peritonitis exudate. METHODS: Seventy- two male rabbits (Oryctogalus

  20. Imaging of appendicitis

    Himal Gajjar

    2008-12-01

    Full Text Available Appendicitis is one of the commonest causes of abdominal pain requiring surgery. Early diagnosis and management are essential to reduce morbidity and mortality. Imaging is valuable in the diagnosis of cases that are clinically atypical. Imaging also allows evaluation of the complications of appendicitis. In certain circumstances, conservative treatment of complicated appendicitis with percutaneous drainage is appropriate.

  1. Anti-Leukemic Activity of Shikonin: Role of ERP57 in Shikonin Induced Apoptosis in Acute Myeloid Leukemia

    Rachana Trivedi

    2016-07-01

    Full Text Available Background/Aims: ER-Stress and activation of unfolded protein response belong to the major factors involved in chemoresistance in cancer cells. In this study we investigated the effect of shikonin on the survival of acute myeloid leukemia cells and the role of ER-stress protein ERP57, a protein disulfide isomerase, in improvement of chemotherapy. Methods: Using MTT assay we studied cytotoxic effects of shikonin on HL-60 cells. The flow cytometry was adopted to examine the shikonin induced mode of cell death in HL-60 cells. The overall protein expression alteration resulting from shikonin treatment was investigated using proteomics methods. Western blotting was performed to quantify the alteration in protein expression in HL-60 after shikonin treatment. Silencing and overexpression studies were carried out to highlight the therapeutic role of ERP57 in shikonin effect on AML cells. Results: Shikonin induces apoptosis in HL-60 cells without significant effect on Primary cells from healthy volunteers. The apoptotic effect was dose and time dependent and was accompanied by strong alteration in cell proteome. Among the proteins targeted by shikonin, ERP57 was significantly downregulated in HL-60 after treatment. Compared to healthy control ERP57 was found to be highly expressed in AML cell line HL60 and was downregulated after shikonin treatment. Overexpression of ERP57 protected HL-60 from shikonin induced apoptosis, whereas knockdown of ERP57 expression resulted in increase in shikonin induced apoptosis. Conclusions: Our results demonstrate that ERP57 plays a crucial role in resistance towards shikonin induced apoptosis in AML cells. Targeting of ERP57 might offer a new therapeutic option for the treatment of acute myeloid leukemia.

  2. Leukemic cell creatine kinase and its isoenzymes.

    Fang, S R; Yao, E G; Wei, S Z; Fan, H; Dong, Z R

    1989-06-01

    Using malachite green single agent coloration and acetate membrane electrophoresis, we studied the cellular creatine kinase (CK) activity and its isoenzymes in 7 normal controls and 26 leukemia patients. The leukemic cellular CK activity was 12.62 +/- 4.86 u/mg protein, 2.2 times higher than the normal value (5.73 +/- 2.66 u/mg protein, p less than 0.05). Only 2 of 5 normal leukocyte samples showed '+' CK isoenzyme MM. 22 leukemia patients had CK isoenzyme. CK-BB appeared mainly in acute granulocytic leukemic, and CK-MM mainly in other types. CK-MB was also found in 6 patients. The recurrence of CK-BB may indicate atavism, and the enhanced anaerobic glycolysis and the accelerated energetic turnover may be on of the metabolic characteristics of leukemic cell. PMID:2512061

  3. The leukemic stem cell

    Jordan, Craig T.

    2007-01-01

    Malignant stem cells have recently been described as the source of several types of human cancer. These unique cell types are typically rare and possess properties that are distinct from most other tumor cells. The properties of leukemic stem cells indicate that current chemotherapy drugs will not be effective. The use of current cytotoxic agents is not effective in leukemia because the agents target both the leukemic and normal stem cell populations. Consequently, new strategies are required...

  4. Schistosomal appendicitis: Incidence in Japan and a case report

    Tadashi Terada

    2009-01-01

    Schistosomal appendicitis is very rare in developed countries like the USA, Europe, and Japan. The author reviewed 311 pathologic archival specimens of vermiform appendix over the past 10 years. One case of schistosomal appendicitis was recognized. Therefore, the incidence of this disease was 0.32% in all appendices surgically resected in our hospital. The patient was a 41-year-old woman presenting with lower abdominal pain. She was a sailor traveling to many countries including endemic areas. Physical examination, laboratory data, and imaging modalities suggested an acute appendicitis, and appendectomy was performed under the diagnosis of ordinary appendicitis. Histologically, numerous schistosomal eggs were present in the vasculatures throughout the appendiceal walls. Some of the eggs were calcified. Stromal foreign body reaction was also recognized. The appendicitis was phlegmonous consisting of severe infiltrations of neutrophils and eosinophils. Acute serositis was also noted. Examination of feces revealed numerous eggs of Schistosoma mansoni. Clinicians should be aware of schistosomal appendicitis.

  5. Infectious ileocecitis--appendicitis mimicking syndrome.

    Zganjer, M; Roic, G; Cizmic, A; Pajic, A

    2005-01-01

    The purpose of our study is to emphasize the central role of ultrasound (US) in finding the cause of abdominal pain in children. Ultrasound of the lower abdomen quadrant should be considered in all cases in which the clinical signs and symptoms are not diagnostic of appendicitis. There is a wide range of clinical syndromes and diseases which can easily be diagnosed using a high resolution ultrasound with adjunct of color and power Doppler. The spectrum of abnormalities includes appendicitis, mesenteric lymphadenitis, infectious ileocecitis, Crohn's disease, intussusception, ovarian cysts, and encysted cerebrospinal fluid. One of the most common causes of acute abdominal pain in children is acute terminal ileitis (infectious ileocecitis) with mesenteric lymphadenitis. Ultrasound is the best tool to rapidly differentiate this disease from acute appendicitis, and prevent unnecessary laparotomy (Ref. 12). PMID:16201735

  6. Rectal contrast-enhanced computed tomography in the diagnosis of acute appendicitis; Tomografia computarizada con contraste rectal en el diagnostico de la apendicitis aguda

    NONE

    2000-07-01

    To assess the efficacy and utility of computed tomography (CT) in the diagnosis of appendicitis, and to evaluate the reliability of CT findings in right iliac fossa in the confirmation or exclusion of this diagnosis. Over a one-year period, 152 patients presenting clinical signs of appendicitis underwent CT scans. The images were reviewed by two radiologists who considered whether the appendix was normal or enlarged and the existence of other signs of appendicitis for the purpose of determining whether or not the patient presented appendicitis. The definitive diagnoses were established by surgery or by clinical follow-up. The sensitivity of CT for the diagnosis of appendicitis was 81.8%, the specificity was 95.3%, the positive predictive value was 93.1%, the negative predictive value was 87.2% and the reliability was 89.9%. The signs of appendicitis observed were: appendicoliths (sensitivity 30.3% and specificity 98.8%), fluid collections (sensitivity 19.7%, specificity 96.5%), cecal enlargement (sensitivity 21.2%, specificity 97.7%), inflammation of pericecal fat (sensitivity 72.7%, specificity 90.7%), fascial thickening (sensitivity 48.5%, specificity 91.9%) and an appendix measuring more than 6 mm (sensitivity 78.8%, specificity 94.3%). Adenopathy and free peritoneal fluid were not significantly related to appendicitis. The presence of a normal appendix filled with air or contrast material had an elevated negative predictive value with respect to appendicitis. In 35 of the 94 cases with negative CT scans, the images suggested alternative diagnoses. CT is a highly reliable diagnostic method for appendicitis. The observation of an appendix filled with air or contrast material has an elevated negative predictive value. The presence of appendicoliths has an elevated positive predictive value. (Author) 29 refs.

  7. Appendicitis after laparoscopic ovarian cystectomy—coincidence or complication

    Gallmann, Dalia Mirjam; Stoessel, Kurt-Aurel; Schoeb, Othmar

    2016-01-01

    Diagnosis of appendicitis, particularly in young women, may be challenging. In case of abdominal pain in the postoperative period of laparoscopic surgery, one should not only think of complications such as bleeding and injury of the bowel but also such as acute appendicitis. We report a case of a 26-year-old female patient with a post-laparoscopic acute appendicitis with appendicolithiasis 3 days after a laparoscopic ovarian cystectomy during which the appendix appeared inconspicuous. Appendicitis after gynecologic laparoscopy is a rare but potentially dangerous condition. One should consider the possibility of a postoperative appendicitis in case of an acute abdomen after laparoscopic surgery. Further studies might be of value to re-evaluate incidental appendectomy especially in cases of appendicolithiasis. PMID:27103602

  8. Appendicitis after laparoscopic ovarian cystectomy-coincidence or complication.

    Gallmann, Dalia Mirjam; Stoessel, Kurt-Aurel; Schoeb, Othmar

    2016-01-01

    Diagnosis of appendicitis, particularly in young women, may be challenging. In case of abdominal pain in the postoperative period of laparoscopic surgery, one should not only think of complications such as bleeding and injury of the bowel but also such as acute appendicitis. We report a case of a 26-year-old female patient with a post-laparoscopic acute appendicitis with appendicolithiasis 3 days after a laparoscopic ovarian cystectomy during which the appendix appeared inconspicuous. Appendicitis after gynecologic laparoscopy is a rare but potentially dangerous condition. One should consider the possibility of a postoperative appendicitis in case of an acute abdomen after laparoscopic surgery. Further studies might be of value to re-evaluate incidental appendectomy especially in cases of appendicolithiasis. PMID:27103602

  9. 急性阑尾炎术后切口感染的相关因素分析及对策%Related factor sanalysis and countermeasure for postoperative wound infection in acute appendicitis

    周思军

    2014-01-01

    目的:探讨引起急性阑尾炎术后切口感染的危险因素,并提出相应的干预对策。方法以2008年1月~2014年7月我院行手术治疗的578例急性阑尾炎患者为研究对象,采用病例对照研究的方法分析引起术后切口感染的危险因素。结果我院急性阑尾炎术后切口感染的发生率为6.06%,单因素分析共筛选出7个因素与切口感染有关;多因素分析结果显示,病程长、阑尾逆行切除、手术时间长、病理类型为化脓性或坏疽穿孔性是急性阑尾炎患者术后切口感染的危险因素,O R值分别为5.692、2.402、0.998、0.078。结论根据病情选择合理术式、在疾病早期实施手术、缩短手术时间以降低术后切口感染的发生率。%Objective To explore the causes of postoperative wound infection in acute appendicitis and propose appropriate interventions .Methods 578 cases of acute appendicitis with surgical incision in our hospital from Jan‐uary 2008 to July 2014 were chose as the objects of this study ,a case‐control study was used to analysis the related factors of postoperative wound infection in acute appendicitis .Results The incidence of postoperative wound in‐fection in acute appendicitis in our hospital was 6 .06% ;7 factors related to the incision infection were screened by univariate analysis;the result of Logistic regression analysis showed that long course of disease ,appendix retrogra‐ded removing ,long operation time and suppurative gangrenous perforated appendicitis were the related factors of in‐cision infection ,the OR value was 5 .692 ,2 .402 ,0 .998 ,0 .078 ,respectively .Conclusions reasonable type of sur‐gery ,implement operation at the early period of the disease ,shorten the operation time should be used to reduce the incidence of postoperative infection .

  10. Oral antibiotics for perforated appendicitis is not recommended

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...... was to give an overview of studies on acute perforated appendicitis with postoperative oral antibiotics. Five studies were found in a database search covering the 1966-2009 period. There is no evidence to support a conversion of the postoperative antibiotic regimen from intravenous to oral...... administration in patients with acute perforated appendicitis....

  11. Primary epiploic appendicitis and echography findings

    This is the case of a woman aged 55 presenting with localized acute abdominal pain in right inferior quadrant of 12 hours of course, leukocytosis and peritoneal reaction. The abdominal echography findings showed a supposed epiploitis but the pain intensity and persistence determined the surgical intervention. Epiploic acute appendicitis is a infrequent affection that must to be suspected in case of acute pain in inferior abdominal quadrants and imaging studies are essential for preoperative diagnosis. (author)

  12. Identification of residual leukemic cells by flow cytometry in childhood B-cell precursor acute lymphoblastic leukemia: verification of leukemic state by flow-sorting and molecular/cytogenetic methods

    Obro, Nina F; Ryder, Lars P; Madsen, Hans O;

    2012-01-01

    Reduction in minimal residual disease, measured by real-time quantitative PCR or flow cytometry, predicts prognosis in childhood B-cell precursor acute lymphoblastic leukemia. We explored whether cells reported as minimal residual disease by flow cytometry represent the malignant clone harboring...... immunophenotype and antigen modulation) that highlight important methodological pitfalls. These findings demonstrate that with sufficient experience, flow cytometry is reliable for minimal residual disease monitoring in B-cell precursor acute lymphoblastic leukemia, although rare cases require supplementary PCR...

  13. Appendicitis in Children: Evaluation of the Pediatric Appendicitis Score in Younger and Older Children

    Martin Salö

    2014-01-01

    Full Text Available Background. This study aimed to evaluate Pediatric Appendicitis Score (PAS, diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis. Method. 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years (n=102 and <4 years (n=20. Results. The mean PAS was lower among the younger compared with the older patients (5.3 and 6.6, resp.; P=0.005, despite the fact that younger children had more severe appendicitis (75.0% and 33.3%, resp.; P=0.001. PAS had low sensitivity in both groups, with a significantly lower sensitivity among the younger patients. Parent and doctor delay were confirmed in children <4 years of age with appendicitis. PAS did not aid in patients with doctor delay. Parameters in patient history, symptoms, and abdominal examination were more diffuse in younger children. Conclusion. PAS should be used with caution when examining children younger than 4 years of age. Diffuse symptoms in younger children with acute appendicitis lead to delay and to later diagnosis and more complicated appendicitis.

  14. An adult intussusception mimicking early appendicitis

    Wei-Chun Tseng; Cheng-Ting Hsiao; Yu-Cheng Hung

    2012-01-01

    Adult intussusception is rare with variable clinical presentation. We reported a case of adult intussusception presenting with symptoms mimicking acute appendicitis. The patient presented as an abdominal pain from epigastric area with shifting gradually to RLQ. The atypical presentation of adult intussusception remains a diagnostic challenge to the emergency physician.

  15. Livstruende appendicitis forårsaget af Fusobacterium necrophorum

    Hagen, Trine Langfeldt; Maeda, Yasuko; Lindberg, Jens Aage; Madsen, Mogens Rørbæk

    Fusobacterium necrophorum is a well-known cause of Lemierre's syndrome. Recent studies suggest a causative association between F. necrophorum and acute appendicitis. We present a case of a 15-year-old previously healthy girl who presented with acute non-perforated appendicitis, intra......-abdominal abscesses and thrombosis that led to omental necrosis. This resulted in a life-threatening septic shock with the need for prolonged intensive care. We suggest that F. necrophorum identified in pus from the abdomen caused this fulminant variation of appendicitis with findings similar to those seen with...

  16. To explore the necessity of peritoneal lavage in acute appendicitis operation%小儿急性阑尾炎手术中腹腔冲洗的必要性探讨

    王建尧; 刘磊; 王斌; 叶明; 冯奇; 陈子民; 叶晓烁; 吴宙光

    2016-01-01

    目的:通过对比各型小儿阑尾炎术中行腹腔冲洗与未行腹腔冲洗的疗效,探讨术中行腹腔冲洗的必要性。方法收集本院近3年内收治的急性阑尾炎病例共350例,其中 A 组为单纯性阑尾炎,行腹腔镜阑尾切除术;B、C 组为化脓性阑尾炎未穿孔,B 组行腹腔镜阑尾切除+腹腔引流术,C 组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术;D、E 组为坏疽穿孔性阑尾炎,D 组行腹腔镜阑尾切除+腹腔引流术,E 组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术。术后对患者资料进行详细统计和相应分析。结果急性单纯性阑尾炎行腹腔镜阑尾切除术后患儿预后良好。急性化脓性阑尾炎组术中行腹腔冲洗后,术后患儿肛门排气排便时间、直肠刺激症状、间断腹痛情况明显增加,且术后腹腔脓肿的发生率明显增多,术后5 d 血常规白细胞稍高,1例并发右侧膈下脓肿,平均住院时间较未冲洗组明显延长;相反,急性坏疽穿孔性阑尾炎组,术中行腹腔冲洗后,患儿术后肛门排气排便时间缩短,术后腹腔残余感染、直肠刺激症状、间断腹痛情况降低,术后腹腔脓肿等并发症的发生率降低,术后5 d 血白细胞较未冲洗组稍低。术后患儿恢复相对较快,住院时间短。结论小儿急性阑尾炎术中冲洗治疗应根据具体情况选择合适的方法,术中调节体位,充分显露脓腔,引流彻底,引流管位置适宜;急性化脓性阑尾炎未穿孔者不需行腹腔冲洗,而急性坏疽穿孔性阑尾炎则需术中行腹腔冲洗。%Objetive To explore the necessity of peritoneal lavage in the operation by comparing post-operative results of various types of acute appendicitis.Methods A total of 350 cases of acute appendicitis in our hospital were collected in 3 years.A group include appendicitis which undergo laparoscopic appendectomy. B,C group which

  17. Comparison of ultrasonography and computed tomography in the diagnosis of acute appendicitis; Comparacion de la ecografia y la tomografia computarizada en el diagnostico de la apendicitis aguda

    Cura, J. L. del; Oleaga, L.; Grande, D.; Farina, M. A.; Isusi, M. [Hospital de Basurto. Bilbao (Spain)

    2001-07-01

    The compare the efficacy of ultrasonography and computed tomography (CT) in cases of suspected appendicitis. To study to what extent age, sex and habits of the patients, as well as the clinical context, influence the diagnostic yield of these two technique. Over a one-year period, 152 patients underwent ultrasonography and CT because of the clinical suspicion of appendicitis. The studies were carried out independently, and the results of each in terms of the presence or absence of appendicitis were unknown to the specialists performing the other. The final diagnoses were established by surgical treatment or clinical follow-up. The sensitivity of CT for the diagnosis of appendicitis was 82%, the specificity was 95%, the positive predictive value was 93%, the negative predictive value was 87% and the reliability was 90%. Ultrasonography has a sensitivity of 83%, a specificity of 97%, a positive predictive value of 95%, a negative predictive value of 88% and a reliability of 91%. Ultrasound was more efficient in patients in which there was a high clinical suspicion and in children, while the results with CT were better in patients in which the clinical diagnosis was less clear. The incidence of false negatives and positives was higher with ultrasound, while CT was more frequently able to identify a normal appendix. Sex and habits had no influence on the respective efficacies, although the performance of ultrasound was simplified in thin patients and that of CT in obese individuals. Ultrasonography and CT are highly reliable in cases of suspected appendicitis, especially when this diagnosis is conformed. Ultrasound is recommended as the technique of choice in children and in patients in which the clinical suspicion is strong. The yield of CT is somewhat greater when the clinical signs and symptoms are less clear. However, the efficacy of both techniques ultimately depends on the expertise of the specialist who interprets them. (Author) 62 refs.

  18. Necrotizing Fasciitis Post- Acute Appendicitis

    Fernandes, C; Dâmaso, C; Duarte, R.; Cardoso, D; Casella, P.

    2011-01-01

    A Fasceíte Necrotizante (FN) é um processo infeccioso da fascia profunda, de evolução rápida e progressiva com necrose secundária do tecido celular subcutâneo. Os autores apresentam um caso de FN da parede abdominal, como complicação extremamente rara de apendicite aguda. Trata-se de uma criança, apendicectomizada por apendicite aguda gangrenada, que evolui para quadro infeccioso grave, com dor e processo inflamatório da parede abdominal. Após diagnóstico, foi submetido a desbridamento cir...

  19. Fiber Intake and Childhood Appendicitis.

    Brender, Jean D.; And Others

    1985-01-01

    Parents of 135 children with appendicitis and of 212 comparison children were interviewed about their children's diet. Results suggest that a liberal intake of whole-grain breads and cereals may decrease the risk of appendicitis during childhood. (KH)

  20. 急性阑尾炎超声与64排螺旋 CT 检查对比分析%The comparative analysis between ultrasound and 64-slice spiral CT examination in acute appendicitis

    王振芳; 岳学旺; 毕言刚; 李飞; 张仕状

    2014-01-01

    目的:探讨超声与64排螺旋 CT 平扫检查在诊断急性阑尾炎中的应用价值。方法收集经手术、病理证实或经保守治疗好转确诊急性阑尾炎的患者65例,术前或治疗前均做了 B 超和 CT 检查,对急性阑尾炎病理改变的显示情况及诊断符合率进行对比分析。结果65例阑尾炎病变,在 CT 图像上正确诊断58例,诊断符合率为89.23%,超声图像正确诊断48例,诊断符合率为73.85%,2种检查方法诊断符合率具有统计学差异(χ2=5.11,P =0.024)。结论多排螺旋 CT 与超声相比在诊断急性阑尾炎方面有较高的诊断符合率。%Objective To investigate the application of ultrasound and 64-slice spiral CT in the diagnosis of acute appendicitis. Methods Sixty-five patients with pathologically or clinally confirmed acute appendicitis were underwent ultrasound and CT examina-tion before operation or conservative treatment.Compared with pathology,the accuracy of CT and B-ultrasound imaging were ana-lyzed.Results Fifty-eight cases were correctly diagnosed by CT and 48 cases were correctly diagnosed by ultrasound,the accuracy was 89.23% (58/65)and 73.85% (48/65),respectively.There was a statistically significant difference between two groups (χ2 =5.1 1,P =0.024).Conclusion The accuracy of multi-slice spiral CT is higher than ultrasound in the diagnosis of acute appendicitis.

  1. Operative management of appendicitis.

    St Peter, Shawn D; Snyder, Charles L

    2016-08-01

    Appendectomy has been the standard of care for appendicitis since the late 1800s, and remains one of the most common operations performed in children. The advent of data-driven medicine has led to questions about every aspect of the operation-whether appendectomy is even necessary, when it should be performed (timing), how the procedure is done (laparoscopic variants versus open and irrigation versus no irrigation), length of hospital stay, and antibiotic duration. The goal of this analysis is to review the current status of, and available data regarding, the surgical management of appendicitis in children. PMID:27521710

  2. Achados principais de exames laboratoriais no diagnóstico de apendicite aguda: uma avaliação prospectiva Main findings in laboratory tests diagnosis of acute appendicitis: a prospective evaluation

    Rafael Nunes Goulart

    2012-06-01

    Full Text Available RACIONAL: Apendicite aguda é a doença abdominal cirúrgica mais comum nas unidades de emergência. Embora o diagnóstico seja clínico, a realização de exames complementares pode ser útil na dúvida diagnóstica. OBJETIVO: Avaliar as principais alterações de exames laboratoriais em pacientes com apendicite aguda, assim como sua relação com a fase evolutiva da doença. MÉTODOS: Avaliação prospectiva de pacientes com diagnóstico de apendicite aguda submetidos ao tratamento cirúrgico. RESULTADOS: Cento e setenta e nove pacientes participaram deste estudo, a maioria do sexo masculino. A idade média foi de 26 anos. Em relação à contagem de leucócitos, 46,9% apresentavam valores BACKGROUND: Acute appendicitis is the most common surgical abdominal disease in the emergency room. Although the diagnosis is clinical the complementary tests may be useful in doubt. AIM: To evaluate the main laboratory tests in patients with acute appendicitis, as well as its relationship with the evolutionary stage of the disease. METHODS: Prospective evaluation of patients with acute appendicitis who underwent surgical treatment. RESULTS: A total of 179 patients participated in this study, most were male. The mean age was 26 years. For leukocyte count 46.9% had values ​​<15.000mm3. The mean percentage of polymorphonuclear cells was 81,7%, 1,2% of sticks, 1% eosinophils, lymphocytes 12,8% and 2,9% monocytes. C-reactive protein was required for 54 patients. It was <10 mg/dl in 19, between 10 and 50 mg/dl in 24 and greater than or equal to 50 mg/dl in 11. Regarding the evolutionary phase 64% patients had early stage (stages 1 and 2, 16,2% stage 3 and 35 stage 4. A total of 57% of patients with white blood cell count greater than or equal to 20.000/mm3 had appendicular perforation (p<0,05. The percentage of polymorphonuclear leukocytes from patients with early stages was lower than the later stages (79,8% and 85,1%, respectively, with p<0,05. Patients

  3. 急性化脓性阑尾炎切口感染的危险因素分析及预防对策%Risk factors analysis and preventative measures of wound infection after surgery of acute suppurative appendicitis

    林振平; 何玉凤

    2014-01-01

    Objective To analyze the risk factors of wound infection after the surgery of acute suppurative appendicitis and explore effective preventive measures. Methods Clinical data of 219 patients with acute suppurative appendicitis admitted to our hospital from January 2011 to February 2014 were analyzed retrospectively and the postoperative wound infection situation was observed. Risk factors of postoperative wound infection were analyzed and preventative experience was summarized. Results Of the 219 patients with acute suppurative appendicitis, 16 patients had postoperative wound infection, with the wound infection rate of 7.3%. After symptomatic treatment, the wound reached stage Ⅱ healing. The wound infection rates were statistically different between different ages, underlying diseases, preoperative application of antibiotics and operative time (P 0.05). Conclusion Elder age, underlying diseases, absence of preoperative antibiotics and operative time are risk factors of acute suppurative appendicitis. Preoperative rational application of antibiotics, intraoperative rational operation, shortening of operative time and strengthening of postoperative observation are the key to preventing wound infection.%目的:分析急性化脓性阑尾炎患者术后切口感染的危险因素,探讨有效的预防对策。方法回顾性分析我院2011年1月~2014年2月间收治的219例急性化脓性阑尾炎患者的临床资料,观察术后切口感染情况,对术后切口感染的危险因素进行分析,总结预防经验。结果本组219例急性化脓性阑尾炎患者,术后切口感染16例,切口感染率为7.3%。经对症处理后,切口达到Ⅱ期愈合。切口感染率在不同年龄、合并基础疾病、术前应用抗生素以及手术时间方面的差异有统计学意义(P<0.05),而不同性别、切口长度及术后抗生素应用时间方面的差异无统计学意义(P>0.05)。结论高龄、合并有基础疾病、

  4. Enterobius vermicularis: A Controversial Cause of Appendicitis

    "Gh Mowlavi

    2004-08-01

    Full Text Available Enterobiasis is undoubtedly one of the most common human helminths infections through the world, with an estimate of 1000 million cases worldwide. Although adult worms and their eggs are frequently found in inflamed appendices, but the role of the parasite in producing appendicitis in humans still remains controversial. Although acute appendicitis may occur at any age, but it is relatively rare at the extremes of age. A histopathological study of infested appendices with Enterobius vermicularis was performed in Khuzestan province, south western Iran, during 2001 to 2003. All 40 samples had surgically been removed during the emergency operations and histopathological process with (H&E staining has been performed for each. One of the main objects of this work was to collect more data about the possible role of this highly prevalent human round worm as a causative agent of appendicitis in humans, leading to different types of appendicitis in this part of the country. In this occasion over the slide examinations of the tissue sections, fewer cases than expected, with worm infested appendices were seen exclusively affected with this parasite.

  5. Infecções parasitárias do apêndice cecal e suas relações com apendicite aguda Parasitic infection of the appendix and its possible relationship to acute appendicitis

    Danielle Fernandes da Silva

    2008-06-01

    Full Text Available Investigou-se a prevalência de infecções parasitárias do apêndice cecal e suas relações com a apendicite. Dos 1.600 apêndices estudados 24 (1,5% apresentaram infecção parasitária. Enterobius vermicularis foi encontrado em 23 casos (95,8% e Taenia sp em apenas um (4,2%. Dezesseis pacientes (66,7% eram menores de 10 anos; 15 eram masculinos e 9 femininos. A análise histopatológica demonstrou inflamação aguda supurativa em 12 casos (50%, eosinofilia em 13 (54,2% e hiperplasia linfóide em 10 (41,7%. Complicações como peritonite ocorreram em 11 e gangrena em 3 casos. As infecções parasitárias do apêndice são causa pouco freqüente de apendicite aguda em crianças e adolescentes.From 1,600 surgically removed appendices, 24 (1.5% were found to have helminths. Enterobius vermicularis was observed in 23 of the 24 specimens (95.8% and Taenia sp was detected in only 1 (4.2% case. Sixteen patients (66.7% were less than 10 year-old; 15 patients were male and 9 female. Pathologic analysis disclosed acute neutrophilic inflammation in 12 cases and lymphoid hyperplasia in 10 of the 24 appendices. Gangrenous appendicitis was diagnosed in 3 cases and peritonitis was found in 11 of the 24 infested appendices. Parasitic infection of the appendix is an uncommon cause of acute appendicitis in children and adolescents.

  6. 急性化脓性阑尾炎术后切口感染25例的临床分析%Clinical analysis of 25 cases of postoperative wound infection in acute suppurative appendicitis

    杨军

    2015-01-01

    Objective:To explore the related factors of postoperative wound infection in patients with acute suppurative appendicitis,to provide a reference for the prevention and treatment of wound infection.Methods:25 patients with postoperative wound infection in acute suppurative appendicitis were selected,analysis of clinical data.Results:Patients were cured and discharged after operation after two weeks.Conclusion:Obesity,appendix pathological type,operation time,incision,surgery, abdominal cavity placed drainage is one of the influencing factors of infection of incisional wound,and reasonable application of antibiotics,postoperative early dressing,postoperative incision infrared physiotherapy also prevents the infection of incisional wound the necessary and effective measures.%目的:探讨导致急性化脓性阑尾炎术后切口感染的相关影响因素,为切口感染的预防、治疗提供参考。方法:收治急性化脓性阑尾炎行阑尾切除术术后切口感染患者25例,分析临床资料。结果:患者均于术后2周治愈出院。结论:肥胖、阑尾的病理类型、手术时间、切口选择、手术方式、腹腔内放置引流是切口感染的影响因素,合理应用抗生素、术后早期换药、术后切口红外线理疗也是预防切口感染的必要的有效措施。

  7. PARP-1 expression in CD34+ leukemic cells in childhood acute lymphoblastic leukemia: relation to response to initial therapy and other prognostic factors.

    Kruk, Agnieszka; Ociepa, Tomasz; Urasiński, Tomasz; Grabarek, Jerzy; Urasińska, Elzbieta

    2015-09-01

    Poly(ADP-ribose) polymerase-1 (PARP-1) is a nuclear protein that impacts DNA repair and apoptosis. Both experimental and ongoing clinical studies indicate that PARP-1 inhibitors are potent and promising anticancer agents. However, the outcome of treatment with PARP-1 inhibitors depends on the expression of PARP-1 protein in the tumor cells. This study aimed to assess PARP-1 expression in peripheral blood CD34+ leukemic cells before and after 12 hours of prednisone administration as well as the relation between PARP-1 expression and early treatment response to initial therapy and other prognostic factors (immunophenotype, age, initial peripheral blood white blood count [WBC], and risk factor group). The study comprised 43 children with de novo ALL. Cytospins of peripheral blood were stained with mouse anti-CD34-FITC and anti-PARP-1 antibody followed by goat anti-mouse APC-conjugated antibody. DNA was counterstained with PI (propidium iodide). Cellular fluorescence was measured by a laser scanning cytometer. Statistically significant differences in baseline PARP-1 expression with respect to early treatment response (good vs. poor), ALL immunophenotype (ALL B vs. ALL T), age (children 6 years vs. children 1-6 years), initial WBC (< 20 000/µl vs. ≥ 20 000/µl), and risk factor group (SR vs. IR vs. HR) were not found. PARP-1 expression was increased 12 hours after treatment in poor early treatment responders, whereas it remained statistically unchanged with respect to ALL immunophenotype, age, initial WBC, risk factor group and early treatment response. The overexpression of PARP-1 in poor early treatment responders suggests that it may contribute to treatment failure in this group of children with ALL. Our observation - if confirmed by other studies - may form the rationale for administration of PARP inhibitors in selected subsets of ALL children. PMID:26619102

  8. Analyses of Laboratory Tests in Cases with Appendicitis in Childhood

    Özkan Cesur

    2016-03-01

    Full Text Available Aim: The present study, we aimed to analyze the values of diagnostic methods in patients with acute and perforated appendicitis Methods: The last year files of 97 patients who performed appendectomy with suspected appendicitis were retrospectively analyzed for demographic information, laboratory and histopathological findings. Results: The mean age of patients was 11 ± 3.36. Female/Male of ratio was as a 1/1,4. Histopathological examination of the patients has been defined as acute appendicitis 37.2% (n=36, suppurative appendicitis 34,1% (n=33, gangrenous-perforated appendicitis 17.8% (n=17, lymphoid hyperplasia 9.8% (n=10, chronic appendicitis 1.1% (n=1. White blood cells (WBC count, neuthrophil ratio (NR and C-Reactive Protein (CRP levels were significantly higher Suppurative and gangrenous-perforated appendicitis than other types (p<0.05. As a result of laboratory investigations of patients with white blood cell count, NR and CRP sensitivity, specificity, positive identification, definition and accuracy rates were negative for WBC count 65%, 60%, 96%, 92%, 65%, respectively. For neutrophil ratio 55%, 60%, 96%, 94%,56%, and CRP 50%, 80%, 92%, 98% 52% respectively. White blood cell count, NR and CRP were evaluated together, for the test 84%, 60%, 97%, 84% 83% was significantly higher. Conclusion: A very significant increase of WBC levels not increase diagnostic accuracy observed but it was complicated cases may be related. WBC count, neutrophil rate and CRP were separately observed not only the independent predictors but selectivity was not sufficient as well. As a result, the level of WBC, NR and CRP were found to be more useful approach to the assessment of cases of complicated appendicitis.

  9. O uso da ultra-sonografia no diagnóstico e evolução da apendicite aguda Ultrasonography in the diagnosis and evolution of acute appendicitis

    Arquimedes Artur Zorzetto

    2003-03-01

    Full Text Available OBJETIVO: Aproximadamente 35% das apendicites agudas têm diagnóstico clínico pré-operatório duvidoso ou incorreto, particularmente grávidas e crianças. A ultra-sonografia, em virtude do seu baixo custo e facilidade de acesso, tem-se mostrado um método diagnóstico importante. Este estudo propôs-se a demonstrar os principais achados de imagem das diversas fases da apendicite, com o objetivo de auxiliar o ultra-sonografista no diagnóstico precoce desta afecção. MATERIAIS E MÉTODOS: São relatados 14 casos de ultra-sonografias abdominais realizadas no período de janeiro a julho de 2001, em pacientes que se apresentavam com quadro de abdome agudo. O exame foi realizado com transdutores de 3,5 MHz e 7,5 MHz. RESULTADOS: O estudo ultra-sonográfico antes da perfuração demonstra apêndice não compressível, com espessamento e perda focal da definição das paredes. Após a perfuração, o apêndice pode não ser visualizado ao exame de ultra-sonografia, sendo evidenciadas alterações secundárias como efeito de massa, formação de plastrão, liquefação e formação de abscesso, além de ar dentro da coleção. CONCLUSÃO: O diagnóstico precoce da apendicite é essencial para minimizar a morbidade, que se mantém elevada se ocorrer perfuração. Apresentações atípicas resultam em confusão diagnóstica e retarde no tratamento. As principais dificuldades e erros são apendicite retrocecal, apendicite focal ou perfurada.OBJECTIVE: Approximately 35% of the patients with acute appendicitis have a doubtful or incorrect preoperatory diagnosis, particularly in pregnant women and children. Ultrasonography has demonstrated to be an important means of diagnosis due to its low cost and easy access. This study is intended to show the main imaging findings of the many phases of appendicitis, thus helping the ultrasonographist to establish an early diagnosis. MATERIALS AND METHODS: From January to June 2001, 14 patients with acute abdominal

  10. Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis

    Sevgi Buyukbese Sarsu; Fatma Sarac

    2016-01-01

    Background. Acute appendicitis (AA) associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluatio...

  11. Apendicectomia videoassistida por acesso único transumbilical comparada à via laparoscópica e laparotômica na apendicite aguda Transumbilical laparoscopic assisted appendectomy compared with laparoscopic and laparotomic approaches in acute appendicitis

    Geraldo José de Souza Lima

    2012-03-01

    Full Text Available RACIONAL: A apendicite aguda é a causa mais comum de abdome agudo cirúrgico. Apesar de quase três décadas de pesquisa, comparando a apendicectomia laparoscópica com a apendicectomia laparotômica, as evidências científicas disponíveis não mostram consenso de opinião a respeito da melhor via de acesso para o tratamento da apendicite aguda. A apendicectomia videoassistida por acesso único transumbilical visa combinar as vantagens do acesso laparoscópico com a simplicidade da técnica laparotômica. OBJETIVO: Comparar as três técnicas sinalisando as vantagens existentes no acesso único transumbilical. MÉTODOS: Estudo retrospectivo, comparativo de três séries englobando 1232 pacientes. As variáveis analisadas foram: tempo operatório, permanência hospitalar, complicações pós-operatórias precoces e tardias, dor pós-operatória e retorno às atividades habituais. RESULTADOS: Observou-se que os procedimentos acesso único transumbilical, apendicectomia laparoscópica e apendicectomia laparotômica apresentaram tempo de operação, em média, de 51,7 minutos, 75,5 minutos e 59,8 minutos, respectivamente, com diferença estatisticamente significativa. A incidência de dor pós-operatória, complicações gerais e infecção de ferida foram maiores no grupo apendicectomia laparotômica. Os grupos apendicectomia laparoscópica e acesso único transumbilical apresentaram retorno mais precoce às atividades habituais e menor permanência hospitalar. CONCLUSÃO: Atualmente não há condições de estabelecer-se entre as três técnicas a de padrão-ouro para o tratamento da apendicite aguda. A efetividade e a segurança da apendicectomia videoassistida por acesso único transumbilical, associadas aos atrativos da técnica, podem fazer dela a escolha preferencial na abordagem inicial dos pacientes com diagnóstico de apendicite aguda.BACKGROUND: Acute appendicitis is the most common cause of acute abdominal surgery. Despite nearly

  12. Acute Appendicitis During Pregnancy:an Analysis Report of 32 Misdiagnosed Cases%妊娠期急性阑尾炎32例报告并误诊原因分析

    宋彬; 宋德锋; 冯野

    2015-01-01

    目的:探讨妊娠期急性阑尾炎的诊断要点与治疗原则,以保障母婴安全。方法回顾分析32例妊娠期急性阑尾炎的临床资料。结果本组早期妊娠6例、中晚期妊娠26例,表现为转移性右下腹痛26例、单纯右下腹痛6例,部分伴恶心、呕吐、发热。7例病程早期误诊为早孕反应4例、急性胃肠炎3例,误诊率21.9%。均经查体、B超或手术病理诊断确诊。本组手术治疗30例术后痊愈,其中2例行人工流产,1例自然流产,27例至孕足月顺利分娩,胎儿无异常;2例予保守治疗症状缓解,1例复发。结论仔细查体、甄别症状并及时行B超检查是提高妊娠期急性阑尾炎确诊率的关键;一旦确诊应积极行手术治疗,以保障母婴安全。%Objective To explore the key points of the diagnosis of acute appendicitis during pregnancy and treatment principle, to ensure the safety of the mother and the infant. Methods Retrospective analysis of the clinical data of 32 cases of pregnancy with acute appendicitis was conducted. Results In the group, there were 6 cases of early pregnancy and 26 cases of middle-late pregnancy, characterized by metastatic right lower quadrant abdominal pain in 26 cases, by right quadrant lower abdominal pain in 6 cases, some of them with nausea, vomiting and fever. 3 cases were misdiagnosed as early pregnancy reac-tion, 34 cases were misdiagnosed as acute gastroenteritis. The 7 initially misdiagnosed cases were 4 cases of early pregnant re-action and 3 cases of AGE and the misdiagnosis rate was 21. 9%. All of them were confirmed with diagnosis by physical exam-ination, ultrasound or surgical pathology. 30 cases of this group had postoperative recovery. 2 cases had abortion, 1 case had spontaneous abortion, 27 cases delivered the birth of full-term pregnancy, and the fetus were normal. 2 cases improved after conservative treatment, 1 case had relapse. Conclusion Careful physical examination, timely identification

  13. Computer tomography imaging of an unusual cause of appendicitis: a case report

    Ngatchou, William; Mols, Pierre; Ramadan, Ahmed S.E.; Ngassa, Michèle; Towo, Pierre Youatou

    2015-01-01

    Foreign body occlusion of appendices lumen is a quite rare cause of appendicitis due to foreign body. We present a case of a 63-year-old male who presented with right lower quadrant pain since 24 hours. Computed tomography (CT) demonstrated an acute appendicitis due to a metallic foreign body which was found to be a bullet.

  14. Computer tomography imaging of an unusual cause of appendicitis: a case report

    Mols, Pierre; Ramadan, Ahmed S. E.; Ngassa, Michèle; Towo, Pierre Youatou

    2015-01-01

    Foreign body occlusion of appendices lumen is a quite rare cause of appendicitis due to foreign body. We present a case of a 63-year-old male who presented with right lower quadrant pain since 24 hours. Computed tomography (CT) demonstrated an acute appendicitis due to a metallic foreign body which was found to be a bullet. PMID:26029649

  15. A Rare Case: Appendectomy After Connected Stump Appendicitis Perforation of the Cecum

    Berke Manoglu

    2016-01-01

    Full Text Available Stump appendicitis is a rare complication after appendectomy . Stump appendicitis made of incomplete appendectomy after a rest appendix tissue develops as a result of the inflammation. Admitted to the emergency department with acute abdomen and a history of appendectomy in patients with a history of current pain in the right lower quadrant , especially that of the patient must be evaluated in terms of stump appendicitis. The fact that the earlier story appendectomy patients , causing a delay in diagnosis and increasing the morbidity Cecal perforation was offered an advanced case of delayed depending on the stump appendicitis in this article.

  16. Stump appendicitis is a rare delayed complication of appendectomy: A case report

    Mehmet Uludag; Adnan Isgor; Muzaffer Basak

    2006-01-01

    Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Paying attention to the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy can prevent the delay of diagnosis and treatment. In patients with stump appendicitis,CT scan not only assists in making an accurate preoperative diagnosis but also excludes other etiologies. We report a 47-year old man with preoperatively diagnosed stump appendicitis by CT, who underwent an open appendectomy 20 years ago.

  17. Fetal liver cells transplantation in the treatment of extremely severe acute radiation injuries induced by large dose irradiation in leukemic patients

    Seven cases of extremely severe acute radiation injuries treated with fetal liver cells transplantation (FLT) are reported. Patients received 6-8 Gy whole body irradiation which was followed by an infusion of fetal liver cell suspension. Hematological reconstitution occurred in all patients and temporary chimera developed in 3 patients after FLT. There were no difference between the hematologic reconstitution in patients with or without chimera

  18. Profiles of US and CT imaging features with a high probability of appendicitis

    Randen, A. van; Lameris, W. [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Es, H.W. van [St Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Hove, W. ten; Bouma, W.H. [Gelre Hospitals, Department of Surgery, Apeldoorn (Netherlands); Leeuwen, M.S. van [University Medical Centre, Department of Radiology, Utrecht (Netherlands); Keulen, E.M. van [Tergooi Hospitals, Department of Radiology, Hilversum (Netherlands); Hulst, V.P.M. van der [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Henneman, O.D. [Bronovo Hospital, Department of Radiology, The Hague (Netherlands); Bossuyt, P.M. [University of Amsterdam, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam (Netherlands); Boermeester, M.A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Stoker, J. [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands)

    2010-07-15

    To identify and evaluate profiles of US and CT features associated with acute appendicitis. Consecutive patients presenting with acute abdominal pain at the emergency department were invited to participate in this study. All patients underwent US and CT. Imaging features known to be associated with appendicitis, and an imaging diagnosis were prospectively recorded by two independent radiologists. A final diagnosis was assigned after 6 months. Associations between appendiceal imaging features and a final diagnosis of appendicitis were evaluated with logistic regression analysis. Appendicitis was assigned to 284 of 942 evaluated patients (30%). All evaluated features were associated with appendicitis. Imaging profiles were created after multivariable logistic regression analysis. Of 147 patients with a thickened appendix, local transducer tenderness and peri-appendiceal fat infiltration on US, 139 (95%) had appendicitis. On CT, 119 patients in whom the appendix was completely visualised, thickened, with peri-appendiceal fat infiltration and appendiceal enhancement, 114 had a final diagnosis of appendicitis (96%). When at least two of these essential features were present on US or CT, sensitivity was 92% (95% CI 89-96%) and 96% (95% CI 93-98%), respectively. Most patients with appendicitis can be categorised within a few imaging profiles on US and CT. When two of the essential features are present the diagnosis of appendicitis can be made accurately. (orig.)

  19. Profiles of US and CT imaging features with a high probability of appendicitis

    To identify and evaluate profiles of US and CT features associated with acute appendicitis. Consecutive patients presenting with acute abdominal pain at the emergency department were invited to participate in this study. All patients underwent US and CT. Imaging features known to be associated with appendicitis, and an imaging diagnosis were prospectively recorded by two independent radiologists. A final diagnosis was assigned after 6 months. Associations between appendiceal imaging features and a final diagnosis of appendicitis were evaluated with logistic regression analysis. Appendicitis was assigned to 284 of 942 evaluated patients (30%). All evaluated features were associated with appendicitis. Imaging profiles were created after multivariable logistic regression analysis. Of 147 patients with a thickened appendix, local transducer tenderness and peri-appendiceal fat infiltration on US, 139 (95%) had appendicitis. On CT, 119 patients in whom the appendix was completely visualised, thickened, with peri-appendiceal fat infiltration and appendiceal enhancement, 114 had a final diagnosis of appendicitis (96%). When at least two of these essential features were present on US or CT, sensitivity was 92% (95% CI 89-96%) and 96% (95% CI 93-98%), respectively. Most patients with appendicitis can be categorised within a few imaging profiles on US and CT. When two of the essential features are present the diagnosis of appendicitis can be made accurately. (orig.)

  20. Estado atual do diagnóstico e tratamento da apendicite aguda na criança: avaliação de 300 casos Present status for diagnosis and treatment of acute appendicitis in children: evaluation of 300 cases

    Pedro Félix Vital Jr

    2005-12-01

    advances in diagnostic methods acute appendicitis still represents a problem in children, resulting in late diagnosis and treatment, and case of greater severity. Our objective is to assess the current state of diagnosis and treatment of acute appendicitis in children treated in two important referral hospitals of São Paulo (Brazil, over a 30 month's period. METHODS: The variables studied were: age, sex, clinical manifestations, time for the diagnosis to be established, the findings from physical examination and laboratory tests, surgical findings and antibiotic protocols, postoperative complications and hospital lenght of stay. RESULTS: In the present sample, of 300 children, 65% were boys and 35% girls, with an initial diagnosis of appendicitis being made in 63% of the cases. The signs and symptoms most frequently encountered were: abdominal pain in the right iliac fossa (85.3% and peritoneal irritation in this region (82%. We identified leukocytosis in 83% of the patients and the urine analysis showed leukocyturia in 39.7% of the patients. Around 92.4% of the simple radiological studies of the abdomen produced images that were not specific to acute appendicitis. Ultrasonography studies diagnosed the disease in 80.1% of the cases. Various antibiotic schemes were used, although there was special attention towards Gram-negative and anaerobic bacteria. The main complication was infection of the surgical wound, and there was no mortality. The average hospital length of stay was 5 days. CONCLUSION: In spite of greater knowledge of acute appendicitis and greater refinement of laboratory and radiological techniques, the diagnosis is still delayed and disease constitutes a cause of great morbidity among pediatric age groups.

  1. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon Resultados del tratamiento conservador inicial y de la cirugía urgente en la apendicitis aguda evolucionada

    J. M. Aranda-Narváez

    2010-11-01

    Full Text Available Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy compared with immediate surgery. Methods: We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients younger than 14, with severe sepsis or with diffuse peritonitis were excluded. A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and later randomized 1:1. The infectious risk stratification was established with the National Nosocomial Infections Surveillance System (NNIS index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p Introducción: Existe controversia acerca del tratamiento idóneo de la apendicitis aguda evolucionada en forma de absceso o flemón. Realizamos un estudio para la evaluación de resultados del tratamiento conservador inicial (antibiótico y drenaje percutáneo si se precisa, con/sin apendicectomía diferida y del tratamiento quirúrgico urgente. Método: Estudio observacional analítico de cohortes retrospectivas. Criterios de inclusión: pacientes con diagnóstico clínico y radiológico de apendicitis aguda evolucionada en forma de absceso o flemón, tratados en nuestro hospital entre enero 1997 y marzo 2009, excluyendo pacientes pediátricos, con sepsis grave o peritonitis difusa. En 15 pacientes con apendicitis complicada con absceso o flemón (cohorte de estudio se indicó tratamiento conservador inicial. El grupo control se obtuvo del resto de pacientes (en

  2. Inhibitory Effects of Omacetaxine on Leukemic Stem Cells and BCR-ABL-Induced Chronic Myeloid Leukemia and Acute Lymphoblastic Leukemia in Mice

    Chen, Yaoyu; Hu, Yiguo; Michaels, Shawnya; Segal, David; Brown, Dennis; Li, Shaoguang

    2009-01-01

    Omacetaxine mepesuccinate (formerly homoharringtonine) is a molecule with a mechanism of action that is different from tyrosine kinase inhibitors and its activity in chronic myeloid leukemia (CML) seems to be independent of BCR-ABL mutation status. Using BCR-ABL-expressing myelogenous and lymphoid cell lines and mouse models of CML and B cell acute lymphoblastic leukemia (B-ALL) induced by wild type BCR-ABL or T315I mutant-BCR-ABL, we evaluated the inhibitory effects of omacetaxine on CML and...

  3. Imaging of appendicitis in adults; Bildgebung der Appendizitis beim Erwachsenen

    Karul, M.; Berliner, C.; Keller, S.; Yamamura, J. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology; Tsui, T.Y. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of General, Visceral- and Thoracic Surgery

    2014-06-15

    Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2 mm, cross-sectional diameter greater than 6 mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance. (orig.)

  4. CD25 expression on residual leukemic blasts at the time of allogeneic hematopoietic stem cell transplant predicts relapse in patients with acute myeloid leukemia without complete remission.

    Ikegawa, Shuntaro; Doki, Noriko; Kurosawa, Shuhei; Yamaguchi, Tsukasa; Sakaguchi, Masahiro; Harada, Kaito; Yamamoto, Keita; Hino, Yutaro; Shingai, Naoki; Senoo, Yasushi; Hattori, Keiichiro; Igarashi, Aiko; Najima, Yuho; Kobayashi, Takeshi; Kakihana, Kazuhiko; Sakamaki, Hisashi; Haraguchi, Kyoko; Okuyama, Yoshiki; Ohashi, Kazuteru

    2016-06-01

    Recent studies have shown that CD25 expression at the time of diagnosis of acute myeloid leukemia (AML) may be associated with an unfavorable outcome. We focus on patients with AML without complete remission (CR) and examine the clinical correlation between surface CD25 expression at the time of transplant and subsequent transplant outcomes. We observed a significant difference in overall survival (OS), disease-free survival (DFS) and cumulative incidence of relapse (CIR) between CD25 positive (+) (n = 22) and negative (-) groups (n = 44) (2-year OS; CD25 (+) group: 5% vs. CD25 (-) group: 40%, p expression was an independent adverse factor for OS (p = 0.002) and relapse (p = 0.001). Patients with AML with residual CD25 positive blasts at the time of transplant may require additional therapy before or after transplant to improve survival. PMID:26422713

  5. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  6. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    Vyas, Rajashree C.; Sides, Corey; Klein, Deborah J. [University of Rochester Medical Center, Rochester, NY (United States); Reddy, Sireesha Y. [University of Rochester, Obstetrics and Gynecology, Rochester, NY (United States); Santos, Mary C. [University of Rochester, Pediatric Surgery, Rochester, NY (United States)

    2008-09-15

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  7. DENTAL MANAGEMENT NEEDS OF HOSPITALIZED LEUKEMIC PATIENTS (CASE REPORT)

    Indriasti Indah Wardhany; Siti Aliyah Pradono

    2015-01-01

    Leukemia is myeloproliferative disorders characterized by differentiation and proliferation of malignantly transformed hematopoetic stem cells, leading to suppression of normal cells, causing anemia, thrombocytopenia, and deficiency of normally functioning leukocytes. It has been classified as either acute or chronic and by cell type. The etiology of leukemia, in most cases, is unknown. Dental management of consideration of the leukemic patient should include history, examination, and screeni...

  8. Apendicite aguda: existe relação entre o grau evolutivo, idade e o tempo de internação? Acute appendicitis: is there a relation between the evolution phase, age and hospital length of stay?

    Carlos Augusto Fischer

    2005-06-01

    Full Text Available OBJETIVO: Identificar uma possível relação entre o grau evolutivo da apendicite aguda, a idade cronológica e a duração do período de internação. MÉTODO: Análise retrospectiva de 272 pacientes submetidos à apendicectomia quanto ao grau evolutivo da apendicite e seu respectivo período de internação. A evolução do processo inflamatório foi classificada pelo exame histopatológico em quatro graus: catarral, flegmonosa, supurativa e gangrenosa. RESULTADOS: A distribuição quanto ao sexo mostrou maior incidência em homens, com 193 casos (70% e a média de idade foi de 29 anos. O período médio de internação foi de 4,3 dias. A incidência dos diferentes graus evolutivos foi de 88 casos (32,3% para o tipo catarral, 79 (29% flegmonosa, 70 (25,7% supurativa e 35 (12,8% gangrenosa. A análise da média de idade e tempo de internação relacionados ao grau evolutivo da apendicite aguda, respectivamente, foi de 27,9 anos e 3,7 dias (catarral, 28,4 anos e 3,9 dias (flegmonosa, 30,1 anos e cinco dias (supurativa e 35 anos e 5,2 dias (gangrenosa. Ao agruparmos os graus obtivemos as médias de 28,1 anos e 3,8 dias para os tipos catarral/flegmonosa e 30,7 anos e cinco dias para supurativa/gangrenosa. Foi observada uma correlação significativa entre o grau de evolução da apendicite e o tempo de internação (p=0.01 e entre a idade e o grau evolutivo (p=0.01. CONCLUSÕES: Pacientes portadores de graus evolutivos mais avançados de apendicite aguda situam-se em faixa etária mais elevadas e tem tempo de internação mais prolongado.BACKGROUND: Acute appendicitis is a very common disease and elderly people appears to carry the worst prognostic outcome. The objective of this paper is to identify a possible relation between the evolutive phase of the appendicitis, age of the patient and hospital length of stay. METHODS: A total of 272 patients submitted to appendectomy were retrospectively evaluated regarding the evolutive phase of

  9. Appendicitis in adults with incidental midgut malrotation: CT findings

    Aim: To report the computed tomography (CT) findings of acute and complicated appendicitis in adults with incidental midgut malrotation. Materials and methods: The medical records and CT studies of eight patients with appendicitis and incidental midgut malrotation who presented to two medical centres between 1998 and 2009 were reviewed. Results: All patients presented with 1–5 days of acute abdominal pain, which was diffuse in two, left-sided in two, lower abdominal in two, and in the right lower quadrant in two patients. The inflamed appendix was right-sided in three, left-sided in three, and in the midline in two patients. Three cases were complicated by a peri-appendicular abscess, and one patient also had a small bowel obstruction. All patients had a complete non-rotation with right-sided duodenum and jejunum, and left-sided colon. All eight patients had an abnormal superior mesenteric artery–superior mesenteric vein (SMA/SMV) relationship and a dysplastic uncinate process of the pancreas. Urgent surgery was performed in six patients and the remaining two were treated conservatively. Conclusion: Altered anatomy in malrotation affects the typical clinical and CT findings of acute appendicitis, therefore delaying diagnosis. When CT shows focal inflammation anywhere within the abdomen, along with an abnormal SMA/SMV relationship, the position of the caecum should be ascertained and acute appendicitis ruled out

  10. Oral antibiotics for perforated appendicitis is not recommended

    Gögenur, Ismail; Rosenberg, Jacob; Alamili, Mahdi

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...

  11. Activation of NF-ĸB in leukemic cells in response to initial prednisone therapy in children with acute lymphoblastic leukaemia: relation to other prognostic factors.

    Kamieńska, Elżbieta; Ociepa, Tomasz; Wysocki, Mariusz; Kurylak, Andrzej; Matysiak, Michał; Urasiński, Tomasz; Urasińska, Elżbieta; Domagała, Wenancjusz

    2011-01-01

    Nuclear factor ĸB (NF-ĸB) is a transcription regulator of proliferation and cell death. Increased activation of NF-ĸB may be responsible for treatment failure in children with acute lymphoblastic leukaemia (ALL). This study aimed to assess changes in NF-ĸB activation in peripheral blood mononuclear cells prior to and after 6 and 12 h of prednisone administration in relation to age, initial WBC count at diagnosis and early treatment response in childhood ALL. The study comprised 55 children with de novo ALL. Cells were stained with mouse anti-NF-ĸB (p65) antibody followed by goat anti-mouse antibody conjugated with FITC and measured by laser scanning cytometer. The nuclear/cytoplasmic (N/C) ratio of NF-ĸB reflecting activation of NF-ĸB was decreased 12 h after treatment in the standard risk group patients, whereas it remained statistically unchanged in the non-standard risk group patients. Changes in the N/C ratio of NF-ĸB were not associated with age and early treatment response; however, in children with an initial WBC count higher than 20 000/μl at diagnosis, this ratio was increased after 6 and 12 h from prednisone administration. The association of higher activation of NF-ĸB with an elevated initial WBC count suggests that activation of NF-ĸB may be responsible for treatment failure in children with ALL. PMID:21574100

  12. [Medicinal and diagnostic laparoscopy in conditions of appendicitis].

    Efimenko, N A; Chursin, V V; Stepanov, A A; Balalykin, A S

    2007-08-01

    The article presents the results of analyze of diagnostic laparoscopy on the example of 1028 patients with clinical characters of appendicitis, diagnosis of 682 patients (66.3%) is conformed. 667 patients (99.3%) had transformation of laparoscopy from diagnostic to medicinal. Postoperative prearranged sanitational laparoscopy was conducted with 28 patients (4.5%), including 1 time--21 patients, 2 times--6 patients, 3 times--patient. 24 patients had different complications (intraperitoneal hemorrhage, commissural and paralytic terminal ileuses, abscesses and infiltrates of abdominal cavity, infiltrates of anterior abdominal wall, subcutaneous eventration of small intestinal loop). There were no lethal outcomes. Average day in a hospital in conditions of acute appendicitis is 4.2 day, in conditions of chronic appendicitis--3.1 day. PMID:18154159

  13. Apendicite aguda no ciclo gravídico-puerperal: um estudo de 13 casos Acute appendicitis in the gravidic-puerperal cycle: a study of 13 cases

    Expedito Fernandes Gurgel

    1998-05-01

    Full Text Available Descrevemos 13 casos de apendicite no ciclo gravídico-puerperal, atendidos na Maternidade Escola Januário Cicco em Natal, no período de 8 anos (jan/89 a dez/96. Todos os casos foram avaliados por uma equipe de obstetras e cirurgiões e a decisão de executar a apendicectomia foi tomada conjuntamente. Onze pacientes eram gestantes (4 no 1º trimestre, 6 no 2º e 1 no 3º e 2 puérperas. A incidência foi 1/3.422 partos, a idade das gestantes variou entre 18 e 30 anos, sendo a maioria nulíparas. No quadro clínico a queixa mais freqüente foi a dor abdominal forte ou moderada, localizada em todo o abdome. A incisão de Rock Daves foi a de eleição, exceto no caso em que a paciente era assintomática e a apendicite foi um achado durante uma cesárea. O apêndice estava roto em 6 casos e dentre eles, 2 apresentaram abscesso de parede abdominal e 1 paciente abortou. Em 9 gestantes a gravidez evoluiu sem intercorrências, culminando com partos a termo. Não houve complicações nas pacientes operadas no puerpério ou naquela apendicectomizada durante a cesárea. Constatou-se associação positiva entre a incidência de perfuração do apêndice e o aumento do intervalo de tempo do início da dor ao ato cirúrgico. Foi observado um aumento da incidência de perfuração quando a dor se expandia por todo o abdome. A precocidade diagnóstica e terapêutica é fundamental no prognóstico destas pacientes.The present study describes 13 cases of appendicitis in the gravidic-puerperal cycle, at the Maternidade Escola Januário Cicco, from Jan/89 to Dec/96. The cases were assisted by a team of obstetricians and surgeons. Eleven patients were pregnant (4 in the 1st trimester, 6 in the 2nd and 1 in the 3rd and 2 were in the puerperal period. The incidence was 1/3.422; the age ranged from 18 to 30 years and the majority was nulliparous. The most frequent symptom was abdominal pain (intense or moderate. The appendix was perforated in 6 cases, 2 of them with

  14. DENTAL MANAGEMENT NEEDS OF HOSPITALIZED LEUKEMIC PATIENTS (CASE REPORT

    Indriasti Indah Wardhany

    2015-06-01

    Full Text Available Leukemia is myeloproliferative disorders characterized by differentiation and proliferation of malignantly transformed hematopoetic stem cells, leading to suppression of normal cells, causing anemia, thrombocytopenia, and deficiency of normally functioning leukocytes. It has been classified as either acute or chronic and by cell type. The etiology of leukemia, in most cases, is unknown. Dental management of consideration of the leukemic patient should include history, examination, and screening laboratory tests. This case report is about dental management needs on several cases of hospitalized leukemic patients. Most of the patients have had oral hygiene and need an invasive dental treatment. Although, based on laboratory tests and patient overall condition, these patients considered as high-risk patients, the dentists should perform dental to prevent further oral infection severity.

  15. Class II-associated invariant chain peptide down-modulation enhances the immunogenicity of myeloid leukemic blasts resulting in increased CD4(+) T-cell responses

    M.M. van Luijn; M.E.D. Chamuleau; J.A. Thompson; S. Ostrand-Rosenberg; T.M. Westers; Y. Souwer; G.J. Ossenkoppele; S.M. Ham; A.A. van de Loosdrecht

    2010-01-01

    Background Disease recurrence in patients with acute myeloid leukemia may be partially explained by the escape of leukemic blasts from CD4(+) T-cell recognition. The current study investigates the role of aberrant HLA class II antigen presentation on leukemic blasts by determining both the clinical

  16. Molecular mechanisms associated with leukemic transformation of MPL-mutant myeloproliferative neoplasms

    Beer, Philip A; Ortmann, Christina A; Stegelmann, Frank;

    2010-01-01

    Somatic activating mutations in MPL, the thrombopoietin receptor, occur in the myeloproliferative neoplasms, although virtually nothing is known about their role in evolution to acute myeloid leukemia. In this study, the MPL T487A mutation, identified in de novo acute myeloid leukemia......, was not detected in 172 patients with a myeloproliferative neoplasm. In patients with a prior MPL W515L-mutant myeloproliferative neoplasm, leukemic transformation was accompanied by MPL-mutant leukemic blasts, was seen in the absence of prior cytoreductive therapy and often involved loss of wild-type MPL...

  17. Murine acute leukemia cell line with megakaryocytic differentiation (MK-8057) induced by whole-body irradiation in C3H/He mice: Cytological properties and kinetics of its leukemic stem cells

    Five cases of murine leukemia with megakaryocytic differentiation were observed among the 417 cases of radiation-induced leukemias which developed in 30% of C3H/HeMs mice exposed at 8 to 10 weeks to 0.5 to 5 gy total body irradiation. Cells from individual leukemic colonies in the spleen of the irradiated mice, and cells from colonies in methylcellulose (MC) culture in vitro, derived from one of these leukemias, MK-8057, were injected into mice; both types of cells caused the deaths of the recipient mice by inducing the same type of leukemia. MK-8057 can be maintained in Dexter-type liquid culture with a feeder layer of irradiated bone marrow cells. There was a linear reciprocal relationship between the increasing number of MK-8057 cells injected versus the survival of the recipient mice. A reciprocal relationship also was seen between an increasing number of leukemic stem cells, corresponding to the number of MK-8057 cells, and the survival of mice injected with MK-8057. Giant nuclear megakaryocytes developed during the course of colony growth in the spleen as they did in the MC culture. Such megakaryocytes were acetylcholinesterase positive, whereas leukemic cells in the peripheral blood showed no sign of platelet production nor of a positive reaction to acetylcholinesterase. Cells maintained in culture were entirely positive in platelet glycoprotein IIb/IIIa when anti-human antibody was used. The larger cells in a splenic cell suspension derived from a moribund mouse were separated and enriched by velocity sedimentation using centrifugal elutriation (CE), and then subjected to flow cytometry using propidium iodide staining. Cells with up to 32N-DNA content were detected. After separating MK-8057 by counter-flow CE, the larger cell fraction produced more leukemic colonies when injected into irradiated mice than did the small cell fraction

  18. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

    Jennings Jason

    2010-01-01

    Full Text Available Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP approach using Polypropylene Mesh (Mesh and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

  19. 急性阑尾炎患者阑尾病灶组织分离的病原体及其耐药性分析%Pathogens isolated from lesion in patients of acute appendicitis and drug resistance analysis

    罗标; 梁结玲; 刘琼章; 徐艳红; 欧阳辉妹; 邓润钦

    2015-01-01

    目的:了解急性阑尾炎患者中常见病原体及其对抗菌药物的耐药性,为临床选择抗菌药物治疗提供参考。方法对2011年1月至2013年12月收集的415例阑尾病灶组织标本采用法国生物梅里埃公司ATB半自动微生物鉴定仪进行细菌鉴定和药敏试验,对药敏结果采用WHONET5.6软件进行统计分析,并对大肠埃希菌、奇异变形杆菌、肺炎克雷伯菌进行了超广谱β-内酰胺酶(ESBL)检测。结果从415例阑尾病灶组织中分离出348株病原体,其中G-杆菌322株(92.52%),G+球菌26株(7.47%);检出率居前5位的病原菌依次为大肠埃希菌(76.14%)、铜绿色假单胞菌(6.90%)、奇异变形杆菌(3.45%)、肺炎克雷伯菌(3.16%)和粪肠球菌(1.44%)。药敏结果显示大肠埃希菌耐药率较低者依次为亚胺培南(0)、哌拉西林/他唑巴坦(0)、阿米卡星(5.3%)、头孢西丁(10.2%)和阿莫西林/克拉维酸(24.6%),大肠埃希菌耐药率较高者依次为青霉素类抗生素类(86.8%~90.6%)、复方新诺明(67.9%)及第一、二代头孢菌素类药物(60.3%~67.9%),G+球菌对万古霉素、替考拉宁、左旋氧氟沙星耐药率最低,对其他抗菌药物都有不同程度的耐药。ESBL确证试验结果显示,265株大肠埃希菌检出124株,产酶率为46.8%;奇异变形杆菌、肺炎克雷伯菌均未检出产ESBL菌株。结论急性阑尾炎感染细菌以G-杆菌为主,特别是以大肠埃希菌居首位;此菌对青霉素类、头孢类和喹诺酮类抗菌药物的耐药率逐年上升,特别是产ESBL菌株呈现出多药耐药现象严峻。应加强病原菌的检测和药敏试验,合理选择抗生素,减少耐药菌株的产生和扩散。%Objective To investigate the common pathogens isolated from lesion in patients of acute appen-dicitis and to analyze their drug resistance, in order to provide guidance for clinical selection of reasonable antibiotics. Methods A total of 415

  20. Appendicitis - Multiple Languages: MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Appendicitis URL of this page: https://medlineplus.gov/languages/appendicitis.html Other topics A-Z A B ...

  1. Xanthogranulomatous Appendicitis in a Child: Report of a Case and Review of the Literature

    Al-Rawabdeh, Sura M.; Vinay Prasad; Denis R. King; Kahwash, Samir B.

    2013-01-01

    Xanthogranulomatous inflammation is a well-described inflammatory process, which may involve any organ but is most frequently encountered in the gall bladder and the kidney. There are rare reports of xanthogranulomatous appendicitis (XA) in the adult population, but only one brief mention of such a diagnosis in a child. In this report, we describe the case of an 11-year-old boy who presented with clinical signs and symptoms of acute appendicitis necessitating appendectomy. Upon microscopic ex...

  2. Stump appendicitis: A rare clinical entity

    Abhinav Kumar

    2013-01-01

    Full Text Available Stump appendicitis is one of the rare delayed complications after appendectomy with reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. We report an 18-year-old patient with Stump appendicitis, who underwent completion appendectomy laparoscopically.

  3. Endometriosis of the Appendix Resulting in Perforated Appendicitis

    Hasegawa, Toru; Yoshida, Koichi; Matsui, Kazuhiro

    2007-01-01

    Endometriosis is a relatively common disease among women of reproductive age. However, gastrointestinal endometriosis is rare and endometriosis of the appendix resulting in perforated appendicitis is even rarer. We experienced a case of endometriosis of the appendix manifesting as panperitonitis caused by perforation of the appendix. The patient was a 35-year-old woman who was hospitalized with an acute abdomen. She was diagnosed with panperitonitis and underwent urgent laparotomy. When perfo...

  4. Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis

    Fadi Al Akhrass; Lina Abdallah; Steven Berger; Rami Sartawi

    2015-01-01

    Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured appendicitis. In addition, we list the docume...

  5. Xanthogranulomatous appendicitis in interval appendectomy specimens of children

    Yusuf Hakan Çavuşoğlu

    2016-05-01

    Full Text Available Xanthogranulomatous inflammation is common in interval appendectomy specimens in adults, but it is unusual in children. Histopathologic specimens of interval appendectomy, within an 8-year period, were reevaluated to assess the true incidence. A computer search of the hospital database of all appendectomies was performed between January 2008 and June 2015 to identify all interval appendectomy cases. A total of 2694 patients underwent appendectomies. Of these, 13 were interval appendectomies. After pathologic evaluation, 2 (15.4% of the specimens were reported as xanthogranulomatous appendicitis (XA. Histopathologic examination of these interval appendectomy specimens, granulomas (59%, xanthogranulomatous inflammation (36% and Crohn-like changes (50% were common in adults. However, XA is a particularly rare clinical entity among children. Two cases of XA were reported in children in the English literature. One was a 12-year old boy that underwent interval appendectomy 6 weeks after an episode of acute appendicitis. The other was an 11-year old boy with acute (non-interval appendicitis, but the complete blood count was suggestive of an acute suppurative inflammation. These two cases are the 3rd and 4th cases of XA reported in children in the English literature, and both were managed by interval appendectomy. Thus, XA may be encountered in interval appendectomy specimens and association with IBD has to be ruled out.

  6. A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

    Cobben, Lodewijk [Medisch Centrum Haaglanden, Department of Radiology, Leidschendam (Netherlands); Groot, Ingrid [Medisch Centrum Haaglanden, Department of Surgery, Leidschendam (Netherlands); Kingma, Lucas; Coerkamp, Emile; Puylaert, Julien [Medisch Centrum Haaglanden, Department of Radiology, Den Haag (Netherlands); Blickman, Johan [Universitair Medisch Centrum St Radboud, Department of Radiology, Geert Grooteplein 10, GA, Nijmegen (Netherlands)

    2009-05-15

    To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes. The imaging results were recorded separately and subsequently correlated with clinical, radiological and histopathological follow-up. The effect of imaging strategies in patients suspected of appendicitis on hospital resources was calculated. Sixty-two of the 138 patients had a histopathologically proven appendicitis. MRI determined appendicitis in 63 patients, with one examination being false positive. The resulting sensitivity and specificity were 100% and 99%, respectively. MRI showed an alternative diagnosis in 41 of the 75 remaining patients. In 22 of the remaining 34 patients, a normal appendix was depicted with MRI. In two patients, where MRI showed no appendicitis, an alternative diagnosis or normal appendix, an unnecessary appendectomy was performed. The overall effect of using MRI in patients suspected of appendicitis on the use of hospital resources could have been a net saving between EUR 55,746 and EUR 72,534. MRI has a high accuracy in detecting and excluding appendicitis, an alternative diagnosis or showing the normal appendix, and can be a valuable and cost-effective tool in the workup of patients clinically suspected of having appendicitis. (orig.)

  7. A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

    To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes. The imaging results were recorded separately and subsequently correlated with clinical, radiological and histopathological follow-up. The effect of imaging strategies in patients suspected of appendicitis on hospital resources was calculated. Sixty-two of the 138 patients had a histopathologically proven appendicitis. MRI determined appendicitis in 63 patients, with one examination being false positive. The resulting sensitivity and specificity were 100% and 99%, respectively. MRI showed an alternative diagnosis in 41 of the 75 remaining patients. In 22 of the remaining 34 patients, a normal appendix was depicted with MRI. In two patients, where MRI showed no appendicitis, an alternative diagnosis or normal appendix, an unnecessary appendectomy was performed. The overall effect of using MRI in patients suspected of appendicitis on the use of hospital resources could have been a net saving between EUR 55,746 and EUR 72,534. MRI has a high accuracy in detecting and excluding appendicitis, an alternative diagnosis or showing the normal appendix, and can be a valuable and cost-effective tool in the workup of patients clinically suspected of having appendicitis. (orig.)

  8. Follow-up study following conservative therapy for appendicitis diagnosed using CT examinations and CT findings predicting recurrence of symptoms

    The purpose of the present study was to determine the recurrence rate of symptoms suggesting acute appendicitis following conservative therapy and feasible CT findings for prediction of recurrence from follow-up of conservatively treated cases in which the diagnosis of acute appendicitis was confirmed by CT. Between December 1997 and June 2002, we studied 233 patients diagnosed with acute appendicitis confirmed by CT. Follow-up of at least 6 months was done in the 62 cases treated conservatively. Recurrent right lower abdominal pain was recognized in 14 (33%) of 43 patients treated conservatively and whose follow-up was completed; appendectomy was done in 9 (21%) and histological examinations of surgically resected specimens showed acute appendicitis in 8 (19%). No significant difference was seen between recurrent and non recurrent cases in the development of positive fecal stones or elevated CT values around the appendix on CT at initial conservative treatment. Appendix enlargement exceeding 9 mm in diameter or ascites was recognized in CT at initial conservative therapy more often in recurrent than non recurrent cases. The recurrence rate of acute appendicitis diagnosed by CT following conservative therapy was 19-33%. Caution must therefore be exercised regarding the possible recurrence of acute appendicitis after conservative therapy in cases with enlarged appendix or ascites on CT at the initiation of conservative therapy. (author)

  9. MAPK/ERK2 phosphorylates ERG at serine 283 in leukemic cells and promotes stem cell signatures and cell proliferation.

    Huang, Y; Thoms, J A I; Tursky, M L; Knezevic, K; Beck, D; Chandrakanthan, V; Suryani, S; Olivier, J; Boulton, A; Glaros, E N; Thomas, S R; Lock, R B; MacKenzie, K L; Bushweller, J H; Wong, J W H; Pimanda, J E

    2016-07-01

    Aberrant ERG (v-ets avian erythroblastosis virus E26 oncogene homolog) expression drives leukemic transformation in mice and high expression is associated with poor patient outcomes in acute myeloid leukemia (AML) and T-acute lymphoblastic leukemia (T-ALL). Protein phosphorylation regulates the activity of many ETS factors but little is known about ERG in leukemic cells. To characterize ERG phosphorylation in leukemic cells, we applied liquid chromatography coupled tandem mass spectrometry and identified five phosphorylated serines on endogenous ERG in T-ALL and AML cells. S283 was distinct as it was abundantly phosphorylated in leukemic cells but not in healthy hematopoietic stem and progenitor cells (HSPCs). Overexpression of a phosphoactive mutant (S283D) increased expansion and clonogenicity of primary HSPCs over and above wild-type ERG. Using a custom antibody, we screened a panel of primary leukemic xenografts and showed that ERG S283 phosphorylation was mediated by mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) signaling and in turn regulated expression of components of this pathway. S283 phosphorylation facilitates ERG enrichment and transactivation at the ERG +85 HSPC enhancer that is active in AML and T-ALL with poor prognosis. Taken together, we have identified a specific post-translational modification in leukemic cells that promotes progenitor proliferation and is a potential target to modulate ERG-driven transcriptional programs in leukemia. PMID:27055868

  10. Aplicação multicêntrica informatizada da coleta de dados clínicos na apendicite aguda Computerized multicentric application of data collection on acute appendicitis

    Crhistiano Coleto Druszcz

    2007-09-01

    êutica das infecções. As complicações pós-operatórias estiveram presentes em 10,32% dos pacientes, correspondendo principalmente às infecções de parede abdominal (64,28%. CONCLUSÃO: O protocolo informatizado de dados clínicos das doenças do cólon, especificamente em sua parte das doenças do apêndice cecal, é viável e eficaz na manipulação de informações clínicas para produção de estudos científicos uni ou multicêntricos.BACKGROUND: A clinical database allows a better way to collect and, consequently, search and cross information to scientific researches. Multicentric studies can be easily created by using this mechanism. AIM: a To analyze the functionality of the computerized database of the appendix diseases; b to show the results of the analyzed data to validate the computerized database of the colon diseases incorporated to SINPE® (Computerized Database Integrated System - INPI 00051543. METHODS: Information provided by 862 patients with acute appendicitis has been collected into the specific protocol of the appendiceal diseases, from three university centers: Hospital de Clínicas of the Universidade Federal do Paraná, Hospital Universitário Evangélico de Curitiba and Hospital do Trabalhador of the Universidade Federal do Paraná. SINPE© was the software used to store, to select and to search information thereby compared to general literature. RESULTS: The Hospital de Clínicas supported 53,83% of the patients, meanwhile, the other two included 31,32% e 14,85%, respectively. Abdominal pain was the most common and characteristic symptom in patients who had confirmation of acute appendicitis. Infectious hemogram (in 77, 81% and abdominal ultrasound showing parietal abnormalities of the appendix (in 67, 40% were the diagnostic exams more frequently adopted to prove the referred diagnosis. Appendectomy, applied in 98, 43% of the patients, was the standard therapeutic proceeding. The MacBurney incision, applied in 74, 55% of all conventional

  11. Acute appendicitis: position paper, WSES, 2013

    Agresta, Ferdinando; Ansaloni, Luca; Catena, Fausto; Verza, Luca Andrea; Prando, Daniela

    2014-01-01

    Appendectomy is one of the most frequently performed operative procedures in general surgery departments of every size and category. Laparoscopic Appendectomy – LA - as compared to Open Appendectomy – OA - was very controversial at first but has found increasing acceptance all over the World, although the percentage of its acceptance is different in the various single National setting. Various meta-analyses and Cochrane reviews have compared LA with OA and different technical details. Further...

  12. ACUTE APPENDICITIS A CLINICO - RADIOLOGICAL STUDY

    Govind

    2015-08-01

    Full Text Available Appendix Latin word means an addition or appendage was first identified as early as 3000 B.C. during the mummification process in Egypt. The prefix vermiform derived its name from its worm like appearance. Appendix was probably discovered by Celsus during dissecting criminal s executed by Caeser and was first depicted in anatomic drawings in 1492 by Leonardo da Vinci.

  13. Abdominal computed tomography during pregnancy for suspected appendicitis: a 5-year experience at a maternity hospital.

    Shetty, Mahesh K; Garrett, Nan M; Carpenter, Wendy S; Shah, Yogesh P; Roberts, Candace

    2010-02-01

    The objective of this article is to evaluate the role of computed tomography (CT) in a pregnant patient with right lower quadrant pain in whom there was a clinical suspicion of acute appendicitis. During a 5-year period the clinical records of all pregnant women who underwent imaging examination for clinically suspected appendicitis were reviewed. The imaging findings were correlated with patient management and final outcome. Thirty-nine pregnant patients were referred for imaging, of which 35 underwent initial evaluation with sonography, 23 of these women underwent a computed tomographic examination, and an additional 4 patients were directly imaged with CT without earlier sonographic assessment. Surgery confirmed appendicitis in all 5 patients who were operated on on the basis of findings of appendicitis on a CT scan. Two patients underwent surgery based on an alternate diagnosis suggested preoperatively (tubal torsion = 1, ovarian torsion = 1). All patients with negative findings at CT had an uneventful clinical course. In those patients who were evaluated only with ultrasound, a diagnosis of appendicitis was missed in 5 patients. The sensitivity of CT in the diagnosis of appendicitis in our study group was 100%, compared with a sensitivity of 46.1% for ultrasound. CT provides an accurate diagnosis in patients suspected to have acute appendicitis and is of value in avoiding false negative exploratory laparatomy with its consequent risk of maternal and fetal mortality and morbidity. Although sonography is the preferred initial imaging modality as its lack of ionizing radiation, CT is more accurate in providing a timely diagnosis and its use is justified to reduce maternal mortality and mortality in patients with appendicitis. PMID:20102691

  14. Historical aspects of appendicitis in children.

    Hamill, James K; Liley, Andrew; Hill, Andrew G

    2014-05-01

    Evidence of appendicitis exists from ancient Egyptian mummies but the appendix was not discovered as an anatomical entity until the renaissance in Western European literature. Much confusion reigned over the cause of right iliac fossa inflammatory disease until the late 19th century, when the appendix was recognized as the cause of the great majority of cases. Coining the term 'appendicitis' and making the case for early surgery, Fitz in 1886 set the scene for recovery from appendicitis through operative intervention. PMID:24165165

  15. Appendicitis in Postpartum Period: A Diagnostic Challenge

    Wadhawan, Divya; Singhal, Seema; Sarda, Nivedtia; Arora, Renu

    2015-01-01

    Infections that occur in the postpartum period are assumed to be related to pregnancy or delivery; however other causes should also be considered. Appendicitis is one of the most common conditions requiring laparotomy during pregnancy, but very few cases of postpartum appendicitis have been reported. We report two such cases and the challenges faced by clinicians in diagnosis of immediate postpartum appendicitis. The first case was managed on lines of puerperal sepsis and the second one as en...

  16. Correlation between the Alvarado Scale and the macroscopic aspect of the appendix in patients with appendicitis

    Célio Fernando de Sousa-Rodrigues

    2014-10-01

    Full Text Available Objective: To evaluate the possible association between the scale of Alvarado (EA and macroscopic appearance (MA of the appendix in patients with acute appendicitis. Methods: after receiving the diagnosis of acute appendicitis, EA data were collected. During appendectomy, MA data were collected. Data from patients without appendicitis were excluded. The Spearman correlation test was used to compare EA with Appendix MA (p < 0.05. Other variables were represented by simple frequency. The confidence interval (CI of 95% was calculated for the correlation test. Results: Data were collected from 67 consecutive patients. The mean age was 37.1 ± 12.5 years and 77.6% of patients were male. The Spearman correlation test used for EA and MA was + 0.77 (95% CI 0.65-0.85, p < 0.0001. Conclusion: although correlation was not perfect, our data indicate that a high score on the scale of Alvarado in patients with appendicitis is correlated with advanced stages of the inflammatory process of acute appendicitis.

  17. 循证护理在预防小儿急性化脓性阑尾炎术后切口感染中的应用分析%Application of Evidence-based Nursing in the Prevention of Incision Infection in Children With Acute Suppurative Appendicitis

    陈雅卓

    2016-01-01

    目的:探讨循证护理对小儿急性化脓性阑尾炎术后切口感染的预防效果。方法选择我院2014年3月~2015年3月收治的急性化脓性阑尾炎术后切口感染患儿62例,将其按照护理方法分为对照组和观察组,对照组行常规护理,观察组行常规护理联合循证护理,对比两组患儿的护理效果。结果对照组伤口愈合率、满意率分别为70.97%、83.87%,观察组分别为93.54%、100%,比较差异有统计学意义(P<0.05)。结论给予急性化脓性阑尾炎患儿应用循证护理,可有效预防切口感染的发生,减轻患儿痛苦。%Objective To explore the effect of evidence-based nursing on prevention of incision infection in children with acute suppurative appendicitis after operation.Methods From March 2014 and March 2015 in our hospital, 62 cases of children with acute suppurative appendicitis surgery incision infection, according to the nursing methods were divided into control group and observation group, control group received routine nursing care, observation group received routine nursing combined cycle syndrome nursing, compared with two groups of children nursing effect. Results The wound healing rate and the satisfaction rate of the control group were 70.97% and 83.87%, respectively, 93.54% and 100% in the observation group, and the difference was significant (P<0.05). Conclusion Acute suppurative appendicitis in children revceiving evidence-based nursing can prevent the occurrence of wound infection, reduce the pain of patients.

  18. Clinical significance of elevated serum and urine amylase levels in patients with appendicitis.

    Swensson, E E; Maull, K I

    1981-12-01

    During the 45 month period beginning January 1977, 251 patients with a pathologically confirmed diagnosis of acute appendicitis underwent celiotomy at the Medical College of Virginia Hospital. A preoperative serum or urine amylase determination was recorded in 155 of the patients (62 percent). Of this group, 15 patients (10 percent) had elevation of serum amylase or 2 hour urine amylase. Hyperamylasemia or hyperamylasuria directly led to misdiagnosis or treatment delay in 5 of the 15 patients. Appendiceal rupture occurred in three patients, two of whom had prolonged (greater than 1 month) hospitalizations directly attributable to the misdiagnosis. As a result of this study, we conclude that (1) acute appendicitis and elevated amylase levels may occur concurrently, (2) hyperamylasemia or hyperamylasuria should not dissuade the surgeon from early operation if other clinical features suggest appendicitis, and (3) abdominal pain and elevation of amylase level define significant intraabdominal disease, not specifically pancreatic disease. PMID:6172043

  19. Cyanobacteria as a Source for Novel Anti-Leukemic Compounds.

    Humisto, Anu; Herfindal, Lars; Jokela, Jouni; Karkman, Antti; Bjørnstad, Ronja; Choudhury, Romi R; Sivonen, Kaarina

    2016-01-01

    Cyanobacteria are an inspiring source of bioactive secondary metabolites. These bioactive agents are a diverse group of compounds which are varying in their bioactive targets, the mechanisms of action, and chemical structures. Cyanobacteria from various environments, especially marine benthic cyanobacteria, are found to be rich sources for the search for novel bioactive compounds. Several compounds with anticancer activities have been discovered from cyanobacteria and some of these have succeeded to enter the clinical trials. Varying anticancer agents are needed to overcome increasing challenges in cancer treatments. Different search methods are used to reveal anticancer compounds from natural products, but cell based methods are the most common. Cyanobacterial bioactive compounds as agents against acute myeloid leukemia are not well studied. Here we examined our new results combined with previous studies of anti-leukemic compounds from cyanobacteria with emphasis to reveal common features in strains producing such activity. We report that cyanobacteria harbor specific anti-leukemic compounds since several studied strains induced apoptosis against AML cells but were inactive against non-malignant cells like hepatocytes. We noted that particularly benthic strains from the Baltic Sea, such as Anabaena sp., were especially potential AML apoptosis inducers. Taken together, this review and re-analysis of data demonstrates the power of maintaining large culture collections for the search for novel bioactivities, and also how anti-AML activity in cyanobacteria can be revealed by relatively simple and low-cost assays. PMID:26306745

  20. Oxidative stress and hypoxia in normal and leukemic stem cells.

    Testa, Ugo; Labbaye, Catherine; Castelli, Germana; Pelosi, Elvira

    2016-07-01

    The main hematopoietic stem cell (HSC) functions, self-renewal and differentiation, are finely regulated by both intrinsic mechanisms such as transcriptional and epigenetic regulators and extrinsic signals originating in the bone marrow microenvironment (HSC niche) or in the body (humoral mediators). The interaction between regulatory signals and cellular metabolism is an emerging area. Several metabolic pathways function differently in HSCs compared with progenitors and differentiated cells. Hypoxia, acting through hypoxia-inducing factors, has emerged as a key regulator of stem cell biology and acts by maintaining HSC quiescence and a condition of metabolic dormancy based on anaerobic glycolytic energetic metabolism, with consequent low production reactive oxygen species (ROS) and high antioxidant defense. Hematopoietic cell differentiation is accompanied by changes in oxidative metabolism (decrease of anaerobic glycolysis and increase of oxidative phosphorylation) and increased levels of ROS. Leukemic stem cells, defined as the cells that initiate and maintain the leukemic process, show peculiar metabolic properties in that they are more dependent on oxidative respiration than on glycolysis and are more sensitive to oxidative stress than normal HSCs. Several mitochondrial abnormalities have been described in acute myeloid leukemia (AML) cells, explaining the shift to aerobic glycolysis observed in these cells and offering the unique opportunity for therapeutic metabolic targeting. Finally, frequent mutations of the mitochondrial isocitrate dehydrogenase-2 (IDH2) enzyme are observed in AML cells, in which the mutated enzyme acts as an oncogenic driver and can be targeted using specific inhibitors under clinical evaluation with promising results. PMID:27179622

  1. Validação do escore de Alvarado no diagnóstico de apendicite aguda em crianças e adolescentes no Instituto Materno Infantil de Pernambuco, IMIP The Alvarado score validation in diagnosing acute appendicitis in children and teenagers at the Instituto Materno Infantil de Pernambuco, IMIP

    Paulo Sérgio Gomes Nogueira Borges

    2003-12-01

    Full Text Available OBJETIVOS: determinar a acurácia do escore de Alvarado para o diagnóstico de apendicite aguda em crianças e adolescentes admitidos na emergência do Instituto Materno Infantil de Pernambuco (IMIP. MÉTODOS: foi realizado um estudo de validação de método diagnóstico (escore clínico-laboratorial para diagnóstico de apendicite aguda tendo o exame histopatológico como padrão ouro. A amostra estudada consistiu de 81 crianças e adolescentes, admitidas na emergência pediátrica do IMIP com dor abdominal suspeita de apendicite aguda, no período de março a outubro de 2002. Os pacientes foram atendidos na emergência pediátrica e avaliados quanto ao escore de Alvarado. Entretanto a decisão cirúrgica foi tomada pelo cirurgião responsável. RESULTADOS: tomando como ponto de corte o valor >5 pontos, encontramos uma sensibilidade de 92,6%, especificidade 63,6%, valor preditivo positivo de 86,2% e valor preditivo negativo de 77,8%. CONCLUSÕES: o escore de Alvarado é um procedimento pouco invasivo, simples, rápido, reprodutível, que utilizando o ponto de corte >5 pontos apresenta-se como instrumento de alto valor na triagem de crianças e adolescentes com suspeita diagnóstica de apendicite aguda.OBJECTIVES: to determine the accuracy of the Alvarado score in diagnosing acute appendicitis in children and adolescents admitted in the emergency unit of the Instituto Materno Infantil de Pernambuco (IMIP. METHODS: a diagnostic test study was carried out (clinical and laboratory score to diagnose acute appendicitis using histopathology exam as the golden standard. The sample studied consisted of 81 children and adolescents admitted in the pediatrics emergency unit of IMIP with symptoms and signs consistent with clinical suspicion of acute appendicitis from the period of March to October 2002. Patients were examined in the pediatric emergency and assessed by the Alvarado score. Nevertheless, the decision to whether or not perform the surgery was

  2. An unusual presentation of perforated appendicitis in epigastric region☆

    Odabasi, Mehmet; Arslan, Cem; Abuoglu, Hasan; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, M.A. Tolga

    2013-01-01

    INTRODUCTION Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation. PRESENTATION OF CASE A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. DISCUSSION While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. CONCLUSION Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia. PMID:24441442

  3. Chromosome aberrations and transforming genes in leukemic and non-leukemic patients with a history of atomic bomb exposure

    To investigate leukemogenesis in atomic bomb (A-bomb) survivors, chromosome aberrations in bone marrow cells, and T- and B-lymphocytes from 135 healthy persons who had been exposed within 1,000 m of the hypocenter of the Hiroshima A-bomb were sequentially examined. Leukemic marrow cells from 468 patients with acute or chronic type of leukemias, including 25 acute leukemias exposed to 1 rad or more of radiation were also studied cytogenetically. Analysis of breakpoints observed in T-lymphocytes with stable types of abnormalities revealed a nonrandom distribution, and clustering in specific regions of chromosomes such as 22q1, 14q3, and 5q3. Statistical analysis revealed a higher incidence of translocations in 50 bands, including those containing cellular oncogenes such as 8q22, 8q24, and 9q34. Of these 50 bands, 20 were matched with bands specific for leukemia and cancer and 14 with constitutive fragile sites. In leukemic marrow, all 10 patients who had been exposed to radiation of more than 200 rad and then developed acute non-lymphocytic leukemia had chromosome aberrations. Their aberrations were more complex than those in patients exposed to less than 200 rad (33 patients) and in the non-exposed patients (134 patients). DNA samples extracted from bone marrow cells of 13 survivors, including 4 healthy survivors with more than 30% chromosome abnormalities in the bone marrow and 9 leukemia patients were used for in vivo selection assay of transforming genes. Tumor formation in nude mice was observed in 3 of the 4 healthy survivors and 9 leukemia patients. All of the transfectants were shown to contain Alu sequences. The transforming N-ras gene was detected for the first time in the bone marrow cells from 3 heavily exposed survivors and from 7 leukemia patients with a history of radiation exposure

  4. Neonatal appendicitis with perforation: A case report and review of literature

    Gupta Vipul

    2005-01-01

    Full Text Available Acute perforated appendicitis is described as a rare clinical entity in 20 days old male neonate presented clinically with features suggestive of peritonitis. Surgical exploration revealed perforated appendix with free fluid in peritoneal cavity. Appendectomy with general supportive measures resulted in a satisfactory recovery. Authors review their experience with this rare entity along with pertinent literature.

  5. A rare case of appendicitis incarcerated in an inguinal hernia

    Smith-Singares, Eduardo; Boachie, Joseph Adjei; Iglesias, Izaskun Melania

    2016-01-01

    Amyand's hernia was coined after Claudius Amyand (1660–1740), who was the first to describe the presence of a perforated appendix in a hernial sac and also was the first to perform a successful appendectomy in 1735. It is an exceptionally rare condition in which the hernia itself contains the appendix, which may not necessarily be inflamed. The presence of an inflamed appendix further contributes to the rarity of this case. We report a case of acute appendicitis brought on by its incarceratio...

  6. Bilateral breast involvement in acute myeloid leukemia

    Hakeem A, Mandakini BT, Asif K, Firdaus, Shagufta RC

    2013-04-01

    Full Text Available Breast involvement by leukemic infiltration is usually bilateral, but may be unilateral. Clinically patients can present with either single or multiple masses, or with diffuse breast engorgement, with or without nodularity. The affected patients are predominantly young adults. We present a case of an adolescent girl with acute myeloid leukemia having bilateral breast infiltration by leukemic cells.

  7. Retinoic acid-induced gene expression in normal and leukemic myeloid cells

    1986-01-01

    Retinoic acid has been shown to induce large accumulations of tissue transglutaminase in cultured myeloid cells. Addition of retinoic acid to mouse resident peritoneal macrophages increased the level of tissue transglutaminase mRNA within 30-60 min. Retinoic acid also increased tissue transglutaminase mRNA levels in human promyelocytic leukemia (HL- 60) cells. These studies show that retinoic acid can induce acute alterations in specific gene expression in both normal and leukemic myeloid cells.

  8. Blastic plasmacytoid dendritic cell neoplasm with leukemic presentation: an Italian multicenter study

    Pagano, Livio; Valentini, Caterina Giovanna; Pulsoni, Alessandro; Fisogni, Simona; Carluccio, Paola; Mannelli, Francesco; Lunghi, Monia; Pica, Gianmatteo; Onida, Francesco; Cattaneo, Chiara; Piccaluga, Pier Paolo; Di Bona, Eros; Todisco, Elisabetta; Musto, Pellegrino; Spadea, Antonio

    2013-01-01

    The objective of this study was to evaluate the clinical features, prognostic factors, and efficacy of treatments in patients with blastic plasmacytoid dendritic cell neoplasm with a leukemic presentation at onset of the disease. In order to do this, a retrospective multicenter study was performed from 2005-2011 in 28 Italian hematology divisions in which 43 cases were collected. Forty-one patients received an induction therapy, consisting of an acute myeloid leukemia-type regimen in 26 patie...

  9. SALL4 is a key regulator of survival and apoptosis in human leukemic cells

    Yang, Jianchang; Chai, Li; Gao, Chong; Fowles, Taylor C.; Alipio, Zaida; Dang, Hien; Xu, Dan; Fink, Louis M.; Ward, David C.; Ma, Yupo

    2008-01-01

    Increasing studies suggest that SALL4 may play vital roles in leukemogenesis and stem cell phenotypes. We have mapped the global gene targets of SALL4 using chromatin immunoprecipitation followed by microarray hybridization and identified more than 2000 high-confidence, SALL4-binding genes in the human acute promyelocytic leukemic cell line, NB4. Analysis of SALL4-binding sites reveals that genes involved in cell death, cancer, DNA replication/repair, and cell cycle were highly enriched (P < ...

  10. Elimination of leukemic cells from human transplants by laser nano-thermolysis

    Lapotko, Dmitri; Lukianova, Ekaterina; Potapnev, Michail; Aleinikova, Olga; Oraevsky, Alexander

    2006-02-01

    We describe novel ex vivo method for elimination of tumor cells from bone marrow and blood, Laser Activated Nano-Thermolysis for Cell Elimination Technology (LANTCET) and propose this method for purging of transplants during treatment of leukemia. Human leukemic cells derived from real patients with different diagnoses (acute lymphoblastic leukemias) were selectively damaged by LANTCET in the experiments by laser-induced micro-bubbles that emerge inside individual specifically-targeted cells around the clusters of light-absorbing gold nanoparticles. Pretreatment of the transplants with diagnosis-specific primary monoclonal antibodies and gold nano-particles allowed the formation of nanoparticle clusters inside leukemic cells only. Electron microscopy found the nanoparticulate clusters inside the cells. Total (99.9%) elimination of leukemic cells targeted with specific antibodies and nanoparticles was achieved with single 10-ns laser pulses with optical fluence of 0.2 - 1.0 J/cm2 at the wavelength of 532 nm without significant damage to normal bone marrow cells in the same transplant. All cells were studied for the damage/viability with several control methods after their irradiation by laser pulses. Presented results have proved potential applicability of developed LANTCET technology for efficient and safe purging (cleaning of residual tumor cells) of human bone marrow and blood transplants. Design of extra-corporeal system was proposed that can process the transplant for one patient for less than an hour with parallel detection and counting residual leukemic cells.

  11. The photodynamic effect of Victoria blue BO on peripheral blood mononuclear and leukemic cells

    Fiedorowicz, M. [Hugo Kollatay Univ. of Agriculture, Krakow (Poland); Pituch-Noworolska, A.; Zembala, M. [Polish-American Children`s Hospital, Krakow (Poland). Dept. of Clinical Immunology

    1997-05-01

    The photodynamic effect of Victoria blue BO (VB-BO) and photoirradiation on peripheral blood mononuclear cells was studied. The cells were preincubated with VB-BO followed by photoirradiation and overnight culture. The highest percentage of dead cells (propidium iodide assay in flow cyctometry) was seen in the monocyte population. The lymphocytes showed a lower sensitivity to VB-BO photodynamic action than the monocytes (12% vs 80% of PI-positive cells). The effect of VB-BO and phototreatment on lymphocyte function was studied using a mitogen-induced proliferation assay. A decrease of mitogen response was observed. The VB-BO and photoirradiation were also used on leukemic cells. The leukemic cells from acute myeloid leukemia and B precursors leukemia were sensitive to VB-BO photodynamic action. The high VB-BO sensitivity of monocytes and leukemic cells (myeloid and lymphoid B derived) suggests possible application of VB-BO for selective depletion of monocytes or sensitive leukemic cells. (author).

  12. Appendicitis

    ... Other Kids Are Reading Movie: Digestive System Winter Sports: Sledding, Skiing, Snowboarding, Skating Crushes What's a Booger? ... Do you know the character Madeline ? In one of the stories, she awakens one night at boarding school with a bad pain in ...

  13. Appendicitis

    ... tract, along with the release of hormones and enzymes, helps digest food. The appendix does not appear ... ground meats, fish, and mashed, boiled, or baked potatoes. People can talk with their health care provider ...

  14. Appendicitis

    ... Understanding how Crohn’s Disease treatments affect children’s gut microbiome Jun 10, 2016 See additional news » Related Conditions & Diseases Abdominal Adhesions​ Crohn's Disease Ulcerative Colitis Your Digestive ...

  15. Appendicitis

    ... inflamed. • Guarding. Guarding occurs when a person subconsciously tenses the abdominal muscles during an exam. Voluntary guarding ... do not need to make changes to diet, exercise, or lifestyle. Surgeons recommend limiting physical activity for ...

  16. Burning Fat Fuels Leukemic Stem Cell Heterogeneity.

    Thomas, Daniel; Majeti, Ravindra

    2016-07-01

    Obese leukemia patients exhibit reduced survival after chemotherapy, suggesting an important role of adipose tissue in disease progression. In this issue of Cell Stem Cell, Ye et al. (2016) reveal metabolic heterogeneity in leukemic stem cell (LSC) subpopulations and show that chemotherapy-resistant CD36+ LSCs co-opt gonadal adipose tissue to support their metabolism and survival. PMID:27392217

  17. Cranial irradiation in the management of childhood leukemic hyperleukocytosis

    Acute leukemia with hyperleukocytosis (more than 105/mm3) is at high risk of early sudden death, usually from intracerebral hemorrhage. Emergency cranial irradiation is a relatively simple approach to solve this the problem. We summarized our experience of cranial irradiation in 24 leukemic children who presented with hyperleukocytosis. Between 1990 and 1998, 40 children with acute leukemia presenting with hyper leukocytosis were referred for emergency cranial irradiation. Among these patients, 24 children were evaluable. There were 16 boys and eight girls, their ages ranged from 2 to 13 years (median 9.5 years). The initial leukocyte counts ranged 109,910/mm3 to 501,000/mm3. Peripheral blood smear was performed in all patients and noted the morphology of the blast. Introduction of emergency cranial irradiation was determined by the leukocyte counts (more than 100,000/mm) and the existence of the blast in peripheral blood smear. All patients were treated with intravenous hydration with alkaline fluid and oral allopurinol. Cranial irradiation started on the day of diagnosis. With 2 Gy in one fraction in 4 patients, 4 Gy in two fractions in 20 patients. The WBC count had fallen in 19 patients (83%) and no intracerebral hemorrhage occurred after irradiation. There were five cases of early deaths. Four patients died of metabolic complications, and one patient with intracerebral hemorrhage. He died 5 hours after cranial irradiation. No patient had any immediate side effect from cranial irradiation. Our data suggest, that emergency cranial irradiation can be safely chosen and effective in childhood leukemic patients presenting with high leukocyte counts

  18. Cranial irradiation in the management of childhood leukemic hyperleukocytosis

    Hong, Semie; Kim, Il Han [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2001-06-01

    Acute leukemia with hyperleukocytosis (more than 10{sup 5}/mm{sup 3}) is at high risk of early sudden death, usually from intracerebral hemorrhage. Emergency cranial irradiation is a relatively simple approach to solve this the problem. We summarized our experience of cranial irradiation in 24 leukemic children who presented with hyperleukocytosis. Between 1990 and 1998, 40 children with acute leukemia presenting with hyper leukocytosis were referred for emergency cranial irradiation. Among these patients, 24 children were evaluable. There were 16 boys and eight girls, their ages ranged from 2 to 13 years (median 9.5 years). The initial leukocyte counts ranged 109,910/mm{sup 3} to 501,000/mm{sup 3}. Peripheral blood smear was performed in all patients and noted the morphology of the blast. Introduction of emergency cranial irradiation was determined by the leukocyte counts (more than 100,000/mm) and the existence of the blast in peripheral blood smear. All patients were treated with intravenous hydration with alkaline fluid and oral allopurinol. Cranial irradiation started on the day of diagnosis. With 2 Gy in one fraction in 4 patients, 4 Gy in two fractions in 20 patients. The WBC count had fallen in 19 patients (83%) and no intracerebral hemorrhage occurred after irradiation. There were five cases of early deaths. Four patients died of metabolic complications, and one patient with intracerebral hemorrhage. He died 5 hours after cranial irradiation. No patient had any immediate side effect from cranial irradiation. Our data suggest, that emergency cranial irradiation can be safely chosen and effective in childhood leukemic patients presenting with high leukocyte counts.

  19. A 7 YEAR-7-MONTH OLD BOY WITH LEUKEMIC RETINOPATHY

    Ni Made Rini Suari

    2013-10-01

    Full Text Available Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 Ocular problems in patient with leukemia which are called leukemic retinopathy and subhyaloid hemorrhage is one of its feature. Subhyaloid hemorrhage in children with acute lymphoblastic leukemia (ALL is rarely happened. We reported a boy 7 year 7 month old, complained sudden blurred vision on his both eyes and diagnosed with acute lymphoblastic leukemia. When patient had complained his vision, result of routine hematology showed anemia, thrombocytopenia, and leukocytosis. Treatment of leukemic retinopathy in this patient was supportive and causal therapy with transfusion of thrombocyte concentrate, hydration for leukocytosis, giving chemotherapy intrathecal methotrexate and systemic (vincristine, daunorubicin, L-asparginase. We found gradually undergone resolution of subhyaloid hemorrhages, visible flame shaped thin, and his vision recovered nearly completely to 6/6 OD and 6/20 OS /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  20. Antithymocyte Globulin at Clinically Relevant Concentrations Kills Leukemic Blasts.

    Dabas, Rosy; Lee, Rachelle; Servito, Maria Theresa; Dharmani-Khan, Poonam; Modi, Monica; van Slyke, Tiffany; Luider, Joanne; Durand, Caylib; Larratt, Loree; Brandwein, Joseph; Morris, Don; Daly, Andrew; Khan, Faisal M; Storek, Jan

    2016-05-01

    In contrast to cyclosporine or methotrexate, rabbit antithymocyte globulin (ATG) used for graft-versus-host disease (GVHD) prophylaxis with myeloablative conditioning does not increase the risk of relapse after hematopoietic cell transplantation. The reason for this is unknown. We hypothesized that ATG at concentrations achieved with our standard ATG dose of 4.5 mg/kg exerts antileukemic activity. We measured ATG-induced killing of leukemic blasts via complement-dependent cytotoxicity (CDC) and via complement-independent cytotoxicity (CIC) in marrow or blood from 36 patients with newly diagnosed acute leukemia. The median percentage of blasts killed by CDC was 0.3% at 1 mg/L ATG, 2.8% at 10 mg/L ATG, 12.6% at 25 mg/L ATG, and 42.2% at 50 mg/L ATG. The median percentage of blasts killed by CIC after a 4-hour incubation with ATG was 1.9% at 1 mg/L ATG, 7.15% at 10 mg/L ATG, 12.1% at 25 mg/L ATG, and 13.9% at 50 mg/L ATG. CIC appeared to represent a direct induction of apoptosis by ATG. There was a high variability in the sensitivity of the blasts to ATG; at 50 mg/L, the percentage of blasts killed ranged from 2.6% to 97.2% via CDC and from 1.4% to 69.9% via CIC. In conclusion, ATG at clinically relevant concentrations kills leukemic blasts in vitro. Some acute leukemias are highly sensitive to ATG, whereas others are relatively resistant. This finding could lead to personalized administration of ATG. PMID:26779931

  1. Diagnosing appendicitis: What works, what does not and where to go from here?

    Craig, Simon; Dalton, Sarah

    2016-02-01

    Although acute appendicitis is the most common reason for emergency abdominal surgery in children, diagnosis is far from straightforward. Delays in diagnosis can result in significant complications, whereas over-diagnosis can result in costly inter-hospital transfers and unnecessary surgery. This article aims to describe current evidence-based assessment of children with possible appendicitis presenting to the emergency department. We provide an overview of the literature relating to the various available diagnostic approaches, including the application of history, examination, pathology tests, imaging, and clinical decision rules. PMID:26437742

  2. Leukemic Infiltration of the Appendix as an Unusal Site of Extramedulary Relapse: Report of Two Cases and Review of the Literature

    Mahdi Shahriari

    2010-09-01

    Full Text Available The appendix is an unusual site for extramedulary relapse inacute leukemia. The present case report describes two cases oflate course acute lymphoblastic leukemia presented with leukemicinfiltration of the appendix and complete remission ofbone marrow. The signs and symptoms of the cases suggestthat leukemic involvement of the appendix should be consideredin the differential diagnosis of leukemia patients presentingwith acute abdomen.

  3. Leucograma, proteína C reativa, alfa-1 glicoproteína ácida e velocidade de hemossedimentação na apendicite aguda Leucocyte count, C reactive protein, alpha-1 acid glycoprotein and erithrocyte sedimmentation rate in acute appendicitis

    Bruno Ramalho de Carvalho

    2003-03-01

    ína ácida e velocidade de hemossedimentação mostraram-se pouco sensíveis e específicos. CONCLUSÕES: O leucograma e a proteína C reativa apresentam-se alterados de forma significativa nos casos de apendicite aguda, independentemente do sexo ou da faixa etária. O leucograma e, principalmente, a proteína C reativa devem ser exames considerados em indivíduos com tempo de evolução sintomática superior a 24 horas. Valores aumentados, entretanto, devem ser somados e não substituir a avaliação clínica do médico examinador. Dosagens de velocidade de hemossedimentação e da alfa-1 glicoproteína ácida não trazem auxílio ao diagnóstico da apendicite aguda.BACKGROUND: The diagnosis of acute appendicitis is clinic, but in some cases, it can present unusual symptoms. The diagnostic difficulties still lead surgeons to unnecessary laparotomies, which reach rates from 15% to 40%. Laboratory exams, then, may become important to complement appendicitis diagnosis. The leucocyte count seems to be the most important value, but measurement of acute phase proteins, specially, the C-reactive protein, is object of several studies. PATIENTS AND METHODS: This was a prospective study, involving 63 patients submitted to appendecectomies for acute appendicitis suspicion, in "Hospital das Clínicas", Federal University of Uberlândia, MG, Brazil, in whose blood were made dosages of acute phase proteins and the leucocyte count. RESULTS: The sample was composed by 44 male and 19 female patients, and the majority of them was between 11 and 30 years of age. The flegmonous type was the most freqüent (52.4%. The leucocyte count was altered in 74.6% of the cases and C-reactive protein elevation was observed in 88.9%. The alfa-1 acid glycoprotein and the erithrocyte sedimmentation rate were predominantly normal. The C-reactive protein was augmented in more than 80% of the cases in all ages. Leucocyte count and C-reactive protein were altered in 80% of the patients with the limit of 24

  4. Appendicitis in children: evaluation of the pediatric appendicitis score in younger and older children.

    Salö, Martin; Friman, Gustav; Stenström, Pernilla; Ohlsson, Bodil; Arnbjörnsson, Einar

    2014-01-01

    Background. This study aimed to evaluate Pediatric Appendicitis Score (PAS), diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis. Method. 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years (n = 102) and <4 years (n = 20). Results. The mean PAS wa...

  5. Long term maintenance of myeloid leukemic stem cells cultured with unrelated human mesenchymal stromal cells

    Sawa Ito

    2015-01-01

    Full Text Available Mesenchymal stromal cells (MSCs support the growth and differentiation of normal hematopoietic stem cells (HSCs. Here we studied the ability of MSCs to support the growth and survival of leukemic stem cells (LSCs in vitro. Primary leukemic blasts isolated from the peripheral blood of 8 patients with acute myeloid leukemia (AML were co-cultured with equal numbers of irradiated MSCs derived from unrelated donor bone marrow, with or without cytokines for up to 6 weeks. Four samples showed CD34+CD38− predominance, and four were predominantly CD34+CD38+. CD34+ CD38− predominant leukemia cells maintained the CD34+ CD38− phenotype and were viable for 6 weeks when co-cultured with MSCs compared to co-cultures with cytokines or medium only, which showed rapid differentiation and loss of the LSC phenotype. In contrast, CD34+ CD38+ predominant leukemic cells maintained the CD34+CD38+ phenotype when co-cultured with MSCs alone, but no culture conditions supported survival beyond 4 weeks. Cell cycle analysis showed that MSCs maintained a higher proportion of CD34+ blasts in G0 than leukemic cells cultured with cytokines. AML blasts maintained in culture with MSCs for up to 6 weeks engrafted NSG mice with the same efficiency as their non-cultured counterparts, and the original karyotype persisted after co-culture. Chemosensitivity and transwell assays suggest that MSCs provide pro-survival benefits to leukemic blasts through cell–cell contact. We conclude that MSCs support long-term maintenance of LSCs in vitro. This simple and inexpensive approach will facilitate basic investigation of LSCs and enable screening of novel therapeutic agents targeting LSCs.

  6. Diagnostic limitations of 10 mm thickness single-slice computed tomography for patients with suspected appendicitis

    The aim of this retrospective analysis was to evaluate the accuracy of 10 mm thickness single helical computed tomography (CT) examination for confirming the diagnosis of appendicitis or providing a diagnosis other than appendicitis, including underlying periappendical neoplasms. From April 1, 2001 to March 30, 2005, a total of 272 patients with suspected appendicitis underwent CT examinations. Of the 272 patients, 106 (39%) underwent surgery. Seven CT examinations for seven patients were excluded because of inconsistency of the CT protocol. We therefore reviewed 99 CT images (99 patients) with correlation to surgical-pathological findings to clarify the diagnostic accuracy of CT examinations. We compared the postoperative diagnosis with the preoperative CT report. The final diagnoses were confirmed by macroscopic findings at surgery and pathological evaluations if necessary. Of the 99 patients, 87 had acute appendicitis at surgery. The sensitivity, specificity, and accuracy of CT were 98.9%, 75.0%, and 96.0%, respectively. The positive predictive value and negative predictive value were 96.6% and 90.0%, respectively. Among nine patients in the true-negative category, five had colon cancers; and among three patients in the false-positive category, two had cancer of the cecal-appendiceal region as the underlying disease. CT examination is useful for patients with suspected appendicitis, but radiologists should be aware of the limitation of thick-sliced single helical CT. They should also be aware of the possibility of other diseases, including coincident abdominal neoplasms and underlying cecal-appendiceal cancer. (author)

  7. Frequency of wound infection in non-perforated appendicitis with use of single dose perforative antibiotics

    Antibiotics are used both pre and post-operatively in acute appendicitis for preventing wound infection. It has been observed that the routine use of post-operative antibiotics is not necessary in cases of non-perforated appendicitis as only prophylactic antibiotics are sufficient to prevent wound infection. The aim of this study was to see the frequency of wound infection in non-perforated appendicitis with single dose preoperative antibiotics only. Method: This observational study was conducted at the Department of Surgery, Ayub Medical College, Abbottabad from May to November 2014. A total of 121 patients with non-perforated appendicitis were included in the study. Only single dose preoperative antibiotics were used. The patients were followed for wound infection till 8th post-operative day. Results: 121 patients, 56(46.28%) male and 65(53.72%) female were included in the study. The mean age of patients was 27.41 ± 7.12 years with an age range of 18 to 45 years. In the entire series, 7(5.78%) patients developed wound infection. The infection was minor which settled with conservative therapy. Prophylactic antibiotics were found efficacious in 114(94.21%) patients. There was no significant association between wound infection and age and gender. Conclusion: Single dose preoperative antibiotics were found effective in controlling post-operative wound infection without the need of extending the antibiotics to post-operative period in cases of non-perforated appendicitis. (author)

  8. Uncontrolled hypertension secondary to leukemic cell infiltration of kidneys in a hemodialysis patient.

    Turkmen, Kultigin; Altintepe, Lutfullah; Guney, Ibrahim; Aydogdu, Ismet; Koc, Osman; Erkut, Mehmet Ali; Tonbul, Halil Zeki

    2010-01-01

    Leukemic infiltration of the kidney is usually silent, and the admission of the patients with renal dysfunction or acute kidney injury is uncommon. We present a 34-year old hemodialysis patient with new onset of uncontrolled hypertension, erythropoietin-resistant anemia, thrombocytopenia, and Bell's palsy. On admission, his blood pressure (BP) was 210/110 mmHg and he had petechiae and purpura at upper and lower extremities. Renal ultrasonography (USG) showed bilaterally enlarged kidneys without hydronephrosis, unlike his previous USG, which determined bilaterally atrophic kidneys. Acute lymphoblastic leukemia, hypertensive crisis due to bilateral leukemic cell infiltration of kidneys, tumor lysis syndrome, and leukemic involvement of the facial nerve were diagnosed. Despite intense antihypertensive management, his BP was not controlled. After prednisolone, daunorubicine, and vincristine therapy, the size of kidneys diminished and his BP dropped under normal range. In conclusion, pathological findings such as uncontrolled hypertension, flank pain, skin rashes, and abnormal blood count should be considered carefully, even in patients with end-stage renal disease receiving renal replacement therapy. PMID:21694931

  9. Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis

    Fadi Al Akhrass

    2015-01-01

    Full Text Available Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT following acute ruptured appendicitis. In addition, we list the documented twelve cases of Fusobacterium pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the extrahepatic portal hypertension were achieved with early empiric antibiotic and local thrombolytic therapy. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT after disruption of the gastrointestinal mucosa following an acute intraabdominal infectious process. Early treatment of this condition using anticoagulation and endovascular thrombolysis as adjunctive therapies may prevent PVT complications.

  10. Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis.

    Akhrass, Fadi Al; Abdallah, Lina; Berger, Steven; Sartawi, Rami

    2015-01-01

    Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured appendicitis. In addition, we list the documented twelve cases of Fusobacterium pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the extrahepatic portal hypertension were achieved with early empiric antibiotic and local thrombolytic therapy. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT after disruption of the gastrointestinal mucosa following an acute intraabdominal infectious process. Early treatment of this condition using anticoagulation and endovascular thrombolysis as adjunctive therapies may prevent PVT complications. PMID:26793462

  11. Potential role of curcumin and taurine combination therapy on human myeloid leukemic cells propagated in vitro.

    El-Houseini, Motawa E; Refaei, Mohammed Osman; Amin, Ahmed Ibrahim; Abol-Ftouh, Mahmoud A

    2013-10-01

    Curcumin and taurine are natural products that have been used in this study evaluating their therapeutic effect on myeloid leukemic cells propagated in vitro. Sixty patients with myeloid leukemia and 30 healthy volunteers were enrolled in the study. All patient groups were admitted to the Medical Oncology Department of the National Cancer Institute, Cairo University. There were statistically significant differences between treated leukemic cells compared to normal mononuclear leukocytes in cell density, interferon-γ and immunophenotypic profile, mainly CD4+, CD8 + and CD25+. This work highlights the possibility of using curcumin and taurine as a potential useful therapy in the management of patients suffering from chronic and acute myeloid leukemias. PMID:23418874

  12. Synthesis of Multiester-appended and Multicarboxylic-appended Imidazolium Ionic Liquids

    Wei Guo GENG; Xue Hui LI; Le Fu WANG; Hong Li DUAN; Wei Ping PAN

    2006-01-01

    Multiester-appended imidazolium ionic liquids were synthesized in a quatemization reaction between the imidazole derivatives carrying single or double esters and ethyl chloroacetate or bromoethane. Multicarboxylic-appended imidazolium ionic liquids were achieved from the hydrolysis of the corresponding ionic liquids. The influences of multifunctional groups on the transition temperatures and viscosity of these new ionic liquids were investigated.

  13. Uncontrolled hypertension secondary to leukemic cell infiltration of kidneys in a hemodialysis patient

    Kultigin Turkmen

    2010-06-01

    Full Text Available Kultigin Turkmen1, Lutfullah Altintepe2, Ibrahim Guney2, Ismet Aydogdu3, Osman Koc4, Mehmet Ali Erkut5, Halil Zeki Tonbul11Department of Nephrology, Meram School of Medicine, Selcuk University, 2Meram Training and Research Hospital, Selcuk University, 3Department of Hematology, Meram School of Medicine, Selcuk University, 4Department of Radiology, Meram School of Medicine, Selcuk University, 5Department of Hematology, Meram Training and Research Hospital, Selcuk UniversityAbstract: Leukemic infiltration of the kidney is usually silent, and the admission of the patients with renal dysfunction or acute kidney injury is uncommon. We present a 34-year old hemodialysis patient with new onset of uncontrolled hypertension, erythropoietin-resistant anemia, thrombocytopenia, and Bell’s palsy. On admission, his blood pressure (BP was 210/110 mmHg and he had petechiae and purpura at upper and lower extremities. Renal ultrasonography (USG showed bilaterally enlarged kidneys without hydronephrosis, unlike his previous USG, which determined bilaterally atrophic kidneys. Acute lymphoblastic leukemia, hypertensive crisis due to bilateral leukemic cell infiltration of kidneys, tumor lysis syndrome, and leukemic involvement of the facial nerve were diagnosed. Despite intense antihypertensive management, his BP was not controlled. After prednisolone, daunorubicine, and vincristine therapy, the size of kidneys diminished and his BP dropped under normal range. In conclusion, pathological findings such as uncontrolled hypertension, flank pain, skin rashes, and abnormal blood count should be considered carefully, even in patients with end-stage renal disease receiving renal replacement therapy.Keywords: leukemic cell infiltration, uncontrolled hypertension, hemodialysis

  14. CT findings of leukemic pulmonary infiltration with pathologic correlation

    The aim of this study was to demonstrate the characteristic CT findings of leukemic pulmonary infiltration based on the pathologic findings. The CT findings of 11 leukemic patients with leukemic pulmonary infiltration were compared with those of 22 leukemic patients with other diseases as a control group. Evaluated pulmonary parenchymal CT findings included thickening of bronchovascular bundles and interlobular septa, prominence of peripheral pulmonary arteries, ground-glass opacities, air-space consolidation, and nodules. The CT-pathologic correlations for leukemic infiltration were evaluated in 7 patients. Frequent parenchymal CT findings were thickening of bronchovascular bundles (81.8%), prominence of peripheral pulmonary arteries (81.8%), and non-lobular and non-segmental ground-glass opacities (90.9%). The first two findings were significantly more frequently observed in leukemic infiltration than in the control group, had good interobserver agreement, and corresponded pathologically to leukemic cell infiltration around the pulmonary arteries, bronchi, or bronchioles. Non-lobular and non-segmental ground-glass opacity corresponded to leukemic cell infiltration within alveolar spaces and septa adjacent to the pulmonary arteries or bronchi and also corresponded to hemorrhage, edema, or diffuse alveolar damage. Thickening of bronchovascular bundles and prominence of peripheral pulmonary arteries are CT findings suggestive for leukemic infiltration and correspond to peribronchovascular tumor extension. (orig.)

  15. Utilidad de la tomografía computada en pacientes con dolor en fosa iliaca derecha: Apendicitis aguda y su diagnóstico diferencial Usefulness of computed tomography in patients with right inferior abdominal quadrant pain: acute appendicitis and its alternative diagnosis

    Sebastián Atilio Rossini

    2009-03-01

    fosa iliaca derecha. Conclusión: La TCH posee una elevada sensibilidad y especificidad para el diagnóstico de apendicitis aguda y para la evaluación y manejo de los pacientes con un cuadro de abdomen agudo de fosa iliaca derecha.Purpose: To review the tomography findings of the acute appendicitis, their complications and alternative diagnosis. To value the use of helicoidal computed tomography (HCT in the diagnosis of acute appendicitis and in the study of patients with right inferior abdominal quadrant (RIQ pain and acute abdomen, for diagnosis and eventual complications, in order to decide treatment. Materials and method: For five months, the populations included in this retrospectively study were all patients delivered for presenting with RIQ pain for a HCT exam. These exams were made with oral and intravenous contrasts, when there were not contraindications. The HCT results were correlated with clinical follow up, surgery and histopathologic exams. Results: Over a total of 100 patients studied, 53 presented tomographic diagnosis of appendicitis, 22 of which presented perforation signs; 27 showed an alternative diagnosis (ovaries follicles, uretheral litiasis, tiphlitis, diverticulitis, colitis, salpingitis, 18 patients did not present tomographic findings to support the clinical symptoms and 2 presented indetermined results. These data represented a sensibility of 100%, specifity of 95,7%, positive predictiv value (PPV of 96,2% and negative predictiv value (NPV of 100% for the tomography diagnosis of acute appendicitis and a sensibility of 100%, specificity of 81,8%, PPV of 95,1% and NPV of 100% for the tomography diagnosis of the different etiology in patient with right inferior acute abdomen. Conclusion: HCT is extremely useful in the study of patients with acute abdomen with origin in the RIQ, not only to make a diagnosis, but also to evaluate the complications, so as to decide proper treatment.

  16. Appendicitis in children less than five years old: A challenge for the general practitioner.

    Marzuillo, Pierluigi; Germani, Claudio; Krauss, Baruch S; Barbi, Egidio

    2015-05-01

    Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness (61% of the patients) followed by guarding (55%), diffuse tenderness (39%), rebound (32%), and mass (6%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis. PMID:26015876

  17. Granulomatous appendicitis in children: A single institutional experience

    Kamalesh Pal

    2014-01-01

    Full Text Available Background: Granulomatous appendicitis (GA is a rare entity, mostly mentioned in adults. There have been anecdotal case reports describing GA in the paediatric population. This study was aimed at reviewing the cases of appendectomies to assess the incidence and characteristics of GA in children in a tertiary care University hospital. Materials and Methods: Records of children (<13 years age with biopsy proven granulomatous lesions in the appendectomy specimen, treated during 1991-2011, were analysed. Data regarding demography, clinical presentation, radiological findings, intra-operative finding, histology, diagnosis and follow-up were recorded and descriptively analysed. Results: Twelve out of 1150 (1.04% appendectomies were biopsy proven GA. Male to female ratio was 8:4. Four had Yersinia enterocolitis, two had Crohn′s disease (CD; one isolated Crohn′s Appendicitis, one Ileo-cecal Crohn′ with appendicitis and five were idiopathic. Remaining one case, initially diagnosed as idiopathic GA, developed full blown ileo-cecal CD at 2 nd month post-operative. Age ranged between 4 and 11 years with inflammatory bowel disease (IBD affecting older children and Yersinia, seen in younger children. Majority (10/12 remained asymptomatic at a maximum of 5 years of follow-up. Two patients had recurrent symptoms; one with sub-acute obstruction (2 years follow-up and another with flaring of Crohn′s ileitis (2 months follow-up. Conclusions: GA in children is a rare entity, with incidence of 1.04% and male preponderance in our series. Idiopathic causes were the most common followed by Yersinia enterocolitis and CD. Although majority remained asymptomatic, IBD should be ruled out in case of recurrence of pain or alteration of bowel habit. Therefore, a long-term follow-up (at least for 5 years of idiopathic GA is suggested in children.

  18. Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis

    Sevgi Buyukbese Sarsu

    2016-01-01

    Full Text Available Background. Acute appendicitis (AA associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluation. The area under a receiver operating characteristic (ROC curve (AUC was performed to examine diagnostic accuracy. Results. When WBC and CRP were used in combination, based on cut-off values of ≥13.1 × 103/μL for WBC counts and ≥1.17 mg/dL for CRP level, diagnostic parameters were as follows: sensitivity, 98.7%; specificity, 71.3%; PPV, 50.6%; NPV, 99.5%; diagnostic accuracy, 77.6%; LR(+, 3.44; LR(−, 0.017. AUC values were 0.845 (95% CI 0.800–0.891 for WBC and 0.887 (95% CI 0.841–0.932 for CRP. Conclusions. For complicated appendicitis, CRP has the highest degree of diagnostic accuracy. The diagnosis of appendicitis should be made primarily based on clinical examination, and obviously more specific and systemic inflammatory markers are needed. Combined use of cut-off values of WBC (≥13100/μL and CRP (≥1.17 mg/L yields a higher sensitivity and NPV for the diagnosis of complicated appendicitis.

  19. Fluorouracil Selectively Enriches Stem-like Leukemic Cells in a Leukemic Cell Line

    Ling Zhang, Song Yang, Yu-Juan He, Hui-Yuan Shao, Li Wang, Hui Chen, Yu-Jie Gao, Feng-Xian Qing, Xian-Chun Chen, Liu-Yang Zhao, Shi Tan

    2010-01-01

    Full Text Available Recent studies have reported that cancer stem cells (CSCs could be isolated from solid cancer cell lines, in which the purity of CSCs was higher than that from tumor tissues. Separation of CSCs from leukemic cell lines was rarely reported. In this study, CD34+CD38- stem-like cell subsets in human KG-1a leukemic cell line were enriched by cytotoxic agent 5-fluorouracil (5-FU. After 4 days incubation of KG-1a cell line with 5-FU (50 μg/ml, the CD34+CD38- subpopulation of cell lines was enriched more than 10 times. The enriched cells had proliferate potential in vitro, low level of RNA transcription and Hoechst 33342 dye efflux ability, accompanied by high expression of ATP-binding cassette transporter protein ABCG2. Our findings suggest that treatment with 5-FU offers an easy method to isolate leukemic stem-like subpopulation. It can facilitate studies of leukemic stem cell biology and the development of new therapeutic strategies.

  20. Mild Appendicitis Complication Rates Similar for Surgery, Antibiotics

    ... nih.gov/medlineplus/news/fullstory_157975.html Mild Appendicitis Complication Rates Similar for Surgery, Antibiotics Decision not ... News) -- Antibiotics can be used to treat mild appendicitis, but the condition returns in some patients who ...

  1. Alternative diagnoses at paediatric appendicitis MRI

    As the utilization of MRI in the assessment for paediatric appendicitis increases in clinical practice, it is important to recognize alternative diagnoses as the cause of abdominal pain. The purpose of this review is to share our institution's experience using MRI in the evaluation of 510 paediatric patients presenting with suspected appendicitis over a 30 month interval (July 2011 to December 2013). An alternative diagnosis was documented in 98/510 (19.2%) patients; adnexal pathology (6.3%, n = 32), enteritis–colitis (6.3%, n = 32), and mesenteric adenitis (2.2%, n = 11) comprised the majority of cases. These common entities and other less frequent illustrative cases obtained during our overall institutional experience with MRI for suspected appendicitis are reviewed

  2. Pitfalls in CT diagnosis of appendicitis: pictorial essay

    Despite the high diagnostic accuracy of CT for appendicitis, numerous pitfalls exist that may result in a misdiagnosis. This pictorial review outlines the potential pitfalls in the CT diagnosis of appendicitis that includes atypical position of the appendix and coexisting pathologies. Various mimickers of appendicitis and clinical dilemmas will be highlighted. Upon completion, the reviewer should have an improved ability to recognise appendicitis mimickers and identify equivocal or atypical findings.

  3. Criteria and Classification of Hybrid Acute Leukemia in 72 Acute Leukemias Based Mainly on Flow Cytometric Analysis

    Aoki, Sadao; Nomoto, Nobuhiko; Maruyama, Souichi; Shinada, Shoji; Shibata, Akira

    1991-01-01

    Phenotypes of leukemic cells can be determined through dual staining with pairs of FITC-labeled and PE-labeled monoclonal antibodies using a laser flow cytometer. Hybrid acute leukemia (HAL) was diagnosed when leukemic cells expressed 2 or more lymphoid markers and at least on myeloid marker simultaneously. Based on this criteria, nineteen out of 72 cases with untreated acute leukemia were diagnosed as HAL, 15 of 29 (51%) patients with acute lymphoblastic leukemia and 4 of 43 (9%) patients wi...

  4. PUMA promotes apoptosis of hematopoietic progenitors driving leukemic progression in a mouse model of myelodysplasia.

    Guirguis, A A; Slape, C I; Failla, L M; Saw, J; Tremblay, C S; Powell, D R; Rossello, F; Wei, A; Strasser, A; Curtis, D J

    2016-06-01

    Myelodysplastic syndrome (MDS) is characterized by ineffective hematopoiesis with resultant cytopenias. Increased apoptosis and aberrantly functioning progenitors are thought to contribute to this phenotype. As is the case for other malignancies, overcoming apoptosis is believed to be important in progression toward acute myeloid leukemia (AML). Using the NUP98-HOXD13 (NHD13) transgenic mouse model of MDS, we previously reported that overexpression of the anti-apoptotic protein BCL2, blocked apoptosis and improved cytopenias, paradoxically, delaying leukemic progression. To further understand this surprising result, we examined the role of p53 and its pro-apoptotic effectors, PUMA and NOXA in NHD13 mice. The absence of p53 or PUMA but not NOXA reduced apoptosis and expanded the numbers of MDS-repopulating cells. Despite a similar effect on apoptosis and cell numbers, the absence of p53 and PUMA had diametrically opposed effects on progression to AML: absence of p53 accelerated leukemic progression, while absence of PUMA significantly delayed progression. This may be explained in part by differences in cellular responses to DNA damage. The absence of p53 led to higher levels of γ-H2AX (indicative of persistent DNA lesions) while PUMA-deficient NHD13 progenitors resolved DNA lesions in a manner comparable to wild-type cells. These results suggest that targeting PUMA may improve the cytopenias of MDS without a detrimental effect on leukemic progression thus warranting further investigation. PMID:26742432

  5. DNMT3A and TET2 in the Pre-Leukemic Phase of Hematopoietic Disorders.

    Sato, Hanae; Wheat, Justin C; Steidl, Ulrich; Ito, Keisuke

    2016-01-01

    In recent years, advances in next-generation sequencing (NGS) technology have provided the opportunity to detect putative genetic drivers of disease, particularly cancers, with very high sensitivity. This knowledge has substantially improved our understanding of tumor pathogenesis. In hematological malignancies such as acute myeloid leukemia and myelodysplastic syndromes, pioneering work combining multi-parameter flow cytometry and targeted resequencing in leukemia have clearly shown that different classes of mutations appear to be acquired in particular sequences along the hematopoietic differentiation hierarchy. Moreover, as these mutations can be found in "normal" cells recovered during remission and can be detected at relapse, there is strong evidence for the existence of "pre-leukemic" stem cells (pre-LSC). These cells, while phenotypically normal by flow cytometry, morphology, and functional studies, are speculated to be molecularly poised to transform owing to a limited number of predisposing mutations. Identifying these "pre-leukemic" mutations and how they propagate a pre-malignant state has important implications for understanding the etiology of these disorders and for the development of novel therapeutics. NGS studies have found a substantial enrichment for mutations in epigenetic/chromatin remodeling regulators in pre-LSC, and elegant genetic models have confirmed that these mutations can predispose to a variety of hematological malignancies. In this review, we will discuss the current understanding of pre-leukemic biology in myeloid malignancies, and how mutations in two key epigenetic regulators, DNMT3A and TET2, may contribute to disease pathogenesis. PMID:27597933

  6. Epiploic appendicitis - ultrasonography and computed tomography findings

    Epiploic appendicitis is an uncommon inflammatory condition, which is presently better diagnosed by current imaging methods such as computed tomography and ultrasonography that allow a non-invasive and efficient diagnostic approach. The author studied 6 patients with epiploic appendicitis. The patients were submitted to computed tomography that showed paracolic oval lesions of 1 to 2 cm of diameter, fat attenuation and a thin peripheral hyperdense rim associated with adjacent fat stranding. Ultrasound examination performed in two patients showed hyperechoic ovoid noncompressible masses at the site of maximum abdominal tenderness. (author)

  7. Interleukin-6 (IL-6) is an intermediate in IL-1-induced proliferation of leukemic human megakaryoblasts

    We have examined the in vitro effects of recombinant human (rh) interleukin-1 (IL-1) on the growth of purified megakaryoblasts obtained from patients with acute megakaryoblastic leukemia. We demonstrate that both IL-1 alpha and IL-1 beta treatment of these cells led to stimulation of DNA synthesis (as shown by increase of 3H-thymidine incorporation up to 35-fold) and also resulted in colony formation of leukemic megakaryoblasts. However, the stimulatory effect of IL-1 was dependent on endogenous production of IL-6, because addition of neutralizing monoclonal antibody (MoAb) to IL-6 abrogated the stimulatory activity of IL-1. In contrast, neutralizing MoAbs to granulocyte (G)-colony stimulating factor (CSF), granulocyte-macrophage (GM)-CSF, and macrophage (M)-CSF failed to counteract the growth-enhancing effects of IL-1. Leukemic megakaryoblasts accumulated IL-6 mRNA and released IL-6 protein into their culture supernatant when exposed to rh IL-1 but failed to disclose transcripts for G-, GM-, and M-CSF under these conditions. Analysis of IL-6 receptor (IL-6R) transcript levels demonstrated that megakaryoblasts constitutively expressed IL-6R mRNA and that these transcripts are down-regulated to undetectable levels upon exposure to IL-1 and IL-6. Increase of 3H-thymidine incorporation by megakaryoblasts could be duplicated by exogenous IL-6 that could be blocked by neutralizing MoAb to IL-6. In conclusion, our results suggest that leukemic megakaryoblasts could produce and secrete IL-6, and express IL-6R, and that the growth-enhancing effect of IL-1 on these cells is indirect, via production of IL-6 by leukemic cells

  8. Frequent deletions of JARID2 in leukemic transformation of chronic myeloid malignancies.

    Puda, Ana; Milosevic, Jelena D; Berg, Tiina; Klampfl, Thorsten; Harutyunyan, Ashot S; Gisslinger, Bettina; Rumi, Elisa; Pietra, Daniela; Malcovati, Luca; Elena, Chiara; Doubek, Michael; Steurer, Michael; Tosic, Natasa; Pavlovic, Sonja; Guglielmelli, Paola; Pieri, Lisa; Vannucchi, Alessandro M; Gisslinger, Heinz; Cazzola, Mario; Kralovics, Robert

    2012-03-01

    Chronic myeloproliferative neoplasms (MPN) and myelodysplastic syndromes (MDS) have an inherent tendency to progress to acute myeloid leukemia (AML). Using high-resolution SNP microarrays, we studied a total of 517 MPN and MDS patients in different disease stages, including 77 AML cases with previous history of MPN (N = 46) or MDS (N = 31). Frequent chromosomal deletions of variable sizes were detected, allowing the mapping of putative tumor suppressor genes involved in the leukemic transformation process. We detected frequent deletions on the short arm of chromosome 6 (del6p). The common deleted region on 6p mapped to a 1.1-Mb region and contained only the JARID2 gene--member of the polycomb repressive complex 2 (PRC2). When we compared the frequency of del6p between chronic and leukemic phase, we observed a strong association of del6p with leukemic transformation (P = 0.0033). Subsequently, analysis of deletion profiles of other PRC2 members revealed frequent losses of genes such as EZH2, AEBP2, and SUZ12; however, the deletions targeting these genes were large. We also identified two patients with homozygous losses of JARID2 and AEBP2. We observed frequent codeletion of AEBP2 and ETV6, and similarly, SUZ12 and NF1. Using next generation exome sequencing of 40 patients, we identified only one somatic mutation in the PRC2 complex member SUZ12. As the frequency of point mutations in PRC2 members was found to be low, deletions were the main type of lesions targeting PRC2 complex members. Our study suggests an essential role of the PRC2 complex in the leukemic transformation of chronic myeloid disorders. PMID:22190018

  9. A case of Fournier's gangrene in a young immunocompetent male patient resulting from a delayed diagnosis of appendicitis.

    Wanis, Michael; Nafie, Shady; Mellon, John Kilian

    2016-01-01

    We discuss the case of a 28-year-old male patient presenting to our department with an atypical history of acute scrotal swelling on a background of abdominal pain. He was diagnosed with a perforated appendicitis and Fournier's gangrene. PMID:27106611

  10. A case of Fournier’s gangrene in a young immunocompetent male patient resulting from a delayed diagnosis of appendicitis

    Wanis, Michael; Nafie, Shady; Mellon, John Kilian

    2016-01-01

    We discuss the case of a 28-year-old male patient presenting to our department with an atypical history of acute scrotal swelling on a background of abdominal pain. He was diagnosed with a perforated appendicitis and Fournier’s gangrene. PMID:27106611

  11. Up-regulation of TIMP-2 expression promotes SHI-1 leukemic cells proliferation and infiltration in immunodeficiency mice

    Li Zhenjiang; Chen Zixing; Cen Jiannong; He Jun; Qiu Qiaocheng; Xue Yongquan

    2014-01-01

    Background MMPs and TIMPs play important roles in tumor angiogenesis and invasion.Studies have shown that TIMP-2 has two roles in tumor invasion.However,its role in leukemic infiltration has not been well investigated.This study explored the roles of TIMP-2 in extramedullary infiltration of acute monocytic leukemic SHI-1 cells both in vitro and in vitro.Methods A retroviral vector carrying the human TIMP-2 cDNA was constructed and transfected into the monocytic leukemic cell line SHI-1.The expression of TIMP-2 in the positive clones was determined.The proliferation of SHI-1 cells was examined by MTT assay.Trans-Matrigel invasion assays were used to investigate the infiltration ability in vitro.SHI-1 cells were intravenously injected into pre-treated nu/nu mice to investigate the infiltration ability feature in vitro.Results The expression of TIMP-2 on the cell membrane was significantly elevated in SHI-1/TIMP-2 cells.Over-expression of TIMP-2 promoted the cells proliferation and the invasions in vitro.The SHI-1/TIMP-2 cells demonstrated higher infiltration ability when intravenously injected into nu/nu mice.Conclusion Over-expression of TIMP-2,especially on the cell membrane,may play important roles in promoting the proliferation and infiltration of SHI-1 leukemic cells.

  12. Usefulness and limit of CT diagnosis on appendicitis

    CT was performed in 104 patients with abdominal pain suspected appendicitis. CT showed positive finding (abnormal appendix, appendicolith, pericecal inflammatory change, fluid collection, LN swelling, abscess) and complication of appendicitis clearly. CT diagnosis showed high accuracy than clinical diagnosis. CT proved its usefulness especially only CT imaging showed the correct diagnosis. On the other hand, diverticulitis and terminal ileitis common diagnostic disease of appendicitis showed similar clinical appearance and CT image, caused to be difficult to diagnose correctly. In the cases showing similar image to appendicitis or atypical image, CT also proved its limit of the diagnosis on appendicitis. (author)

  13. Cytomegalovirus appendicitis in an immunocompetent host.

    Canterino, Joseph E; McCormack, Michael; Gurung, Ananta; Passarelli, James; Landry, Marie L; Golden, Marjorie

    2016-05-01

    Cytomegalovirus (CMV) is a common viral pathogen. Asymptomatic infection or a mononucleosis syndrome are the most common manifestations in otherwise healthy individuals. End-organ disease is rare in immunocompetent individuals. Here, we describe a case of CMV appendicitis in a patient without an immune-compromising condition. PMID:26942831

  14. MBA-induced differentiation of myeloid leukemic cell lines is associated with altered G1 cell cycle regulators and related genes

    王钦红; 谢毅; 范华骅

    2004-01-01

    @@The proliferation and differentiation of hematopoietic cells can be regulated by a number of physiological agents including hexamethylene bisacetamide (HMBA). Clinically, HMBA has been used for the treatment of acute myeloid leukemia and myelodysplastic syndrome.1 However, the mechanism of the effect of HMBA on the differentiation of myeloid leukemic cells is largely unkown. Up to now, related reports have not been found. We used HL-60 and U937 cell lines to study the effect of HMBA on the differentiation of myeloid leukemic cells and to explore the possible mechanism.

  15. Ultrasound, Computed Tomography, and Laboratory Findings in the Diagnosis of Appendicitis

    Purpose: To determine the diagnostic accuracy and the clinical impact of ultrasound (US) and computed tomography (CT) in diagnosing appendicitis, and to evaluate the impact of laboratory tests on the treatment of acute appendicitis. Material and Methods: All patients who, during 2005, underwent an acute ultrasound or CT investigation due to suspected appendicitis, or were diagnosed and/or surgically treated for appendicitis at Umeaa Univ. Hospital, Umeaa, were included. The type of radiological investigation, its findings, the choice of treatment, final diagnosis, C-reactive protein (CRP), leukocyte particle count (LPC), body temperature, age, and sex were recorded for each patient. The histological result from surgery was considered the gold standard. Results: The material included 305 cases with an overall appendicitis prevalence of 58%. Fifty-two percent of the patients were female. The mean age was 29 years, with a total range of 2-94 years. Twenty percent (60/305) underwent a CT investigation, 40% (123/305) underwent an US investigation, 5% (14/305) underwent both a CT and an US investigation, and 35% (108/305) of patients did not undergo any radiological investigation at all. The sensitivities and specificities were 91% and 94% for CT, and 83% and 98% for US, respectively. The positive likelihood ratio was 15.1 and 45.5 for CT and US, and the negative likelihood ratio was 0.09 and 0.18 for CT and US, respectively. It was not possible to visualize the appendix in 31% of patients examined with US. The prevalence of appendicitis in this group was the same as the prevalence among patients where it was possible to see the appendix, i.e., 35%. The mean CRP for all patients with appendicitis was 59 (95% CI 10-491) mg/l, and the mean LPC was 11.1 (95% CI 2.6-28.1) x10-9/l. The mean LPC level was significantly higher for the appendicitis patients. Body temperature could not significantly verify or exclude appendicitis. The overall negative appendectomy rate was 9% (16

  16. Bone Scintigraphic Findings in Leukemic Patients

    The leukemias represent diffuse lesions of the bone marrow and significant bony abnormalities are associated with the more aggressive varieties of leukemias and with the younger age groups. On plain film, several roentgenographic findings are observed such as diffuse osteopenia, radiolucent metaphyseal bands, osteolytic lesions and periostitis. We evaluated bone scintigraphic findings using 99mTc-methylene diphosphonate (99mTc-MDP) in ten patients with proven leukemia. The scan is abnormal in 90%. We classified abnormal scintigraphic findings to 3 types and these are increased diffuse juxta-articular uptake, focal increase of uptake and combined type. The common sites of focal uptake were femur, humerus, tibia, spine, ribs, calvarium, scapula and mandible. We concluded that 99mTc-MDP bone scintigraphy is sensitive imaging modality in leukemic patients with bone pain.

  17. Bone Scintigraphic Findings in Leukemic Patients

    Choi, Hyo Sun; Park, Jeong Mi; Shon, Hyeong Seon; Chang, Soo Kyo; Kim, Choon Yul; Bahk, Yong Hee; Shinn, Kyung Sub [Catholic University College of Medicine, Seoul (Korea, Republic of)

    1992-03-15

    The leukemias represent diffuse lesions of the bone marrow and significant bony abnormalities are associated with the more aggressive varieties of leukemias and with the younger age groups. On plain film, several roentgenographic findings are observed such as diffuse osteopenia, radiolucent metaphyseal bands, osteolytic lesions and periostitis. We evaluated bone scintigraphic findings using {sup 99m}Tc-methylene diphosphonate ({sup 99m}Tc-MDP) in ten patients with proven leukemia. The scan is abnormal in 90%. We classified abnormal scintigraphic findings to 3 types and these are increased diffuse juxta-articular uptake, focal increase of uptake and combined type. The common sites of focal uptake were femur, humerus, tibia, spine, ribs, calvarium, scapula and mandible. We concluded that {sup 99m}Tc-MDP bone scintigraphy is sensitive imaging modality in leukemic patients with bone pain.

  18. Classificação laparoscópica da apendicite aguda: correlação entre graus da doença e as variáveis perioperatórias Acute appendicitis laparoscopic classification: correlation between disease grade and intraoperative variables

    Carlos Augusto Gomes

    2006-10-01

    Full Text Available OBJETIVO: Apresentar a classificação laparoscópica da apendicite aguda e verificar a relação entre os graus da doença com o tempo de sintomas, tempo operatório, permanência hospitalar, complicações infecciosas e uso de antimicrobianos. MÉTODO: Estudo prospectivo, transversal, envolvendo 105 pacientes com diagnóstico de apendicite aguda e submetidos a apendicectomia laparoscópica entre Janeiro de 2000 e Julho de 2001. A doença foi classificada em grau 0 - Normal; 1 - Hiperemia e edema; 2 - Exsudato fibrinoso; 3 - Necrose segmentar; 4A - Abscesso; 4B - Peritonite regional; 4C - Necrose da base do apêndice; 5 - Peritonite difusa. RESULTADOS: A distribuição dos pacientes segundo a classificação foi: grau 0 (10,4%; 1 (40%; 2 (29,5%; 3 (2,9%; 4A (1,9%; 4B (4,8%; 4C (3,8% e 5 (6,7%. O tempo médio de início de sintomas acima de 40 h correlacionou-se com possibilidade de necrose e peritonite. O tempo operatório variou de 18 a 126 minutos, média de 31,4 minutos. A permanência hospitalar variou de 12 a 192 h, média de 39,5 h. A maior incidência de complicações Infecciosa ocorreu nos graus 4 e 5. O antimicrobiano foi de uso profilático graus 0, 1 e 2 e terapêutico nos demais. A laparotomia foi necessária duas (1,9% vezes e não houve óbito. CONCLUSÕES: A classificação laparoscópica da apendicite aguda contemplou todas as formas clínicas da doença, possibilitou correlação com os tempos início de sintomas, operatório e de permanência hospitalar. Permitiu ainda, prever complicações infecciosas e racionalizar o uso de antimicrobianos.BACKGROUND: Laparoscopic classification of acute appendicitis is presented. The relationship between the grades of the disease with the time of symptoms, operating time, length of hospital stay, infectious complication rate and antimicrobials use is verified. METHODS: Consecutive patients (n= 105 who underwent a laparoscopic appendectomy from January 2000, through July 2001, were studied

  19. Effects of ethidine and hydrocortisone on post-anesthesia shivering in surgery for acute purulent appendicitis%氢化可的松和哌替啶治疗急性化脓性阑尾炎麻醉后寒战疗效评价

    谢文静; 李北平

    2013-01-01

    目的 评价氢化可的松和哌替啶对急性化脓性阑尾炎蛛网膜下隙阻滞麻醉后寒战的治疗作用.方法 急性化脓性阑尾炎蛛网膜下隙阻滞麻醉后寒战Wrench分级2级及以上的患者73 例,随机分为氢化可的松(2.0 mg/ kg)组、哌替啶( 0.05 mg/ kg)组和生理盐水 (10 ml)组.术中监测肛温(T)及常规麻醉监测指标.记录各组基础体温(T0),寒战发生时(T1),寒战后10 min(T2)、30 min(T3)、60 min(T4)体温,对T1~T4时间点的寒战进行评分,并观察不良反应的发生情况.结果 与对照组相比,哌替啶组和氢化可的松组患者麻醉后寒战缓解迅速,持续时间短,症状较轻(P<0.05);哌替啶组患者恶心、呕吐发生率较氢化可的松组高(P<0.05).结论 哌替啶和氢化可的松均可用于麻醉后寒战治疗;氢化可的松较少引起恶心、呕吐等不良反应,更适用于急性化脓性阑尾炎麻醉后寒战的治疗.%Objective To investigate the effects of treatment with pethidine and hydrocortisone on post-anesthesia shivering following subarachnoid block anesthesia in surgery for acute purulent appendicitis . Methods 73 patients with purulent appendectomy (Wrench Ⅱ-Ⅳ) were randomly divided into three groups,pethidine (0.05 mg/kg) group,hy- drocortisone (2.0 mg/ kg) group and normal saline group. Signs and parameters such as body temprature were monitored during the operation. Manifestations of shivering,were evaluated at 0,10,30 and 60 min after shivering,and the side effects such as nausea and vomiting were observed . Results The time of recovery from shivering was significantly shorter in pethidine and hydrocortisone group ( P < 0.05 ) . The incidence of nausea and vomiting was much lower in hydrocorti-sone group than in pethidine and saline group ( P < 0.05 ). Conclusions Pethidine and hydrocortisone are effective for the treatment of post -anesthesia shivering. Compared with pethidine,hydrocortisone had fewer side effects such as nausia and

  20. Role of drains in laparoscopic appendectomy for complicated appendicitis at a busy county hospital.

    Pakula, Andrea M; Skinner, Ruby; Jones, Amber; Chung, Ray; Martin, Maureen

    2014-10-01

    Laparoscopic appendectomy (LA) has become the treatment of choice for acute appendicitis with equal or better outcomes than traditional open appendectomy (OA). LA in patients with a gangrenous or perforated appendicitis carries increased rate of pelvic abscess formation when compared with OA. We hypothesized routine placement of pelvic drains in gangrenous or perforated appendicitis decreases pelvic abscess formation after LA. Three hundred thirty-one patients undergoing LA between January 2007 and June 2011 were reviewed. Patients with perforated or gangrenous appendicitis were included. Group I had a Jackson-Pratt (JP) drain(s) placed and Group II had no JP drain. Data included patient demographics, emergency department laboratory values and vital signs, and computed axial tomography scan findings, intra-abdominal or pelvic abscess postoperatively, interventional radiology drainage, and length of stay. Clinic follow-up notes were reviewed. One hundred forty-eight patients were identified. Forty-three patients had placement of JP drains (Group I) and 105 patients had no JP drain (Group II). Three patients (three of 43 [6%]) in Group I developed pelvic abscess and 21 of 105 (20%) patients in Group II developed pelvic abscesses requiring subsequent drainage. This was statistically significant. Patient demographics, temperature, and mean white blood count before surgery were similar. Presurgery computed tomography (CT) with appendicolith and CT with abscess were more prevalent in Group I. The use of JP drainage in patients with perforated or gangrenous appendicitis during LA has decreased rates of pelvic abscess. This was demonstrated despite the drain group having appendicolith or abscess on preoperative CT. PMID:25264664

  1. Spontaneous splenic rupture and Anisakis appendicitis presenting as abdominal pain: a case report

    Valle Joaquín

    2012-04-01

    Full Text Available Abstract Introduction Anisakidosis, human infection with nematodes of the family Anisakidae, is caused most commonly by Anisakis simplex. Acquired by the consumption of raw or undercooked marine fish or squid, anisakidosis occurs where such dietary customs are practiced, including Japan, the coastal regions of Europe and the United States. Rupture of the spleen is a relatively common complication of trauma and many systemic disorders affecting the reticuloendothelial system, including infections and neoplasias. A rare subtype of rupture occurring spontaneously and arising from a normal spleen has been recognized as a distinct clinicopathologic entity. Herein we discuss the case of a woman who presented to our institution with appendicitis secondary to Anisakis and spontaneous spleen rupture. Case presentation We report the case of a 53-year-old Caucasian woman who presented with hemorrhagic shock and abdominal pain and was subsequently found to have spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. She underwent open surgical resection of the splenic rupture and the appendicitis without any significant postoperative complications. Histopathologic examination revealed appendicitis secondary to Anisakis simplex and splenic rupture of undetermined etiology. Conclusions To the best of our knowledge, this report is the first of a woman with the diagnosis of spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. Digestive anisakiasis may present as an acute abdomen. Emergency physicians should know and consider this diagnosis in patients with ileitis or colitis, especially if an antecedent of raw or undercooked fish ingestion is present. Spontaneous rupture of the spleen is an extremely rare event. Increased awareness of this condition will enhance early diagnosis and effective treatment. Further research is required to identify the possible risk factors associated with spontaneous rupture of the spleen.

  2. Should the non-operative management of appendicitis be the new standard of care?

    Gandy, Robert C; Wang, Frank

    2016-04-01

    Appendicitis is one of the most commonly encountered emergency presentations to the general surgical services. The operative management of this condition is associated with significant financial costs and represents a significant workload on the emergency surgical services. Negative appendicectomy rates remain high (20-25%) despite advancements in laboratory testing and imaging techniques. Recent data from randomized controlled trials suggests that non-operative management in patients presenting with uncomplicated or non-perforated acute appendicitis is a viable alternative, with only 23% of patients requiring an appendicectomy at 1 year and an overall reduction in complications. In view of this, the traditional teaching of mandatory appendicectomy for all patients with acute appendicitis should be challenged. This article briefly reviews the evidence that supports the use of diagnostic tests to reduce the negative appendicectomy rate and examines the potential selection criteria for non-operative management. The data raises the questions: can a 20-25% negative appendicectomy rate be defended as best practice and can the traditional dogma of early appendicectomy to prevent perforation be supported? PMID:26991357

  3. APPENDICITIS IN PEDIATRICS: DIAGNOSTIC VALUE OF LEOKOCYTE COUNT, CRP, NEUTROPHIL TO LYMPHOCYTE RATIO

    M NAZEM

    2000-03-01

    Full Text Available Introduction. Appendicitis is the most common cause of acute surgical abdomen. However, many atypical manifestations of this disease make much difficulties in differential diagnosis. Diagnostic methods such as sonography or isotope scan are expensive or completely depend on sonographist's experience. So because there is no preoperative definite diagnostic test for appendicitis patients, it seems necessary to evaluate different variables to achieve this goal. Laboratory tests are inexpensive and available. Methods. A Series of 116 consecutive under 14 years old patients presenting with right lower quadrant pain were studied. All of the patients underwent operation and diagnosis was confirmed by histology. WBC count> 10000/mm3, neutr/Lymph>3/5 and positive CRP were indices of study. Findings. The sensitivity of WBC count above 10000/mm3, neutrophill to lymphocyte count ratio (>3/5 and positive CRP were 96, 76 and 70 percent, respectively. The specificity of them were 46, 65 and 68 percent. The sensitivity of combination of variables 53 percent and the specificity was 82 percent. Conclusion. These findings suggest that each of studied variable are usefull for diagnosis of acute appendicitis but the combination is usefull for rule- out the disease.

  4. Oral and dental considerations in pediatric leukemic patient.

    Padmini, Chiyadu; Bai, K Yellamma

    2014-01-01

    Throughout the world, there have been drastic decline in mortality rate in pediatric leukemic population due to early diagnosis and improvements in oncology treatment. The pediatric dentist plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child's health and quality of life during, and follow up of the cancer treatment. This manuscript discusses recommendations and promotes dental care of the pediatric leukemic patients. PMID:24724033

  5. Oral and Dental Considerations in Pediatric Leukemic Patient

    Padmini, Chiyadu; Bai, K. Yellamma

    2014-01-01

    Throughout the world, there have been drastic decline in mortality rate in pediatric leukemic population due to early diagnosis and improvements in oncology treatment. The pediatric dentist plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child's health and quality of life during, and follow up of the cancer treatment. This manuscript discusses recommendations and promotes dental care of the pediatric leukemic patients.

  6. Clinico-pathological study of appendicitis in a tertiary centre in Vindhya region, Madhya Pradesh, India

    Priyank Sharma

    2016-07-01

    Conclusions: In this study we found that clinical score is a simple, rapid and non-invasive method to early diagnosis of appendicitis. TLC are inflammatory marker are also useful in early diagnosis of acute appendicitis. Ultrasound abdomen is also useful to confirm the diagnosis. The majority of our patients presented early disease. Conservative approach of treatment gave positive response and then we planned for elective appendectomy after regular interval. Because of these negative appendectomy rate are decreasing and morbidity period are also decreasing pre or post appendectomy. There was much less post-operative complication, which were higher in emergency appendectomy. In our study we concluded that timely intervention reduce the negative appendectomy and reduce the length of morbidity. [Int J Res Med Sci 2016; 4(7.000: 2914-2920

  7. Improving diagnosis of appendicitis. Early autologous leukocyte scanning

    A prospective nonrandomized study investigating the accuracy and utility of autologous leukocyte scanning in the diagnosis of appendicitis was performed. One hundred patients in whom the clinical diagnosis of appendicitis was uncertain underwent indium 111 oxyquinoline labelling of autologous leukocytes and underwent scanning 2 hours following reinjection. Of 32 patients with proved appendicitis, three scans revealed normal results (false-negative rate, 0.09). Of 68 patients without appendicitis, three scans had positive results (false-positive rate, 0.03; sensitivity, 0.91; specificity, 0.97; predictive value of positive scan, 0.94; predictive value of negative scan, 0.96; and overall accuracy, 0.95). Scan results altered clinical decisions in 19 patients. In 13 cases, the scan produced images consistent with diagnoses other than appendicitis, expediting appropriate management. Early-imaging In 111 oxyquinoline autologous leukocyte scanning is a practical and highly accurate adjunct for diagnosing appendicitis

  8. Ultrasonography in the diagnosis of appendicitis: evaluation by meta-analysis

    We wanted to review the usefulness of ultrasonography (US) for the diagnosis of appendicitis and to evaluate the diagnostic accuracy of US according to patients' and researcher's characteristics. The relevant Korean articles published between 1985 and 2003 were included in this study if the patients had clinical symptoms of acute appendicitis. The histopathologic findings were the reference standard and the data were presented for 2 x 2 tables. Articles were excluded if patients had no sonographic signs of appendicitis according to graded-compression US. Two reviewers independently extracted the data on study characteristics. The Hasselblad method was used to obtain the combined estimates of sensitivity and specificity for the performance of US. Twenty-two articles (2,643 patients) fulfilled all inclusion criteria. The estimate of δ calculated by combining the sensitivity and specificity was 2.0054(95% confidence interval [CI]: 1.8553, 2.1554) by a random effects model. The overall sensitivity and specificity (95% CI) were 86.7% (85.4 to 88.0), and 90.0% (88.9 to 91.2), respectively. According to the subgroup meta-analysis by patients' characteristics, the δ estimate (95% CI) of dominantly younger age, male, and highly clinical suggestive group for US was 2.2388 (1.8758 to 2.6019), 2.7131 (2.2493 to 3.1770), and 2.4582 (1.7387 to 3.1777), respectively. Also according to subgroup meta-analysis by researcher's characteristics, the δ value (95% CI) for US done by diagnostic radiologists and gray-scale was 2.0195 (1.7942 to 2.2447) and 2.2630 (1.8444 to 2.6815). This evidence suggests that US may be useful for the diagnosis of acute appendicitis, especially when patients are younger age, male, and highly clinical suggestive

  9. Patient and surgeon factors are associated with the use of laparoscopy in appendicitis.

    McCartan, D P

    2012-02-01

    Aim The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis. Method Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy. Results The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048). Conclusion This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.

  10. Rapid identification of the multidrug resistance in the human leukemic cells by near-infrared Fourier transform Raman microspectroscopy

    Beljebbar, Abdelilah; Morjani, Hamid; Sockalingum, Ganesh D.; Manfait, Michel

    1998-04-01

    In this work, we have studied the cancer cell lines sharing a common feature: the multi-drug resistance where P- glycoprotein is responsible for the active efflux of the drug out of the cell. For this, we have used two types of cells, MDR-human leukemic K562 cells and non-MDR acute promyelocytic leukemic HL60 cells. The comparison between normalized micro FT-Raman spectra of resistant and sensitive K652 cells shows a decrease in the intensity of the amide I and III bands and a down shift of the amide I band. On the other hand, control experiments with HL60 cells do not show any remarkable changes. Analysis of micro-FT-Raman spectra by resolution enhancement methods and by chemometrics tools reveal further information concerning the conformational changes of the cell constituents involved in the expression of the MDR-phenotype.

  11. T-cell ALL in ataxia telangiectasia cured with only 7 weeks of anti-leukemic therapy

    Hersby, Ditte S; Sehested, Astrid; Kristensen, Kim;

    2015-01-01

    A 20-month-old girl diagnosed with T-cell acute lymphoblastic leukemia was treated according to the Nordic NOPHO ALL2000 protocol. The patient developed severe immunosuppression and experienced life-threatening adenovirus infection, which was treated with ribavirin and cidofovir. α-fetoprotein was...... 20- to 30-fold elevated, and genetic analysis confirmed the diagnosis of ataxia telangiectasia. Despite receiving only 7 weeks of anti-leukemic therapy, she has stayed in first remission now 8 years after the diagnosis. We speculate that this could be because of increased chemosensitivity of ATM......-mutated leukemic cells, adenovirus causing a direct oncolytic effect, and/or high levels of endogenous cortisol during her severe infection....

  12. Unusual perforated appendicitis within umbilical hernia: CT findings.

    Arnáiz, J; Ortiz, A; Marco de Lucas, E; Piedra, T; Jordá, J; Arnáiz, A M; Pagola, M A

    2006-01-01

    We present the first imaging report of perforated appendicitis in an umbilical hernia. Computed tomography demonstrated a gas-forming abscess within an umbilical hernia and the cecum was found inside the hernial sac, with an inner relation to the abscess. Computed tomographic findings suggested appendicitis as possible diagnosis, which was confirmed at surgery. Physicians must consider appendicitis within the differential diagnosis of an abdominal abscess located near to the cecum, even at an unexpected location. PMID:16465570

  13. MRI for clinically suspected pediatric appendicitis: case interpretation

    Moore, Michael M.; Brian, James M.; Methratta, Sosamma T.; Hulse, Michael A.; Choudhary, Arabinda K.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Division of Pediatric Radiology, Department of Radiology, Hershey, PA (United States)

    2014-05-15

    As utilization of MRI for clinically suspected pediatric appendicitis becomes more common, there will be increased focus on case interpretation. The purpose of this pictorial essay is to share our institution's case interpretation experience. MRI findings of appendicitis include appendicoliths, tip appendicitis, intraluminal fluid-debris level, pitfalls of size measurements, and complications including abscesses. The normal appendix and inguinal appendix are also discussed. (orig.)

  14. A STUDY TO ASSESS THE PROPORTION AND ASSOCIATION OF APPENDICITIS WITH POSITIONAL VARIATION IN A SOUTH INDIAN RURAL TERTIARY CARE CENTER

    Sandeep Kumar David

    2016-03-01

    Full Text Available CONTEXT The commonest position of appendix vermiformis according to the literature is retrocaecal. While during surgery there was found to have variation. Several studies done to assess the position of appendix vermiformis in patients with acute appendicitis has given a conflicting results. Depending on the position the symptom complex also changes, producing different problems and differential diagnosis. AIM This study assess the position of appendix vermiformis in patients with inflamed appendix in the patients undergoing surgery for acute appendicitis at Dr. SM CSI Medical College, Karakonam. DESIGN METHOD AND ANALYSIS The study is a retrospective study done over 2 years in 109 patients who underwent appendicectomy at Dr. SMCSI Medical College. The prevalence of appendicitis among different age groups, and the different position were studied. RESULTS Of the 109 patients 71 were females and 38 males. In the study population 21-40 years age group had the highest frequency of appendicitis. Subcaecal position was seen in 49.5 % of the patients followed by 28.4%. In both the sex group sub caecal position is the commonest position with 57.9% and 45.1% respectively in male and female patients. CONCLUSION Among the patients with acute appendicitis subcaecal position was the commonest position

  15. Epiploic appendagitis of caecum: a diagnostic dilemma [Appendicitis epiploica des Blinddarms: ein diagnostisches Dilemma

    Rashid, Arshad

    2012-10-01

    Full Text Available [english] Epiploic appendagitis is a rare cause of acute abdomen. Depending on the site of occurrence, it can mimic any cause of acute abdomen or disease of the colon and caecal appendix; making its preoperative diagnosis very difficult. We present here a case of a 7-year-old boy misdiagnosed preoperatively as acute appendicitis and later on, upon surgical exploration, found to have caecal appendagitis. The affected epiploic appendage was removed and the patient had an uneventful recovery. We also review the relevant literature and discuss the measures to overcome this diagnostic dilemma. General surgeons should be aware of this self-limiting disease and consider it as a differential diagnosis of acute abdomen.[german] Appendicitis epiploica oder epiploische Appendagitis ist eine seltene Ursache des akuten Abdomens. Je nach Ort des Auftretens kann sie jede Ursache für akuten Unterleibsschmerz oder Erkrankungen des Dickdarms und Appendix vermiformis imitieren, was ihre präoperative Diagnose sehr schwierig macht. Wir präsentieren hier den Fall eines alten Jungen, bei dem präoperativ akute Blinddarmentzündung diagnostiziert wurde. Beim chirurgischen Eingriff stellte sich dann eine Appendicitis epiploica des Blinddarms als Befund heraus. Der betroffene Appendix epiploica wurde entfernt und der Patient erholte sich ohne besondere Vorkommnisse. Wir geben auch eine Übersicht über die relevante Literatur und diskutieren die Maßnahmen, um dieses diagnostische Dilemma zu überwinden. Allgemeine Chirurgen sollten sich dieser selbstlimitierenden Krankheit bewusst sein und sie als eine Differentialdiagnose bei akutem Abdomen in Betracht ziehen.

  16. Musashi2 modulates K562 leukemic cell proliferation and apoptosis involving the MAPK pathway

    Zhang, Huijuan; Tan, Shi; Wang, Juan; Chen, Shana; Quan, Jing; Xian, Jingrong; Zhang, Shuai shuai; He, Jingang; Zhang, Ling, E-mail: lingzhang@cqmu.edu.cn

    2014-01-01

    The RNA-binding protein Musashi2 (Msi2) has been identified as a master regulator within a variety of stem cell populations via the regulation of translational gene expression. A recent study has suggested that Msi2 is strongly expressed in leukemic cells of acute myeloid leukemia patients, and elevated Msi2 is associated with poor prognosis. However, the potential role of Msi2 in leukemogenesis is still not well understood. Here, we investigated the effect of Msi2 knockdown on the biological properties of leukemic cells. High expression of Msi2 was found in K562 and KG-1a leukemic cell lines, and low expression was observed in the U937 cell line. We transduced K562 cells with two independent adenoviral shRNA vectors targeting Msi2 and confirmed knockdown of Msi2 at the mRNA and protein levels. Msi2 silencing inhibited cell growth and caused cell cycle arrest by increasing the expression of p21 and decreasing the expression of cyclin D1 and cdk2. In addition, knockdown of Msi2 promoted cellular apoptosis via the upregulation of Bax and downregulation of Bcl-2 expression. Furthermore, Msi2 knockdown resulted in the inactivation of the ERK/MAPK and p38/MAPK pathways, but no remarkable change in p-AKT was observed. These data provide evidence that Msi2 plays an important role in leukemogenesis involving the MAPK signaling pathway, which indicates that Msi2 may be a novel target for leukemia treatment. - Highlights: • Knockdown of Msi2 inhibited K562 cell growth and arrested cell cycle progression. • Knockdown of Msi2 induced K562 cell apoptosis via the regulation of Bax and Bcl-2. • The MAPK pathway was involved in the process of Msi2-mediated leukemogenesis. • Our data indicate that Msi2 is a potential new target for leukemia treatment.

  17. Acute lymphocytic Leukemia masquerading as acute osteomyelitis

    Two children each developed a focal destructive bone lesion accompanied by intermittent fever, swelling, tenderness and elevated ESR. Blood counts were normal; bone marrow aspiration showed acute leukemia. The bone lesions healed in both patients after anti-leukemic therapy. We suggest that the similar roentgenographic appearance of osteomyelitis, bone infarction and focal destructive lesions in leukemia probably reflects a common, basically ischemic process of bone. (orig.)

  18. SIMULATIONS OF FLOWFIELDS AROUND UNDERWATER APPENDED BODIES

    Huang Zhen-yu; Cheng Hong-rong; Zhou Lian-di; Miao Guo-ping

    2003-01-01

    The numerical method which is based on flux difference splitting, LU decomposition, and implicit high-resolution third-order Essentially Non-Oscillatory (ENO) scheme was constructed for the efficient computation of steady state solution to three-dimensional incompressible Navier-Stokes equations in general coordinates. The flowfields over underwater axisymmetric bodies, full-appended axisymmetric bodies and axisymetric bodies with a ring-wing duct were simulated. The method is proved to be capable of predicting the circumferential-mean velocity distribution at model scale to the accuracy of around 3% of measured values, and of predicting some details of flow features, for example, the wake harmonics.

  19. CT diagnosis of appendicitis with atypical clinical features

    Objective: To investigate the value of CT in diagnosis of appendicitis with atypical clinical features. Methods: CT manifestations of 20 cases of appendicitis, which were not initially considered on clinical presentation, confirmed surgically and pathologically were retrospectively analyzed. Results: The CT findings of appendicitis included: (1) The appendix enlarged in diameter, with wall thickening and enhancement after administration of IV contrast material (7 cases), presence of appendicolith in 4 cases. (2) pericecal inflammation (14 cases). (3) Localized abscess of right lower quadrant (11 cases), calcified appendicolith seen in 2 cases. CT misdiagnosed 2 cases as tumour of ascending colon, and another 2 cases as pelvic inflammatory disease. Conclusions: The clinical diagnosis of appendicitis is very difficult when patients present with atypical signs and symptoms, but in most cases, the correct diagnosis of appendicitis could be made on the basis of CT findings

  20. File list: His.Bld.05.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available His.Bld.05.AllAg.Leukemic_bone_marrow mm9 Histone Blood Leukemic bone marrow SRX471...ttp://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/His.Bld.05.AllAg.Leukemic_bone_marrow.bed ...

  1. File list: Oth.Bld.50.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

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  2. File list: Oth.Bld.20.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

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  3. File list: Oth.Bld.05.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available Oth.Bld.05.AllAg.Leukemic_bone_marrow mm9 TFs and others Blood Leukemic bone marrow... http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Oth.Bld.05.AllAg.Leukemic_bone_marrow.bed ...

  4. File list: ALL.Bld.10.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available ALL.Bld.10.AllAg.Leukemic_bone_marrow mm9 All antigens Blood Leukemic bone marrow S...243 http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/ALL.Bld.10.AllAg.Leukemic_bone_marrow.bed ...

  5. File list: Unc.Bld.50.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available Unc.Bld.50.AllAg.Leukemic_bone_marrow mm9 Unclassified Blood Leukemic bone marrow h...ttp://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Unc.Bld.50.AllAg.Leukemic_bone_marrow.bed ...

  6. File list: Pol.Bld.20.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available Pol.Bld.20.AllAg.Leukemic_bone_marrow mm9 RNA polymerase Blood Leukemic bone marrow... http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Pol.Bld.20.AllAg.Leukemic_bone_marrow.bed ...

  7. File list: Unc.Bld.20.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

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  8. File list: ALL.Bld.50.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available ALL.Bld.50.AllAg.Leukemic_bone_marrow mm9 All antigens Blood Leukemic bone marrow S...261 http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/ALL.Bld.50.AllAg.Leukemic_bone_marrow.bed ...

  9. File list: His.Bld.50.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available His.Bld.50.AllAg.Leukemic_bone_marrow mm9 Histone Blood Leukemic bone marrow SRX471...ttp://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/His.Bld.50.AllAg.Leukemic_bone_marrow.bed ...

  10. File list: Unc.Bld.05.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available Unc.Bld.05.AllAg.Leukemic_bone_marrow mm9 Unclassified Blood Leukemic bone marrow h...ttp://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Unc.Bld.05.AllAg.Leukemic_bone_marrow.bed ...

  11. File list: Unc.Bld.10.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available Unc.Bld.10.AllAg.Leukemic_bone_marrow mm9 Unclassified Blood Leukemic bone marrow h...ttp://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Unc.Bld.10.AllAg.Leukemic_bone_marrow.bed ...

  12. File list: DNS.Bld.20.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available DNS.Bld.20.AllAg.Leukemic_bone_marrow mm9 DNase-seq Blood Leukemic bone marrow http...://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/DNS.Bld.20.AllAg.Leukemic_bone_marrow.bed ...

  13. File list: His.Bld.20.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available His.Bld.20.AllAg.Leukemic_bone_marrow mm9 Histone Blood Leukemic bone marrow SRX471...ttp://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/His.Bld.20.AllAg.Leukemic_bone_marrow.bed ...

  14. File list: Pol.Bld.10.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available Pol.Bld.10.AllAg.Leukemic_bone_marrow mm9 RNA polymerase Blood Leukemic bone marrow... http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Pol.Bld.10.AllAg.Leukemic_bone_marrow.bed ...

  15. File list: ALL.Bld.20.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available ALL.Bld.20.AllAg.Leukemic_bone_marrow mm9 All antigens Blood Leukemic bone marrow S...243 http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/ALL.Bld.20.AllAg.Leukemic_bone_marrow.bed ...

  16. File list: DNS.Bld.10.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available DNS.Bld.10.AllAg.Leukemic_bone_marrow mm9 DNase-seq Blood Leukemic bone marrow http...://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/DNS.Bld.10.AllAg.Leukemic_bone_marrow.bed ...

  17. File list: Oth.Bld.10.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available Oth.Bld.10.AllAg.Leukemic_bone_marrow mm9 TFs and others Blood Leukemic bone marrow... http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Oth.Bld.10.AllAg.Leukemic_bone_marrow.bed ...

  18. File list: ALL.Bld.05.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available ALL.Bld.05.AllAg.Leukemic_bone_marrow mm9 All antigens Blood Leukemic bone marrow S...251 http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/ALL.Bld.05.AllAg.Leukemic_bone_marrow.bed ...

  19. File list: DNS.Bld.05.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available DNS.Bld.05.AllAg.Leukemic_bone_marrow mm9 DNase-seq Blood Leukemic bone marrow http...://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/DNS.Bld.05.AllAg.Leukemic_bone_marrow.bed ...

  20. File list: Pol.Bld.50.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available Pol.Bld.50.AllAg.Leukemic_bone_marrow mm9 RNA polymerase Blood Leukemic bone marrow... http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Pol.Bld.50.AllAg.Leukemic_bone_marrow.bed ...

  1. File list: DNS.Bld.50.AllAg.Leukemic_bone_marrow [Chip-atlas[Archive

    Full Text Available DNS.Bld.50.AllAg.Leukemic_bone_marrow mm9 DNase-seq Blood Leukemic bone marrow http...://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/DNS.Bld.50.AllAg.Leukemic_bone_marrow.bed ...

  2. Apendicite em hérnia femoral com formação de fístula estercoral Stercoral fistula formation in femoral hernia with appendicitis

    Antonio Carlos Weston

    1999-02-01

    Full Text Available The presentation of acute appendicitis in femoral hernia is rare. The gastrointestinal symptons are overshadowed by the local findings. This may lead to delayed diagnosis and complications such as formation of fistula. The authors report a case of a 76-year-old female patient which presented with stercoral fistula after drainage of a right groin abscess ten months earlier.

  3. A diagnostic dilemma: Left-sided appendicitis in a 10 year old boy with previously undiagnosed intestinal malrotation. A case report

    Ashvini Shekhar

    2015-01-01

    Conclusion: Left sided acute appendicitis is a diagnostic dilemma, thus often leading to management delays. It is pertinent to remember that malrotation of the gut is more common than previously thought, and not just a disease of infancy. It is advisable to consider imaging studies while balancing the risk-benefit-ratio of radiation exposure, especially in paediatric cases to cinch the diagnosis.

  4. Genetic instability in leukemic cells from atomic bomb survivors

    MSI (Micro Satellite Instability) analysis was enforced for 29 patients with AML (atomic bomb survivors 13 cases, unexposed persons 16 cases) who developed from 1986 to 1994. When the cases that alterations at two or more parts were recognized in micro-satellite analyses of leukemic cell were defined as MSI, 2 of 16 unexposed persons and 10 of 13 survivors were positive, and significant high rate was recognized (p<0.01) among survivors. This result suggest genetic instability in leukemic cell of atomic bomb survivors. (K.H.)

  5. Diabetes insipidus uncovered during conservative management of complicated acute appendicitis

    Mamtani, Anita; Odom, Stephen R.; Butler, Kathryn L.

    2016-01-01

    Key Clinical Message Diabetes insipidus (DI) arises from impaired function of antidiuretic hormone, characterized by hypovolemia, hypernatremia, polyuria, and polydipsia. This case is a reminder of the rare but challenging obstacle that undiagnosed DI poses in fasting surgical patients, requiring prompt recognition and vigilant management of marked homeostatic imbalances.

  6. Diabetes insipidus uncovered during conservative management of complicated acute appendicitis.

    Mamtani, Anita; Odom, Stephen R; Butler, Kathryn L

    2016-05-01

    Diabetes insipidus (DI) arises from impaired function of antidiuretic hormone, characterized by hypovolemia, hypernatremia, polyuria, and polydipsia. This case is a reminder of the rare but challenging obstacle that undiagnosed DI poses in fasting surgical patients, requiring prompt recognition and vigilant management of marked homeostatic imbalances. PMID:27190614

  7. Methotrexate resistance in relation to treatment outcome in childhood acute lymphoblastic leukemia

    Wojtuszkiewicz, Anna; Peters, Godefridus J; van Woerden, Nicole L;

    2015-01-01

    BACKGROUND: Methotrexate (MTX) eradicates leukemic cells by disrupting de novo nucleotide biosynthesis and DNA replication, resulting in cell death. Since its introduction in 1947, MTX-containing chemotherapeutic regimens have proven instrumental in achieving curative effects in acute lymphoblastic...

  8. Normal Hematopoietic Stem Cells within the AML Bone Marrow Have a Distinct and Higher ALDH Activity Level than Co-Existing Leukemic Stem Cells

    Schuurhuis, Gerrit J.; Meel, Michael H.; Wouters, Floris; Min, Lisa A.; Terwijn, Monique; de Jonge, Nick A.; Kelder, Angele; Snel, Alexander N; Zweegman, Sonja; Ossenkoppele, Gert J.; Smit, Linda

    2013-01-01

    Persistence of leukemic stem cells (LSC) after chemotherapy is thought to be responsible for relapse and prevents the curative treatment of acute myeloid leukemia (AML) patients. LSC and normal hematopoietic stem cells (HSC) share many characteristics and co-exist in the bone marrow of AML patients. For the development of successful LSC-targeted therapy, enabling eradication of LSC while sparing HSC, the identification of differences between LSC and HSC residing within the AML bone marrow is ...

  9. Parasitic Appendicitis From Past to Present in Turkey

    G Coskun

    2010-09-01

    Full Text Available Background: Understanding the etiology of appendicitis is important for developing effective treatments the rela­tionship between parasitic appendicitis and various socio-cultural factors were examined, particu­larly with respect to the incidence of literacy. The aim of the article was to research the relations between para­sitic appendicitis and literacy ratio in population.Methods: Cases of parasitic appendicitis resulting in surgery performed at Buca Seyfi Demirsoy Large State Hospital Surgery Clinic between 2002 and 2009 were retrospectively reviewed and classified accord­ing to age, sex, type of parasite, morbidity, and mortality. Studies conducted in different regions of Turkey as well as in other countries were reviewed to determine if there was a relationship between para­sitic appendicitis and literacy. Results: Of the 1,969 appendectomy cases reviewed, nine were classified as parasitic appendicitis (0.45%. Enterobius vermicularis was observed in seven cases and Taenia spp. in two. The average age was 26.4 yr. No morbidity or mortality was found.Conclusion: The data were compared with a retrospective review of studies conducted in the same regions and a decrease in the rate of parasitic appendicitis was observed during the period between the two re­views. It was determined that a low literacy rate was associated with an increase in the incidence of para­sitic appendicitis. Observations made between different countries also produced similar results. In coun­tries where the incidence of parasitic appendiciticis was greater than 1.5%, the literacy rate was less than 88%. To avoid appendectomy resulting from parasites, it is important to increase education and literacy. In some areas, individuals with appendicitis undergo surgery due to a lack of education or poor literacy.

  10. Aberrant methylation of the M-type phospholipase A2 receptor gene in leukemic cells

    The M-type phospholipase A2 receptor (PLA2R1) plays a crucial role in several signaling pathways and may act as tumor-suppressor. This study examined the expression and methylation of the PLA2R1 gene in Jurkat and U937 leukemic cell lines and its methylation in patients with myelodysplastic syndrome (MDS) or acute leukemia. Sites of methylation of the PLA2R1 locus were identified by sequencing bisulfite-modified DNA fragments. Methylation specific-high resolution melting (MS-HRM) analysis was then carried out to quantify PLA2R1 methylation at 5-CpG sites identified with differences in methylation between healthy control subjects and leukemic patients using sequencing of bisulfite-modified genomic DNA. Expression of PLA2R1 was found to be completely down-regulated in Jurkat and U937 cells, accompanied by complete methylation of PLA2R1 promoter and down-stream regions; PLA2R1 was re-expressed after exposure of cells to 5-aza-2´-deoxycytidine. MS-HRM analysis of the PLA2R1 locus in patients with different types of leukemia indicated an average methylation of 28.9% ± 17.8%, compared to less than 9% in control subjects. In MDS patients the extent of PLA2R1 methylation significantly increased with disease risk. Furthermore, measurements of PLA2R1 methylation appeared useful for predicting responsiveness to the methyltransferase inhibitor, azacitidine, as a pre-emptive treatment to avoid hematological relapse in patients with high-risk MDS or acute myeloid leukemia. The study shows for the first time that PLA2R1 gene sequences are a target of hypermethylation in leukemia, which may have pathophysiological relevance for disease evolution in MDS and leukemogenesis

  11. Aberrant methylation of the M-type phospholipase A2 receptor gene in leukemic cells

    Menschikowski Mario

    2012-12-01

    Full Text Available Abstract Background The M-type phospholipase A2 receptor (PLA2R1 plays a crucial role in several signaling pathways and may act as tumor-suppressor. This study examined the expression and methylation of the PLA2R1 gene in Jurkat and U937 leukemic cell lines and its methylation in patients with myelodysplastic syndrome (MDS or acute leukemia. Methods Sites of methylation of the PLA2R1 locus were identified by sequencing bisulfite-modified DNA fragments. Methylation specific-high resolution melting (MS-HRM analysis was then carried out to quantify PLA2R1 methylation at 5`-CpG sites identified with differences in methylation between healthy control subjects and leukemic patients using sequencing of bisulfite-modified genomic DNA. Results Expression of PLA2R1 was found to be completely down-regulated in Jurkat and U937 cells, accompanied by complete methylation of PLA2R1 promoter and down-stream regions; PLA2R1 was re-expressed after exposure of cells to 5-aza-2´-deoxycytidine. MS-HRM analysis of the PLA2R1 locus in patients with different types of leukemia indicated an average methylation of 28.9% ± 17.8%, compared to less than 9% in control subjects. In MDS patients the extent of PLA2R1 methylation significantly increased with disease risk. Furthermore, measurements of PLA2R1 methylation appeared useful for predicting responsiveness to the methyltransferase inhibitor, azacitidine, as a pre-emptive treatment to avoid hematological relapse in patients with high-risk MDS or acute myeloid leukemia. Conclusions The study shows for the first time that PLA2R1 gene sequences are a target of hypermethylation in leukemia, which may have pathophysiological relevance for disease evolution in MDS and leukemogenesis.

  12. Loss of Mismatched HLA on the Leukemic Blasts of Patients With Relapsed Lymphoid Malignancies Following Bone Marrow Transplantation From Related Donors With HLA Class II Mismatches in the Graft Versus Host Direction.

    Hirabayashi, Koichi; Kurata, Takashi; Horiuchi, Kazuki; Saito, Shoji; Shigemura, Tomonari; Tanaka, Miyuki; Yanagisawa, Ryu; Matsuda, Kazuyuki; Sakashita, Kazuo; Koike, Kenichi; Nakazawa, Yozo

    2016-04-01

    Mechanisms of relapse of acute lymphoblastic leukemia (ALL) after human leukocyte antigen (HLA) class II mismatched hematopoietic stem cell transplantation (HSCT) remain unclear. We report two children with relapsed ALL after HSCT from related donors with HLA-DRB1 and -DQB1 mismatches in the graft versus host direction. One lost HLA-DRB1, DQB1, and DPB1 alleles, and the other lost one HLA haplotype of the leukemic blasts at relapse. HLA class II loss may be a triggering event for ALL relapse after partially HLA-mismatched-related HSCT. In addition, HLA typing of relapsed leukemic blasts could be vital in the selection of retransplant donors. PMID:26544669

  13. When and why use unenhanced computed tomography in patients with acute abdomen

    The use of unenhanced computed tomography has been frequently recommended for the initial assessment of patients with clinical suspicion of acute abdomen instead of other diagnostic methods. The authors present a review of the literature on the main aspects, advantages, limitations and efficacy of unenhanced computed tomography for the diagnosis of acute appendicitis, renal colic, diverticulitis, acute pancreatitis, primary epiploic appendicitis, pneumoperitoneum and small bowel obstruction. The advantages and limitations of this technique are also discussed. (author)

  14. New synthetic strategies for xanthene-dye-appended cyclodextrins.

    Malanga, Milo; Darcsi, Andras; Balint, Mihaly; Benkovics, Gabor; Sohajda, Tamas; Beni, Szabolcs

    2016-01-01

    Xanthene dyes can be appended to cyclodextrins via an ester or amide bridge in order to switch the fluorescence on or off. This is made possible through the formation of nonfluorescent lactones or lactams as the fluorophore can reversibly cyclize. In this context we report a green approach for the synthesis of switchable xanthene-dye-appended cyclodextrins based on the coupling agent 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMT-MM). By using 6-monoamino-β-cyclodextrin and commercially available inexpensive dyes, we prepared rhodamine- and fluorescein-appended cyclodextrins. The compounds were characterized by NMR and IR spectroscopy and MS spectrometry, their UV-vis spectra were recorded at various pH, and their purity was determined by capillary electrophoresis. Two potential models for the supramolecular assembly of the xanthene-dye-appended cyclodextrins were developed based on the set of data collected by the extensive NMR characterization. PMID:27340446

  15. BODIPY atropisomer interconversion, face discrimination, and superstructure appending.

    Doulain, Pierre-Emmanuel; Goze, Christine; Bodio, Ewen; Richard, Philippe; Decréau, Richard A

    2016-03-25

    A strategy was developed to append sterically hindered apical pickets on both faces of the BODIPY platform to prevent stacking and aggregation. Ortho-substitution of both the meso-phenyl ring and the boron-bound catechol affords the right directionality to append pickets, achieve face discrimination, featuring two interconvertible atropisomers, and is reminiscent of the picket-fence strategy in porphyrins. PMID:26927530

  16. CT following US for possible appendicitis: anatomic coverage

    O' Malley, Martin E. [University of Toronto, Princess Margaret Hospital, 3-920, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Alharbi, Fawaz [University of Toronto, Toronto General Hospital, NCSB 1C572, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Qassim University, Department of Medical Imaging, Buraydah, Qassim (Saudi Arabia); Chawla, Tanya P. [University of Toronto, Mount Sinai Hospital, Room 567, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Moshonov, Hadas [University of Toronto, Joint Department of Medical Imaging, Toronto, Ontario (Canada)

    2016-02-15

    To determine superior-inferior anatomic borders for CT following inconclusive/nondiagnostic US for possible appendicitis. Ninety-nine patients with possible appendicitis and inconclusive/nondiagnostic US followed by CT were included in this retrospective study. Two radiologists reviewed CT images and determined superior-inferior anatomic borders required to diagnose or exclude appendicitis and diagnose alternative causes. This ''targeted'' coverage was used to estimate potential reduction in anatomic coverage compared to standard abdominal/pelvic CT. The study group included 83 women and 16 men; mean age 32 (median, 29; range 18-73) years. Final diagnoses were: nonspecific abdominal pain 50/99 (51 %), appendicitis 26/99 (26 %), gynaecological 12/99 (12 %), gastrointestinal 9/99 (10 %), and musculoskeletal 2/99 (2 %). Median dose-length product for standard CT was 890.0 (range, 306.3 - 2493.9) mGy.cm. To confidently diagnose/exclude appendicitis or identify alternative diagnoses, maximum superior-inferior anatomic CT coverage was the superior border of L2-superior border of pubic symphysis, for both reviewers. Targeted CT would reduce anatomic coverage by 30-55 % (mean 39 %, median 40 %) compared to standard CT. When CT is performed for appendicitis following inconclusive/nondiagnostic US, targeted CT from the superior border of L2-superior border of pubic symphysis can be used resulting in significant reduction in exposure to ionizing radiation compared to standard CT. (orig.)

  17. CT following US for possible appendicitis: anatomic coverage

    To determine superior-inferior anatomic borders for CT following inconclusive/nondiagnostic US for possible appendicitis. Ninety-nine patients with possible appendicitis and inconclusive/nondiagnostic US followed by CT were included in this retrospective study. Two radiologists reviewed CT images and determined superior-inferior anatomic borders required to diagnose or exclude appendicitis and diagnose alternative causes. This ''targeted'' coverage was used to estimate potential reduction in anatomic coverage compared to standard abdominal/pelvic CT. The study group included 83 women and 16 men; mean age 32 (median, 29; range 18-73) years. Final diagnoses were: nonspecific abdominal pain 50/99 (51 %), appendicitis 26/99 (26 %), gynaecological 12/99 (12 %), gastrointestinal 9/99 (10 %), and musculoskeletal 2/99 (2 %). Median dose-length product for standard CT was 890.0 (range, 306.3 - 2493.9) mGy.cm. To confidently diagnose/exclude appendicitis or identify alternative diagnoses, maximum superior-inferior anatomic CT coverage was the superior border of L2-superior border of pubic symphysis, for both reviewers. Targeted CT would reduce anatomic coverage by 30-55 % (mean 39 %, median 40 %) compared to standard CT. When CT is performed for appendicitis following inconclusive/nondiagnostic US, targeted CT from the superior border of L2-superior border of pubic symphysis can be used resulting in significant reduction in exposure to ionizing radiation compared to standard CT. (orig.)

  18. The role of imaging in children with suspected appendicitis: the UK perspective

    The diagnosis of uncomplicated acute appendicitis is often straightforward, allowing timely appendicectomy without the need for expensive tests or imaging. Repeated clinical examination by an experienced surgeon has traditionally been the key to making the diagnosis in both straightforward and difficult cases. Nonetheless, all surgeons will remove some normal appendices. Sometimes it can be particularly difficult to make the diagnosis, especially in the child under 5 years of age, in teenage girls, in young women and in the elderly. When difficult to make, the diagnosis may be significantly delayed and since the pathology is progressive, the patient may suffer potentially avoidable complications. This paper looks at two potential roles for imaging. Firstly, can imaging, applied selectively, help make the difficult diagnosis less difficult and so reduce delays and morbidity? Secondly, could imaging all patients with suspected appendicitis reduce the number of normal appendices removed from children who seem to have all the signs and symptoms of straightforward uncomplicated acute appendicitis but who actually have presumed self-resolving non-appendiceal pathology? The answer to these questions may depend on three factors that are not entirely independent: a surgical unit's current audited negative appendicectomy rate, population base/case mix and the expertise of the examining surgeon. Individual surgeons and some surgical units, by policy, use modern imaging techniques with quite different frequencies that may be appropriate depending on these three factors. This article argues that a careful history and repeated clinical examination is the key to making the diagnosis, with imaging, primarily ultrasonography, being used in patients with a palpable mass or in those having had 48 h of hospital observation without progress. In Europe, imaging has played a limited role in the investigation of the child with suspected appendicitis with the diagnosis relying on repeated

  19. Duplication and loss of chromosome 21 in two children with Down syndrome and acute leukemia

    Rogan, P.K.; Close, P.; Gannutz, L. [Pennsylvania State Univ., Hershey, PA (United States)] [and others

    1995-11-06

    Acute leukemia in Down syndrome (DS) is often associated with additional changes in the number of structure of chromosome 21. We present two DS patients whose leukemic karyotypes were associated with changes in chromosome 21 ploidy. Patient 1 developed acute lymphocytic leukemia (type L1); disomy for chromosome 21 was evident in all blast cells examined. Loss of the paternal chromosome in the leukemic clone produced maternal uniparental disomy with isodisomy over a 25-cM interval. The second patient had acute monoblastic leukemia (type M5) with tetrasomy 21 in all leukemic cells. DNA polymorphism analysis showed duplicate paternal chromosomes in the constitutional genotype. The maternal chromosome was subsequently duplicated in the leukemic clone. The distinct inheritance patterns of chromosome 21 in the blast cells of these patients would appear to indicate that leukemogenesis occurred by different genetic mechanisms in each individual. 57 refs., 2 figs., 3 tabs.

  20. Novel agents inhibit human leukemic cells

    Wei-ping YU; Juan LI

    2012-01-01

    Ouabain (OUA) and pyrithione zinc (PZ) have been proved as the potential drugs for treating acute myeloid leukemia (AML).Selected from a screening among 1040 Food and Drug Administration-approved pharmacological agents,both drugs showability to induce apoptosis of the culturing AML cells,exhibiting the poisoning effect on the cells.Studies also reveal the efficiency of the drugs in inhibiting the growth of human AML cells injected into the mice lacking of immunity and killing primary AML cells from the peripheral blood of AML patients[1].