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Query: UMLS:C0003615 (appendicitis)
 4,439 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The role of the common parameters of inflammation in the diagnosis of acute appendicitis was studied by measuring axillary temperature (Tax), blood leukocyte (Leuk) and lymphocyte fraction (Lymph), serum C-reactive protein (CRP) and ESR in 354 patients with clinical diagnosis of acute appendicitis. Laparotomy showed normal appendix in 97 cases, but deduction of 14 with other surgically correctable disorders gave the negative appendectomy rate 83/354 (23.4%). The appendix had perforated in 9.9%. Tax, Leuk, Lymph and CRP could significantly differentiate acute appendicitis from the other cases, with respective sensitivity (and false positive) percentages 88.7 (66.0), 78.5 (24.7), 84.4 (48.5) and 52.7 (24.7). Although such statistical differences are not particularly helpful in preoperative diagnosis of individual cases, none of the 37 patients with simultaneously normal Leuk, Lymph and CRP had obvious appendicitis (2 probably had incipient inflammation). If laparotomy had not been performed in these 37 cases, almost half of the unnecessary operations could have been avoided, thereby reducing the negative appendectomy rate to 15.2%, with 11.7% perforation rate.
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PMID:Inflammation parameters in the diagnosis of acute appendicitis. 335 83

In cases of partially uncharacteristic clinical symptoms with no typical leukocytosis and no ESR elevation, laparotomy reveals not seldom an acute phlegmonous appendix. As compared with the similar disease in younger people appendicitis of the aged presents more complications and a higher mortality rate which can partially explained by clinically meaningful secondary findings and a lesser degree of peritoneal inflammation. The mortality rate of appendicitis in the aged could be markedly reduced. This may be attributed to emergency operation of clinically diagnosed appendicitis in the aged, to improve anaesthetic technique, to infusion therapy and parenteral feeding and last not least postoperative administering of antibiotics.
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PMID:[Appendicitis in the aged (author's transl)]. 726 36

In a retrospective study, clinical and laboratory findings in 454 patients subjected to laparotomy for suspected acute appendicitis were evaluated. A normal appendix was found in 25% of the total series and was twice as common in female as in male patients. Perforated appendicitis was present in 8% of the series, most commonly in the youngest (less than 5 years) and the oldest (greater than 40 years) age groups. The incidence of severe appendicitis increased with the duration of the preoperative abdominal symptoms. Of the patients with a 'laboratory profile' including fever and leukocytosis, 44% had gangrenous or perferated appendicitis. Of those who additionally had elevated ESR (greater than 20 mm), 62% showed a gangernous or perforated appendicitis. The overall incidence of wound infection was 13.9%. Wound infection was closely related to the state of the appendix. The results thus indicated that patient's age, duration of abdominal symptoms and the 'laboratory profile' are important parameters for assessment of clinically suspected acute appendicitis.
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PMID:Clinical and laboratory findings in patients subjected to laparotomy for suspected acute appendicitis. 737 84

Forty-seven consecutive patients with clinically suspected acute appendicitis were studied at this hospital from June, 1994 to March, 1995. All the patients had received a complete study protocol including: detailed history and physical examination; complete blood cell count with differential count; erythrocyte sedimentation rate; C-reactive protein and sonographic examination. The male to female ratio is 29: 18. The age range is from 4 to 14 years. Thirty patients received laparotomy and 27 were diagnosed as appendicitis by histologic findings including 6 cases of perforated appendicitis. The remaining 3 patients had no evidence of appendicitis histologically. The other 17 patients were observed clinically. In these, the abdominal pain resolved spontaneously, or it was proved due to other diseases. The sensitivity and specificity of these laboratory examinations are: leukocytosis (> 10,000/mm3): 85. 2%, 65%; leukocytosis with a shift-to-the-left (neutrophil > 75%): 81.5%, 70%; elevated ESR (> 20 mm/hr): 40.7%, 85%; elevated CRP (> 0.9 mg/dl): 70.4%, 65%; (> 5 mg/dl); 51.9%, 95%; sonography: 85.2%, 100%. There were 4 false-negative and no false-positive ultrasonographic results in our study. Five of the 6 case of perforated appendicitis had elevated CRP levels of more than 8 mg/dl. In conclusion, detailed history taking and physical examination are still the most reliable tools for diagnosis. For the doubtful cases, sonography can provide excellent specificity and good sensitivity for differential diagnosis. The classical tools of leukocytosis and shift-to-the-left can only provide a screening property but not for diagnosis. CRP was not a good predictor in our study, but it can be a useful parameter when perforated appendicitis is suspected.
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PMID:Laboratory aid and ultrasonography in the diagnosis of appendicitis in children. 859 27

In the revised guideline of the Dutch College of General Practitioners on pelvic inflammatory disease (PID), 5 criteria must be met to establish the diagnosis: (a) non-acute lower abdominal pain; (b) pain on upward movement or adnexal tenderness during vaginal touch; (c) painful or swollen adnexae; (d) ESR > or = 15 mm in the 1st hour or a temperature > 38 degrees C, and (e) no indications for other diseases, such as appendicitis or an extra-uterine pregnancy. Treatment is started when all criteria are met. In case ofuncertainty, the patient should be referred to a gynaecologist. In quite a few patients, however, the accumulated certainty obtained by a general practitioner from the 5 criteria still leaves room for doubt about the right moment for referral. Another potential weak point in this otherwise very practicable guideline is that the start of treatment in young women of childbearing age, in whom this disease is most prevalent, could well have been recommended at an earlier stage.
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PMID:[The practice guideline 'pelvic inflammatory disease' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice]. 1747 70

The 1995 guideline on pelvic inflammatory disease (PID) has been updated. The general practitioner should consider PID whenever a woman of childbearing age complains of lower abdominal pain; the diagnosis should then be based on 5 criteria: (a) non-acute lower abdominal pain; (b) pain on upward movement or adnexal tenderness during vaginal touch; (c) painful or swollen adnexae; (d) ESR > or = 15 mm in the 1st hour or a temperature > 38 degree C, and (e) no indications for other diseases, such as appendicitis or an extra-uterine pregnancy. In case of diagnostic doubt, a gynaecologist must be consulted. Rapid treatment with antibiotics diminishes symptoms, shortens the course of disease, and may prevent complications such as infertility or extra-uterine pregnancy. Treatment should be started with ofloxacin and metronidazole. Due to the increasing antibiotic resistance of Neisseria gonorrhoeae, when there are indications for this pathogen the medicinal treatment should immediately be directed at it by means of cefotaxim, doxycycline and metronidazole. In his or her information to the patient, the general practitioner should devote attention to the major role of sexually transmissible micro-organisms and give advice, if necessary, regarding high-risk behaviour.
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PMID:[Summary of the practice guideline 'Pelvic inflammatory disease' (first revision) from the Dutch College of General Practitioners]. 1747 70

Authors describe a case of asymptomatic amoebic liver abscess discovered at the seven years old boy admitted, and operated on account of appendicitis. In otherwise correct postappendectomy period raised leucocytosis and ESR was observed. Ultrasound examination revealed an abscess in the right liver lobe. Percutaneous, ultrasound guided, aspiration was performed. A more detailed medical history was taken, in quest for aetiology of abscess. Four months before a boy was on vacation in Venezuela, where he had a bout of diarrhoea. In consecutive months he didn't notify any ailment. Aetiology of an amoebic abscess was confirmed by serological test. Percutaneous aspiration with tynidazole given orally turned out to be effective therapy. The good result of treatment was confirmed by ultrasound examination seven weeks later.
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PMID:[Amoebic liver abscess--case report]. 2049 64