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

Acute appendicitis is the most common diagnosis made (in the Western world) in patients with an "acute abdomen." Although the mortality rate has been vastly reduced, the diagnostic inaccuracy rate of 15% to 20% has remained unchanged in the past 100 years. In this article, the authors report the ultrasonographic findings in 80 patients examined using a small linear-array transducer, which enables direct visualization of the inflamed appendix. During 22 months, 80 patients (28 males and 52 females; age range, 3 to 81 years; mean, 32.3 years) with equivocal clinical signs and symptoms of acute appendicitis were examined sonographically. Of the 29 patients whose appendicitis was verified at surgery, ultrasonography was positive in 26, with an overall sensitivity of 90%. Of the 51 patients who did not have appendicitis, ultrasonography was negative in all, with a specificity of 100%. The authors concur with reports in the literature that ultrasonography is helpful in diagnosing appendicitis.
J Natl Med Assoc 1989 Sep
PMID:Ultrasound with graded compression in the evaluation of acute appendicitis. 267 64

Endometriosis affects 8%-15% of all women, and of these 3%-37% have intestinal involvement. Affected women are typically of childbearing age and of low parity, with a history of cyclic abdominal pain and progressive dysmenorrhea. Endometriosis may involve the rectum and sigmoid, ileum, cecum, and appendix, generating symptoms suggestive of acute obstruction, appendicitis, ileitis, diverticulitis, or colonic carcinoma. Thus, this entity should be included in the differential diagnosis of recurrent abdominal pain and other episodic bowel symptoms in women of childbearing age.
Mt Sinai J Med 1989 Sep
PMID:Intestinal endometriosis and its complications: case report and review. 267 1

Strongyloidiasis is a potentially life-threatening condition which, when appropriately diagnosed early in its course, is easily eradicated. When severe, it may mimic other disease processes including appendicitis or severe pelvic inflammatory disease. The diagnosis of parasitic infestation should be considered in any individual who has lived in an endemic area and presents with diarrhea regardless of attendant conditions and superimposed disease processes. A minimum workup consisting of stool examination for ova and parasites should be performed on all such individuals. Thiabendazol is the treatment of choice in nonpregnant patients; however, piperazine tartrate has established safety and efficacy in pregnancy and is therefore preferable in the pregnant patient.
Obstet Gynecol 1989 Sep
PMID:Pelvic inflammatory disease complicated by massive helminthic hyperinfection. 276 37

Although the clinical diagnosis of appendicitis in pregnancy seems to be complicated by the physiologic changes of pregnancy, evidence from controlled studies is lacking. The aims of this study were to determine whether there are any features of appendicitis in pregnant women that would help to establish the diagnosis and whether any difference exists between the presentation of appendicitis in pregnant and nonpregnant women. Twenty-eight pregnant women with a clinical diagnosis of appendicitis were compared with an equal number of nonpregnant patients matched for age and randomly selected from a group of patients who had appendicitis. No differences were observed in the presenting symptoms, physical signs and laboratory tests. The false-positive rates were identical. The results indicated that the diagnosis of appendicitis is no more difficult in the pregnant state than in the nonpregnant state.
Can J Surg 1989 Sep
PMID:Diagnosis of acute appendicitis in pregnancy. 276 41

Ileocecal mass is occasionally encountered unexpectedly by surgeons operating for presumed appendicitis. A five-year retrospective study was performed to review the management of this problem. Thirteen patients were identified who had had right hemicolectomy performed for unexpected mass in which neoplasm, diverticular disease, or inflammatory bowel disease could not be differentiated from severe appendicitis at laparotomy. Seven patients (group 1) had a final pathologic diagnosis of appendiceal phlegmon. The other patients (group 2) had Crohn's disease, typhlitis, or neoplasm. Right hemicolectomy was performed with a morbidity of 7% and mortality of 7% in all patients. This procedure is acceptable for unexpected cecal mass.
Arch Surg 1989 Sep
PMID:Evaluation of right hemicolectomy for unexpected cecal mass. 277 5

Removal of a normal appendix because of suspected appendicitis occurs most frequently in women of reproductive age. We investigated the value of laparoscopy in the diagnostic evaluation for possible appendicitis in women of childbearing age. Fifty-one women were entered in a management protocol, which included diagnostic laparoscopy in instances with atypical features. Twenty patients underwent immediate appendectomy because of history and physical findings classical for appendicitis; 31 women with atypical history and physical findings underwent an initial diagnostic laparoscopy. In the group of patients who underwent immediate appendectomy because of classical presentation, five of the appendices removed were normal. At laparoscopy, appendicitis was diagnosed in five patients, another disease in 15 and no diagnostic abnormality was found in six. Five patients had a normal appendix removed, two because of questionable inflammation and three because of nonvisualization of the appendix. There were no false-negative examination results. Twenty-one patients required no further operative intervention after laparoscopy. The negative appendectomy rate remained unchanged (ten negative appendectomies of 30 performed). Definitive diagnoses of eight instances of pelvic inflammatory disease, six of ruptured ovarian cysts and one instance of ileitis of the small intestine were made earlier than would have been possible without diagnostic laparoscopy in this setting. Diagnostic laparoscopy permits earlier definitive diagnosis and prompt institution of appropriate therapy for disease of the female reproductive tract that simulates appendicitis. Caution is advised, however, when diagnostic laparoscopy is applied more frequently than right lower quadrant exploration in the management of probable appendicitis. The improvement in diagnostic accuracy may be offset by an increased number of negative appendectomies resulting from nonvisualization and false-positive inflammation.
Surg Gynecol Obstet 1988 Sep
PMID:Value of diagnostic laparoscopy in young women with possible appendicitis. 297 Jun 82

This study reports eight patients who underwent appendicectomy between 1978 and 1986 for apparently isolated, previously undiagnosed Crohn's disease of the appendix. All patients have since remained well with no sign of disease recurrence. This may represent a less aggressive form of Crohn's disease or be a different entity, namely granulomatous appendicitis.
Ann R Coll Surg Engl 1988 Sep
PMID:Crohn's disease of the appendix. 305 7

A multicentre study of computer aided diagnosis for patients with acute abdominal pain was performed in eight centres with over 250 participating doctors and 16,737 patients. Performance in diagnosis and decision making was compared over two periods: a test period (when a small computer system was provided to aid diagnosis) and a baseline period (before the system was installed). The two periods were well matched for type of case and rate of accrual. The system proved reliable and was used in 75.1% of possible cases. User reaction was broadly favourable. During the test period improvements were noted in diagnosis, decision making, and patient outcome. Initial diagnostic accuracy rose from 45.6% to 65.3%. The negative laparotomy rate fell by almost half, as did the perforation rate among patients with appendicitis (from 23.7% to 11.5%). The bad management error rate fell from 0.9% to 0.2%, and the observed mortality fell by 22.0%. The savings made were estimated as amounting to 278 laparotomies and 8,516 bed nights during the trial period--equivalent throughout the National Health Service to annual savings in resources worth over 20m pounds and direct cost savings of over 5m pounds. Computer aided diagnosis is a useful system for improving diagnosis and encouraging better clinical practice.
Br Med J (Clin Res Ed) 1986 Sep 27
PMID:Computer aided diagnosis of acute abdominal pain: a multicentre study. 309 64

Cefsulodin (CFS), a new antipseudomonal cephalosporin, shows a potent antibacterial activity against Pseudomonas aeruginosa and some Gram-positive bacteria, whereas it shows low activity against many Gram-negative rods. Against clinical isolates of P. aeruginosa, CFS was about 10 times more active than sulbenicillin and carbenicillin, and had a similar activity to gentamicin and dibekacin. The CFS was administered by an intravenous bolus injection at a dose of 1 g to each of 14 patients operated for acute peritonitis with drainage or radical mastectomy with drainage to treat breast cancer. These cases included 3 of localized peritonitis due to perforative appendicitis, 3 of diffuse peritonitis due to perforative duodenal ulcer, 2 of panperitonitis due to intestinal obstruction and perforative sigmoid colon cancer, 4 of subacute cholangitis, localized peritonitis T-tube choledochal drainage due to choledocholithiasis, and 2 of breast cancer. Materials from drain exudate were taken at intervals with sterilized paper discs and CFS concentrations were determined by the paper disc bioassay method with P. aeruginosa NCTC 10490 as the test organism. Serum concentrations of CFS just after injection reached 135.4 +/- 66.1 micrograms/ml, and they were 2.7 +/- 1.5 micrograms/ml at 6 hours after injection. Concentrations in purulent exudates of patients with acute peritonitis increased quickly after intravenous bolus injections, and reached maximum levels relatively early after injection in cases 2 to 3 days after operation. In cases 10 to 13 days after operation, CFS levels were comparatively low and reached to peak levels at 4 to 5 hours after injection. Levels of CFS in purulent exudate tended to increase in proportion to the severity of symptoms, as did CFS levels in appendix wall. Pseudomonas spp. were not isolated in this study, but MICs of CFS were mostly around 1.56 to 3.13 micrograms/ml when clinically isolated Pseudomonas spp. were present at 10(6) cells/ml. Levels of CFS in infected exudate were higher than the above MIC values against Pseudomonas spp. Therefore, CFS were a useful drug for the chemotherapy against pseudomonal infections.
Jpn J Antibiot 1986 Sep
PMID:[Cefsulodin concentration in exudates from drainage of patients with acute peritonitis following intravenous administration]. 309 29

This prospective study compared the efficacy of sulbactam/ampicillin and clindamycin/gentamicin in the treatment of children with bacterial peritonitis. Of the 29 children enrolled, 17 were evaluable; eight received sulbactam/ampicillin/gentamicin and nine clindamycin/gentamicin. Sixteen patients were previously healthy children with appendicitis. An average of 3.6 bacterial species were recovered from the peritoneal fluid of each patient. E coli and B fragilis were the most common aerobic and anaerobic isolates, recovered from 15 and ten patients, respectively. Pseudomonas aeruginosa was recovered from seven of 17 children; the three children with P aeruginosa infections randomized to the sulbactam/ampicillin group received gentamicin in addition to the investigational agents throughout the treatment course. Although the study groups were small, there was no difference in age, sex, number of pathogens per patient, duration of hospitalization, toxicity, or treatment failures between the two treatment groups or between children infected with P aeruginosa and controls. As a result of the high prevalence of P aeruginosa in the peritoneal exudate of otherwise healthy children with appendicitis, initial antimicrobial therapy in this patient population should include agents effective against this organism.
J Pediatr Surg 1987 Sep
PMID:Pseudomonas aeruginosa as a primary pathogen in children with bacterial peritonitis. 311 5


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