Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Proponents of laparoscopic appendectomy emphasize the advantages of laparoscopic operation--decreased hospitalization, paralytic ileus, postoperative pain and wound complications, including infection. This study compared open laparoscopic appendectomy with laparoscopic appendectomy. To compare the two techniques, patients undergoing laparoscopic appendectomy at four hospitals were compared with patients undergoing open appendectomy during a six month period. Excluded were incidental appendectomies and patients with perforated appendicitis. An equal number of pediatric patients undergoing laparoscopic and open procedures were included in the analysis to avoid bias, because most of the laparoscopic appendectomies were performed in the adult patient population (age of more than 16 years). A University Medical Center, a Veterans Administration and two community hospitals were the settings. Patients undergoing laparoscopic appendectomy (n = 54) had an average age of 25.7 +/- 1.5 (range of six to 59 years). These patients were compared with 121 patients undergoing open appendectomy whose average age was 23.7 +/- 1.8 (range of three to 83 years). The race and gender distribution were similar in the two groups. Traditional open appendectomy was compared with a group of patients undergoing laparoscopic appendectomy. Variables evaluated were operating room time, number of patients who reported nausea, days until patient tolerated a regular diet, days of hospitalization, postoperative pain medication and wound infection rate. Results are expressed as the mean plus or minus standard error of the mean. Analysis of variance was used to compute continuous variables and Fischer's exact test was used for discrete variables. The laparoscopic approach was attempted in 61 patients and completed in 54 patients. Open appendectomy was performed upon 121 patients. Nineteen patients (18 who underwent open operation and one patient who underwent laparoscopic operation) were excluded from further analysis because of perforated appendicitis. The open procedure took less time (p < 0.05). However, there were more wound infections than in the laparoscopic group (seven of 103 versus zero of 53; p = 0.09). Patients with acute appendicitis recuperated more quickly from the laparoscopic procedure, as evidenced by the time until eating regular diet, period of hospitalization, incidence of nausea and pain medications on postoperative day one (p < 0.05). The absence of wound infections after laparoscopic appendectomy can be attributed to the practice of placing the appendix in a sterile bag or into the trocar sleeve before removal from the abdomen. Laparoscopic appendectomy reduces the period of hospitalization, postoperative ileus, nausea and postoperative pain in patients with acute appendicitis.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:A review of the results of laparoscopic versus open appendectomy. 821 99

A total of 111 patients referred with a diagnosis of suspected "appendicitis" were entered into a prospective study. The surgeon and radiologist in charge of ultrasonography made separate diagnoses, and their findings were then combined and discussed as indications for surgery. Clinically, a history of pain migration proved to be reliable (p < 0.0001) as a diagnostic indicator, in contrast to nausea and initial irregularity of bowels. The duration of symptoms was significantly shorter in patients with proved appendicitis than among patients with negative findings (median 24 hours compared with 41 hours, p < 0.04). Among patients with perforated appendicitis, the symptomatic history was prolonged (not significantly) by 3 hours. Peritoneal signs such as pain on percussion, rebound tenderness, guarding, and a leukocytosis of more than 13,000/mm3 were indicative of appendicitis (p = 0.0001 for each sign). Lively bowel sounds excluded the possibility of appendicitis (p = 0.001). Scanty bowel sounds, rectal tenderness, axillorectal temperature difference, and a left shift in leukocytes were of no diagnostic significance. The doctor's "clinical experience" is significant at the level of p < 0.03. On ultrasonography, the following signs were indicative of appendicitis: periappendicular infiltration (p = 0.0003), a visible "cockade," and an appendix larger than 12 mm in diameter (p = 0.04). For 75% of the patients the surgeon was sure of his own clinical diagnosis and did not allow himself to be influenced by the sonographic findings. In 12% of doubtful cases ultrasonographic results decisively favored operation, and in 4.5% (n = 5) it prevented an unnecessary laparotomy in the presence of positive clinical symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Appendicitis diagnosis today: clinical and ultrasonic deductions. 851 21

The symptoms of right-sided renal colic mimic sometimes acute appendicitis. A prospective comparative study of 188 patients with ureteral stone and 188 patients with acute appendicitis was performed to evaluate the features of differential diagnosis. Appendicitis caused more often nausea (81 vs 11%), fever and localized pain in the McBurney (97 vs 59%) than renal colic. The patients with ureteral stone had tenderness in 16% in the right lower quadrant. The mean values of C-reactive protein (41 mg/l) and blood leukocytes (14 x 10(9)/l) were elevated in appendicitis, but not in renal colic (14 mg/l and 10 x 10(9)/ l). Urinanalysis revealed red cells in 92% of ureteral stones compared with 26% in appendicitis. Only one of 188 patients with appendicitis was first misdiagnosed to have renal colic. A mistake of appendicitis for ureteral stone is clinically rare occurring only once or twice per year in the hospital where 700-800 emergency appendectomies are annually performed.
 ...
PMID:A chance of misdiagnosis between acute appendicitis and renal colic. 893 24

A prospective study of 810 consecutive cases submitted to emergency appendicectomy was performed to determine the predictive value of abdominal pain, nausea, vomiting, fever, abdominal tenderness and total and differential leucocyte count in the diagnosis of appendicitis. Age, sex, time of evolution and degree of inflammation were considered as conditioning factors. Most of the cases were diagnosed within the first 12 h. Pain demonstrated acceptable sensitivity (85.2%) and a high positive predictive value (95.7%) but with an important proportion of false negatives (14.8%). The predictive value of abdominal exploration was 97.6% with a sensitivity of 96.1%. Leucocytosis increased with the degree of inflammation and values above the cut off point established (12,500 leucocytes/dl and 85% segmented) significantly increased the strength of the association. Pain on palpation and leucocytosis with shift to the left increased the sensitivity to 98.1% with false positives of 1.3%. The percentage of acute perforated appendicitis increased from 5 to 15.3% when diagnosis was delayed more than 12 h. Once the clinical manifestations and analytical alterations were established (6 h after initiation of the clinical picture) these did not modify with the time of evolution. The greater the involvement of the appendix the earlier the presentation although, logically, the later the diagnosis the greater the percentage of perforated appendix. The classical criteria of pain, tenderness and leucocytosis with left deviation does not allow the diagnosis of 1.9% of the cases of appendicitis with 1.3% of false positives. Once the clinical manifestations are established, these do not modify with the time of evolution, but the percentage of perforations does increase with time. To reduce this percentage, diagnosis must be made within the first 24 h.
 ...
PMID:[Diagnostic validity of signs and symptoms defining the diagnosis of acute appendicitis]. 907 90

The clinical diagnosis of appendicitis needs to be improved, as up to 40% of explorations for suspected appendicitis are unnecessary. The use of body temperature and laboratory examinations as diagnostic aids in the management of these patients is controversial. The diagnostic power of these variables compared to that of the disease history and clinical findings is not well studied. In this study we prospectively assessed and compared the diagnostic value of 21 elements of the history, clinical findings, body temperature, and laboratory examinations in 496 patients with suspected appendicitis. The diagnostic value of each variable was compared from the area under the receiver operating characteristic (ROC) curve and the likelihood ratios (LR). Logistic regression was used to analyze the diagnostic value of a combination of variables and to analyze independent relations. No single variable had sufficiently high discriminating or predicting power to be used as a true diagnostic test. The inflammatory variables (temperature, leukocyte and differential white blood cell (WBC) counts, C-reactive protein) had discriminating and predicting powers similar to those of the clinical findings (direct and rebound abdominal tenderness and guarding). Anorexia, nausea, and right-sided rectal tenderness had no diagnostic value. The leukocyte and differential WBC counts, C-reactive protein, rebound tenderness, guarding, and gender were independent predictors of appendicitis with a combined ROC area of 0. 93 for appendicitis. This showed that inflammatory variables contain important diagnostic information, especially with advanced appendicitis. They should therefore always be included in the diagnostic workup in patients with suspected appendicitis.
 ...
PMID:Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. 988 Apr 21

The appendicitis is the commonest cause of an acute abdomen in children older 1 year of age. Only 5% of children with appendicitis are younger than 2 years of age. There is a familial preponderance. The younger the child the faster the symptoms of the disease are increasing in intensity. The symptoms starts with unspecific periumbilical or epigastric pain, followed by nausea, vomiting and restlessness at night. Finally the pain moves to the position of the appendix. The position of the appendix shows a high variation in children thus the pain characteristic is not uniform. Laboratory tests are not reliable but ultrasonography is recommended to exclude other diseases and to try to confirm the diagnoses. With the technique of "Graded compression Sonography" the rate of non identified appendicitis has been reduced under 5%. Laparoscopy is another option. Its use just for diagnostic purposes is limited but is recommended widely for primary therapeutic treatment with laparoscopic performed appendectomy. Laparoscopy has a special advantage against conventional appendectomy in the diagnostic of recurrent unspecific abdominal pain in children and in cases with interval appendectomy. Finally in pseudoappendicitis and pseudoperitonitis in children with immunvasculitis and other extraabdominal diseases. Letality of the acute appendicitis is zero.
 ...
PMID:[Acute appendicitis in the child]. 988 Aug 78

Right-sided colonic diverticulitis is an uncommon disorder that most frequently mimics appendicitis. During pregnancy, displacement of the diseased cecum and ascending colon into the right upper quadrant may result in symptomatology that mimics cholecystitis. A 37-year-old white woman with a history of previous benign incidental appendectomy presented at 20 weeks' gestation with right upper abdominal pain and nausea for 2 days. Significant findings included local rebound tenderness and palpable fullness over the gallbladder, leukocytosis, and low-grade fever, but otherwise unremarkable routine serum laboratory test results and sonographic evidence of biliary tract disease. Cholescintigraphy was rejected by the patient. Persistence of symptoms for 3 hospital days despite administration of broad-spectrum parenteral antibiotics prompted surgical intervention. Laparoscopy demonstrated a normal-appearing gall-bladder and an acutely infected, solitary diverticulum of the midascending colon with adhesions to the omentum and to the parietal peritoneum near the gallbladder. Adhesiolysis, omental biopsy, and peritoneal drainage were performed endoscopically. The patient recovered uneventfully and delivered vaginally at term without fetal or maternal complications. Right-sided colonic diverticulitis may present during pregnancy and may mimic symptoms of acute cholecystitis. Laparoscopic treatment of a solitary, acutely infected colonic diverticulum is feasible in this setting.
 ...
PMID:Right-sided colonic diverticulitis mimicking acute cholecystitis in pregnancy: case report and laparoscopic treatment. 995 Jan 33

Visceral pain is caused by either distension or contraction of the visceral muscular wall or obstruction of hollow gastrointestinal organs. Unlike the somatic pain due to peritonitis, visceral pain is diffuse, epigastric, periumbilical and is often accompanied by nausea, vomiting and restlessness. We demonstrate the significance of visceral pain in the differential diagnosis of the acute abdomen presenting five cases of appendicitis and cholecystitis. A correct early diagnosis of the acute abdomen while signs of local peritonitis are still absent (appendicitis in atypical location, recurrent acute appendicitis, spontaneous reopening of an occlusion) is facilitated by the awareness for the characteristics and symptoms of visceral pain, and therefore careful taking of the patient's history. A history lacking visceral pain on the other hand represents an important clue for the diagnosis of other conditions (gynecological, diverticulititis, etc.) with acute pelvic peritonitis.
 ...
PMID:[Visceral pain in acute abdomen]. 1032 Nov 25

Appendicitis is one of the most common causes of acute abdominal pain in the industrialized world. Appendicitis must be considered in the differential diagnosis of any patient presenting with abdominal pain. Workup may include blood tests, abdominal radiographs, abdominal ultrasound, and focused appendix computed tomography. Unfortunately, none of these provides definitive results. Although several signs and symptoms are associated with appendicitis, their inconsistent presentation, especially among the young and the elderly, can lead to an erroneous diagnosis. The classic sequence of symptoms includes the onset of vague epigastric or periumbilical pain; associated nausea, anorexia, or unsustained vomiting; and pain migrating to the right lower quadrant. In uncomplicated cases, the treatment of appendicitis is appendectomy. However, less definitive presentations merit further diagnostic testing and close follow-up.
 ...
PMID:Recognizing the various presentations of appendicitis. 1047 9

Acute colonic diverticulitis typically occurs in patients older than 60 years of age but is uncommon in patients under the age of 40, which may lead to a delay in diagnosis. Because abdominal pain is a very common presenting symptom in emergency department patients, we retrospectively analyzed the cases of 21 patients 40 years of age and younger diagnosed with acute diverticulitis and characterized the presenting signs and symptoms, laboratory and radiographic findings, treatment, and outcome. There were 17 men and 4 women with a mean age of 34.1 +/-5.9 years. All patients had abdominal pain, with 14 (67%) patients noting pain in the left lower quadrant (LLQ) and 5 (24%) patients noting right lower quadrant (RLQ) pain. Nausea was present in 18 (86%) patients and fever in 15 (71%) patients. The mean pulse rate was 103 +/- 16 and the mean temperature was 100.7 +/- 1.4 F. Leukocytosis was present in 19 (90%) patients. Plain abdominal radiographs were obtained in 19 (91%) patients and were normal in 15 (79%) of these cases. Computed tomographic (CT) scans were obtained in 15 (71%) patients which revealed findings consistent with acute diverticulitis in 14 (93%) patients. The admitting diagnosis was diverticulitis in 10 of the 12 patients with LLQ tenderness and appendicitis in 4 of the 6 patients with RLQ tenderness. Overall, six patients were taken to surgery: three patients had cecal diverticulitis and three patients had perforated colonic diverticulitis. General treatment measures included bowel rest in 18 (86%) patients, and intravenous fluids and antibiotics in all patients. All patients survived. In conclusion, acute diverticulitis is uncommon in patients under 40 years of age; however, this condition may be confused with other conditions, usually acute appendicitis. As a result, clinicians should consider acute diverticulitis in young patients with acute abdominal pain, especially if they are male with nausea, fever, tachycardia, and leukocytosis, and consider obtaining a CT scan to aid in the diagnosis.
 ...
PMID:Acute diverticulitis in patients 40 years of age and younger. 1075 Sep 16


<< Previous 1 2 3 4 5 6 7 8 9 Next >>