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Query: UMLS:C0085693 (acute appendicitis)
 3,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of acute appendicitis has been reported to vary substantially by country, geographic region, race, sex, season, and occupation, but the reasons for this variation are unknown. We evaluated several risk factors for appendicitis by analyzing data from hospital discharge abstracts on all cases of acute appendicitis treated surgically in nonfederal hospitals in California from 1983 to 1986 (N = 102,546). Comparison of age and sex-specific incidence rates for four racial/ethnic groups (white, Hispanic, black, and Asian/other) revealed rates in blacks and the Asian/other group one-half or less of the rates for whites and Hispanics between the ages of 5 and 29 years. Incidence rates in males were higher than rates in females in all racial/ethnic groups for most ages (RR = 1.1-1.7). Seasonal variation in incidence was modest. Peak rates occurred in July, August, and September, and the lowest rates occurred in December. Hypotheses about the etiology of appendicitis must account for substantial racial/ethnic, gender, age variation, and modest seasonal variation in the incidence.
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PMID:The epidemiology of acute appendicitis in California: racial, gender, and seasonal variation. 174 78

Infection with Yersinia enterocolitica had been associated with acute appendicitis in approximately six per cent of patients in northern European countries. However, the incidence of Y. enterocolitica in patients with appendicitis in this country is uncertain. Therefore, this study was undertaken to ascertain whether Y. enterocolitica is a possible infectious agent in appendicitis in the southwestern United States. Fifty prospective patients (35 men and 15 women) with an average age of 22.3 years (range 3 to 62 years) underwent appendectomy for presumed appendicitis. Portions of each specimen were cultured for Y. enterocolitica with highly selective media (Cefsulodin-Irgasan-Novobiocin [CIN] agar). Pathologically, 44 of the patients had appendicitis and 6 patients had normal appendices. Four of the 44 patients (9.1%) with appendicitis were found to be culture positive for Y. enterocolitica, while it was recovered from none of the normal appendices. This indicates that Y. enterocolitica may represent the major pathogen in acute appendicitis in a small, but distinct, portion of indigent patients within Los Angeles County as it does elsewhere in the world.
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PMID:The role of Yersinia enterocolitica in appendicitis in the southwestern United States. 174 91

Current opinion favors the use of antimicrobial prophylaxis in all operations for acute appendicitis. In clinical trials with placebo controls, the reduction in the rate of postoperative infectious complications is most apparent in perforated and/or gangrenous appendicitis, but benefits are also seen in nonperforated appendicitis and even in those with a normal appendix. In elective colorectal operations, it has been established that all patients should receive prophylactic antibiotics. The choices are an oral bowel preparation consisting of neomycin or kanamycin combined with erythromycin or metronidazole; a parenteral antimicrobial drug such as cefoxitin or cefotetan; or a combined oral/parenteral regimen. Risk factors for postoperative wound infection include a prolonged duration of surgery (greater than 3.5 hours) and rectal resection. The most popular prophylactic regimen employed by American surgeons, particularly in the presence of adverse risk factors, is oral neomycin/erythromycin along with a short course (one to three doses) of a systemic cephalosporin active against anaerobes.
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PMID:Antimicrobial prophylaxis for appendectomy and colorectal surgery. 175 91

During the last decade neonatal surgical results have improved considerably. Except for infants born with serious congenital heart disease, diaphragmatic hernia or exomphalos, postoperative mortality rates for infants with single anomalies have fallen to the region of 10%. This dramatic success story has been marred by a corresponding increase in the number of individuals with several anomalies entering late childhood with severe chronic handicaps. During the remainder of this century much effort will be expended in devising programmes of investigation which will attempt to predict which individuals will have a poor long-term prognosis. Such programmes will necessitate very close liaison between obstetricians, radiologists, neonatologists, local paediatricians, paediatric surgeons, general practitioners and parents. Very urgent surgery is necessary for the best results in infants with gastroschisis, intestinal volvulus and irreducible inguinal hernia, but for most other conditions there have been recent trends away from very urgent surgery to operation during daylight hours within the ensuing 24 h. Surgery within a few hours of presentation is necessary for intussusception and for early acute appendicitis, but perforated appendicitis should be treated by aggressive fluid replacement and intravenous antibiotics and surgery should be contemplated only in the rare cases of continued deterioration.
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PMID:Paediatric emergencies. 176 28

Presentation of 55 patients aged more than 65 years, appendectomized with the diagnosis of acute appendicitis. After histological study, we saw 6 normal cecal appendixes (10.9%), so the real number of acute appendicitis operated was 49 out of 435 (11.2%) interventions. The clinical history was typical in most of the patients and, nevertheless, we noticed a diagnostic delay greater than 24 hours in 31 (63.2%), and greater than 48 hours in 17 patients (34.6%). We verified the existence of a high percentage of perforated appendicitis (36.7%) closely related to a long evolution time, not being able to show, in the group studied, an increase of early appendix perforations in comparison with the rest. These results suggest that the high morbidity of acute appendicitis in old patients is due, to a great extent, to a delay in the performance of the appendectomy.
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PMID:[Acute appendicitis in the elderly patient]. 176 68

The results of prospectively determined scoring system for the diagnosis of appendicitis (sex, age, duration of symptoms, contracture, hyperleucocytosis) are reported. Between 1984 and 1989, 492 patients with suspected appendicitis were examined. Among the 208 operated patients, 169 had acute appendicitis (81.25 percent). Diagnosis of the abdominal pain was established in one of 3 patients without appendicitis (105/323; non operated patients or operated patients with normal appendix). Eighty-five percent of the non operated patients and 92 percent of the patients operated on with normal appendix have been followed (mean follow-up 26 months). Ten percent of the non operated patients (24/237) have been operated on during follow up; 13.9 percent of the operated patients with normal appendix (5/36) and 22.8 percent of the non operated patients (54/237) still complained of persistent right lower quadrant pain (no significative difference). In conclusion, a clinical scoring system is of help in suspected acute appendicitis. This attitude requires the cooperation of the general practitioner and must be well explained to families of patients.
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PMID:[Prospective study of a predictive scoring system for the diagnosis of appendicitis in patients with right lower quadrant pain. Long-term outcome]. 176 68

The reliability of the signs and symptoms of acute appendicitis are reviewed. The wide variation in clinical findings when the different studies are compared can probably be explained by the huge quantity of retrospective studies. Migration of pain to the right iliac fossa and/or guarding/rigidity support the diagnosis of appendicitis. The diagnosis of appendicitis should be doubted when anorexia, nausea and vomiting are absent, when symptoms have persisted for more than 72 h without apparent perforation, or when tenderness in the right iliac fossa is absent. Presentation in proximity to menstruation, cervical dislocation tenderness and bilateral adnexal tenderness indicates pelvic inflammatory disease. Small children have high perforation rates because of their uniform response to many illnesses and relative inability to express themselves and cooperate. The clinical findings in young and old patients are similar, except for a higher rate of abdominal distension in old patients. With a more thorough knowledge of the signs and symptoms of acute appendicitis and a constant awareness of its possible presence, it should be possible to increase the diagnostic accuracy.
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PMID:Assessment of the reliability of the symptoms and signs of acute appendicitis. 140 57

The clinical usefulness of laboratory tests was examined in 258 patients admitted to the emergency room with the general practitioner's tentative diagnosis, acute appendicitis. Acute appendectomy was performed on 91 patients. Histological examination of the appendix confirmed the diagnosis in 69 cases (acute appendicitis 20, phlegmonous appendicitis 36, perforation 13). Seven patients with appendicular infiltrate were not subjected to operation but the diagnosis was clear from clinical examination. On close examination/operation by the surgical team, 96 admitted patients were excluded from the primary diagnosis, acute appendicitis, and served as a control group. Receiver Operation Characteristic curves (ROC-curves) showed that the sensitivity and specificity and hence diagnostic efficiency for total white blood cell count, number of segmented leukocytes and C-reactive protein concentration for the detection of acute appendicitis were higher than for erythrocyte sedimentation rate, alpha 1-antiproteinase concentration and body temperature. We observed that when all three parameters, C-reactive protein, white blood cell count and segmented leukocytes, are within the normal range the diagnosis, acute appendicitis is highly unlikely. The diagnostic value of the different laboratory parameters appears, moreover, to be highly dependent on the degree of inflammation/perforation and the development of appendicular infiltration. However, diagnostic efficiency can be improved, and unnecessary surgery prevented, by performance of an appropriately selected combination of laboratory tests combined with evaluation of clinical symptoms.
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PMID:The value of laboratory tests in patients suspected of acute appendicitis. 178 82

The pathological records of appendicectomy specimens from patients with suspected acute appendicitis at the University Hospital of the West Indies during the 5-year period 1984-1988 were studied. The numbers of cases, their ages, sex and seasonal incidence were similar to those of other studies. The overall false positive diagnosis rate was 25% (16% in males, 38% in females). The main diagnostic difficulty was in young females in whom surgery for suspected appendicitis often proved unnecessary.
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PMID:Appendicectomy at the University Hospital of the West Indies (1984-1988). A retrospective review. 178 94

In cases of clinical suspicion of an acute appendicitis sonography uncovers another disease as the real cause of the symptoms in about one-quarter of such cases. Bacterial ileocaecitis is most frequently diagnosed (11.6% of N = 786). In special bacteriological stool cultures, Yersinia enterocolitica and Campylobacter jejuni were identified, whereas Salmonella enteritidis was a rarer finding. The typical sonographic manifestation of bacterial ileocaecitis compared against Crohn's disease of the ileocaecal region is described. These two diseases can be differentiated against each other by means of sonography; likewise, it is also possible to distinguish them from appendicitis. Since stool cultures--which are not always prepared if diarrhoea is only mild or completely absent--are received relatively late in acute cases, knowledge of the sonographic manifestation of bacterial ileo caecitis can help save many an unnecessary laparotomy.
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PMID:[Bacterial ileocecitis: a "new" disease]. 179 86


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