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

Clinical picture and differential diagnosis of Yersinia arthritis are shown by means of three own observations. It is an acute oligoarthritis affecting especially knee- and ankle-joints. The involved joints are very painful, swollen and warm. There may be a history of enteritis or suspicion of acute appendicitis because of lower abdominal pain, but this is not obligatory. The laboratory parameters of inflammation (ESR, C-reactive protein, white blood count, serumproteinelectrophoresis) are changed significantly. Diagnosis is made by serum agglutination reaction (Widal-reaction) against ceesurface antigens (O-antigens) of Yersinia enterocolitica. Almost only people with the HL-A antigen B27 tend to get arthritis during Yersinia infection. The differential diagnosis has to consider reactive arthritis during Salmonella or Shigella infections, acute sarcoidosis, Reiter's disease and rheumatoid arthritis.
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PMID:[Yersinia arthritis (author's transl)]. 52 13

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 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

The body of literature concerning studies of the applications of CRP measurement in the pediatric population continues to grow. Based on current data serial CRP measurements appear to be most useful for monitoring patient response to therapy after the primary diagnosis of invasive infectious or inflammatory diseases, for monitoring patients after major surgical procedures and those with serious burns. Monitoring CRP over time may be used to assess for recrudescent disease, a secondary process or ineffective therapy. In addition CRP appears to be suited to most applications for which the ESR is used but offers many advantages. At present there are no objective outcome-based clinical trial data to justify using CRP values alone, whether elevated or normal, as a basis for management decisions regarding instituting or withholding antimicrobial therapy, or its early discontinuance for patients suspected of having neonatal sepsis, meningitis, bacteremia or pneumonia, regardless of immune status. In addition, because of significant inconsistencies among studies for which CRP has been applied to differential diagnosis of bacterial vs. viral diseases, including meningitis, acute otitis media and lower respiratory tract infection, we cannot recommend it for this purpose. Data do not support a role for CRP in differential diagnosis of acute appendicitis or for localizing urinary tract infections.
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PMID:Clinical applications of C-reactive protein in pediatrics. 927 Oct 34