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

Appendicitis is one of the most common causes for laparatomy in children. Diagnosis can be very problematic, especially if appendicitis is combined with gastro-enteritis. Furthermore, difficulties can be encountered in diagnosis of diseases such as mucoviscidosis, leukosis, immunosuppressive or chemotherapy are present. In addition to the common clinical examination we have to look for other methods to complete the indication for appendectomy. Therefore in 1985 we added the CRP-determination to our diagnostics for patients with suspected appendicitis. In a retrospective study 269 patients who had signs of acute appendicitis were examined. We found that the determination of the CRP-level, in conjunction with the standard parameters of appendicitis, represents a valuable addition to the diagnostic armamentarium. However our data shows, that the CRP-level in itself cannot be regarded as a sole criteria for an unambiguous diagnosis of non-acute appendicitis, as it is the case with any other appendicitis parameter.
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PMID:[The value of C-reative protein analysis for the differential diagnosis of non-acute appendicitis]. 194 46

A comparison of laboratory tests was undertaken in 106 patients admitted to the emergency room with the tentative diagnosis of acute appendicitis and who subsequently underwent appendectomy. The tests examined included the total white blood cell count, manual differential count, cytochemical differential count, and C-reactive protein. The sensitivity, specificity, efficiency, and predictive value of these tests in the diagnosis of acute appendicitis were calculated. The cytochemically determined neutrophil count, when greater than the upper limit of the reference interval of either 75% or 7.88 X 10(9)/L, and the total white blood count greater than the upper limit of the reference interval of 10.5 X 10(9)/L were the single best tests for the diagnosis of acute appendicitis with the highest sensitivities of all tests examined (81-84%). The manual differential count and C-reactive protein showed significantly lower sensitivities. Test combinations also were examined. The combinations consisted of two or more tests joined by an "or" rule, i.e., if any one of the individually linked tests of the combination is above the reference interval, the combination is considered as indicating acute appendicitis. When either of the following test combinations were utilized--(1) total white count greater than 10.5 X 10(9)/L or cytochemical neutrophils greater than either 75% or 7.88 X 10(9)/L or CRP greater than 1.2 mg/dL; (2) total white count greater than 10.5 X 10(9)/L or manual bands greater than either 11% or 1.15 X 10(9)/L or CRP greater than 1.2 mg/dL--the sensitivity of the combination in the diagnosis of acute appendicitis approached 100% with a specificity in the range of 50%. We suggest that these test combinations may be useful in deciding which patients need further observation and reexamination prior to surgery. We also suggest the need for further studies to assess the usefulness of these tests in other types of acute inflammation and infection.
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PMID:The assessment of laboratory tests in the diagnosis of acute appendicitis. 688 Nov 1

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

This study was designed to determine the values of C-Reactive Protein measurements (an acute phase reactant, CRP) and leucocyte counts in prevention of negative appendectomies. Despite improvements in diagnostic methods, negative appendectomy rates still remain between 10-30% in acute appendicitis. Cost-effective and easily applicable diagnostic methods with prompt results are required to reduce negative appendectomy rates. In this prospective study, one hundred twenty-six patients were operated on for initial diagnosis of acute appendicitis between July 1999 and July 2000. CRP and leucocyte count were measured in all cases. The data of the outcomes of clinic and pathological findings were analyzed statistically. Among the 126 study patients, 71 (56.3%) were male and 55 (43.7%) were female. 79 (62.6%) cases had noncomplicated appendicitis, 27 (21.4%) cases had complicated appendicitis and 20 (15.8%) cases had negative appendectomy. The mean CRP level was significantly higher (p < 0.001) in patients with complicated acute appendicitis than in those with noncomplicated acute appendicitis and in those with negative appendectomy. The mean leucocyte count was significantly lower (p < 0.001) in patient with negative appendectomy than in those with noncomplicated appendicitis and in those with complicated appendicitis. Although CRP increases with inflammation, it increases markedly after the occurrence of complication. The increase in leucocyte count is early sign of appendix inflammation. CRP measurements or leucocyte counts are not effective alone to prevent negative appendectomies.
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PMID:[The value of C-reactive protein and leucocyte count in preventing negative appendectomies]. 1170 13

The increase in leucocyte count is a very early marker of appendiceal inflammation, whereas CRP increases are usually seen only after protracted inflammation such as appendiceal perforation or abscess formation. Acute appendicitis is unlikely in adult patients with normal leucocyte count and CRP value, even if clinical symptoms and signs indicate acute appendicitis. However, a normal leucocyte count and CRP value do not effectively exclude appendicitis in children.
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PMID:[Too many unnecessary appendectomies. Leukocyte count and CRP value for safer diagnosis]. 1196 9

Case reports of patients with acute appendicitis that was not recognised in time highlight the probability and the implications of significant complications. Early surgical treatment is dependent on early diagnosis, and this is usually the domain of general practice. With regard to the missed cases, it is important to see them in proper perspective: appendicitis is present in only a minority of all presentations of abdominal pain. General practitioners should refer 'liberally' in case of even minor signs or symptoms, so that appendicitis will be missed only in cases with a highly atypical presentation. It is important to realise that this happens, but it is not possible to draw conclusions from it that can serve as a guide to routine practice, as referral of all presentations of abdominal pain would be undesirable. There is a need to test the added value of diagnostic procedures like CRP and echography. However, until there is evidence that this could change the practice in atypical cases, practitioners can do no better than to reflect upon their faults.
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PMID:[An analysis of cases of missed acute appendicitis: for the time being there is no basis for a better policy]. 1246 68

The authors present a diagnostically difficult case of a three year old girl with abdominal pain. The girl with abdominal pains, nausea, upper airways infarction and some urinary system symptoms was admitted to Children's Surgical Clinic for observation. She was given antibiotic therapy and i.v. infusions. WBC was 29.6 tys./ul and CRP 2.7 mg/dl. No other abnormalities were detected in biochemical or sonographic investigation. The girl was submitted to laparotomy because of unclear abdominal signs suggesting acute appendicitis. Phlegmonous appendicitis and twisted/rotated left ovary with multiple adhesions were found. Histopathological investigation showed teratoma of the left ovary. Postoperative course went without complication.
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PMID:[Rare coexistence of phlegmonous appendicitis and tumor of a twisted left ovary]. 1291 74

In the last decades a lot of significant correlations between clinical and anthropometric parameters were found, e.g. the relationships between somatotypical and endocrine parameters or between body dimensions and echocardiographic heart size. During operation, surgeons often find a wide range of appendix size of patients with varying body dimensions. A goal of this work is the detection of the relationships between anthropometric characteristics (height, weight, body mass index (= BMI)), inflammation parameters (histological inflammation degree, leukocyte count and C-reactive protein (= CRP)) and the appendix length with n=167 consecutive patients (time period 1.1.2004 - 31.12.2006; range of age 7-95 years, median age 20 years; average age of men 27.7, women 26.6 years), which had to be operated because of acute appendicitis. Appendectomy was laparoscopic in 95 % of the patients and open in 5 %. The appendix length of the male patients was high-significantly longer with a mean of 7.5 cm (SD = 2.1) than those of the female patients with 6.3 cm (SD = 1.6). The following mean anthropometric values were registered: height 169.8 (SD = 15.6) cm for the males and 165.2 (SD = 9.6) cm for the females, weight 70.4 (SD = 23.4) kg for the males and 61.9 (SD = 16.1) kg for the females, BMI 24.1 (SD = 5.4) kg/m2 for the males and 22.9 (SD = 4.8) kg/m2 for the females. The mean leukocyte count was 12,700 (SD = 5500)/ml for the males and 11,600 (SD = 4900)/ml for the females, CRP was 4.3 (SD = 5.4) mg/l for the males and 4.5 (SD = 8.9) mg/l for the females. Concerning the histopathological diagnosis, n=76 patients (45.5 %) suffered from a submucous fibrosis bliteration, n 1 (12.6 ) from an acute purulent inflammation degree, n = 65 (38.9 ) from an ulcerative hlegmonous inflammation degree and n (3 ) from a perforation. While no significant Spearman's correlation coefficient between appendix length and CRP was found, the appendix length correlated highly significantly to the body weight (r = 0.25) and significantly to leukocyte count (r = 0.16), body height (r = 0.16), BMI (r = 0.17) and the histological inflammation degree (r = 0.18). Thus, the correlations found were lower than the relationships between anthropometric and endocrine or echocardiographic parameters described in literature.
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PMID:[On the relationship between body dimensions and appendix length]. 1843 6

Endometriosis is prevalent among women of reproductive age, and is most commonly found in the gynecologic organs themselves and the surrounding pelvic peritoneum. Endometriosis of the appendix, however, is rare. Preoperative diagnosis is difficult and a definitive diagnosis is usually established following histopathological examination of the appendix. We report a case of endometriosis of the appendix in a 29-year-old woman who presented with right lower quadrant abdominal pain. Rebound tenderness was localized to McBurney's point. Her WBC count was 12,300/mm3 and her CRP was 6.497 mg/dl. Ultrasound and computed tomography detected a calcified region inside the cecum and slight thickening of the wall of the appendix. Based on these findings, the patient was diagnosed with acute appendicitis and underwent an appendectomy. The appendix appeared mildly congested, but the mucosa of the appendix was nearly normal and without macroscopic inflammation. Histopathological examination demonstrated ectopic endometrial glands and stroma in the muscularis. These stroma cells were positive for CD10 on immunohistochemical staining, establishing a diagnosis of endometriosis of the appendix. The patient had a good clinical course and no residual pain postoperatively.
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PMID:A case of endometriosis of the appendix. 2063 87


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