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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 accurate clinical diagnosis of acute appendicitis is difficult, and many techniques have been suggested to improve diagnostic accuracy such as laparoscopy, ultrasonography and barium enema examination. In this study serial total leucocyte counts and serial C-reactive protein (CRP) concentrations in acute appendicitis were measured. The sensitivity and specificity of serial leucocyte counts in acute appendicitis were 92 and 100 per cent, and for CRP concentrations 69 and 75 per cent, respectively. The sensitivity and specificity of serial total leucocyte counts fulfilled the criteria for a diagnostic test. It is suggested that in patients with equivocal clinical findings, clinical observation combined with serial leucocyte counts may improve decision making.
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PMID:Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. 851 16

C-reactive protein (CRP) has been measured in plasma of patients with acute appendicitis and in controls without appendicitis to test the accuracy and diagnostic performance of a new rapid test kit for CRP (NycoCard CRP). The values obtained for CRP by the rapid test correlated well (Rs = 0.92) with the reference method for measuring CRP. The sensitivity, specificity and predictive values were calculated at different cut-off values. At values > 10 mg l-1 a sensitivity of 58% and a negative predictive value of 72% were found. Higher values of sensitivity were observed for men than for women, 69% and 44% respectively. Patients with acute appendicitis who had had symptoms for more than 24 h, had elevated CRP values (cut-off > 10 mg l-1) in more than 80% of cases. Our study shows that the rapid CRP test and the reference CRP test gave an almost identical result.
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PMID:Rapid C-reactive protein (CRP) measurements in the diagnosis of acute appendicitis. 145 49

The efficacy of imipenem-cilastatin was compared with that of tobramycin and metronidazole for the treatment of appendicitis-associated abdominal infections in children in an open, randomized trial. Two hundred eighteen patients between 2.5 and 16.8 years of age hospitalized for appendectomy because of suspected acute appendicitis were allocated to 5 treatment groups. The appendix was perforated in 54 (33.8%) of the 160 cases with appendicitis. All patients responded favorably to treatment. Infection in the wound occurred in 15 of 125 (12.0%) of those without preoperative antibiotic therapy and in 5 of 83 (6.0%) of those given imipenem preoperatively (P = 0.12; 95% confidence interval, -2.2 to 14.2%). C-reactive protein decreased significantly faster in those with perforated appendix treated with imipenem than in those treated with tobramycin and metronidazole (58.2 mg/liter vs. 89.4 mg/liter, P less than 0.05 on the third postoperative day). Imipenem-cilastatin was at least as effective and economically comparable as tobramycin and metronidazole for the treatment of appendicitis-associated infections in children.
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PMID:Imipenem-cilastatin vs. tobramycin and metronidazole for appendicitis-related infections. 160 80

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

One hundred patients with suspected acute abdominal inflammation were imaged at 0.5, 2-3, 4-6, and 24 hours after the administration of Tc-99m HMPAO labeled autologous leukocytes. Scan findings were retrospectively compared with final diagnosis, serum C-reactive protein (CRP), and antibiotic treatment. Clinical findings were confirmed with surgery, barium enema, or sigmoidoscopy in 61 patients, and diagnosis was based only on clinical findings in 13 patients. In 26 patients, symptoms subsided before a final diagnosis was made. Tc-99m leukocyte images were positive in 45 of the 61 patients with a confirmed diagnosis, including all patients with acute cholecystitis (N = 4) and inflammatory bowel disease (N = 8). They were also positive in nineteen out of 25 patients who had acute colonic diverticulitis and in 6 out of 7 who had intra-abdominal abscesses. Abnormal activity was found in patients with colonic carcinoma, small bowel infarction, and acute appendicitis. Abnormal activity was visualized in 0.5-hour images in all but one of the positive cases. With the exception of two postoperative cases, malignant lymphoma, and a liver abscess, a CRP level of greater than 75 mg/L was associated with positive image findings. Antibiotic treatment did not affect imaging findings. Imaging with Tc-99m labeled leukocytes appears to be valuable for detecting and localizing abdominal inflammation, and three-phase imaging during the first 4-6 hours is recommended. In some cases, 24-hour images may be useful for distinguishing small bowel from large bowel inflammation.
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PMID:Tc-99m labeled leukocytes in imaging of patients with suspected acute abdominal inflammation. 220 80

The diagnostic value of C-reactive protein (CRP), total white blood cell (WBC) count, total neutrophil count, and neutrophil differential count were evaluated in a prospective blinded study of 204 patients submitted with the tentative diagnosis of acute appendicitis. The laboratory tests were performed on blood samples obtained at the time of admission, and the results were stored until the patients were discharged. One hundred patients were operated on: 59 had appendicitis, 3 had other surgically correctable diseases, and 38 had a superfluous exploration. All 104 nonoperated patients recovered spontaneously. The sensitivity, specificity, and predictive values of single tests and test combinations were calculated at different cutoff levels. Using standard reference intervals, WBC count demonstrated the best sensitivity (83 percent) and predictive value of a negative result (88 percent). Combining the tests by an "or" rule enhanced the sensitivity to 100 percent, employing WBC count or CRP or neutrophil percentage above the reference range (triple test), but at the expense of the predictive value of a positive test (37 percent). It was concluded that both single tests and combined tests are of limited value in predicting acute appendicitis. However, the same triple test combination proved a predictive value of a negative result at 100 percent (95 percent confidence limits 92 to 100 percent), indicating that acute appendicitis is unlikely when these tests are simultaneously negative. The triple test combination was valid in 32 percent of the patients who were free from appendicitis. In the study group, 10 of the patients (25 percent) who had a superfluous exploration had a negative triple test, and they might have avoided surgery if it had been used. Therefore, the triple test is recommended as a help in reducing the significant rate of negative laparotomies in patients suspected of having acute appendicitis.
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PMID:Laboratory aid in the diagnosis of acute appendicitis. A blinded, prospective trial concerning diagnostic value of leukocyte count, neutrophil differential count, and C-reactive protein. 267 22

The clinical usefulness of preoperative determination of total and differential white blood cell count and C-reactive protein was studied in 113 patients undergoing emergency appendectomy for suspected acute appendicitis. The diagnosis was confirmed in 86 (76%) of the patients. In all 86 cases at least one of the three laboratory tests gave an abnormal result. The highest incidence of abnormal results was found in the most advanced stages of inflammatory reaction in the appendix. In nine of the 27 patients with histologically normal appendix all three laboratory parameters were normal. The "negative appendectomy rate" would have fallen from 24% to 16% in this study if the patients with negative results in all three tests had not been operated on.
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PMID:Laboratory tests in patients with suspected acute appendicitis. 274 14

C-reactive protein (CRP) was measured in 70 consecutive patients hospitalized with the diagnosis of acute appendicitis. Of these, 28 patients (Group 1) had acute appendicitis, 25 patients (Group 2) had no identifiable focus of infection and improved with general supportive care, and 17 patients (Group 3) had an identifiable cause for their illness, though not appendicitis. CRP level was not helpful in distinguishing among patients in any group when symptoms were present for 12 hours or less. When symptoms were present for more than 12 hours, all patients in Groups 1 and 3 and half of the patients in Group 2 had a significant increase in CRP value. Thus, a normal CRP value in a patient presenting with a duration of symptoms of more than 12 hours occurred only in Group 2; this difference was statistically significant (P less than 0.001). When symptoms are present for more than 12 hours, an increased CRP value supports the diagnosis of acute appendicitis and will identify patients who have signs and symptoms similar to acute appendicitis but who have another identifiable illness. When the CRP value is normal in a patient who has had symptoms for more than 12 hours, this patient does not have acute, appendicitis and can be followed in an outpatient setting.
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PMID:Prospective evaluation of C-reactive protein in patients suspected to have acute appendicitis. 274 30

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


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