Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0085693 (acute appendicitis)
 3,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The role of clinical and computer-based decisions in the diagnosis of acute appendicitis was studied in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology (OMGE). One thousand three hundred and thirty-three patients presenting with acute abdominal pain were included in the study. Twenty-two preoperative clinical history variables, 14 clinical signs, and 3 tests were evaluated in a multivariate analysis to find the best combination of independent predictors of acute appendicitis for males and females. Independent predictors of acute appendicitis in males were tenderness, previous abdominal surgery, rebound, rigidity, location of pain at diagnosis, guarding, and body temperature. To sum up the contributions of the most significant diagnostic factors, a diagnostic score (DS) was built. When the male patients with a DS value between -2.00 and -0.48 were considered nondefined (n = 75, follow-up required before deciding to operate), the sensitivity of the computer-aided diagnosis in detecting acute appendicitis in males was 0.95, with a specificity of 0.89 and an efficiency of 0.91. In males whose leucocyte count was available (n = 476), previous abdominal surgery, leucocytosis, location of pain at diagnosis, tenderness, rigidity, rebound, guarding, rectal digital tenderness, and body temperature predicted significantly acute appendicitis. The DS reached a sensitivity of 0.94 (the cut-off level was -1.74), with a specificity of 0.80 and an efficiency of 0.84. (ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Sex-specific diagnostic scores for acute appendicitis. 812 77

From October 1990 to October 1992 the first 23 laparoscopically operated patients were recorded. 11 patients retrospectively including a supplementary questioning to missing data, 12 patients prospectively with a follow-up 6-8 weeks later. They were compared with 35 from April 1991 to April 1992 conventionally operated and prospectively observed patients. Laparoscopy was performed on patients with subacute clinical signs. The median age was comparable. Acute appendicitis was histologically confirmed in 18% of the laparoscopically and in 80% of the conventionally operated patients. Operating time was in mean 110 minutes for laparoscopic and 65 minutes for open appendectomy. The postoperative complications for laparoscopy included 4 Douglas abscesses (2 x open and 2 x pararectal revisions), one peritonitis due to a defect Roeder-loop and an haematoma of the abdominal wall. One case of wound infection (3%), one pericoecal abscess which needed an ileoascendostomy and a postoperative fatigue syndrome were recorded for open appendectomy. The postoperative return to normal diet was faster for laparoscopy. Return to normal bowel habits, the need of analgesia and the nominal analogue scales concerning pain, quality of sleep, well-being and appetite showed no obvious differences between the two operation methods. The postoperative stay was on average 6.7 days for laparoscopy and 5.6 days for the open operation. The results show the severe complications which may happen when introducing this new operation method. The laparoscopic appendectomy should only be performed electively in subacute appendicitis or when diagnostic exploration shows an inflamed appendix. Careful rinsing of the operation site and perioperative antibiotic treatment are mandatory. We made good experiences when using a stapler for the removal of the appendix.
 ...
PMID:[Does laparoscopic appendectomy have advantages? Laparoscopic appendectomy in comparison with conventional appendectomy--an observational study during introduction of laparoscopy]. 814 46

Those having chronic and recurrent appendicitis represent a small portion of patients with disorders of the appendix. We present a series of nine patients who underwent appendectomy for chronic or recurrent appendicitis at The Johns Hopkins Hospital, Baltimore, Maryland, between July 1984 and October 1992. There were seven women and two men (median age of 30 years, range of 15 to 63 years). All patients presented with pain in the right lower quadrant or lower abdomen of three or more weeks duration (mean of 16.0 +/- 8.4 months, range of three weeks to seven years), had no alternative diagnosis to account for the symptoms, had pathologic evidence of chronic inflammation or fibrosis of the appendix and had complete relief of the symptoms after appendectomy. Although the patients presented herein had clinical and pathologic evidence for recurrent or chronic appendicitis, careful review of the course of each patient before surgical referral revealed at least one episode of acute pain in the abdomen consistent with acute appendicitis managed by nonoperative means. This suggests that, while recurrent acute appendicitis and chronic appendicitis do occur, they can be avoided by the accurate diagnosis and operative management of acute appendicitis. We conclude that acute appendicitis can resolve spontaneously and recur repeatedly in the same individual; in the evaluation of a patient with abdominal pain, a history of prior similar episodes of pain should never dissuade one from considering the diagnosis of acute appendicitis, and recurrent acute appendicitis and chronic appendicitis should be considered in the differential diagnosis of recurrent pain in the lower abdomen.
 ...
PMID:Chronic and recurrent appendicitis are uncommon entities often misdiagnosed. 814 38

Though laparoscopic appendectomy started endoscopic surgery in general surgery, it has yet not reached the acceptance as is the case with cholecystectomy. The application of this technique in possibly bland appendices and reports that the technique was accompanied by severe complications, increases the scepticism about it. This made us decide to start a randomized controlled trial: laparoscopic vs. conventional appendectomy. More than 1000 endoscopic interventions mainly performed at the gallbladder and the stomach and 165 prospectively documented and partly treated patients with acute appendicitis were the basis to start this trial. "Acute Appendicitis" was diagnosed on the basis of clinical symptoms by means of the computer-aided questionnaire of the EC-study "Acute Abdominal Pain", a self-developed validated diagnostic score, the macroscopic findings and the careful assessment of the histology of the resected appendix. Beside the technical feasibility, principle end-points were mainly intensity and course of postoperative pain measured by means of the Visual Analogue Scale (VAS) in lying, standing and moving position and the postoperative consumption of analgesics. We assessed a difference of 15 points on the VAS as clinically relevant. Of 57 patients with acute appendicitis we performed open appendectomy in 23 and laparoscopy in 34 patients according to randomization. In 9 patients of the laparoscopy group it was necessary to change over to open appendectomy for different reasons resulting in a direct comparison of 25 laparoscopies versus 23 open appendectomies. There were no differences between sociodemographic and preclinical data in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Laparoscopic or classical appendectomy? A prospective randomized study]. 816 12

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 retrospective study was performed to evaluate the usefulness of various historical, clinical, and laboratory findings in differentiating acute appendicitis from pelvic inflammatory disease (PID) in women of childbearing age. The records of all female patients presenting to the emergency department with abdominal pain who were found to have histologically proven appendicitis (n = 80) or PID confirmed on endocervical culture (n = 71) were reviewed. Clinically useful indicators favoring appendicitis included the presence of anorexia and the onset of pain later than day 14 of the menstrual cycle. Indicators favoring PID included a history of vaginal discharge, urinary symptoms, prior PID, tenderness outside the right lower quadrant, cervical motion tenderness, vaginal discharge on pelvic examination, and positive urinalysis. Despite these indicators, differentiating acute appendicitis from PID remains difficult.
 ...
PMID:Differentiating acute appendicitis from pelvic inflammatory disease in women of childbearing age. 824 May 53

Results and complications in 100 patients treated over a 3-year period with the laparoscopic approach for clinically diagnosed acute appendicitis are evaluated. They are compared with results and complications in 100 patients with the same diagnosis who had been treated with the open technique performed by the same surgeon during the same 3 years. The results suggest that laparoscopy provides excellent exposure of the appendix regardless of its position. In the absence of pathology of the appendix, laparoscopy allows for a thorough examination of the entire abdomen and pelvis and good exposure and definitive treatment of most surgical conditions encountered. In the event of appendicitis, regardless of its severity, laparoscopic appendectomy results in less postoperative pain, shorter hospital stays, faster return to normal activities, fewer postoperative complications, and superior cosmetic results. Our experience suggests that the laparoscopic approach is the best approach to diagnosis and treatment of the conditions encountered in patients with suspected appendicitis.
 ...
PMID:Laparoscopic appendectomy: treatment of choice for suspected appendicitis. 826 Dec 73

The decision to operate for abdominal pain in patients with leukopenia can be exceedingly difficult. Surgical exploration may be the only effective way to differentiate acute appendicitis from other causes, but it involves considerable risk of infectious complications due to immunosuppression. Leukemic patients, who presented significant RLQ pain, had been indicated for operation, despite having advanced disease or having had received chemotherapy or steroids. Four adult leukemia patients, complicated by acute appendicitis, were reviewed. Two patients were in induction chemotherapy, one receiving salvage chemotherapy due to relapse and the other was in conservative treatment. Two patients were acute myelocytic leukemia (AML), one had acute lymphocytic leukemia (ALL), and the other had aleukemic leukemia. All patients underwent appendectomy and recovered without complication. Our experience supports the theory that the surgical management of appendicitis in acute leukemia is the most effective way, in spite of leukopenia.
 ...
PMID:Acute appendicitis in patients with acute leukemia. 826 46

Ninety surgical cases of cecal diverticulitis at the University of Hawaii hospitals were reviewed from 1980 to 1991. Seventy-eight percent of the study group were of Asian descent, with a mean age of 41.7 years. Right lower quadrant pain and tenderness were the only constant findings, occurring in 86 and 87 of the 90 patients, respectively. The most common preoperative diagnosis was acute appendicitis, occurring in 73% of patients. A right colectomy or cecectomy was performed in 49 patients, an appendectomy in 29, and a diverticulectomy in 10. Seventeen complications occurred, only 1 of which was in the appendectomy group. Follow-up of up to 10 years was successful in 27 of 29 appendectomy patients, only 4 of whom had recurrent pain. There were no instances of a missed cecal carcinoma. We concluded that in those patients in whom carcinoma can be ruled out and in whom there is no evidence of abscess formation, appendectomy combined with postoperative antibiotics is a safe and effective method for the treatment of cecal diverticulitis.
 ...
PMID:Surgical management of cecal diverticulitis. 827 46

Acute appendicitis is a common disorder and, ideally, should be diagnosed prior to the onset of gangrene or perforation. Nonetheless, the goal of early diagnosis remains elusive. In a prospective study, 100 appendectomies were performed for suspected acute appendicitis over 19 months. The location of the appendix was noted by the operating surgeon and was listed as anterior intraperitoneal, retrocecal, pericolic gutter, retroileal, pelvic, or retroperitoneal. The latter four positions were regarded as sites in which the appendix was hidden from the anterior parietal peritoneum. Fifteen patients did not have appendicitis. Of the 85 inflamed appendices, 25 were indurated, 19 were suppurative, and 41 were gangrenous or perforated. Patients with gangrene or perforation were more likely to have pain and tenderness at a site other than the right lower quadrant and had a higher mean heart rate on admission than patients with simple appendicitis, but there were no other differences in symptoms, signs, or laboratory findings among the groups. The appendix was in a hidden location in 15 per cent of patients with simple appendicitis or without appendicitis, compared with 68 per cent of patients with gangrenous or perforative appendicitis (P < 0.001). Complications were more frequent, and hospital stays were longer in patients with advanced appendicitis (P < 0.001). Patients and physicians were equally responsible for delays in treatment, but the high incidence of hidden appendices in those with advanced appendicitis resulted in less severe symptoms and signs than expected. Anatomic variations in the location of the appendix are often responsible for delays in the diagnosis of appendicitis.
 ...
PMID:The anatomy of appendicitis. 827 77


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>