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

Since the middle to the end of the 80 s, the sonographic detection of diverticulitis has been increasingly improved. In a paper including a larger number of patients published in 1992, W. B. Schwerk demonstrated a high sensitivity and specificity. The detection of diverticulitis was the final entry into the chapter of acute abdominal sonography, after the diagnosis of gastrointestinal perforation, acute appendicitis and ureterolithiasis had been achieved with high reliability. Until then, diverticulitis was a classic surgical disease and a contrast enema with water-soluble contrast medium the diagnostic method of choice. Invariably, the radiologist added the well known comment: Cancer of the sigmoid colon cannot be excluded with certainty. What has changed in the 12 years after Schwerk's publication? Many internists practising sonography have discovered the sonographic diagnosis of this condition and, depending on the severity, treat the less complicated cases with intravenous antibiotics and parental nutrition or with oral antibiotics and low-ballast diet. Soon, abscesses were healed with sonographically guided aspiration and drainage. For a long time, the older generation of surgeons stayed with contrast enemas and prolonged parenteral therapy and, in case of complications, surgical interventions, though surgeons early recognized the diagnostic contribution of sonography. Influenced by radiologists and the Anglo-American literature, surgeons increasingly used computed tomography (CT) as standard method for the initial diagnostic work-up for the last five to eight years. A physician dedicated to gastrointestinal sonography cannot accept this approach, in particular, since sonography is easy and reliable, provides a reasonable differential diagnosis and was found to help the surgeons. An exception is the deep-seated diverticulitis in the sometimes barely accessible distal sigmoid colon. Furthermore, an experienced clinician will anyhow proceed to CT in any unexplained discrepancy between clinical and sonographic findings. It reflects the high value given to sonography if our surgical colleagues use this diagnostic method in the primary diagnosis of acute diverticulitis and achieve results that are as good as the results of the expensive and by all criteria more elaborate CT. The extended application of ultrasound for the omentum and in necrotic epiploic appendagitis should be mentioned here as well. Altogether, CT can be easily refrained from in 80 % to 90 % of cases with suspected diverticulitis. In view of the DRG era, this is an important argument, and emphasizes the economic role of sonography, the necessity of correct coding of sonographic procedures and the need of more sonographic training. Only quality will increase the acceptance of sonography as diagnostic tool as repeatedly demanded and presented in this journal. If this fails, it is highly likely that the diagnostic potential of sonography will remain unexploited or, under the best of circumstances, rediscovered after a 5-year expiration date in a new literature search in 10 years.
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PMID:[Sonographic diagnosis of diverticulitis: the burdensome way to acceptance]. 1536 35

The costs of the operative treatment of acute appendicitis have to be verified under DRG conditions. Laparoscopic and open appendectomies in a 5-year-period were evaluated retrospectively. Analyses of costs of the year 2004 were performed according to the clinical automatic settlement (SAP / R3) in direct comparison to the data of 140 participating hospitals using the same software. In the 5-year-period 775 of 830 (91.8 %) appendectomies were started laparoscopically, in 68 cases the method was converted to the open surgical procedure. Postoperative complications required radiologic interventional treatment or reoperation in 4.2 % of the patients. The arising costs in the own hospital and the 140 associated hospitals were defrayed only for 90 % by the DRG-payment system. The deficit for the DRG codes G 23 Z, G 22 Z and G 07 Z were 212 euro, 296 euro and 455 euro per case. Compensation of costs in clinical routine results from reduction of duration of patients stay (162 euro per day) or avoidance of the laparoscopic procedure. The material costs of laparoscopic appendectomy are 4.3 times higher than the costs of the open conventional procedure (310 euro vs. 71 euro). The clinical costs of appendectomy are not compensated by the DRG-System. The surgeon has to take into account the economic aspects of the intended operative procedure.
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PMID:[Economic observations on the operative treatment of acute appendicitis]. 1751 15