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

A prospective study of 100 consecutive patients was carried out to determine if a knowledge of the white cell count was a useful factor in determining the correct management of patients presenting with suspected acute appendicitis. A retrospective study of the differential white cell count and neutrophil morphology was performed to see if these investigations would provide more specific aids to diagnosis. These studies show that such haematological information is only of limited supportive value in the total assessment of these patients. Where the clinical findings are at variance with the white cell count, the clinical findings should take precedence.
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PMID:An assessment of the value of the white cell count in the management of suspected acute appendicitis. 119 53

In a prospective 5-year investigation of acute appendicitis 603 consecutive patients with the disorder were studied in detail. Of this number 388 (64.3%) were female and 215 (35.7%) male giving a female: male ratio of 1.8:1. The patients were aged 4-65 years with a median age of 23.1 years; females with a median age of 22.1 years were younger than males with a median age of 25.4 years. Patients presented to hospital late: 3-7 days (median 5 days) from the onset of symptoms; the strikingly most common of these was abdominal pain seen in all the patients, and tenderness, local or with rebound was uniformly elicited. Supportive laboratory and radiological services were not regularly available; however, when white cell count was obtainable leucocytosis with a left shift was a useful finding. At operation 422 (70%) patients had an acutely inflamed appendix, 121 (20%) gangrenous or perforated appendicitis and 18 (3%) an appendix abscess; an appendix mass was palpable in 42 (7%) patients and these were treated conservatively. Wound infection complicated surgery in 18 (3%) patients; there were no operative deaths. Acute appendicitis was the second commonest surgical abdominal emergency during the period under study, and the results of treatment compare favourably with series from the developed countries of the West.
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PMID:Tropical surgical abdominal emergencies: acute appendicitis. 276 56

A retrospective study of 201 patients, 152 with simple and 49 with complicated, appendicitis is presented. Diagnosis of simple acute appendicitis was made on symptoms of abdominal pain, anorexia, nausea and vomiting, together with rebound abdominal tenderness and not on white blood cell count. Normal white blood cell count was found in 80.3% cases of simple acute appendicitis while elevated white cell count was associated with 85.7% of complicated appendicitis. There was no mortality in 152 patients who had appendectomies for uncomplicated acute appendicitis, but the mortality rate in the 49 patients with complications was 12.2%. This was responsible for the overall mortality rate of 3% for all appendectomies in this report. Complicated appendicitis in this review was largely due to pre-admission delays and the ingestion of strong cathartics, both of which could not be influenced by surgeons.
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PMID:Acute appendicitis: a clinical pattern in Port Harcourt Nigeria. 279 30

Appendicitis is the first 3 years of life is uncommon and most cases are perforated at laparotomy. Case records at the Adelaide Children's Hospital were reviewed over a 12-year period. The findings were that acute appendicitis in this age group is commonly associated with respiratory symptoms and diarrhoea, the appendix was gangrenous or perforated in 92% of cases, and there was a significant delay in diagnosis. It is concluded that full evaluation of any child of this age with fever, vomiting, abdominal pain and tenderness is mandatory, and should include rectal examination, abdominal radiographs, differential white cell count and urinary examination. Examination under sedation may be necessary.
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PMID:Appendicitis in the first three years of life. 327 Mar 21

776 patients seen in our emergency ward with abdominal pain for less than one week duration were prospectively analysed. In 49% of these patients no cause was found and 19% had acute appendicitis. Among 180 appendectomized patients, 147 (82%) had acute appendicitis whereas 33 (18%) had no inflammation of the appendix. Clinical presentation with a pain duration of less than 36 hours, steady abdominal pain, guarding in the right iliac fossa and a white cell count above 12,000/mm3 (12 g/l) were the best criteria for prediction of acute appendicitis versus a normal appendix. Perforated appendicitis was found in 18% of the patients with acute appendicitis but in only one patient for whom appendectomy had been deferred on the grounds of atypical presentation. Thus, in most cases, the perforation was preexistent to admission. We therefore recommended a 24-48-hour observation period for patients with uncertain diagnosis. Rates of normal appendices and perforated appendices of about 20% seem to be difficult to improve upon.
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PMID:[A prospective study of 776 cases of acute non-traumatic abdominal pain. Acute appendicitis and its diagnosis]. 367 66

49 children younger than 3 years old and treated for acute appendicitis were investigated retrospectively. The symptoms of this age group are general and diarrhea is not uncommon. Examination of the urine including microscopy should always be performed. The white cell count in peripheral blood is of doubtful value in diagnosing acute appendicitis. A roentgenographic examination of the abdomen was helpful in 78% of the patients studied. The correct diagnosis was delayed in 43% of the cases and this extended the observation time by 2.9 +/- 2.4 days. The appendix was perforated in 79%, complications occurred in 18% and there was no mortality. A high degree of alertness seems essential for the early diagnosis of acute appendicitis in this age group.
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PMID:Acute appendicitis during the first three years of life. 713 32

In patients with right lower quadrant pain, the total white cell count is an unreliable predictor of appendicitis. It has been reported that the lymphocyte count can fall in acute appendicitis. This study was undertaken to investigate whether the neutrophil:lymphocyte ratio is a more sensitive indicator than the total leucocyte count. A retrospective study was performed of patients undergoing appendectomy for suspected appendicitis over a 2-year period. A total of 402 patients were identified; histopathology confirmed appendicitis in 367 (91%). Other significant pathology was found in 13 (3.2%). Twenty-two (5.5%) had a histologically normal appendix and recovered uneventfully with no other diagnosis being made. A total of 298 (79%) patients with appendicitis had an elevated preoperative total white cell count. The neutrophil:lymphocyte ratio was calculated for each patient. Using an upper limit of 3.5:1, it was found that 324 (88%) of patients with appendicitis had a ratio equal to or greater than this value. This was significantly different from the proportion with a raised total leucocyte count (P = 0.001). We suggest that the simple calculation of the neutrophil:lymphocyte ratio may provide a parameter that is more sensitive than the total leucocyte count in the prediction of appendicitis.
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PMID:Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis. 788 42

Although acute appendicitis is often difficult to diagnose and negative laparotomy rates of 25 per cent are common, several options are currently available for the preoperative work-up. Careful history taking and physical examination are essential, together with analysis of inflammatory variables (C-reactive protein and white cell count). After admission, additional help is available in the form of ultrasonography and computerised tomography (CT), ultrasonography apparently being best in slender and normal weight patients (body mass indices < 25) and CT in overweight patients. The article reports how, without using invasive laparoscopy, a negative laparotomy rate of 7.2 per cent (11% in women and 4% in men) was obtained in 1998 at a hospital serving a population of 330,000.
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PMID:[A high degree of accuracy is possible in the diagnosis of appendicitis. Laboratory tests, ultrasonography and computerized tomography are of great value]. 1041 51

A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute appendicitis in children. Altogether 100 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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PMID:Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. White cell count and diagnosing appendicitis in children. 1220 92

A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute appendicitis in adults. Altogether 176 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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PMID:Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. White cell count and diagnosing appendicitis in adults. 1220 94


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