BACKGROUND Early detection of acute appendicitis(AA)in pediatric cases,critical to avoiding life-threatening complications such as perforation or abscess,remains challenging.AIM To evaluate the utility of abdominal ul...BACKGROUND Early detection of acute appendicitis(AA)in pediatric cases,critical to avoiding life-threatening complications such as perforation or abscess,remains challenging.AIM To evaluate the utility of abdominal ultrasonography(AUS)in diagnosing pediatric AA.METHODS Overall,102 pediatric patients(aged 3-12 years)suspected of having AA were enrolled and divided into the AA(n=78)and non-AA(n=24)groups.All children underwent AUS and computed tomography(CT).Comparative analyses regarding general patient characteristics and appendix-specific parameters were conducted.The diagnostic performance of AUS and CT in pediatric AA was evaluated.RESULTS All appendix-related parameters were greater in the AA group than in the non-AA group.The areas under the receiver-operating characteristic curves for pediatric AA diagnosis using AUS,CT,and AUS+CT were 0.870,0.824,and 0.931(all P<0.001),respectively(AUS:94.87%sensitivity,79.17%specificity;CT:89.74%sensitivity,75.00%specificity;combined:98.72%sensitivity,87.50%specificity).The positive predictive value(PPV),negative predictive value(NPV),accuracy rate,positive detection rate,and misdiagnosis rate of AUS were 93.67%,82.61%,91.18%,72.55%,and 20.83%,respectively.CT had a slightly lower PPV(92.11%)and NPV(69.23%),along with accuracy,positive detection,and misdiagnosis rates of 86.27%,68.63%,and 25%,respectively.Their combination improved performance,yielding 96.25%PPV,95.45%NPV,96.08%accuracy,75.49%positive detection rate,and 12.50%misdiagnosis rate.CONCLUSION AUS demonstrates certain diagnostic potential in AA diagnosis in pediatric patients,and its combination with CT further improves diagnostic efficacy.展开更多
Acute appendicitis remains one of the most common causes of emergency abdominal surgery globally.Imaging plays a pivotal role in confirming or excluding the diagnosis and identifying complications that influence manag...Acute appendicitis remains one of the most common causes of emergency abdominal surgery globally.Imaging plays a pivotal role in confirming or excluding the diagnosis and identifying complications that influence management pathways.This narrative review synthesizes contemporary evidence and consensusbased imaging protocols for appendicitis,with a focus on computed tomography,magnetic resonance imaging,and ultrasound.The article explores advanced diagnostic criteria,interpretation challenges,imaging algorithms derived from professional society guidelines,and special considerations including pregnancy and pediatric populations.Clinical practice recommendations by the World Society of Emergency Surgery,European Association of Endoscopic Surgery,American College of Radiology,and Infectious Diseases Society of America are incorporated to frame best practices.展开更多
The misfolding,aggregation,and deposition of alpha-synuclein into Lewy bodies are pivotal events that trigger pathological changes in Parkinson's disease.Extracellular vesicles are nanosized lipidbilayer vesicles ...The misfolding,aggregation,and deposition of alpha-synuclein into Lewy bodies are pivotal events that trigger pathological changes in Parkinson's disease.Extracellular vesicles are nanosized lipidbilayer vesicles secreted by cells that play a crucial role in intercellular communication due to their diverse cargo.Among these,brain-derived extracellular vesicles,which are secreted by various brain cells such as neurons,glial cells,and Schwann cells,have garnered increasing attention.They serve as a promising tool for elucidating Parkinson's disease pathogenesis and for advancing diagnostic and therapeutic strategies.This review highlights the recent advancements in our understanding of brain-derived extracellular vesicles released into the blood and their role in the pathogenesis of Parkinson's disease,with specific emphasis on their involvement in the aggregation and spread of alpha-synuclein.Brain-derived extracellular vesicles contribute to disease progression through multiple mechanisms,including autophagy-lysosome dysfunction,neuroinflammation,and oxidative stress,collectively driving neurodegeneration in Parkinson's disease.Their application in Parkinson's disease diagnosis is a primary focus of this review.Recent studies have demonstrated that brainderived extracellular vesicles can be isolated from peripheral blood samples,as they carryα-synuclein and other key biomarkers such as DJ-1 and various micro RNAs.These findings highlight the potential of brain-derived extracellular vesicles,not only for the early diagnosis of Parkinson's disease but also for disease progression monitoring and differential diagnosis.Additionally,an overview of explorations into the potential therapeutic applications of brain-derived extracellular vesicles for Parkinson's disease is provided.Therapeutic strategies targeting brain-derived extracellular vesicles involve modulating the release and uptake of pathological alpha-synuclein-containing brain-derived extracellular vesicles to inhibit the spread of the protein.Moreover,brain-derived extracellular vesicles show immense promise as therapeutic delivery vehicles capable of transporting drugs into the central nervous system.Importantly,brain-derived extracellular vesicles also play a crucial role in neural regeneration by promoting neuronal protection,supporting axonal regeneration,and facilitating myelin repair,further enhancing their therapeutic potential in Parkinson's disease and other neurological disorders.Further clarification is needed of the methods for identifying and extracting brain-derived extracellular vesicles,and large-scale cohort studies are necessary to validate the accuracy and specificity of these biomarkers.Future research should focus on systematically elucidating the unique mechanistic roles of brain-derived extracellular vesicles,as well as their distinct advantages in the clinical translation of methods for early detection and therapeutic development.展开更多
AIM:To investigate the diagnostic accuracy of the mean platelet volume and platelet distribution width in acute appendicitis.METHODS:This retrospective,case-controlled study compared 295 patients with acute appendicit...AIM:To investigate the diagnostic accuracy of the mean platelet volume and platelet distribution width in acute appendicitis.METHODS:This retrospective,case-controlled study compared 295 patients with acute appendicitis(Group?Ⅰ),100 patients with other intra-abdominal infections(GroupⅡ),and 100 healthy individuals(GroupⅢ)between January 2012 and January 2013.The age,gender,and white blood cell count,neutrophil percentage,mean platelet volume,and platelet distribution width values from blood samples were compared among the groups.Statistical analyses were performed using SPSS for Windows 21.0 software.In addition,the sensitivity,specificity,positive and negative predictive values and likelihood ratios,and diagnostic accuracy were calculated.RESULTS:The mean ages of patients were 29.9±12.0years for Group?Ⅰ,31.5±14.0 years for GroupⅡ,and30.4±13.0 years for GroupⅢ.Demographic features such as age and gender were not significantly different among the groups.White blood cell count,neutrophil percentage and platelet distribution width were significantly higher in Group?Ⅰ?compared to groupsⅡandⅢ(P<0.05).Diagnostically,the sensitivity,specificity and diagnostic accuracy were 73.1%,94.0%,and 78%for white blood cell count,70.0%,96.0%,and 76.0%for neutrophil percentage,29.5%,49.0%,and 34.0%for mean platelet volume,and 97.1%,93.0%,and 96.0%for platelet distribution width,respectively.The highest diagnostic accuracy detected was for platelet distribution width between Group?Ⅰ?and GroupⅢ(P<0.01).CONCLUSION:Platelet distribution width analysis can be used for diagnosis of acute appendicitis without requiring additional tests,thus reducing the cost and loss of time.展开更多
AIM:To assess the reliability and practical applicability of the widely used Alvarado,Eskelinen,Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA)scoring systems in patients with suspected acute appendi...AIM:To assess the reliability and practical applicability of the widely used Alvarado,Eskelinen,Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA)scoring systems in patients with suspected acute appendicitis.METHODS:Patients admitted to our tertiary center due to suspected acute appendicitis constituted the study group.Patients were divided into two groups.appendicitis group(Group A)consisted of patients who underwent appendectomy and were histopathologically diagnosed with acute appendicitis,and non-appendicitis group(Group N-A)consisted of patients who underwent negative appendectomy and were diagnosed with pathologies other than appendicitis and patients that were followed non-operatively.The operative findings for the patients,the additional analyses from follow up of the patients and the results of those analyses were recorded using the follow-up forms.RESULTS:One hundred and thirteen patients with suspected acute appendicitis were included in the study.Of the 113 patients(62 males,51 females),the mean age was 30.2±10.1(range 18-67)years.Of the 113patients,94 patients underwent surgery,while the rest were followed non-operatively.Of the 94 patients,77patients were histopathologically diagnosed with acute appendicitis.Our study showed a sensitivity level of81%for the Alvarado system when a cut-off value of 6.5was used,a sensitivity level of 83.1%for the Ohmann system when a cut-off value of 13.75 was used,a sensitivity level of 80.5%for the Eskelinen system when a cut-off value of 63.72 was used,and a sensitivity level of 83.1%for the RIPASA system when a cut-off value of 10.25 was used.CONCLUSION:The Ohmann and RIPASA scoring systems had the highest specificity for the diagnosis of acute appendicitis.展开更多
Introduction: Acute appendicitis is the major surgical abdominal disease in emergency departments and is also among the five leading causes of litigation against emergency physicians. Delayed diagnosis of appendicitis...Introduction: Acute appendicitis is the major surgical abdominal disease in emergency departments and is also among the five leading causes of litigation against emergency physicians. Delayed diagnosis of appendicitis is more likely to occur in patients, who present atypically, and those lack a thorough physical examination, or those received intramuscular narcotic analgesia. The aim of this study was to study the effect of delay in diagnosis of acute appendicitis as regard postoperative findings, length of hospital stay and post-operative complications. Patients & Methods: Patients with complicated appendicitis were subjected to the present study and treated by a single surgical team. The parameters of our study were incidence of perforation or gangrene at surgery, length of stay and post-operative complications. Results: The present study showed that delay in diagnosis of acute appendicitis is associated with a more advanced stage of disease and a higher morbidity. Conclusion: careful attention to the patient’s history;a thorough physical examination and early clinical review help to minimize the possibility of delayed diagnosis of appendicitis. Appendicitis with a delay in treatment usually leads to high perforation rates, and unfavorable outcome.展开更多
BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate wheth...BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.展开更多
BACKGROUND: Appendicitis is a common disease requiring surgery. Bedside ultrasound(BUS) is a core technique for emergency medicine(EM). The Alvarado score is a well-studied diagnostic tool for appendicitis. This study...BACKGROUND: Appendicitis is a common disease requiring surgery. Bedside ultrasound(BUS) is a core technique for emergency medicine(EM). The Alvarado score is a well-studied diagnostic tool for appendicitis. This study aimed to investigate the relationship between patients' symptoms, Alvarado score and ultrasound(US) findings, as performed by emergency physicians(EPs) and radiologists, of patients with suspected appendicitis.METHODS: Three EM specialists underwent the BUS course and core course for appendicitis assessment. Patients suspected of having appendicitis were selected and their Alvarado and modif ied(m) Alvarado scores calculated. The specialists performed the BUS. Then, patients were given a formal US and surgery consultation if necessary. Preliminary diagnoses, admission or discharge from the emergency department(ED) and fi nal diagnosis were documented. The patients were also followed up after discharge from the hospital.RESULTS: The determined cut-off value was 2 for Alvarado and 3 for m Alvarado scores. The sensitivities of the two scores were 100%. Each score was used to rule out appendicitis. The results of EP-performed BUS were as follows: accuracy 70%, sensitivity 0.733, specifi city 0.673, + LR 2.24, and – LR 0.40(95%CI). Radiologists were better than EPs at diagnosing appendicitis and radiologists and EPs were equally strong at ruling out appendicitis by US. When US was combined with Alvarado and m Alvarado scores, EP US+Alvarado/m Alvarado scores ≤3 and radiology US+Alvarado/m Alvarado scores ≤4 perfectly ruled out appendicitis.CONCLUSION: BUS performed by EPs is moderately useful in detecting appendicitis. Combined with scoring systems, BUS may be a perfect tool for ruling out decisions in EDs.展开更多
Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic muc...Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic mucosal resection(EMR)serve as alternative treatments for lesions at the appendiceal orifice(AO).However,EMR is not appropriate when the lesion margin within the AO cannot be visualized.When lesions extend into the lumen,extended laparoscopic appendectomy(ELA)or combined surgery can be used to resect the lesions.Compared with traditional surgery and EMR,ELA or combined surgery is a safer and more precise option that preserves the function of the ileocecal region.However,the need for coordination between surgeons and endoscopists,along with the requirement for staged procedures and multiple bowel preparations,increases the complexity of the treatment.In recent years,with the advancement of endoscopic full-thickness resection,endoscopic transcecal appendectomy(ETA)has been used to treat SSLs involving the AO.The use of choledochoscopy in conjunction with ETA can further enhance treatment precision.This integrated approach holds promise for replacing the combined endoscopic and laparoscopic surgical techniques.However,additional data are required to confirm its safety and efficacy.展开更多
BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix...BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.METHODS:A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years.Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.RESULTS:Data from two community hospitals indicated visualization rate of the appendix as 11.0%and 23.2%for site 1 and site 2 respectively.In cases where the ultrasound was repeated the visualization rate remains the same.A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis.The results revealed that the visualization of an appendix(P=0.52),significantly improved the diagnosis of appendicitis(z=34,P<0.001).CONCLUSION:Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis.In our study,we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound.Hence,the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.展开更多
Objectives: Acute appendicitis remains the commonest intra-abdominal surgical emergency. This study sought to identify the clinical factors that are most reliable in the diagnosis of acute appendicitis. Methods: This ...Objectives: Acute appendicitis remains the commonest intra-abdominal surgical emergency. This study sought to identify the clinical factors that are most reliable in the diagnosis of acute appendicitis. Methods: This was a retrospective review of consecutive adult appendicectomies over a 6 months period. The frequency of different clinical parameters was assessed to determine the most reliable predictors of acute appendicitis. A simple triad of 3 of the most frequent clinical parameters was examined for diagnostic potential by calculating its sensitivity, specificity, positive predictive value and negative predictive value. Results: There were a total of 124 patients. The median age was 33 years while the gender distribution was 54 males to 70 females. The most common clinical parameters in the patients with appendicitis were right iliac fossa tenderness or peritonism (100.0%), anorexia (78.8%), nausea (75.9%), migratory abdominal pain i.e. pain migrating to right lower quadrant (55.7%), tachycardia (41.3%) and pyrexia i.e. body temperature of 37.8 degrees Celsius and above (22.1%). The simple triad of anorexia, right iliac fossa tenderness and migratory abdominal pain showed specificity for the diagnosis of acute appendicitis of 84.2% and sensitivity of 45.7%. The positive predictive value of this triad was 94.1% while the negative predictive value was 21.9%. Conclusion: Our study reveals that the positivity for this simple clinical triad strongly rules in the diagnosis of acute appendicitis. Its specificity and positive predictive value compares with the most reliable scoring systems for acute appendicitis in literature. Further approaches to diagnosis such as imaging and diagnostic laparoscopy should be considered when this triad is negative and appendicitis is suspected. This simple diagnostic approach allows for prompt diagnosis and treatment which expectedly would improve the morbidity associated with acute appendicitis.展开更多
Objective: To investigate the diagnostic value of platelet parameters in acute appendicitis. Methods: This retrospective case-controlled study was performed among 200 healthy people and 200 patients with a primary dia...Objective: To investigate the diagnostic value of platelet parameters in acute appendicitis. Methods: This retrospective case-controlled study was performed among 200 healthy people and 200 patients with a primary diagnosis of acute appendicitis between October 2017 and June 2018. The patients were classified into three groups: the acute complicated appendicitis (suppurative and gangrenous) group, acute non-complicated appendicitis group and the control group. Red blood cell, white blood cell, lymphocyte, monocyte and platelets count, red blood cell distribution width, hemoglobin, hematocrit, mean platelet volume, platelet distribution width, and C-reactive protein were compared between the groups. Results: Thirty-nine (19.5%) patients with acute appendicitis had no complication and 161 (80.5%) developed a complication. The white blood cell count, neutrophil count and C-reactive protein serum levels were significantly higher, whereas the mean age, lymphocyte count, monocyte count, red blood cell distribution width and platelet count were significantly lower in acute appendicitis patients with and without complications compared with the control group. Moreover, combined analysis of best diagnostic parameters (white blood cell, neutrophil and lymphocyte counts) showed that combined parallel sensitivity and specificity were 98.7% and 42.7%, respectively. Conclusions: White blood cell, lymphocyte counts and neutrophil count could be used for diagnosis of acute appendicitis. More over the utility of mean platelet volume for differential diagnosis might be overestimated.展开更多
Background:Asymptomatic and oligosymptomatic appendicitis are rare and challenging diagnoses that should not be missed.Case presentation:A young female patient presented with mild to moderate pain in the middle and lo...Background:Asymptomatic and oligosymptomatic appendicitis are rare and challenging diagnoses that should not be missed.Case presentation:A young female patient presented with mild to moderate pain in the middle and lower abdomen,and the results of physical examination,including digital rectal examination,were otherwise non-contributory.Ultrasonography demonstrated a marked increase of the outer appendiceal diameter up to 12.0mm and a trace of free liquid around the terminal ileum.Subsequent surgical exploration and histological examination allowed for a final diagnosis of putrid,ulcero-phlegmonous,hemorrhagic appendicitis and periappendicitis.Conclusion:Ultrasonography is increasingly used for the diagnosis of appendiceal inflammation,particularly in military medical settings.Increases in the outer appendiceal diameter up to>6.0mm under compression have recently been demonstrated to be indicative of acute appendicitis.At a minimum,in cases with doubtful physical examination results,ultrasonography should be considered as an element in the diagnosis of acute appendicitis.展开更多
Objective: The aim of our study was to propose a solution for rationalizing requests for ultrasound examination and CT scan in suspected acute appendicitis, based on use of the Alvarado score. Patients and Methods: We...Objective: The aim of our study was to propose a solution for rationalizing requests for ultrasound examination and CT scan in suspected acute appendicitis, based on use of the Alvarado score. Patients and Methods: We included in our study all patients consulting for pain of the right iliac fossa, whatever their age and sex, who had been diagnosed with acute appendicitis and who had undergone appendectomy. We used the Alvarado scoring system, based on clinical items and laboratory measurements, to diagnose appendicitis. Results: One hundred eleven patients, of whom 77 were men (69.4%) and 34 were women (30.6%), with a sex ratio of 2:2.6, were included. Mean age was 31.29 ± 1.31 years, with a range of 1 to 81 years. The diagnosis of definite appendicitis was established in 54 patients (48.6%). Abdominal ultrasound examination had been performed in 80 patients (72.1%). It established a diagnosis of appendicitis in 69 patients (86.2%), while in 11 patients (13.8%) the appendix was described as normal or was not visualized. Conclusion: Our study demonstrated good agreement between peroperative diagnosis and the result of the Alvarado score applied a posteriori. Ultrasound was not always contributory to the diagnosis of acute appendicitis. It could be reserved for patients whose clinical and laboratory score indicated that appendicitis was unlikely.展开更多
BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandem...BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.展开更多
Background and Aim: Despite the fact that acute appendicitis is the most common surgical emergency all around the world, its diagnosis is still based on clinical evaluation and accuracy of the diagnosis depending on e...Background and Aim: Despite the fact that acute appendicitis is the most common surgical emergency all around the world, its diagnosis is still based on clinical evaluation and accuracy of the diagnosis depending on experience. The aim of this study is to evaluate the role of inflammatory markers in diagnosis of acute appendicitis. Material and Method: The study includes 77 cases with histopathologically proven acute appendicitis and 17 control cases. Blood samples were obtained from all cases and C-reactive protein (CRP), Granulocyte Colony Stimulating Factor (G-CSF) and Total Antioxidant Capacity (TAC) were measured. Findings: In cases with acute appendicitis, CRP and G-CSF levels were found to be related to acute appendicitis;however, TAC was not affected by the disease process. Moreover, CRP and G-CSF levels were correlated with the disease severity. Conclusion: Both CRP and G-CSF can be used in diagnosis of acute appendicitis. Furthermore, increased CRP level can be a marker to show advanced cases. However, G-CSF is not an effective marker to show disease severity.展开更多
Objective:To investigate the significance of serum bilirubin in the diagnosis of atypical acute appendicitis.Methods:perform a retrospective analysis of 120 patients with atypical acute appendicitis diagnosed in our h...Objective:To investigate the significance of serum bilirubin in the diagnosis of atypical acute appendicitis.Methods:perform a retrospective analysis of 120 patients with atypical acute appendicitis diagnosed in our hospital from July 2012 to July 2016.All patients underwent routine liver function tests before surgery.Results:83 patients were confirmed by surgery as acute appendicitis,of which 68 patients had elevated serum total bilirubin and direct bilirubin,and 15 patients were normal;37 patients were confirmed by surgery as non-acute appendicitis,of which 7 patients had elevated serum total bilirubin and direct bilirubin,and 30 patients were normal.Conclusion:The increase of serum bilirubin level has certain clinical significance for the diagnosis of atypical acute appendicitis.展开更多
Objective: to analyze the compliance of patients with acute appendicitis diagnosed by abdominal color Doppler ultrasound. Methods: sixty-two selected patients with acute appendicitis underwent surgery in our hospital,...Objective: to analyze the compliance of patients with acute appendicitis diagnosed by abdominal color Doppler ultrasound. Methods: sixty-two selected patients with acute appendicitis underwent surgery in our hospital, and were diagnosed as acute appendicitis by pathological examination after operation. The examination time was distributed between April 2021 and April 2022, and all the selected patients volunteered to participate in this experimental study. Calculate and analyze the coincidence of patients with acute appendicitis diagnosed by abdominal color Doppler ultrasound. Results: 48 cases of simple appendicitis, 3 cases of suppurative appendicitis, 4 cases of gangrenous appendicitis and 4 cases of periappendiceal abscess were examined by abdominal color Doppler ultrasound. Among them, two cases of simple appendicitis were diagnosed as acute pancreatitis and kidney calculi respectively. Compared with pathological results, the total misdiagnosis rate was 3.23% (2/62), while the missed diagnosis rate was 1.61%(1/62). Compared with pathological results, the diagnostic accuracy of abdominal color Doppler ultrasound was 95.16%, which was lower than pathological results, but there was no significant difference between them (P > 0.05). Conclusion: the condition of acute appendicitis changes rapidly and there are many kinds. Using abdominal color Doppler ultrasound to examine patients can accurately judge the disease types of patients, and has a high diagnostic coincidence rate, which is convenient for clinicians to formulate a reasonable treatment plan, which can save patients lives and ensure their rapid recovery. Therefore, abdominal color Doppler ultrasound can be used in clinical diagnosis of appendicitis.展开更多
Mesenteric adenitis consists of an important differential diagnosis of potentially serious diseases such as acute appendicitis, since they manifest themselves with a similar clinical picture. Case report: A 17-year-ol...Mesenteric adenitis consists of an important differential diagnosis of potentially serious diseases such as acute appendicitis, since they manifest themselves with a similar clinical picture. Case report: A 17-year-old male patient presented with periumbilical abdominal pain for 2 days, of abrupt onset and moderate intensity, who gave away with a common analgesic, which progressed to the right iliac fossa (RIF) and increased of intensity. He also reported liquid diarrhea, with several episodes a day, without mucus and/or blood, 38°C fever, anorexia and vomiting. He was hospitalized for investigating a possible diagnostic of Acute Appendicitis. In the exams, it was considered mesenteric adenitis, and antibiotic therapy was prescribed. The patient had complete improvement at the end of treatment. Conclusions: Given its importance as a differential diagnosis of numerous pathologies, as well as controversial before the therapeutic and diagnostic conduct, it is essential to report these cases in order to elucidate the specificities of this disease.展开更多
Introduction: Diagnostic wanderings of acute appendicitis are responsible for serious complications or abusive appendectomies. Existing Clinico-biological scores are efficient. Objective: To determine the diagnostic e...Introduction: Diagnostic wanderings of acute appendicitis are responsible for serious complications or abusive appendectomies. Existing Clinico-biological scores are efficient. Objective: To determine the diagnostic efficiency of Fran?ois’ score in acute appendicitis. Methodology: over 10 months, all the patients admitted in the CHUD-Parakou Emergency Department for pain in the right iliac fossa had been examined by resident students who calculated Fran?ois’ score. After verification by the surgeon, patients were put into three categories: category 1 score ≥ 2;category 2, score between -6 and 2;category 3, score below -6. Sensitivity and specificity were calculated. Results: out of 54 patients selected (29 men and 25 women), 29 were classified as group 1;19 as group 2 and 6 as group 3. An ultrasound was performed in all patients in group 2, and signs in favor of appendicitis were found in 12 patients. Of the 41 appendicectomies performed, the histologic analysis of 33 operative specimens found a pathological appendix. Sensitivity, specificity and negative predictive value per group were 100%. It has prevented almost in one every four patients (24.07%) an abusive appendectomy. Conclusion: This score would reduce diagnostic wanderings and target patient groups for imaging studies.展开更多
文摘BACKGROUND Early detection of acute appendicitis(AA)in pediatric cases,critical to avoiding life-threatening complications such as perforation or abscess,remains challenging.AIM To evaluate the utility of abdominal ultrasonography(AUS)in diagnosing pediatric AA.METHODS Overall,102 pediatric patients(aged 3-12 years)suspected of having AA were enrolled and divided into the AA(n=78)and non-AA(n=24)groups.All children underwent AUS and computed tomography(CT).Comparative analyses regarding general patient characteristics and appendix-specific parameters were conducted.The diagnostic performance of AUS and CT in pediatric AA was evaluated.RESULTS All appendix-related parameters were greater in the AA group than in the non-AA group.The areas under the receiver-operating characteristic curves for pediatric AA diagnosis using AUS,CT,and AUS+CT were 0.870,0.824,and 0.931(all P<0.001),respectively(AUS:94.87%sensitivity,79.17%specificity;CT:89.74%sensitivity,75.00%specificity;combined:98.72%sensitivity,87.50%specificity).The positive predictive value(PPV),negative predictive value(NPV),accuracy rate,positive detection rate,and misdiagnosis rate of AUS were 93.67%,82.61%,91.18%,72.55%,and 20.83%,respectively.CT had a slightly lower PPV(92.11%)and NPV(69.23%),along with accuracy,positive detection,and misdiagnosis rates of 86.27%,68.63%,and 25%,respectively.Their combination improved performance,yielding 96.25%PPV,95.45%NPV,96.08%accuracy,75.49%positive detection rate,and 12.50%misdiagnosis rate.CONCLUSION AUS demonstrates certain diagnostic potential in AA diagnosis in pediatric patients,and its combination with CT further improves diagnostic efficacy.
文摘Acute appendicitis remains one of the most common causes of emergency abdominal surgery globally.Imaging plays a pivotal role in confirming or excluding the diagnosis and identifying complications that influence management pathways.This narrative review synthesizes contemporary evidence and consensusbased imaging protocols for appendicitis,with a focus on computed tomography,magnetic resonance imaging,and ultrasound.The article explores advanced diagnostic criteria,interpretation challenges,imaging algorithms derived from professional society guidelines,and special considerations including pregnancy and pediatric populations.Clinical practice recommendations by the World Society of Emergency Surgery,European Association of Endoscopic Surgery,American College of Radiology,and Infectious Diseases Society of America are incorporated to frame best practices.
基金supported by the National Natural Science Foundation of China,No.822712782019 Wuhan Huanghe Talents Program+3 种基金2020 Wuhan Medical Research Project,No.20200206010123032021 Hubei Youth Top-notch Talent Training Program2022 Outstanding Youth Project of Natural Science Foundation of Hubei Province,No.2022CFA106Medical Research Program of Huatongguokang,No.2023HT036(all to NX)。
文摘The misfolding,aggregation,and deposition of alpha-synuclein into Lewy bodies are pivotal events that trigger pathological changes in Parkinson's disease.Extracellular vesicles are nanosized lipidbilayer vesicles secreted by cells that play a crucial role in intercellular communication due to their diverse cargo.Among these,brain-derived extracellular vesicles,which are secreted by various brain cells such as neurons,glial cells,and Schwann cells,have garnered increasing attention.They serve as a promising tool for elucidating Parkinson's disease pathogenesis and for advancing diagnostic and therapeutic strategies.This review highlights the recent advancements in our understanding of brain-derived extracellular vesicles released into the blood and their role in the pathogenesis of Parkinson's disease,with specific emphasis on their involvement in the aggregation and spread of alpha-synuclein.Brain-derived extracellular vesicles contribute to disease progression through multiple mechanisms,including autophagy-lysosome dysfunction,neuroinflammation,and oxidative stress,collectively driving neurodegeneration in Parkinson's disease.Their application in Parkinson's disease diagnosis is a primary focus of this review.Recent studies have demonstrated that brainderived extracellular vesicles can be isolated from peripheral blood samples,as they carryα-synuclein and other key biomarkers such as DJ-1 and various micro RNAs.These findings highlight the potential of brain-derived extracellular vesicles,not only for the early diagnosis of Parkinson's disease but also for disease progression monitoring and differential diagnosis.Additionally,an overview of explorations into the potential therapeutic applications of brain-derived extracellular vesicles for Parkinson's disease is provided.Therapeutic strategies targeting brain-derived extracellular vesicles involve modulating the release and uptake of pathological alpha-synuclein-containing brain-derived extracellular vesicles to inhibit the spread of the protein.Moreover,brain-derived extracellular vesicles show immense promise as therapeutic delivery vehicles capable of transporting drugs into the central nervous system.Importantly,brain-derived extracellular vesicles also play a crucial role in neural regeneration by promoting neuronal protection,supporting axonal regeneration,and facilitating myelin repair,further enhancing their therapeutic potential in Parkinson's disease and other neurological disorders.Further clarification is needed of the methods for identifying and extracting brain-derived extracellular vesicles,and large-scale cohort studies are necessary to validate the accuracy and specificity of these biomarkers.Future research should focus on systematically elucidating the unique mechanistic roles of brain-derived extracellular vesicles,as well as their distinct advantages in the clinical translation of methods for early detection and therapeutic development.
文摘AIM:To investigate the diagnostic accuracy of the mean platelet volume and platelet distribution width in acute appendicitis.METHODS:This retrospective,case-controlled study compared 295 patients with acute appendicitis(Group?Ⅰ),100 patients with other intra-abdominal infections(GroupⅡ),and 100 healthy individuals(GroupⅢ)between January 2012 and January 2013.The age,gender,and white blood cell count,neutrophil percentage,mean platelet volume,and platelet distribution width values from blood samples were compared among the groups.Statistical analyses were performed using SPSS for Windows 21.0 software.In addition,the sensitivity,specificity,positive and negative predictive values and likelihood ratios,and diagnostic accuracy were calculated.RESULTS:The mean ages of patients were 29.9±12.0years for Group?Ⅰ,31.5±14.0 years for GroupⅡ,and30.4±13.0 years for GroupⅢ.Demographic features such as age and gender were not significantly different among the groups.White blood cell count,neutrophil percentage and platelet distribution width were significantly higher in Group?Ⅰ?compared to groupsⅡandⅢ(P<0.05).Diagnostically,the sensitivity,specificity and diagnostic accuracy were 73.1%,94.0%,and 78%for white blood cell count,70.0%,96.0%,and 76.0%for neutrophil percentage,29.5%,49.0%,and 34.0%for mean platelet volume,and 97.1%,93.0%,and 96.0%for platelet distribution width,respectively.The highest diagnostic accuracy detected was for platelet distribution width between Group?Ⅰ?and GroupⅢ(P<0.01).CONCLUSION:Platelet distribution width analysis can be used for diagnosis of acute appendicitis without requiring additional tests,thus reducing the cost and loss of time.
文摘AIM:To assess the reliability and practical applicability of the widely used Alvarado,Eskelinen,Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA)scoring systems in patients with suspected acute appendicitis.METHODS:Patients admitted to our tertiary center due to suspected acute appendicitis constituted the study group.Patients were divided into two groups.appendicitis group(Group A)consisted of patients who underwent appendectomy and were histopathologically diagnosed with acute appendicitis,and non-appendicitis group(Group N-A)consisted of patients who underwent negative appendectomy and were diagnosed with pathologies other than appendicitis and patients that were followed non-operatively.The operative findings for the patients,the additional analyses from follow up of the patients and the results of those analyses were recorded using the follow-up forms.RESULTS:One hundred and thirteen patients with suspected acute appendicitis were included in the study.Of the 113 patients(62 males,51 females),the mean age was 30.2±10.1(range 18-67)years.Of the 113patients,94 patients underwent surgery,while the rest were followed non-operatively.Of the 94 patients,77patients were histopathologically diagnosed with acute appendicitis.Our study showed a sensitivity level of81%for the Alvarado system when a cut-off value of 6.5was used,a sensitivity level of 83.1%for the Ohmann system when a cut-off value of 13.75 was used,a sensitivity level of 80.5%for the Eskelinen system when a cut-off value of 63.72 was used,and a sensitivity level of 83.1%for the RIPASA system when a cut-off value of 10.25 was used.CONCLUSION:The Ohmann and RIPASA scoring systems had the highest specificity for the diagnosis of acute appendicitis.
文摘Introduction: Acute appendicitis is the major surgical abdominal disease in emergency departments and is also among the five leading causes of litigation against emergency physicians. Delayed diagnosis of appendicitis is more likely to occur in patients, who present atypically, and those lack a thorough physical examination, or those received intramuscular narcotic analgesia. The aim of this study was to study the effect of delay in diagnosis of acute appendicitis as regard postoperative findings, length of hospital stay and post-operative complications. Patients & Methods: Patients with complicated appendicitis were subjected to the present study and treated by a single surgical team. The parameters of our study were incidence of perforation or gangrene at surgery, length of stay and post-operative complications. Results: The present study showed that delay in diagnosis of acute appendicitis is associated with a more advanced stage of disease and a higher morbidity. Conclusion: careful attention to the patient’s history;a thorough physical examination and early clinical review help to minimize the possibility of delayed diagnosis of appendicitis. Appendicitis with a delay in treatment usually leads to high perforation rates, and unfavorable outcome.
文摘BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.
文摘BACKGROUND: Appendicitis is a common disease requiring surgery. Bedside ultrasound(BUS) is a core technique for emergency medicine(EM). The Alvarado score is a well-studied diagnostic tool for appendicitis. This study aimed to investigate the relationship between patients' symptoms, Alvarado score and ultrasound(US) findings, as performed by emergency physicians(EPs) and radiologists, of patients with suspected appendicitis.METHODS: Three EM specialists underwent the BUS course and core course for appendicitis assessment. Patients suspected of having appendicitis were selected and their Alvarado and modif ied(m) Alvarado scores calculated. The specialists performed the BUS. Then, patients were given a formal US and surgery consultation if necessary. Preliminary diagnoses, admission or discharge from the emergency department(ED) and fi nal diagnosis were documented. The patients were also followed up after discharge from the hospital.RESULTS: The determined cut-off value was 2 for Alvarado and 3 for m Alvarado scores. The sensitivities of the two scores were 100%. Each score was used to rule out appendicitis. The results of EP-performed BUS were as follows: accuracy 70%, sensitivity 0.733, specifi city 0.673, + LR 2.24, and – LR 0.40(95%CI). Radiologists were better than EPs at diagnosing appendicitis and radiologists and EPs were equally strong at ruling out appendicitis by US. When US was combined with Alvarado and m Alvarado scores, EP US+Alvarado/m Alvarado scores ≤3 and radiology US+Alvarado/m Alvarado scores ≤4 perfectly ruled out appendicitis.CONCLUSION: BUS performed by EPs is moderately useful in detecting appendicitis. Combined with scoring systems, BUS may be a perfect tool for ruling out decisions in EDs.
文摘Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic mucosal resection(EMR)serve as alternative treatments for lesions at the appendiceal orifice(AO).However,EMR is not appropriate when the lesion margin within the AO cannot be visualized.When lesions extend into the lumen,extended laparoscopic appendectomy(ELA)or combined surgery can be used to resect the lesions.Compared with traditional surgery and EMR,ELA or combined surgery is a safer and more precise option that preserves the function of the ileocecal region.However,the need for coordination between surgeons and endoscopists,along with the requirement for staged procedures and multiple bowel preparations,increases the complexity of the treatment.In recent years,with the advancement of endoscopic full-thickness resection,endoscopic transcecal appendectomy(ETA)has been used to treat SSLs involving the AO.The use of choledochoscopy in conjunction with ETA can further enhance treatment precision.This integrated approach holds promise for replacing the combined endoscopic and laparoscopic surgical techniques.However,additional data are required to confirm its safety and efficacy.
文摘BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.METHODS:A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years.Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.RESULTS:Data from two community hospitals indicated visualization rate of the appendix as 11.0%and 23.2%for site 1 and site 2 respectively.In cases where the ultrasound was repeated the visualization rate remains the same.A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis.The results revealed that the visualization of an appendix(P=0.52),significantly improved the diagnosis of appendicitis(z=34,P<0.001).CONCLUSION:Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis.In our study,we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound.Hence,the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.
文摘Objectives: Acute appendicitis remains the commonest intra-abdominal surgical emergency. This study sought to identify the clinical factors that are most reliable in the diagnosis of acute appendicitis. Methods: This was a retrospective review of consecutive adult appendicectomies over a 6 months period. The frequency of different clinical parameters was assessed to determine the most reliable predictors of acute appendicitis. A simple triad of 3 of the most frequent clinical parameters was examined for diagnostic potential by calculating its sensitivity, specificity, positive predictive value and negative predictive value. Results: There were a total of 124 patients. The median age was 33 years while the gender distribution was 54 males to 70 females. The most common clinical parameters in the patients with appendicitis were right iliac fossa tenderness or peritonism (100.0%), anorexia (78.8%), nausea (75.9%), migratory abdominal pain i.e. pain migrating to right lower quadrant (55.7%), tachycardia (41.3%) and pyrexia i.e. body temperature of 37.8 degrees Celsius and above (22.1%). The simple triad of anorexia, right iliac fossa tenderness and migratory abdominal pain showed specificity for the diagnosis of acute appendicitis of 84.2% and sensitivity of 45.7%. The positive predictive value of this triad was 94.1% while the negative predictive value was 21.9%. Conclusion: Our study reveals that the positivity for this simple clinical triad strongly rules in the diagnosis of acute appendicitis. Its specificity and positive predictive value compares with the most reliable scoring systems for acute appendicitis in literature. Further approaches to diagnosis such as imaging and diagnostic laparoscopy should be considered when this triad is negative and appendicitis is suspected. This simple diagnostic approach allows for prompt diagnosis and treatment which expectedly would improve the morbidity associated with acute appendicitis.
文摘Objective: To investigate the diagnostic value of platelet parameters in acute appendicitis. Methods: This retrospective case-controlled study was performed among 200 healthy people and 200 patients with a primary diagnosis of acute appendicitis between October 2017 and June 2018. The patients were classified into three groups: the acute complicated appendicitis (suppurative and gangrenous) group, acute non-complicated appendicitis group and the control group. Red blood cell, white blood cell, lymphocyte, monocyte and platelets count, red blood cell distribution width, hemoglobin, hematocrit, mean platelet volume, platelet distribution width, and C-reactive protein were compared between the groups. Results: Thirty-nine (19.5%) patients with acute appendicitis had no complication and 161 (80.5%) developed a complication. The white blood cell count, neutrophil count and C-reactive protein serum levels were significantly higher, whereas the mean age, lymphocyte count, monocyte count, red blood cell distribution width and platelet count were significantly lower in acute appendicitis patients with and without complications compared with the control group. Moreover, combined analysis of best diagnostic parameters (white blood cell, neutrophil and lymphocyte counts) showed that combined parallel sensitivity and specificity were 98.7% and 42.7%, respectively. Conclusions: White blood cell, lymphocyte counts and neutrophil count could be used for diagnosis of acute appendicitis. More over the utility of mean platelet volume for differential diagnosis might be overestimated.
文摘Background:Asymptomatic and oligosymptomatic appendicitis are rare and challenging diagnoses that should not be missed.Case presentation:A young female patient presented with mild to moderate pain in the middle and lower abdomen,and the results of physical examination,including digital rectal examination,were otherwise non-contributory.Ultrasonography demonstrated a marked increase of the outer appendiceal diameter up to 12.0mm and a trace of free liquid around the terminal ileum.Subsequent surgical exploration and histological examination allowed for a final diagnosis of putrid,ulcero-phlegmonous,hemorrhagic appendicitis and periappendicitis.Conclusion:Ultrasonography is increasingly used for the diagnosis of appendiceal inflammation,particularly in military medical settings.Increases in the outer appendiceal diameter up to>6.0mm under compression have recently been demonstrated to be indicative of acute appendicitis.At a minimum,in cases with doubtful physical examination results,ultrasonography should be considered as an element in the diagnosis of acute appendicitis.
文摘Objective: The aim of our study was to propose a solution for rationalizing requests for ultrasound examination and CT scan in suspected acute appendicitis, based on use of the Alvarado score. Patients and Methods: We included in our study all patients consulting for pain of the right iliac fossa, whatever their age and sex, who had been diagnosed with acute appendicitis and who had undergone appendectomy. We used the Alvarado scoring system, based on clinical items and laboratory measurements, to diagnose appendicitis. Results: One hundred eleven patients, of whom 77 were men (69.4%) and 34 were women (30.6%), with a sex ratio of 2:2.6, were included. Mean age was 31.29 ± 1.31 years, with a range of 1 to 81 years. The diagnosis of definite appendicitis was established in 54 patients (48.6%). Abdominal ultrasound examination had been performed in 80 patients (72.1%). It established a diagnosis of appendicitis in 69 patients (86.2%), while in 11 patients (13.8%) the appendix was described as normal or was not visualized. Conclusion: Our study demonstrated good agreement between peroperative diagnosis and the result of the Alvarado score applied a posteriori. Ultrasound was not always contributory to the diagnosis of acute appendicitis. It could be reserved for patients whose clinical and laboratory score indicated that appendicitis was unlikely.
文摘BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.
文摘Background and Aim: Despite the fact that acute appendicitis is the most common surgical emergency all around the world, its diagnosis is still based on clinical evaluation and accuracy of the diagnosis depending on experience. The aim of this study is to evaluate the role of inflammatory markers in diagnosis of acute appendicitis. Material and Method: The study includes 77 cases with histopathologically proven acute appendicitis and 17 control cases. Blood samples were obtained from all cases and C-reactive protein (CRP), Granulocyte Colony Stimulating Factor (G-CSF) and Total Antioxidant Capacity (TAC) were measured. Findings: In cases with acute appendicitis, CRP and G-CSF levels were found to be related to acute appendicitis;however, TAC was not affected by the disease process. Moreover, CRP and G-CSF levels were correlated with the disease severity. Conclusion: Both CRP and G-CSF can be used in diagnosis of acute appendicitis. Furthermore, increased CRP level can be a marker to show advanced cases. However, G-CSF is not an effective marker to show disease severity.
文摘Objective:To investigate the significance of serum bilirubin in the diagnosis of atypical acute appendicitis.Methods:perform a retrospective analysis of 120 patients with atypical acute appendicitis diagnosed in our hospital from July 2012 to July 2016.All patients underwent routine liver function tests before surgery.Results:83 patients were confirmed by surgery as acute appendicitis,of which 68 patients had elevated serum total bilirubin and direct bilirubin,and 15 patients were normal;37 patients were confirmed by surgery as non-acute appendicitis,of which 7 patients had elevated serum total bilirubin and direct bilirubin,and 30 patients were normal.Conclusion:The increase of serum bilirubin level has certain clinical significance for the diagnosis of atypical acute appendicitis.
文摘Objective: to analyze the compliance of patients with acute appendicitis diagnosed by abdominal color Doppler ultrasound. Methods: sixty-two selected patients with acute appendicitis underwent surgery in our hospital, and were diagnosed as acute appendicitis by pathological examination after operation. The examination time was distributed between April 2021 and April 2022, and all the selected patients volunteered to participate in this experimental study. Calculate and analyze the coincidence of patients with acute appendicitis diagnosed by abdominal color Doppler ultrasound. Results: 48 cases of simple appendicitis, 3 cases of suppurative appendicitis, 4 cases of gangrenous appendicitis and 4 cases of periappendiceal abscess were examined by abdominal color Doppler ultrasound. Among them, two cases of simple appendicitis were diagnosed as acute pancreatitis and kidney calculi respectively. Compared with pathological results, the total misdiagnosis rate was 3.23% (2/62), while the missed diagnosis rate was 1.61%(1/62). Compared with pathological results, the diagnostic accuracy of abdominal color Doppler ultrasound was 95.16%, which was lower than pathological results, but there was no significant difference between them (P > 0.05). Conclusion: the condition of acute appendicitis changes rapidly and there are many kinds. Using abdominal color Doppler ultrasound to examine patients can accurately judge the disease types of patients, and has a high diagnostic coincidence rate, which is convenient for clinicians to formulate a reasonable treatment plan, which can save patients lives and ensure their rapid recovery. Therefore, abdominal color Doppler ultrasound can be used in clinical diagnosis of appendicitis.
文摘Mesenteric adenitis consists of an important differential diagnosis of potentially serious diseases such as acute appendicitis, since they manifest themselves with a similar clinical picture. Case report: A 17-year-old male patient presented with periumbilical abdominal pain for 2 days, of abrupt onset and moderate intensity, who gave away with a common analgesic, which progressed to the right iliac fossa (RIF) and increased of intensity. He also reported liquid diarrhea, with several episodes a day, without mucus and/or blood, 38°C fever, anorexia and vomiting. He was hospitalized for investigating a possible diagnostic of Acute Appendicitis. In the exams, it was considered mesenteric adenitis, and antibiotic therapy was prescribed. The patient had complete improvement at the end of treatment. Conclusions: Given its importance as a differential diagnosis of numerous pathologies, as well as controversial before the therapeutic and diagnostic conduct, it is essential to report these cases in order to elucidate the specificities of this disease.
文摘Introduction: Diagnostic wanderings of acute appendicitis are responsible for serious complications or abusive appendectomies. Existing Clinico-biological scores are efficient. Objective: To determine the diagnostic efficiency of Fran?ois’ score in acute appendicitis. Methodology: over 10 months, all the patients admitted in the CHUD-Parakou Emergency Department for pain in the right iliac fossa had been examined by resident students who calculated Fran?ois’ score. After verification by the surgeon, patients were put into three categories: category 1 score ≥ 2;category 2, score between -6 and 2;category 3, score below -6. Sensitivity and specificity were calculated. Results: out of 54 patients selected (29 men and 25 women), 29 were classified as group 1;19 as group 2 and 6 as group 3. An ultrasound was performed in all patients in group 2, and signs in favor of appendicitis were found in 12 patients. Of the 41 appendicectomies performed, the histologic analysis of 33 operative specimens found a pathological appendix. Sensitivity, specificity and negative predictive value per group were 100%. It has prevented almost in one every four patients (24.07%) an abusive appendectomy. Conclusion: This score would reduce diagnostic wanderings and target patient groups for imaging studies.
