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PubMed1997

Additional value of biochemical tests in suspected acute appendicitis.

OBJECTIVE: To evaluate the efficacy of biochemical tests in diagnosing acute appendicitis. DESIGN: Open prospective study. SETTING: District hospital, Norway. SUBJECTS: 257 patients with suspected acute appendicitis. INTERVENTIONS: Initial diagnostic accuracy of a logistic regression model using available clinical data was compared with results of corresponding models that included an increasing number of inflammatory parameters. MAIN OUTCOME MEASURES: The estimated probabilities of appendicitis in different testing groups were analysed using receiver operating characteristic (ROC) curves. RESULTS: A model including only clinical variables had a mean area under the ROC curve of 0.854. When the total white blood cell count, C-reactive protein concentration, and neutrophil count were added, the model improved significantly to 0.920. CONCLUSION: Biochemical tests are of additional value in a computer model, and the tests should, if used rationally, also provide physicians with important information in the investigation of acute appendicitis.

Abdominal Pain↗
PubMed1976

[Anaerobic bacteria isolated from appendices and appendicitis cases].

Anaerobic bacteria were isolated from 17 of 40 normal appendices and appendicitis cases in Ankara. In both cases gram positive, nonsporulating, and gram negative organisms were isolated. Gram positive cocci were only isolated from appendicitis cases. The bacteria isolated from appendicitis are usually like the anaerobic bacteria of the colon flora. All anaerobic bacteria in appendix flora can cause appendicitis in suitable conditions.

Anaerobiosis↗
PubMed1997

Routine ultrasonography in the diagnosis of acute appendicitis: a valuable tool in daily practice?

Initial clinical examination, laboratory inflammation parameters, and routine ultrasonography (US) were evaluated prospectively in 205 patients admitted for suspected acute appendicitis. The purpose of the study was to compare initial clinical examination and laboratory tests with the accuracy of US obtained in daily practice. All ultrasonographic examinations were performed by residents in radiology and radiologists qualified for routine abdominal US but not specifically trained in the diagnostics of appendicitis. Initial clinical examination had the highest sensitivity, but the specificity was poor. The single laboratory tests were of limited value in predicting appendicitis. The accuracy of US was disappointing, and the reported promising results of previous studies were not confirmed. Sonographers with less experience had a higher sensitivity but a poorer specificity compared with more experienced sonographers, who had a high specificity at the cost of extremely poor sensitivity. Biases, dichotomization problems, and factors influencing the accuracy of US in patients with suspected acute appendicitis are discussed.

Acute Disease↗
PubMed1997

[Is perforating appendicitis a separate disease picture?].

Large epidemiological studies recently published suggest that perforating appendicitis may represent a separate disease entity. To find out whether perforating and nonperforating appendicitis may be distinguished by clinical features (history and examination, lab tests) data from 519 cases of acute appendicitis (17.7% perforations) were analysed, and significant differences were recorded in various aspects of history and clinical examination. It was concluded that perforating and nonperforating appendicitis may clinically be distinguished reliably in the majority of cases.

Adult↗
PubMed1998

Perforated appendicitis: is it truly a surgical urgency?

Advanced perforated appendicitis with localized findings has classically been treated with either operative therapy or with percutaneous drainage. The role of nonoperative therapy followed by interval appendectomy (IA) remains controversial. We assessed the safety and efficacy of conservative management for perforated appendicitis in a 5-year review of patients treated conservatively for perforated appendicitis with localized abscess or phlegmon. Patients were treated initially with intravenous antibiotics, and CT-guided drainage was used only if the patient failed to improve after 48 to 72 hours. Patients still not improving underwent appendectomy. Patients responding to conservative therapy were recommended IA in 6 to 12 weeks. Sixty-six patients with 54 abscesses and 10 phlegmons were treated. Fifty-one patients (92%) improved without surgery. Only 58 per cent of the abscesses required percutaneous drainage. The mean length of stay for conservative therapy was 7.6 days. Forty-one patients underwent IA with a 10 per cent morbidity and a mean length of stay of 1.4 days. Conservative management of appendicitis with localized perforation or phlegmon is safe and effective. Percutaneous drainage is frequently not required. IA is associated with low morbidity without prolonged hospitalization.

Abscess↗
PubMed1998

[Acute appendicitis and pregnancy; experience at Hospital Espanõl of Mexico].

Acute appendicitis the most common surgical complication during pregnancy. The diagnosis is difficult and requires an urgent surgical treatment. The basic objective of this article was to determine the clinic profile of this association. We review the cases with acute appendicitis and pregnancy presented since January 1990 to December 1996 in our hospital. We found 17 cases, with an average age of 28.6 years. Of this 17 cases 12 were truly appendicitis. The time between the onset of the first symptom to the laparotomy was of 43.25 hours. The natural history of the appendicitis is not modified by the presence of a pregnancy. Abdominal pain remains as the clue symptom and was present in 100% of the patients. Finally an early diagnosis and treatment allows a reduction in the maternal fetal mortality.

Adolescent↗
PubMed1998

[Appendicitis admitting diagnosis. A 3-year analysis].

During a period of three years 863 patients were stationary admitted with a appendicitis as assignment diagnosis. Appendicitis of a disease of the appendix was found in 59.4% of the patients. 40.6% of all admitted patients showed no evidence of appendicitis. Out of these cases, 281 patients (32.6%) were treated conservatively, 69 patients (8%) underwent an operation. The result of the analysis indicated, that the assignment diagnosis appendicitis--now as before--is significantly doubtful having an impact on the subsequential decisions.

Adolescent↗
PubMed1998

[Acute appendicitis in the child].

The appendicitis is the commonest cause of an acute abdomen in children older 1 year of age. Only 5% of children with appendicitis are younger than 2 years of age. There is a familial preponderance. The younger the child the faster the symptoms of the disease are increasing in intensity. The symptoms starts with unspecific periumbilical or epigastric pain, followed by nausea, vomiting and restlessness at night. Finally the pain moves to the position of the appendix. The position of the appendix shows a high variation in children thus the pain characteristic is not uniform. Laboratory tests are not reliable but ultrasonography is recommended to exclude other diseases and to try to confirm the diagnoses. With the technique of "Graded compression Sonography" the rate of non identified appendicitis has been reduced under 5%. Laparoscopy is another option. Its use just for diagnostic purposes is limited but is recommended widely for primary therapeutic treatment with laparoscopic performed appendectomy. Laparoscopy has a special advantage against conventional appendectomy in the diagnostic of recurrent unspecific abdominal pain in children and in cases with interval appendectomy. Finally in pseudoappendicitis and pseudoperitonitis in children with immunvasculitis and other extraabdominal diseases. Letality of the acute appendicitis is zero.

Abdomen, Acute↗
PubMed2003

Pyrrole-appended derivatives of O-confused oxaporphyrins and their complexes with nickel(II), palladium(II), and silver(III).

Condensation of 2,4-bis(phenylhydroxymethyl)furan with pyrrole and p-toluylaldehyde formed, instead of the expected 5,20-diphenyl-10,15-di(p-tolyl)-2-oxa-21-carbaporphyrin, a pyrrole addition product [(H,pyr)OCPH]H(2); this product can formally be considered as an effect of hydrogenation of 3-(2'-pyrrolyl)-5,20-diphenyl-10,15-di(p-tolyl)-2-oxa-21-carbaporphyrin ([(pyr)OCPH]H). The new oxacarbaporphyrinoid presents the (1)H NMR spectroscopy features of an aromatic molecule, including the upfield shift of the inner H21 atom. Insertion of NiCl(2) or PdCl(2) into [(H,pyr)OCPH]H(2) gave two structurally related organometallic complexes, [(pyr)OCP]Ni(II)] and [(pyr)OCP]Pd(II)], in which the metal ions are bound by three pyrrolic nitrogens and the trigonally hybridized C21 atom of the inverted furan. The reaction of [(H,pyr)OCPH]H(2) with silver(I) acetate yields a stable Ag(III) complex [(C(2)H(5)O,pyr)OCP]Ag(III)] substituted at the C3 position by the ethoxy and pyrrole moieties. The macrocyclic frame of [(H,pyr)OCPH]H(2) is conserved. Addition of trifluoroacetic acid to [(C(2)H(5)O,pyr)OCP]Ag(III)] yielded a new aromatic complex [(pyr)OCP]Ag(III)](+). The structures of [(pyr)OCP]Ni(II)] and [(C(2)H(5)O,pyr)OCP]Ag(III)] have been determined by X-ray crystallography. In both molecules the macrocycles are only slightly distorted from planarity and the nickel(II) and silver(III) are located in the NNNC plane. The dihedral angle between the macrocyclic and appended-pyrrole planes of [(pyr)OCP]Ni(II)] reflects the biphenyl-like arrangement with the NH group pointing out toward the adjacent phenyl ring on the C5 position. Tetrahedral geometry around the C3 atom was detected for [(C(2)H(5)O,pyr)OCP]Ag(III)]. The Ni[bond]C and Ag[bond]C bond lengths are similar to other nickel(II) or silver(III) carbaporphyrinoids where the trigonal carbon atom coordinates the metal ion. The trend detected in the (13)C chemical shifts for the appended-pyrrole resonances has been rationalized by the extent of effective conjugation between the macrocycle and the appended pyrrole moiety controlled by the hybridization of the C3 atom and the metal ion oxidation state. The dianionic or trianionic macrocyclic core of the pyrrole-appended derivatives is favored to match the oxidation state of nickel(II), palladium(II), or silver(III), respectively.

Journal Article↗
PubMed2002

Intron positions delineate the evolutionary path of a pervasively appended peptide in five human aminoacyl-tRNA synthetases.

Recent progress in genome sequencing has revealed a correspondence between the evolution of multicellularity and the appending of new peptides onto age-old enzyme bodies. Indicative of the pervasive nature of these appended peptides, in some cases the same sequences have been appended to a number of different enzymes. By analyzing the positions of introns within one such roaming peptide, an approximately 50-amino acid motif appended to five human aminoacyl-tRNA synthetases, I have delineated its path in eukaryote evolution. The motif was first acquired as an N-terminal extension by histidyl- and glycyl-tRNA synthetases at a very early stage of eukaryote evolution. Later, but not less than 1200 million years ago, the motif spread from histidyl-tRNA synthetase to the C and N terminals of glutamyl- and prolyl-tRNA synthetase, respectively, and then spread further during the evolution of the Chordate lineage to the N terminal of tryptophanyl-tRNA synthetase. In similar fashion, the motif in glycyl-tRNA synthetase spread to the C terminal of methionyl-tRNA synthetase not later than 1000 million years ago.

Amino Acid Sequence↗
PubMed2002

Diagnosis of acute appendicitis with unenhanced helical CT: a study of 130 patients.

The aim of this study was to determine the sensitivity, specificity, and diagnostic accuracy of helical computed tomography (CT) without oral, intravenous, or rectal administration of contrast material in confirming the diagnosis of acute appendicitis in patients with suggestive clinical and laboratory findings. One hundred and thirty patients with suspected acute appendicitis underwent an unenhanced helical CT scan. Scans were obtained in a single breath-hold from the level of umbilicus to the pubic symphysis using a 5-mm collimation. Oral, intravenous, or rectal contrast materials were not used. The criteria for diagnosis of acute appendicitis included an enlarged diameter of appendix more than 6 mm with associated periappendiceal inflammation. The results yielded a sensitivity of 94.7%, a specificity of 91.7%, an accuracy of 93.8%, a positive predictive value of 96.7%, and a negative predictive value of 86.8%. Unenhanced helical CT accurately diagnoses acute appendicitis, and it protects the patients from unnecessary further time-consuming diagnostic procedures, the risks associated with contrast material administration, and unnecessary surgical interventions.

Journal Article↗
PubMed2004

Appending epidemiological studies to conventional case-control studies (hybride case-control studies).

This paper summarizes several studies that can be appended to conventional case-control studies especially in the context of case-control studies that focus on etiologic questions. Appending studies to case-control studies may further add to the understanding of the epidemiology of diseases under investigation. We explain their uses, implications and limitations. One can append the following studies to a case-control study: (1) case-only study, (2) case crossover study, (3) case cross-sectional study, (4) control cross-sectional study, (5) case follow-up study, and (6) control follow-up study. The choice of the additional studies that are appended to the conventional case-control study has implications for the set of data and biological material that has to be collected, the ethical review board and the informed consent. Due to several limitations, the attachment of additional studies to a case-control study should be carefully considered and limited to only few additional studies in order to avoid overburden of the study participants and study personnel.

Biomedical Research↗
PubMed1997

Rescuing an essential enzyme-RNA complex with a non-essential appended domain.

Certain protein-RNA complexes, such as synthetase-tRNA complexes, are essential for cell survival. These complexes are formed with a precise molecular fit along the interface of the reacting partners, and mutational analyses have shown that amino acid or nucleotide substitutions at the interface can be used to disrupt functional or repair non-functional complexes. In contrast, we demonstrate here a feature of a eukaryote system that rescues a disrupted complex without directly re-engineering the interface. The monomeric yeast Saccharomyces cerevisiae glutaminyl-tRNA synthetase, like several other class I eukaryote tRNA synthetases, has an active-site-containing 'body' that is closely homologous to its Escherichia coli relative, but is tagged at its N-terminus with a novel and dispensable appended domain whose role has been obscure. Because of differences between the yeast and E. coli glutamine tRNAs that presumably perturb the enzyme-tRNA interface, E. coli glutaminyl-tRNA synthetase does not charge yeast tRNA. However, linking the novel appended domain of the yeast to the E. coli enzyme enabled the E. coli protein to function as a yeast enzyme, in vitro and in vivo. The appended domain appears to contribute an RNA interaction that compensates for weak or poor complex formation. In eukaryotes, extra appended domains occur frequently in these proteins. These domains may be essential when there are conditions that would otherwise weaken or disrupt formation of a critical RNA-protein complex. They may also be adapted for other, specialized RNA-related functions in specific instances.

Amino Acyl-tRNA Synthetases↗
PubMed1997

Acute appendicitis---a recent audit of an old problem.

We conducted a retrospective review of all patients who had an appendicectomy performed at the Queen Elizabeth Hospital, Hong Kong, from January 1993 through December 1994. The diagnostic accuracy for true appendicitis was 74%. Nine per cent of patients had other pathologies, which also needed exploration. The diagnostic accuracy in female patients was 66%, compared with 82% for male patients (P<0.0001). Female patients aged between 15 to 40 years were diagnosed accurately 62% of the time, which has significantly lower than the rate for other female patients (P=0.016). the overall morbidity and mortality rates were 9.2% and 3%, respectively. Complicated appendicitis had a higher morbidity rate of 21%, compared with 9% for uncomplicated appendicitis (P<0.0001). Results for patients who were operated on the day of admission were compared with those who were operated on the day after admission. No significant difference in diagnostic accuracy (P=0.46), percentage of complicated appendicitis (P=0.7), and morbidity rate (P=0.8) was found.

Journal Article↗
PubMed2000

Simple and complicated acute appendicitis. Indications for a correct diagnosis.

BACKGROUND: In this retrospective investigation the symptoms, signs, and laboratory findings collected in 2 groups of patients with simple and complicated acute appendicitis, respectively, have been observed in order to give some indication for a correct diagnosis and surgical treatment. METHODS: A total of 103 consecutive patients affected by simple and complicated acute appendicitis submitted to surgical operation have been studied. RESULTS: Data collected show statistically significant differences between clinical presentation of simple and complicated acute appendicitis. CONCLUSIONS: The conclusion is draws in that anamnesis and clinical examination of the patients affected by acute appendicitis are the best indications for an exact diagnosis and to select patients who need an immediate operation.

Journal Article↗
PubMed1999

Clinical benefit of a diagnostic score for appendicitis: results of a prospective interventional study. German Study Group of Acute Abdominal Pain.

HYPOTHESIS: Clinical use of a diagnostic score improves decision making in acute appendicitis. DESIGN: A before-and-after trial comparing a group of patients undergoing standard diagnostic workup with no additional diagnostic support (phase 1) with a group of patients undergoing additional diagnostic support with a score (phase 2). SETTING: Eight departments of surgery in Germany and Austria. PATIENTS: Eight hundred seventy patients with acute abdominal pain in phase 1 (October 1, 1994, to April 30, 1995) and 614 patients in phase 2 (February 1, 1995, to August 15, 1995). INTERVENTIONS: Structured and standardized history and clinical investigation in all patients with computer-based documentation; introduction of the diagnostic score after phase 1 and computer-supported use of the score in phase 2. RESULTS: The 2 groups were comparable with respect to signs, symptoms, and investigations related to acute appendicitis. Diagnostic performance of the final examiner decreased with the score (specificity, 86% vs 78%; positive predictive value, 67% vs 50%; and accuracy, 88% vs 81%). There were no differences in the rates of perforated appendix, appendectomy with normal findings, and complications; however, the delayed appendectomy rate (2% vs 8%) and the delayed discharge rate (11% vs 22%) were significantly lower with diagnostic support by the score (P = .02). CONCLUSIONS: Integration of a score into the diagnostic process may have unforeseen clinical effects. The tested score cannot be recommended as a standard tool for diagnostic decision making in acute appendicitis.

Acute Disease↗
PubMed2001

Results of a pilot trial comparing prolonged intravenous antibiotics with sequential intravenous/oral antibiotics for children with perforated appendicitis.

HYPOTHESIS: For children with perforated appendicitis, the use of a prolonged course of intravenous (i.v.) antibiotics is equivalent to a short course of i.v. antibiotics followed by sequential conversion to oral (PO) antibiotics. DESIGN: Prospective, randomized, clinical trial. SETTING: Multicenter study in tertiary children's hospitals. PATIENTS: Children (aged 5-18 years) with perforated appendicitis found at laparotomy. INTERVENTION: Children were randomized after appendectomy either to a 10-day course of a combination of i.v. ampicillin, gentamicin sulfate, and clindamycin (n = 10); or to a short course of a combination of i.v. ampicillin, gentamicin, and clindamycin, followed by conversion to a combination of p.o. amoxicillin and clavulanate potassium plus metronidazole (n = 16). MAIN OUTCOME MEASURES: The primary outcome measure was clinical success, which was rated as complete, partial, or failure. Secondary outcome measures included return of oral intake, duration of fever, return of normal white blood cell count, and patient charges. Treatment equivalence was determined using confidence interval analysis. RESULTS: We found treatment equivalence between the i.v. and i.v./p.o. groups, with 6 (60%) complete and 4 (40%) partial successes for the 10 patients in the i.v. group and 15 (94%) complete and 1 (6%) partial successes for the 16 patients in the i.v./p.o. group (P< or =.05). There was no difference in return of oral intake, duration of fever, or return of normal white blood cell count between the groups. Conversion to oral therapy results in savings of approximately $1500 per case. CONCLUSION: There is treatment equivalence between prolonged i.v. therapy and i.v. therapy followed by conversion to oral antibiotic therapy in children with perforated appendicitis.

Administration, Oral↗
PubMed2004

Advantages of focused helical computed tomographic scanning with rectal contrast only vs triple contrast in the diagnosis of clinically uncertain acute appendicitis: a prospective randomized study.

HYPOTHESIS: Focused helical computed tomographic (CT) scanning with rectal contrast only is a superior diagnostic modality compared with the traditional triple-contrast CT scan for the diagnosis of acute appendicitis. DESIGN: Prospective randomized analysis of both CT scan modalities. INTERVENTIONS: Only patients with uncertain diagnosis of acute appendicitis were entered in the study. The patients were then randomized to undergo the traditional triple-contrast CT scan or the new focused CT scan with rectal contrast only. Surgical management included operation or observation for 23 hours. RESULTS: Ninety-one patients participated in the study, including 52 in the triple-contrast group and 39 in the rectal-contrast group. The demographics of the triple-contrast vs the rectal-contrast groups were similar. The triple-contrast group had a sensitivity of 97%, specificity of 86%, positive predictive value of 90%, and negative predictive value of 93%. The rectal-contrast group had a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. There were 4 false-positive findings and 1 false-negative finding in the triple-contrast group compared with none in the rectal-contrast group. In the triple-contrast group, there were 13 perforated appendixes compared with 1 in the rectal-contrast group. The cost of a triple-contrast scan was 620 US dollars compared with 305 US dollars for a focused rectal-contrast scan. The negative appendectomy rate for the study was 8.0% (4 of 48 patients in the triple-contrast group vs 3 of 39 in the rectal-contrast group). CONCLUSIONS: The demographics, sensitivity, specificity, and positive and negative predictive values were comparable in both groups. The focused rectal-contrast procedure was better tolerated by patients and demonstrated decreased morbidity, delay to diagnosis, perforation rate, and negative appendectomy rate with no missed diagnosis and decreased cost. Therefore, we believe that focused helical CT scanning with rectal contrast only is a superior diagnostic modality compared with the traditional triple-contrast CT scan for the diagnosis of acute appendicitis.

Adult↗