Sometimes appendicitis can wait.
American Journal of Hematology (Impact Factor: 4). 08/2004; 76(3):312-3. DOI:10.1002/ajh.20086
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ABSTRACT: To evaluate a focused, helical computed tomographic (CT) technique for imaging the appendix in patients suspected of having appendicitis. One hundred patients prospectively underwent appendix CT examination, with use of oral and colon contrast media and contiguous, thin-collimation, helical CT imaging of the right lower quadrant. Results were correlated with the results of surgery and pathologic examination from 61 patients or from clinical follow-up in 39 patients. CT scans were positive for appendicitis in 59 patients: true-positive in 56 patients on the basis of surgery and pathologic examination, and false-positive in two patients on the basis of clinical follow-up; in the case of the other positive scan, the clinical outcome was indeterminate. CT scans were negative for appendicitis in 41 patients: true-negative in five patients on the basis of surgery and pathologic examination, and true-negative in 36 patients on the basis of clinical follow-up. CT had a sensitivity of 100%, a specificity of 95%, a positive predictive value of 97%, a negative predictive value of 100%, and an accuracy of 98%. The normal appendix was always identified. CT helped establish alternative diagnoses in 33 of the 41 patients (80%) in whom the results of CT were negative for appendicitis. Appendix CT examination can help diagnose or exclude appendicitis and establish an alternative diagnosis.Radiology 02/1997; 202(1):139-44. · 6.34 Impact Factor
- The American journal of roentgenology, radium therapy, and nuclear medicine 07/1970; 109(2):341-50.
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ABSTRACT: Of 6,099 children treated for malignancy, 16 (ages 3.5 to 18 years) developed acute appendicitis between 1962 and 1989. Fourteen had leukemia (ALL 10, AML 4). One each had rhabdomyosarcoma and Ewing's sarcoma. Active malignancy at diagnosis was noted in 10, 4 of whom had severe neutropenia (absolute neutrophil count less than 500/mm3). Of all the leukemics (2,794/6,099), abdominal pain during induction was a frequent complaint. The incidence of appendicitis, however, was low (0.5%). Nine of the 16 patients presented classically, facilitating prompt diagnosis and treatment. Six diagnoses were delayed. Three of these patients presented atypically with vague, nonlocalized pain, abdominal distention, lack of abdominal guarding, fever, dehydration, diarrhea, and unusual symptoms such as upper gastrointestinal bleeding. In each of these 6 patients the appendix was ruptured. Delays led to complications and deaths. Three patients required perioperative transfusions to treat excessive bleeding and two patients with ruptured appendicitis developed wound abscesses. Two patients died; in one, ruptured appendix was diagnosed only at autopsy. The other patient died of uncontrolled sepsis. Typhlitis occurring during induction chemotherapy may present similarly and is the main differential diagnosis. Typhlitis will usually improve with medical treatment alone. Nausea and vomiting (13/16), right lower quadrant pain (13/16), guarding (14/16), tachycardia (12/16), fever (10/16), and rebound tenderness (10/16) were the most frequent signs and symptoms of appendicitis. Persistent localized abdominal pain and guarding, lack of improvement with medical treatment, clinical deterioration, and the development of a mass were our indications for laparotomy. Despite major improvements in therapy, there is still a 37.5% error rate in our ability to accurately diagnose appendicitis in pediatric cancer patients.Journal of Pediatric Surgery 05/1992; 27(4):476-9. · 1.38 Impact Factor
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