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Purpose A systematic literature review was performed to evaluate the effectiveness of abdominal sonography and abdominal computed tomography (CT) in diagnosing acute appendicitis in adult and pediatric patients. Methods Peer-revie...
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Purpose A systematic literature review was performed to evaluate the effectiveness of abdominal sonography and abdominal computed tomography (CT) in diagnosing acute appendicitis in adult and pediatric patients. Methods Peer-reviewed literature published between 1986 and 2014 was searched using multiple medical literature databases. Studies included in this review were conducted on human patients; included more than 50 patients; reported diagnostic values; evaluated pediatric patients, adults, or both (pregnant women excluded); and used histological results from surgery or clinical follow-up as a reference standard. Results In the sonography studies, the calculated pooled values of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 86%, 94%, 100%, and 92%, respectively. In the CT studies, the calculated pooled values of sensitivity, specificity, PPV, and NPV were 95%, 94%, 95%, and 99%, respectively. Discussion Unenhanced CT is used frequently to minimize harmful effects of radiation, especially for pediatric patients. Performing sonography can reduce the cost of a negative exploration, which can generate unnecessary financial burdens for patients. Conclusion This study suggests that sonography is an effective first-line diagnostic tool for acute appendicitis and that CT should be performed for patients with inconclusive sonographic findinas.
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Abstract Background Radiation exposure is the reason for the decreased utilization of computed tomography (CT) in pediatric centers (PCs). We sought to compare the radiation dose exposure of CT imaging performed at outside hospita...
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Abstract Background Radiation exposure is the reason for the decreased utilization of computed tomography (CT) in pediatric centers (PCs). We sought to compare the radiation dose exposure of CT imaging performed at outside hospitals (OH) versus PC in pediatric patients with acute appendicitis (AA). Material and methods A retrospective review of all patients managed at our PC for AA from January 2011 to March 2016 was performed. Patients who had CT imaging for AA at OH were compared to those who underwent CT for appendicitis at our PC. Radiation dosing was compared using the dose index (CTDI [mGY]) and dose length product (DLP [mGYcm]). Independent t -test samples were used to compare means for radiation dose. Results 379 patients met inclusion criteria. There were 59.4% (225) patients imaged at our PC and 40.6% (154) patients were transferred from an OH. When performed at OH, 6.5% of CTs were considered inadequate as they were done without intravenous contrast compared to 1.3% in our PC. Mean CTDI was 6.9 at our PC and 11.8 at OH ( P ?<?0.0001). Mean DLP at PC was 296.2 versus 456.8 at OH ( P ?<?0.0001). An excess radiation dose of 4.9 mGY and 160.5 mGYcm was noted when CT scan was performed at OH versus PC. Conclusions Using DLP as a gauge of radiation exposure, CT imaging performed at OH has a 44% higher radiation rate relative to the exposure at PC. In cases of suspected AA at a facility without pediatric surgeons, early transfer to PC prior to imaging is advocated.
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Objective: To compare diagnostic accuracy of contrast enhanced low-dose computed tomography (CT) accomplished in the OPTICAP trial phantom phase to standard CT in patients with suspected acute appendicitis. Background: Increasing ...
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Objective: To compare diagnostic accuracy of contrast enhanced low-dose computed tomography (CT) accomplished in the OPTICAP trial phantom phase to standard CT in patients with suspected acute appendicitis. Background: Increasing use of CT as the gold standard in diagnosing acute appendicitis has raised concerns regarding radiation exposure. Unenhanced low-dose CT protocols have shown similar diagnostic accuracy with standard CT for diagnosing appendicitis. To our knowledge, there are no other trials in which the same patient with suspected acute appendicitis underwent both standard and low-dose CT allowing interpatient comparison. Methods: OPTICAP is an interpatient protocol sequence randomized noninferiority single-center trial performed at Turku University Hospital between November, 2015 and August, 2016. Sixty patients with suspected acute appendicitis and body mass index <30 kg/m(2)were enrolled to undergo both standard and low-dose contrast enhanced CT scans, which were categorized as normal, uncomplicated or complicated appendicitis by 2 radiologists in blinded manner. All patients with CT confirmed appendicitis underwent appendectomy to obtain histopathology. Results: The low-dose protocol was not inferior to standard protocol in terms of diagnostic accuracy; 79% [95% confidence interval (CI) 66%-89%) accurate diagnosis in low-dose and 80% (95% CI 67%-90%) in standard CT by primary radiologist. Accuracy to categorize appendicitis severity was 79% for both protocols. The mean radiation dose of low-dose CT was significantly lower compared with standard CT (3.33 and 4.44 mSv, respectively). Conclusion: Diagnostic accuracy of contrast enhanced low-dose CT was not inferior to standard CT in diagnosing acute appendicitis or distinguishing between uncomplicated and complicated acute appendicitis in patients with a high likelihood of acute appendicitis. Low-dose CT enabled significant radiation dose reduction.
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Introduction and Aim In about 20–25% of appendicectomies performed for clinically suspected acute appendicitis, definite morphological changes are lacking on histopathological examination. The present study was done to investigat...
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Introduction and Aim In about 20–25% of appendicectomies performed for clinically suspected acute appendicitis, definite morphological changes are lacking on histopathological examination. The present study was done to investigate whether any changes in neurons and mast cells could be detected in patients presenting with clinical acute appendicitis but found to have normal appendix at histopathology.
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Acute appendicitis is an important differential diagnosis in children with pain in the right iliac fossa. Some patients have equivocal signs that make the diagnosis difficult. Many patients with suspected acute appendicitis are ad...
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Acute appendicitis is an important differential diagnosis in children with pain in the right iliac fossa. Some patients have equivocal signs that make the diagnosis difficult. Many patients with suspected acute appendicitis are admitted for observation and finally discharged because they did not have appendicitis. We decided to design this study to investigate whether the Alvarado score could be used by emergency room doctors as a criterion for admission to hospital. Patients and Methods: This is a prospective study comprising 350 patients who attended the emergency department with suspected acute appendicitis in the period from May 2007 to April 2009. All patients were scored by Alvarado score in the emergency department before admission. The Alvarado score is based on three symptoms, three signs and two laboratory findings. The decision for admission and surgery was made independent of the score. The diagnosis of patients who underwent appendicectomy was confirmed by both operative findings and postoperative histopathology. Results: We studied the Alvarado scores of 350 patients who presented to the emergency department with pain in the right iliac fossa; their age ranged from 8 to 14 years; 182 patients (52%) operated with the aim to treat acute appendicitis, 168 patients (48%) were discharged without surgical intervention and advised to attend the out-patient clinic after 24 hours for re-evaluation. we have found that patients with a low Alvarado score (less than 6) did not have acute appendicitis. Conclusion: Patients with equivocal signs can present a diagnostic challenge and are very often admitted to the surgical department for observation. The Alvarado score can be used as a scoring system that help in taking the decision for admission of cases with suspected acute appendicitis especially by primary healthcare providers.
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Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms’ evolution, and systemic inflammatory respon...
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Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms’ evolution, and systemic inflammatory response syndrome (SIRS).
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In recent years, digital endoscopy has established as key technology for medical screenings and minimally invasive surgery. Endoscopy image processing techniques have been applied to the diagnosis of diseases. In this paper, an ef...
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In recent years, digital endoscopy has established as key technology for medical screenings and minimally invasive surgery. Endoscopy image processing techniques have been applied to the diagnosis of diseases. In this paper, an effective approach is proposed to process endoscopic images to detect acute appendicitis. For this purpose, we first introduced image enhancement techniques that allow us to improve quality of endoscopic image for further processing. A simple and effective image segmentation technique was developed to detect vessels and vermiform appendix. The hierarchical set of features have been extracted for detecting acute appendicitis. It includes geometrical, colorimetric, densitometric, and topological features. For each appendicitis feature discriminant indexes have been introduced for diagnosis. This method has achieved good results in clinical application.
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Acute appendicitis is one of the most common reasons for emergency surgery. At Stockholm South General Hospital, information on all patients - 15 years or older - undergoing surgery for acute appendicitis is included in a quality ...
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Acute appendicitis is one of the most common reasons for emergency surgery. At Stockholm South General Hospital, information on all patients - 15 years or older - undergoing surgery for acute appendicitis is included in a quality register. Data on surgical method, preoperative imaging, hospital stay, intraoperative findings, and 30-day complications were recorded for each patient. From January 2004 to December 2014, 5,614 consecutive patients were registered. The percentage of patients examined with preoperative imaging increased from 30% in 2004 to 93% in 2014. The use of laparoscopic appendectomy increased from 6 to 79%. Negative appendectomies decreased from 7.5-10 to 1.7%. The mean perforation rate was 28.6%. Some form of postoperative complication occurred in 6.6% of those on whom laparoscopy was performed and 10.5% of those who underwent an open surgery, with a significant difference ( p
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