Diagnostic value of appendicular Doppler ultrasonography in acute appendicitis.

BACKGROUND: Acute appendicitis is one of the most common causes of acute abdominal pain prompting emergency department (ED) visits. It is critical for the physicians to promptly and accurately diagnose acute appendicitis. The present study aimed to evaluate the diagnostic efficacy of Doppler ultrasonography (USG) in patients with acute appendicitis and compare this new method with other commonly used radio-diagnostic tools. METHODS: All patients who were diagnosed with acute appendicitis at the Kecioren Training and Research Hospital ED and later underwent appendectomy between October 2012 and April 2013 were included in the study. Approval from the ethics committee was obtained for this prospective study. The patients' demographic information, physical examination findings, vital signs, Alvarado scores, and laboratory and radiological exam results were recorded. RESULTS: A total of 60 patients were enrolled in the study. In 46 of the 60 patients, diagnosis of acute appendicitis was confirmed by histopathology results, whereas 14 patients, diagnoses was not confirmed by lab tests. Doppler USG could detect 43 of the 46 patients as true positives, and it detected 2 of the 14 patients with negative lab results as false positives. For diagnosis of acute appendicitis, sensitivity of appendicular Doppler USG was 93%, specificity was 85%, accuracy was 91%, positive likelihood ratio was 6.5, and negative likelihood ratio was 0.08. CONCLUSION: Doppler imaging can offer a high level of diagnostic success in patients with acute appendicitis. Appendicular Doppler USG offers a rapid and easy application without the need to expose patients to contrast medium and is superior to both USG and computed tomography. Therefore, we recommend the use of appendicular Doppler imaging as the primary radiological exam in diagnosing acute appendicitis.

Can we use serum gamma-glutamyl transferase levels to predict early mortality in stroke?

OBJECTIVE: Serum gamma-glutamyl transferase (GGT) is a marker for alcohol consumption and hepatobiliary diseases. There are reports on the prognostic role of GGT in coronary artery diseases and stroke. The aim of our study was to identify the potential differences in GGT levels in different types of stroke, and to evaluate the correlation between GGT and 30-day mortality. METHOD: Patients diagnosed with stroke in emergency department between 01.01.2010 and 30.12.2012 was included in the study. Imaging techniques were used to distinguish between hemorrhagic and ischemic stroke. Ischemic strokes were further classified as either atherosclerotic/lacunar or embolic. Parameters including age, gender, vital signs (systolic and diastolic blood pressure), comorbid diseases (HT, DM, CAD, smoking and alcohol consumption), used medications, previous history of stroke, NIHSS score at the time of admission to emergency department, laboratory parameters (glucose, white blood cell count, hemoglobin, platelet, total cholesterol, creatinine) and duration of hospitalization were recorded. Death records were obtained from patients' medical records. RESULTS: One thousand eighty six patients were included in the study. GGT levels were not significantly different between ischemic and hemorrhagic strokes (p=0.435). On the other hand, GGT levels in embolic strokes were significantly higher compared to atherosclerotic/lacunar strokes (p=0.001). GGT levels [median 24.50 (16.00-43.00)] in Intensive Care Unit patients were significantly higher compared to GGT level [22.00 (15.00-34.25)] in admitted to service beds patients (p=0.015). Median GGT level of deceased patients was 24.00 (16.00-41.25) and median GGT level of alive patients was 22.00 (15.00-35.00). GGT level of deceased patients was significantly higher compared to GGT levels of alive patients (p=0.048). CONCLUSION: There was no difference in GGT levels between ischemic and hemorrhagic strokes; however, GGT levels in embolic strokes were significantly higher compared to atherosclerotic/lacunar strokes. High GGT levels are correlated with early mortality in stroke. We believe that GGT may be used as a predictor of mortality in future studies.

Hepatic toxocariasis: a rare cause of right upper abdominal pain in the emergency department.

Toxocara canis and Toxocara cati are common helminths that reside in the intestinal tract of cats and dogs. Toxocariasis and, commonly, T. canis, is a disease commonly seen in children, which is characterised by hypereosinophilia, hepatomegaly, fever, transient pulmonary infiltration, and hypergammaglobulinaemia. Humans, who are not the actual host for these parasitic worms, are infected following oral intake of the infective eggs. Radiological differentiation of hepatic toxocariasis can be difficult, as liver lesions, which present as multiple hypoechoic lesions with regular borders, can look like a tumour, an infarction or an infection. We report on a case that presented to our emergency department (ED) with abdominal pain. During the initial review, the pathology in the liver was thought to be an infarction or an infection; however, the patient was diagnosed with hepatic toxocariasis following further evaluation.

[The role of blood S100B and lactate levels in minor head traumas in children and adults and correlation with brain computerized tomography]. / Çocuk ve eriskin minör kafa travmalarinda kan S100B ile laktatin rolü ve bilgisayarli beyin tomografisi ile korelasyonu.

BACKGROUND: In this study, we aimed to set levels of blood S100B and lactate and to determine any correlation with brain computerized tomography in minor head traumas in children and adults. METHODS: This clinical trial is a prospective study including 100 head trauma patients who applied to Ankara Training and Research Hospital emergency service. RESULTS: In this study, cut-off ranges of 0.0-0.15 ug/ml and 0.9-1.7 mmol/L for blood S100B and lactate levels, respectively, were used. S100B level was higher than the cut-off range in 42% of patients and lactate level was higher in 56% of patients. No significant differences were determined between age groups. When the relation between S100B and lactate levels with brain CT was evaluated, no statistically significant relation was determined. CONCLUSION: According to our results, in minor head traumas, the determination of elevated serum S100B and lactate levels cannot take the place of clinical examination and the use of cranial CT. Although the patients in our study group had minor head trauma, we do not consider S100B and lactate to be reliable markers for estimating progression.

Our new stethoscope in the emergency department: handheld ultrasound.

BACKGROUND: The concept of Focused Assessment with Ultrasound for Trauma (FAST), which was introduced by Rozycki et al. in 1996, has started a new era in the management of trauma patients. Today, Advanced Trauma Life Support (ATLS) suggests bedside ultrasonography (USG) evaluation of trauma patients. We aimed to investigate the usability and the reliability of handheld ultrasound (Vscan) in determining free fluid during the initial evaluation of trauma patients. METHODS: This was a multi-center, prospective study involving multiple trauma patients who presented to three hospital emergency departments (EDs). FAST was completed using Vscan by an emergency physician and an abdominal USG was performed by a radiologist on all patients. Results of Vscan, abdominal USG and other radiological studies, if performed, were compared. RESULTS: A total of 216 patients were included in the study. Of those, 203 had negative Vscan results, while 13 had positive results. When USG performed by a radiologist was considered as the gold standard, Vscan sensitivity for FAST was 88.9%, specificity was 97.6%, negative predictive value was 99.5%, and positive predictive value was 61.5% in our study. CONCLUSION: Vscan, as the smallest portable imaging device, seems to have a promising future as an indispensable gadget, equal to stethoscopes, in evaluating trauma and other critical patients.