Augmenting the decision making process in acute appendicitis: A retrospective cohort study.

INTRODUCTION: Acute appendicitis is a common surgical diagnosis. We investigated the use of blood markers (WCC, CRP and serum bilirubin) and diagnostic imaging (USS and CT scan) to arrive at this diagnosis, as well as the surgical approach used for appendicectomy. METHODS: This was a retrospective analysis of consecutive patients undergoing appendicectomy in seven hospitals within GG&C Health Board during a 6 month study period. Data were collected from electronic patient records. Sensitivity and specificity of each investigation for diagnosing acute appendicitis was calculated. RESULTS: 363 patients were included. Appendicectomy was performed open in 53%, laparoscopically in 43% and converted in 4%. Diagnostic imaging was used in 38%. The overall negative appendicectomy rate was 15% (18% when no imaging was used, 23% when USS was used and 1% when CT scanning was used). Elevated bilirubin had a sensitivity of 0.44 and a specificity of 0.84 for detecting acute appendicitis. Sensitivity and specificity for elevated WCC were 0.78 and 0.55, and for elevated CRP were 0.81 and 0.59, respectively. The specificity of bilirubin for diagnosing perforated appendicitis was 0.63. DISCUSSION: WCC and CRP were sensitive blood markers in acute appendicitis, whereas serum bilirubin was more specific. Diagnostic imaging with a CT scan was very effective at reducing the rate of negative appendicectomy, but USS was not. CONCLUSION: Serum bilirubin has utility in diagnosing acute appendicitis, irrespective of whether perforation has occurred. CT scanning should be considered the first line imaging modality for investigation of acute appendicitis if diagnosis is in doubt.

Transient increase in IL-1ß, IL-6 and TNF-α gene expression in rat liver exposed to gold nanoparticles.

Most studies have used in vitro systems to test inflammatory responses of nanoparticles; these may not reflect the real biological response of body organs. In fact, certain nanoparticles have provoked opposite effects under in vitro and in vivo conditions. Current understanding of the biocompatibility of gold nanoparticles is controversial. We studied the acute (1 day) and sub-chronic (5 days) effects of gold nanoparticles (10 and 50 nm in diameter) on expression of interleukin-1 beta (IL-1ß), IL-6 and tumor necrosis factor alpha (TNF-α) in rat liver. Real-time PCR analysis showed that gold nanoparticles of both sizes significantly increased cytokine gene expression on day 1; this had subsided by day 5. The 50-nm gold nanoparticle produced more severe inflammation than the smaller gold nanoparticle. These findings indicate a possible biocompatibility of medium-sized gold nanoparticles, as they caused only a transient increase in proinflammatory cytokines, followed by normalization during sub-chronic repeated exposure.