A Diagnostic Score (DS) Is a Powerful Tool in Diagnosis of Acute Appendicitis in Elderly Patients With Acute Abdominal Pain.

BACKGROUND/AIM: Although acute appendicitis (AA) in elderly patients is different from AA in younger patients, the accuracy of diagnostic scores (DSs) in detecting AA is rarely considered. PATIENTS AND METHODS: A cohort of 470 AAP (acute abdominal pain) patients older than 50 years, including 224 women (53.7%) and 193 men (46.3%), were included in the study. The most significant diagnostic predictors were used to construct DS formulas for AA diagnosis with (Tax+) and without body temperature (Tax-). Meta-analytical techniques were used to calculate the summary Se and Sp estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) symptoms ii) signs and tests iii) DSTax- and iv) DSTax+ were as follows: i) AUC=0.658 (95%CI=0.601-0.709); ii) AUC=0.751 (95%CI=0.701-0.800), iii) AUC=0.977 (95%CI=0.942-1.000), and for iv) AUC=0.980 (95%CI=0.956-1.000). Using roccomp analysis for these AUC values, the differences were significant as follows: between i) and ii) p=0.0358; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.682. CONCLUSION: Similar to younger AA patients, the DS formula was superior to both the clinical history-taking and findings, and therefore, the use of DS should be an important part of the diagnostic decision tree of AA also in the elderly patients presenting with AAP.

[Is medication possible for acute appendicitis?] / Vozmozhna li konservativnaia terapiia ostrogo appenditsita?

AIM: To study the possibility of antibacterial therapy for acute appendicitis as an alternative to surgical treatment. MATERIAL AND METHODS: For the period 1985-2010 diagnostic laparoscopy was performed in 5548 patients with suspected acute appendicitis. Acute phlegmonous or gangrenous appendicitis was observed in 2275 (41.0%) patients who underwent laparoscopic appendectomy. Other acute diseases occurred in 2458 (44.3%) patients. Acute catarrhal appendicitis or secondary inflammation of the appendix were diagnosed in 815 (14.7%) patients; they did not get appendectomy. In-hospital antibacterial therapy has been administered for 1-2 days followed by discharge for outpatient treatment. One patient with acute destructive appendicitis who refused surgery was treated with antibiotics. RESULTS: Antibacterial therapy in 815 patients with acute catarrhal appendicitis allowed to avoid surgical treatment. Complications (appendicular infiltration, abscess), repeated hospitalizations within 1 month were absent. Antibacterial treatment provided recovery in 1 patient with destructive appendicitis who refused surgical treatment. CONCLUSION: Patients with acute catarrhal appendicitis diagnosed with laparoscopy do not need for appendectomy and can be cured by antibacterial therapy.

The Lived Experiences of Persons Hospitalized for Construction of an Urgent Fecal Ostomy.

PURPOSE: The purpose of this study was to describe the lived experiences of hospital stays for patients undergoing urgent ostomy surgery. DESIGN: Qualitative, descriptive, phenomenological study. SUBJECTS AND SETTING: Six persons undergoing acute hospital admission and urgent ileostomy or colostomy surgery (either permanent or temporary) participated in the study. Participants were of Danish ethnicity and between the ages of 48 and 75 years. The research setting was the surgical department at a university hospital in the Capital Region of Denmark. METHODS: Data collection and analyses were guided by a Reflective Lifeworld Research approach; this approach is based on phenomenological philosophy. Data were collected during in-depth interviews using a semistructured interview guide. Their average length was 50 minutes (range, 30-65 minutes). Interviews were digitally recorded and transcribed. Transcriptions were analyzed in 4 phases according to the principles of Reflective Lifeworld Research. RESULTS: The phenomenon we labeled "lived experiences of acute hospitalization with construction of an urgent unplanned fecal ostomy" comprised 4 constituents: (1) undergoing unexpected bodily changes, (2) partnership with professional caregivers, (3) experience of vulnerability, and (4) a lack of continuity. These constituents can be described as a number of challenges due to both hospitalization and ostomy creation. CONCLUSION: We found that individuals experience a number of challenges due to acute hospitalization and urgent construction of a fecal ostomy. These challenges are due to the unexpected bodily changes and interpersonal and organizational conditions. Nurses should be aware of not only the physical implications of urgent creation of a fecal ostomy but also the individual and psychological implications of this event.

A prospective non-randomized controlled, multicenter trial comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis (the ACTUAA study).

PURPOSE: Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20 years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan. METHODS: All adult patients in the age range 18 to 65 years with suspected AA, consecutively admitted to the Surgical Department of the 13 participating Italian Hospitals, will be invited to take part in the study. A multicenter prospective collected registry developed by surgeons, radiologists, and pathologists with expertise in the diagnosis and treatment of uncomplicated acute appendicitis represents the best research method to assess the long-term role of antibiotics in the management of the disease. Comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Quality of life, length of hospital stay, pain evaluation, and time to return to normal activity will be evaluated as secondary outcome measures. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT03080103.

Factors influencing delayed hospital presentation in patients with appendicitis: the APPE survey.

BACKGROUND: Among patients with acute appendicitis (AA), perforation is thought to be associated with symptom duration before treatment. Perforation rates vary between hospitals raising the possibility that some perforations are preventable. The factors that compel patients to present earlier or later are unknown but are critical in developing quality improvement interventions aimed at reducing perforation rates. MATERIALS AND METHODS: The Appendicitis Patient Pre-Hospital Experience (APPE) Survey is a prospective study of adults and parents of children with AA in six hospitals participating in Washington State's Comparative Effectiveness Research Translation Network (CERTAIN). The APPE survey includes questions about symptom duration before presentation (late defined as >24 h), predisposing characteristics, enabling factors, and need. RESULTS: Among 80 patients, perforation occurred more frequently in late presenters (44% versus 11%, P < 0.01). Late presenters more frequently drove themselves to the hospital (64% versus 52%, P = 0.05) as opposed to relying on friends/family members and described their health behavior as "waiting it out" when something is wrong (71% versus 46%, P = 0.03). We found similar sociodemographics, clinical characteristics, health care utilization, optimism, health care trust, and risk taking between the two cohorts. CONCLUSIONS: Late presenters described reduced social support and a tendency to "wait it out" and had higher rates of perforation than early presenters. These characteristics have not been well-studied conditions but are important to understand to identify patients at high risk for delayed presentation. Future interventions might target those with low social support or those who are reluctant to seek care early to decrease rates of perforation.

Pending appendicectomy: a personal experience and review of a doctor's own illness.

Doctors will inevitably 1 day become patients. Whether as an acute emergency or as part of routine screening, doctors often find it difficult to recognise and act on their own healthcare needs. This article aims to provide a personal account and reflections from the point of view of a doctor in denial about his acute appendicitis, and a friend and fellow colleague's attempts to convince him to seek help. We review the challenges, learning points and literature about why doctors ignore their health needs, both physical and psychological, and suggest potential changes to tackle this issue based on the current literature, support networks and personal experiences.

Surgery: a patient's perspective and lessons learnt.

This article discusses a hospital experience from the point of view of a patient, in this case a healthcare worker herself - a dental student. The author relates her experience of a three-day hospital stay and appendectomy, during which time she experienced the breaking of bad news, the consent process, and the importance of good communication - all from the patient's viewpoint.

Impact of Age on Pain Perception for Typical Painful Diagnoses in the Emergency Department.

BACKGROUND: Age-related differences in pain perception have been demonstrated in experimental settings but have been investigated scarcely and without valid scale in the clinical framework. OBJECTIVES: To examine the effect of age on pain perception for recognized painful diagnoses encountered in the emergency department (ED). METHODS: A post-hoc analysis of real-time archived data was performed in a tertiary urban and a secondary regional ED. We included all consecutive adult patients (≥18 years) with the following diagnosis at discharge: renal colic, pancreatitis, appendicitis, headache/migraine, dislocation and extremities fractures, and a pain evaluation of ≥1 (0-10, verbal numerical scale) at triage. The primary outcome was to compare for each of these diagnoses the level of pain intensity between four age groups (18-44; 45-64; 65-74; 75+ years). RESULTS: A total of 15,670 patients (48% women) were triaged with a mean pain intensity of 7.7 (SD=2.0). Women exhibited greater pain scores than men for pancreatitis, headache/migraine, and extremity fracture. Renal colic, pancreatitis, appendicitis, and headache/migraine showed a linear decrease in pain scores with age whereas dislocation and extremity fractures did not present age differences. Mean differences in pain intensity scores between young adults (18-44 years) and patients aged ≥75 years were 0.79 (95% confidence interval [95% CI] 0.5-1.1) for renal colic, 1.1 (95% CI 0.7-1.4) for pancreatitis, 0.70 (95% CI 0.2-1.2) for appendicitis, and 0.86 (95% CI 0.6-1.1) for headache/migraine. CONCLUSION: Older patients perceive similar pain for dislocation and extremity fractures and less for visceral and headache/migraine pain; however, these age differences may not be clinically important.

Effect of BMI on the quality of life in patients after appendectomy depending on surgical modality.

UNLABELLED: Acute appendicitis is one of the most common diseases requiring rapid surgical intervention. The disease occurs most often in people between 10 and 30 years of age, the risk of acute appendicitis during the whole life is 6-20%. The aim of the study was to assess the impact of BMI on the quality of life of patients operated for acute appendicitis according to the method of operation (LA- Laparoscopical Appendectomy OA - Open Appendectomy) and follow-up time after surgery. MATERIAL AND METHODS: The study was conducted on a group of 86 randomly selected patients- 40 operated conventionally (18 women and 22 men) and from 46 patients undergoing laparoscopy (33 women and 13 men), which were operated during the period between 15 July 2007 and 27 February 2009. Each patient was assessed by BMI, recognizing the value of > 25 kg/m(2) as overweight. In this study the basis of quality of life was a form Medical Outcomes Study36 -the Short Form or SF-36v.2. RESULTS: Patients operated on in LA for 6 months observation to better assessed general health (GH) independently of BMI, while those with BMI ≤ 25 better assessed social functioning (SF) (p =0.027), an overall assessment of Physical Component Summary (PCS) (p = 0.048),Mental Component Summary (MCS) (p = 0.022) as well as an overall indicator of quality of life (p =0.025). The relationships that was not found in observations of more than 6 months after surgery (ns). CONCLUSIONS: Questionnaire SF-36v.2 facilitated an objective assessment of quality of life of patients operated on for acute appendicitis. Patients operated on by laparoscopic in observation for 6 months above assessed the quality of life regardless of BMI. The relationships that was not found in observations of more than 6 months after surgery (ns).

Ability of pediatric physicians to judge the likelihood of intussusception.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in infants and children. To date, no study has evaluated the ability of physicians to predict the likelihood of intussusception. OBJECTIVE: This study aimed to determine the ability of pediatric physicians to predict intussusception in patients being evaluated for intussusception and to investigate whether certain clinical findings correlate with physicians' risk assessment. METHODS: A prospective cohort study of children aged 1 month to 6 years who presented with possible intussusception. The predicted likelihood of intussusception was recorded by physicians before knowledge of imaging results or final diagnosis. We defined a physician's prediction as high versus low risk based on a threshold prediction of 25% likelihood. RESULTS: A total of 308 patients were studied including 38 (12.3%) with intussusception. Physicians' prediction was positively associated with the risk of intussusception (test for linear trend: odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.7; P < 0.001). Among patients considered high risk, the rate of intussusception was 36% (95% CI, 25%-49%) compared with 6% for those judged to be low risk (95% CI, 4%-10%). Using a threshold of 25% likelihood, successful prediction of high versus low risk occurred in 82% (95% CI, 77%-86%). Clinical predictors associated with assigning a designation of higher risk of intussusception included lethargy at home (OR, 2.7; 95% CI, 1.4-5.5) and bloody stool (OR, 2.5; 95% CI, 1.0-5.9). CONCLUSIONS: Pediatric physicians can accurately predict the likelihood of intussusception. This ability to properly judge the risk of intussusception can be incorporated into management strategies.

A quality of life comparison of laparoscopic and open approaches in acute appendicitis: a randomised prospective study.

BACKGROUND AND OBJECTIVES: The study aimed to evaluate the utility of a laparoscopic approach in the management of patients with right lower abdominal pain and in the quality of life after the operation. METHODS: Patients with suspected appendicitis were included in the study. They were randomly assigned either to treatment with a traditional open approach or with a laparoscopic approach. The patients' data, including demographic data, complications and gastro-intestinal quality of life index scores, were collected at the 6th week and 6th month and compared between the groups. RESULTS: Overall, 83 appendectomies were performed. Other pathologies were ovulation bleeding, ovarian cyst, Meckel's diverticulum, ectopic pregnancy and leiomyoma of the uterus. Negative appendectomy rate was 7%. Severe infection occurred in five of the open group. The advantages of the laparoscopy also showed significantly in hospital stay (55.80 +/- 20.97 hours vs. 75.06 +/- 35.14 hours), the need for narcotics and in visual analog score, as well as in the gastrointestinal quality of life index (85.88 +/- 9.73 vs 101.30 +/- 9.31). The quality of life is still better in the long-term (95.14 +/- 8.45 vs 120.36 +/- 10.25). When the groups were compared according to the subgroups of gastro-intestinal quality of life index, except for disease-specific items, in all categories a significant improvement was seen in the laparoscopically treated patients. This improvement was observed in the follow-up period also. However, the hospital costs (987.50 +/- 77.25 USD vs. 406.27 +/- 100.59 USD) and operative time (56.25 +/- 10.9 vs. 49.41 +/- 11.76 minutes) still continued to be a problem for the laparoscopic group. CONCLUSION: Laparoscopic appendectomy is a safe method, which also has advantages of diagnostic procedure for other pathologies, a better quality of life both in the early and late period, and a short hospital stay. The important advantage is also seen in the late period with better quality of life.

Recurrent abdominal pain before and after appendectomy.

BACKGROUND: Patients with non-inflamed appendix have been reported to have had more hospitalizations and emotional disorders before and after the operation than patients with acute appendicitis. OBJECTIVES: To compare abdominal pain characteristics, as well as demographic and psychosocial data in children with histologically confirmed appendicitis compared to non-inflamed appendices. METHODS: Charts of children with suspected appendicitis who had undergone appendectomy were retrospectively reviewed for relevant clinical and laboratory data. The patients or their parents were then contacted by phone and were asked to respond to a detailed questionnaire on abdominal symptoms as well as demographic and psychosocial data. RESULTS: The study group comprised 156 children: 117 with histologically confirmed appendicitis and 39 with normal appendices. Eighty-two patients (53.2%) were located and interviewed: 62 (54%) with appendicitis and 20 (51%) with normal appendices. Of the 82 children, 16 reported recurrent episodes of abdominal pain before or after surgery: 11 (17.7%) in the appendicitis group and 5 (25%) in the normal appendix group. Only six patients fulfilled the formal criteria for the diagnosis of recurrent abdominal pain: 5 (8%) from the appendicitis group and 1 (5%) from the non-inflamed appendix group (not significant). In addition, no significant statistical differences were found between the groups regarding school performance, behavior and social interaction with peers. CONCLUSIONS: We could not demonstrate an increased incidence of recurrent abdominal pain, nor could we identify significant psychosocial morbidity in those children undergoing an appendectomy for a non-inflamed appendix.

Long-term hospital attendance of children and adults who have undergone removal of normal or inflamed appendices.

BACKGROUND: Early studies suggested that presentations with unexplained acute abdominal pain were associated with increased long-term rates of hospital attendance and self-harm, especially in women, but few studies were large enough for definitive findings. AIMS: To test the hypothesis that such presentations are followed by higher long-term utilisation rates of secondary health care even excluding further abdominal symptoms, and particularly for self-harm, than presentations with acute appendicitis. METHOD: New hospital attendance rates, liaison psychiatry attendances and self-harm attendances of patients with normal appendices at emergency appendicectomy were compared with those of appendicitis patients. RESULTS: Attendance rates of all kinds were significantly higher for normal appendix patients than for appendicitis patients, with equal strengths of finding for males and females. CONCLUSIONS: People with normal appendices at emergency appendicectomy show higher long-term rates of hospital attendance. This has implications for how these patients are best managed by health care systems.

Acontecimientos vitales estresantes: relación con las enfermedades físicas en la infancia y adolescencia / Stressfull life events: the relationship to physical diseases in childhood and adolescence

Se hace una revisión sobre la importancia de los acontecimientos vitales ya sean recientes o acumulativos en la aparición y o exacerbación de enfermedades físicas (inflamación de garganta, hernias, apendicitis), el dolor crónico (cefaleas, abdominalgias, dolor en el pecho, etc.) y enfermedades crónicas en la infancia y adolescencia (diabetes, asma, fibrosis cistica, hemofilia, artritis reumatoide, herpes) (AU)

[Principles of functioning of various systems of the human body in the post-aggressive period]. / Printsip raboty nekotorykh sistem organizma cheloveka v postagressivnom periode.

The authors' investigations provide the conclusion that in a post-aggressive period there are organized cyclic fluctuations in the body hormones, penetrability of vessels, electrolytes and blood cells. The cycle takes 48 hours.