A novel noninvasive appendicitis score with a urine biomarker.

PURPOSE: The aim of our study was to develop an appendicitis score incorporating a urine biomarker, Leucine rich alpha-2-glycoprotein (LRG), for evaluation of children with abdominal pain. METHODS: From January to August 2017 we prospectively enrolled children aged 4-16 years old admitted for suspected appendicitis. Urine samples for LRG analysis were obtained preoperatively and quantified by enzyme-linked immunosorbent assay (ELISA) after correction for patient hydration status. The diagnosis of appendicitis was based on operative findings and histology. Logistic regression was used to identify prospective predictors. RESULTS: A total of 148 patients were recruited, of which 42(28.4%) were confirmed appendicitis. Our Appendicitis Urinary Biomarker (AuB) model incorporated urine LRG with 3 clinical predictors: 'constant pain', 'right iliac fossa tenderness', 'pain on percussion'. Area under the ROC curve for AuB was 0.82 versus 0.78 for the Pediatric Appendicitis Score (PAS) on the same cohort of patients. A model-calculated risk score of <0.15 is interpreted as low risk of appendicitis. Sensitivity for the AuB at this cutoff was 97.6%, specificity 37.7%, negative predictive value 97.6%, positive predictive value 38.3%, and negative likelihood ratio 0.06. CONCLUSION: The noninvasive AuB score appears promising as a diagnostic tool for excluding appendicitis in children without the need for blood sampling. TYPE OF STUDY: Study of diagnostic test. LEVEL OF EVIDENCE: Level III.

Does elevated urinary 5-hydroxyindole acetic acid level predict acute appendicitis in children?

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency in children, and appendectomy is the most frequent acute abdominal operation. Prompt diagnosis and surgical treatment are required to reduce the risk of perforation and prevent complications, especially in small children. Enterochromaffin cells that contain large amounts of serotonin are mostly located in the distal appendix. Serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) could therefore be a marker for acute appendicitis. OBJECTIVE: We tested urinary 5-HIAA concentrations in spot urine samples from children with acute appendicitis. METHODS: We enrolled 93 patients who underwent surgery for suspicion of acute appendicitis. The diagnosis was made intraoperatively and confirmed histopathologically. Additionally, urine samples from 102 healthy children were collected as controls. Their 5-HIAA was measured using high-performance liquid chromatography. RESULTS: Acute appendicitis was diagnosed in 81 patients, whereas there were other explanations for abdominal pain in the remaining 12 patients in the non-appendicitis group. The control group comprised 102 healthy children. Considering the median of all measured 5-HIAA values as the cut-off, we analysed the proportions of patients with elevated values in all the groups. Our analysis showed that statistically there was no significant difference in the distribution of percentages among the groups. The area under the curve for 5-HIAA was 0.55 (95% CI 0.47 to 0.62) with sensitivity and specificity 60.4% and 48.9%, respectively. CONCLUSIONS: Urine 5-HIAA concentration measured in spot samples is not a reliable method for diagnosing acute appendicitis in children.

Spot urinary 5-hydroxyindoleacetic acid is not an ideal diagnostic test for acute appendicitis.

BACKGROUND AND PURPOSE OF THE STUDY: There is growing evidence to suggest the use of urinary 5-hydroxyindoleacetic acid (5-HIAA) test to help with the diagnosis of appendicitis. The aim of our study was to establish whether urinary 5-HIAA could be used as an effective diagnostic test for acute appendicitis. DESIGN AND METHODS: A prospective double-blinded study was carried out from December 2014 to October 2015. Patients admitted to the emergency surgical ward of a teaching hospital with suspected appendicitis were included in the study. The diagnostic accuracy of the test was measured by receiver operating characteristic curve. RESULTS: Ninety-seven patients were divided into 2 groups: acute appendicitis (n=38) and other diagnosis (n=59). The median value of urinary 5-HIAA was 24.19µmol/L (range, 5.39-138.27) for acute appendicitis vs 18.87µmol/L (range, 2.27-120.59) for other diagnosis group (P=.038). The sensitivity and specificity of urinary 5-HIAA at a cutoff value of 19µmol/L were 71% and 50%, respectively. Receiver operating characteristic analysis showed that the area under curve was 0.64 (confidence interval [CI], 0.513-0.737) for urinary 5-HIAA, which was lower than white blood cell count (0.69; CI, 0.574-0.797), neutrophil count (0.68; CI, 0.565-0.792), and C-reactive protein (0.76; CI, 0.657-0.857). There was no significant difference in the median values of 5-HIAA between different grades of severity of appendicitis (P=.704). CONCLUSION: Urinary 5-HIAA is not an ideal test for the diagnosis of acute appendicitis.

The significance of urinary beta-2 microglobulin level for differential diagnosis of familial Mediterranean fever and acute appendicitis.

The clinical and laboratory parameters widely used are not specific to discriminate the abdominal pain due to FMF attack from that of acute appendicitis. The present study aims to investigate the urinary beta-2 microglobulin (U-ß2M) level as a potential parameter to identify these two diseases mimicking each other. A total of 51 patients with established FMF diagnosis due to Tel Hashomer criteria on colchicine treatment (1-1.5 mg/day), 15 patients with acute appendicitis who had appropriate clinical picture and were also supported pathologically after the surgery, and 20 healthy controls were enrolled in the study. Of the 51 patients with FMF, 25 were at an attack period, while remaining 26 were not. For the diagnosis of acute attack, as well as physical examination, laboratory tests including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were performed. From urine specimens U-ß2M, microalbumin, and N-acetyl glucosaminidase (U-NAG) were measured. U-ß2M levels were significantly higher in acute appendicitis group compared to FMF attack, FMF non-attack, and control groups (p < 0.001, p < 0.001, and p < 0.001, respectively). U-NAG and microalbuminuria were significantly higher in acute appendicitis, FMF attack, and FMF non-attack groups compared to controls (U-NAG p < 0.001, p = 0.016, p = 0.004, microalbuminuria p < 0.001, p < 0.001, p < 0.001, respectively). Microalbuminuria was significantly higher in acute appendicitis group compared to the FMF attack group (p = 0.004). Determination of U-ß2M levels may be helpful for differential diagnosis of peritonitis attacks of FMF patients on colchicine treatment and acute appendicitis. However, this finding should be substantiated with other studies.

Different urinalysis appearances in children with simple and perforated appendicitis.

PURPOSE: This study aimed to determine whether routine urinalysis may serve as a tool in discriminating between acute appendicitis and perforated appendicitis in children. BASIC PROCEDURES: We prospectively collected 357 patients with clinically suspected acute appendicitis. Urinalysis was performed in patients with clinically suspected acute appendicitis before surgical intervention. Routine urinalysis is composed of 2 examinations: chemical tests for abnormal chemical constituents and microscopic tests for abnormal insoluble constituents. Receiver operating characteristic curves for urine white blood cell (WBC) counts and urine red blood cell (RBC) counts in distinguishing between patients with simple appendicitis and patients with perforated appendicitis were also analyzed. MAIN FINDINGS: Urine ketone bodies, leukocyte esterase, specific gravity, pH, WBC, and RBC counts were all significant parameters among patients with normal appendices, simple appendicitis, and perforated appendicitis (all P < .05). Based on multivariate logistic regression analysis, positive urine ketone bodies and nitrate were significant parameters in predicting perforated appendicitis (P = .002 and P = .008, respectively). According to the results of receiver operating characteristic curves, the appropriate cutoff values were 2.0/high-power field for urine RBC counts and 4.0/high-power field for urine WBC counts in predicting perforated appendicitis in children. PRINCIPAL CONCLUSIONS: Routine urinalysis may serve to aid in discriminating between simple and perforated appendicitis. Clinically, we believe that these urine parameters may aid primary emergency physicians with decision making in patients with clinically suspected appendicitis.

Detection and diagnostic value of urine leucine-rich α-2-glycoprotein in children with suspected acute appendicitis.

STUDY OBJECTIVE: Previously, we used a proteomics approach for the discovery of new diagnostic markers of acute appendicitis and identified leucine-rich α-2-glycoprotein (LRG) that was elevated in the urine of children with acute appendicitis and enriched in diseased appendices. Here, we sought to evaluate the diagnostic utility of enzyme-linked immunosorbent assay (ELISA) of urine LRG in a blinded, prospective, cohort study of children being evaluated for acute abdominal pain. METHODS: Urine LRG concentration was measured with a commercially available LRG ELISA and selected ion monitoring mass spectrometry. Urine LRG test performance was evaluated blindly against the pathologic diagnosis and histologic grade of appendicitis. RESULTS: Urine LRG was measured in 49 patients. Mean urine LRG concentration measured with commercial LRG ELISA was significantly elevated in patients with acute appendicitis but exhibited an interference effect. Direct measurements using selected ion monitoring mass spectrometry demonstrated that LRG was elevated more than 100-fold in patients with acute appendicitis compared with those without, with the receiver operating characteristic area under the curve of 0.98 (95% confidence interval 0.96 to 1.0). Among patients with acute appendicitis, elevations of urine LRG measured with ELISA and selected ion monitoring mass spectrometry correlated with the histologic severity of appendicitis. CONCLUSION: Urine LRG ELISA allows for discrimination between patients with and without acute appendicitis but exhibits limited accuracy because of immunoassay interference. Direct measurements of urine LRG with selected ion monitoring mass spectrometry demonstrate superior diagnostic performance. Development of a clinical-grade urine LRG assay is needed to advance the diagnostic accuracy of clinical evaluations of appendicitis.

Novel serum and urine markers for pediatric appendicitis.

OBJECTIVES: The objective was to describe the association between two novel biomarkers, calprotectin and leucine-rich alpha glycoprotein-1 (LRG), and appendicitis in children. METHODS: This was a prospective, cross-sectional study of children 3 to 18 years old presenting to a pediatric emergency department (ED) with possible appendicitis. Blood and urine samples were assayed for calprotectin and LRG via enzyme-linked immunosorbent assay (ELISA). Final diagnosis was determined by histopathology or telephone follow-up. Biomarker levels were compared for subjects with and without appendicitis. Recursive partitioning was used to identify thresholds that predicted appendicitis. RESULTS: Of 176 subjects, mean (±SD) age was 11.6 (±4.0) years and 52% were male. Fifty-eight patients (34%) were diagnosed with appendicitis. Median plasma calprotectin, serum LRG, and urine LRG levels were higher in appendicitis versus nonappendicitis (p < 0.008). When stratified by perforation status, median plasma calprotectin and serum LRG levels were higher in nonperforated appendicitis versus nonappendicitis (p < 0.01). Median serum LRG, urine LRG, and plasma calprotectin levels were higher in perforated appendicitis compared to nonperforated appendicitis (p < 0.05). Urine calprotectin did not differ among groups. A serum LRG < 40,150 ng/mL, a urine LRG < 42 ng/mL, and a plasma calprotectin < 159 ng/mL, each provided a sensitivity and negative predictive value of 100% to identify children at low risk for appendicitis, but with specificities ranging from 23% to 35%. The standard white blood cell (WBC) count achieved 100% sensitivity at a higher specificity than both novel biomarkers. CONCLUSIONS: Plasma calprotectin and serum/urine LRG are elevated in pediatric appendicitis. No individual marker performed as well as the WBC count.

Is urinary 5-hydroxyindoleacetic acid helpful for early diagnosis of acute appendicitis?

OBJECTIVE: Acute appendicitis is the most common abdominal emergency in children and young adults. There are a lot of serotonin-containing cells in the appendix, which release serotonin into the bloodstream in response to inflammation. Consequently, serotonin is converted to 5-hydroxyindoleacetic acid (5-HIAA) and secreted into the urine. On this basis, urinary 5-HIAA could be a marker for acute appendicitis. In this study, we investigated the value of 5-HIAA levels in spot urine in the diagnosis of acute appendicitis. METHODS: The urinary 5-HIAA was measured by an enzyme-linked immunosorbent assay in the spot urine of 70 patients who presented to the emergency department with a clinical picture of acute appendicitis. Urine concentration results were correlated to final histopathologic reports, and the diagnostic value of this factor was measured. RESULTS: Diagnosis of appendicitis was confirmed by histopathologic reports in 59 of 70 patients with presumptive diagnosis of appendicitis. Considering 5.25 mg/L as the cutoff point for urinary 5-HIAA, 28 patients had high urinary 5-HIAA levels, whereas 42 patients had values within reference range. The sensitivity and specificity of this test was 44% and 81%, respectively. CONCLUSIONS: The measurement of urinary 5-HIAA levels is not an ideal diagnostic tool for ruling out or determination of acute appendicitis.

Discovery and validation of urine markers of acute pediatric appendicitis using high-accuracy mass spectrometry.

STUDY OBJECTIVE: Molecular definition of disease has been changing all aspects of medical practice, from diagnosis and screening to understanding and treatment. Acute appendicitis is among many human conditions that are complicated by the heterogeneity of clinical presentation and shortage of diagnostic markers. Here, we sought to profile the urine of patients with appendicitis, with the goal of identifying new diagnostic markers. METHODS: Candidate markers were identified from the urine of children with histologically proven appendicitis by using high-accuracy mass spectrometry proteome profiling. These systemic and local markers were used to assess the probability of appendicitis in a blinded, prospective study of children being evaluated for acute abdominal pain in our emergency department. Tests of performance of the markers were evaluated against the pathologic diagnosis and histologic grade of appendicitis. RESULTS: Test performance of 57 identified candidate markers was studied in 67 patients, with median age of 11 years, 37% of whom had appendicitis. Several exhibited favorable diagnostic performance, including calgranulin A (S100-A8), alpha-1-acid glycoprotein 1 (orosomucoid), and leucine-rich alpha-2-glycoprotein (LRG), with the receiver operating characteristic area under the curve and values of 0.84 (95% confidence interval [CI] 0.72 to 0.95), 0.84 (95% CI 0.72 to 0.95), and 0.97 (95% CI 0.93 to 1.0), respectively. LRG was enriched in diseased appendices, and its abundance correlated with severity of appendicitis. CONCLUSION: High-accuracy mass spectrometry urine proteome profiling allowed identification of diagnostic markers of acute appendicitis. Usage of LRG and other identified biomarkers may improve the diagnostic accuracy of clinical evaluations of appendicitis.

The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis.

PURPOSE: Acute appendicitis is one of the most common surgical emergencies. Diagnosis is usually made depending on the presenting history, clinical evaluation, and laboratory tests. The aim of this study was to investigate the role of urinary 5-hydroxyindoleacetic acid (U-5-HIAA) in the early diagnosis of acute appendicitis. METHODS: Thirty-five pigmented male rabbits were divided into 5 groups. Group 1 is the control (n = 7); group 2 is the sham (n = 10). The appendix was ligated from its base, and an appendectomy was performed after 12, 24, 36 hours in group 3 (n = 7), group 4 (n = 7), and group 5 (n = 7), respectively. Spot urine samples were obtained for U-5-HIAA determination, and appendectomy tissues were examined histopathologically. RESULTS: Acute appendicitis was diagnosed in all animals in group 3, group 4, and group 5, and the mean levels of U-5-HIAA in group 3 were higher than in the other groups. The mean of U-5-HIAA levels between animals with appendicitis and those without showed a significant difference (P = .003). The U-5-HIAA cutoff point of 4.15 mg/g creatinine had a sensitivity of 85%, a specificity of 64.29%, and an accuracy of 76% (area under curve = 0.805) for acute appendicitis. The probability of acute appendicitis is found to be 10, 2 times more when the U-5-HIAA level is greater than 4.15 mg/g creatinine. CONCLUSION: We have concluded that spot U-5-HIAA level increases significantly in the early stages of acute appendicitis.

A prospective clinical trial evaluating urinary 5-hydroxyindoleacetic acid levels in the diagnosis of acute appendicitis.

BACKGROUND: To improve the diagnostic accuracy of identifying acute appendicitis, imaging modalities, such as ultrasound and the computed tomography scan, are used in combination with the history and physical examination. There is no reliable single laboratory marker to assist with this diagnosis. During inflammation, enterochromaffin cells in the appendix secrete serotonin, and 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite excreted in urine, has been found to be elevated in patients presenting with acute appendicitis. OBJECTIVE: The aim of this study was to measure the urinary 5-HIAA concentrations of patients presenting with symptoms of acute appendicitis to determine the sensitivity and specificity of urinary 5-HIAA levels for diagnosing acute appendicitis. METHODS: 5-HIAA was quantitatively measured by high-performance liquid chromatography in the spot urine of 100 healthy individuals, aged 18 to 70 years, who presented to the emergency medicine department with a clinical picture of acute appendicitis. Urine concentration results were correlated to the gold standard of histopathologic reports of removed appendices. The sensitivity, specificity, and their 95% confidence intervals were derived. RESULTS: Of the 100 patients presenting with symptoms consistent with acute appendicitis, 72 had appendectomies and 2 had cholecystectomies. The remaining 26 patients were discharged after hospital observation. A total of 64 patients were found to have appendicitis: 52 had acute appendicitis, whereas 12 had perforated and/or gangrenous (nonacute) appendices. The acute appendicitis group had a mean urinary 5-HIAA level of 19.31 micromol/L, slightly lower than the 23.10 micromol/L of the patients with gangrenous/perforated appendicitis. The group without appendicitis had a urinary 5-HIAA value of 17.27 micromol/L. Using the lowest of previously reported cutoffs, we calculated the sensitivity and specificity of this test for acute appendicitis as 63% and 33%, respectively. CONCLUSION: Urinary 5-HIAA level is not a good diagnostic tool for determining acute appendicitis.

Simultaneous determination of 5-hydroxyindoleacetic acid and 5-hydroxytryptamine in urine samples from patients with acute appendicitis by liquid chromatography using poly(bromophenol blue) film modified electrode.

The fabrication and application of a novel electrochemical detection (ED) system with a poly(bromophenol blue) (PBPB) film chemically modified electrode (CME) for high performance liquid chromatography (HPLC) were described. The electrochemical behaviors of 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) at this CME were investigated by cyclic voltammetry (CV) and differential pulse voltammetry (DPV). It was found that the PBPB CME efficiently exhibited electrocatalytic effect on the current responses of 5-HT and 5-HIAA with relatively high sensitivity, stability and long life of activity. In HPLC-ED, the two analytes had good and stable current responses at the CME and their linear ranges were over four orders of magnitude (R> or =0.9992) with the detection limits being 0.25 nmol L(-1) for 5-HT and 0.50 nmol L(-1) for 5-HIAA. The application of this method for the determination of 5-HT and 5-HIAA in urine samples from patients with acute appendicitis (AA) was satisfactory.

Urine leukotriene B4 in familial Mediterranean fever and other forms of right lower abdominal pain.

BACKGROUND: Acute right lower abdominal pain may present a diagnostic dilemma. Leukotrienes have been found to be elevated in familial Mediterranean fever (FMF), a disease manifesting with recurrent episodes of "acute abdomen." OBJECTIVES: To determine whether urine leukotriene B4 (LTB4) may differentiate between an FMF attack and some other forms of acute right lower abdominal pain. METHODS: The LTB4 level was determined, using a commercial enzyme-linked immunosorbent assay (ELISA), in urine samples obtained from 36 patients with acute (< 24 hours) right lower abdominal pain presenting to the emergency department, and from 18 healthy volunteers. RESULTS: Compared with the healthy control subjects, LTB4 was significantly higher in those who had FMF (12 patients, p < 0.03). In other forms of acute right lower abdominal pain, including appendicitis (eight patients), urologic disorders (eight patients), and nonspecific abdominal pain (eight patients), intermediate levels of LTB4 were observed, not significantly different from those of either FMF patients or healthy control subjects. CONCLUSIONS: In the samples tested, urine LTB4 levels were not instrumental in differentiating FMF from other acute right lower abdominal pain.

The value of 5-hydroxyindolacetic acid levels in spot urine in the diagnosis of acute appendicitis.

BACKGROUND: We investigated the value of 5-hydroxyindolacetic acid (5-HIAA) levels in spot urine in the diagnosis of acute appendicitis. METHODS: Forty-three patients (11 females, 32 males; mean age 26.3 years; range 16 to 73 years) who were admitted to the emergency room with acute abdominal pain and suspected acute appendicitis were evaluated by means of physical examination, leukocyte counts, urine analysis, measurements of 5-HIAA in spot urine, abdominal x-rays, and sonography. Of these, 25 patients underwent appendectomy after a clinical diagnosis of acute appendicitis. Spot urine analyses were made in all the patients within the first hour of admission with the use of spectrophotometric and colorimetric methods; 5-HIAA levels were read at 540 nm. RESULTS: At laparotomy, 22 patients (88%; 3 females, 19 males; mean age 26.18 years; range 15 to 38 years) were found to have acute appendicitis (11 phlegmonous, 11 gangrenous), whereas three patients (12%; 2 females, 1 male) had negative findings. No significant differences were found between patients with confirmed acute appendicitis, patients without appendectomy, and those with negative laparotomy with respect to the mean leukocyte counts and 5-HIAA levels (p>0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 5-HIAA for the diagnosis of acute appendicitis were calculated as 22%, 93%, 71%, 62%, and 63%, respectively. CONCLUSION: Measurement of 5-HIAA levels in spot urine is not helpful in the diagnosis of acute appendicitis.

Diagnostic monitoring of urine by means of synchronous fluorescence spectrum.

A novel approach to clinical-biochemical analysis of urine is presented in this work. Urine composition is defined graphically as a record of synchronous fluorescence spectra (SFS). The graphical standard has been made from SFS of urine samples from healthy children. Simple comparison of a standard record with that of an analyzed urine sample will immediately reveal changes in its composition. Reproducibility of the graphical definition is very high and it maintains its characteristic shape during repeated measurements over a span of 2 years. It is possible to elaborate patients' own standard for those with chronic illness. It differs from a normal course but it is characteristic for a given patient and it enables the clinician to monitor changes or the outcome of therapy at regular medical examinations. Application of this method for monitoring of urine composition for selected cases is a new alternative with several advantages. Analysis without any added reagents very quickly detects some illnesses near onset when they may be clinically asymptomatic and classical screening methods show negative results. Computerization of spectral measuring and filing the results enables to give a likely diagnosis or a deviation from standard. This method can also serve a doctor-clinician either to confirm or to exclude a concrete diagnosis.

Spot urine 5-hydroxy indole acetic acid and acute appendicitis.

BACKGROUND/AIMS: Appendectomy for suspected appendicitis cases is a common procedure. Its clinical diagnosis needs to be supported by accurate confirmatory tests. No single paraclinical test with a high degree of sensitivity and specificity is available for its diagnosis. The appendix contains numerous serotonin-producing cells (enterochromaffin cells). In the inflammatory process and subsequent cell injury, serotonin is released and converted to 5-HIAA (5-hydroxy indole acetic acid). We studied the elevation of 5-HIAA in the spot urine of acute appendicitis patients. METHODOLOGY: 5-HIAA was measured by high-performance liquid chromatography in the spot urine samples of 40 healthy individuals and 166 patients who presented to emergency units of the university hospitals with acute abdominal pain. The results of the urine concentrations were compared to the histopathology reports of the removed appendices and the final diagnosis of other diseases. RESULTS: From 80 cases with a presumptive diagnosis of appendicitis, 73 were operated on and seven cases discharged after a few hours observation. Sixty-five out of 66 documented appendicitis patients showed a striking increase of urinary spot 5-HIAA with significant differences vs. all cases of healthy control individuals (P < 0.001). The 5-HIAA values of all of the negative appendectomy cases (n = 7) and all of the discharged cases after the observation period (n = 7) were within healthy control ranges. The mean value of the appendicitis group (42.76 +/- 2.26 mumol/L) was also significantly higher vs. all other acute abdomens which could mimic acute appendicitis (P < 0.05) excepting gastroenteritis patients. Considering 20 mumol/L as the cutoff value sensitivity, specificity, positive and negative predictive values of this test for discriminating appendicitis in clinically suspected patients were 98%, 100%, 100% and 93%, respectively and in all acute abdomens were 98%, 71%, 69% and 98.6%, respectively. The patients with gastroenteritis also showed elevation of 5-HIAA (43.05 +/- 2.7 mumol/L) vs. other nonappendicitis groups (P < 0.05). CONCLUSIONS: We have concluded that measurement of 5-HIAA in spot urine is a highly reliable test supporting the clinical diagnosis of appendicitis and if it does not show an increase, appendicitis can be ruled out with a very high degree of confidence which helps to reduce unnecessary appendectomies. In clinically suspected appendicitis patients with diarrhea, an increase of 5-HIAA may not confirm the diagnosis.

[Chemoluminescence of blood and urine in diffuse appendicular peritonitis in children]. / Khemoliuminestsentsiia krovi i mochi pri rasprostranennom appendikuliarnom peritonite u detei.

The results of the study of hemiluminescence of native blood, plasma and urine in 56 children with diffuse purulent peritonitis demonstrate that changes of light-sum of the luminescence of the investigated media could reflect aggravation of endogenous intoxication connected with development of organic insufficiency. The usage of blood and urine hemiluminescence for definition of the gravity of endogenous intoxication in diffuse forms of appendicular peritonitis in children is suggested.

Urinalysis, ultrasound analysis, and renal dynamic scintigraphy in acute appendicitis.

OBJECTIVES: The influence of acute appendicitis (AA) on the right kidney and urinalysis was investigated. Permanent damage of the urinary tract and abnormal urinalysis have been previously reported in AA. METHODS: Appendectomy was performed in 84 patients with no previous urogenital, retroperitoneal, or pelvic disease, trauma, or operation. AA was confirmed in 66 of them. Control groups were the remaining 18 patients and 40 patients with varicocele repair. Renal sonography and urinalyses were done prior to operation, on days 1, 3, and 6 postoperatively. Pentetic acid renal scintigraphy was done on postoperative day 1 in patients with abnormal urinalysis. An obstructive radiographic curve indicated furosemide renography. RESULTS: Abnormal urinalysis was found in 48% of patients with AA before appendectomy and in 12% on day 6 postoperatively. Sonography showed pyelocaliceal dilation of the right kidney in 38% of patients with AA prior to appendectomy and in none on day 6 postoperatively. Patients with AA had pyelocaliceal dilation of the right kidney more frequently than those in the control groups (P < 0.001). It was more frequent in patients having abnormal urinalysis (P < 0.01). Scintigraphy confirmed pyelocaliceal dilation of the right kidney in 38% of patients with abnormal urinalysis. Furosemide renography excluded an obstruction in all of them. CONCLUSIONS: Inflammation is the major cause of abnormal urinalysis and transitory pyelocaliceal dilation in some patients with AA. Erythrocyturia, pyuria, proteinuria, and pyelocaliceal dilation detected by sonography or scintigraphy can frequently be found in patients with AA, but should not mislead the surgeon in the diagnosis of AA.