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Acute Appendicitis

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P Gronroos – One of the best experts on this subject based on the ideXlab platform.

  • leucocyte count and c reactive protein in the diagnosis of Acute Appendicitis
    British Journal of Surgery, 1999
    Co-Authors: Juha Grönroos, P Gronroos
    Abstract:

    Background: The aim of the present work was to study the preoperative leucocyte counts and C-reactive protein (CRP) values in three groups of patients operated on for a clinical suspicion of Acute Appendicitis with different findings at appendicectomy: an uninflamed appendix, uncomplicated Acute Appendicitis or complicated Acute Appendicitis. In particular, patients with Acute Appendicitis but a normal leucocyte count and CRP level were sought. Methods: In this retrospective study, the mean preoperative leucocyte count and CRP value in 100 consecutive patients with an uninflamed appendix (group A), in 100 consecutive patients with uncomplicated Acute Appendicitis (group B) and in 100 consecutive patients with complicated Acute Appendicitis (group C) were calculated. The numbers of patients with (1) both values normal, (2) only leucocyte count raised, (3) only CRP level raised and (4) both values raised were calculated in each of the three groups. Results: The increase in leucocyte count was an early marker of appendiceal inflammation, whereas the CRP value increased markedly only after appendiceal perforation or abscess formation. Group A (uninflamed appendix) contained 24 patients in whom both values were normal. Neither group B (uncomplicated Acute Appendicitis) nor group C (complicated Acute Appendicitis) contained any patient with both values in the normal range. Conclusion: Acute Appendicitis is very unlikely when both the leucocyte count and CRP value are normal. © 1999 British Journal of Surgery Society Ltd

Juha Grönroos – One of the best experts on this subject based on the ideXlab platform.

  • Appendicolith Appendicitis is clinically complicated Acute Appendicitis-is it histopathologically different from uncomplicated Acute Appendicitis.
    International journal of colorectal disease, 2019
    Co-Authors: Jari Mällinen, Siina Vaarala, Markus J. Mäkinen, Elina Lietzén, Juha Grönroos, Pasi Ohtonen, Tero Rautio, Paulina Salminen
    Abstract:

    Acute Appendicitis may present as uncomplicated and complicated and these disease forms differ both epidemiologically and clinically. Complicated Acute Appendicitis has traditionally been defined as an Appendicitis complicated by perforation or a periappendicular abscess, and an appendicolith represents a predisposing factor of complicated disease. There are histopathological differences between uncomplicated Acute Appendicitis and the previously established traditional forms of complicated Acute Appendicitis, but to our knowledge, the histopathological differences between uncomplicated Acute Appendicitis and complicated Acute Appendicitis presenting with an appendicolith have not yet been reported. The study purpose was to assess these differences with two prospective patient cohorts: (1) computed tomography (CT) confirmed uncomplicated Acute Appendicitis patients enrolled in the surgical treatment arm of the randomized APPAC trial comparing appendectomy with antibiotics for the treatment of uncomplicated Acute Appendicitis and (2) patients with CT-verified Acute Appendicitis presenting with an appendicolith excluded from the APPAC trial. The following histopathological parameters were assessed: appendiceal diameter, depth of inflammation, micro-abscesses, density of eosinophils, and neutrophils in appendiceal wall and surface epithelium degeneration. Using multivariable logistic regression models adjusted for age, gender, and symptom duration, statistically significant differences were detected in the depth of inflammation ≤ 2.8 mm (adjusted OR 2.18 (95%CI: 1.29–3.71, p = 0.004), micro-abscesses (adjusted OR 2.16 (95%CI: 1.22–3.83, p = 0.008), the number of eosinophils and neutrophils ≥ 150/mm2 (adjusted OR 0.97 (95%CI: 0.95–0.99, p = 0.013), adjusted OR 3.04 (95%CI: 1.82–5.09, p 

  • appendiceal neoplasm risk associated with complicated Acute Appendicitis a population based study
    International Journal of Colorectal Disease, 2019
    Co-Authors: Elina Lietzén, Juha Grönroos, Tero Rautio, Jukkapekka Mecklin, Ari Leppaniemi, Pia Nordstrom
    Abstract:

    PURPOSE Appendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated Acute Appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among Acute Appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated Acute Appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to Appendicitis in patients with uncomplicated and complicated Acute Appendicitis. METHODS This nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and Acute Appendicitis diagnosis with medical reports evaluated at eight study hospitals. RESULTS Altogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected Acute Appendicitis in 276 patients (58%). In the whole study, histologically Acute Appendicitis and tumor were both present in 53% (n = 250), and out of these, 41% (n = 102) were complicated and 59% (n = 148) uncomplicated Acute Appendicitis. The associated tumor risk was significantly higher in complicated Acute Appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, p < 0.001). Overall tumor prevalence among Acute Appendicitis patients was 1.24%. CONCLUSIONS Appendiceal tumor prevalence in Acute Appendicitis was low. Tumor risk was significantly higher in complicated Acute Appendicitis compared with uncomplicated Acute Appendicitis. The risk of missed appendiceal tumors related to antibiotic therapy of uncomplicated Acute Appendicitis is very low.

  • leucocyte count and c reactive protein in the diagnosis of Acute Appendicitis
    British Journal of Surgery, 1999
    Co-Authors: Juha Grönroos, P Gronroos
    Abstract:

    Background: The aim of the present work was to study the preoperative leucocyte counts and C-reactive protein (CRP) values in three groups of patients operated on for a clinical suspicion of Acute Appendicitis with different findings at appendicectomy: an uninflamed appendix, uncomplicated Acute Appendicitis or complicated Acute Appendicitis. In particular, patients with Acute Appendicitis but a normal leucocyte count and CRP level were sought. Methods: In this retrospective study, the mean preoperative leucocyte count and CRP value in 100 consecutive patients with an uninflamed appendix (group A), in 100 consecutive patients with uncomplicated Acute Appendicitis (group B) and in 100 consecutive patients with complicated Acute Appendicitis (group C) were calculated. The numbers of patients with (1) both values normal, (2) only leucocyte count raised, (3) only CRP level raised and (4) both values raised were calculated in each of the three groups. Results: The increase in leucocyte count was an early marker of appendiceal inflammation, whereas the CRP value increased markedly only after appendiceal perforation or abscess formation. Group A (uninflamed appendix) contained 24 patients in whom both values were normal. Neither group B (uncomplicated Acute Appendicitis) nor group C (complicated Acute Appendicitis) contained any patient with both values in the normal range. Conclusion: Acute Appendicitis is very unlikely when both the leucocyte count and CRP value are normal. © 1999 British Journal of Surgery Society Ltd

Heinrich Mj Janzing – One of the best experts on this subject based on the ideXlab platform.

  • appendectomy versus antibiotic treatment for Acute Appendicitis
    Cochrane Database of Systematic Reviews, 2011
    Co-Authors: Ingrid Mha Wilms, Dominique Enm Suykerbuykde Hoog, Dianne C De Visser, Heinrich Mj Janzing
    Abstract:

    Background Acute Appendicitis is one of the most common causes of Acute abdominal pain. Present day treatment of choice for Acute Appendicitis is appendectomy, however complications are inherent to operative treatment. Though surgical appendectomy remains the standard treatment, several investigators have investigated conservative antibiotic treatment of Acute Appendicitis and reported good results. Objectives Is antibiotic treatment as effective as surgical appendectomy (laparoscopic or open) in patients with Acute Appendicitis on recovery within two weeks, without major complications (including recurrence) within one year? Search methods We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 6, 2011); MEDLINE (until June 2011); EMBASE (until June 2011); Prospective Trial Registers (June 2011) and reference lists of articles. Selection criteria Randomised and quasi-randomised clinical trials (RCT and qRCT) comparing antibiotic treatment with appendectomy in patients with suspected Appendicitis were included. Excluded were studies which primarily focused on the complications of Acute Appendicitis. Data collection and analysis Two authors independently assessed trial quality and extracted data. The review authors contacted the trial authors for additional information if required. Statistical analysis was carried out using Review Manager and MetaAnalyst. A non-inferiority analysis was performed, comparing antibiotic treatment (ABT) to the gold standard (appendectomy). By consensus, a 20% margin of non-inferiority was considered clinically relevant. Main results Five RCT’s (901 patients) were assessed. In total 73.4% (95% CI 62.7 to 81.9) of patients who were treated with antibiotics and 97.4 (95% CI 94.4 to 98.8) patients who directly got an appendectomy were cured within two weeks without major complications (including recurrence) within one year. The lower 95% CI was 15.2% below the 20% margin for the primary outcome. Authors’ conclusions The upper bound of the 95% CI of ABT for cure within two weeks without major complications crosses the 20% margin of appendectomy, so the outcome is inconclusive. Also the quality of the studies was low to moderate, for that reason the results should be interpret with caution and definite conclusions cannot be made. Therefore we conclude that appendectomy remains the standard treatment for Acute Appendicitis. Antibiotic treatment might be used as an alternative treatment in a good quality RCT or in specific patients or conditions were surgery is contraindicated.

Shamsul Bari – One of the best experts on this subject based on the ideXlab platform.

Sudha Elangovan – One of the best experts on this subject based on the ideXlab platform.

  • Clinical and laboratory findings in Acute Appendicitis in the elderly.
    The Journal of the American Board of Family Practice, 1996
    Co-Authors: Sudha Elangovan
    Abstract:

    Background: Early diagnosis and surgery are important factors by which the morbidity and mortality of Acute Appendicitis in elderly patients can be lowered. This study was conducted to determine clinical and laboratory results that are commonly associated with Acute Appendicitis in elderly patients. Methods: A retrospective chart review was conducted of patients aged 60 years or older who underwent appendectomy or laparotomy for suspected Acute Appendicitis during a 5-year period in a metropolitan county. Acute Appendicitis was confirmed by the pathology report. Results: Elevated band cells and right lower quadrant pain were predictors of Acute Appendicitis in clinically suspected cases. Band cells greater than 6 percent had an excellent positive predictive value, as all patients with elevated band cells had Acute Appendicitis. With increasing white cell count and temperature, specificity increased, sensitivity decreased, and the positive predictive value remained high. Conclusions: It is essential to have a high degree of suspicion to recognize Acute Appendicitis in an afebrile elderly patient who has abdominal pain, a mildly elevated white cell count, and band cells in the upper limits of normal.