Diagnostic value of maximal-outer-diameter and maximal-mural-thickness in use of ultrasound for acute appendicitis in children

AIM: To evaluate the maximal-outer-diameter (MOD) and the maximal-mural-thickness (MMT) of the appendix in children with acute appendicitis and to determine their optimal cut-off values to diagnose acute appendicitis. METHODS: In total, 164 appendixes from 160 children between 1 and 17 years old (84 males, 76 females; mean age, 7.38 years) were examined by high-resolution abdominal ultrasound for acute abdominal pain and the suspicion of acute appendicitis. We measured the MOD and the MMT at the thickest point of the appendix. Patients were categorized into two groups according to their medical records: patients who had surgery (surgical appendix group) and patients who did not have surgery (non-surgical appendix group). Data were analyzed by MedCalc v.9.3. The rank sum test (Mann-Whitney test) was used to evaluate the difference in the MOD and the MMT between the two groups. ROC curve analysis was used to determine the optimal cut-off value of the MOD and the MMT on diagnosis of acute appendicitis. RESULTS: There were 121 appendixes (73.8%) in the non-surgical appendix group and 43 appendixes (26.2%) in the surgical appendix group. The median MOD differed significantly between the two groups (0.37 cm vs 0.76 cm, P < 0.0001), and the median MMT also differed (0.15 cm vs 0.33 cm, P < 0.0001). The optimal cut-off value of the MOD and the MMT for diagnosis of acute appendicitis in children was > 0.57 cm (sensitivity 95.4%, specificity 93.4%) and > 0.22 cm (sensitivity 90.7%, specificity 79.3%), respectively. CONCLUSION: The MOD and the MMT are reliable criteria to diagnose acute appendicitis in children. An MOD > 0.57 cm and an MMT > 0.22 cm are the optimal criteria.

Comparison of computed tomography findings between bacteremic and non-bacteremic acute pyelonephritis due to Escherichia coli

AIM:To identify computed tomography(CT)findings that are associated with the presence of bacteremia in patients with acute pyelonephritis(APN)due to Escherichia coli(E.coli).METHODS:The clinical data and contrast-enhanced CT findings of 128 patients who were diagnosed with APN due to E.coli and showed renal abnormality on contrast-enhanced CT between January 2003 and November 2013 were retrospectively reviewed.The patients were divided into two groups according to the presence of bacteremia:The bacteremia group and the non-bacteremia group.The abnormality on contrast-enhanced CT were categorized into 5 renal and 4 extrarenal CT findings and compared between the two groups using the χ~2 test and multivariate logistic regression.RESULTS:Among the 128 patients,34 patients(26.6%)were classified into the bacteremia group and 94 patients(73.4%)into the non-bacteremia group.There was no statistically significant difference in gender between the two groups(P = 0.09),but the age of thepatients in the bacteremia group was higher than that of the patients in the non-bacteremia group(P < 0.01).Compared to the non-bacteremia group,1 renal CT finding such as urothelial thickening and 3 extrarenal CT findings such as diffuse peritoneal thickening,cystitis and pulmonary congestion were more frequently observed in the bacteremia group with statistical significance.The logistic regression analysis revealed that CT findings,including urothelial thickening,diffuse peritoneal thickening,cystitis and pulmonary congestion were suggested as the predictive CT findings of bacteremic APN.CONCLUSION:On CT,urothelial thickening,diffuse peritoneal thickening,cystitis,and pulmonary congestion are more frequently observed in patients with bacteremic APN due to E.coli.

Stereotactic guidance for navigated percutaneous sacroiliac joint fusion

Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^（？）multidimensional surgical imaging with StealthStation^（？）navigation（Medtronic,Inc.Minneapolis,MN）.Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^（？） integrated with StealthStation^（？） allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage（s） packed with autograft and/or allograft were then placed.O-arm^（？） image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.