Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controv...Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controversial.There are two options for treatment:Immediate operative management and nonoperative management with antibiotics and/or drainage of any abscess or phlegmon.Each method of treatment has advantages and disadvantages.Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events.In many cases,non-operative management with or without drainage and interval appendectomy is advised.The reasons for this approach include new medications and policies for the use of antibiotic therapy.Furthermore,advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries.However,questions have been raised about the risk of recurrence,prolonged use of antibiotics,lengthened hospital stay and delay in returning to daily activities.Moreover,the need for interval appendectomy is currently under debate because of the low risk of recurrence.Due to the paucity of high-quality studies,more randomized controlled trials to determine the precise management strategy are needed.This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.展开更多
Appendicitis is the most common acute surgical emergency of childhood. Since the original report by Puylaert in 1986, the use of ultrasonography in the diagnosis of appendicitis has been the subject of considerable st...Appendicitis is the most common acute surgical emergency of childhood. Since the original report by Puylaert in 1986, the use of ultrasonography in the diagnosis of appendicitis has been the subject of considerable study. Among the reported diagnostic criteria, the maximal outer diameter (MOD) of the appendix is accepted as the one of the most reliable criteria used to differentiate between a normal appendix and acute appendicitis. However, MOD measurement is subject to inaccuracies because luminal distention by non-compressible, non-inflammatory material such as fecal material, or increased maximal mural thickness due to reactive mucosal lym-phoid hyperplasia, or a medical cause due to a generalized gastrointestinal disease, such as Crohn’s disease, can cause the measurement to exceed the upper limits of normality. The aim of this article is to introduce the spectrum of ultrasonographic findings in the normal andabnormal appendix and eventually to reduce unneces-sary surgery in children.展开更多
BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix...BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.METHODS:A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years.Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.RESULTS:Data from two community hospitals indicated visualization rate of the appendix as 11.0%and 23.2%for site 1 and site 2 respectively.In cases where the ultrasound was repeated the visualization rate remains the same.A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis.The results revealed that the visualization of an appendix(P=0.52),significantly improved the diagnosis of appendicitis(z=34,P<0.001).CONCLUSION:Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis.In our study,we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound.Hence,the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.展开更多
Objective: Appetite loss is seen in 90% to 95% of patients with acute appendicitis;however, the cause of this symptom remains unknown. This study is performed to determine whether changes in the blood levels of two an...Objective: Appetite loss is seen in 90% to 95% of patients with acute appendicitis;however, the cause of this symptom remains unknown. This study is performed to determine whether changes in the blood levels of two anorexigenic hormones, leptin and NUCB2/nesfatin-1, can help to diagnose acute appendicitis in children and whether these two parameters can distinguish acute appendicitis from abdominal pain. Methods: Sixty children with comparable ages and body mass indices are divided into three groups of 20 children each: those with acute appendicitis, those with abdominal pain, and controls. The blood sample with acute appendicitis is taken preoperatively (T1), and subsequent samples are taken 24 hrs postoperatively (T2) and 3 days postoperatively (T3). The blood sample with abdominal pain subjects is also taken in the corresponding times with those with acute appendicitis while blood sample from controls is only taken in the T1 corresponding time. Leptin and NUCB2/nesfatin-1 levels are measured by enzyme-linked immunosorbent assay. Results: The serum leptin levels are significantly higher preoperatively than postoperatively in all three groups. The NUCB2/nesfatin-1 levels at T1 in acute appendicitis are significantly higher than those at T2 in all three groups, but are restored at T3 to levels similar to those of controls. Neutrophil percentage has a sensitivity of 100%, and specificity of 76.32%, NUCB2/nesfatin-1 level has a sensitivity of 47% and specificity of 95%, and the leptin level has a sensitivity of 64% and specificity of 51% in the diagnosis of acute appendicitis. Conclusions: High preoperative leptin and NUCB2/nesfatin-1 levels may be a causative factor for appetite suppression observed in patients with acute appendicitis. High preoperative and low postoperative serum leptin and NUCB2/nesfatin-1 concentrations may serve as new candidate biomarkers that help to distinguish acute appendicitis from abdominal pain in children in addition to high CRP concentration, high WBC count, and neutrophilia.展开更多
Background Acute kidney injury(AKI)after cardiopulmonary bypass(CPB)is a common complication especially in pedi-atric population.Plasma gelsolin(pGSN)is an anti-inflammatory factor through binding with actin and pro-i...Background Acute kidney injury(AKI)after cardiopulmonary bypass(CPB)is a common complication especially in pedi-atric population.Plasma gelsolin(pGSN)is an anti-inflammatory factor through binding with actin and pro-inflammatory cytokines in circulation.Decrease in pGSN has been reported in some pathologic conditions.The purpose of the study was to determine the alterations of pGSN level in infants and young children after CPB and the role of pGSN as a predictor for the morbidity and severity of post-CPB AKI.Methods Sixty-seven infants and young children at age≤3 years old undergoing CPB were prospectively enrolled.PGSN levels were measured during peri-operative period with enzyme-linked immuno-sorbent assay and normalized with plasma total protein concentration.Other clinical characteristics of the patients were also recorded.Results In patients developing AKI,the normalized pGSN(pGSN_(N))levels significantly decreased at 6 h post-operation and remained low for 24 h post-operation as compared to the patients with non-AKI.PGSNN at 6 h post-operation combining with CPB time presents an excellent predictive value for AKI.Conclusions Decreased pGSN_(N)identifies post-CPB AKI in the patients≤3 years old,and is associated with adverse clini-cal outcomes.The findings suggest that circulating GSN in post-CPB patients may have beneficial effects on diminishing inflammatory responses.展开更多
目的探讨在急性阑尾炎患儿诊断中,超声征象的特点及诊断意义。方法以81例急性阑尾炎患儿为研究对象,将81例急性阑尾炎患儿依病理检测结果分为2组:进展性阑尾炎患儿34例(41.98%),单纯性阑尾炎患儿47例(58.02%)。通过超声检测的间接征象...目的探讨在急性阑尾炎患儿诊断中,超声征象的特点及诊断意义。方法以81例急性阑尾炎患儿为研究对象,将81例急性阑尾炎患儿依病理检测结果分为2组:进展性阑尾炎患儿34例(41.98%),单纯性阑尾炎患儿47例(58.02%)。通过超声检测的间接征象、直接征象,以及病理检查资料,并借助ROC曲线分析超声征象联合应用的曲线下面积(area under curve,AUC),进行综合分析,对患儿超声检查结果进行评分。结果进展组患儿超声检测的管壁连续性中断/层次清晰度不高、管腔积液、阑尾周围或腹腔积液、阑尾周围高回声、盲肠、回肠壁增厚检出率均高于单纯组(P<0.05);进展组超声间接征象、直接征象、联合征象评分均高于单纯组(P<0.05);ROC(receiver oprating characteristic)曲线下,联合征象诊断灵敏度、特异度、阳性预测值和阴性预测值分别为98.77%、97.53%、98.77%、96.30%均高于间接征象、直接征象,AUC为0.902高于间接征象、直接征象(P<0.05)。结论超声检测征象联合诊断,能够为急性阑尾炎患儿的早期诊断提供客观证据,且还可实现对疾病动态监测,从而有利于临床治疗方案的制定。展开更多
文摘Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controversial.There are two options for treatment:Immediate operative management and nonoperative management with antibiotics and/or drainage of any abscess or phlegmon.Each method of treatment has advantages and disadvantages.Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events.In many cases,non-operative management with or without drainage and interval appendectomy is advised.The reasons for this approach include new medications and policies for the use of antibiotic therapy.Furthermore,advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries.However,questions have been raised about the risk of recurrence,prolonged use of antibiotics,lengthened hospital stay and delay in returning to daily activities.Moreover,the need for interval appendectomy is currently under debate because of the low risk of recurrence.Due to the paucity of high-quality studies,more randomized controlled trials to determine the precise management strategy are needed.This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.
文摘Appendicitis is the most common acute surgical emergency of childhood. Since the original report by Puylaert in 1986, the use of ultrasonography in the diagnosis of appendicitis has been the subject of considerable study. Among the reported diagnostic criteria, the maximal outer diameter (MOD) of the appendix is accepted as the one of the most reliable criteria used to differentiate between a normal appendix and acute appendicitis. However, MOD measurement is subject to inaccuracies because luminal distention by non-compressible, non-inflammatory material such as fecal material, or increased maximal mural thickness due to reactive mucosal lym-phoid hyperplasia, or a medical cause due to a generalized gastrointestinal disease, such as Crohn’s disease, can cause the measurement to exceed the upper limits of normality. The aim of this article is to introduce the spectrum of ultrasonographic findings in the normal andabnormal appendix and eventually to reduce unneces-sary surgery in children.
文摘BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.METHODS:A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years.Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.RESULTS:Data from two community hospitals indicated visualization rate of the appendix as 11.0%and 23.2%for site 1 and site 2 respectively.In cases where the ultrasound was repeated the visualization rate remains the same.A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis.The results revealed that the visualization of an appendix(P=0.52),significantly improved the diagnosis of appendicitis(z=34,P<0.001).CONCLUSION:Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis.In our study,we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound.Hence,the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.
文摘Objective: Appetite loss is seen in 90% to 95% of patients with acute appendicitis;however, the cause of this symptom remains unknown. This study is performed to determine whether changes in the blood levels of two anorexigenic hormones, leptin and NUCB2/nesfatin-1, can help to diagnose acute appendicitis in children and whether these two parameters can distinguish acute appendicitis from abdominal pain. Methods: Sixty children with comparable ages and body mass indices are divided into three groups of 20 children each: those with acute appendicitis, those with abdominal pain, and controls. The blood sample with acute appendicitis is taken preoperatively (T1), and subsequent samples are taken 24 hrs postoperatively (T2) and 3 days postoperatively (T3). The blood sample with abdominal pain subjects is also taken in the corresponding times with those with acute appendicitis while blood sample from controls is only taken in the T1 corresponding time. Leptin and NUCB2/nesfatin-1 levels are measured by enzyme-linked immunosorbent assay. Results: The serum leptin levels are significantly higher preoperatively than postoperatively in all three groups. The NUCB2/nesfatin-1 levels at T1 in acute appendicitis are significantly higher than those at T2 in all three groups, but are restored at T3 to levels similar to those of controls. Neutrophil percentage has a sensitivity of 100%, and specificity of 76.32%, NUCB2/nesfatin-1 level has a sensitivity of 47% and specificity of 95%, and the leptin level has a sensitivity of 64% and specificity of 51% in the diagnosis of acute appendicitis. Conclusions: High preoperative leptin and NUCB2/nesfatin-1 levels may be a causative factor for appetite suppression observed in patients with acute appendicitis. High preoperative and low postoperative serum leptin and NUCB2/nesfatin-1 concentrations may serve as new candidate biomarkers that help to distinguish acute appendicitis from abdominal pain in children in addition to high CRP concentration, high WBC count, and neutrophilia.
基金supported by grants from National Natural Science Foundation of China(81100050 to Shan-Shan Shi,81301612 to Xi-Wang Liu)Science and Technology Bureau of Zhejiang Province(2011C23011 to Qiang Shu)+1 种基金Ministry of Education Doctoral Station Foundation(20120101110049 to Qiang Shu)National Key Technology Support Program(2012BAI04B05 to Qiang Shu).
文摘Background Acute kidney injury(AKI)after cardiopulmonary bypass(CPB)is a common complication especially in pedi-atric population.Plasma gelsolin(pGSN)is an anti-inflammatory factor through binding with actin and pro-inflammatory cytokines in circulation.Decrease in pGSN has been reported in some pathologic conditions.The purpose of the study was to determine the alterations of pGSN level in infants and young children after CPB and the role of pGSN as a predictor for the morbidity and severity of post-CPB AKI.Methods Sixty-seven infants and young children at age≤3 years old undergoing CPB were prospectively enrolled.PGSN levels were measured during peri-operative period with enzyme-linked immuno-sorbent assay and normalized with plasma total protein concentration.Other clinical characteristics of the patients were also recorded.Results In patients developing AKI,the normalized pGSN(pGSN_(N))levels significantly decreased at 6 h post-operation and remained low for 24 h post-operation as compared to the patients with non-AKI.PGSNN at 6 h post-operation combining with CPB time presents an excellent predictive value for AKI.Conclusions Decreased pGSN_(N)identifies post-CPB AKI in the patients≤3 years old,and is associated with adverse clini-cal outcomes.The findings suggest that circulating GSN in post-CPB patients may have beneficial effects on diminishing inflammatory responses.
文摘目的探讨在急性阑尾炎患儿诊断中,超声征象的特点及诊断意义。方法以81例急性阑尾炎患儿为研究对象,将81例急性阑尾炎患儿依病理检测结果分为2组:进展性阑尾炎患儿34例(41.98%),单纯性阑尾炎患儿47例(58.02%)。通过超声检测的间接征象、直接征象,以及病理检查资料,并借助ROC曲线分析超声征象联合应用的曲线下面积(area under curve,AUC),进行综合分析,对患儿超声检查结果进行评分。结果进展组患儿超声检测的管壁连续性中断/层次清晰度不高、管腔积液、阑尾周围或腹腔积液、阑尾周围高回声、盲肠、回肠壁增厚检出率均高于单纯组(P<0.05);进展组超声间接征象、直接征象、联合征象评分均高于单纯组(P<0.05);ROC(receiver oprating characteristic)曲线下,联合征象诊断灵敏度、特异度、阳性预测值和阴性预测值分别为98.77%、97.53%、98.77%、96.30%均高于间接征象、直接征象,AUC为0.902高于间接征象、直接征象(P<0.05)。结论超声检测征象联合诊断,能够为急性阑尾炎患儿的早期诊断提供客观证据,且还可实现对疾病动态监测,从而有利于临床治疗方案的制定。
