Appraisal of the modified Alvarado Score for acute appendicits in adults

Decision making in cases of acute appendicitis may be difficult specially for junior surgeons. Radiological investigations do not appear to be helpful. In some studies, the Modified Alvarado Scoring System [MASS] was helpful in minimizing unnecessary appendicectomies. The aim this study was to evaluate the sensitivity of MASS in the diagnosis of acute appendicitis in adults. All adult patients aged 16-years and above who were admitted with a provisional diagnosis of acute appendicitis between January 2001 and January 2002, into the Armed Forces Hospitals, Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia were prospectively entered into this study. The study included 125 patients between the ages of 16 and 76-years. They were prospectively evaluated on admission using the Modified Alvarado Score [MAS] to determine whether or not they had acute appendicitis. The MASS was correlated with the operative and histopathological findings. One hundred and 10 patients [88%] had appendicectomies of which 30 patients [27.3%] had normal appendices on histopathology examination. Overall the MAS system showed a sensitivity of 53.8% and a specificity of 80%. For males, the sensitivity was 56.4% and the specificity was 100%. For females, the sensitivity and specificity were 48% and 62.5%. From the results, the MASS is not sufficiently sensitive adopted as a method of diagnosing of acute appendicitis in adults in our environment. Further, requirements may be needed to improve its sensitivity and specificity

Efficacy of local anaesthesia and simplicity of mesh plug technique in open inguinal hernia repair in patients above 60 years of age

Local anesthesia offers several advantages over other types of anesthesia because it is limited to a small body area. This study evaluates the efficacy of local anesthesia arid the simplicity of the Mesh Plug technique in open inguinal hernia repair, particularly in patients over the age of 60 years. A prospective study was conducted on 150 patients above the age of 60 who were admitted to a specialized hernia clinic in the Armed Forces Hospital, Southern Region, Saudi Arabia. They underwent inguinal hernia repair using the Mesh Plug technique under local anesthesia as a day surgery procedure. The mean age was 69 years. Concomitant diseases were present in 60 [40%] patients. Local anesthesia was used in 144 [96%] patients. Operative time, hospital stay and the postoperative analgesic requirement were recorded. The postoperative pain was evaluated for the first eight hours using the Wong/Baker face scale. The mean hospital stay was 0.6 day [range 8 hours - 7 days], 138 patients were discharged after eight hours from the day surgery unit, while 12 patients stayed between 1-7 days. The mean operative time starting from local anesthesia infiltration was 36 minutes [range 30-50 minutes]. Local complications were reported in 39 men, 18 [12%] had bruising, 18 [12%] had a seroma and three [2%] had neuralgia. Neither infection nor recurrence was recorded during the period under review. Local anesthesia and the Mesh Plug technique in inguinal hernia repair is a safe and effective procedure in elderly patients. Age and concomitant diseases should not be a contraindication to elective hernia repair