Diagnostic accuracy of alvarado score in the diagnosis of acute appendicitis

To determine the diagnostic accuracy of Alvarado score in the diagnosis of acute appendicitis. Study was conducted in Surgical Ward 5, Pakistan Institute of Medical Sciences Islamabad. Duration of study was Six month from December 2006 to June 2007. Hundred consecutive patients which presented to our surgical team with acute appendicitis were assessed prospectively using Alvarado score. They were given specific scores according to the variable and divided into two groups, group one [score >7] group two [score <7]. All patients were operated irrespective of score, if clinical diagnosis of acute appendicitis was made. Postoperatively, diagnosis was confirmed by histopathology report. Validity of scoring system was assessed by calculating sensitivity, specificity and positive predictive value. Total 100 patients were included in the study, which included 65 males and 35 females, at score >7, appendicitis was confirmed in 53/54 patients, while at scores <7 appendicitis was confirmed in 38/46 patients. The sensitivity was 58.2%, specificity was 88.9% and positive predictive value was 98.1%. Clinical experience remains of major importance in diagnosing acute appendicitis. The Alvarado score is a simple, easy scoring system at both end of scale

Sentinel lymph node biopsy in breast cancer by using isosulfan blue

To determine the sensitivity of sentinel node involvement by breast cancer in case of clinically axillary lymph node negative breast cancer. The study was conducted at Pakistan Institute of Medical Sciences, Islamabad in department of general surgery ward 5 from March 2006 to July 2007. Thirty patients with tumor size of either T1 or T2 and clinically negative axillary lymph node were enrolled in this study. These patients were subjected to sentinel lymph node biopsy by blue dye injected in peri-tumor parenchyma then dissection was done to localize sentinel node followed by formal axillary dissection [level II]. The histopathology of sentinel node was compared with axillary lymph node. Sentinel lymph node was successfully localized in all 30 patients [100%]. The sensitivity, specificity, accuracy and false negative rate were 92.8%, 100%, 96.7%, 5.9% respectively. The axilla was metastatic in 14 cases [46.7%], one had negative sentinel lymph node but positive non sentinel lymph node [false negative], and four had sentinel lymph node metastasis alone. Sentinel lymph node biopsy by using blue dye have a high diagnostic accuracy and prevent unnecessary dissection of axilla in majority of patients with early node negative breast carcinoma