Alvarado score; evaluation in precise diagnosis of acute appendicitis

Objective: To evaluate the usefulness and accuracy of Alvarado scoring system in the precise diagnosis of acute appendicitis to decrease the rate of negative appendectomies

Design: Descriptive study

Place and duration of study: The study was conducted in Military Hospital Rawapindi from Aug 2010 to Dec 2011

Patients and methods: In this study, initially 351 cases by convenience sampling, were included but later 31 patients were excluded specially females because they turned out to be cases of PID, renal / ureteric colic or UTI. Patients with score of 4 or above underwent appendectomy. 320 patients were operated. All except gangrenous and perforated appendices were subjected to histopathology. Six operated cases were found to be having normal appendices. Twenty patients were treated conservatively because their scores were less than 4 according to Alvarado scoring system. Those patients were observed till their symptoms settled

Results: Male to female ratio was 1.46:1. 71.2 % [n=196] patients were between 13-24years. On the basis of Alvarado score 62.50 % [n=200] patients secured 7 and above while 31.25 % [n=100] were having 4 and above score. Remaining 6.25 % [n=20] had less than 4 score. Out of total [n=300] 98 % [n=294] were histopathologically proven to be acute appendicitis while 2 % [n=6] were of normal histopathology

Conclusions: We concluded that Alvarado Score is a useful parameter / yardstick in diagnosis of acute appendicitis

A survey on the diagnosis and treatment of biliary tract cancers in Shanghai / 中华外科杂志

<p><b>OBJECTIVE</b>To survey the status of diagnosis and treatment of biliary tract cancer in Shanghai.</p><p><b>METHODS</b>A clinical epidemiology investigation was carried out on 658 new cases of biliary duct cancers aged 35-74, that registered between June 1997 and May 2001 in urban Shanghai. Clinical findings were collected in 390 gallbladder cancer, 195 bile duct cancer and 73 ampullary cancer.</p><p><b>RESULTS</b>Biliary tract cancers mainly occurred in elderly patients. Ratio of males to female was 1:2.61 in gallbladder cancer, while bile duct cancer and ampullary cancer were slightly more common in men. Association with gallstones was 68.5%, 43.1% and 22.4% for gallbladder cancer, bile duct cancer and ampullary cancer, respectively. Diagnostic accuracy rate of B-ultrasonography was 63.1% in gallbladder cancer. Incidental gallbladder cancer accounted for 20%, while stage IVA and IVB patients reached up to 43.6%. Misdiagnosis rate was still high in bile duct cancer and ampullary cancer, it was 19.1% and 47.1% respectively. In addition, most patients presented jaundice at diagnosis. 69 cases (18.2%) of gallbladder cancer, 50 cases (25.6%) of bile duct cancer and 54 cases (74%) of ampullary cancer underwent radical resection, the 1-, 3- and 5-year survival rates were 58.5%, 42.8% and 40.7%, 58%, 28.3% and 11.1%, 81.5%, 39.2% and 26.9%, respectively. 79 patients with bile duct cancer underwent palliative drainage, and most cases died within 1 year. Metal endo-prostheses or plastic stents were placed into the biliary tract in 38 patients. The median survival was about 7 months.</p><p><b>CONCLUSIONS</b>It is difficult to make early diagnosis of biliary tract cancers. Standardization of the operation for gallbladder cancer must be respected. Surgical exploration should be undertaken when a bile duct cancer is suspected and there are no contraindications to surgery. Pancreatoduodenectomy should be recommended for ampullary cancer.</p>

Tea consumption and risk of biliary tract cancers and gallstone disease: a population-based case-control study in Shanghai, China / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the relationship between tea consumption, biliary tract cancers and gallstone disease.</p><p><b>METHODS</b>A population-based case-control study was conducted in urban Shanghai from 1 June 1997 to 31 May 2001 involving interviews with 627 new cases of biliary tract cancers (including 368 cases of gallbladder cancer, 191 cases of extrahepatic bile duct cancer and 68 cases of cancer of the ampulla of Vater) aged 35 to 74 years and 959 population controls frequency-matched to cases by gender and age in five-year group. 1037 patients of gallstone disease were selected from the same hospital. All subjects were interviewed in person by trained interviewers by use of a structured questionnaire. Unconditional logistic regression analysis was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI).</p><p><b>RESULTS</b>Compared with tea non-drinkers, current tea consumption was inversely associated with risk of gallbladder cancer, extrahepatic bile duct cancer and gallstone disease among females with OR of 0.57 (95% CI: 0.34-0.96), 0.53 (95% CI: 0.27-1.03) and 0.71 (95% CI: 0.51-0.99), respectively. OR declined with younger age at initiation of tea drinking and with longer duration of tea consumption (P for trend < 0.05). Among males, the corresponding OR were mostly below one, although not statistically significant.</p><p><b>CONCLUSION</b>Tea consumption may decrease the risk of cancers of the gallbladder and extrahepatic bile duct among females. The protective effect appears to be independent of gallstone disease.</p>