Modified alvarado score: is there a role for reducing rate of negative appendicectomy?

To evaluate the usefulness of modified Alvarado scoring system in reducing rate of negative appendicectomy. In the period from July 2002 to April 2004, 122 patients with lower right abdominal pain were admitted and subjected to this prospective trial According to the modified Alvarado score [MAS] patients had ether a score = 7 or a score > 7. For those patients with mostly suspected appendicitis [score > 7] [73 patients] appendicectomy was performed. For those patients with possible appendicitis [score < 7] [14 patients] diagnostic laparoscopy was performed whenever indicated to confirm or refute the diagnosis The presence of a high score [over 7] was found to be an easy and satisfactory aid to early diagnosis of appendicitis in children and men with a diagnostic accuracy of 100%, 96.1% respectively, while in women, it falls disappointingly short of expectations [67%] with false positive rate over 30%. In patients with low score [<7] the diagnostic accuracy of MAS was 60%, 57.1%, and 50% in men, women and children respectively without statistically significant difference. However the use of laparoscopy reduced the negative appendix rate to zero% in this group. The Modified Alvarado score [did well in reducing rate of negative appendicectomy in children and men but diagnostic laparoscopy should be considered in women particularly in the childbearing age and in patients with possible appendicitis [score < 7]

Management of diaphyseal non union of the tibia by autogenous bone marrow graft and interlocking fixation

Twenty one patients [fourteen males and seven females] between the age of [19-60 years] with an age of 42 years with diaphyseal non union of the tibia were treated by autogenous bone marrow graft and interlocking fixation. In one patient autogenous bone marrow graft was used in combination with allogenic bone graft to fill the defect in the tibial diaphysis which was 5cm in the antero-lateral aspect of the tibia. All patients were presented with an established non-union of the tibia with an average 9.4 months [6-16 months]. Autogenous bone marrow graft was obtained from the posterior wing of the ilium. The average length of follow-up was 17.7 months [10-20 months]. Union occurred in 20 patients [95.2%] at average of 9.9 months [6 -14months]. One case ended with non-union due to breaking of the nail. Infection occurred in two patients. Shortening occurred in four patients and external rotation deformity occurred in two patients

Activated protein -0 C resistance [APC-R] and recurrent pregnancy loss

Activated protein - C [APC] is an anticoagulant which deactivates factors Va and VIlla and facilitates fibrinolysis by elevating plasminogen activator levels. Mutation of factor V gene renders factor V resistant to APC with increased incidence of thrombosis. There are several reports about the association between activated protein-C resistance [APC-R] and poor obstetric outcome. This work aimed to study the relationship between APC-R and first trimester pregnancy loss. Thirty pregnant women in the first trimester were categorized in this study into 3 groups: group [A] included 10 healthy women with no history of previous abortion as controtls. Group [B] and [C] included women with a history of first trimester recurrent abortion. Group B included 10 pregnant women. Their results at 8 and 10 weeks of pregnancy were categorized as subgroups Bl and B2 respectively. Group C included 10 women who had abortion at time of blood sample. General, pelvic and uterine ultrasound examinations were done. Liver function tests [ALT, and AST], kidney function tests [serum urea and creatinine], random blood sugar, prothrombin time, activated partial thromboplastin time and APC-R assay were measured to all subjects included in this study. Any case with a medical problem which could result in abortion was excluded. APC-R was significantly higher [p< 0.05] among groups B2 and C, than group A" controls", while no significant difference [P>0.05] was found between groups Bl and A. APC-R positive cases were significantly higher [P<0.05] among unfavorable outcome of pregnancy than those with favorable outcome in group B, while no significant difference [P>0.05] was observed among group A. APC-R positive cases were significantly higher [P<0.001] among those with positive family history of thromboembolism while no significant difference [P>0.05] was found in relation to past history of thromboembolism, gravidity or age. The most predictive risk factor to APC-R was family history of thromboembolism with odd ratio = 25. In conclusion, this study found an association between APC-R and recurrent pregnancy loss in the first trimester. So, it is recommended to measure APC-R to pregnant women with a history of first trimester pregnancy loss especially to those with a positive family history of thromboembolic events

In situ extracorporeal shock wave lithotripsy for lower ureteral calculi

Twenty male patients with lower ureteric radio-opaque calculi ranging from 5 mm to 22 mm were treated by extracorporeal shock wave lithotripsy [ESWL] using the lithostaLithotriper. Seventy percent [70%] of the cases were treated by a single session, and 20% were treated by multiple sessions with a success of 90%. Routinely, patients were treated without hospitalization, while 2 [10%] had persistent stone fragments that required hospitalization for endourological manipulations and 2 [10%] for medical treatment of persistent renal colic. These results strongly suggest that in situ extracoroporeal shock wave lithotripsy is an effective and noninvasive method to treat lower ureteric calculi