The Sensitivity and Specificity of the Conventional Symptoms and Signs in Making a Diagnosis of Acute Appendicitis

Introduction: Simple appendicitis can progress to perforation; which is associated with a much higher morbidity and mortality. So; surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. Objective: This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis.Methods: The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender; clinical presentation (signs and symptoms) and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal; acutely inflamed and gangrenous. Results: Clinical diagnosis was made correctly in 807 (93.2) of the patients. White blood cells count ranged from 3.70 to 45.30 /mm3 (mean 17.5353 /mm3). It was 10;000/mm3 in 133 (15.4) patients.Conclusions: Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

Importance of Fine Needle Aspirationin Evaluation of Single Nodular Goiter

Background:Improvements in the sensitivity and specificity of biochemical thyroid tests; as well as the development of fine needle aspiration biopsy (FNA) and improved cytological techniques; have dramatically impacted clinical strategies for detecting and treating thyroid disorders.Fine needle aspiration is a safe and relatively painless procedure where a hypodermic needle passed into the lump and samples of tissue taken out.This procedure will provide us with more information about the nature of the lump; and especially differentiate between a benign and malignant mass.Objectives: The current prospective study designed to evaluate the sensitivity; specificity andaccuracy of FNA. The study was performed in the regional major hospital; Khartoum; Sudan.Patients and methods: A thousand and three hundred thirty one patients who underwent thyroid surgery 'between' January 2004 to June 2007 were enrolled.Results: 247 (18.3) had single nodular goiter. The incidence of benign and malignant lesions in single nodular goiter were 204 (87.6) and 29 (12.4) respectively.The overall sensitivity; specificity and accuracy of FNA were 95.5; 99.5and 99.4respectively.Conclusion: Also there is correlation between the nodule size and the result of FNA; as the nodular size increase there is increase of the probability of malignant changes. So; solitary or dominant nodules 7 1cm in diameter might be evaluated by FNA