Different modalities in early diagnosis of acute appendicitis in children

Acute appendicitis [AA] is a common surgical problem that is associated with an acute-phase reaction. Previous studies have shown that cytokines and acute-phase proteins are activated and may serve as indicators for the severity of appendicitis. During inflammation, enterochromaffin cells in the appendix secrete serotonin, and 5-hydroxy indole acetic acid [5-HIAA]; a serotonin metabolite excreted in urine, has been found to be elevated in patients presenting with acute appendicitis. As there is no reliable single laboratory marker to assist in diagnosis of acute appendicitis so the aim of this study was to compare diagnostic values of different serum inflammatory markers in acute appendicitis in children. A total of 90 children were admitted in the emergency unit with suspected acute appendicitis. Fourteen children were excluded as they were diagnosed with pneumonia [4], urinary tract infection [3], tonsillopharyngitis [5] and gastroenteritis [2]. According to required treatment, patients were divided into two groups. One group comprised 46 children with acute appendicitis who had surgical intervention while the other group comprised 30 children with non-specific abdominal pain. All patients were subjected to history, clinical examination, abdominal ultrasound, white cell count, C- reactive protein, interleukin-6 and urinary 5-hydroxy indole acetic acid. Ultrasonography and urinary 5-HIAA showed the highest diagnostic accuracy [91.1% and 87.8% respectively], followed by serum IL-6 concentration [70%], white blood cell count [67.8%], clinical signs [66.7%], and serum C-reactive protein concentration [61%]. Ultrasonography and 5-HIAA achieved also the highest specificity [90.9%] and positive [91.1% and 90.7%] and negative [88.9% and 85.1%] predictive values, whereas clinical signs showed the highest sensitivity [91.3%] followed by ultrasonography [89.1%] and urinary 5-HIAA [84.8%]. Combination of ultrasonography and urinary 5-HIAA increase the diagnostic accuracy of acute appendicitis and provide surgeons with complementary information in discerning the necessity for urgent operation

Hepatitis C virus and helicobacter pylori infections in pediatric non-hodgkin's lymphoma

It has been recently hypothesized that Hepatitis C virus [HCV] and Helicobacter pylori [H.pylori] might be involved in the pathogenesis of non-Hodgkin's lymphoma [NHL]. However, most of the studies were done on adult patients. So the objective of this study was to determine the prevalence of these infections in pediatric NHL patients and if there is any possible clinical or histopathologic picture linked to the presence of these infectious agents. The study was carried out on 40 pediatric NHL patients, either as new cases or with relapsing disease, presenting to the Hematology Unit of Pediatric Department. In addition, 20 apparently healthy children were studied as control group. Each child was investigated for the presence of H.pylori and HCV IgG antibodies using enzyme immuno-assay [EIA] and for the presence of HCV-RNA by the reverse transcriptase polymerase chain reaction [RT-PCR]. H.pylori IgG antibodies were detected in 19/40 of pediatric NHL patients [47.5%] and in none of the control group [P < 0.001]; whereas HCV antibodies were found in 8/40 of the patient group [20%] and in 1/20 of controls [5%] [P > 0.05]. HCV-RNA was detected by RT-PCR in 7/40 [17.5%] of the patients and in none of the controls. No specific histological subtype, extra-nodal presentation nor stage of disease was related to H.pylori or HCV positivity. Older age group was related to H.pylori positive NHL patients. Also a positive relation between the presence of H.pylori antibodies and the complaint of vomiting and diarrhea was observed in the patient group [P < 0.001]. In conclusion, a high prevalence of HCV and H. Pylori infections was reported in pediatric NHL patients. As regard the hypothesis of their pathogenetic role in lymphomagenesis it is still unclear, whether these agents have a direct role in malignant transformation in pediatric lymphoma since a typical NHL clinico-histological feature associated with HCV and H.pylori is deficient

Quantitative image analysis of osseous interface with self tapping screws versus absorbable screws: a histochemical experimental study

This study was conducted to evaluate as well as to compare the ability of two different screw systems used as a fixation devices in maxillofacial trauma, orthognathic surgery and bone augmentation. A quantitative assessment using the image analysis software was used to assess the ability for new bone formation as well as maturation at the screw-bone interface. The histological as well as the histochemical results revealed more bone formation in response to titanium screws more than absorbable ones. This variability in osteogenesis was found to be statistically significant after 2 and 4 weeks of post-surgical follow up periods while after 8 weeks this difference did not showed any statistical significance. These data suggested that the biological fixation of both systems is challenging and although early osteogenesis of titanium screw system is more favorable, yet the absorbable screw system represents a good alternative solution