The Diagnostic Value of Serum C-Reactive Protein in Patients Suspected to Have Acute Appendicitis

C-reactive protein(CRP), a normal constituent of the serum in healthy individuals, increases in response to various bacterial infections and cellular necrosis. To find out if the C-reactive protein concentration is of any value in the diagnosis of acute appendicitis, ninety consecutive patients suspected to have acute appendicitis were studied prospectively. Of these, 54 patients(group A) had acute appendicitis and 6 patients(group B) underwent surgery with a diagnosis of acute appendicitis; however, histopathology disclosed a normal appendix. Seventeen patients(group C) had no identifiable cause for their illness and 13 patients(group D) had an identifiable cause for their illness, though not appendicitis. The mean serum CRP value was 49.00mg/L in group A, 18.92mg/L in group B, 20.31mg/L in group C, and 63.22mg/L in group D. Within group A, the mean CRP value in the 36 patients with the inflammed appendix was 33.56mg/L. The mean value in the 7 patients with the gangrenous appendix was 73.16mg/L, and 97.61mg/L in 11 patients with the perforative appendix. Serum CRP levels were normal in two patients with acute appendicitis. Besides these 2 patients, all patients with normal CRP had a normal appendix found at the time of operation or their symptoms resolved spontaneously. It is concluded that an increase in CRP levels to more than 5 mg/L is not a definitive indicator of acute appendicitis. However, when there is doubt about the diagnosis of acute appendicitis, a normal serum CRP level should be used as a basis for the decision to defer surgery.

The incidence of Thyroid Carcinoma in Solitary Cold Nodules and in Multinodular Goiter

The management of thyroid nodules, about which widely differing views have been expressed for many years, is still a controversial subject. The primary reason for concern about thyroid nodules is that they might be malignant.The incidence of carcinoma in patients with multinodular goiters has reported to be considerably lower than in patients with a single nodule. In this retrospective study of 510 cases of thyroidectomies over a 14-year period, 151 patients with factors predisposing them to neoplasia, such as Grave's disease and thyroiditis, were eliminated. The remaining 93 patients with clinically evident multinodular goiters were compared with remaining the 226 patients with a solitary cold nodule. The incidence of carcinoma in the 266 patients with a solitary cold nodule was 15.4%. In the 93 patients with clinically evident multinodular goiters, the incidence of carcinoma was 18.3%. The difference is not significant. It is of interest that male patients with multinodular goiters had the highest incidence of carcinoma at 25.0%, whereas, males with a solitary cold nodule had an incidence of only 17.9%. In conclusion, once known factors that predispose patients to neoplasia are eliminated, there does not seem to be a significant difference in the incidence of thyroid carcinoma between patients with operatively and histopathologically proved solitary cold nodules and those with multinodular goiter.

En-Bloc Resection of Extended Total Gastrectomy VS. Total Gastrectomy for Proximal Gastric Cancer

It is very important to select the appropriate operative method in cancer surgery. For proximal gastric cancer, a total gastrectomy (TG) has usually had less morbidity and mortality than an extended total gastrectomy (ETG). To compare and evaluate the results of a TG with those of an ETG, the authors analyzed 50 cases treated by a TG and 50 cases treated by an ETG during the last 12 years. The results were as follows: The post operative complication rates were 34% for a TG and 54% for an ETG, the average operation time was 3 hours 53 minutes for a TG and 3 hours 42 minutes for an ETG, the postoperative fasting period was 7.1 days for a TG and 6.5 days for an ETG, and the mean length of hospital stay was 21.4 days for a TG and 22.6 days for an ETG. the ETG had a higher complication rate than the TG, but there was no statistical difference between the operation times, the postoperative fasting periods, and the length of stay in the hospital. from our experience, it is suggested that the ETG is easier, or almost the same, to carry out than the TG procedure. Therefore, we recommend an ETG for proximal gastric cancer to achieve better curative results.

Quantitative Analysis of Bone Density on Roentgenography in Korean / 대한정형외과학회잡지

The bone is the dynamic living tissue which is always maintained bone mineral content by bone resorption and formation. It has been well known that the bone mineral content is decreased very slowly with aging. It is very difficult to diagnose the osteopenia because it is almost subclinical. Another important problem in the osteopenia is the fracture occurring spontaneously. The quantitative method of bone mineral mass provide an information to diagnose the osteopenia and predict the risk of spontaneous fracture. Various methods have been used to access the degree of bone atrophy but have not been routinely available for clinical application in the hospital. The microdensitometric method is a noninvasive, easy, accurate, and objective one to monitor the degree of changes in the skeletal mass quantitatively. So, we measured the 7 indices at the middle site of the 2nd metacarpal bone with a microdensitometer and computer on an X-ray film of the hands and studied the correlations between the age and indices of those under 30 and over 30 yrs old in healthy and fracture groups. The results were obtained as follows : 1. There was a significant high correlation between age and indices in healthy and fracture groups. 2. The measurement of age by microdensitometric method was highly correlated with the chronological age. 3. Comparing both groups, There was a significant correlation of D (P<0.001), MCI(P<0.01), and d (P<0.01) over 30 yrs in male and GSmin (P<0.001) and ΣGS/D (P<0.01) over 30 yrs in female. 4. In fracture group, 1) The index of bone width(D) was slightly larger than in the healthy group. 2) The metacarpal index(MCI) was lower than in the healthy group. 3) The index of medulla width(d) was wider than in the healthy group. 4) The density index of cortex(GSmax) was smaller than in the healthy group. 5) The density index of cortex and medulla(GSmin) was smaller than in the healthy group. 6) There was no considerable difference in ΣGS/D between healthy and fracture groups. 7) The densitometric pattern was more aggrevated than in the healthy group.