Diagnostic Scores for Appendicitis: A Systematic Review of Scores’ Performance.

Aims: Several scoring systems have been developed for diagnosis of appendicitis. This study aims to systematically explore how those scores were derived and validated, and to compare their performance. Study Design: Systematic review. Place and Duration of Study: We searched Medline from 1949 and EMBASE from 1974 to March 2012 to identify relevant articles published in English. Methodology: Information about model development and performance was extracted. The “risk of bias” assessment tool was developed based on a critical appraisal guide for clinical prediction rules. Calibration (O/E ratio) and discrimination (C-statistic) coefficients were estimated. A meta-analysis was applied to pool calibration coefficients and Cstatistics. Results: Forty-four out of 468 studies were eligible. Of these, 14 developed or modified diagnostic scoring systems and 30 validated existing models. Four scores had been most frequently validated, i.e., Alvarado, modified Alvarado, Fenyo, and Eskelinen. Among them, only the Eskelinen model was derived based on a multivariate regression whereas the rest used univariate or non-statistical methodology. All studies reported very good but imprecise calibration. For discrimination, the pooled C-statistics for these corresponding scores were 0.77, 0.86, 0.81, and 0.84 respectively. In the external validation, the discriminative performance decreased about 25.3% and 10.1% for the Alvarado and Fenyo scores respectively. Conclusion: The research methods for scoring systems of appendicitis were inconsistent. More efficient scoring systems which have been internally and externally validated are required.

Colonic detoxification among patients attending general surgical clinics: an epidemiological study.

BACKGROUND: Colonic detoxification is a popular form of "alternative medicine". OBJECTIVE: To study the epidemiology of colonic detoxification in general surgical outpatients. MATERIAL AND METHOD: Questionnaires consisting of items measuring demographic variables, methods and resources of colonic detoxification, factors associated with the preference to undergo colonic detoxification, and results of colonic detoxification were administered to general surgical outpatients. Patients were classified as having colorectal and non-colorectal conditions. RESULTS: One thousand nine hundred and thirty nine questionnaires were distributed and returned Ninety-one patients (4.7%) had colonic detoxification. More female patients performed colonic detoxification than male patients (83.5% vs. 16.5%). The mean age of patients who performed colonic detoxification was 50.0 +/- 11.3 years (range 22-71 years). Coffee was the most commonly used substance for colonic detoxification (90.1%). The majority of patients performed the procedures by themselves (73.6%). The frequency of procedures was 1-5 times per month in 26.4% of patients. Seventy eight percent of patients felt better, while 17.6% felt the same and 4.4% felt worse after the procedure. The patients who performed colonic detoxification had more colorectal problems than those who did not; the risk ratio was 1.35 (95% CI, 0.82 to 2.22), but this was not statistically significant (p = 0.241). In subgroup analysis, cancer was the significant preferential factor in patients who performed colonic detoxification (risk ratio = 1.55 (95% CI, 1.13-2.14), and p-value = 0.011). The complication rate of colonic detoxification was 2.19% (rectal bleeding). CONCLUSION: The presented article was the first study of colonic detoxification in a Thai population. The result of the present study suggests that colorectal conditions are not related to the performance of colonic detoxification.

Prognostic significance of microvessel density in breast cancer of Thai women.

OBJECTIVE: Angiogenesis is important in the process of tumor growth and progression of breast cancer Microvessel density (MVD) is the most commonly used technique to quantify intratumoral angiogenesis in breast cancer. In the present study, the authors investigated the prognostic indicator of intratumoral MVD in predicting overall survival, disease recurrence, and distance metastasis of breast cancer. MATERIAL AND METHOD: Two hundred patients who were diagnosed as invasive breast cancer from January 2000 to December 2004 were included in the present study, but only 64 patients had complete pathological specimens and tumor receptor studies. Representative paraffin sections of the primary tumor including the tumor border were immunostained with a monoclonal anti-CD34 antibody. The area of highest vascular density ("hot spot") was identified and the average count of three hot spots in each tumor was used for analyses. The distribution of MVD was categorized into high and low MVD as more than 76 and less than 76 respectively. Overall survival probability was estimated by the Kaplan-Meier method. A multivariate Cox regression was employed to examine the relationship between MVD and disease outcomes while adjusting for other concomitant variables. RESULT: The tumor size and more advanced disease have correlated with poor outcomes of invasive breast cancer. Tumor size is a poor predictor for local recurrence [Harzard ratio 1.02 (95% CI 0.99-1.04)] and more disease staging have correlated with distance metastases [Harzard ratio 1.48 (95% CI 0.98-2.24)]. The cancer staging only predicted poor outcome in invasive breast cancer in overall recurrence [Harzard ratio 1.51 (95% CI 1.05-2.16)]. MVD is not correlated with both tumor recurrence and distance metastases [Hazard ratio for local recurrence 1.01 (95% CI 0.99-1.04) and Harzard ratio 1.00 (95% CI 0.97-1.02)]. CONCLUSION: The microvessel density (MVD) has not predicted poor outcomes of invasive breast cancer in Thai woman.

Endoscopic removal of one live biliary Fasciola gigantica.

Biliary fascioliasis was diagnosed in a woman from Angthong province, who presented herself with anorexia, weight loss, and jaundice for one month. Intraoperative retrograded cholangiopancreatography revealed a filling defect considered as a stone and bile sludge. By the sphincterotomy and balloon-extraction technique, one live fluke was removed and identified as Fasciola gigantica. A single dose of praziquantel, 25 mg/kg of body weight/day, was given although the postoperative stool examination revealed no Fasciola spp. egg. The patient was doing well after the fluke removal. According to a previous review, in this country, Ayutthaya is the southernmost province for the distribution of fascioliasis.