Experimental Study of 99mTc-Ciprofloxacin (Infecton) Imaging for the Diagnosis of the Acute Appendicitis

PURPOSE: Acute appendicitis is the most common disease requiring abdominal surgery, but for atypical clinical findings, a preoperative diagnosis is difficult and the frequency of a false positive and false negative diagnosis is high. The authors compared the diagnostic accuracy of a Technetium-99m-ciprofloxacin scan with that of the other diagnostic tools and evaluated its potential for clinical applications. METHODS: Seventeen patients were among those patients who visited the emergency room due to right lower quadrant (RLQ) pain were selected for this study. The decision for primary treatment was based on the clinical findings (RLQ pain, nausea, tenderness, rebound tenderness, leukocytosis, etc) and the radiological findings (abdominal ultrasonogram, abdominal computed tomography, etc). The 99mTc-ciprofloxacin scan was conducted regardless of the decision above. For the patients who underwent surgery, the final diagnosis of acute appendicitis was based on the pathologic result and for patients who did not undergo surgery, the final diagnosis was determined by the clinical course. RESULTS: Seventeen patients were enrolled in this study (7 males, 10 females). The patient's age ranged from 8 to 71 years and the average age was 29.2 years. The diagnostic accuracy of acute appendicitis is presented in order of the clinical findings, the radiological findings and the 99mTc- ciprofloxacin scan as follows: The sensitivity was 100%, 90.9% and 100%; the specificity rates was 33.3%, 50% and 67%; the positive predictive value was 87.5%, 90.9% and 93%; the negative predictive values was 100%, 50% and 100%; the false positive rate was 66.7%, 50% and 33.3%; the false negative rate was 0%, 9% and 0%. The respective p-values for the correlation between these results and the final diagnosis were 0.021, 0.049 and 0.002. CONCLUSION: A 99mTc-ciprofloxacin scan can decrease the false positive and the false negative rate and increase the diagnostic accuracy of acute appendicitis patients.

Correlation of the Serum Nitrate/Nitrite Level with the Severity of Biliary Tract Inflammation

PURPOSE: The relationship between the biophysical and biochemical processes of gallbladder bile and nitric oxide is still not well known. In this study, the correlation between nitric oxide production and the degree of biliary tract inflammation was investigated and the levels of nitrate/nitrite (NOx) and stable metabolite of nitric oxide in the serum proposed for assessing the severity of biliary tract inflammation. METHODS: Eighty two patients with biliary tract inflammation who underwent operative treatment between March and July 2002 were included in this study. Of the 82 patients, there were 31 and 51 men and women, respectively. The mean age was 53, ranging from 21 to 82 years. The subjects were divided into three groups, GB stone (n=42), and acute cholecystitis (n=27), and cholangitis (n= 13). The severity of biliary tract inflammation was assessed using the WBC count, total bilirubin count, GB wall thickness on pathology, bile duct stone detected on ultrasonography, open conversion of cholecystectomy, pyrexia and tenderness/rebound tenderness on physical examination. The serum NOx concentrations were analyzed according to the groups, clinicopathological, laboratory and radiological findings. The serum NOx levels were measured using the Griess reaction after conversion of all nitrates to nitrites. RESULTS: The nitrate/nitrite levels in the GB, acute cholecystitis and cholangitis groups were 70.0+/-44.6, 126.8+/-54.5 and 142.0+/-44.6mumol/L, respectively, with statistical differences between the three groups (P< 0.05). The NOx level in patients with pyrexia, hyperbilirubinemia, leukocytosis, GB wall thickness on pathology and open conversion were markedly increased compared with the control group (P<0.05). These data demonstrate the relationship between the intensity of nitric oxide and the severity of biliary tract inflammation. CONCLUSION: Measurement of the NOx concentration in patients with biliary tract inflammation provides information about the severity and course of the disease. These results suggest there is a correlation between nitric oxide and the degree of biliary tract inflammation.

Clinical Analysis of Hilar Cholangiocarcinoma: Focused on the Prognosis of Patients with Positive Resection Margin / 한국간담췌외과학회지

BACKGROUND/AIMS: Hilar cholangiocarcinoma is a tumor with poor prognosis although curative surgical resection is known to be the most effective treatment. To obtain negative resection margin is still a challenging problem for surgeons. We designed this study to investigate further the treatment strategies of the hilar cholangiocarcinoma by comparing the prognosis of patients managed by different modalities with special emphasis on the polarity of the resection margin. METHODS: A retrospective clinical study was performed at the Inha University Hospital for 70 patients managed for hilar cholangiocarcinoma from June 1996 to May 2002. RESULTS: The patients consisted of 45 men and 25 women. The average age of the patients was 66.4 years old. The survival rate for 1 year and 3 years and the median survival period were investigated. For the negative resection margin sub-group, those were 100%, 28.6% and 23 months respectively, while those for the positive resection margin sub-group were 70.6%, 10.8% and 19 months respectively. For the palliative bypass surgery sub-group, those were 0%, 0%, and 5 months, for the biliary stent sub-group, those were 5.3%, 0% and 5 months and for the intraductal radiotherapy sub-group, those were 20%, 0% and 7 months respectively. When the patients were divided between the resection and the non- resection groups, those figures were 79.2%, 12.1% and 20 months for the resection group while for the non-resection group, those were 11.9%, 0% and 6 months respectively. Statistical analysis showed that the survival rates for the resection and the non-resection groups were different (p=0.0001). However, the survival difference for the negative and the positive resection margin sub-groups were insignificant (p= 0.2401). For the three sub-groups of the non-resection group, the survival difference for each sub-groups were also insignificant (p=0.2979). Postoperative complication was observed in 12 patients (38.7%). Three patients died and the postoperative mortality rate was 9.7%. CONCLUSION: To improve the survival of the hilar cholangiocarcinoma patients, it is believed that the best treatment is the aggressive resection of the tumor even if it is difficult to obtain negative resection margin. Considering the high morbidity and mortality rate of extensive surgery and comparable survival of the positive resection margin patients, further extension of the extent of resection to obtain negative resection margin should be performed in selected patients.

A Clinical Analysis of Surgery in the Elderly Patients with Acute Abdomen

PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.

A Clinical Analysis of Surgery in the Elderly Patients with Acute Abdomen

PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.