Role Of Raised C-Reactive Protein (CRP) As the Indicator for Surgical Intervention in Clinically Diagnosed Acute Appendicitis

Background: The diagnosis of acute appendicitis relies more on the clinical acumen of the surgeon than on the investigations. As the condition is associated with an acute-phase reaction the analysis of WBC, neutrophil percentage and serum level of CRP has been demonstrated to be important diagnostic tools. Surprisingly the level of CRP becomes proportionately raised with increasing severity of the histopathological variety of the appendix. Aim of the study: The aim of this study was to compare the preoperative CRP level with postoperative histological findings and find out a predictive value of CRP as an indicator for surgical intervention in acute appendicitis.Material & Methods:It was a prospective, cross-sectional, observational study executed in the Department of Surgery, Dhaka Medical College Hospital from January to December of 2015 where 107 patients were included in this study. Preoperative level of CRP and WBC count was done in all selected patients. Histopathological severity of the resected specimen of the appendix was determined postoperatively. The correlation between preoperative clinical factors and the actual histological severity and identification of surgical indication markers was assessed to determine whether only the CRP level significantly differs between the surgical treatment necessary group and the possible non-surgical treatment group.Results:54% (58) of the patients were female out of a total of 107. Peak incidence (25.2%) was in the 16-20 years age group. Neither age nor gender had any significance with the type of appendicitis. Among the patients 28.1% (30) had gangrenous appendicitis. In patients with histopathologically proven acute appendicitis, both the WBC count and serum CRP level were raised. But only the CRP level significantly differs between gangrenous appendicitis and uncomplicated appendicitis (p-value<0.0001). The specificity and sensitivity of serum CRP for gangrenous appendicitis were 97% and 71% respectively. The ROC curve indicated that the cutoff value of CRP for gangrenous appendicitis is 6.2 mg/dl. Conclusions:A normal pre-operative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal or uncomplicated inflammation of the appendix. The rate of unnecessary appendectomies would probably reduce in this patient group by deferring surgery. Only the CRP level is consistent with the severity of appendicitis and can be considered to be a surgical indication marker for acute appendicitis.

Hyalinizing Cholecystitis: A Rare Subtype of Chronic Cholecystitis

Hyalinising cholecystitis is rare form of chronic cholecystitis. It comprises about 1.6% of the cholecystectomy specimens. Hyalinising cholecystitis is said to be associated with risk of gallbladder cancer. We hereby present a case of a 54-year-old woman who came with chief complain of pain in right upper abdomen. She was diagnosed as a case of chronic cholecystitis on ultrasonography. For this the patient underwent cholecystectomy during which the gallbladder was removed. The final diagnosis of hyalinising cholecystitis was given on histopathology.

Cholesterol granuloma of the orbit: An atypical presentation.

Cholesterol granuloma is a rare, well-defined lesion of the orbit. In the orbit, diploe of the frontal bone is involved almost exclusively. We report an atypical case of cholesterol granuloma involving superomedial quadrant of orbit. A 42-year-old male presented with progressive, painless, proptosis with inferotemporal displacement of left eye. A large mass was felt beneath the bony orbital margin in the superomedial quadrant of the left orbit. Computerized tomography (CT) scan revealed an extraconal superomedial, heterogeneous enhancing mass which was isodense with brain and pushing the globe inferolaterally and anteriorly. Excision biopsy of the tumor revealed the typical features of a cholesterol granuloma without any epithelial elements. Cholesterol granuloma of the orbit is a rare entity, but it can be diagnosed and differentiated from other lesions of the superior orbit by its characteristic clinical, radiological and histopathological features. An appropriate intervention in time carries a good prognosis with almost no recurrence.

Apoptotic Effects of Curcumin (Diferuloyl Methane) on Squamous Cell Carcinoma of the Cervix.

Apoptotic effects of curcumin (diferuloyl methane) on squamous cell carcinoma of the cervix. The present study was conducted in departments of Pathology and Biochemistry, JNMC, AMU, over a period of one and half yrs. Caspase-3 and TNF-alpha assay was performed on monocytes isolated from cervical carcinoma patients and cultured with curcumin; cytosmears and sections from cervical carcinoma tissue cultured with curcumin were prepared for the morphological evidence of apoptosis. Curcumin in the doses of 500 microg/ml increased the caspase-3 levels and decreases the level of TNF-alpha in human cells. Cytosmears and sections from cervical carcinoma tissue cultured with curcumin showed better differentiation and increased number of apoptotic cells as compared to non curcumin controls. Curcumin in a dose of 500 microg/ ml promoted apoptotic preparedness of human cells and induced apoptotic change in cervical carcinoma cells.