[Evaluation of neutrophil-lymphocyte ratio usefulness in the diagnosis of appendicitis]. / Wartosc wskaznika neutrofilowo-limfocytarnego w diagnostyce zapalenia wyrostka robaczkowego.

UNLABELLED: The aim of the study was the evaluation ofneutrophil-lymphocyte ratio usefulness in the diagnosis of appendicitis. MATERIAL AND METHODS: The study concerned 469 patients: 280 (59.7%) women and 189 (40.3%) men (mean age 34 + 18 years), who underwent operation due to suspicion of appendicitis, in the years 1997-2003. Retrospective analysis ofintraoperative diagnoses, pathological reports and laboratory tests was performed. Optimal values ofneutrophil-lymphocyte (N/L) ratio and leukocytosis, according to sensitivity and specificity in appendicitis diagnosis, were chosen and then compared among patients with different stages of appendicitis. The results were evaluated according to their statistical significance. RESULTS: Optimal values of N/L ratio and leukocytosis, according to sensitivity and specificity, were > or = 3.5 for N/L and > or = 12000/mm3 for leukocytosis. N/L ratio > or = 3.5 occurred to have much higher sensitivity (77.5% vs. 55%) but lower specificity (73.3% vs. 81.6%) than leukocytosis. Both leukocytosis and N/L had satisfactory values of prediction and likelihood ratio for positive ad negative results. CONCLUSIONS: (1) N/L ratio has higher sensitivity than leukocytosis, especially in appendicitis phlegmonosa and gangrenosa. (2) Both leukocytosis and N/L ratio have quite high specificity. In cases other than appendicitis that have similar clinical symptoms and are ultimately diagnosed intraoperatively, the N/L ratio and leukocyte count are rarely elevated above 3.5 and 12000/mm3 respectively. (3) Due to easiness of calculation and still high rate of false positive and negative diagnoses, N/L ratio is worth using in establishing the diagnosis of appendicitis.

[Percutaneous ethanol injections in the treatment of secondary hyperparathyroidism]. / Przezskórne wstrzykniecia etanolu w leczeniu nadczynnosci wtórnej przytarczyc.

INTRODUCTION: Renal insufficiency is the most common etiology of secondary hyperparathyroidism. In case of resistance for conservative treatment, methods of choice are surgical intervention or percutaneous ethanol injections. AIM OF THE STUDY: The aim of the study was to evaluate usefulness of percutaneous ethanol injection therapy in the treatment of patients with secondary hyperparathyroidism. MATERIAL AND METHODS: We performed percutaneous 96% ethanol injections under USG guideance in 51 patients: 22 women (mean age 49.6 years) and 29 men (46.6 yrs). The base level of parathormone was 689.35 pg/ml. We managed to visualize one parathyroid gland in 34 patients, 2 in 12, 3 in 5 patients. The mean volume of a single gland was 0,8 cm3. All the injections were performed with the use of needle number 6. We repeated injections in case of no effects. One injection was performed in 18 patients, 2 in 18, 3 in 13, 5 in 1 and 6 in 1 patient. Before and after the treatment patients were examined with USG, scintigraphy and densitometry. Serum levels of calcium (Ca), phosphorus (P), parathormone (PTH) and alkaline phosphatase (FA) activity were also obtained. The main criteria for success was decrease in parathormone level of 50% or more in comparison with pre-injection level or to less than 200 pg/ml. RESULTS: In the whole group of patients after the first month, positive results were observed in 67%. There were no changes in 23%, and PTH level increased in 10%. After 6 months-positive results in 53%, no change in 35% and increase in 12%. We noted the best results in patients with PTH less than 800 pg/ml-72% of them had positive results after 1 as far as after the 6 month. CONCLUSIONS: Percutaneous ethanol injections are valuable method of treatment of secondary hyperparathyroidism. The best results can be obtained if PTH level is less than 800 pg/ml, one parathyroid gland dominating over the rest is visualised in USG, and if patient responds after 1 or at least 2 injections.