Nonoperative treatment of acute appendicitis in children.

BACKGROUND/PURPOSE: Appendicitis is considered by many surgeons to be a surgical emergency for which necessary to avoid perforation of the appendix. Although it has also been treated nonoperatively using antibiotic therapy, experience in such treatment in children with acute appendicitis (AA) is extremely limited. In addition, previous studies on nonoperative treatment (NT) showed it to be a cause of morbidity and mortality. The authors hold that not all appendicitis cases respond to NT because only some of the cases recover. In the present study, 16 of 95 cases with AA were selected for NT according to physical and ultrasound examinations. The clinical and ultrasonographic findings of the cases are presented. METHODS: The medical records of all children with appendicitis treated between August 2003 and March 2006 were retrospectively reviewed. Patients who had history of abdominal pain for less than 24 hours with localized abdominal tenderness and hemodynamic stability underwent NT. Children were treated with parenteral antibiotics (ampicillin with sulbactam, 100 mg x kg(-1) x 24 h(-1), divided into 3 doses daily, and ornidasole, 20 mg x kg(-1) x 24 h(-1), divided into 2 doses daily), intravenous fluid, and nothing by mouth for at least 48 hours. RESULTS: A total of 136 patients with appendicitis were treated. Of the cases, 95 (70%) were AA, and 41 (30%) had perforated appendicitis. Sixteen (16.8%) cases of AA were selected for NT (12 boys and 4 girls; age range, 5-13 years; mean age, 9 years). The mean anteroposterior diameter of the appendix at the presentation was 7.11 +/- 1.01 mm (range, 6-9.5 mm). Ultrasound examination was repeated after 48 hours of treatment. The mean diameter of the appendix was 4.64 +/- 0.82 mm (range, 3.6-6.8 mm). The difference was statistically significant (t = 9.63, P < .0001). Nonoperative treatment was successful in 15 (93.7%) of the 16 patients. CONCLUSION: Hyperplasia of the appendiceal lymphoid follicle frequently causes luminal obstruction. Antibiotic therapy probably causes regression of lymphoid hyperplasia because of suppression of bacterial infection and prevents ischemia and bacterial invasion in the early stage of appendicitis. We found that some of the patients who had a history of abdominal pain for less than 24 hours with localized abdominal tenderness and hemodynamic stability could be treated nonoperatively.

Doppler waveform of the hepatic veins in an obese population.

The objective is to investigate the effect of obesity and hepatosteatosis on the Doppler waveform pattern of the hepatic veins. B-mode and duplex Doppler sonography of the liver and the right hepatic vein was performed in 102 obese subjects and 84 healthy volunteers. The severity of fatty infiltration was graded as mild, moderate and severe. The flow pattern of the right hepatic vein was classified as triphasic, biphasic and monophasic. The Doppler flow pattern in the right hepatic vein was triphasic in 56 (55%), biphasic in 27 (26%) and monophasic in 19 (19%) obese patients, whereas it was triphasic in 83 (99%) and biphasic in 1 (1%) control subject, achieving a statistical significance (Mann-Whitney U-test, P<0.001). There was an inverse correlation between the sonographic grade of the hepatosteatosis and the phasicity of hepatic venous flow (r=-0.67, P<0.001). The hepatic vein pulsatility is significantly dampened in obese patients correlating with the grade of hepatosteatosis. The body habitus itself does not have an independent effect on hepatic venous waveform. The alteration in hepatic vein Doppler flow pattern in an obese population may suggest reduced vascular compliance in the liver because of fatty infiltration.

[Comparison of low dose and standard dose CT in the evaluation of inflammatory diseases of paranasal sinuses]. / Inflamatuar paranazal sinüs hastaliklarinda düsük doz ve standart doz BT'nin karsilastirilmasi.

PURPOSE: The aim of this study was to investigate the diagnostic value of low dose CT (LDCT) by comparing the identification of sinonasal anatomical structures, anatomic variations and detectability of inflammatory changes at low and standard dose CT (SDCT). MATERIALS AND METHODS: A total of 30 patients who were referred to CT scan for the assessment of paranasal sinuses underwent CT examinations at both standard [110 mA, 120 kV, 5 mm collimation (3 mm collimation at the level of the ostiomeatal unit)] and low dose [22 mA, 120 kV, 5 mm collimation (3 mm collimation at the level of the ostiomeatal unit)]. All images were photographed at identical window settings (window width, 4000 HU; window level, 50 HU) on laser film. Ten sinonasal anatomical structures (five on the right and five on the left) and inflammatory mucosal changes were recorded for each patient. The detectability and conspicuity levels were scored for each finding. RESULTS: A total of 297 sinonasal anatomical structures were identified at SDCT, whereas 296 structures were detected at LDCT. Inflammatory mucosal changes and anatomical variations were equally identified at both SDCT and LDCT (p > 0.05). There was no statistically significant difference between SDCT and LDCT in the detection on of anatomical structures, variations and inflammatory changes (p > 0.05). CONCLUSION: The low dose CT protocol used in this study provided images of adequate quality, and proved to be reliable in the evaluation of normal and diseased paranasal sinuses.

Sonographic assessment of changes in thickness of different abdominal fat layers in response to diet in obese women.

PURPOSE: We evaluated the potential application of sonography to monitor alterations in abdominal fat thickness in obese women before and after dieting. METHODS: This study included 40 obese women (mean age, 42.2 +/- 9.4 years; mean body mass index [BMI], 36.0 +/- 5.9 kg/m2) who underwent a 3-month low-calorie diet. Height, weight, waist circumference (WC), and hip circumference (HC) were measured. BMI and waist-to-hip ratio (WHR) were calculated. Abdominal subcutaneous (S) and intra-abdominal preperitoneal (P) fat were measured at their maximum (max) and minimum (min) thickness sites using a 7.5-MHz linear-array probe. Intra-abdominal visceral (V) fat was measured using a 3.5-MHz convex-array probe. Measurements were taken before and after caloric restriction. RESULTS: The mean weight was reduced from 88.6 +/- 17.1 kg to 83.0 +/- 15.9 kg (p < 0.0001). The mean changes in S(min) (r = 0.376, p = 0.017), S(max) (r = 0.508, (p = 0.001), P(min) (r = 0.439, p = 0.005), and V (r = 0.365, p = 0.022) fat thicknesses were positively correlated with change in weight; the change in P(max) fat thickness showed the best and most significant correlation (r = 0.591, p < 0.0001). BMI (r = 0.969, p < 0.0001), WC (r = 0.510, p = 0.001), and HC (r = 0.422, p = 0.007) changes were also positively correlated with weight change, but the WHR change (r = 0.019, p > 0.05) was not. CONCLUSIONS: All the abdominal fat layers, particularly the intra-abdominal P fat, will decrease in response to loss of body fat by dieting. Sonography seems to be useful in monitoring small variations in the thicknesses of abdominal S and intra-abdominal P and V fat.