Predictive value of abnormally raised serum bilirubin in acute appendicitis: a cohort study.

UNLABELLED: Appendicitis is a common clinical diagnosis aided by biochemical, haematological and radiological investigations. The role of some investigations, such as bilirubin, is controversial but could indicate complicated appendicitis. Accurate diagnosis enables prioritisation of patients on operating lists and a possible reduction in unnecessary investigations. METHODS: This is a retrospective cohort study of 1347 patients who underwent appendicectomy. Statistical analysis of serum bilirubin levels was performed according to histological classification of appendicitis. RESULTS: Mean serum bilirubin levels; perforated/gangrenous appendicitis 20.5 mg/L (SD 12.6), inflamed appendicitis mean 17.5 mg/L (SD CI 11.1), normal appendix mean 12.6 mg/L (7.0). Kruskal-Wallis indicated bilirubin levels were significantly different (H=128.87, df=4, p<.001) between histological groups, and a post hoc analysis with Bonferroni adjustment showed perforated/gangrenous to be significantly higher than all other groups (p<.001). Binary logistic regression combining White Cell Count (WCC) level, C-Reactive Protein (CRP) and Bilirubin levels gave a sensitivity and specificity of .69 with AUROC=.766 (std error .015) for gangrenous/perforated. Assessment according to clinical relevance showed only 30.4% of patients with an abnormally raised bilirubin had gangrenous/perforated appendicitis. CONCLUSIONS: Serum bilirubin does not independently predict perforation/gangrenous appendicitis. Statistical analysis showed differences in mean bilirubin between histological groups however this did not relate to clinical significance as bilirubin levels were still within normal clinical limits. Diagnosis of complicated appendicitis should be made on clinical grounds, with utilization of biochemical/haematological investigations, but there should not be independent reliance on investigations such as bilirubin.

Delayed presentation of vernix caseosa peritonitis.

INTRODUCTION: Vernix caseosa peritonitis (VCP) is a rare and poorly recognised condition resulting from a sustained foreign body reaction to the vernix caseosa of the baby. This case-based review aims to highlight its importance for any medical team managing patients with peritonitis who have undergone a recent Caesarean section. CASE REPORT: A 31-year-old woman presented 5 weeks after a Caesarean section with symptoms and signs of peritonitis. CONCLUSIONS: Laparotomy and peritoneal lavage is the mainstay of treatment for VCP. Knowledge of the condition may stop inadvertent resection of normal intra-abdominal organs. Greater awareness of VCP is required to ensure earlier recognition as patients can recover well following timely operative intervention.

3D prostate elastography: algorithm, simulations and experiments.

A multi-resolution hybrid strain estimator is presented. The estimator is locally initialized by the B-mode tracking stage. Nonlinear and linear stretching regimes are applied in successive RF tracking stages for refining the estimated axial and lateral displacements. A staggering operator is used to derive the strain images from the reconstructed axial displacements. Simulations and experiments, conducted at a center frequency of 12 MHz, 40% fractional bandwidth, on a 128 element transducer with 0.2 mm pitch, with elastographic window length of 2 mm and overlap of 90%, demonstrate a 3-6 dB improvement in the elastographic contrast-to-noise ratio over the results obtained using conventional multi-stage stretching based strain estimators. The average image cross-correlation coefficient obtained using the proposed algorithm was improved by 6-8%. 3D elastographic simulations conducted to study the performance of a 3D elastographic imaging framework predict achievable axial and lateral resolutions of approximately five and ten wavelengths, respectively. A close correspondence between inclusions reconstructed from experimental elastograms and the known physical shape of actual 3D inclusions demonstrates the potential application of 3D elastography for identifying and classifying the detected lesions (invisible in sonograms) on the basis of their shape.

Brucellar epididymoorchitis - report of five cases.

We report here 5 bacteriologically proven cases of Brucellar epididymoorchitis. Four cases presented with unilateral epididymoorchitis and with bilateral presentation in one case. Blood culture grew Brucella melitensis in all 5 cases. B.melitensis was isolated in testicular aspirate of 4 patients. Brucella agglutinins were demonstrated in testicular aspirate of 4 patients and semen of 2 patients. To our knowledge this is the first report of bacteriologically proven cases of brucellar epididymoorchitis in the world literature.

Retrospective prediction of birth weight by growth velocity curves during neonatal period.

In this prospective study, birth weight of 304 babies born at Kamla Nehru Hospital Pune during study period was recorded. From these 304 babies, babies with birth weight above 2000 grams were selected (260 babies) to prepare growth velocity curves. Daily weight of these 260 babies was recorded for 30 days. The mean birth weight of study population was 2742.5 grams. Among the daily weight recorded babies, all the babies lost weight ranging from 92 to 218 grams (mean 121 grams) after birth. The weight loss continued upto 5 days. Days required to gain weight equal to birth weight ranged from 5 to 13 days. Total weight gain observed in 30 days was 734.7 grams. Predictive value of these curves was tested in 49 infants. Deviation upto 50 grams of predicted birth weight from actual birth weight was observed in 90% of babies on day-2, 79% on day-4, 65% on day-8 and 39% on day-30.

Preventing distortion of quick couplers of hoses of central pipe lines--a cheap and simple method.

A cheap and practical approach of steel chains attached to the station outlet quick couplers helps in maintaining the shape of the quick couplers and ensures their effective functioning over a long period of time and avoids mishap of connection due to damage of these couplers.