ABSTRACT
UNLABELLED: The rate of unnecessary appendectomy is frequently criticized. Today, sonography and CT-scan are helpful tools to minimize this rate. Which value has the ultrasonography in the decision making today? METHODS: Retrospective analysis of 132 patients undergoing appendectomy in respect of sonography and rate of histologically confirmed appendicitis from 1.1.95-31.12.98. Prospective analysis of 99 patients admitted for acute appendicitis in respect of pre- and posttest-probability (after sonography) by the responsible surgeon from 1.1.99-31.12.00. RESULTS: Retrospective part: 122/132 patients had an acute appendicitis (92%). Sonography was performed in 64% of the patients. There was only one wrongly positive sonography. Prospective part: 76/99 patients were operated on. 70/76 had an acute appendicitis (92%). Sonography was performed in 87%. Six patients presented a histologically normal appendix: In two of them no increase of the probability after sonography was noted, in three of them an slight increase of only 20%, and in one of them a decrease of 20% even. CONCLUSION: Sonography with a pre- and posttest-probability is recommended in clinically doubtful cases. In our experience the physician performing the sonography is almost always right. But the diagnosis of an acute appendicitis remains a combination of clinical and sonographic evaluation.
Subject(s)
Appendectomy/statistics & numerical data , Appendicitis/diagnostic imaging , Patient Admission/statistics & numerical data , Unnecessary Procedures/statistics & numerical data , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Appendicitis/epidemiology , Appendicitis/surgery , Child , Child, Preschool , Diagnostic Errors/statistics & numerical data , Female , Humans , Male , Middle Aged , Prospective Studies , Quality Assurance, Health Care/statistics & numerical data , Retrospective Studies , Sensitivity and Specificity , Switzerland , UltrasonographyABSTRACT
UNLABELLED: Twenty infants with chronic renal failure from the first weeks of life, received strict conservative treatment consisting of a protein-restricted, calorie-enriched diet, supplements of essential amino acids, sodium chloride, sodium bicarbonate, calcium and vitamin D. The last 10 patients also received erythropoietin. Neither nasogastric nor gastrostomy tubes were used in any of these patients. Four patients needed dialysis in the second half of the 1st year of life. We analysed the patients' growth in weight, height and head circumference from birth until the age of 12 months. At the age of 12 months, mean values of height, weight and head circumference SDS were -1.63, -1.53 and -1.01 respectively as compared to healthy children. The body length data also compare favourably with those from a large cohort of chronic renal failure patients collected by the European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood; here the mean height SDS at 12 months of age is -3.3. CONCLUSION: This retrospective analysis shows that the generally observed progressive growth retardation in infants with chronic renal failure can be prevented by early and adequate conservative management.
