Comparison of Tzanakis score vs Alvarado score in the effective diagnosis of acute appendicitis.

BACKGROUND: Acute appendicitis is the most frequent surgical emergency encountered worldwide. This study was conducted to compare the efficacy of Tzanakis score and Alvarado score in diagnosing acute appendicitis. OBJECTIVES: The aim of this study is to compare the efficacy of Tzanakis scoring system with Alvarado scoring system in diagnosing AA. METHODS: This was a retrospective and nonrandomized observational study conducted in Dhulikhel hospital. It included 200 clinically diagnosed cases of acute appendicitis who underwent emergency open or laparoscopic appendectomy during the year 2012. Final diagnosis of acute appendicitis was based on histological findings given by pathologist. RESULTS: The sensitivity, specificity, positive predictive value and negative predictive value of Tzanakis score was 86.9%, 75.0, 97.5% and 33.3% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score was 76.0%, 75.0%, 97.2% and 21.4% respectively. Negative appendectomy was 8.0%. CONCLUSION: Tzanakis scoring system is an effective scoring system in diagnosing acute appendicitis.

Analysis of serum lipid profile in cholelithiasis patients.

BACKGROUND: Gallstone diseases being common disorder, multiple studies have shown an association between gallstones and abnormal lipids. This study is to compare the serum lipid abnormalities in females who have cholelithiasis with controls. METHODS: A retrospective study of females who underwent cholecystectomy for gallstone disease was carried out. A total of 133 patients were divided into two age groups ≤ 40 and >40 years. In age group ≤ 40 years, there were 72 cases with no controls, whereas, in >40 years, 61 cases were compared with 67 controls. The serum lipid profile were collected and compared according to the age groups. The groups were compared by using Student's t-test, p<0.05 was considered statistically significant. RESULTS: In age group >40 years serum LDL of gallstone patients were statistically significantly raised (P<0.05) (95% CI -22.077; -850) compared with controls and serum total cholesterol and triglycerides were not statistically significantly high (P >0.05). Serum HDL and VLDL were lower in gallstone patients but not statistically significant (P >0.05) compared to control group. CONCLUSIONS: The study showed that serum LDL level was statistically significant in females >40 years of age, whereas other parameters were not statistically significantly different.

Laparoscopic versus open appendectomy in acute appendicitis.

BACKGROUND: Although laparoscopic appendectomy is widely practiced nowadays, controversy still continues about the advantages of laparoscopic versus open appendectomy. To compare LA with OA to determine the length of hospital stay, post operative morbidity and length of operation. METHODS: A retrospective study carried out, between February 2009 and January 2012, involving 226 patients (111 males and 115 females) with a diagnosis of suspected acute appendicitis. LA group consisted of 54 patients and OA group of 172 patients. The groups were compared by using Chi-square test for categorical variables and student t-test for continuous variables. RESULTS: The mean length of hospital stay in LA was 2.69 days and in OA 4.03 days (p<0.001). The mean operative time in LA was 61.52 minutes and in OA 39.61 minutes (p<0.001). Post operative wound infection was seen in one patient (1.8%) in LA group and 17 patients (9.8%) in OA group. Conversion to open surgery was not necessary. CONCLUSIONS: Laparoscopic appendectomy is as safe and effective as open procedure with major benefits like less post operative pain, decreased wound infection, less hospital stay and early return to normal activities.