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Appendectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Diagnosis of acute appendicitis still relies on a typical history and clinical findings. In many instances, no further tests are required. Laboratory studies provide limited help in arriving at a definitive diagnosis. Most children will have an elevated left-shifted leukocyte count. Elevated C-reactive protein (CRP) values are helpful for the diagnosis but do not occur in the early phases of the disease. When the diagnosis is questionable, abdominal ultrasonography (US) is useful, not only to visualize an inflamed appendix, but also to exclude other abdominal and pelvic conditions, especially in teenage girls.
Medical Evaluation of Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Michael Camilleri, Jeffrey W. Frank
The role for abdominal ultrasonography is chiefly the exclusion of biliary-tract or pancreatic disease in patients presenting with upper abdominal pain or dyspepsia. In our experience, ultrasonographic detection of pathology in the bil-iopancreatic region is rare in the absence of other clinical features such as the indicative location, typical nature, and radiation of pain, as well as Murphy’s sign. In the absence of these common features or “alarm” symptoms or signs, computed tomography of the abdomen or pelvis is unnecessary when the clinical features suggest a functional gastrointestinal disorder.
Unexplained Fever In Hematologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
The “fever work-up” includes a complete physical examination and the following laboratory investigation: complete hematologic analysis, aerobic and anaerobic blood cultures (three consecutive samples are usually taken over a few-hour period), urine cultures and urinalysis, cultures of stools and chest roentgenogram.20,92 If the patient is not granulocytopenic (polymorphonuclears >500 per mm3) and no cause of the fever is found, a broad spectrum antibiotic such as amoxycillin is prescribed. If, on the other hand, granulocytopenia is present, further investigation takes place while the patient is hospitalized. Urine, sputum, and stools are examined for the presence of additional pathogens. Blood cultures and serologic investigation for antibodies to viruses (herpes simplex, herpes zoster, adenovirus, cytomegalovirus, respiratory syncytial, influenza, parainfluenza) psittacosis, mycoplasma, and HBsAg are carried out. Evidence of Candida and Aspergillus infection is also looked for. Abdominal ultrasonography, CT scan, and other radiological and laboratory investigations are undertaken according to the physician’s suspicion.
Adiponectin–leptin ratio for the early detection of lean non-alcoholic fatty liver disease independent of insulin resistance
Published in Annals of Medicine, 2023
Chia-Wen Lu, Kuen-Cheh Yang, Yu-Chiao Chi, Tsan-Yu Wu, Chien-Hsieh Chiang, Hao-Hsiang Chang, Kuo-Chin Huang, Wei-Shiung Yang
This study was conducted cross-sectionally in a community in Northern Taiwan. All the participants enrolled when they received a regular health check-up in National Taiwan University Hospital, Hsin-Chu branch. All the subjects completed standardized questionnaires through individual interview regarding socio-demographics, smoking, drinking, exercise and medical history. Subjects who had a history of diabetes, were taking antihyperglycemic agents or insulin or fasting serum glucose ≥126 mg/dl or haemoglobin A1c ≥6.5% were excluded. In total, 575 adults older than 20 years were enrolled. Weight, height and Blood pressure (BP) were measured by calibrated, electronic stadiometers and sphygmomanometers. WC was measured horizontally through the middle point between the upper border of iliac bones and the lower border of the ribs. Body fat percentage was measured through bioelectrical impedance analysis by a portable body composition analyser (TANITA BC-418, Japan). Abdominal ultrasonography was performed by three experienced physicians using a 3.5–5 MHz transducer and a high-resolution B-mode scanner (Hitachi Aloka ProSound Alpha 6, Japan). The severity of NAFLD was calculated using the US-FLI score [9]. The details about the including and excluding criteria, questionnaires, the scoring of fatty liver by abdominal ultrasonography and blood analyses please refer to our published study [33]. Informed consent forms were signed. This study was approved by the Institutional Review Board of National Taiwan University Hospital (IRB NO. 201210012RIC).
MicroRNA 21 and microRNA 155 levels in resistant hypertension, and their relationships with aldosterone
Published in Renal Failure, 2021
Sonat Pınar Kara, Gulsum Ozkan, Ahsen Yılmaz, Nergiz Bayrakçı, Savaş Güzel, Elif Geyik
Patients failing to meet target BP values despite using at least three antihypertensives, one a diuretic, at the maximum doses and in appropriate combinations, were regarded as RH [1]. Detailed histories were taken from all patients, including dietary habits (salt, alcohol, and licorice root consumption), drugs or substances used (narcotics, NSAIDS, oral contraceptives, etc.), sleep habits, and sleeping patterns. All resistant HT patients underwent pulmonary medicine examination in order to rule out Obstructive sleep apnea syndrome (OSAS). Exclusion was based on the OSAS Berlin questionnaire. Conditions causing pseudo-resistance were excluded. White coat HT was excluded in cases with a mean day-long 24-h ABPM value ≥130/80 mmHg following office measurements, and these were regarded as true RH. Creatinine, 24-h urinary albumin and Na excretion, fasting blood sugar, Na, potassium (K), calcium (Ca), complete blood count, and thyroid-stimulating hormone (TSH) tests were performed as recommended by the guidelines in order to screen for diseases capable of causing secondary HT [1]. Abdominal ultrasonography was performed on all patients. Patients with pseudo-resistant HT and secondary HT determined by screening tests were excluded from the study.
Kikuchi–Fujimoto disease triggered by Salmonella enteritidis in a child with concurrent auto-immune thyroiditis and papilloedema
Published in Paediatrics and International Child Health, 2018
Esma Altinel Açoğlu, Eyup Sari, Gürses Şahin, Melahat Melek Oğuz, Meltem Akçaboy, Pelin Zorlu, Saliha Senel
Investigations. Haemoglobin was 12.3 g/dL, total leucocyte count 2.8 × 109/L (40% neutrophils and 60% lymphocytes), platelets 216 × 109/L, erythrocyte sedimentation rate (ESR) was 20 mm/h, C-reactive protein (CRP) 42 mg/L (0–6) and lactic dehydrogenase 671 IU/L (≤240). Routine biochemistry, prothrombin time, activated partial thromboplastin time (aPTT), international normalised ratio (INR), serum immunoglobulins (IgG, IgM and IgA), urine analysis and bone marrow examination were normal. Abdominal ultrasonography was normal. Chest radiograph demonstrated an area of soft tissue density approximately 24 × 14 mm at the superior aspect of the left hilum. CT of the chest showed multiple lymph nodes, the largest of which measured 18 × 9 mm in the left mediastinal region and 12 × 9 mm in the left hilar region.