Evaluation of the diagnostic value of platelet indices in pediatric acute appendicitis

Objective: Abdominal examination findings in pediatric acute appendicitis (AA) significantly vary by age. Therefore, grading systems have been developed for diagnosing pediatric appendicitis, and laboratory and radiological findings have an important role in this diagnosis. However, there is a need to develop new parameters for diagnosing AA. This study aimed to investigate the diagnostic value of platelet indices in AA. Methods: This retrospective, observational study included 207 pediatric patients who were admitted to the Emergency Department and operated on for AA. The patients were divided into three groups on the basis of their surgical and histopathological findings (non-AA, uncomplicated AA, and complicated AA). Results: There was no significant difference in the mean platelet volume/platelet count (MPV/PC) ratio among the groups. The white blood cell (WBC) count and the MPV/PC ratio showed a significant negative relationship (r = −0.239). The specificity for MPV was 61.8% and the sensitivity was 68.8%. Receiver operating curve analysis of WBC and MPV showed significance for diagnosing AA. Conclusion: There is a negative, but weak, relationship between the WBC count and the MPV/PC ratio. However, the MPV/PC ratio could be a useful parameter for diagnosing pediatric AA according to receiver operating curve analysis. © The Author(s) 2020

Factors affecting survival of life and health related quality of life in patients with small bowel atresia and stenosis.

TEZ8931Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2013.Kaynakça (s. 43-47) var.viii, 48 s. : res. ; 29 cm.Purpose: In this study we aimed to investigate the causes of morbidity and mortality and the factors that influence survival in life and growth in patients followed up with small bowel atresia/stenosis. Patients and method: 85 patients included to this study that admitted to our clinic with small bowel atresia/stenosis or followed up with duodenal, proximal jejunoileal, distal jejunoileal atresia/stenosis between 2002-2012. Data on patients gender, prenatal diagnosis, time of diagnosis, time of birth, birth weight, maternal age, level of parental consanguinity, clinical features, associated anomalies, peroperative findings, postoperative hospitalisation, duration of total parenteral nutrition, period to enteral feeding, time of full dose oral feeding recorded and factors affecting morbidity and mortality and growth parameters analysed. Results: 85 patients were included in this study, 44 female and 41 were male. 35 of these patients were duodenal, 29 proximal jejunoileal, 21 distal jejunoileal atresia/stenosis. 58% of the patients was premature and the rate of prematurity was more at patients with duodenal atresia/stenosis. Kinship between parents was high in patients with distal jejunoileal atresia/stenosis. 64% of the patients was diagnosed by prenatal ultrasonographic study. Additional congenital anomaly have seen at 74% of patients with duodenal atresia/stenosis and 42% of jejunoileal atresia/stenosis. Most common additional anomaly of patients with duodenal atresia/stenosis was congenital hearth disease and Down Syndrome respectively. Duodenoduodenostomy was most common used method of operation for duodenal atresia and resection and primary anastomosis for jejunoileal atresias. Mortality rate was 18%. Overall complication rate was 20% in all groups and most common complication was sepsis. Most common cause of death was sepsis and in these patients rate of prematurity, low birth weight and additional congenital anomaly was higher. Patients were examined in terms of growth and developement, in duodenal atresia/stenosis group body weight and persantiles were normal, in jejunoileal atresia group persantiles of length was lower. Conclusion: In patients with small bowel atresia/stenosis rate of mortality was similar according to rates in the literature. Prematurity, low birth weight and additional congenital anomalies was higher in patients who died, so surgical complications did not intended as a primer. Appearance of very low rates of late-term complications could be related to the patient's irregular long term follow up. In patients with jejunoileal atresia/stenosis, persantiles of length were lower and we recommend close follow-up of patients for diet and growth in postoperative period.Amaç: İnce barsak atrezi/stenozu nedeniyle takip edilen hastaların morbidite ve mortalite nedenlerini ve yaŞamda kalımı etkileyen faktörleri araştırmak, büyüme geliŞmelerini incelemektir. Hastalar ve Yöntem: İnce barsak atrezisi/stenozu nedeniyle 2002-2012 yılları arasında kliniğimize başvuran duodenal, proksimal jejunoileal, distal jejunoileal atrezi/stenoz nedeniyle takip edilen 85 hasta çalışmaya dahil edildi. Hastaların cinsiyeti, prenatal tanısı olup olmadığı, tanı konulma zamanı, doğum haftası, kilosu, anne yaşı, anne-baba akrabalık düzeyi, klinik özellikleri, eşlik eden anomaliler, ameliyattaki bulgular, ameliyat sonrası kalış süresi, total parenteral nütrisyon süresi, oral beslenmeye geçiş süresi, tam doz beslenme süresi ile ilgili veriler kaydedilerek morbidite ve mortaliteyi etkileyen faktörler ve büyüme gelişme parametreleri incelendi. Bulgular: ÇalıŞmaya dahil edilen 85 hastanın 44'ü kız, 41'i erkekti. Bu hastaların 35'inde duodenal, 29'unda proksimal jeunoileal, 21'inde ise distal jejunoileal atrezi/stenoz mevcuttu. % 58 oranında prematürite mevcut olup bu oran duodenal atrezi/stenoz hastalarında daha fazla idi. Ebeveynler arasında akrabalık durumunda distal jejunoileal/stenoz görülme olasılığı daha yüksekti. Hastaların % 56'sı prenatal ultrasonografi ile tespit edildi. Duodenal atrezi/stenozu olan hastalarda eŞlik eden konjenital anomali oranı % 74, jejunoileal atrezi/stenozu olan hastalarda % 42 idi. Duodenal atrezi/stenozu olan hastalara en sık eşlik eden anomali konjenital kalp hastalığı ve Down Sendromu idi. Duodenal atrezilerde en sık kullanılan ameliyat yöntemi duodenoduodenostomi, jejunoileal atrezilerde ise rezeksiyon+primer anastomoz idi. Mortalite oranı % 18, tüm gruplarda genel komplikasyon oranı % 20 olup, en sık görülen komplikasyon sepsisti. Kaybedilen hastalarda en sık karşılaşılan ölüm nedeni sepsis olup bu hastalarda; prematürite, düşük doğum ağırlığı ve ek konjenital anomali görülme sıklığı artmıştı. Hastalar büyüme gelişme açısından incelendiğinde duodenal atrezi/stenoz grubunda vücut ağırlığı ve kilo persentillerinin normal değerlerde olduğu, jejunoileal atrezilerde ise boy persentillerinin düşük olduğu tespit edildi. Sonuç: İnce barsak atrezisi/stenozu nedeniyle takip ve tedavisi yapılan hastaların mortalite sıklığının literatürdeki ile benzer oranlarda olduğu tespit edildi. Kaybedilen hastalarda prematürite, düşük doğum ağırlığı ve eşlik eden konjenital anomalilerin sıklık oranının artmış olduğu bulunmuş, mortalitenin primer olarak cerrahi komplikasyona bağlı olmadığı düşünülmüştür. Geç dönem komplikasyonların oldukça düşük oranda görülmesinin hastaların uzun dönem takiplerine düzenli olarak gelmemesinden kaynaklandığı düŞünülmüŞtür. Jejunoileal atrezi/stenozu olan hastalarda boy persentilleri düşük olup bu hastaların ameliyat sonrası dönemde beslenme ve büyüme-gelişme açısından yakın takip edilmesini öneriyoruz