The impact of diagnostic delay on the course of acute appendicitis

BACKGROUND: The diagnosis of acute appendicitis is often delayed, which may complicate the further course of the disease. AIMS: To review appendectomy cases in order to determine the incidence of diagnostic delay, the underlying factors, and impact on the course of the disease. METHODS: Records of all children who underwent appendectomy from 1994 to 1997 were reviewed. The 129 cases were divided into group A (diagnostic period within 48 hours) and group B (diagnostic period 48 hours or more). RESULTS: In the group with diagnostic delay, significantly more children had first been referred to a paediatrician rather than to a surgeon. In almost half of the cases in this group initial diagnosis was not appendicitis but gastroenteritis. The perforation rate in group A was 24%, and in group B, 71%. Children under 5 years of age all presented in the delayed group B and had a perforation rate of 82%. The delayed group showed a higher number of postoperative complications and a longer hospitalisation period. CONCLUSIONS: Appendicitis is hard to diagnose when, because of a progressing disease process, the classical clinical picture is absent. The major factor in diagnostic delay is suspected gastroenteritis. Early surgical consultation in a child with deteriorating gastroenteritis is advised. Ultrasonographs can be of major help if abdominal signs and symptoms are non-specific for appendicitis

Beoordeling erosiebestendigheid dijkgrasland Friese kust; 1 IJsselmeerkering

Ter ondersteuning van het integraal beleid voor het behoud en beheer van waterkeringen is onderzoek verricht naar de actuele erosiebestenigheid van de grasmat van de IJsselmeerkust van Friesland

Beoordeling erosiebestendigheid dijkgrasland Friese kust; 2 Waddenzeedijk Friesland vaste wal

Ter ondersteuning van het integraal beleid voor het behoud en beheer van waterkeringen is onderzoek verricht naar de actuele erosiebestendigheid van de grasmat van de Waddenzeekust van de Friese vaste wal

Trunk abnormalities in adolescence : a school health care based epidemiological cohort study

The rationale for the studies presented in this thesis was the whish to answer the question whether an extra scoliosis screening should be added to the two periodical medical examinations during adolescence. It was decided to use data collected in a prospective follow-up study conducted since 1984 to answer the following subquestions: 1. What is the prevalence of trunk abnormalities, including scoliosis and Scheuermann's disease? 2. What is the incidence of trunk abnormalities? 3. What ace the determinants of trunk abnormalities? 4. Are the current frequency of periodical medical examinations during adolescence, and the applied method of examining posture and back, adequate for early detection of adolescent idiopathic scoliosis? 5. Is it feasible to have scoliosis screening performed by school nurses? 6. What happens in the period between referral for scoliosis by the school physician and the onset of observation or treatment by the orthopedic surgeon

Pathophysiological consequences of pneumoperitoneum

Laparoscopic surgery has been performed for more than a century, although its nse was mainly restricted to diagnostic purposes 1. 2 Recent developments in instrumental design and methods of visualization have contributed to further implementation of laparoscopic techniques 3 In 1985, Muhe performed the first laparoscopic cholecystectomy 4 After further development of this technique by Moure! and Dubois 5· 6, laparoscopic techniques have gained wide acceptance in surgical practice. Except for laparoscopic gallbladder removal, minimally invasive techniques now have been established for other surgical procedures such as gastric ftmdoplication, appendectomy, splenectomy and (donor) nephrectomy 7-10 The popularity of these techniques may be explained by the growing evidence that the minimally invasive approach is associated with a reduction in operative morbidity, such as less postoperative pain, decreased systemic stress response, shorter hospitalization and improved cosmesis 11-15 The pneumoperitoneum is the crucial element in laparoscopic surgery. Each laparoscopic procedure requires a working space in the abdominal cavity to allow safe introduction of trocars and instruments and for exposure of the abdominal contents. Intraperitoneal insufflation of gas is the most common method to elevate the abdominal wall and suppress the viscera. Carbon dioxide (C02) is the preferred gas for establishing a pneumoperitoneum because it is non-flammable and inexpensive. However, C02 absorption through the peritoneal membrane leads to hypercapnia and acidosis and in order to reduce these effects, minute ventilation has to be adjusted. In addition, the increased intra-abdominal pressure due to intraperitoneal gas insufflation influences hemodynamic and respiratory ftmction

Vegetatie en erosiebestendigheid van extensief beheerd grasland op Waddendijken in Friesland; effecten op de samenstelling, zodedichtheid en doorworteling van de grasmat, 7 jaar na beëindiging van de mestgift

In dit rapport worden de resultaten beschreven van 7 jaar (1997-2004) onbemest hooien en weiden in proefvakken in Friesland. Het doel is om na te gaan hoe de vegetatiesamenstelling veranderd, of de doorworteling van de grasmat verbeterd, en of de zodedichtheid voldoende blijft volgens het `voorschrift Toetsen op veiligheid¿ (VTV). Na 7 jaar beheer van hooien of weiden zonder bemesting kan gezegd worden dat seizoens fluctuaties grote invloed hebben op de doorworteling en de zodedichtheid. Over het algemeen veranderd de vegetatiesamenstelling van de onbemeste proefvakken, soorten van voedselrijke bodems verdwijnen, en soorten van minder voedselrijke bodems kunnen zich vestigen. De doorworteling neemt af in de bovenste bodemlagen, maar neemt toe in de diepere bodemlagen, ongeacht het beheer. Op een uitzondering na voldoen alle proefvakken wat betreft zodedichtheid aan de norm van het `voorschrift toetsen op veiligheid¿