Incidence and Significance of Inconclusive Results in Ultrasound for Appendicitis in Children and Teenagers

AbstractPurposeFrustratingly, sonography to assess for appendicitis in children often leads to an inconclusive report (eg, “suspicious for appendicitis”) or nonvisualization of the appendix. To aid in planning who to image and how to interpret the results, we investigated whether these 2 results were more frequent in teenagers than preteens and the prevalence of appendicitis associated with each result.MethodsWe retrospectively reviewed sonographic and surgical findings in patients <18 years (n = 189) referred with clinical suspicion of appendicitis over a 12-month period. Children (≤12.0 years old; n = 86) and teens (>12.0 years old; n = 103) were compared.ResultsPrevalence of appendicitis was 34% in each group, similar to other centres; 0% for those with negative ultrasound reports (0/35), 10% for nonvisualized appendix (8/84), 68% for inconclusive report (15/22), and 85% for positive ultrasound (41/48). Teens were significantly more likely to have an inconclusive ultrasound. Inconclusive reports were because of borderline findings (eg, appendix size near 6 mm; 9/22), body habitus, bowel gas, or unusual findings due in retrospect to perforation. The rate of nonvisualization of the appendix did not vary significantly with age (42% vs 47%).ConclusionAn inconclusive result of ultrasound for appendicitis was significantly more frequent in teens than in preteens and carried a high (68%) likelihood of appendicitis. Conversely, a nonvisualized appendix was equally frequent in teens and preteens, and had a low likelihood of appendicitis (only 10% positive). These findings encourage the use of ultrasound in preteens in particular and can assist interpretation of these common results

Effects of season on Vitamin D and bone metabolism in a healthy population of western Canadians

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Sex differences in the treatment and outcome of emergency general surgery.

BACKGROUND:Sociodemographic characteristics, such as sex, have been shown to influence health care delivery. Acute care surgery models are effective in decreasing mortality and morbidity after emergency surgeries, but sex-based differences in delivery and outcomes have not been explored. Our objective was to explore sex associated differences in the patient characteristics and clinical outcomes of those admitted to emergency general surgery. METHODS:A post-hoc analysis of 512 emergency general surgical patients admitted consecutively to two tertiary care hospitals in Alberta Canada, between April 1, 2014 and July 31, 2015. We measured associations between sex and patient demographics, pre-, intra- and post-operative delivery of care, as well as post-operative outcomes. FINDINGS:Of those excluded from the analysis, older females were more likely to undergo conservative management compared to older men (41% vs 34%, p = 0.03). Overall, there were no differences between sexes for time from admission to surgery, time spent in surgery, overall complication rate, mortality, hospital length of stay, or discharge disposition. Women were more likely to have a cancer diagnosis [OR 4.12 (95% CI: 1.61-10.5), p = 0.003, adjusted for age], while men were more likely to receive hernia surgery [OR 2.33 (95% CI 1.35-4.02), p = 0.002, adjusted for age and Charlson Comorbidity Index]. Finally, men were more likely to have a major respiratory complication [OR 2.73 (95% CI: 1.19-6.24), p = 0.02, adjusted for age]. CONCLUSIONS:Only two differences in peri and post-operative complications between sexes were noted, which suggests sex-based disparity in quality of care is limited once a decision has been made to operate. Future studies with larger databases are needed to corroborate our findings and investigate potential sex biases in surgical versus conservative management

A pilgrim's progress: Seeking meaning in primordial germ cell migration

Comparative studies of primordial germ cell (PGC) development across organisms in many phyla reveal surprising diversity in the route of migration, timing and underlying molecular mechanisms, suggesting that the process of migration itself is conserved. However, beyond the perfunctory transport of cellular precursors to their later arising home of the gonads, does PGC migration serve a function? Here we propose that the process of migration plays an additional role in quality control, by eliminating PGCs incapable of completing migration as well as through mechanisms that favor PGCs capable of responding appropriately to migration cues. Focusing on PGCs in mice, we explore evidence for a selective capacity of migration, considering the tandem regulation of proliferation and migration, cell-intrinsic and extrinsic control, the potential for tumors derived from failed PGC migrants, the potential mechanisms by which migratory PGCs vary in their cellular behaviors, and corresponding effects on development. We discuss the implications of a selective role of PGC migration for in vitro gametogenesis