The value of unenhanced CT in the diagnosis of acute appendicitis

OBJECTIVE: To establish the accuracy of unenhanced CT in the preoperative diagnosis of acute appendicitis.DESIGN: Accuracy study, prospective and blinded.SETTING: The University Hospital.PARTICIPANTS: 52 patients with clinical and laboratorial manifestations of acute appendicitis. CT diagnosis was made by: presence of an abnormal appendix, appendiceal calculi with pericecal phlegmon or alterations in the pericecal appendicular site and absence of signs that may lead to other diagnosis.MAIN OUTCOME MEASURES: Overall accuracy, comparing the tomographic aspects with the intra-operative findings and pathological reports (gold standard).RESULTS: Acute appendicitis was confirmed in 44 cases. Efficacy was 92%, sensitivity was 91%, specificity was 100%, positive predictive value was 100% and negative predictive value was 67%.CONCLUSIONS: Unenhanced CT presents a similar overall accuracy to that reported by other authors who studied enhanced CT diagnosis of acute appendicitis.OBJETIVO: Estabelecer a eficácia da TC sem contraste EV ou VO no diagnóstico pré-operatório da apendicite aguda. TIPO DE ESTUDO: estudo de acurácia prospectivo, independente. LOCAL: hospital-escola de atenção terciária (instituição mista). PACIENTES: 52 pacientes com suspeita clínico-laboratorial de apendicite aguda. MÉTODO DIAGNÓSTICO: Os exames tomográficos foram realizados sem contraste EV ou VO. O diagnóstico tomográfico de apendicite aguda foi feito na presença de apêndice anormal, apendicolito com flegmão pericecal ou alterações na região apendicular, sem sinais que indicassem um diagnóstico alternativo. VARIÁVEIS ESTUDADAS: eficácia, sensibilidade, especificidade, valor preditivo positivo e negativo, comparando os aspectos tomográficos com os achados intra-operatórios e laudos anatomopatológicos (padrão ouro). RESULTADOS: O diagnóstico definitivo de apendicite aguda foi observado em 44 casos. A eficácia do método foi de 92%; sensibilidade de 91%; especificidade de 100%; o valor preditivo positivo foi de 100% e o valor preditivo negativo de 67%. CONCLUSÃO: A TC sem contraste EV e VO apresenta eficácia global semelhantre à TC com contraste relatada por outros autores, no diagnóstico da apendicite aguda.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Fatty liver incidence and predictive variables.

Although fatty liver predicts ischemic heart disease, the incidence and predictors of fatty liver need examination. The objective of this study was to determine fatty liver incidence and predictive variables. Using abdominal ultrasonography, we followed biennially through 2007 (mean follow-up, 11.6+/-4.6 years) 1635 Nagasaki atomic bomb survivors (606 men) without fatty liver at baseline (November 1990 through October 1992). We examined potential predictive variables with the Cox proportional hazard model and longitudinal trends with the Wilcoxon rank-sum test. In all, 323 (124 men) new fatty liver cases were diagnosed. The incidence was 19.9/1000 person-years (22.3 for men, 18.6 for women) and peaked in the sixth decade of life. After controlling for age, sex, and smoking and drinking habits, obesity (relative risk (RR), 2.93; 95% confidence interval (CI), 2.33-3.69, P<0.001), low high-density lipoprotein-cholesterol (RR, 1.87; 95% CI, 1.42-2.47; P<0.001), hypertriglyceridemia (RR, 2.49; 95% CI, 1.96-3.15; P<0.001), glucose intolerance (RR, 1.51; 95% CI, 1.09-2.10; P=0.013) and hypertension (RR, 1.63; 95% CI, 1.30-2.04; P<0.001) were predictive of fatty liver. In multivariate analysis including all variables, obesity (RR, 2.55; 95% CI, 1.93-3.38; P<0.001), hypertriglyceridemia (RR, 1.92; 95% CI, 1.41-2.62; P<0.001) and hypertension (RR, 1.31; 95% CI, 1.01-1.71; P=0.046) remained predictive. In fatty liver cases, body mass index and serum triglycerides, but not systolic or diastolic blood pressure, increased significantly and steadily up to the time of the diagnosis. Obesity, hypertriglyceridemia and, to a lesser extent, hypertension might serve as predictive variables for fatty liver