Eugene Albu

Diagnostic value of C-reactive protein in acute appendicitis

Serum C-reactive protein was measured in 56 patients hospitalized with a suspected diagnosis of acute appendicitis. Based on these determinations, four groups of patients were defined: Group A=26 patients with acute appendicitis who had a C-reactive protein level higher than 2.5 mg/dl. Group B=4 patients with a C-reactive protein level lower than 2.5 mg/dl who, after surgery based on a presumed diagnosis of acute appendicitis, were found to have a normal appendix. Group C=22 patients with nonspecific abdominal pain, 18 (72 percent) of whom had an elevated C-reactive protein level, although in only 4 (7.1 percent) were these levels higher than 2.5 percent mg/dl. Group D=4 patients who had diseases other than acute appendicitis. It is concluded that an increase in C-reactive protein levels to more than 2.5 mg/dl is not a definite indicator of acute appendicitis. However, if the C-reactive protein level in blood drawn 12 hours after the onset of symptoms is less than 2.5 mg/ dl, acute appendicitis can be excluded.

Predictors of the severity of acute pancreatitis in patients with HIV infection or AIDS.

We retrospectively reviewed the charts of 54 human immunodeficiency virus (HIV) infected patients or acquired immunodeficiency syndrome (AIDS), who were hospitalized at the Bronx-Lebanon Hospital Center with acute pancreatitis between January 1993 and December 1995. Nineteen were female and 35 were male patients. Thirty-five (65%) of 54 patients were younger than 40 years (average age, 42 years). Forty-eight (89%) of the patients had a CD4 count of <200 units/ml of blood. Seventeen (32%) patients died either of complications of acute pancreatitis or of underlying disease. The conventional prognostic criteria used to assess the severity of pancreatitis, including Ransons and Imries criteria and the APACHE II system, were applied. We determined that these criteria were not appropriate to our HIV/AIDS patients. Only serum calcium levels at 48 h after admission and serum creatinine and blood urea nitrogen (BUN) at admission and at 48 h after admission had significant p values (<0.05). We believe that the predictors commonly used to identify the severity of pancreatitis were not useful in these patients because of their low CD4 counts and preexisting liver and renal disease.

Ten years later: a single hospital experience with malignancy in HIV/AIDS.

We present our experience in the era of HAART with 5,112 patients having HIV infection or AIDS, treated between 2002 and 2006 in our hospital, 182 of whom had malignancies (3.56%). We compared our findings to those from a similar cohort of patients studied 10 years earlier.

Gallstone pancreatitis in adolescents

During a 5-year period (1980 to 1985) in the Adolescent Unit at Bronx-Lebanon Hospital Center, 18 patients were admitted with the diagnosis of gallstone disease, four of whom, at the time of their admission, had associated acute pancreatitis. Although gallstone pancreatitis is infrequent in adolescents, it is an important differential diagnosis of upper abdominal pain in youngsters with gallstone disease. The most frequently encountered mechanisms of gallstone pancreatitis in adolescents appear to be impacted stones, congenital pathology in the ampullary area, and passage of small stones through the common bile duct, with temporary obstruction and inflammation followed by disruption of pancreatic ductules and/or acinar cell membrane. Proper management includes cholecystectomy and the mandatory performance of an intraoperative cholangiogram. Sphincterotomy or sphincteroplasty, which are frequently performed in adults with gallstone pancreatitis, should be avoided in adolescents. Even if impacted stones have to be removed at this age, papillotomy suffices. After an acute episode, a properly timed surgical treatment is curative.

Cholelithiasis and teenage mothers.

Between 1980 and 1988, 23 female adolescents were hospitalized at the Bronx-Lebanon Hospital Center for symptomatic cholelithiasis. The known risk factors for gallstone formation in adolescents were considered. In ten of the patients (43%), none of the risk factors was present. All ten patients, however, had in common a recent history of pregnancy. This finding is consistent with the current literature on the possible mechanism of gallstone formation during pregnancy.

Delayed splenic rupture in a drug addict

We present the case of a drug addict who was admitted with abdominal pain but gave no history of trauma. He subsequently left the hospital against medical advice, only to be readmitted a few days later with persistent abdominal pain. He was found to have splenic rupture. This case emphasizes the importance of ruling out intra-abdominal trauma in any drug addict presenting with acute abdomen.

Medullary carcinoma of the stomach with lymphocytic infiltration: A case report and literature review

Medullary carcinoma of the stomach is a rare morphopathologic entity with a relatively benign course. Because of its rarity, it is not included in the classical categories of gastric cancer. We presen

Ultrasound as an aid in the diagnosis of acute appendicitis

This 1-year prospective study used high-resolution ultrasound at 5 MHz to assess 79 patients admitted with a possible diagnosis of acute appendicitis. The sonographic criterion used to diagnose acute appendicitis was visualization of a noncompressible appendiceal shadow having a diameter of 5 mm or more. Ultrasound examination proved to be a valuable tool in the differential diagnosis of acute appendicitis in all patients who had equivocal symptoms and signs. Ultrasound was particularly useful when applied to female patients of childbearing age.

Management of Amyloidosis Presenting as Intestinal Obstruction

A 55-year-old woman presented with symptoms and signs of intestinal obstruction. At exploratory laparotomy, neither an extra- nor an intraluminal obstructing lesion was found. However, there was a thi

Congenital Ileal Mucosal Septum and Phytobezoar with Acute Episode of Small Bowel Obstruction in an Adult

An unusual case of high intestinal obstruction is presented. This obstruction resulted form impaction of a phytobezoar at the level of a congenital ileal mucosal septum, a type-I intestinal atresia. Patients with this condition have a patent intestine and may reach adulthood with symptoms occurring only when an impaction develops. The preoperative diagnosis in such cases is difficult and the lesion may be missed even at laparotomy. In evaluating the cause of an otherwise unexplained intestinal obstruction, one should consider the possiblity of an intraluminal mucosal defect. Treatment consists of identifying the level of obstruction with segmental resection of the bowel including the mucosal defect, evacuation of the obstructing content and complete evaluation of the patency of the rest of the intestine.