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1
Grunder, Adrian. « Appendicitis acuta im Kindesalter / ». [S.l : s.n.], 1987. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Ferguson, Mark R., Jason N. Wright, Anh-Vu Ngo, Sarah M. Desoky et Ramesh S. Iyer. « Imaging of Acute Appendicitis in Children ». GEORG THIEME VERLAG KG, 2017. http://hdl.handle.net/10150/625179.
Texte intégralRésumé :
Acute appendicitis is a common cause of abdominal surgery in children, and is the result of appendiceal luminal obstruction and subsequent inflammation. The clinical presentation is often variable, allowing imaging to play a central role in disease identification and characterization. Ultrasound is often the modality of choice for diagnosis of appendicitis in children. Ready availability and lack of ionizing radiation are attractive features of sonography, though operator dependence is a potential barrier. Computed tomography (CT) was historically the preferred modality in children, as in adults, but recent awareness of the risks of radiation has reduced its usage. The purpose of this article is to detail the imaging findings of appendicitis in children. The discussion will focus on typical signs of appendicitis seen on ultrasound, CT, and magnetic resonance imaging. Considerations for percutaneous drainage by interventional radiology will also be presented. Finally, the evolution of imaging algorithms for appendicitis will be discussed.
3
Andersson, Manne. « Structured management of patients with suspected acute appendicitis ». Doctoral thesis, Linköpings universitet, Institutionen för klinisk och experimentell medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-113766.
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Background. Acute appendicitis (“appendicitis”) is one of the most common abdominal surgical emergencies worldwide. In spite of this, the diagnostic pathways are highly variable across countries, between centres and physicians. This has implications for the use of resources, exposure of patients to ionising radiation and patient outcome. The aim of this thesis is to construct and validate a diagnostic appendicitis score, to evaluate new inflammatory markers for inclusion in the score, and explore the effect of implementing a structured management algorithm for patients with suspected appendicitis. Also, we compare the outcome of management with routine diagnostic imaging versus observation and selective imaging in equivocal cases. Methods. In study I, the Appendicitis Inflammatory Response (AIR) score was constructed from eight variables with independent diagnostic value (right lower quadrant pain, rebound tenderness or muscular defence, WBC count, proportion of polymorphonuclear granulocytes, CRP, body temperature and vomiting). Its diagnostic properties were evaluated and compared with the Alvarado score. In study II, we performed an external validation and evaluation of novel inflammatory markers for inclusion in the score on patients with suspected appendicitis at two Swedish hospitals. In study III we externally validated and evaluated the impact of an AIR-scorebased algorithm assigning patients to a low or high risk of having appendicitis in an interventional multicentre study involving 25 Swedish hospitals and 3791 patients. In study IV, we compared the efficiency of routine diagnostic imaging with repeated clinical assessment followed by selective imaging in a randomised trial of 1028 patients with equivocal signs of appendicitis, as indicated by an intermediate AIR score, from study III. Main results. In study I we found that the AIR score could assign 63% of the patients to either a high- or low-risk group of appendicitis with an accuracy of 97%, which compared favourably with the Alvarado score. In study II, the diagnostic properties of the AIR score proved to be reproducible, but the inclusion of novel inflammatory markers did not improve the diagnostic accuracy. In study III, the AIR-score-based algorithm led to a reduction in negative explorations, operations for nonperforated appendicitis and hospital admissions in the low-risk group and reduced use of imaging in both low- and high-risk groups. In study IV, routine imaging led to more operations for nonperforated appendicitis but had no effect on negative explorations or perforated appendicitis. Conclusions. The AIR score was found to have promising diagnostic properties that were not improved further with the inclusion of novel inflammatory variables. Structured management of patients with suspected appendicitis according to an AIR-score-based algorithm may improve outcome while reducing hospital admissions and use of imaging. Patients with equivocal signs of appendicitis do not benefit from routine imaging which may lead to an increased detection of, and treatment for, uncomplicated cases of appendicitis that are otherwise allowed to resolve spontaneously.
4
Овечкін, Денис Вячеславович, Денис Вячеславович Овечкин, Denys Viacheslavovych Ovechkin, Ігор Едуардович Зайцев, Игорь Эдуардович Зайцев, Ihor Eduardovych Zaitsev et B. N. Agyiri. « Analysis of blood inflammatory markers for detection of acute appendicitis in children ». Thesis, Видавництво СумДУ, 2011. http://essuir.sumdu.edu.ua/handle/123456789/15962.
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Guzmán, Edson, et Nadia García. « Clinical scores for prediction of acute appendicitis in children in a hospital of Lima, Perú ». Annals of Pediatric Surgery, 2014. http://hdl.handle.net/10757/612234.
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Objective: To determine the usefulness of the Alvarado score and the Pediatric Appendicitis score (PAS) in the Pediatric Emergency of the National Hospital Daniel A. Carrion.
Materials and methods: A prospective observational study was carried out of patients younger than 15 years of age with abdominal pain and suspected acute appendicitis (AA) attending the Pediatric Emergency in a Hospital of Lima, Peru. These patients underwent a survey to assess the parameters of the Alvarado score and PAS.
Results: Three hundred and seventeen patients with abdominal pain and suspected of AA were recruited over a study period of 12 months. Of the patients, 232 were considered to have AA clinically and underwent surgery. 85.3% were confirmed by pathology and 14.7% were normal. The mean Alvarado score was 8.27±1.31; the mean Surgical Procedure Assessment (SPA) score was 8.08±1.47. Sensitivity and specificity for both scores are equivalent. The area under the curve for the Alvarado score and SPA were 0.887 and 0.901, respectively. Alvarado score higher than 6 had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.9, 75.6, 97.4, 68.1, and 86.4%, respectively. SPA higher than 6 points had sensitivity, specificity, PPV, NPV, and accuracy of 84.3, 80.7, 94.7, 73.1, and 86.7%, respectively.
Conclusion: Alvarado score and the PAS are scores with high sensitivity, specificity, PPV, and accuracy for the diagnosis of AA when the score is higher than 6 points. The results found in our study justify their use in emergency services, but they should not be used as the only means of clinically determining the need for surgery.
6
Овечкін, Денис Вячеславович, Денис Вячеславович Овечкин, Denys Viacheslavovych Ovechkin, O. M. Bulchenko et A. A. Dennis. « Clinical-diagnostic and therapeutic features of acute appendicitis in children ». Thesis, Sumy State University, 2014. http://essuir.sumdu.edu.ua/handle/123456789/36586.
Texte intégralRésumé :
Acute appendicitis is the most frequent disease in childhood. It requires an emergency surgical intervention and has a number of features in comparison with adults. It is more severe, and diagnostics is more complex. This is due primarily to the large number of diseases occurring with pseudo abdominal syndrome, difficulties of inspection and revealing of local symptoms particularly in young children.
When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/36586
7
Богачов, Д. В., et І. В. Марус. « Перспективи ендовідеохірургічного методу лікування гострого апендициту ». Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/27351.
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Наук. кер.: В.В. ЛеоновРезультати лікування хворих з гострим апендицитом залежать від багатьох причин: своєчасної та точної діагностики, правильно визначених показів до оперативного втручання, термінів їх виконання, адекватності вибору доступу в черевну порожнину та лікувальних заходів. При цитуванні документа, використовуйте посилання http://essuir.sumdu.edu.ua/handle/123456789/27351
8
Безродний, Б. Г., А. В. Іовіца, Л. Д. Мартинович, А. І. Мойсеєнко, Б. Т. Карташов et В. М. Ольховецький. « Значення синдрому подразненого кишечника у патогенезі гострого апендициту та його ускладнень ». Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/27341.
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Laurell, Helena. « Acute Abdominal Pain ». Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7161.
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The aim was to identify diagnostic difficulties for acute abdominal pain at the emergency department and during hospital stay. A total of 3349 patients admitted to Mora Hospital with acute abdominal pain of up to seven days duration, were registered prospectively for history and clinical signs according to a structured schedule. The preliminary diagnosis from the attending physician at the emergency department, any investigations or surgery and final diagnosis were registered at a follow-up after at least one year.
There were no differences in diagnostic performance between physicians with 0.5 to 5 years of medical experience. The information collected and a careful examination of the patient was more important than formal competence. The main differential diagnostic problem was non-specific abdominal pain; this was the same for diagnoses requiring surgery. Patients originally diagnosed as not needing surgery had a median delay before operation of 22 hours (mean 40 hours, with 95% confidence interval of 30-50 hours), compared to 8 hours (mean 15 hours, 95% confidence interval of 12-28 hours) for patients with the same final follow-up diagnosis as the preliminary diagnosis. Constipation was a diagnostic pitfall, as 9% of the patients considered constipated required surgery for potentially life threatening reasons and 8% were later found to have an abdominal malignancy. Both the preliminary diagnosis and the discharge diagnosis were less reliable for elderly patients than for younger patients. Elderly patients often had specific organ disease and arrived at the emergency department after a longer history of abdominal pain.
This study confirms that assessment of suspected appendicitis can still be based on clinical judgements combined with laboratory tests. Classical clinical findings indicating localised inflammation, such as isolated pain in the right iliac fossa, rebound tenderness, right-sided rectal tenderness, pain migration to the right iliac fossa, local guarding and aggravation of pain when moving, were reliable for predicting acute appendicitis. A CT scan can be saved for the more equivocal cases of acute abdominal pain. A generous strategy regarding CT scan among elderly patients with acute abdominal pain, even in the absence of pronounced signs of an inflammatory intra-abdominal process, is recommended.
10
Bilyk, I. I. « Certain aspects in treatment of peritonitis as a complication of acute appendicitis ». Thesis, БДМУ, 2020. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18161.
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Carotenuto, Giuseppe. « 3T MRI in the Evaluation of Acute Appendicitis in the Pediatric Population ». Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/623242.
Texte intégralRésumé :
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Computer tomography (CT) is commonly used to evaluate suspected acute appendicitis; however, ionizing radiation limits its use in children. This study assesses 3T magnetic resonance imaging (MRI) as an imaging modality in the evaluation of suspected acute appendicitis in the pediatric population. This study is a retrospective review of prospectively‐collected data from 155 pediatric subjects who underwent MRI and 197 pediatric subjects who underwent CT for suspected acute appendicitis. Sensitivity, specificity, appendix visualization rate, positive appendicitis rate, and alternative diagnosis rate are determined. Sensitivity and specificity of MRI are 100% and 98%, 99% and 97% for CT (p = 0.61 and 0.53), respectively. Appendix visualization rate is 77% for MRI, 90% for CT (p = 0.0002), positive appendicitis rate is 25% for MRI, 34% for CT (p = 0.175), and alternative diagnosis rate is 3% for MRI, 3% for CT (p = 0.175). This study supports 3T MRI as a comparable modality to CT in the evaluation of suspected acute appendicitis in the pediatric population. Although MRI visualizes the appendix at a lower rate than CT, our protocol maintains 100% sensitivity with no false negatives. Our appendix visualization rate with 3T MRI (77%) is an improvement from published data from both 1.5T and 3T MRI systems. The exam time differential is clinically insignificant and use of MRI spares the patient the ionizing radiation and intravenous contrast of CT.
12
Crawford, William Jeffrey. « An ensemble and modular neural network approach to the diagnosis of acute appendicitis ». Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape3/PQDD_0015/MQ53144.pdf.
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Yang, Estin. « Acute Appendicitis in the Public and Private Sectors in Cape Town, South Africa ». Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/9383.
Texte intégralRésumé :
Includes abstract.Includes bibliographical references.
Compared to the Western world, the incidence of appendicitis is relatively low in South Africa, but with higher complication and rupture rates. Although there have been numerous studies published on appendicitis in South Africa, the literature is notably missing outcome data in the private sector. Therefore, this study aims to compare acute appendicitis in the public and private sectors in Cape Town, exploring patient characteristics, perforation rates, outcomes, and return to work.
14
Mällinen, J. (Jari). « Studies on acute appendicitis with a special reference to appendicoliths and periappendicular abscesses ». Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526223339.
Texte intégralRésumé :
Abstract Epidemiological and clinical data suggest that acute appendicitis might have two different forms with different disease severities. Uncomplicated and complicated acute appendicitis appear to be distinct entities instead of consecutive events. Appendicitis does not always inevitably progress to perforation and most cases are uncomplicated by nature. This supports the importance of an accurate differential diagnosis between uncomplicated and complicated acute appendicitis enabling treatment optimization. This thesis consists of three studies. The first study evaluated the possibility to differentiate between uncomplicated and complicated appendicitis using only clinical symptoms and laboratory markers with a special focus on predicting the presence of an appendicolith without the use of modern imaging. We found neither sufficiently reliable to accurately estimate the severity of acute appendicitis or to determine the presence of an appendicolith, supporting the use of computed tomography imaging to assess the disease. The second study focused on clarifying the histopathological differences between uncomplicated acute appendicitis and acute appendicitis presenting with an appendicolith; a calcified deposit of faecal material in the appendiceal lumen. It’s presence has been shown to predict perforation and failure of conservative treatment. This study evaluated the histopathological findings of computed tomography diagnosed uncomplicated acute appendicitis and appendicolith appendicitis without perforation. Acute appendicitis presenting with an appendicolith was histopathologically different from uncomplicated acute appendicitis on all the assessed histological parameters, indicating the potentially complicated nature of appendicolith appendicitis. The third study was a randomized, multicentre clinical trial comparing interval appendectomy with follow-up with magnetic resonance imaging after successful initial non-operative treatment of complicated acute appendicitis presenting with a periappendicular abscess. The study hypothesis was that an interval appendectomy might not be necessary based on the previously reported low appendicitis recurrence rate after a periappendicular abscess. The original study hypothesis was left unresolved, as an unexpectedly high rate of appendiceal neoplasms was detected in the study population and the study was prematurely terminated. The neoplasm rate after a periappendicular abscess in this prematurely terminated study was high (20%). All the neoplasms were detected in patients over 40 years of age, strongly supporting an interval appendectomy for all patients over 40 years of age if this rate of neoplasms is validated in future studiesTiivistelmä Aiemmat tutkimukset viittaavat siihen, että on olemassa kaksi erillistä akuutin umpilisäkkeen tulehduksen muotoa: komplisoitumaton ja komplisoitunut. Nämä muodot eivät ole toistensa jatkumo: umpilisäkkeen tulehdus ei aina johda umpilisäkkeen puhkeamiseen, vaan valtaosa umpilisäkkeen tulehdustapauksista on komplisoitumattomia. Oikean hoitotavan valinta edellyttää tarkkaa erotusdiagnostiikkaa tautimuotojen välillä Tämä väitöskirjatyö koostuu kolmesta osatyöstä. Ensimmäisen osatyö selvitti, onko komplisoitumaton ja komplisoitunut umpilisäkkeen tulehdus mahdollista erottaa ilman kuvantamista kliinisin löydöksin ja laboratoriokokein painottaen ulostekiven olemassaolon ennustamista. Umpilisäkkeen tulehduksen vaikeusasteen tai ulostekiven olemassaolon ennustaminen ei ollut mahdollista pelkästään kliinisten löydösten tai laboratoriokokeiden perusteella. Tämä korostaa tietokonetomografian merkitystä taudin vaikeusasteen arvioinnissa. Toinen osatyö selvitti histologisia eroja komplisoitumattoman umpilisäkkeen tulehduksen ja ulostekiven sisältävän äkillisen umpilisäkkeen tulehduksen välillä. Ulostekiven tiedetään ennustavan umpilisäkkeen puhkeamaa ja konservatiivisen hoidon epäonnistumista. Tutkimuksessa selvitettiin histologisia löydöksiä potilailla, joilla oli tietokonetomografiatutkimuksella varmistettu komplisoitumaton äkillinen umpilisäkkeen tulehdus tai ulostekiven sisältävä äkillinen umpilisäkkeen tulehdus ilman puhkeamaa. Tutkimuksessa todettiin, että ulostekiven sisältävät tulehtuneet umpilisäkkeet poikkeavat kaikkien tutkittujen parametrien osalta komplisoitumattomasta umpilisäkkeen tulehduksesta. Tämä tukee käsitystä ulostekiven sisältävän umpilisäkkeen tulehduksen komplisoituneesta luonteesta. Kolmas osatyö oli randomoitu monikeskustutkimus, jossa verrattiin toisiinsa rauhallisessa vaiheessa tehtyä umpilisäkkeen poistoa ja seurantaa magneettiresonanssikuvauksella potilailla, joilla oli onnistuneesti hoidettu konservatiivisesti umpilisäkkeen ympäryskudoksen paise. Hypoteesina oli, että myöhempi umpilisäkkeen poisto ei ole tarpeen, koska tulehduksen uusiutumisen riski umpilisäkkeen vieruskudoksen paiseen hoidon jälkeen on aiemmin raportoitu matalaksi. Tutkimushypoteesi jäi avoimeksi, koska tutkimuksen aikana havaittiin runsaasti umpilisäkkeen kasvaimia, mikä johti tutkimuksen ennenaikaiseen keskeyttämiseen. Umpilisäkkeen kasvainten ilmaantuvuus oli 20 %, kaikki yli 40-vuotiailla potilailla. Mikäli tutkimuksen tulokset vahvistuvat tulevissa tutkimuksissa, kaikille yli 40-vuotiaille potilaille tulisi suositella umpilisäkkeen poistoa sairastetun umpilisäkkeen vieruskudoksen paiseen jälkeen
15
Feller, Fionna. « Low Field-Of-View CT in the Evaluation of Acute Appendicitis in the Pediatric Population ». Thesis, The University of Arizona, 2018. http://hdl.handle.net/10150/626832.
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Аксенчук, Р. І. « Гострий апендицит у вагітних ». Thesis, Сумський державний університет, 2014. http://essuir.sumdu.edu.ua/handle/123456789/36369.
Texte intégralRésumé :
Гострий апендицит (ГА) – найчастіше гостре хірургічне захворювання у вагітних. Діагностика ГА у них ускладнена, що може бути причиною можливих діагностичних помилок і незадовільних результатів лікування.
При цитуванні документа, використовуйте посилання http://essuir.sumdu.edu.ua/handle/123456789/36369
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Жукова, Е. М., et В. А. Наледько. « Лапароскопия как метод диагностики острого аппендицита у беременных ». Thesis, Сумский государственный университет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/48502.
Texte intégralRésumé :
Актуальность. Лапароскопия – инвазивный метод диагностики и лечения
гинекологической и абдоминальной патологии. Как метод диагностики, он является
высокоинформативным. Беременность не является противопоказанием для проведения данной процедуры, однако следует учитывать, что это хирургическое вмешательство, которое может повлиять на дальнейшее протекание беременности.
Цель: определить роль лапароскопии в диагностике и лечении острого аппендицита у
беременных.
18
Шимко, В. В., Г. І. П'ятикоп, О. С. Ганжара et С. Г. Супрун. « Досвід лімфотропної терапії при деструктивних формах гострого апендициту ». Thesis, Сумський державний університет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/48396.
Texte intégralRésumé :
Актуальність. Гострий апендицит – гостре інфекційно-запальне захворювання
червоподібного паростка, яке є домінуючим в ургентній хірургії органів черевної
порожнини. На його долю припадає 60-70% екстрених оперативних втручань. Завдяки зусиллям лікарів, науковців вдалося досягти значних успіхів в лікуванні хворих на гострий апендицит, значно зменшити летальність та частоту ускладнень, оптимізувати тактико-лікувальні алгоритми. Проте незважаючи на це, далеко не всі питання, пов’язані з гострим апендицитом, залишаються вирішеними.
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Marshall, Morwena J. « The diagnostic role of complement cascade biomarkers in acute appendicitis in adults presenting with right iliac fossa pain ». Thesis, Exeter and Plymouth Peninsula Medical School, 2017. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.742773.
Texte intégralRésumé :
Acute appendicitis (AA) is the most common cause for emergency abdominal surgery in the Western world. Diagnostic error results in unnecessary operations in up to thirty per cent of patients with associated morbidity and economic cost. Conventional biomarkers of inflammation, white cell count (WCC) and C-reactive protein (CRP), aid diagnosis but are slow and non-specific. We hypothesised that the complement (C) cascade would be more rapidly triggered by acute inflammation of the appendix, allowing for discrimination between AA and other conditions (non-AA). Aim The aim of this thesis was to: “explore the potential role of the C cascade in the diagnosis ofAA in adults presenting with right iliac fossa (RIF) pain”. Methods A prospective pilot observational study recruited adults with right iliac fossa (RIF) pain admitted to hospital with a clinical suspicion of AA. Admission and serial plasma C4, C3, iC3b and TCC assays and admission urine C3a ELISA results were compared with reference standards for AA to assess diagnostic performance by receiver operating characteristic (ROC) curves. The effect of biomarker interpretation on diagnostic accuracy was studied through varying thresholds of test positivity derived from population, study cohort and individualised patient trend data. The time dependent nature of biomarkers was explored through the effect of duration of symptoms and trend analysis. Results Seventy-four adults were recruited to the study, 26 (35%) were male with a median age of 33 years (range 18 to 84). Twenty-two (30%) patients were diagnosed with AA. Isolated admission C proteins did not discriminate between AA and non-AA. Admission WCC and CRP performed well but their diagnostic performance was enhanced when added to clinical characteristics in the Alvarado score (ROC area under curve (AUC) 0.85 (95% Cl 0.76-0.94). The Alvarado score performed exceptionally in females of reproductive age, with a ROC AUC of 0.92 (95% Cl 0.82-1.00). Trend analysis of TCC over four hours produced the most accurate C cascade biomarker in our study with a ROC AUC of 0.84 (0.69-0.99). Urine C3a was detected in fourteen patients (27%) with RIF pain. Conclusion Our study corroborates the diagnostic role of the Alvarado score in AA in adults with RIF pain and suggests new candidates from the C cascade for further validation. A proposed care pathway incorporating the Alvarado score, CRP and TCC A4 is presented for further evaluation.
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П`ятикоп, Геннадій Іванович, Геннадий Иванович Пятикоп, Hennadii Ivanovych Piatykop et В. В. Шимко. « Імунні порушення та реакція селезінки при гострому апендициті й влив на них лімфотропної терапії ». Thesis, Сумський державний університет, 2017. http://essuir.sumdu.edu.ua/handle/123456789/64746.
Texte intégralRésumé :
Вельми значущою проблемою сучасної абдомінальної ургентної хірургії залишається гостре запалення хробакоподібного охвістя - гострий апендицит. Незважаючи на багаторічні дослідження післяопераційна летальність при цій нозології відносно стабільна на протязі останнього десятиріччя і знаходиться на рівні 0,1 – 0,5%, а за ускладнених форм гострого апендициту та наявності супутніх захворювань зростає до 3 і навіть 10%.
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Amaral, Luana Mesquita. « Associação entre o uso de antimicrobianos, estadio anátomo-patológico e infecção de sítio cirúrgico após apendicectomia ». Universidade Federal de Uberlândia, 2012. https://repositorio.ufu.br/handle/123456789/12727.
Texte intégralRésumé :
Most intra-abdominal infections such as acute appendicitis require surgical
intervention. The use of antimicrobials, however, is essential in the treatment
complementation and reduction of surgical site infection (SSI). The present study aims to
make a critical analysis of the use of antimicrobials use, anatomopathological stage and
surgical site infection after appendectomy. It were analyzed the demographic
data, antimicrobial scheme chosen, the beginning of antimicrobial, usage time and evolution
as the SSI associated with the anatomopathological stage of resected appendices. 233 patients
were evaluated between 14 years and 78 years with male predominance (135 / 57.94%) and in
the third decade of life (72 / 30.90%). In 139 patients (59.65%) surgical time was up to two
hours with a predominance of Phlegmonous Acute Appendicitis (91 / 39.05%) and
Necrotizing Acute Appendicitis (88 / 37.76%). The antimicrobial scheme most used was a
combination of Ampicillin/Sulbactam totalizing 127 (54.50%) patients. Most patients had the
start of the antimicrobial scheme in anesthetic induction (212 /90.94%). Regarding the usage
time of antimicrobials, the prevalence was of less than 24 hours of use (122 / 52.36%)
and 16 (6.87%) presented SSI. Based on the anatomopathological classification on nonnecrotic
appendices, 145 (62.23%) patients should have used a single antimicrobial dose or at
maximum for 24 hours. Of patients with non-necrotic appendix, only 60 (41.37%) used one
dose; 15 (10.34%) used 2 to 4 doses and 70 (48.29%) used more than four doses of
antimicrobial. In 16 (6.87%) patients considered with normal appendix were used more
than four doses of antimicrobials. In the analysis of the SIRI SSI in perspective, no patient
presented with SIRI 0 SSI (4 / 5.79%) patients presented with an SIRI SSI (9 / 5.88%)
patients had 2 SIRI SSI and (1 / 12.5) 3 SIRI SSI presented. Based on anatomopathological
association (necrotic and non-necrotic) of resected appendices for clinical suspicion of acute
appendicitis and the use of antimicrobials, we can conclude: there was unnecessary use of
more than one dose of antimicrobials in patients with uncomplicated appendicitis.A maioria das infecções intra-abdominais, como apendicite aguda, necessita de intervenção cirúrgica. O uso de antimicrobianos, entretanto, é fundamental na complementação do tratamento e redução de infecção do sítio cirúrgico (ISC). O presente estudo tem como objetivo fazer uma análise crítica entre o uso de antimicrobianos, o estádio anátomo-patológico e infecção do sítio cirúrgico após apendicectomia. Foram analisados os dados demográficos, esquema de antimicrobiano escolhido, início do antimicrobiano, tempo de uso e evolução quanto a ISC associada com o estádio anátomo-patológico dos apêndices ressecados. Foram avaliados 233 pacientes entre 14 anos e 78 anos, com predominância do sexo masculino (135 / 57,94%) e na terceira década de vida (72 / 30,90%). Em 139 pacientes (59,63%) o tempo cirúrgico foi de uma a duas horas, com predominância da Apendicite Aguda Flegmonosa (91 / 39,05%) e Apendicite Aguda Necrosante, (88 / 37,76%). O esquema antimicrobiano mais utilizado foi a associação de Ampicilina /Sulbactam, totalizando 127 (54,50%) pacientes. A maioria dos pacientes teve o início do esquema antimicrobiano à indução anestésica, (212 / 90,94%). Em relação ao tempo de uso do antimicrobiano, a prevalência foi de menos de 24 horas de uso, (122 / 52,36%) e 14 (6,01%) apresentaram ISC. Baseado na classificação anátomo-patológica em apêndices não-necrosados, 145 (62,24%) pacientes deveriam ter usado antimicrobiano em dose única ou no máximo por 24 horas. Dos pacientes com apêndice não-necrosados apenas 60 (41,37%) usaram uma dose; 15 (10,34%) usaram de 2 a 4 doses e 70 (48,29%) usaram mais de 4 doses de antimicrobianos. Em 16 (6,87%) pacientes considerados com o apêndice normal foram usadas mais de 4 doses de antimicrobianos. Na análise das ISC sob perspectiva do Índice de Risco de Infecção Cirúrgica (IRIC), nenhum paciente com IRIC 0 apresentou ISC; (4 /5,79%) dos pacientes com IRIC 1 apresentaram ISC;( 9 / 5,88%) dos pacientes IRIC 2 apresentaram ISC e (1/ 12,5%) IRIC 3 apresentaram ISC. Baseado na associação entre o anátomo-patológico (necrosados e não necrosados) dos apêndices ressecados por suspeita clínica de apendicite aguda e o uso de antimicrobianos, podemos concluir que: houve uso desnecessário de mais de uma dose de antimicrobianos nos pacientes com apendicite não complicada.
Mestre em Ciências da Saúde
22
Gudelis, Mindaugas. « Estudio de un nuevo algoritmo de diagnóstico de dolor en fosa ilíaca derecha en el servicio de urgencias y validación de algoritmos clásicos de diagnóstico de la apendicitis aguda ». Doctoral thesis, Universitat de Lleida, 2014. http://hdl.handle.net/10803/286225.
Texte intégralRésumé :
Introducció: Actualment els clínics dels serveis d’urgències no disposem d’un model de diagnòstic de dolor de la fosa ilíaca dreta (FID).
Objectiu: Construcció d’un model senzill basat amb arbres de classificació (CHAID) i model de xarxa neuronal artificial (XNA) que combini els models clàssics, marcadors d’inflamació, característiques del pacient i clínica del dolor en FID a Urgències.
Metodologia: Estudi prospectiu observacional on s’inclogueren pacients majors de 14 anys que van acudir al servei d’urgències de l’hospital Universitari Arnau de Vilanova de Lleida per dolor a la FID, de més de 6h d’evolució. Durant el temps d’estudi a tots se’ls hi van recollir les principals característiques demogràfiques, es van determinar els nivells de leucocits , proteica C reactiva (PCR) i les variables referents a la clínica i exploració física que formen els models clàssics de diagnòstic de d’apendicitis aguda (AA). Construcció d’un model multivariable multinominal amb metodologia CART (Clasification and Regression Trees, selecció automàtica amb jerarquia de variables, punts de tall de variables continues i sistema de validació creuada). Valoració mitjançant anàlisis ROC ( AUC (CI 95%)).
Resultats: Es van recollir 252 casos, 53% eren homes. Edat mitjana 33.3-16 anys. Diagnòstics finals en 4 grups:1 - Dolor simple en FID (dFID) 45%, 2 - Apendicitis aguda (AA) 37%, 3 - Dolor abdominal sense procés infamatori (DACPI) 12%, 4 - Dolor abdominal amb procés inflamatori (DACPI) 6%. Rendiment dels models senzills: Alvarado score (ALS) amb 0.82(0.76-0.87) i PCR amb 0.83(0.77-0.88), Fenyö-Linberg score (FLS) amb 0.88(0.84-0.92). Model XNA determina 4 grups de diagnòstics amb probabilitat: dFID de 0,92(0,88-0,96), AA de 0.95(0.91-0.98), DASPI de 0.92(0.84-0.99) i DACPI de 0,84(0,70-0,99). El CHAID selecciona les variables ALS, PCR, gènere, hores d’evolució de la clínica i dolor amb la tos. El CHAID determina 10 grups de pacients (regles de decisió): 3 amb probabilitat de DFID (71,1-84,4-87%), 5 amb probabilitat e AA (52-52,6-72,7-72,7-94,1%) i 1 amb probabilitat de DASPI 60% i 1 sense probabilitat individual superior al 50%. L’AC aconsegueix un rendiment per a DFID de 0.89(0.85-0.93), per a AA de 0.93(0.90-0.96),, per a DASPI de 0.86 (0.81-0.92) i per a DACPI de 0.82(0.73-0.90).
Conclusions: Per separat, el rendiment diagnòstic dels scores clàssics o de la PCR és insuficient per estratificar la probabilitat diagnosticada en pacients amb dolor en FID. La metodologia basada en CHAID ofereix una eina senzilla per establir a urgències grups de pacients amb diferent ris diagnòstic. El model XNA aconsegueix classificar als pacients però te una interpretació nul·la de la red obtinguda. El CHAID troba grups amb una altra probabilitat de AA i de dFID. Els pacients amb dubtes de diagnòstic es beneficiaran de més probes diagnòstiques i/o període en observació.Introducción: Actualmente los clínicos de los servicios de urgencias no disponemos de un modelo de diagnóstico de dolor en fosa ilíaca derecha (FID). Objetivo: Elaboración de un modelo de diagnóstico sencillo basado en árboles de clasificación (CHAID) y en un modelo de red neuronal artificial (RNA) que combine los modelos clásicos, los marcadores de inflamación sistémica y las características del paciente que presenta clínica de dolor en FID en Urgencias. Metodología: Estudio prospectivo observacional en el que se incluyeron pacientes mayores de 14 años que acudieron a servicio de urgencias del Hospital Universitario Arnau de Vilanova de Lleida por dolor en FID de más de 6 h. de evolución. Durante el tiempo de duración del estudio se recogieron una serie de parámetros a todos los pacientes entre los cuáles destacan sus características demográficas, nivel de leucocitos y proteína C reactiva (PCR) en suero junto a variables clínicas y de exploración física que determinan los modelos clásicos de diagnóstico de apendicitis aguda (AA). Se construyó un modelo multivariable multinomial con metodología CART (Clasification and Regression Trees, selección automática con jerarquía de variables , puntos de corte de variables continuas y sistema de validación cruzada). Valoración mediante análisis ROC -AUC(CI 95%)-. Resultados: Se obtuvo una N= 252 casos. La distribución por sexo fue 53% hombres y 47% mujeres. Edad media 33.3±16 años. Los diagnósticos finales obtenidos se clasificaron en 4 grupos con la siguiente distribución: 1- Dolor simple en FID (dFID) 45%, 2- Apendicitis aguda (AA) 37%, 3- Dolor abdominal sin proceso inflamatorio (DASPI) 12%, 4- Dolor abdominal con proceso inflamatorio (DACPI) 6%. Rendimiento de los modelos sencillos: Alvarado score (ALS) con 0.82(0.76-0.87) y PCR con 0.83(0.77-0.88), Fenyö-Linberg score (FLS) con 0,88(0,84- 0,92). Modelo RNA grupos diagnósticos con la siguiente probabilidad: dFID de 0,92(0,88-0,96), AA de 0,95(0,91-0,98), DASPI de 0,92(0,84-0,99) y DACPI de 0,84(0,70-0,99. El CHAID selecciona las variable ALS, PCR, género, horas de evolución de la clínica y dolor con la tos, determinando 10 grupos de pacientes (reglas de decisión): 3 con probabilidad de dFID (71,1-84,4-87%), 5 con probabilidad de AA (52-52,6-72,7-72,7-94,1 %) y 1 con probabilidad de DASPI 60% y 1 sin probabilidad individual superior al 50 %. El AC consigue un rendimiento para dFID de 0.89(0.85-0.93), para AA de 0.93(0.90-0.96), para DASPI de 0.86(0.81-0.92) y para DACPI de 0.82(0.73-0.90). Conclusiones: Por separado, el rendimiento diagnóstico de los scores clásicos o de la PCR es insuficiente para estratificar la probabilidad diagnóstica en pacientes con dolor en FID. La metodología basada en CHAID ofrece una herramienta sencilla para establecer en Urgencias grupos de pacientes con distinto riesgo diagnóstico. El modelo RNA consigue clasificar a los pacientes pero tiene nula interpretación de la red obtenida. El CHAID encuentra grupos con alta probabilidad de AA y de dFID. Los pacientes con dudas diagnósticas se beneficiarán de más pruebas diagnósticas y/o período de observación.
Introduction: Nowadays, the professionals of emergency departments do not have the diagnostic algorithm for right iliac fossa pain (RIF). Objectives: Construction of simple diagnostic algorithm for RIF pain based on Classification Tree and Artificial Neural Network (ANN) methods, which combines classical models for diagnosis acute appendicitis, inflammatory markers, patient characteristics and clinic RIF pain in Emergency Department. Methods: The prospective observational study, which includes patients, older then 14 years, with RIF pain who were admitted in Emergency Department of University Hospital Arnau de Villanova of Lleida. The signs, symptoms, laboratory values and pathology reports of each patient were collected and evaluated. The construction of multinomial multivariable model was done using CART methodology (Classification and Regression Trees, autonomic selection of hierarchy of variables, cutoff points of continuous variables and cross-validation) and Artificial Neural Network (ANN) method. Valuation was done using ROC analysis (AUC (95% CI)). Results: Out of total 252 patients, 53% were males. The age ranged 33.3±16 years. Final diagnosis we divided in 4 groups: 1- (NsP) Nonspecific RIF pain (45 %), 2 – (AA) Acute appendicitis (37%), 3 - (NID) other abdominal disease without inflammation (12%), 4 - (IBD) Inflammatory bowel disease (6.0 %). Efficiency of simple models: Alvarado score (ALS) 0,82(0,76- 0,87) and C-reactive protein (CRP) 0,83(0,77-0,88), Fenyö-Linberg score (FLS) 0,88(0,84-0,92). The CT selects the variables of ASS, CRP, sex and duration of the clinical symptoms determining 7 groups of patients (application of decision rules): 3 groups of probability of AA (59,3-62,5-90,5%), 2 with probability of NsP (68,9-82,6 %) and 2 without probability superior then 50%. The CT shows the efficiency for AA of 0,89 (0,85-0,93), NsP 0,84 (0,79-0,89), IBD of 0,84 (0,78-0,90) and for NID 0,66 (0,57-0,75). Conclusions: The classic score and CRP have insufficient diagnostic efficiency to stratify the diagnostic probability to patients with right iliac fossa pain. The methodology based on CHAID offer us the simple way to establish the groups of patients with different diagnostic in Emergency Department. The ANN method obtains to classify the patients but it has no interpretation. The decision tree technique finds high probability of the groups with AA and NsP. The patients with questionable diagnostic will benefit of another diagnostic proofs o longer observation period.
23
ERCULIANI, Elena. « Appendicite acuta in età pediatrica : livello di acido 5-idrossindolacetico urinario per la diagnosi precoce ». Doctoral thesis, 2010. http://hdl.handle.net/11562/343193.
Texte intégralRésumé :
Background: L’appendicite acuta rappresenta tutt’ora la più frequente urgenza addominale anche in età pediatrica. Non esiste un singolo test laboratoristico altamente sensibile e specifico che possa da solo discriminare l’appendicite acuta dalla altre cause di dolore addominale in età pediatrica. L’appendice è ricca di cellule serotoninergiche (cellule enterocromaffini). Durante il processo infiammatorio la serotonina viene rilasciata e rapidamente metabolizzata a livello epatico in acido 5-idrossi indolacetico (5-HIAA) e successivamente secreto nelle urine.
Methods: 5-HIAA è stato dosato tramite HPLC nel campione urine spot di 99 pazienti, di cui 45 femmine (età media 129 ± 31 mesi) e 54 maschi (età media 117 ± 27 mesi), ricoverati presso il reparto di Chirurgia Pediatrica di Verona con quadro clinico compatibile con appendicite acuta.
Conclusion: la determinazione dell’5-HIAA urinario può diventare un test pratico e non invasivo per la diagnosi precoce di appendicite acuta. Ulteriori studi clinici sono tuttavia necessari per raccogliere ulteriori informazioni su questo test.Background: Acute appendicitis is the most common abdominal emergency also in childhood. There is no reliable single laboratory marker that we can use to detect early inflammation of the appendix. The appendix contains serotoning-producing cells. During the inflammation process serotonin is released and converted to 5-HIAA (5 hydroxy indole acetic acid). Methods: urinary 5-HIAA was measured by HPLC in the spot urine of 99 children, 45 female (mean age 129 ± 31 months) and 54 male (mean age117 ± 27 months), who present acute abdominal pain suspected to be acute appendicitis, in the Department of Pediatric Surgery of Verona. Conclusion: spot urine 5-HIAA determination may be a practical and non-invasive method in the early diagnosis of acute appendicitis. Clinical studies are necessary for further information about this test.
24
Huang, Hui-Chu, et 黃慧珠. « The Prediction System for Acute Appendicitis ». Thesis, 2008. http://ndltd.ncl.edu.tw/handle/56776577586492915003.
Texte intégralRésumé :
碩士南台科技大學
企業管理系
96
Acute appendicitis is a disease in common and causes acute abdominal pain which is easily mixed up by other abdominal or intestines and stomach diseases. Therefore, it is difficult to make a diagnosis due to the symptoms of acute appendicitis as diverse and changeable. The MANTRELS is an accessory tool for predicting the occurrence of acute appendicitis. In order to understand its efficacy in predicting Taiwanese patients, this study employs the rationale of the MANTRELS, designs a multi-tally system, and conducts an empirical study of validating it with Taiwanese cases. The findings support the efficacy of the MANTRELS created in 1986 while applied to analyze the 716 cases in this study. In order to enhance the efficacy of predicting acute appendicitis, this study employs C4.5 and logistic regression to construct predictive models. The experiement results show that both the C4.5 model and logistic regression model achieve better performance than the MANTRELS does in terms of predicting acute appendicitis. C4.5 decision tree is more sensitive than logistic regression in terms of the size of training data and variable types.
25
Bervell, Joel. « The use of antibiotics vs. appendectomies for uncomplicated acute appendicitis ». Thesis, 2019. https://hdl.handle.net/2144/36682.
Texte intégralRésumé :
BACKRGOUND: Appendicitis is the condition in which the appendix, a finger-length appendage located in the right lower quadrant (RLQ) of the abdomen, becomes inflamed due to a bacterial infection. Every year, nearly 300,000 cases of appendicitis are diagnosed at hospitals and clinics throughout the United States. In the U.S., the current standard of care for appendicitis is an appendectomy; surgery that completely removes the appendix from the body. Numerous studies in Europe, however, have demonstrated that antibiotics can be an equally safe and effective treatment for treating appendicitis. This clinical research study hypothesizes that antibiotics for intra-abdominal infections like appendicitis can be an effective treatment.
METHODS: Patients that met eligibility were randomized to either antibiotic treatment or appendectomy treatment. If patients decided not to randomize, they had the option to join the Electronic Medical Record (EMR) cohort in which they could choose the treatment that they received. Patients in both cohorts were followed along via EMRs for the span of two years after initial treatment. Individuals who consented to the randomization group also received follow-up phone calls at specified points in time.
RESULTS: A total of 374 patients were approached between March 2016 – March 2018. 100 patients consented to the randomization group and 118 patients elected into the EMR group. In the randomization group, 49 patients were randomized to appendectomy and 51 were randomized to antibiotic treatment. 21 patients in the antibiotic treatment group (41.1%) returned back to the hospital within two years of their index visit for an appendectomy. From the EMR cohort, 109 patients chose to receive appendectomies, and 9 patients received antibiotics.
CONCLUSION: Treatment with antibiotics can serve as an alternative to surgery. However, due to the recurrence rate of 41% after two years, antibiotics should only be used as a means to delay permanent treatment. If a patient’s current situation is not immediately life-threatening, they should be granted the option to decide whether they would prefer to take antibiotics or elect into surgery.2021-06-14T00:00:00Z
26
Gonçalves, Raquel Reis Lima. « Post-operative antibiotic duration in acute complicated appendicitis management ». Master's thesis, 2017. https://hdl.handle.net/10216/104691.
Texte intégral
27
Gonçalves, Raquel Reis Lima. « Post-operative antibiotic duration in acute complicated appendicitis management ». Dissertação, 2017. https://hdl.handle.net/10216/104691.
Texte intégral
28
Frank, Lora. « The reliability of iridology in the diagnosis of previous acute appendicitis, as evidenced by appendectomy ». Thesis, 2012. http://hdl.handle.net/10210/5233.
Texte intégralRésumé :
M.Tech.Iridology is defined as a science that identifies pathological and functional changes within organs via assessing the iris for aberrant lines, spots, and discolourations (Medow, 2000). According to iridology, the iris does not reflect changes during anaesthesia, due to its inhibitory effect on nerves impulses, and in cases of organ removal, it reflects the pre-surgical condition (Jensen, 1986). The Homoeopathic profession is frequently associated with iridology and in a recent survey by Rostovsky et al. (2009) investigating the perceptions of Masters of Technology graduates in Homoeopathy on the existing programme offered by the University of Johannesburg, iridology was highly regarded as a potential additional skill requirement for assessing the health status of the patient. This was a randomized and controlled quantitative study. The study aimed to assess the reliability of iridology in the diagnosis of previous acute appendicitis, as evidenced by appendectomy. A total of 60 participants took part in the study. Of the 60 participants, 30 had had an appendectomy due to acute appendicitis, and 30 with their appendix intact with no prior history of appendicitis. All participants were recruited on the premises of Rita Frank Optometrists. Each participant signed a Participant Information and Consent Form (Appendix E) and a Consent Form to Photograph the iris (Appendix F). Thereafter the researcher obtained the information required in a private setting (Appendix G). Afterwards each participant’s right iris was documented by photograph with the use of a specialist non-mydriatic retinal camera (Canon EOS-20D), reset for the iris, by the researcher. The photographs were then randomized by an external person and no identifying data made available to the three raters. The raters included the researcher and two practising iridologists. Data was obtained from the analyses of the photographs wherein the presence or absence of lesions (implying acute appendicitis) was indicated by the raters. All the data was captured into an Excel spreadsheet (Appendix H) and sent for statistical analysis. vi None of the three raters showed a significant success rate in determining correctly who had had acute appendicitis and resultant appendectomies and who had not. The outcome of this study indicated an outcome that was subject to chance. The null hypothesis that states that appendectomy due to acute appendicitis does not manifest in a corresponding lesion in the typical organ area of the eye, is supported. It is in the opinion of the researcher that the association of iridology with homoeopathic practice may harm the credibility of the profession and that further research on iridology is needed to disprove this conviction.
29
Kopsch, Ulrike. « Akute Appendizitis - Verlässligkeit der präoperativen Diagnostik, chirurgisches Management und Vergleich des intraoperativen und histopathologischen Befundes ». Doctoral thesis, 2016. http://hdl.handle.net/11858/00-1735-0000-0028-87C3-B.
Texte intégral
30
Chuang, Wei-Yao, et 莊惟堯. « Supporting Acute Appendicitis Diagnosis : a Pre-Clustering-Based Classification Technique ». Thesis, 2010. http://ndltd.ncl.edu.tw/handle/49241393172954793903.
Texte intégralRésumé :
碩士國立嘉義大學
資訊管理學系碩士班
98
Due to the rising cost and increasing service quality demand on medical field, how to save on unnecessary medical expenses is an important issue and challenge. Acute appendicitis which is a common surgical condition requires timely and accurate diagnosis. However, because the symptoms of acute appendicitis are diverse and atypical, it is difficult to diagnose. While prior research has recognized the use of classification technique to support acute appendicitis diagnosis, the skewed distribution of the instances in different classes has negative influence on prevalent classification technique. In this research, we propose a pre-clustering-based classification (PCC) technique to address the skewed distribution problem common to acute appendicitis diagnosis. For the evaluation of PCC, we adopt the dataset which contains 574 clinical cases of positive and negative acute appendicitis obtained from a medical center in Taiwan. Our evaluation includes tradition support vector machine, synthetic minority over-sampling technique, multi-classifier committee, Alvarado scoring system, and under sampling for performance benchmark purposes. Our result show that the PCC technique is able to reduce the negative effect of skewed distribution problem. In comparison with the benchmark techniques, PCC technique presents an improvement on prediction.
31
Huang, Te-Chia, et 黃德佳. « A Data Mining Approach to The Diagnostic Assistance of Acute Appendicitis ». Thesis, 2007. http://ndltd.ncl.edu.tw/handle/84191134914515181650.
Texte intégralRésumé :
碩士南台科技大學
企業管理系
95
Acute appendicitis is the most common disease, which needs surgical intervention, in the world. Although the treatment of acute appendicitis is simple and straightforward, its diagnosis is still difficult. No single laboratory or image examination can make the diagnosis of acute appendicitis more accurate. Therefore, it is still a challenge to physicians to reduce appendiceal perforation and negative appendectomy rates. Traditionally, history taking and physical examination are still very important in appendicitis diagnosis. Due to the raise of human resource cost, unavailability of experienced physicians and requirement of medical quality, the accuracy of appendicitis diagnosis should be improved with new low-cost methods. For this reason, many methods, including new high resolution image tools and laboratory examination, have been used to raise the diagnostic accuracy of acute appendicitis. However, the results are not satisfied. The information technology may provide alternative approaches to acute appendicitis diagnosis. In this study, the classification approach and committee machine are applied to build a prognostic model to provide a economical diagnostic assistance for acute appendicitis. The results of this study should be helpful to the development of the computer-aided system in the other medical field.
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Lin, Shih-Pin, et 林師彬. « The Study on the Diagnosis of Acute Appendicitis from the Meridian Theory ». Thesis, 2004. http://ndltd.ncl.edu.tw/handle/54327178942404629744.
Texte intégralRésumé :
碩士中國醫藥大學
中國醫學研究所
92
Acute appendicitis is the most common acute abdominal diseases nowadays. There are 49030 patients who were diagnosed as acute appendicitis during 2002 in Taiwan. Since the clinical presentation is variable, only 80% can be diagnosed correctly. The complications including intestinal perforation , abscess ,and sepsis are life threatening. Our study is aimed to diagnose acute appendicitis in early stage. After collecting a serial of traditional Chinese medical methods, we use meridian theory to compare and analyze the clinical presentation in acute appendicitis and the result reveals that the traditional Chinese medical doctors can diagnose accurately in early stage by inspection, palpation. Their experiences may offer us inspirations especially in clinical course and prognosis . Our conclusion is that by combining western medical techniques and traditional meridian theory, we may raise the accurate diagnostic percentage and prevent patients from severe complications.
33
Tseng, Yu-Chi, et 曾毓淇. « Applications of Bayesian Network in Evaluating Acute Appendicitis in the Emergency Department ». Thesis, 2009. http://ndltd.ncl.edu.tw/handle/94312528133947270048.
Texte intégralRésumé :
碩士臺北醫學大學
醫學資訊研究所
97
Background: Appendicitis is the most common surgical emergency in the Worldwide. But it has been estimated that the accuracy of the clinical diagnosis of acute appendicitis is only between 76 percent and 92 percent. So, improving the diagnosis of acute appendicitis in order to prevent unneeded surgery is a critical topic that has been debated often. Over the years various clinical scoring systems (some computer assisted) have been used, but it concluded that the rate of misdiagnosis of acute appendicitis still has not changed over the last twenty years. So we selected some key clinical problems of acute appendicitis and try to evaluate and construct inference process overall using Bayesian Network in this study. Objectives: Because of delay or mistake in diagnosis and inference will leads to increased rates of morbidity and mortality, the purpose of this study was to evaluate and construct inference process overall using Bayesian Network. On the other hand, we also hope to evaluate the feasibility and suitability of Bayesian networks for predicting variant variables for the patients with acute appendicitis in this study. Methods: We included patients presenting to the ED during a 30 -months period ( January 1, 2005 – June 30, 2007 ) and were assigned a coded final ED visit diagnosis as acute appendicitis, and received operation. Then we collect 14 variables that are commonly available during ED and hospitalization period as following: sex, age, temperature, shifting pain, anorexia, diarrhea, nausea, WBC level, hsCRP level, pathologic reports, undergo CT, symptom signs to operation period, operation type, length of hospitalization, and then modeling a Bayesian Network using these variables. Finally, for the purpose for realizing the outline and inference process overall of above key clinical problem, we try to observe some definite variables in the network and can understand the relationslip of them. Results: The result of this study revealed that no specific clinical difference compared with Bayesian Network inference model and traditional statistical outcome as we know. For example: longer symptoms onset to operation period will lead to longer length of hospitalization period; more severe pathologic state will mean longer length of hospitalization period and increasing rate of open appendectomy. Conclusions: The accuracy of diagnosis of acute appendicitis in the emergency department using the traditional approach has been shown to be less than fifty percent, and the result of this study revealed that Bayesian analysis was seen a suitable approach to the important clinical problems of analysis of acute appendicitis in the Emergency Department. So this study demonstrated that a BN can be applied to evaluate acute appendicitis using routinely available electronic data in the emergency.
34
Lin, Hsing-Lin, et 林杏麟. « Analysis of Factors Related to Cost of Emergency Medical - Taking One Medical Center’s Pneumonia, Acute Myocardial Infarction, Acute Appendicits and Acute Cholecystitis as an Example ». Thesis, 2008. http://ndltd.ncl.edu.tw/handle/75055554187742960248.
Texte intégralRésumé :
碩士高雄醫學大學
醫務管理學研究所碩士在職專班
96
Objective：The Bureau of National Health Insurance of Taiwan introduced the Global Budget System into the healthy system step by step to control the increasing expansion of medical expenses. In this system, dentists, traditional and western medicine practicers are all included, and the medical expenses applied from the Bureau of National Health Insurance are limited. To establish the strategy for the impact of the policy, all hospital and clinic had developed their own plans. Transferring the patients was adopted by the clinic and small hospitals to control the cost. Some hospitals would control the admission, personal budget for the physician and limitation the numbers of patients to the clinic. The results of the effect forced the patients to emergency room of larger hospitals. However, due to the larger hospitals could not refuse the patients by laws and medical ethics, the patient would flow out the emergency room and might damage the emergency system. But in the system, the total budget for a hospital is fixed, and the expense of patients treated in the emergency room is also included in the hospital budget. The increasing of the emergency fee will compromise the other departments’ budget. Therefore, the whole finance of the hospitals do not improve by the policy of the hospitals. Therefore, the issue of the strategy for the big hospital is worth to confer and research. Methods：Our study was based on the data bank of a medical center. We tried to find the relation and different of the age, length of stay in emergency department, cost in the emergency department, fee of admission, the length of admission and total cost of admission in the fours disease, acute appendicitis, cholecystitis, acute myocardial infraction and pneumonia. Finally, we proposed a Hour-Medical Expenditure to compare different diseases’ medical expenditure. Results：In the four diseases, the different diseases, patient’s age, the length of stay in emergency department and the length of admission could be the predictors of the emergency expenditure. Conclusion and Suggestion：The cost of emergency medicine is an important part of the whole medical expense. If control the expenditure of the emergency, relatively, we can reduce the whole medical expenditure. Emergency expense has positive correlation with length of stay of emergency department. The longer length of stay of emergency department, the more cost will be spent in emergency and medical expense. Under the global budget, it is not efficiency to treat patient in the emergency department. Because it will increase the medical cost but substantially no benefit to the hospitals and patients because the patient finally should admission to hospital for further treatment. Control of hospital bed occupancy is not a good policy to control global budget, except others special consideration. Reduced the length of stay in emergency department is the effective way of medical recourses utility and control the medical expenditure.
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Kirzinger, Wolfgang J. Guthy Erik. « Treffsicherheit der Diagnose Appendicitis acuta : eine retrospektive Analyse unter besonderer Berücksichtigung der Qualifikation des diagnostizierenden Chirurgen / ». 2005. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=015034324&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
Texte intégral
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Huang, Shih-Ya, et 黃詩雅. « Application of Two-Stage Data Mining Techniques for the Diagnosis of Acute Appendicitis ». Thesis, 2015. http://ndltd.ncl.edu.tw/handle/63445234030004799704.
Texte intégralRésumé :
碩士國立雲林科技大學
工業工程與管理系
103
Acute appendicitis is one of the main reasons that causes acute abdominal pain. There is a 7 percent chances that a person diagnosed with acute appendicitis. Both severity and time span is hard to predict. Traditionally, the doctors usually need to face the patient in order to conduct further diagnostic assessment, however, assessment as such don’t tend to provide an efficient result as past reports indicate that 15 to 30 percent of appendectomies are still negative. Therefore, this study applies the method of data mining to create a better way to diagnose acute appendicitis. This study uses 2005 patient files which include the case of Yeh Jehn-Shan. First the study applies data mining method by using the K-Means and Fuzzy C-means clustering technique. After that, the study then uses the classification methods: the Decision Tree, Back Propagation Neural Networks, Support Vector Machine establish prediction model to try to compare and figure out if indeed the two staged data mining methods of unsupervised and supervised works to improve the prognosis of acute appendicitis. The result indicates that is combined with the two-stage data mining techniques model enhance the ability to predict appendicitis classification effectively then using the integrated model is better than the individual classification model. The best model is combined with K-means and Back Propagation Neural Networks, and the accuracy reaches 94.74%, the sensitivity reaches 0.965, the specificity reaches 0.928. Ultimately a more efficient prognosis format will improve the diagnosis of acute appendicitis for the doctors; as for the patients, it will lower the chances of miss-diagnosis and the possible increase of medical costs, which most importantly upgrades the quality of medical health care.
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chin, lengsu william, et 陳連書. « THE ROLE OF LEUCOCYTE COUNT AND C-REACTIVE PROTEIN IN DIAGNOSIS OF ACUTE APPENDICITIS ». Thesis, 2001. http://ndltd.ncl.edu.tw/handle/61673202556463358495.
Texte intégralRésumé :
碩士中山醫學大學
醫學研究所
90
ABSTRACT PURPOSE: The aim of this research was to study the role and important of leucocyte count and C-reactive protein in clinical suspicious of acute appendicitis. METHODS: We performed a retrospective study of 420 cases, which underwent operation under the impression of acute appendicitis by clinical data and with a mean age of 34.12 years. The diagnosis of acute appendicitis was confirmed by pathology of the removed appendix vermiformis. According the pathological reports, it was divided into three groups: (Group A) uninflamed appendix vermiformis (n=149), (Group B) simple acute appendicitis (n=202), and (Group C) acute gangrenous appendicitis (n=69). Each group was compared by mean values of leucocyte count and C-reactive protein by using two-sided Student’s t-test. RESULT: The mean values and standard deviation of leucocyte count and C-reactive protein in each group are: Group A WBC (13967/μl ± 5334)， CRP (3.67mg/dl ± 4.93), Group B WBC (14803/μl ± 4381)， CRP (3.99 mg/dl ± 6.41), and Group C WBC (15068/μl ± 3423)， CRP (4.99 mg/dl ± 3.77). The leucocyte count and C-reactive protein increase in simple acute appendicitis, and acute gangrenous appendicitis group but not significant when compare to the uninflamed appendix group by using Student’s t-test. CONCLUSION: Leucocyte count and C-reactive protein are not a good inflammatory serum marker for clinical suspicious of acute appendicitis. Neither normal nor increase in leucocyte count and C-reactive protein could suggest the possibility of acute appendicitis.
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Mai, Nguyen Thi Tuyet, et 阮氏雪梅. « Clinical Manifestations Of Acute Appendicitis Among Elderly At Nguyen Tri Phuong Hospital, Ho Chi Minh ». Thesis, 2014. http://ndltd.ncl.edu.tw/handle/84495170183980698569.
Texte intégralRésumé :
碩士美和科技大學
健康照護研究所
102
Abstract Background: Acute appendicitis (APP) is a less common cause of abdominal pain in elderly patients than in younger patients, but the severity among elderly patients appears to be higher. Diagnosing an elderly patient who presents with abdominal pain due to APP is a difficult challenge due to atypical manifestations, comorbidities and socio-behavioral factors which are associated with this group of patients. Therefore, identification clinical presentation of patients with APP is crucial to improve punctuation and accuracy of APP diagnosis. In Nguyen Tri Phuong Hospital, the diagnostic procedure of APP although is available, the rate of misdiagnosis of APP in the elderly is surprisingly up to 18%. The reason for misdiagnosis is largely due to the fact that physicians are lack of experience of recognizing clinical presentations of APP in elderly patients; nevertheless, there are not any studies identifying clinical manifestations of APP in elderly in the hospital setting. Objective: The primary purpose of the present study is to identify all medical history, physical examinations and laboratory findings related to APP and their relationships with the occurrence of APP in elderly patients who are hospitalized and treated at Nguyen Tri Phuong Hospital. Methods: A retrospective study was carried out at Nguyen Tri Phuong Hospital with a total of 130 older patients with APP in Nguyen Tri Phuong Hospital. Medical records of participants were reviewed to explore all clinical presentation of participants. The significance of the results was assessed by Chi-Square test at p-value of 0.05 using SPSS version 16. Results: In this study female accounted for large portion of study population (61.54%). The mean age of participants was 71.01 ± 7.4 with a range from 60 to 89. Most of patients were unemployed or did not work at all (88.46%). Kinh was the ethnic community predominant in the study (87.69%). More than half of patients (57.69%) had finished elementary of secondary school, while only 3.85% had the education of above high school. Regarding marital status, 67.69% patients had married and 25.38% were widows or widowers. The duration of symptom before admission to the hospital ranged from 1 to 14 days. Most of patients (84.62%) were indicated to operation of APP within 24 hours after admission. Regarding clinical symptoms, all of patients complained about abdominal pain, of whom right iliac fossa is the most common position of abdominal pain (58.46%), followed by the abdominal pain at the epigastric position (45.38%). There were 45.38% patients reported the pain shift. Other common symptoms followed the abdominal pain were nausea or vomiting (15.38%) and diarrhoea (10%). Mild fever was found in only 22.31% of total patients, while 92.31% had positive Macburney’s point and 63.08% had tenderness. The mean WBC count was 13.93 ± 4.97 and the proportion of leukocytosis was 63.08%. The means of CRP was 51.41 ± 54.92. The proportion of glycaemia was 46.15%. The means of creatinine, SGOT, SGPT were 87.05 ± 23.07, 30.00 ± 19.9, 27.91 ± 21.34, respectively. There were no association had been found between clinical symptoms and background profile of patients. Conclusion: Among patients, hypertension and diabetes were two most common comorbid diseases those patients had 50% and 11.54%. The most common symptoms were abdominal pain (100%), nausea/votmitting (15.38%), and diarrhoea (10.00%). Macburney’s point and tenderness were found to occure more frequent among patients (92.31% and 63.08%) than fever (22.31%). Leukocytosis was identified in 63.08% of patients, while other laboratory tests were not specific for APP diagnosis. Recommendations: The findings showed that some common menifestations of APP in elderly population treated at Nguyen Tri Phuong Hospital could be used to create a set of criteria specific for diagnosis of APP in elderly. However, to make it come true, a further study comparing the realibility and validity of the set and other established scoring system such as Alvarado, Lintula must be carried out. Key words: acute appendicitis, clinical manifestation, elderly
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Chen, Chin-Yau, et 陳慶耀. « Study of bacteriology in acute appendicitis and the role of stomatin in breast cancer progression ». Thesis, 2013. http://ndltd.ncl.edu.tw/handle/88877563307960503904.
Texte intégralRésumé :
博士國立陽明大學
微生物及免疫學研究所
101
Background and objectives: Human epidermal growth factor receptor-2 (HER2) is overexpressed in 25%-30% of breast cancers. HER2 is preferentially localized in the lipid rafts, in which a major component is stomatin. This study aimed to elucidate the role of stomatin expression to the progression of HER2-positive breast cancer. Methods: The BT474 and SK-BR-3 are HER2-overexpressing breast cancer cell lines. The cell proliferation, migration and invasion were tested under overexpression and down-regulation of stomatin. Imunohistochemical staining of tissue samples from patients of infiltrating ductal carcinoma of breast were analyzed. Results: When stomatin is overexpressed in BT474, the proliferation and migration ability of the cells decreased. On the contrary, when stomatin was knocked down in the SK-BR-3, cell proliferation and migration were increased. In a total of 35 clinical cases of HER2-positive breast cancer, the absence of stomatin expression correlated with an older age, a more advanced stage, being estrogen receptor negative, and being progesterone receptor negative. The absence of stomatin expression was associated with a decreased 5-year-survival (14% vs. 93%, p&;lt;0.001) by survival analysis and was an independent prognostic factor by multivariate analysis. Conclusion: These results suggest that stomatin is a prognostic indicator for HER2-positive breast cancer.
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Tseng, Wan-ting, et 曾婉婷. « Knowledge Extraction for Decision of Performing Costly Medical xaminations：An Example of Computed Tomography for Acute Appendicitis ». Thesis, 2009. http://ndltd.ncl.edu.tw/handle/26921940824742363151.
Texte intégralRésumé :
碩士南台科技大學
企業管理系
97
Knowledge, the new competitive weapon of the 21ST century, will be also an important strategy of leading the enterprise competitiveness and management. With the introduction of knowledge management into each industry one after another, this trend has also become very popular in the medical industry. Under the operation pressure caused by National Health Insurance Policy, it leads the operation and management of hospitals to be specific. In order to survive under the critical managing environment, hospitals have adopted various methods to control their cost. Meanwhile, they also have to improve the quality of medical care to enhance their competitiveness, among which the adoption of clinical pathways is commonly used in the quality control of clinical medical care. The symptoms of acute appendicitis are volatile and difficult to confirm. The application of CT scan check-up on this illness can provide physicians useful and diagnostic information in details. Furthermore, it can help improve the accuracy of diagnosis and reduce the incidence of negative appendectomy rate. However, CT scan is the physical exam item at higher price. If setting any regulations with reason and distinction allows clinicians to follow, this will make important medical resources work more effectively, help hospitals to control the growth of medical cost, improve quality of medical care, assist the hospitals to describe clearly the need for high-expense health care, and reduce health insurance expenses deleted. This study follows the spirit of the establishment of clinical pathways to try to build up the appropriate rules of high-expense examination for the purpose of making the best use of medical resource to assist medical units and to improve the quality of medical care. This study adopts the evidence-based analysis of historical cases. The instructions of tomography from a large number of acute appendicitis cases are clearly extracted. Initially adopting the semi-automation , single-variable analysis, and the use of Alvarado appendicitis supporting score to extract some knowledge which the doctors decide to use from tomography examinations. The use of association rules technologies from data mining, along with the way of automation and analysis of multi-variable approach, explores the analysis of the history cases and summarizes the instructions about the tomography examination：When the age over 40-year-old and the sex is male, if the Alvarado scores gets more than 4 points, and then doctors can think about using CT scan to confirm the occurrence of appendicitis, or rule out suspected cases of appendicitis. They hope that all the useful and tacit knowledge hidden in a large number of historical cases can be converted to help determine the high-expense examination with explicit knowledge in the right time. Finally, it can enhance the control of the medical institutions over medical resources, quality ,and reach to make good use of medical resources under the goal of maintaining patient safety.
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Liu, Tsai-Ling, et 劉才綾. « Comparison of Perforation Rate among nationals and migrants/immigrants with Acute Appendicitis in Taiwan, 1996-2001 ». Thesis, 2008. http://ndltd.ncl.edu.tw/handle/91245312312611926115.
Texte intégralRésumé :
碩士國立陽明大學
公共衛生研究所
96
Background: Disparity in access to care is a critical public health concern. With globalization, immigrant population grows rapidly in recent years in many countries. Immigrant-related health care issues become more and more important, however, there are limited researches in Asia. Hence, this study aimed to assess possible disparity in access to care between migrants/immigrants and nationals under National Health Insurance in Taiwan. Method: National population-based data with patients whose age 20 or more in Taiwan under NHI were studied. Frequency of use and expenditures for ambulatory care, inpatient care and emergency care were analyzed separately. Rupture appendicitis was also analyzed as an outcome indicator of access to care. Two-part model and logistic regression were applied. Results: It showed that migrants/immigrants had significantly lower rate of health care utilization, particularly the gap remained consistently from year 1996 to 2001. On the other hand, no significant difference was found between nationals and migrants/immigrants under the NHI program in Taiwan (OR=1.01, 95CI: 0.93~1.11). Conclusion: This study found that although migrants/immigrants had significantly lower rate of health care utilization than nationals, but when they faced an acute, non-selective emergency condition, such as appendicitis, their rate of adverse outcome was not higher than nationals. Our findings suggest that using more dimensions of indicators may help to avoid possible misleading inferences in access to care.
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Yang, Kuo-Hung, et 楊國宏. « A Study of Feature Extraction with Back Propagation Neural Network and Support Vector Machine in Acute Appendicitis ». Thesis, 2014. http://ndltd.ncl.edu.tw/handle/52980058108551678513.
Texte intégralRésumé :
碩士國立雲林科技大學
工業工程與管理系
102
Appendicitis is the most common cause of acute surgical abdomen in Emergency Room (ER).In the early, the acute appendicitis are similar with peritonitis, genital diseases of female, gastrointestinal disease and urinary disease. According to the literature review the percentage of negative appendectomies has been reported to vary in 25% to50 %. The important factors that influence the acute appendicitis were applied based on the index of symptoms, signs and laboratory data were applied in feature extraction with principal component analysis. Also, back propagation neural network and support vector machines combined with principal component analysis were used to establish the prediction model for acute appendicitis. 188 appendectomy cases form regional hospital located in southern Taiwan from were used to test to proposed system by four-fold cross validation. The result indicates that the proposed back propagation neural network combined with integrated type of principal component analysis is the best method to predict acute appendicitis, and the accuracy reaches 95.74%. This computer aided clinical evaluation system can help the hospital to decrease the numbers unnecessary operation of the derivative cost and dissension, assist the doctor to balance the rate of ruptured or negative appendectomies and the uncertainty of operation, and reduce the anxiety for the patient and their family.
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Вітченко, Валентина Олександрівна. « Особливості загально-клінічних показників крові при гострих захворюваннях черевної порожнини ». Магістерська робота, 2020. https://dspace.znu.edu.ua/jspui/handle/12345/4149.
Texte intégralRésumé :
Вітченко В. О. Особливості загально-клінічних показників крові при гострих захворюваннях черевної порожнини : кваліфікаційна робота магістра спеціальності 091 «Біологія» / наук. керівник Н. В. Новосад. Запоріжжя : ЗНУ, 2020. 86 с.UA : Дана робота викладена на 86 сторінках друкованого тексту, містить 2 рисунки, 8 таблиць, 13 додатків. Перелік посилань включає 67 джерел, в тому числі іноземною мовою ‒ 20. Метою роботи було вивчення особливостей загально-клінічних та біохімічних показників крові хворих з гострими захворюваннями черевної порожнини в залежності від віку. Методи дослідження: загально-клінічні, біохімічні, статистичні. Матеріалом для дослідження була кров хворих на гострий апендицит, гострий холецистит, з перфорацією виразки шлунку або дванадцятипалої кишки. Встановлено, що у всіх обстежених підвищувався вміст лейкоцитів, нейтрофілів, ШОЕ, знижувався відсоток лімфоцитів. При гострому апендициті підвищувався вміст моноцитів, в 25-46 років – гемоглобіну, еозинофілів та глюкози. При гострому холециститі зростав рівень загального білірубіну, АЛТ, α-амілази, в 25-46 років – гемоглобіну, в 46-65 років– глюкози. При перфорації виразки в 36-55 років підвищувався рівень АСТ, в 46-55 років–еозинофілів, в 46-65 років – глюкози, в 36-45 років знижувався гемоглобін. Новизна роботи. Вперше проведено порівняльний аналіз загально-клінічних та біохімічних показників крові мешканців Запорізької області з гострими захворюваннями черевної порожнини, виявлено особливості змін в залежності від віку та нозологічної форми. Значущість роботи – pезультати дослiдження пошиpюють уявлення пpо стан хворих з гострими захворюваннями черевної порожнини, відображають їх особливості на догоспітальному етапі у різних вікових групах. Результати можуть бути використані хірургами для диференційної діагностики, підвищення результативності лікування та зменшення кількості ускладнень.
EN : This work is presented on 86 pages of printed text, contains 8 tables, 13 appendices. The list of references includes 67 sources, 20 of which are in latin. Work's purpose was studying the characteristics of clinical and biochemical indices of blood of patients with acute diseases of the abdominal cavity depending on age. Research methods: clinical, biochemical and statistical. The material for the research was the blood of patients with acute appendicitis, acute cholecystitis, with perforation of gastric or duodenal ulcers. It was discovered that all examined patients had the rise in the amount of leukocytes, neutrophils, ESR, and the decrease in the percentage of lymphocytes. In case of acute appendicitis level of monocytes increased, patients aged 25-45 years had an increase in hemoglobin, eosinophils and glucose. In case of acute cholecystitis amount of total bilirubin, ALT, α-amylase grew, patients aged 25-45 years had an increase in hemoglobin, 46-55 years – in glucose. In case of perforation patients aged 36-55 years had an increase in AST, 46-55 years –in eosinophils, 46-65 years – in glucose, patients aged 36-45 had a decrease in hemoglobin. Work’s novelty. a comparative analysis of clinical and biochemical indices of blood of patients living in Zaporozhye region with acute diseases of the abdominal cavity was conducted for the first time, characteristics of changes depending on age and nosological form were revealed. Work’s significance - the results widen a concept of condition of patients with acute diseases of the abdominal cavity, shows their characteristics at pre-hospital stage in different age groups. The results can be used by surgeons for the differential diagnosis, increasing the effectiveness of treatment and reducing the complications.
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Hsieh, Chung-Ho, et 謝忠和. « Reforming traditional clinical decision support tools with machine learning technique—application of random forests, support vector machines and artificial neural networks in diagnosis of acute appendicitis and risk assessment of breast cancer ». Thesis, 2012. http://ndltd.ncl.edu.tw/handle/a9kyxz.
Texte intégralRésumé :
博士國立陽明大學
生物醫學資訊研究所
101
Development of machine learning has significant progress in the last decades. The development of computing power consistently follows the Morre’s law—the number of transistors on a chip doubles approximately every eighteen months, so do the performance of a chip. Lots of algorithms have been developed and have been proved to be high performance in different fields. In contrast, most of the current clinical decisional support tools (CDSTs) were developed on the base of traditional methods. This leads to the hypothesis that new clinical decisional support tools built with machine learning technique may out-perform those with traditional methods. In this study, we try to use machine learning technique to develop CDSTs and apply them in two clinical scenarios, diagnosing acute appendicitis and estimating breast cancer risk, to prove our hypothesis. Acute appendicitis (AAP) is one of the most common conditions needing emergency operation, but clinical diagnosis of AAP is still difficult. One of the most common used traditional CDSTs in diagnosing AAP is the Alvarado score. We built 3 CDSTs with machine learning algorithms –random forests (RF), support vector machines (SVMs), and artificial neural networks (ANNs), and compared with the Alvarado score. Between January 2006 and December 2008, patients who had a consultation session with surgeons for suspected AAP were enrolled. Seventy-five percent of the data set was used to construct models, and twenty-five percent of the data set was withheld to evaluate model performance. The 3 models were compared with traditional logistic regression (LR) model and the Alvarado score. The area under the receiver operating characteristic curve (AUC) was used to evaluate performance. Data from a total of 180 patients were collected. The mean age of patients was 39.4 years (range 16-85). Final diagnosis revealed 115 patients with and 65 without appendicitis. The AUC of RF, SVMs, ANNs, LR, and Alvarado was 0.98, 0.96, 0.91, 0.87, and 0.77 respectively. RF performed better than ANNs, LR, and Alvarado. Breast cancer is a major cancer in the world. An accurate estimate of a woman’s breast cancer risk is very important for patient counseling and management. The Gail model is widely used for breast cancer risk assessment. We built 3 machine learning models with the same algorithms as previous study and compared with the Gail model. Between January 2010 and December 2010, women whose age between 40 and 69 and received breast cancer screening with sonography in Taipei City were enrolled. The primary result of sonography was categorized based on the Breast Imaging Reporting and Data System (BI-RADS). The BI-RADS category 1 and 2 were grouped as low risk group, and the BI-RADS category 4, 5 and 6 as high risk group. Fourteen input variables were used for model construction. One-third of the data set were used for training and two-thirds were used for testing. The models were built with RF, SVMs and ANNs. SMOTE and AdaBoost were also used in model construction. The performances of the models were evaluated with AUCs. There were totally 2601 candidates collected. The mean age was 46.3 years (range 40-69). The number of BI-RADs category 0, 1, 2, 3, 4, 5, and 6 was 84 (3.2%), 1251 (48.1%), 276 (10.6%), 32 (1.2), 5 (0.2%), and 28 (1.1%) respectively. The AUCs of RF, SVMs, ANNs, and Gail model was 0.92, 0.80, 0.57, and 0.55 respectively. RF also performed better than Gail model in this study. From above studies, we can demonstrate building better CDSTs with machine learning technique, which outperform the traditional CDSTs. The same technique can be applied to reform other traditional CDSTs. When combining with electronic medical record, it’s possible to provide better health care effectively via the well performed CDSTs built by machine learning technique.