Abstract:
:Background The relevance of ultrasound (US) in diagnosing acute appendicitis is controversial. The validity of US in comparison with other imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), is unclear, as is the difference between surgeon-performed ultrasound (SPUS) and radiologist-performed ultrasound (RPUS). On the basis of a review of current literature, our study aimed to develop a US-based algorithm to simplify the choice between additional diagnostic measures and surgery. Methods MEDLINE (PubMed®) was searched for literature published between 2010 and 2016. A total of 53 relevant full-text articles were eventually evaluated. Results Ultrasound (US) is an established part of algorithms used to diagnose acute appendicitis and has already replaced CT as the imaging technique of choice. The differences between SPUS and RPUS with regard to sensitivity, specificity, and positive and negative predictive values (PPV, NPV) are not statistically significant. The benefit of SPUS over RPUS is the simultaneous clinical assessment of the patient by the surgeon while the sonogram is performed (sonopalpation), which can increase diagnostic accuracy even further. Radiation exposure as a result of CT could be avoided or significantly reduced through the routine use of US, which is increasingly being used and is widely available. Conclusions SPUS should be the first imaging technique used to diagnose patients with suspected appendicitis. Additional diagnosis using CT or MRI is only recommended if sonographic imaging of the appendix is impossible in combination with specific clinical and laboratory criteria. A structured diagnostic approach with obligatory use of (SP)US, as described in the diagnostic algorithm, should be used for detection of acute appendicitis. :Hintergrund Der Stellenwert der Sonografie (Ultraschall, US) bei der Diagnostik der akuten Appendizitis ist umstritten. Unklar ist, welche Wertigkeit der US im Vergleich zu anderen bildgebenden Verfahren wie der Computertomografie (CT) und der Magnetresonanztomografie (MRT) besitzt, aber auch, ob zwischen chirurgisch durchgeführter Sonografie („surgeon-performed ultrasound“, SPUS) und der radiologischen Sonografie („radiologist-performed ultrasound“, RPUS) Unterschiede bestehen. Ziel unserer Studie ist es, anhand einer aktuellen Literaturrecherche einen US-gestützten Algorithmus aufzuzeigen, mit dessen Hilfe die Entscheidung zu weiterer Diagnostik oder Operation vereinfacht werden kann. Material und Methoden Es wurde eine Literaturrecherche in MEDLINE (PubMed®) der Jahre 2010 bis 2016 durchgeführt. Insgesamt wurden 53 relevante Volltextartikel ausgewertet. Ergebnisse Der US wird vielfach als integraler Bestandteil im diagnostischen Algorithmus der akuten Appendizitis eingesetzt. SPUS und RPUS unterscheiden sich in Bezug auf Sensitivität, Spezifität, positiv und negativ prädiktivem Wert (PPV, NPV) nicht statistisch signifikant. Der SPUS bietet gegenüber dem RPUS den Vorteil der simultanen klinischen Einschätzung des Patienten durch den Chirurgen während der sonografischen Untersuchung („Sonopalpation“), wodurch die diagnostische Treffsicherheit nochmals erhöht werden kann. Die Strahlenexposition durch CT konnte aufgrund des vermehrt eingesetzten und gut verfügbaren US bereits deutlich reduziert werden. Schlussfolgerung Der SPUS sollte als integraler Bestandteil eines strukturierten diagnostischen Algorithmus, wie beschrieben, bei allen Patienten mit Verdacht auf akute Appendizitis als erstes bildgebendes Verfahren zur Anwendung kommen. Nur bei nicht möglicher sonografischer Visualisierung der Appendix in Verbindung mit spezifischen klinischen und/oder laborchemischen Kriterien empfiehlt sich eine zusätzliche Diagnostik mittels CT oder MRT.
journal_name
Zentralbl Chirjournal_title
Zentralblatt fur Chirurgieauthors
Beltzer CR,Zischek C,Schmidt R,Friemert B,Achatz G,Palm HGdoi
10.1055/s-0043-114414subject
Has Abstractpub_date
2017-08-01 00:00:00pages
395-403issue
4eissn
0044-409Xissn
1438-9592journal_volume
142pub_type
杂志文章,评审abstract::In Germany, medical education is defined and controlled by the medical association; however hospitals are responsible for its implementation. Surgical trainees do not only need to acquire theoretical knowledge, but also practical skills. For years, young surgeons were trained primarily in the operating theatre. Nowada...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/a-0826-5097
更新日期:2019-12-01 00:00:00
abstract::Based on the example of the sigmoid resection, we did a cost-income analysis evaluating the particular expenses and effects of the new DRG-based medical financing system. We analysed the cost of diagnostic tests, medication and nutrition, surgery, personnel and non medical expenses for 20 open and 27 laparoscopic oper...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2004-820301
更新日期:2004-08-01 00:00:00
abstract::While laparoscopic cholecystectomy has become the procedure of choice for the elective treatment of symptomatic cholecystolithiasis the question whether patients with acute cholecystitis should be operated laparoscopically or conventionally is still debated. Nevertheless, more and more surgeons tend to use the laparos...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1999-01-01 00:00:00
abstract::The use of Hemostypic agents like oxised regenerated cellulose and collagen sponge is widespread in cases with severe hemorrhage that cannot be treated by conservative measure. With these materials however one cannot bring compression to the source of bleeding. We therefore have been using absorbable mesh (Vicryl, Dex...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00
abstract::An account is given in this paper of computer-assisted statistical records of surgery, with reference being made to the example of annual evaluation in 1988 as compared to 1985/86 data. Surgical statistics are shown to be important to administrative and medical management of a surgical hospital or department as well a...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1990-01-01 00:00:00
abstract:INTRODUCTION:Recent innovations in laser scanning technology provide a potentially useful tool for three-dimensional surface registration for image-guided surgery. The purpose of this study is to evaluate the clinical reliability of this technique in oral and maxillofacial surgical procedures using image-guided navigat...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2003-40811
更新日期:2003-07-01 00:00:00
abstract::The aim of this study was to determine whether arterial reconstructions in old age carry an acceptable risk and are reasonable as far as long term results are concerned. The operative mortality was 3,4% for reconstructions distal to the inguinal ligament and 20.5% for reconstructions in the aorto-iliac region. Limb am...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1980-01-01 00:00:00
abstract::From 1973 to June 1982, 218 patients older than 70 years (148 women, 70 men) suffering from acute bowel obstruction were seen at our Dept. The mortality rate came up to 33%. Main causes of the ileus were incarcerated hernias and colonic obstruction (25% each). In case of an incarcerated hernia the authors emphasize ea...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1984-01-01 00:00:00
abstract::The German Stomach Cancer TNM Study Group registered 1444 patients from 1982 to 1984 in a multicenter observational study to validate the tumor node metastasis stage groupings. The follow-up-rate in 1989 was 99.4%. Among others the pattern of lymph node metastases and the benefit of systematic lymphadenectomy (SLA) wa...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1996-01-01 00:00:00
abstract::Following a brief overview on parathyroid surgery, ontogenesis, anatomy and physiology of the parathyroids are described. Clinical symptoms and signs of hyperparathyroidism are as variable as the topography of parathyroid bodies may be. While parathyroid hyperfunction can easily be demonstrated by determination of ser...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::Laparoscopic colorectal procedures for treatment of benign disorders are increasingly appreciated. However, laparoscopic resections for rectal cancer are controversial. In the Department of Surgery at the Medical University of Lübeck 25 patients with rectal cancer were treated by laparoscopic procedures within four ye...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1997-01-01 00:00:00
abstract:INTRODUCTION:Intraarterial thrombolysis of acute arterial occlusions in the lower limbs is an established therapeutic procedure. However, its value as a primary treatment is discussed controversially and it is mostly seen as a competing procedure to primary vascular surgical interventions. METHODS:From January 2001 to...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2008-1076866
更新日期:2008-08-01 00:00:00
abstract::The indication for replantation of traumatised limbs cannot be forced into any scheme. Each single case has to be critically considered as individual problem with main reference to age, sex, general condition, profession and motivation of patient and personal competence and qualification. A factor of central importanc...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1979-01-01 00:00:00
abstract::Experience with gastro-restrictive obesity showed the necessity of detailed research in three main tasks: 1. characteristics of morbidly obese people 2. psychological effects of surgery 3. interaction of these characteristics and effects of surgery. We carried out 7 studies with a total of 650 participants. Clinical i...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2002-36465
更新日期:2002-12-01 00:00:00
abstract::Surgical treatment was applied to 74 cases of ankle joint fractures at the author's hospital, between 1979 and 1984. Follow-up checks were made on 59 patients, within one to seven years from surgery. Luxation fractures accounted for 39 per cent. The rates of wound edge necrosis and bone infection were three per cent e...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract::This report presents late results of primary suture of fresh ruptures of knee ligaments. Considering the rapid development of knee surgery the control of a surgical procedure practically unchanged since 15 years seems necessary. On the basis of these late results immediate suture of ruptured knee ligaments is a useful...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::Together with the classical conservative treatment or the rarely necessary surgical thrombectomy in patients with acute deep vein thrombosis, catheter-directed thrombolysis is becoming more and more popular. This review provides a critical view on the evidence for catheter-directed thrombolysis providing a "Contra" po...
journal_title:Zentralblatt fur Chirurgie
pub_type: 评论,杂志文章
doi:10.1055/s-0034-1368632
更新日期:2014-10-01 00:00:00
abstract::In this paper it is tried to give an answer whether Bassini-plastic as compared to the excellent results of Shouldice operation should be further performed. In a consecutive series of 197 Bassini operations from 1982-1986 we found after a mean follow up time of 6.8 years a 3.2% recurrency rate. We suggest therefore th...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract::The frequency of pacemaker complications has decreased during later periods of observations. The rate of pacing lead fractures has been reported to amount to 6.2%. According to our experience and data based on 3607 pacemaker implantations for over 15 years this retrospective study examines the following parameters: pa...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1984-01-01 00:00:00
abstract:BACKGROUND:Postoperative pancreatic fistula is a relevant complication after pancreatoduodenectomy. Therefore, preoperative detection of high risk patients may be important. We evaluated preoperative CT-imaging by planimetry at the expected resection plane along the superior mesenteric vein and correlated the results w...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-0035-1546193
更新日期:2016-08-01 00:00:00
abstract::Hybrid systems with hepatocyte cultures in bioreactors are in development for therapeutical liver assistance. Here, a culture model with a special bioreactor construction was developed: Capillary membrane systems create a three dimensional artificial framework for hepatocyte adhesion, aggregation and reorganization of...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract::In 9 out of 24 cases we experienced complications when implanting the Kimray-Greenfield-Filter. As a result of this the introduction of this filter is now performed by a guide wire. To obtain maximum results the introducer and the filter itself should be improved. ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1983-01-01 00:00:00
abstract::Lokal recidivation rate in carcinoma of the female breast represents besides the 5- to 10-years survival rate an important parameter for primary surgical treatment. At the Chirurgische Universitätsklinik Tübingen radical mastectomy in the Rotter-Halsted technique as well as extended radical mastectomy were abandoned b...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1977-01-01 00:00:00
abstract::The functioning of our anti-infectious regimen now working over a period of 7 years with 4 checks per year has been controlled. The wound infection rate came up to a percentage of 1.55. Blunders concerning chemical disinfection especially could be detected in spite of check-ups made every 3 months. ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract:BACKGROUND:In spite of dynamic development of modern diagnostic and therapeutic methods, the long-term results of surgical therapy in pancreatic cancer are still unsatisfying. The aim of this study was to analyse long-term results of surgical palliation for pancreatic cancer in a pancreatic surgery centre. METHODS:We ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2002-35760
更新日期:2002-11-01 00:00:00
abstract::Decisions in surgery will have to consider economic obligations more than ever before. Consequences are evident: the assessment of surgical efficiency will be insufficient when only considering the accuracy and results of a clinical study. We actually will have to document, moreover, the economic impact of therapeutic...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00
abstract::The clinical value of growth factor treatment of chronic wounds has yet to be determined. Beneficial effects have been reported so far only from specialized wound care centers where growth factors supplemented the results achieved with good wound care. In general optimization of current methods of external wound care,...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:2000-01-01 00:00:00
abstract::At the University Hospital of Cologne-Lindenthal 260 patients underwent carotid endarterectomy during a period of 10 years. 9 patients died, representing an operative mortality rate of 2.9%. 80% of our patients with an acute stroke died. We see no indication for surgery in acute stroke. Postoperatively, 20 patients ha...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract:UNLABELLED:Hereditary pancreatitis is an autosomal dominant disease. Recently, the genetic defect has been mapped to chromosome 7q35 and consists mainly of a point mutation in exon 3 of the cationic trypsinogen gene which causes an Arg(CGC)-His(CAC) substitution at residue 117. In patients with hereditary pancreatitis ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2001-19145
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVE:Incisional hernia repair with conventional techniques (simple closure, Mayo) is associated with high recurrence rates in the range of 30-50%. Surgical repair using different prosthetic biomaterials gains more and more acceptance. Therefore we wanted to evaluate our own results of hernia repair and analyze the...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00