PubMed · 953597
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1976-08-21. Editorial: Children with appendicitis.. https://pubmed.ncbi.nlm.nih.gov/953597/
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The author--using his 30 years practical medical experience, from the point of view of a family doctor giving the first diagnose, analyses the problem of acute abdomen. Gives an overview of anamnesis (heteroanamnesis) and the data and their significance investigated during the physical examination of patient (inspection, palpation, percussion, auscultation), and that of the usefulness for the right diagnose. The author orients the reader's attention to the fact, that the beginning of the third millennium in the world of instrumental and laboratory diagnostics, in case of certain illnesses--so in the case of acute abdomen--physical examinations have not lost a bit from their significance.
OBJECTIVES: To compare the accuracy of laparoscopy performed within 24 h of admission and the conventional method based on clinical observation in the etiological diagnosis of non-specific acute lower abdominal pain (NSLAP) in women of reproductive age. METHODS: A total of 110 patients who met the selection criteria and were seen from November 1997 to June 2000 at the Instituto Materno Infantil, a referral hospital for maternal and perinatal care in Bogotá, were randomly divided into two groups. The effectiveness of each method was evaluated according to number of diagnoses reached, length of in-patient stay before diagnosis, complications, and diagnostic accuracy when compared with a standard given by microbiological and histopathological findings as well as clinical course. RESULTS: The early laparoscopy group did not experience more accurate diagnoses (85% vs. 79%, P=0.61) or a greater number of complications (11% vs. 9%, P=0.48), although the patients' stay was shorter (1.3 vs. 2.3 days, P=0.008) than the stay of the conventional-diagnosis group. Sensitivity analysis showed more accurate judgements with laparoscopy in four of the five NSLAP causes, but only in two of the cases did this greater accuracy have clinical significance. CONCLUSIONS: Early laparoscopy did not show a clear benefit in women with NSLAP.
A 20-year-old woman presented with abdominal pain of 4-h duration and of sudden onset. A plain abdominal radiograph showed a giant ureteral stone measuring 12 cm causing ureteral obstruction. Abdominal ultrasound revealed severe dilatation of the two upper thirds of the left ureter and a hydronephrotic ipsilateral kidney. Subsequent renal scan demonstrated that it was a non-functional kidney while the contralateral kidney was normal. A left nephroureterectomy was performed.