Mathematical modeling for prediction of complicated acute appendicitis in children

Endogenous intoxication, which accompanies the complicated course of acute appendicitis in children, is one of the serious conditions, which are the main cause of complications in the postoperative period. Diverse clinical observations done by clinicians suggest that despite the use of modern technologies in operating equipment, anesthetic support, the number of complications in the postoperative period has no tendency to decrease, and the main cause of lethal outcomes with appendicular peritonitis is lightning development of severe degree of endotoxicosis, which develops as a result of resorbing toxic substances formed of many components, including pathogenic microflora and destruction metabolism. Purpose. Creation of a mathematical model for prediction of complicated acute appendicitis in children using the functions of regression analysis of EXCEL spreadsheet by approximating experimental data. Materials and methods. In the work, there is information about 59 patients with acute appendicitis treated at the clinic of pediatric surgery at the National Pirogov Memorial Medical University. The data on patients were divided into two groups: patients with not complicated course of pathology – 24 patients, and patients with complicated course of acute appendicitis – 35 children. The control group served the data of 37 healthy children. In each of the three groups, the following parameters were studied: gender, age, bed day, duration of the disease, presence of symptoms of peritoneal irritation, the nature of exudate in the abdominal cavity, the number of red blood cells, hemoglobin, leukocytosis, quantitative characteristics of white blood formula, ESR, cellogenic endogenous intoxication: leukocyte index of intoxication and hematological index of intoxication. All the data were determined directly at the time of hospitalization of a patient to the hospital. Results. Discussion. Based on multiple correlation x = f (x1 , x2 ) a two-factor mathematical model of probability of the complicated course of acute appendicitis in children was created. According to the obtained results of the study of the system of three equations with three unknowns, it was established that if the indicator of the form of the disease is y = 2.67 and above, when, in numerical terms, the result falls into the zone of complicated flow of acute appendicitis and completely coincides with data analysis of the three groups of patients. Conclusions. The components that determine the uncomplicated course of acute appendicitis in children, according to the developed two-factor model, include LII and GPI, which exceed the values intoxication of certain intervals studied at the time of hospitalization. The analyzed indices were determined by the degree of severity of the pathological process, duration of disease, virulence of microflora and age of patients against the background of the formed endogenous intoxication syndrome.

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Comparative analysis of the results of computerized phonoenterography in patients with acute destructive appendicitis before surgery and in the postoperative period

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj20173469-475 ◽

2017 ◽

Vol 25 (3) ◽

pp. 469-475

Author(s):

K. V. Philippova ◽

O. V. Zaitsev

Keyword(s):

Abdominal Pain ◽

Comparative Analysis ◽

Acute Appendicitis ◽

Postoperative Period ◽

Spectral Power ◽

Abdominal Cavity ◽

Pain Syndrome ◽

Acoustic Signals ◽

Early Postoperative Period ◽

Control Group

Using the method of computerized phonoenterography we made an analysis of motor-evacuation function of the gastrointestinal tract in 35 patients with acute destructive appendicitis before surgery and in the postoperative period and in 30 patients without abdominal pain syndrome and concomitant pathology of the organs of the abdominal cavity. The obtained results of computerized phonoenterography different in the group of patients with acute appendicitis before appendectomy in comparison with group of patients without acute abdominal pathology (control group). For patients after appendectomy statistically significant differences with the control group in the vast majority of bands wasn’t obtained. Given the fact that the densities of the spectral power of acoustic signals of the abdominal cavity to assess the motor-evacuation function of the intestine in these groups of patients, we showed a reduction of motor-evacuation function of the intestine in patients with acute destructive appendicitis before surgery in comparison with patients of control group and recover in the postoperative period. Thus, the method of computerized phonoenterography is advisable to apply for the diagnosis of lower motor function of the intestine in patients with acute appendicitis, and in the early postoperative period in patients with acute destructive appendicitis for monitoring recovery of intestinal motility.

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Pediatric acute appendicitis: Searching the diagnosis in portal vein

Ultrasound ◽

10.1177/1742271x20918001 ◽

2020 ◽

Vol 28 (3) ◽

pp. 174-179

Author(s):

Sonay Aydin ◽

Berna Ucan

Keyword(s):

Acute Appendicitis ◽

Portal Vein ◽

Flow Velocity ◽

Clinical Signs ◽

The Other ◽

Control Group ◽

Healthy Children ◽

Portal Vein Flow ◽

Diagnosis Group ◽

Vein Diameter

Introduction Acute appendicitis is the most common reason for emergency abdominal surgery in the pediatric population. Ultrasound (US) is a widely used modality to diagnose acute appendicitis. The aim of this study was to evaluate the effectiveness of portal vein diameter and flow velocity in acute appendicitis diagnosis. Methods Portal vein diameter and flow velocity were measured in children who were referred to radiology with a clinical diagnosis of acute appendicitis. The largest appendix diameter and leukocyte count of the patients were recorded. A control group was created which consisted of healthy children, and their portal vein diameter and flow velocities were also measured. Results The median age of the population was 10 years (range, 3–17 years). Mean portal vein diameter was 7.53 ± 1.55 mm in the control group, 7.92 ± 1.88 mm in the other diagnosis group, and 8.76 ± 1.91 mm in the acute appendicitis group. Mean portal vein diameter was significantly higher in the acute appendicitis group (p = 0.001). Median portal vein flow velocity was 17 cm/s (10–29 cm/s) in the control group, 18.3 cm/s (8–27 cm/s) in the other diagnosis group, and 20.5 cm/s in the acute appendicitis group. Median portal vein flow velocity was significantly higher in the acute appendicitis group (p = 0.00). Conclusion Detecting an increase in portal vein diameter and/or flow velocity in equivocal cases may support other clinical signs associated with acute appendicitis. Portal vein diameter and flow velocity can serve as additional diagnostic markers in acute appendicitis cases.

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Diagnostic Role Of MPV In Acute Appendicitis

10.46611/ajm-20204 ◽

2020 ◽

pp. 10-13

Author(s):

◽

Keyword(s):

Acute Appendicitis ◽

Mean Platelet Volume ◽

Pathological Diagnosis ◽

Control Group ◽

Healthy Children ◽

Platelet Volume ◽

Blood Samples ◽

Diagnostic Role ◽

And Control

Introduction: The aim of this study was to investigate the diagnostic role of mean platelet volume (MPV) for acute appendicitis. Methods: Patient files were retrospectively observed. MPV of 311 patients with pathological diagnosis of acute appendicitis were compared with the MPV of 314 healthy children (blood samples were taken for elective operations). SPSS (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) was used to evaluate the results. Results: 188 of acute appendicitis were male (%60.5). Mean age of acute appendicitis group was 10.22±3.83. MPV of children with the diagnosis of acute appendicitis (8.37±0.83fL) and the control group (10.55±0.83fL). MPV values were statistically different between the acute appendicitis and control group (p<0,001). Conclusion: MPV may be used as a marker for the diagnosis of acute appendicitis, but it is not a specific biomarker for appendicitis.

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Changes in the sizes of the kidney after contralateral nephrectomy in the experiment

Reports of Morphology ◽

10.31393/morphology-journal-2018-24(3)-08 ◽

2018 ◽

Vol 24 (3) ◽

pp. 52-57

Author(s):

V.M. Monastyrskyi

Keyword(s):

Postoperative Period ◽

Left Kidney ◽

Abdominal Cavity ◽

White Male ◽

Male Rats ◽

Control Group ◽

Close Relationship ◽

Length Width ◽

Sexually Mature ◽

Experimental Group

The evaluation of renal measurements such as length, width and thickness, volume is important in the diagnosis and treatment of many renal disorders, since there is a close relationship between the sizes of the kidneys and its function. The purpose of the study was to establish and compare during the postoperative period changes in the mass and sizes of the kidney left after nephrectomy in the sexually mature male rats. An experimental study was carried out on 84 sexually mature white male rats weighing 178-194 grams. Animals were divided into two groups: control (42 rats) and experimental (42 rats). In the control group, the animals under ketamine anesthesia were followed by an abdominal cavity dilution, after which the abdominal wall was applied in a row. All animals of the experimental group performed surgical intervention – nephrectomy of the left kidney. The animals were withdrawn from the trial by intra-pleural administration of thiopental-sodium 50 mg/kg after 7, 14, 21, 30, 90 days after nephrectomy. Macroscopic evaluation and description of the kidneys of animals was performed after their removal. Their weight was determined on the laboratory scale of HLR-200 up to 0.1 mg, and the length, width and thickness of the organ were measured with the help of a caliper to an accuracy of 0.05 mm. Calculated the volume of the kidney. The statistical analysis of the obtained results was carried out using the program STATISTICA 5.5 using parametric methods for evaluating the results. It was established that the mass, length, width, thickness and volume of the kidney of animals in the experimental group, as compared with the control group, were statistically significantly higher in all terms of observation. The fraction of the growth of the width and thickness of the single kidney of animals in the experimental group compared with the control animals in the animals was statistically significantly greater than the proportion of kidney growth during the postoperative period. It was found that the largest increase in the mass and thickness of the kidney, as compared with the control group, was observed after 30 days of the postoperative period, and the greatest increase in the length and width of the kidney, as compared with the control group, was observed after 14 days of the postoperative period.

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Diagnostics and treatment of abdominal complications after gynecological endoscopic operations

Reproductive health of woman ◽

10.30841/2708-8731.1.2021.229720 ◽

2021 ◽

Vol 1 ◽

pp. 75-79

Author(s):

Yu.P. Vdovichenko ◽

V.I. Boyko ◽

V.A. Terehov

Keyword(s):

Postoperative Complications ◽

Postoperative Period ◽

Diagnostic Laparoscopy ◽

Abdominal Cavity ◽

Early Postoperative Period ◽

Main Group ◽

Laparoscopic Technique ◽

Control Group ◽

Diffuse Peritonitis ◽

Abdominal Complications

The objective: to analyze the results of repeated laparoscopy in gynecological patients with suspected intraperitoneal postoperative complications.Materials and methods. The study involved 42 patients (mean age 46±11,3 years), in whom postoperative abdominal complications after surgical treatment of various gynecological diseases required repeated operations. Depending on the method of re-intervention, the patients were divided into 2 groups: the main group (n=20) – women who only used laparoscopy to correct postoperative complications; control (n=22) – women who were given indications for relaparotomy to correct postoperative complications during diagnostic laparoscopy. Relaparotomy was performed in 8 patients of the control group. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in terms of age and structure of operations performed on the pelvic organs, and statistically comparable.Results. During the study, the results of repeated laparoscopy of 34 gynecological patients with suspected intraperitoneal postoperative complications were analyzed. In all patients of the main group (47,6%), laparoscopy was revealed as the only and final method of treatment of postoperative complications, while in 7 women repeated relaparoscopy was used from 2 to 4 times, and in 13 women laparoscopy was performed once. In the control group (53,3%), 10 patients during diagnostic laparoscopy were exposed to indications for relaparotomy, in 4 patients the capabilities of the operating team and laparoscopic technique allowed performing some elements of the operation and completing it with a minilaparotomy approach, and 8 patients underwent relaparotomy immediately.Peritonitis and intraperitoneal bleeding prevail in the structure of early abdominal complications. The use of the video laparoscopic technique made it possible in 28,6% of patients with diffuse peritonitis to successfully eliminate the developed complication, eliminate its source and sanitize the abdominal cavity. Laparoscopic hemostasis was successfully performed in 7 patients.Compared with the standard, the use of video endoscopic technique allowed improving the indicators of diagnostic value: to increase the sensitivity level by 1,07 times, specificity by 1,39 times and diagnostic accuracy by 1,11 times.Conclusion. In general, in the early postoperative period, 47 relaparoscopies were performed for suspected complications, which is explained by programmed abdominal sanitization and the use of dynamic laparoscopy to control the course of intraperitoneal complications. Based on the analysis of the material under study, we proposed general indications and contraindications for relaparoscopy in the early postoperative period in order to diagnose and treat postoperative complications. Justifying each of the points, we were guided by the real possibilities of the method in general clinical practice, which in some cases are inferior in their effectiveness to relaparotomy.

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RESULTS OF ENDOSCOPIC DIAGNOSIS OF BLEEDING AFTER ABDOMINAL SURGICAL OPERATIONS

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.21.3.129 ◽

2021 ◽

Vol 21 (3) ◽

pp. 129-134

Author(s):

I. A. Yusubov ◽

N. A. Gasimov ◽

E. Y. Sharifov

Keyword(s):

Blood Pressure ◽

Gastrointestinal Bleeding ◽

Postoperative Period ◽

Abdominal Cavity ◽

Postoperative Bleeding ◽

Clinical Signs ◽

Control Group ◽

Laboratory Findings ◽

Abdominal Bleeding ◽

Surgical Methods

The aim of the study is to conduct a comparative analysis of the effectiveness of endovidiosurgical diagnosis techniques to detect gastrointestinal and intra-abdominal bleeding, which may occur after abdominal operations. Materials and methods. The main group included patients (n=408), whose condition was controlled by the endovideosurgical techniques. The control group included patients (n=102) who were controlled by using conventional surgical methods to correct bleeding that may occurred after similar surgical interventions. Gastrointestinal bleeding was observed in 323 patients, and intra-abdominal bleeding was observed in 85 patients. In all cases, endoscopic haemostasis was performed by clipping (n=57), submucosal infiltration (n=32), electrocoagulation (n=29), argon-plasma coagulation (n=74), and combined techniques (n=54). Results and discussion. 408 patients with clinical signs of bleeding in the early postoperative period were examined by endoscopic techniques. Patients with alarming clinical and laboratory findings underwent ultrasound examination, which revealed the presence of free fluid in one or more parts of the abdominal cavity. Laparoscopy was performed in the first hours of the postoperative period in 17 cases (n=17); on the first day of the postoperative period (n=36), on the second day (n=19), on the third (n=8), on the fifth (n=3), and on the sixth day (n=2). Complications were excluded in 7 (16.0%) patients, despite a decrease in blood pressure and haemoglobin levels. The volume of blood found in the abdominal cavity, including clots, ranged from 30 ml to 2000 ml. Signs of ongoing bleeding (the predominance of a large amount of liquid blood with a small number of clots) were found in 49 (57.6%) cases, and signs of arrested bleeding (the presence of a large number of clots with a small amount of liquid blood) was detected in 29 (34.1%) cases. Haemostasis was provided by electrocoagulation (n=35), clipping (n=15), suturing (n=12) and tamponade from a mini-laporatomic incision (n=9). Gastrointestinal bleeding was observed in 323 patients, and intra-abdominal bleeding in 85 patients. In 8.4% (n=27) of cases, the suspicious cases of postoperative complication were excluded by endoscopic examinations. In 91.6% (n=296) of clinical cases, early postoperative bleeding or signs of unstable haemostasis with the risk of repeated bleeding were confirmed. In cases of alarming clinical and laboratory findings indicating intra-abdominal bleeding, diagnostic laparoscopy enables to exclude complications in 16.0% of patients, despite a decrease in blood pressure and haemoglobin levels.

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The acute peritonitis treatment optimizing in early postoperative period

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2020-179-5-57-62 ◽

2021 ◽

Vol 179 (5) ◽

pp. 57-62

Author(s):

E. K. Dzidzava ◽

A. P. Vlasov ◽

O. V. Markin ◽

I. V. Fedoseykin ◽

I. V. Gluchova ◽

...

Keyword(s):

Functional Status ◽

Treatment Regimen ◽

Abdominal Cavity ◽

Laboratory Data ◽

Blood Parameters ◽

Early Postoperative Period ◽

Control Group ◽

Acute Peritonitis ◽

Endogenous Intoxication ◽

Purulent Peritonitis

The Objective was to evaluate the effectiveness of original physiotherapeutic methods in the treatment of patients with acute spread purulent peritonitis.Methods and Materials. We done a treatment approach analysis of 72 patients with peritonitis after programmed sanitation of the abdominal cavity. The control group included 42 patients with standardized treatment regimen. The main group consisted of 35 patients. Their treatment included low-intensity laser radiation of the abdominal cavity, electrical stimulation of the duodenum according to the original methods. We evaluated dynamic changes of the blood parameters, endogenous intoxication markers, the functional status of the liver, kidneys, and intestines.Results. The use of original physiotherapeutic methods in the treatment of patients with acute peritonitis leads to a significant improvement in clinical and laboratory data. The functional status of the liver, kidneys and intestine restored rapidly. Mortality rate decreased from 28.7 to 17.1 % (χ2=1.392, p=0.238), hospital stay decreased by 5.7 hospital days (p<0.05).Conclusion. The treatment regimen for severe peritonitis leads to a relatively rapid relief of the inflammatory process in the abdominal cavity, as well as the restoration of the functional status of the liver, kidneys and intestine. It largely determines the correction of homeostatic indicators, including reducing the severity of endogenous intoxication.

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Model of differential diagnosis of nervous system lesions in young children

Лечащий врач ◽

10.51793/os.2021.24.9.006 ◽

2021 ◽

Author(s):

Т. С. Кривоногова ◽

О. М. Гергет ◽

В. А. Желев ◽

Е. В. Голикова ◽

Е. В. Михалев ◽

...

Keyword(s):

Mathematical Model ◽

Nervous System ◽

Differential Diagnosis ◽

Control Group ◽

Diagnostic Model ◽

Healthy Children ◽

Morphological Examination ◽

Term Infants ◽

Traumatic Lesions ◽

Area And Perimeter

Перинатальная патология центральной нервной системы занимает ведущие позиции в структуре детской заболеваемости, что диктует необходимость поиска оптимальных подходов к ранней диагностике гипоксически-ишемических и травматических поражений центральной нервной системы, в том числе с использованием технологий математического моделирования. Цель работы состоит в создании и апробации математической модели дифференциальной диагностики гипоксически-ишемических и травматических поражений нервной системы у детей с использованием метода кариометрии. В исследование были включены 290 доношенных детей первого года жизни: первая группа сравнения включала 120 новорожденных с гипоксически-ишемическим поражением центральной нрвной системы, вторая – 120 новорожденных с ее травматическим поражением, контрольная группа включала 50 здоровых детей. Всем детям в возрасте 1, 3, 6, 9 месяцев и 1 года оценивались физическое и нервно-психическое развитие, двигательные функции по методу Л. Т. Журбы. На первом месяце жизни проводились нейросонография головного мозга, рентгенологическое обследование головы и шейного отдела позвоночника в двух проекциях. В возрасте 1, 3 и 6 месяцев выполнялось морфологическое исследование лимфоцитов (кариометрия). Для создания математической модели дифференциальной диагностики гипоксически-ишемических и травматических поражений нервной системы были взяты 12 показателей нейросонографии и 4 показателя морфологии лимфоцитов периферической капиллярной крови (площадь и периметр ядра, площадь и периметр клетки). В построении диагностической модели использовали самообучающуюся искусственную нейронную сеть, работа которой воспроизведена при помощи созданного программного приложения. Исследование показало, что полученная нами модель проста в использовании, экономит время на постановку диагноза, обладает высокой степенью распознавания: специфичность модели – 89,2%, чувствительность 92%. Perinatal pathology of the Central nervous system (CNS) occupies a leading position in the structure of childhood morbidity, which dictates the need to find optimal approaches to the early diagnosis of hypoxic-ischemic and traumatic CNS lesions, including using mathematical modeling technologies. Objective: to create and test a mathematical model for differential diagnosis of hypoxic-ischemic and traumatic lesions of the nervous system in children using the karyometry method. The study included 290 full-term infants of the first year of life: the first comparison group included 120 newborns with hypoxic – ischemic CNS damage, the second group-120 newborns with traumatic CNS damage, the control group included 50 healthy children. All children aged 1, 3, 6, 9 months and 1 year were evaluated for physical and neuropsychic development, motor functions according to the method of L. T. Zhurba. In the first month of life, neurosonography of the brain, x-ray examination of the head and cervical spine in two projections were performed. Morphological examination of lymphocytes (karyometry) was performed at the ages of 1, 3 and 6 months. To create a mathematical model for differential diagnosis of hypoxic-ischemic and traumatic lesions of the nervous system, 12 indicators of neurosonography and 4 indicators of peripheral capillary blood lymphocyte morphology (area and perimeter of the nucleus, area and perimeter of the cell) were taken. A self-learning artificial neural network was used in the construction of the diagnostic model, the operation of which was reproduced using the created software application. The study showed that the model we obtained is easy to use, saves time for diagnosis, and has a high degree of recognition: the model specificity is 89,2%, and the sensitivity is 92%.

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Role of Mean Platelet Volume in Diagnosis of Childhood Acute Appendicitis

Emergency Medicine International ◽

10.1155/2012/823095 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 14

Author(s):

Bunyamin Uyanik ◽

Cemil Kavalci ◽

Engin Deniz Arslan ◽

Fevzi Yilmaz ◽

Ozgur Aslan ◽

...

Keyword(s):

Acute Appendicitis ◽

Mean Platelet Volume ◽

Diagnostic Value ◽

Control Group ◽

Healthy Children ◽

Platelet Volume ◽

Pediatric Age Group ◽

Significant Difference ◽

Group 2 ◽

Group 1

Introduction. Acute appendicitis is the leading cause of abdominal pain in children requiring emergency surgical intervention. The aim of this study is to investigate the diagnostic value of MPV in early diagnosis of acute appendicitis cases in pediatric age group.Methods. This study was performed retrospectively. Three hundred five patients operated on with the diagnosis of appendicitis and pathologically found to be acute appendicitis were classified as Group 1 and 305 healthy children were classified as control Group 2.Results. One hundred ninety-seven of 305 cases in Group 1 are males (64.6%), in Group 2, 151 of 305 cases are males (49.5%). The mean MPV in Group 1 was7.9±0.9(fL), and whereas in Group 2 was7.7±0.8(fL). There was no statistically significant difference regarding MPV values (P>0.05).Conclusion. In our study we detected that mean platelet volume has no diagnostic value in pediatric acute appendicitis cases.

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CLINICAL AND LABORATORY FEATURES OF ENDOGENOUS INTOXICATION SYNDROME IN CHILDREN UNDER 3 YEARS WITH PNEUMONIA

10.25005/2074-0581-2020-22-3-403-408 ◽

2020 ◽

pp. 403-408

Author(s):

R.M. ABDURAKHIMOV ◽

◽

A. VOKHIDOV ◽

Keyword(s):

Uric Acid ◽

Lactic Acid ◽

Respiratory Failure ◽

Control Group ◽

Healthy Children ◽

Lactic Acid Concentration ◽

Gradual Reduction ◽

Endogenous Intoxication ◽

Laboratory Survey ◽

Haematological Indices

Objective: To study the clinical features of the course and the dynamics of some haematological indices in endogenous intoxication syndrome in children under 3 years of age suffering from pneumonia. Methods: There were 80 children under surveillance, of which 60 were pneumonia patients (main group), and 20 healthy children (control group). Laboratory survey included determining levels of leukocyte index of intoxication (LII), lactic and uric acids. The respiratory failure (RF) I is noted in 51.6%, RF II in 34.2% and RF III in 14.2% of cases. Results: Clinically and radiologically, 60.5% of children were diagnosed with bilateral processes in lungs, and in 39.5% the unilateral process. Signs of endogenous intoxication were: hyperhidrosis (59.4%), acrocyanosis (46.6%), perioral cyanosis (55.5%), mottled skin integument (49.2%), pronounced subcutaneous venous network (48.2%). The LII rate in the acute period had a strong tendency towards an increase of up to 5 days, with a gradual reduction to normal reference values by the end of the first week. It was found that high levels of lactic and uric acids were closely correlated with hypoxia. For example, in RF I, II and III levels of lactic acid were 1.3±0.1, 1.9±0.2 and 2.61±0.25 respectively. Children with RF III have degrees of lactic acid concentration that was statistically significant (p<0.001) higher than in the control group. Conclusions: Lactic and uric acid levels depend on the degree of RF and can indicate the severity of endogenous intoxication syndrome. The reduction of LII indices below 3.0 by the end of the first week of the disease, maybe a sign of a favorable outcome. Keywords: Pneumonia, respiratory failure, endogenous intoxication, leukocyte index of intoxication, lactic acid, uric acid.

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