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Background: Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis. Methods: One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including <0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml. Results: The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery. Conclusions: Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml. [ABSTRACT FROM AUTHOR]

Background: Delay in diagnosis and treatment of perforated appendicitis may cause life-threatening complications. The aim of this study was to determine and compare pre-operative total and direct bilirubin levels in cases of simple and perforated acute appendicitis in order to improve the clinical decision making. Methods: This prospective observational study included eighty patients who underwent open appendectomy, during a one-year period from March 2010 to March 2011 in the surgical department of Hazrat-e-Rasool Akram Hospital, an academic teaching hospital in Tehran- Iran. Pre-operative total and direct levels of bilirubin were compared in two groups of histologically proved appendicitis (simple and perforated), each including 40 patients. Results: Eighty patients who underwent open appendectomy including 70% men and 30% women with a mean age of 34±11 years in Group I (perforated appendicitis) and 47.5% women and 52.5% men with a mean age of 33±14 in Group II (simple appendicitis) were included in this study. The mean bilirubin levels were higher for patients with perforated acute appendicitis compared to those with a non-perforated simple appendicitis (1.04±05 mg/dl vs 0.7±0.1 mg/dl) and this difference is highly significant (p<0.01). Conclusion: Assessment of preoperative total bilirubin is useful for the differential diagnosis of perforated versus acute simple appendicitis and total bilirubin should be used as an independent parameter in the early diagnosis of appendix perforation [ABSTRACT FROM AUTHOR]

Backgrounds: There are controversies among surgeons about prophylaxis of deep vein thrombosis (DVT) in laparoscopic cholecystectomy. The aim of this study was the assessment of patients' condition after laparoscopic cholecystectomy without any prophylactic measure. Methods: 100 cases of laparoscopic cholecystectomy without DVT prophylaxis were followed by duplex scanning in the first postoperative day and by physical examination and patient history at the first to second postoperative week however no clinical sign was found for DVT. Results: Only one case of partially thrombosis (1%) was found by duplex scanning which was managed conservatively. Conclusion: Laparoscopic cholecystectomy may consider as a low-risk procedure and routine prophylaxis may not be justified in the absence of other risk factor. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that they have no competing interests.