No abstract

The augmented histamine test (Kay, 1953) has been widely used as a reliable means of measuring maximal acid secretion by the stomach. There is general agreement that the dose of histamine (0.04 mg./kg. body weight) recommended by Kay evokes a maximal or near-maximal acid response. However, the period during which the response is greatest is the subject of dispute, and workers have used the acid output in different periods to report their results. Most have used the response in the 30-minute period from 15 to 45 minutes after the histamine injection, as originally suggested by Kay. Baron (1963) showed that the maximal response did not always coincide with this period and suggested that the greatest halfhour response (the " peak half-hour ") should be used whenever it occurred. Other workers have referred to the secretion during the whole 60-minute period after histamine as the maximal histamine response (Bruce et al., 1959).If the results of augmented histamine tests are expressed in different ways the conclusions may also differ. In this paper we present a detailed analysis of the effect of reporting the results in these different ways. The data are taken from acid tests in a consecutive series of 100 patients with duodenal ulcer studied before and after vagotomy with a simple drainage procedure. In the augmented histamine test four basal specimens were aspirated at 15-minute intervals after removal of the fasting juice. Mepyramine maleate, 50 mg., was injected intramuscularly, and 30 minutes later histamine acid phosphate, 0.04 mg./kg. of body weight, was given by subcutaneous injection. Thereafter 15-minute aspirates were collected for one hour. Materials and MethodsIn the medical vagotomy test a combination of hexamethonium bromide, 50 mg., and atropine sulphate, 0.325 mg., was given as a single deep intramuscular injection one and a half hours before the injection of histamine. The details of antihistamine and histamine dosage and timing were otherwise the same as in the augmented histamine test.In the insulin test 20 units of soluble insulin was given intravenously after collection of two 15-minute basal specimens. Blood sugar concentration fell to below 35 mg./100 ml. in all cases. Fifteen-minute aspirates were collected for two hours after the insulin injection.The volume of each 15-minute specimen was measured.

No abstract

Aims Females of child bearing age are at higher risk of negative appendectomy rate, the accepted overall NAR is up to (20-25%). Presented is our study to examine the real NAR in the female’s cohort aged (15-45 years) in the form of quality improvement project to improve patient’s outcome. Methodology Retrospective study in the form of Full audit cycle over 18 months, the first cycle was conducted over 12 months period, followed by the action plan and reassessment over 6 months. Preoperative clinical, laboratory, radiographic and histopathological data were collected. Results Over the whole audit period 632 cases were analysed, 238 cases were females in the child bearing age included in our cohort. Over the first phase 419 appendectomy cases were performed, among those 156(37%) were females in child bearing age. Overall NAR was 29% and in our females cohort was 43.5%. Over the second cycle, 213 cases performed, out of which 82(38%) cases included in our cohort. Overall NAR reduced to 25% and in our cohort was 37% Conclusions Despite the advances in diagnostic modalities, Females are at significantly higher risk of NAR 37%. Our overall NAR reduced from 29% to 25% compared to the young females cohort, the rate dropped from 43% to 37%. specific consideration and regular auditing of results regards this cohort are highly recommended. Validation of appendicitis scores for risk stratification, Serial examinations and radiological adjuncts are possible solutions to reduce the NAR among this group.

Aims Appendicitis remains the most common acute surgical condition.  No standard guidelines for the use of imaging studies, and there is a discrepancy between the published data regarding accuracy of these modalities and our practical findings. Yet the growing number of USS reported as “appendix not visualized” has led us to rethink about the value of USS in acute appendicitis.  Methods A retrospective single centre study for all females (15-45 years) underwent emergency appendectomy for suspected acute appendicitis. Analysis of preoperative clinical, radiographic and postoperative histopathological data was done. Results 632 cases analysed over 18months, out of those 238 (37%) were females (15-45 years). USS was done in 129(54%) cases. 25(10.5) cases had both USS and CTAP. 32(13%) cases had only CTAP. The mean rate of appendix visualization in the USS was 30%(71cases) two thirds reported by radiologist versus one third by sonographers. Our negative appendectomy rate dropped from 25 to 15% after a positive scan.  Conclusions Traditional preference for ultrasound in the UK compared to CTAP in young population is mostly due to the potential hazards of irradiation, but USS commonly does not visualise the appendix in our practice (70%), and has low sensitivity and specificity for appendicitis.  However, following a positive USS, NAR dropped to 15%. Radiologists had a higher visualization rate of appendix compared to sonographers. Commitment to improve the performance of ultrasonography by allocating adequately timed sessions to the most experienced radiologists and increasing the use of low dose CT scans are possible solutions.