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Abnormal laboratory findings cannot reliably deliver a diagnosis of acute appendicitis. However, acute appendicitis is very unlikely when leucocyte count, neutrophil percentage and CRP level are simultaneously normal.

Objective: To identify the risk factors predicting septic shock and severe hemorrhage in percutaneous nephrolithotomy (PCNL). Methods: We retrospectively analyzed 420 renal calculi patients who underwent ultrasound-guided PCNL from March 2005 to May 2011. Data on patients who experienced infectious shock requiring anti-shock therapy and severe renal bleeding requiring angiographic renal embolization or nephrectomy were compared with other patients using univariate analyses. Results: Of 420 patients, 10 (2.4%) suffered septic shock and 4 (1%) had severe hemorrhage. The two significant risk factors for infectious shock were preoperative urine white blood cell count and operation time. For severe bleeding the absence of hydronephrosis and puncture time were significant risk factors. Operation time >90 min was associated with both septic shock and severe renal bleeding (p = 0.017). In contrast, the risk of encountering severe renal bleeding was higher if a nephroscope rather than a ureteroscope was used (p = 0.045). Conclusions: Operation time was a risk factor for both septic shock and severe hemorrhage. The patients without hydronephrosis before operation were more likely to suffer severe renal bleeding. Reducing intraoperative puncture time can reduce the probability of severe post-PCNL hemorrhage. The use of a comparatively gross nephroscope passage was likely to result in severe renal bleeding.

For uncomplicated diverticulitis of the right colon diagnosed preoperatively, antibiotic therapy with bowel rest is an effective treatment. Once it is encountered during surgery for presumed acute appendicitis, a conservative approach involving prophylactic appendectomy and postoperative antibiotics is recommended. For patients with recurrent diseases, medical treatment is still safe and efficient. Colectomy is indicated when complications occur or when malignancy is strongly suspected.

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Leukocyte count, neutrophil percentage, and C-reactive protein (CRP) have been shown to give valuable information in the diagnosis of acute appendicitis. However, whether these laboratory tests have the same clinical applicability in the elderly as in young patients remains unclear. This retrospective study aimed to clarify the role of these tests in the diagnosis of acute appendicitis in patients aged 60 years or over. Eighty-five consecutive elderly patients underwent appendectomy for suspected acute appendicitis during a 30-month period. Histologically verified appendicitis was found in 77 of the 85 patients (90.6%). There was no significant difference in leukocyte counts or CRP values between patients with acute appendicitis and those with a normal appendix. The sensitivities of leukocyte count, neutrophil percentage, and CRP in the diagnosis of acute appendicitis were 71.4 per cent, 88.3 per cent, and 90 per cent, respectively, while the specificities were 37.5 per cent, 25 per cent, and 37.5 per cent, respectively. Of 77 patients with acute appendicitis, only two had all three tests simultaneously normal. In conclusion, patients with normal results in all three tests are highly unlikely to have acute appendicitis and should be evaluated with extra caution before surgery.

Purpose -The aim of this study was to draw on the theory of planned behavior (TPB) and attempt to identify the factors influencing the customer decision to purchase via online auctions, focusing on how managers selling via online auctions can modify product positioning and promotion decisions in order to make their offerings more congruent with these factors. Design/methodology/approach -The study employed a survey instrument to collect data from Yahoo!Kimo website consumers in Taiwan, obtaining 450 samples which were analyzed with structural equation modeling. Findings -Attitude toward online auctions, perceived behavioral control and past related experiences significantly and positively influence the intention to purchase on online auctions, whereas subjective norm does not have such influence. Additionally, past related experiences have a positive effect on perceived behavioral control. Research limitations/implications -There has been a relative dearth of work on online auction customer behavior. By applying the TPB to online auction research, it was empirically supported that behavioral intention to purchase via online auctions is determined by attitude and perceived behavior control. Past related experiences were further integrated, discovering that they can strengthen perceived behavioral control. Practical implications -Recommendations are put forward in order to help better align product positioning and promotion decisions in online auctions with customer attitudes, perceived behavioral control, and past related experiences. These constructs may also be capable of explaining employee actions in general managerial contexts, thus extending the contribution of the paper beyond the limited world of online auctions. Originality/value -This study integrated online auctions, the theory of planned behavior and consumer decision-making philosophies in order to develop and empirically test a theoretical framework of consumer decision making in online auctions.

The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.