M.Tech. / Iridology is defined as a science that identifies pathological and functional changes within organs via assessing the iris for aberrant lines, spots, and discolourations (Medow, 2000). According to iridology, the iris does not reflect changes during anaesthesia, due to its inhibitory effect on nerves impulses, and in cases of organ removal, it reflects the pre-surgical condition (Jensen, 1986). The Homoeopathic profession is frequently associated with iridology and in a recent survey by Rostovsky et al. (2009) investigating the perceptions of Masters of Technology graduates in Homoeopathy on the existing programme offered by the University of Johannesburg, iridology was highly regarded as a potential additional skill requirement for assessing the health status of the patient. This was a randomized and controlled quantitative study. The study aimed to assess the reliability of iridology in the diagnosis of previous acute appendicitis, as evidenced by appendectomy. A total of 60 participants took part in the study. Of the 60 participants, 30 had had an appendectomy due to acute appendicitis, and 30 with their appendix intact with no prior history of appendicitis. All participants were recruited on the premises of Rita Frank Optometrists. Each participant signed a Participant Information and Consent Form (Appendix E) and a Consent Form to Photograph the iris (Appendix F). Thereafter the researcher obtained the information required in a private setting (Appendix G). Afterwards each participant’s right iris was documented by photograph with the use of a specialist non-mydriatic retinal camera (Canon EOS-20D), reset for the iris, by the researcher. The photographs were then randomized by an external person and no identifying data made available to the three raters. The raters included the researcher and two practising iridologists. Data was obtained from the analyses of the photographs wherein the presence or absence of lesions (implying acute appendicitis) was indicated by the raters. All the data was captured into an Excel spreadsheet (Appendix H) and sent for statistical analysis. vi None of the three raters showed a significant success rate in determining correctly who had had acute appendicitis and resultant appendectomies and who had not. The outcome of this study indicated an outcome that was subject to chance. The null hypothesis that states that appendectomy due to acute appendicitis does not manifest in a corresponding lesion in the typical organ area of the eye, is supported. It is in the opinion of the researcher that the association of iridology with homoeopathic practice may harm the credibility of the profession and that further research on iridology is needed to disprove this conviction.

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

Objective: To determine the usefulness of the Alvarado score and the Pediatric Appendicitis score (PAS) in the Pediatric Emergency of the National Hospital Daniel A. Carrion. Materials and methods: A prospective observational study was carried out of patients younger than 15 years of age with abdominal pain and suspected acute appendicitis (AA) attending the Pediatric Emergency in a Hospital of Lima, Peru. These patients underwent a survey to assess the parameters of the Alvarado score and PAS. Results: Three hundred and seventeen patients with abdominal pain and suspected of AA were recruited over a study period of 12 months. Of the patients, 232 were considered to have AA clinically and underwent surgery. 85.3% were confirmed by pathology and 14.7% were normal. The mean Alvarado score was 8.27±1.31; the mean Surgical Procedure Assessment (SPA) score was 8.08±1.47. Sensitivity and specificity for both scores are equivalent. The area under the curve for the Alvarado score and SPA were 0.887 and 0.901, respectively. Alvarado score higher than 6 had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.9, 75.6, 97.4, 68.1, and 86.4%, respectively. SPA higher than 6 points had sensitivity, specificity, PPV, NPV, and accuracy of 84.3, 80.7, 94.7, 73.1, and 86.7%, respectively. Conclusion: Alvarado score and the PAS are scores with high sensitivity, specificity, PPV, and accuracy for the diagnosis of AA when the score is higher than 6 points. The results found in our study justify their use in emergency services, but they should not be used as the only means of clinically determining the need for surgery.

Situs inversus totalis (SIT) is a rare disease in which there is transposition of thoracic and abdominal organs. The symptoms of appendicitis in SIT are often confused with other intraperitoneal processes such as diverticulitis. We report the case of a 65-year-old, attended by emergency epigastric pain of 20 hours of the onset after a few hours left iliac fosse migrates associated with hyporexia. Diverticulitis is diagnosed in the first instance, and after the respective imaging tests is discarded for being relevant findings with situs inversus totalis and left poses appendicitis. Therefore, the realization of an adequate medical history and physical examination supported by imaging tests are important to keep in mind, appendicitis as part of the differential diagnosis, in order to avoid errors in diagnosis and treatment.. / Revisión por pares

Yes / Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention in paediatric patients. Ultrasound is generally the diagnostic imaging modality of choice, followed by CT, where paediatric appendicitis is suspected. However, high operator dependency and diagnostic restrictions related to anatomical and clinical presentation may limit consistency of application. This paper explores whether MRI is a viable alternative to ultrasound as the primary imaging modality. Method: A systematic review of the literature was undertaken. A search of Medline, Cinahl, PubMed Central and Google Scholar was undertaken supplemented by a review of reference lists, author searching and review of NICE evidence base for existing guidelines. Included studies were assessed for bias using the QUADAS-2 quality assessment tool and data were extracted systematically using a purposefully designed electronic data extraction proforma. Results: Seven studies were included in final review. The age range of participants extended from 0 to 19 years. Only one study with a patient age range of 0e14 used sedation. Sensitivity estimates from the included studies ranged from 92% to 100% while specificity ranged from 89% to 100%. A significant variation in the number and type of sequences was noted between the studies. Conclusion: MRI offers high sensitivity and specificity comparable to contrast enhanced CT and greater than ultrasound as reported in the literature. Where accessibility is not a restriction, MRI is a viable alternative to ultrasound in the assessment and diagnosis of paediatric appendicitis. Clinical practice recommendations have been provided to facilitate the translation of evidence into practice.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Le but de notre travail a été d’évaluer l’effet de la réduction de la dose d’irradiation en TDM multibarrette quant à la performance diagnostique, la confiance de l’observateur dans le diagnostic proposé, la capacité à suggérer un diagnostic alternatif dans quelques pathologies courantes et/ou caractérisées par des situations de faibles contrastes entre les structures anatomiques normales ou pathologiques. Nous avons donc comparé ces paramètres entre des TDM à doses réduites et à doses standard telles que couramment rapportées dans la littérature dans les circonstances suivantes : • La suspicion clinique de colique néphrétique: le contraste naturel élevé du calcium avec les structures voisines suggère de pouvoir réduire fortement la dose, dans une pathologie potentiellement récidivante et qui intéresse des patients jeunes dont le pronostic est excellent. Notre étude a montré qu’une dose 10 fois inférieure à celle générée par des examens TDM courants permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique de sinusite chronique: le contraste naturel élevé entre l’air des cavités sinusales, la muqueuse nasale et les os de la face permet de réduire fortement la dose, dans cette pathologie potentiellement récidivante et qui intéresse des patients jeunes dont le pronostic est excellent. Notre étude a montré qu’une dose 10 à 25 fois inférieure à celle générée par des examens TDM courants, et dès lors inférieure à celle générée par quatre incidences radiographiques, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique d’appendicite aiguë: L’appendice est situé dans une atmosphère anatomique caractérisée par un faible contraste entre les structures. Néanmoins, comme l’appendicite est une pathologie qui concerne l’adolescent et l’adulte jeune, nous avons tenté de réduire la dose des TDM dans ce contexte. Notre étude a montré qu’une dose 3 à 10 fois inférieure à celle générée par des examens TDM courants, et dès lors inférieure à celle générée par trois incidences radiographiques, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique de diverticulite aiguë du colon: la diverticulite aiguë du colon est également caractérisée par une atmosphère anatomique de faible contraste entre les structures. Néanmoins, comme cette pathologie peut concerner l’adulte jeune et récidiver, nous avons tenté de réduire la dose des TDM dans ce contexte. Notre étude a montré qu’une dose 3 à 10 fois inférieure à celle générée par des examens TDM courants, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • Le diagnostic d’embolie pulmonaire aiguë: la TDM spiralée occupe une position centrale dans le diagnostic d’embolie pulmonaire aiguë mais impose l’injection intraveineuse de produit de contraste iodé. La comparaison d’images obtenues à des doses variables d’irradiation a nécessité leur traitement à posteriori pour simuler la réduction de dose. Notre étude a montré qu’une dose 9 fois inférieure à celle générée par des examens TDM conventionnels permet des performances diagnostiques semblables. Ces investigations ont été complétées par l’investigation de l’influence du genre, de l’indice de masse corporelle et de l’âge sur la modulation automatique du courant au tube radiogène (6). Cette investigation a montré que la modulation automatique ne réduit la dose d’irradiation que d’au plus 20% avec peu ou pas de différence en fonction du genre, de l’âge ou de l’indice de masse corporel des patients ; indiquant ainsi qu’elle ne pouvait pas remplacer la réduction de la charge volontaire de l’opérateur.

Thesis (M.Sc.). / Written for the Dept. of Epidemiology, Biostatistics and Occupational Health. Title from title page of PDF (viewed 2008/12/04). Includes bibliographical references.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / CT abdomen and pelvis is a widely-used imaging modality used in the evaluation of appendicitis but it carries risks of radiation. A recent retrospective review localizes all appendices (both normal and abnormal) below the level of the L1 vertebral body, obviating the need to scan superior to that level. This study is a retrospective review of prospectively-collected data from 171 consecutive pediatric patients presenting with clinical suspicion of acute appendicitis and undergoing “low FOV CT.” The low FOV CT uses the L1 vertebral body as the superior aspect of the exam instead of the of the dome of the diaphragm as in standard CT.