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Appendicitis Detection Fails to Improve in Last Decade

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TIMES MEDICAL WRITER

Despite advances in medical technology, U.S. doctors’ ability to correctly diagnose appendicitis has not improved during the last decade, with about 40,000 Americans still undergoing unnecessary appendectomies each year, Washington researchers said.

Women are far more likely to be incorrectly diagnosed. Researchers found that an appendicitis diagnosis was missed in 23% of women, compared with about 9% of men, according to a research team led by Dr. David R. Flum of the University of Washington in Seattle.

Surgeons had assumed the rate of misdiagnosis was declining. Clinical trials using CT and MRI scanning and laparoscopy--in which researchers view the appendix directly through an endoscope--have found the techniques to be 95% to 98% accurate. But apparently this success isn’t being translated into actual clinical practice.

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Flum and his colleagues studied 63,707 appendectomies performed in Washington hospitals from 1987 to 1998. They reported in the Oct. 10 Journal of the American Medical Assn. that only 84.5% of those undergoing surgery actually had appendicitis and that the rate was essentially unchanged during the decade. .

Women probably have a higher rate of misdiagnosis because they have a more complex anatomy in the right side of their abdomens, such as an ovary, a uterus and fallopian tubes. Problems in these organs, such as cysts, can be mistaken for appendicitis.

Pregnancy Test Can Be Inaccurate if Taken Early

Home pregnancy tests performed on the first day after a woman misses her menstrual period may give an inaccurate reading because the embryo has not yet become implanted, a new study shows.

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Pregnancy tests measure blood levels of human chorionic gonadotropin, a hormone whose concentration increases after the embryo implants in the uterus.

Researchers cautioned that a negative test shortly after a missed period does not mean that a woman is pregnant and that the test should be repeated later.

Dr. Allen Wilcox and his colleagues at the National Institute of Environmental Health Sciences in Durham, N.C., studied 136 women who had conceived.

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They reported in the Oct. 10 Journal of the American Medical Assn. that the embryo had indeed become implanted on the first day in 90% of the women, but that it had not in the remaining 10%.

Those women yielded a negative pregnancy test even though they were, in fact, pregnant.

Poor Results From Creutzfeld-Jakob Drug

A potential new treatment for Creutzfeld-Jakob disease, a close cousin of Mad Cow disease, has proved disappointing in humans. Dr. Stanley Prusiner and his colleagues at UC San Francisco reported recently that the antimalarial drug quinacrine inhibited the prions that cause the disease in test tube studies.

Prusiner told a meeting at the National Institutes of Health last week that the first patient to receive the drug, a 20-year-old British woman, showed a modest initial improvement after receiving the drug. But her condition then worsened. A second patient, a 66-year-old man, had three weeks of therapy without effect before his family stopped the treatment and he died.

Douching Increases Risk for Bacteria Overgrowth

Douching increases the risk of bacterial vaginosis, an overgrowth of bacteria that normally dwell in the vagina, leading to an abnormal vaginal discharge. Dr. Claudia Holzman and her colleagues at Michigan State University in East Lansing studied 496 women at three medical clinics in central Michigan. The prevalence of bacterial vaginosis ranged from 15% to 30% at the clinics.

The researchers reported in the October issue of the American Journal of Public Health that women who had douched in the preceding two months were three times as likely to develop vaginosis as those who had not.

One way douching might induce vaginosis, they said, is by disturbing the natural balance of bacteria in the vagina, enabling some to proliferate more than normal.

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Numbness Could Foretell a Full-Blown Stroke

Patients who suffer temporary weakness or numbness on one side of their body after a mini-stroke are much more likely to suffer a full-blown stroke than those who suffer only temporary blindness in one eye, a new study has found.

A multicenter team reported in the Oct. 11 New England Journal of Medicine that patients who had a temporary loss of sight were only about half as likely to suffer a stroke in the following three years as those who suffered weakness or numbness.

For those who did suffer weakness or numbness in the mini-strokes, formally called transient ischemic attacks, the risk of a subsequent stroke could be cut in half by cleaning plaque out of the carotid artery, which supplies blood to the brain.

Drug Raises Risk of Developing Tuberculosis

A drug used to treat arthritis and Crohn’s disease nearly quadruples the risk of developing tuberculosis and doctors should test for TB before administering the drug, according to researchers from the Boston University School of Medicine.

The drug infliximab, whose trade name is Remicade, controls symptoms of arthritis and Crohn’s by selectively suppressing the immune system, but physicians fear that suppression can allow a latent TB infection to blossom into disease.

Dr. Joseph Keane and his colleagues analyzed 70 cases collected from August 1998 through May 2001 by the Food and Drug Administration. The normal rate of TB among arthritis sufferers is about 6.2 cases per 100,000 people annually.

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Researchers reported in the Oct. 11 New England Journal of Medicine that the rate among infliximab users was 24.4 cases per 100,000. The drug’s manufacturer, Centocor, changed product labeling on Aug. 15 to recommend that physicians administer a tuberculin test before prescribing the drug.

Sleeping Aid Could Be Harmful for Elderly

Patients older than 70 who are hospitalized should not be given diphenhydramine as a sleeping aid or to counter allergic reactions because it can produce symptoms of delirium, a new study finds. Diphenhydramine is the primary ingredient in products such as Benadryl and Sominex.

Dr. Joseph V. Agostini and his colleagues at the Yale School of Medicine studied 426 patients, age 70 or older, during their hospitalization, using daily interviews and other tests to monitor their mental status.

The researchers reported in the Sept. 24 Archives of Internal Medicine that diphenhydramine was associated with a 70% increase in risk of impaired mental status.

In particular, patients given the drug often exhibited an altered attention level, disorganized speech, change in consciousness and alertness, and behavioral disturbances.

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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.

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