Recognized as the most common cause of emergency surgery in children, appendicitis is an irritation, inflammation, and infection of the appendix. The majority of appendicitis cases occur between the ages of 6 and 20 years with approximately four appendectomies performed for every 1,000 children under the age of 14. Because appendicitis is often difficult to accurately detect in children, the suspicion of the condition leads to the performance of unnecessary surgeries on about 30 percent of the children who undergo them. In addition, 30 to 45 percent of patients suffer an appendix rupture before a diagnosis is made.
With a new technological breakthrough, researchers from the Proteomics Center at Children’s Hospital in Boston have developed a urine test that can detect “biomarkers” indicating appendicitis in children. The promise shown by this new test could lead to improved diagnosis, possibly even replace the use of CT scans, and eliminate the exposure of children to radiation. The details of the research were recently published in the journal Annals of Emergency Medicine.
The appendix is a narrow, elongated tube closed at one end, extending from the cecum, a blind pocket off the first part of the large intestine. Although the exact function of the human appendix is unknown, it plays a role as a part of the body’s immune system during the early years of life. Later, the appendix ceases to function as other organs continue to protect against infection.
Appendicitis occurs when the interior of the appendix gets filled with material such as mucus, stool, or parasites that causes it to swell. This leads to irritation, inflammation, and a decreased blood flow that is inadequate for the body part to maintain health, which causes the appendix to begin to die. An irritated appendix can rapidly become infected and can even rupture, which can quickly become a life-threatening situation. Rupture can occur as holes develop in the walls of the appendix that allow substances to leak into the abdomen. This causes an infection inside the abdomen known as peritonitis.
The researchers at Boston Children’s Hospital evaluated urine samples taken from children before and after an appendectomy. The research group detected several biomarkers, including proteins that are associated with immune response and inflammation. The biomarker that showed the most sensitivity to testing was alpha-2-glycoprotein (LRG).
According to Hanno Steen, the director of proteomics at Children's Hospital Boston, who directed the proteomics work on the study, the discovery of the biomarker was made possible by recent advancements in mass spectrometry technology. Although the research team acknowledged both limitations of the analysis and the need for further studies, Steen noted, “…we are very optimistic that we can push this further," Steen said. “The ultimate hope is to have something in hand that can be used in the clinic as a dipstick test or something like that,” Steen said.
Another goal of the research team is to explore whether or not the protein is present in detectable levels in blood. For patients suffering from abdominal pains, urine testing is common. However, in some cases, such as those involving the testing of infants, blood would be the better choice since infants would need to undergo catheterization prior to urine testing.
source : www.healthnews.com
Monday, July 20, 2009
Urine Test May Detect Childhood Appendicitis
Shriners Hospitals to Remain Open with Changes Reflecting Financial Squeeze
The Shriners have decided that they will keep the doors of all their hospitals open to children for treatment in 20 cities across America, as well as one in both Canada and Mexico. These include Springfield's orthopedic hospital on Carew Street, as well as a burn unit located in Galveston, Texas, that was seriously damaged by Hurricane Ike. However, some of the locations could be forced to downgrade to outpatient surgical centers. In addition, the possible sale or lease of real estate will be considered. The news comes from the Shriners Hospitals For Children’s newly elected Chief Executive Officer, Douglas Maxwell.
A proposal to permanently close six of the Shriner’s facilities was rejected by the 1,300 member governing body this week. These included hospitals located in Springfield, Massachusetts; Greenville, South Carolina; Spokane, Washington; Shreveport, Louisiana; Erie, Pennsylvania: and Galveston, Texas. Instead the decision was made during the Shriners annual convention in San Antonio, Texas, to investigate downsizing hospital operations as well as to begin to accept insurance payments.
According to Maxwell, “We've not changed who we are. We will always take care of children the best we can.” He then acknowledged that the Shriners hospital system will need to be "right-sized," and mentioned the possibility of turning some of the nonprofit organization’s orthopedic facilities into outpatient surgical centers.
Maxwell also noted that Shriners International, based in Florida, would look into selling or leasing some of the hospital real estate in order to trim down its current operating budget of $856,000,000. He explained that eventually the system could have only eight regional inpatient hospitals, with the other 14 becoming outpatient centers. In addition, some centers could be moved to smaller facilities, allowing for the sale of the old buildings to nearby hospitals that are in need of additional space.
Throughout their 87-year history, the Shriner’s hospitals have offered free care for children, without the need for insurance billing. However, with mounting financial pressures, reimbursements provided by insurance companies could help to ease the financial crisis faced by the fraternity. Although Maxwell hopes that insurance billing will begin within the year, the fraternity has just begun the task of examining how operations will need to change and how quickly hospitals can establish systems to bill insurance providers.
It remains unclear as to the amount of revenues insurance reimbursements would provide and it is unlikely that the hospitals will charge families insurance company co-payments. Children of families with no insurance will continue to be treated for free. For now, Maxwell held that all children suffering from orthopedic conditions, spinal cord injuries, burns and cleft palates would continue to be treated free of charge.
The Shriner Hospital system has treated hundreds of thousands of children since it opened back in 1922. Although the Shriner’s hospitals have primarily been funded through an endowment, the plummeting stock market of a sputtering economy diminished the bequest from $8 billion to $5 billion in less than a year.
Only a fraction of the operating budget comes from donations gathered by well-recognized Shriner members wearing their red fezzes. However, Maxwell said that the Shriners are confident the hospital system will be able to continue operations over the long term.
