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SUMMARYObjectivesAcute appendicitis (AA) is the most common indication for emergency abdominal surgery, although it remains difficult to diagnose. In this study, we investigated the the clinical utility of mean platelet volume in the diagnosis of acute appendicitis.MethodsThe medical records of 241 patients who had undergone appendectomy between June 2013 and March 2014 were investigated retrospectively. Sixty patients who had undergone at least one complete blood count during preoperative hospital admission and who had no other active inflammatory conditions at the time the sample was taken were included in the study. Mean platelet volume and leukocyte count values were determined in each patient at hospital admission and during active acute appendicitis. Age, sex, mean platelet volume and leukocyte counts were recorded for each patient.ResultsThe mean age of patients was 33.15±10.94 years and the male to female ratio was 1.5:1. The mean leukocyte count prior to acute appendicitis was 7.42±2.12×103/mm3. Mean leukocyte count was significantly higher (13.14±2.99×103/mm3) in acute appendicitis. The optimal leukocyte count cutoff point for the diagnosis of acute appendicitis was 10.10×103/mm3, with sensitivity of 94% and a specificity of 75%. The mean platelet volume prior to acute appendicitis was 7.58±1.11 fL. Mean platelet volume was significantly lower (7.03±0.8 fL) in acute appendicitis. The optimal mean platelet volume cutoff point for the diagnosis of AA was 6.10 fL, with a sensitivity of 83% and a specificity of 42%. Area under the curve for leukocyte count diagnosis was 0.67 and 0.69 for the diagnosis of AA by mean platelet volume.ConclusionsMean platelet volume was significantly decreased in acute appendicitis. Mean platelet volume can be used as a supportive diagnostic parameter in the diagnosis of acute appendicitis.

Fetuin-A might be a novel indicator of disease activity in patients with FMF and could be used as an adjunctive marker for differentiation of FMF attacks. The negative correlation between serum fetuin-A and other inflammatory markers may also be indicative of inflammation-dependent downregulation of fetuin-A expression in FMF patients.

In the light of these results, cerulein is an appropriate agent for experimental AP rat model and Anakinra has a favorable therapeutic effect on acute experimental pancreatitis model. Moreover, Anakinra significantly decreases cerulein-related pancreatic tissue injury and pancreatic apoptosis.

We report the case of a 24-year-old male patient admitted for recent ascites and splenomegaly of unknown origin. The patient was referred to our institution with complaints of diarrhea, epigastric pain, abdominal cramping and weight loss over the past three weeks. The acute onset presented with colicky abdominal pain and peritoneal effusion. History revealed reduced appetite and weight gain of 7 kg over the last one month. His past medical history and family history was negative. He had no history of alcohol abuse or viral hepatitis infection. Laboratory data revealed normal transaminases and bilirubin levels, and alkaline phosphatase and gammaglutamyltransferase were within normal range. A diagnostic laparoscopy was performed which showed free peritoneal fluid and normal abdominal viscera. Upper gastrointestinal system endoscopy performed a few days later revealed diffuse severe erythematous pangastritis and gastroduodenal gastric reflux. Duodenal biopsies showed chronic nonspecific duodenitis. Antrum and corpus biopsies showed chronic gastritis. The ascitic fluid was straw-colored and sterile with 80% eosinophils. Stool exam was negative for parasitic infection. Treatment with albendazole 400 mg twice daily for 5 days led to the disappearance of ascites and other signs and symptoms. Three months after albendazole treatment the eosinophilic cell count was normal. The final diagnosis was consistent with parasitic infection while the clinical, sonographic and histological findings suggested an eosinophilic ascites. We emphasize the importance of excluding parasitic infection in all patients with eosinophilic ascites. We chose an alternative way (albendazole treatment) to resolve this clinical picture. With our alternative way for excluding this parasitic infection, we treated the patient and then found the cause.