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Tue Feb 28 03:03:29 GMT 2012

that's why, when I saw the kid for the third episode (which happened during 
 the week, unlike the other two which happened Sat night), I set him up for 
the  outpatient contrasted CT scan, which documented the non vis of the 
appy.

*I* was convinced from the first visit.....

ck

In a message dated 02/27/12 13:26:15 Central Standard Time,  
seppelt at med.usyd.edu.au writes:

So a  teenage boy got at least 30 mSv radiation (3 CT scans, old technology 
 scanners) because a surgeon wouldn't make a 5 cm cut in his abdomen?!! I  
wonder how many trainee surgeons know ANYTHING about the doses of radiation  
they are exposing people too. It will get very interesting when these kids  
start getting leukemia and the med-mal lawyers start looking backwards and  
asking whether past scans were actually indicated (lawyers read the 
radiology  literature too).

Cheers, Ian

Sent from my iPad

On  27/02/2012, at 11:34 PM, Krin135 at aol.com wrote:

> I've had several  cases like that, but one was a prominent case in my 
clinic 
> days in  the mid 1990s: mid teen male, slender and muscular, consistent 
but 
>  intermittent RLQ pain. no fevers, significant nausea associated with the 

> RLQ  pain,  some constipation; labs were consistently clear  (WBC never 
more 
> than  about 13K, clear urine, etc). He was sick  enough during the 
episodes 
> that he was  missing school during  them (and this was an A student who 
enjoyed 
> going to  school!).  Physical exam was suspicious for appy, with RLQ 
> tenderness and   guarding, but no rigidity. Genitalia was normal for age 
with no 
>  masses, hernias  or tenderness. Rectal exam (on the second and third  
visits) 
> showed no masses or  prostate tenderness. Single beam CT  scans (x3 over 
the 
> space of 6 weeks) read as  'no pathology but  appendix not visualized' by 
the 
> attending radiologist- the  last  CT was a double contrast scan, 
incidentally.
> 
> I finally  convinced my local surgeon to do a mini lap on the kid based 
on  
>  the non-vis appendix on the contrast scan, where a 1x2cm fecalith and 
>  evidence  of chronic appendicitis was noted.
> 
> Sometime  later, that surgeon complained to me that I was sending him too 

>  many hot appys and gall bladders, and not enough 'normal 
bellies'....seems I  
> was  skewing his stats too much....
> 
> ck
>  
> 
> In a message dated 02/26/12 20:57:42 Central Standard  Time,  
> jrhmdtraum at aol.com writes:
> 
> Let me   give you a prime example for today's great reliance on CT over   
PE.
> 
> 
> My daughter goes to GW University.  Last  Sat her stomach  hurt and she 
went 
> to the student clinic where  the doc used PE and dx'ed  appendicitis.   
She 
>  referred her to the GW ER.  The resident's  exam was also consistent  
with 
> appi, but they did a CT and the radiology  resident read it  as normal so 
they 
> sent her home.  Sun morning, the   radiology attending came in and reread 
the 
> CT as positive for appi  and called  her back.  She went to OR and had a 
hot 
>  appendix with omentum wrapped  around the perforation in the tip.
>  
> 
> PE positive but ignored for  misread CE.  In our  day, she would have 
been 
> on the table Sat morning an  no CT or  ultrasound.done.
> 
> 
> Our surgical residents are not  allowed by  hospital policy to do vaginal 
> exams - they must call  the OB/GYN  resident.
> 
> 
> Yes, PE is something of  the  past.
> 
> 
> 
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