More than 4 percent of preschool-aged children in the United States have blood lead levels above 10 [micro]g per dL (0.50 [micro]mol per L), and these levels have been associated with a decline in IQ. The Centers for Disease Control and Prevention adv
What problems does lead cause? High lead levels in the body can cause problems with the brain, kidneys, and bone marrow (soft tissue inside bones). Symptoms of high lead levels can include belly pain, headaches, vomiting, confusion, muscle wea
Beta-lactam antibiotics include penicillins, cephalosporins and related compounds. As a group, these drugs are active against many gram-positive, gram-negative and anaerobic organisms. Information based on "expert opinion" and antimicrobial susceptibi
Family physicians can assess the smoking behavior of their patients in a few minutes, using carefully chosen questions. The CAGE questionnaire for smoking (modified from the familiar CAGE questionnaire for alcoholism), the "four Cs" test and the Fager
How do I feel about giving up smoking?Check one of the boxes below:[] I like to smoke, and I'm not planning to quit.[] I like lots of things about smoking, but I would like to quit.[] I'm ready to quit smoking now. If you said, "I l
Knee osteoarthritis is a common but often difficult problem to manage in primary care. Traditional nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medication
What is osteoarthritis? Osteoarthritis is a painful knee problem. It is also called degenerative arthritis or wear-and-tear arthritis. Arthritis is what happens when the tissue that protects the bones wears away. This tissue is called cartilag
This feature is part of a year-long series of excerpts and special commentaries celebrating AFP's 50th year of publication. Excerpts from the two 1950 volumes of GP, AFP's predecessor, appear along with highlights of 50 years of family medicine.
Arizona Sept. 10-13: Breast-feeding medicine: the nature and nuture of infant nutrition. Omni Hotel & Golf Resort, Tucson. (16 3/4 hrs: P) Sponsor: Academy of Breastfeeding Medicine. Contact Janene Dawson: 913-541-9077. Sept. 22-25: In
Interest in the effects of creatine use by a number of American athletes has led to numerous studies. Many of these studies have produced conflicting findings. The American College of Sports Medicine (ACSM) has published a consensus statement from the
Author: Richard Sadovsky
Date: Nov 15, 1996
Acute cholecystitis is a common abdominal condition resulting from chemical or bacterial inflammation of the gallbladder. It is generally related to gallstones and subsequent unresolved obstruction. Early surgery is the treatment of choice because of the greater mortality and morbidity associated with treatment delay. The clinical presentation is most commonly characterized by abdominal pain, anorexia, nausea and vomiting. Some studies have also demonstrated the presence of fever and leukocytosis as typical findings. Gruber and associates retrospectively reviewed the medical charts of patients presenting to an emergency department to determine the frequency of fever and leukocytosis associated with acute cholecystitis.
Patients were included in the study if they had a positive hepato-iminodiacetic acid (HIDA) scan establishing the diagnosis of acute cholecystitis. All of the patients underwent surgery, and pathologic diagnosis of acute cholecystitis was made if neutrophils were present and there was no evidence of chronicity. A total of 198 patients were identified (median age: 59 years). Pathologic examination revealed acute cholecystitis in 154 subjects (78 percent) and chronic cholecystitis in 44 subjects (22 percent). Of the 154 patients with acute cholecystitis, 51 (34 percent) were found to have gangrenous cholecystitis.
During the first eight hours following arrival in the emergency department, 32 percent of the patients had fever (defined as an oral temperature of 37.7[degrees]C 100.0[degrees]F or greater or a rectal temperature of 38.0[degrees]C [100.4[degrees]F], and 61 percent had leukocytosis (defined as a white blood cell count of 11,000 per mL [11.0 x [10.sup.9] per L] or greater). Thirty-one percent of the patients did not have fever or leukocytosis. The presence of fever or leukocytosis was not related to the duration of symptoms, time elapsed before surgery, or the sex of the patient. The occurrence of fever was not related to the occurrence of leukocytosis. The maximum temperature and white blood cell count during the first 24 hours in the hospital were also recorded; fever developed in 66 percent of the patients and leukocytosis developed in 76 percent.
The authors conclude that typical clinical presentations of acute cholecystitis include abdominal pain or pain on examination, and history of nausea and vomiting. Most patients with nongangrenous cholecystitis did not have fever, and 32 percent of all patients with acute cholecystitis lacked leukocytosis. The clinician should not depend on the presence of these signs to make the diagnosis of acute cholecystitis.
Gruber PJ, et al. Presence of fever and leukocytosis in acute cholecystitis. Ann Emerg Med 1996;28:273-7.
COPYRIGHT 1996 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group