Blue Jays' Halladay out 4-6 weeks with appendicitis

Former Cy Young winner Roy Halladay is expected to miss 4-6 weeks because of appendicitis, the latest bad break for the struggling Toronto Blue Jays. Halladay will have an appendectomy later tonight.

Halladay lasted only five innings Thursday night and was hit hard in an 8-0 loss to Boston. The 2003 AL Cy Young winner is 4-2 with a 4.37 ERA in eight starts. The rout by Boston was the Blue Jays' ninth straight loss and left them in last place in the AL East.

On Thursday, Toronto lost closer B.J. Ryan for the year after he had ligament replacement surgery on his left elbow.
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Jays Ace Roy Halladay Has Appendicitis

Former Cy Young winner Roy Halladay is expected to miss four to six weeks because of appendicitis, the latest bad break for the struggling Toronto Blue Jays. Halladay was set to have an appendectomy Friday night.

Halladay lasted only five innings Thursday night and was hit hard in an 8-0 loss to Boston. The 2003 AL Cy Young winner is 4-2 with a 4.37 ERA in eight starts.

The rout by Boston was the Blue Jays' ninth straight loss and left them in last place in the AL East.

On Thursday, Toronto lost closer B.J. Ryan for the year after he had ligament replacement surgery on his left elbow.
source:/www.myfoxkc.com

Halladay out with appendicitis

The Toronto Blue Jays Friday placed pitching ace Roy Halladay on the 15-day disabled list with acute appendicitis.

In his last two starts, both losses, the hard-throwing right-hander gave up 17 runs and 23 hits in 10 1/3 innings.

He began the season 4-0 with a 2.28 ERA, which led to an American League Pitcher of the Month Award for April.

Halladay, a four-time all-star, is expected to miss 4-6 weeks after undergoing surgery.
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Blue Jays place Halladay on DL with appendicitis

The Toronto Blue Jays placed pitcher Roy Halladay on the 15-day disabled list Friday with acute appendicitis.

The former American League Cy Young Award winner will undergo surgery and is expected to miss four to six weeks of action.

Halladay is 4-2 with a 4.37 earned run average in eight starts. His performance has dipped recently, however. In his last two outings -- both losses -- Halladay has allowed 17 runs on 23 hits in just 10 1/3 innings.

Halladay started the season with a perfect 4-0 record with a 2.28 ERA and won the AL Pitcher of the Month Award.
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Blue Jays place Halladay on DL with appendicitis

Toronto, ON (Sports Network) - The Toronto Blue Jays placed pitcher Roy Halladay on the 15-day disabled list Friday with acute appendicitis.

The former American League Cy Young Award winner will undergo surgery and is expected to miss four to six weeks of action.

Halladay is 4-2 with a 4.37 earned run average in eight starts. His performance has dipped recently, however. In his last two outings -- both losses -- Halladay has allowed 17 runs on 23 hits in just 10 1/3 innings.

Halladay started the season with a perfect 4-0 record with a 2.28 ERA and won the AL Pitcher of the Month Award.
source:www.sportsnetwork.com

Appendicitis sidelines Blue Jays ace Halladay

Former Cy Young winner Roy Halladay is expected to miss four to six weeks because of appendicitis, the latest bad break for the struggling Toronto Blue Jays. Halladay was set to have an appendectomy Friday night. Halladay lasted only five innings Thursday night and was hit hard in an 8-0 loss to Boston. The 2003 AL Cy Young winner is 4-2 with a 4.37 ERA in eight starts. The rout by Boston was the Blue Jays' ninth straight loss and left them in last place in the AL East. On Thursday, Toronto lost closer B.J. Ryan for the year after he had ligament replacement surgery on his left elbow.
source:abclocal.go.com

Appendicitis sidelines Blue Jays ace Halladay

Former Cy Young winner Roy Halladay is expected to miss four to six weeks because of appendicitis, the latest bad break for the struggling Toronto Blue Jays. Halladay was set to have an appendectomy Friday night. Halladay lasted only five innings Thursday night and was hit hard in an 8-0 loss to Boston. The 2003 AL Cy Young winner is 4-2 with a 4.37 ERA in eight starts. The rout by Boston was the Blue Jays' ninth straight loss and left them in last place in the AL East. On Thursday, Toronto lost closer B.J. Ryan for the year after he had ligament replacement surgery on his left elbow.
source:abclocal.go.com

Jays ace felled by appendicitis

A case of acute appendicitis will sideline ace Roy Halladay for 4-to-6 weeks in the latest, and perhaps most severe, blow to the Toronto Blue Jays this season.
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CT Scan Slows Time to Appendectomy

If the classic signs of appendicitis are present, there's no need for a confirmatory CT-scan, a researcher said here.

In fact, waiting for a CT scan was associated with a significantly higher risk of perforated appendix (P=0.015) in a single-institution retrospective analysis, according to Herbert Chen, M.D., of the University of Wisconsin at Madison.
Although a CT scan can be relatively rapid, it was associated with a significantly greater time (P<0.001) from ER to OR, Dr. Chen said during Digestive Disease Week.

He hopes the study "will change people's attitudes" toward the use of CT in cases of suspected appendicitis, Dr. Chen said. He noted that some smaller studies have reported similar results. (ACEP: CT No Help in Suspected Appendicitis)

With 411 patients over a three-year period, Dr. Chen said, "ours has the advantage of large numbers."

Over the three years, he said, 256 patients (62%) with suspected acute appendicitis had a pre-operative CT scan, while 155 went directly to surgery with no prior imaging.

Those who did not get a CT scan were younger (mean of 31 years versus 37) and more likely to be male (66%) - differences that were significant at P<0.001 and P=0.001, respectively.

There was no difference in the length of surgery or white blood cell count, but significantly:

* The time from presentation to the operating room was 8.2 hours for those getting a CT scan, compared with 5.1 hours for others.
* The risk of perforation was 17% in those getting a CT scan, compared with 8%.
* The rate of negative procedures - no appendicitis found during surgery - was not significantly different between the groups.

Dr. Chen said physicians should be "very selective" about who gets sent for a CT scan, because a delayed surgery is associated with an increased risk of complications.

"I would say if someone comes in with the straightforward signs and symptoms that we as surgeons are all taught, that patient should not have a CT scan," he said.

If the diagnosis is in doubt - usually in older patient and women - a CT scan can be useful, he said.

Dr. Chen said he thinks the increasing use of CT for appendicitis is a function of doctors not wanting to miss anything, possibly because of legal issues.

"We have seen a dramatic increase in the utilization of CT scanning," he said. "Everyone wants to get the diagnosis right."

But it's unlikely things will change, said Gregory Ginsberg, M.D., of the University of Pennsylvania, who moderated a press conference at which Dr. Chen discussed his study.

"That horse has left the barn," Dr. Ginsberg said. He noted that the study was retrospective and so represents "clinical decisions" taken by physicians at the time.

But he agreed with Dr. Chen that CT should take second place to a doctor's clinical judgment.

"I want to underscore that diagnostic imaging is adjunctive," he said, "but does not replace thoughtful consideration in the eyes and hands of an experienced clinician."
source:www.medpagetoday.com

Preoperative CT Scans for Presumed Appendicitis Should Be Used More Selectively: Presented at DDW

Preoperative computed tomography (CT) scanning of patients with presumed appendicitis should be used very selectively, since they can delay surgical intervention and lead to an increased risk of perforation, researchers reported here at Digestive Diseases Week (DDW).

"Our findings suggest that CT scanning is used too often and contributes to delays that, in turn, cause a higher perforation rate," said presenter and investigator Herbert Chen, MD, assistant professor, division of general surgery, and chief, endocrine surgery, University of Wisconsin School of Medicine, Madison, Wisconsin, United States.

Dr. Chen discussed the findings of his study in a press briefing on May 22nd.

"This situation seems to be driven largely by medical-legal concerns," added briefing moderator Gregory Ginsberg, MD, director, endoscopic services, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.

Dr. Chen and colleagues analysed retrospectively CT scan records of adult patients with appendicitis at the University of Wisconsin Hospital in Madison to determine the sensitivity, specificity, and effect on clinical outcome. They correlated surgical findings, including incidence of perforation, to imaging results.

During a 3-year period, 410 subjects underwent appendectomy for presumed acute appendicitis, and 255 (62%) underwent preoperative CT scanning. The other 155 subjects (38%) did not undergo CT imaging before surgery.

Mean white blood cell counts at presentation in the emergency room were similar between the 2 groups.

The researchers reported that CT had a 93% overall sensitivity but only a 59% specificity for acute appendicitis.

Patients who were given CT scanning were older and were more likely to be female. They also waited longer between admission and surgery than those who were not scanned (8.2 vs 5.1 hours).

Notably, perforation appeared in 17% of those who were scanned compared with 8% of those who were not scanned.

"The potential delay that associated with higher perforation leads us to believe that CT should be used more selectively," Dr. Chen said.
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Computed Tomography in Diagnosis of Acute Appendicitis

It can be difficult to assess whether a patient is experiencing acute appendicitis or has an intestinal upset. CT, or computed tomography, scans can help determine if the patient needs to have his or her appendix removed. However, while having a clear picture showing the appendix confirms patient and physician suspicions, the time required to conduct the scan delays time to a potential operation, with the risk that the appendix could perforate while the patient awaits the test results.

Researchers at the University of Wisconsin in Madison, Wis. evaluated the differences between patients who received a CT scan before removal of their appendix and those who went directly to surgery without the test.

In this study, investigators reviewed the hospital records for 412 adult patients admitted to University of Wisconsin Hospital during a three-year period. The researchers compared the white blood cell counts taken from patients both upon arrival to the emergency room and at the operating room. Of the 410 patients showing signs of acute appendicitis, more than half (62%) had a CT scan before the removal of their appendix.

Patients who were ordered a CT scan were older, more likely to be female and had experienced a longer waiting period between admittance and surgery than those who were not ordered a scan (8.2 vs. 5.1 hours). Additionally, perforation was seen in 17 percent of those who had a CT scan, while only eight percent of those who did not get a CT scan experienced perforation.

"These findings suggest that pre-operative CT scanning in patients experiencing acute appendicitis symptoms should be used selectively," said Herbert Chen, M.D., of University of Wisconsin and lead author of the study. "CT imaging may delay surgery, increasing the likelihood of the appendix rupturing and causing potentially dangerous complications for the patient."-American Gastroenterological Association
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