Australasian Science: Australia's authority on science since 1938

Speed Bump Pain a Sign of Appendicitis

By Magdeline Lum

Appendicitis could be diagnosed by a patient’s pain when driving to hospital over speed bumps.

There have long been anecdotal reports of a link between acute appendicitis and pain experienced when driving over speed bumps. Could it be used as a diagnostic tool? There has never been any evidence to support this until now.

A district general hospital in Buckinghamshire in the United Kingdom was chosen as the location for a small prospective study. The researchers describe the roads of Buckinghamshire as “almost universally surfaced in tarmac and are smooth” – apart from speed bumps.

The patients involved were aged over 16 and had been referred to the on-call surgical team as part of their normal care by either a GP or an emergency room doctor with suspected appendicitis. The study took place over a 6-month period.

Patients were asked whether their pain increased or worsened when going over speed bumps on their way to the hospital. Of the 34 patients who eventually had surgery and were found to have a blocked appendix, 33 were “speed bump positive”. They had experienced a jarring pain when going over a speed bump.

There were also “speed bump positive” patients who did not have appendicitis. These patients were diagnosed with other abdominal problems, including a ruptured ovarian cyst and diverticulitis. This does not make speed bumps a reliable test for confirming appendicitis.

However, the evidence showed that speed bumps could be used to rule out problems associated with the appendix with more confidence. The study concluded that questioning patients about their drive over speed bumps could be used as part of routine assessment.

Radioactive Bacteria Treating Cancer

Pancreatic cancer is the sixth-highest cause of death for all cancer types in Australia. Only about 6% of people with this cancer survive 5 years after diagnosis compared with a 5-year survival of 88% for breast cancer, 93% for thyroid cancer and 19% for lung cancer. Currently there are very few treatment options available.

Now researchers have shown in a mouse model that bacteria can be used to deliver radioisotopes to kill pancreatic cancer that has spread, or metastasised, to other parts of the body.

The bacteria chosen was Listeria mono­cytogenes, which belongs to a bacterial family that can cause serious health complications including fever, muscle aches, nausea, septicaemia, convulsions and death. Infection during pregnancy can lead to miscarriage or stillbirths.

It turns out that the combination of two potentially lethal things does not make the situation worse. Radiation has long been used to treat cancer, and a healthy immune system normally removes Listeria.

In 2009 Dr Claudia Gravekamp of the Albert Einstein College of Medicine had discovered why Listeria infects cancer cells and not healthy ones. Since the tumour cells can suppress the immune system, Listeria can infect them. However, the immune system is able to overwhelm Listeria in normal cells.

Now, in research published in the Proceedings of the National Academy of Sciences, Gravekamp and Dr Ekaterina Dadachova have used a weakened form of L. mono­cytogenes to carry radioactive antibodies preferentially to the metastatic cancer cells.

After several doses, the mice that had received the treatment had 90% fewer metastatic tumours than those that had received radiotherapy and saline. However, the original cancer in the pancreas remained unaffected.

The treatment regime remains a long way from reaching human trials. There is still the need to explain what was observed in this trial, and what remains unknown is the effect of radiation on healthy organs.

“At this point, we can say that we have a therapy that is very effective for reducing metastasis in mice,” Gravekamp said. “Our goal is to clear 100% of the metastases, because every cancer cell that stays behind can potentially form new tumours.”

The researchers expect the treatment could be improved by fine-tuning the treatment schedule, using higher doses of radiation, or by placing additional anti-cancer agents onto the bacteria.