Abdominal Abnormalities Research Articles

Value of thoracic and abdominal screening in dogs with neurological signs.

To detect the incidence of clinically important thoracic and abdominal imaging abnormalities in patients with neurological signs but with no clinical signs or laboratory findings consistent with thoracic or abdominal disease. Review of imaging findings in dogs with neurological signs but no thoracic or abdominal signs that underwent thoracic, or thoracic and abdominal screening during the same hospitalisation as the neurological investigation. Two hundred and six dogs were included in the thoracic study. Of those, only eight (3.9%) had clinically important findings and in only five cases (2.4%) were the findings related to pathology identified on MRI. One hundred and forty-seven dogs were included in the abdominal study. Abnormalities were found in 23 dogs (15.6%), but in only eight (5.4%) were they considered to be of current clinical importance and in only three (2%) were they related to the pathology identified on MRI. Ultrasonography provided valuable additional information in 22 cases (15%) but this was only considered important in four (2.7%) and related to the neurological condition in one (0.7%). As expected, abdominal ultrasonography often provided more information than radiography alone in the abdominal screening but this was rarely clinically relevant or related to the reason for referral. Thoracic and abdominal screening of neurological patients with no clinically evident thoracic or abdominal clinical signs only infrequently identified occult but clinically important pathology which changed the current management plan, regardless of neurolocalisation or age.

Pentalogy of Cantrell: A case report of probable pentalogy of Cantrell in a full-term neonate

Background: Pentalogy of Cantrell (PC) is an extremely rare congenital anomaly which was first described in 1985. The incidence of the PC has been reported to vary from 5.5-7.9 cases per million live births. This anomaly involves diaphragmatic pericardial defects, lower sternal defect, intracardiac anomalies, ventral abdominal wall abnormality, and anterior diaphragmatic defect. Considering the number of presented anomalies, PC is classified into three groups of certain, probable, or incomplete pentalogy. Although the etiology of PC is unknown, it has been assumed that abnormalities in intra embryonic mesodermal differentiation formation and migration at around 14-18 days after conception are responsible for the anomalies observed in PC. The prenatal diagnosis of the PC can be made via prenatal two-dimensional or three-dimensional ultrasound. Case report: This case report investigated an Iranian 2-hour-old full-term neonate who was referred to Imam Reza Hospital, Kermanshah, Iran, due to respiratory distress and abdominal wall defect. The patient was finally diagnosed with a probable PC, although his prenatal investigations were considered normal. Conclusion: Although ultrasonography is a widely available tool for prenatal diagnosis of PC, as in our case, the absence of ectopic heart and omphalocele makes the prenatal diagnosis of PC via ultrasonography less possible. Keyword

Anthropometric Determinations of Umbilical Position in Iraqi Adults.

Introduction Umbilicus is an important surface landmark on the anterior abdominal wall in addition to its aesthetic and psychological effect. Objectives The objective of the study is to determine the position of umbilicus in Iraqi adults to provide a guide for the neoumbilicus in abdominoplasty. Subjects and Methods This is an observational study performed on 100 volunteers with no abdominal wall abnormality. Measurements included weight, height, body mass index (BMI), distance from xiphoid to umbilicus, distance from xiphoid process to pubic symphysis, distance from xiphoid process to both anterior superior iliac spine (ASIS), distance from pubic symphysis to umbilicus and from pubic symphysis to xiphisternum, distance of umbilicus to both ASIS, and distance of umbilicus to interspinous line and to inter-anterior hypochondrium line. Results The study included 100 volunteers, with 50% male and 50% female whose age ranges between 18 to 60 years. The results were a follows: distance from xiphoid process to umbilicus and distance from xiphoid process to pubic symphysis were 18.03 ± 3.25 cm and 32.21 ± 4.64 cm, respectively; distances from xiphoid process to right ASIS and left ASIS were 25.95 ± 5.72 cm and 25.84 ± 6.02 cm, respectively; distance from pubic symphysis to umbilicus was 17.66 ± 3.12 cm; distance of umbilicus to interspinous line was 9.25 ± 1.84 cm. The distance from umbilicus to inter anterior hypochondrium line was 9.905 ± 2.19 cm. Conclusion These measurements can determine the neoumbilicus position, reduce practical mistakes, and improve postsurgical outcomes.

Dandy-Walker Malformation

Dandy-Walker Malformation

Sonographic Assessment of Some Abdominal Organs in Children with Sickle Cell Disease in Ilorin, Nigeria.

Background:The irregular sickle cells can block blood vessels, causing tissue and organ damage and in most cases presented with pain as a result of organ ischemia. Ultrasonography is an easily available instrument for investigating abdominal organs which are most commonly affected by sickle cell disease (SCD). This study was aimed to assessing liver, gall bladder, spleen, and kidney in children with SCD in Ilorin, Kwara State.Methods:A prospective cross-sectional study was conducted among children with SCD in Ilorin from September 2017 to April 2018. An ethical approval was obtained from the Human Research and Ethics Committee of the Kwara State Ministry of Health. In this study, 106 children with SCD and 106 normal children for control were included. Abdominal ultrasound scan was performed on all the selected subjects and the findings were recorded on the data capture sheet. Descriptive and inferential statistic was used in the data analysis, SPSS version 20 was used and the P = 0.05.Results:In the children with SCD, hepatomegaly was found in 45 (42.5%), 29 (27.4%) had coarse echo pattern of liver and 16 (15.1%) had hyperechoic liver, 5 (4.7%) had gallbladder stone, 2 (1.9%) had gallbladder sludge, and 6 (5.6%) had thickened gallbladder wall. Twenty-five (23.6%) had splenomegaly, and 7 (6.6%) had autosplenectomy. Four (3.8%) showed reduced corticomedullary differentiation in each kidney, five (4.7%) in each kidney had mild calyceal dilatation. One (0.9%) had mild calyceal dilatation with reduced corticomedullary differentiation with accompanying loss of renal sinus fat.Conclusion:Abdominal ultrasound imaging for patients with SCD showed a high incidence of abdominal abnormalities, especially in solid organs such as liver, kidney, and spleen.

Abdominal CT in COVID-19 patients: incidence, indications, and findings.

PurposeThe purpose of this study was to evaluate the frequency, indications, and findings of abdominal CTs ordered in the initial evaluation of patients who had a positive COVID-19 test performed in our institution.MethodsRetrospective chart review was performed on all patients who had a positive test for COVID-19 performed at a single quaternary care center from 1/20/2020 through 5/8/2020. In a subset of patients undergoing abdominal CT as part of the initial evaluation, the demographics, suspected COVID-19 status at the time of scan, presenting complaints, and abdominal CT findings were recorded. Cardiothoracic radiologists reviewed and scored the visualized lung bases for the likelihood of COVID-19.ResultsOnly 43 (4.1%) of 1057 COVID-19 patients presented with abdominal complaints sufficient to warrant an abdominal CT. Of these 43 patients, the vast majority (39, 91%) were known or suspected to have COVID-19 at the time of the scan. Most (27/43, 63%) scans showed no acute abdominal abnormality, and those that were positive did not share a discernable pattern of abnormalities. Lung base abnormalities were common, and there was moderate inter-reviewer reliability.ConclusionA minority of COVID-19 patients present with abdominal complaints sufficient to warrant a dedicated CT of the abdomen, and most of these studies will be negative or have abdominal findings not associated with COVID-19. Appropriate lung base findings are a more consistent indication of COVID-19 infection than abdominal findings.

Abdominal lymphatic system visibility, morphology, and abnormalities in children as seen on routine MCRP and its association with immune-mediated diseases.

(1) To assess the visibility and diameters of the thoracic duct (TD) and cisterna chyli (CC) on MR cholangiopancreatography (MRCP) in children. (2) To evaluate for the presence of any lymphatic abnormalities and assess their association with diseases in which the immune system is implicated in etiopathogenesis. This retrospective study included 142 MRCPs performed in children 8-17years old and without prior surgeries. Two radiologists reviewed all exams for visibility and diameters of the TD and CC, and presence of abnormal lymphatic collaterals. TD and CC diameters in various disease processes were compared using Student's t tests. The association of collaterals with immune-mediated diseases was assessed using Fisher's exact tests. The TD and CC were seen in 134/142 (93.7%) cases with mean diameter of 3.25 ± 1.07mm and 126/142 (88.7%) cases with mean diameter of 4.55 ± 1.37mm respectively. The mean diameter of CC was larger in patients with portal hypertension (p = 0.021). There were no significant differences in the TD and CC diameters between immune-mediated and non-immune-mediated diseases. Retroperitoneal collaterals were seen in 41/142 (28.8%) of cases and were associated with both portal hypertension (p = 0.0019) and immune-mediated diseases (p = 0.0083). The TD and CC can be visualized in the majority of children on routine MRCP images, and CC has larger diameter in patients with portal hypertension. The association of collaterals with immune-mediated diseases supports a potential role of the lymphatic system in the etiopathogenesis of immune-mediated diseases. • The lymphatic system has been increasingly implicated in a number of inflammatory and immune-mediated diseases. • The abdominal lymphatic system can be visualized in the majority of children above 8years on routine MRCP images. Similar to adult studies, the cisterna chyli is significantly larger in children with portal hypertension. • Retroperitoneal lymphatic collaterals, seen in 29% children, are associated with immune-mediated diseases, which supports the potential role of the lymphatic system in the pathogenesis of immune-mediated diseases.

Two cases of Prune Belly Syndrome from Kagera Region Tanzania.

Prune Belly Syndrome is a rare congenital disorder with unknown aetiology, consisting of a triad of abdominal muscle wall weakness, undescended testes, and urinary tract abnormalities. We are unaware of any preceding report of Prune Belly Syndrome in Tanzania, and here we describe two cases reported in Kagera region. The first case is a 2 month old boy with the triad of Prune Belly Syndrome along with pectus carinatum who died due to septicaemia. This case posed a diagnostic challenge at birth and during the natal period. Paucity of comprehensive knowledge of congenital malformations at the peripheral health facilities may have also contributed to the diagnostic challenge in the first place.The second case is a neonate who was referred to regional referral hospital where he was diagnosed with Prune Belly Syndrome at the age of four weeks. Because of limited capacity to manage congenital malformations at the regional referral hospital, he was referred to an urologist at the zonal referral hospital. However, inadequacies in supporting systems to the parents compounded care of the neonate with Prune Belly Syndrome.High index of Prune Belly Syndrome suspicion is needed in a resource limited setting in order to timely make diagnosis. There is also a need to strengthen institutional and individual's capacity for prenatal screening to detect congenital anomalies at an early stage of foetus development. Multidisciplinary management approach is necessary in order to improve the quality of life for patients with Prune Belly Syndrome. Psychosocial and medical support systems should be put in place in order to enhance preparedness for patient care in resource limited settings including equipping the referral hospital with different specialists and ensuring availability of basic investigations for patients.

PERANAN MRI ABDOMEN PADA KASUS HERLYN WERNER WUNDERLICH

Background: Herlyn-Werner-Wunderlich syndrome (HWW) is a very rare genetic syndrome, a combination of anomalies between the mullerian and mesonephric ducts characterized by uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis, also known as Obstructed Hemivaginal syndrome and Ipsilateral Renal Anomaly (OHVIRA). Magnetic Resonance Imaging (MRI) is an effective diagnostic support tool for finding out anatomical abdominal abnormalities with the right choice of protocol sequences to obtain optimal MRI images.
 Method: This study used a qualitative descriptive approach by presenting a case of a 20 year old female patient who had complaints of lower abdominal pain, no previous medical history and irregular menstruation. MRI Abdomen without contrast was performed using an MRI 1.5 Tesla signa explorer GE Healthcare at EMC Tangerang Hospital. Using the Coronal T2 SSFSE sequence, T1 fat sat LAVA, Axial T2 SSFSE, T1 fat sat LAVA breath hold method and Coronal 3D IFIR (MRA renal without contrast). Specifically for the pelvic area with the Axial T2 Propeller, Coronal T2 fat sat, and Sagittal T2 sequences.
 Result: In the Axial T2 propeller sequence, pelvic area retrieval revealed two separate uterine corpuses (uterus didelphys) accompanied by a heterogeneous oval lesion most likely originating from the left side of the vagina (hemivagina). Whereas in the Coronal T2 sequence the whole abdomen was taken and confirmed by the Coronal 3D IFIR, the right kidney was anatomically visible while the left kidney was not visible (agenesis).
 Conclusion: Abdominal MRI is a very accurate diagnostic tool to perform Herlyn-Werner-Wunderlich (HWW) syndrome without contrast agent with SSFSE T2 sequences, T2 propeller and 3D IFIR which have an important role in visualizing the quality of MRI images.

Screening CT angiography in patients with suspected fibromuscular dysplasia: improved patient care with single-session skull vertex to pelvis coverage.

Imaging plays a key role in the workup of patients with clinically suspected fibromuscular dysplasia (FMD), and research has highlighted the potential of computed tomography angiography (CTA) in screening for thoracic, abdominal, and pelvic arterial abnormalities in these patients. We sought to evaluate imaging findings from patients with suspected or diagnosed FMD who underwent screening CTA at our institution with a novel single-acquisition protocol that offers increased anatomic coverage, with images obtained from the skull vertex to the pelvis. Images from 80 consecutive patients scanned with the novel single-session CTA protocol covering the skull vertex to the pelvis were compared with images from 20 additional consecutive patients who underwent CTA for the head and neck separate from CTA of the chest, abdomen, and pelvis. Compared with CTA performed in separate sessions, the single-session CTA protocol decreased the radiation dose by 38% (P<0.001) and decreased the contrast dose by 39% (P<0.001), with satisfactory image quality noted in all instances. Additionally, higher mean contrast attenuation was noted in the aortic arch with use of the novel protocol (409±76 HU) versus with use of the dual-acquisition protocol (260±38 HU; P<0.001). These results suggest that use of a novel single-session CTA protocol extending from the skull vertex to the pelvis provides effective screening imaging in patients with suspected or diagnosed FMD as compared with multisession, standard-pitch CTA.

An analysis of clinical risk factors for adolescent scoliosis caused by spinal cord abnormalities in China: proposal for a selective whole-spine MRI examination scheme

BackgroundApproximately 80% of adolescent scoliosis cases are idiopathic, and some non-idiopathic scoliosis cases caused by spinal cord abnormalities are misdiagnosed as idiopathic scoliosis. This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities, explored the feasibility of whole-spine MRI, and provided a theoretical basis for the routine diagnosis and treatment of adolescent idiopathic scoliosis.MethodThe clinical data of adolescent scoliosis patients who were admitted to Shanghai Tongren Hospital and Shanghai Changhai Hospital between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. Sex, age, main curvature angle, main curvature direction, kyphosis angle, scoliosis type, coronal plane balance, sagittal plane balance, abdominal wall reflex, sensory abnormality, ankle clonus and tendon reflexes were compared between the two groups. Student’s t test was used to evaluate the differences in the continuous variables, and the chi-square test was used to evaluate the differences in the categorical variables. Fisher’s exact test was applied to detect the difference in the rate of intraspinal anomalies between the groups. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities.ResultA total of 714 adolescent scoliosis patients with a mean age of 13.5 (10–18 years) were included in the study, and intramedullary abnormalities were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P < 0.01). Logistic regression showed that the ratios for sex, scoliosis direction, scoliosis type, abdominal wall reflex and ankle clonus were 2.987, 3.493, 4.823, 3.94 and 8.083, respectively. The ROC curve showed a sensitivity of 66.18% and a specificity of 89.01%, and the Youden index corresponding to the optimal critical point was 0.5519.ConclusionRisk factors associated with adolescent scoliosis caused by abnormal intramedullary abnormalities included male sex, thoracic scoliosis on the left side, sharp curvature of the spine, abnormal abdominal wall reflex and ankle clonus. In adolescent scoliosis patients, the incidence of scoliosis caused by intramedullary abnormalities was approximately 9.5%. These clinical indicators suggest that there is a high-risk adolescent scoliosis population who should undergo whole-spinal MRI preoperatively to rule out intramedullary abnormalities.

A case of a linear foreign body removal in a miniature companion pig

Despite the recent rise in popularity of miniature pigs as companion animals, there are few published reports available regarding gastrointestinal surgery in these animals. This case report describes a 4-year-old castrated male companion potbellied pig who was diagnosed with a small bowel linear foreign body and associated pyloric outflow obstruction. A gastrotomy and three enterotomies involving the proximal and mid-jejunum and proximal centripetal loop of the spiral colon were performed to remove the linear foreign body. The surgical techniques and post-operative care described in this case report provided effective treatment of the linear foreign body and adequately prevented clinical evidence of post-operative complications in the companion potbellied pig. Follow-up information was obtained via telephone interviews and a recheck appointment one year later revealed a healthy animal with no abdominal radiographic or ultrasonographic abnormalities.

The Pentalogy of Cantrell: A Case Report

Pentalogy of Cantrell (PC) is a rare anomaly marked by the coexistence of omphalocele and ectopia cordis. Pentalogy of Cantrell comprises of the following five characteristics: midline, upper abdominal wall disorder (e.g. omphalocele, gastroschisis); defect of lower sternum (i.e. cleft sternum or absent sternum); anterior diaphragmatic defect (i.e. hypoplastic diaphragm, anterior diaphragmatic hernia); pericardial abnormality (e.g. ectopia cordis); congenital abnormalities of the heart (e.g. tetralogy of Fallot, ventricular septal defect, atrial septal defect). Toyama classified this syndrome into: class I – the occurrence of all 5 defects; class – II the occurrence of 4 defects with intracardiac and ventral abdominal wall abnormalities definitely present; class III – an incomplete expression of the disorders showing various combinations of defects, although sternal anomalies are definitely present. The incidence is estimated 5.5 – 7.9 per 1 million live births with male predominance. PC can be diagnosed since antenatal through ultrasonography examination. Unfortunately, the mortality rate is quite high with minimal survival rate even with surgical reconstruction. We present a case of one-day old infant whom was referred from West Nusa Tenggara with suspicion of PC syndrome and neonatal pneumonia. The baby was born through cesarean section with mild asphyxia, birth weight was 3000 gram and body length was 48 cm. There was no family and pregnancy risk factor. The multidisciplinary team consist of neonatologist, pediatric cardiologist and pediatric surgeon was teamed up to handle this case. There were some abnormalities in complete blood counts such as decreasing number of lymphocyte and neutrophil percentage and also increasing basophil percentage. Chest and abdominal X-ray showed a suspicion of pneumonia but this didn’t align with our physical examination. Echocardiography showed the infant had congenital heart defects such as Taussig Bing anomaly, single atrium, mild valvular pulmonary stenosis, mild tricuspid regurgitation and mesocardia. Genetic testing and further radiologic examination other than plain X-ray were not done in this case. There was no further intervention for this patient other than regular echocardiography and antibiotic topical treatment.

Abdominal ultrasonographic findings in dogs with mammary tumors: association with tumor characteristics and survival

Abdominal ultrasound is frequently performed as part of initial staging of canine mammary tumors. The aims of this study were to describe abdominal ultrasonographic findings present at diagnosis of mammary tumors in dogs and to assess their value for associations with histopathological results and treatment outcome. The medical records of 201 female dogs diagnosed with mammary tumors that had abdominal ultrasonography performed as part of their initial clinical evaluation were reviewed. Histopathological diagnosis of malignant mammary tumors was obtained in most cases (86%; 172 cases). One hundred and fifty-seven animals (78%) had some ultrasonographic abnormality. A total of 338 ultrasonographic changes were identified, and the spleen was the organ with the highest frequency of ultrasonographic changes (20%), followed by the uterus (18%) and the liver (16%). Abdominal ultrasonography abnormalities were not associated with mammary tumor malignancy (OR = 1.7; P = 0.27). Ultrasonographic evidence of enlarged intraabdominal lymph nodes was associated with metastases in surface regional lymph nodes (P < 0.05). Dogs with regional metastasis were more likely to present some abdominal ultrasonographic change (OR = 6.1; P = 0.04). Animals with ultrasonographic evidence of intraabdominal lymph node enlargement presented shorter survival after mastectomy. Abdominal ultrasonographic abnormalities are common in dogs with mammary tumors and are not associated with malignancy. However, the presence of intraabdominal lymph node enlargement identified by ultrasound may be associated with regional metastasis and shorter survival rates.

Kagami\u2013Ogata syndrome in a fetus presenting with polyhydramnios, malformations, and preterm delivery: a case report

BackgroundKagami–Ogata syndrome is also known as paternal uniparental disomy 14 and related disorders and is caused by abnormal genomic imprinting in the long arm of the chromosome 14q32.2 region. Its clinical manifestations include polyhydramnios in the fetal stage, respiratory insufficiency because of a small thorax, abdominal wall abnormalities, and peculiar facial features after birth.Case presentationA 38-year-old Japanese primigravida woman was referred to our hospital in the 19th week of pregnancy for suspected omphalocele. She had a history of hypothyroidism but was prescribed orally administered levothyroxine (50 μg/day) prior to conception and was euthyroid. Her ultrasound scan prior to visiting our hospital revealed fetal omphalocele, heavy for date, and polyhydramnios. The mother was advised to be admitted for observation from 28 weeks of gestation for threatened premature delivery. She required amniodrainage at 29 and 32 weeks of gestation. At 35 weeks of gestation, the fetal membrane prematurely ruptured and she gave birth after an emergency Cesarean section. The infant was a male child with a birth weight of 3188 g, and was suspected to have Kagami–Ogata syndrome after birth based on thoracic hypoplasia, swallowing function abnormalities, and peculiar facial features. A definitive diagnosis was established by performing genetic testing of the infant after obtaining informed written consent from both the parents; the results of the genetic testing revealed hypermethylated intergenic-differentially methylated region and maternally expressed gene 3-differentially methylated region in the corresponding chromosome 14 region. Both the parents were genetically tested after adequate genetic counseling, which revealed a de novo microdeletion in a differentially methylated region.ConclusionKagami–Ogata syndrome should have been suspected because of the presence of polyhydramnios and omphalocele during pregnancy. Respiratory insufficiency soon after birth, because of a small thorax, is expected in this disease and a diagnosis during pregnancy may have enabled appropriate care after birth.

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

ObjectiveUltrasound is ubiquitous in live paediatric imaging; however, its usage in post-mortem setting is less established. This systematic review aims to evaluate the diagnostic accuracy of paediatric post-mortem ultrasound (PMUS).DesignMEDLINE,...

A study of surgical site infections in a general practice hospital

Background: Surgical site infections (SSI), major contributor to increased morbidity, mortality and healthcare costs among surgical patients worldwide. This study evaluates the incidence of surgical site infections in abdominal surgeries.Methods: This prospective observational study was conducted at Siri hospital, Khammam after obtaining permission from the hospital ethics committee. A total of 250 patients of elective and emergency abdominal surgery were included and studied about surgical site infections and factors influencing it.Results: This study includes 250 patients with abdominal abnormalities. In this 48(19.2%) patients were recorded with surgical site infection. As the age increases SSI was also increases. ASA scores of III (5.6%) &amp; IV (8.0%) were associated with the increased SSI. These SSI were more common in intestinal obstruction with gangrene cases 7 (2.8%) and also in accidental trauma/injury cases 7 (2.8%). SSI can be noticed after 48 hour of infection and recorded up to 10 days of postoperative period. The surgical wound incidence was clean (14.6%), clean contaminated (29.2%), contaminated (20.8%) and dirty (35.4%) respectively. Major factors that influence the SSI were diabetes, obesity, pre-operative anti biotic usage, duration of surgery, emergency surgery and level of haemoglobin and albumin levels. The organisms isolated from SSI were E.coli (22.9%), Methicillin Resistant Staphylococcus aureus (18.7%), Proteus species (16.6%), Klebsiella species (16.6%), Pseudomonas aeruginosa (8.3%), Staphylococcus aureus (6.2%) and mixed bacterial infections (10.4%).Conclusions: Surgical site infections were more commonly seen in abdominal surgeries. SSI was higher in older people. Control of factors influencing and bacterial contamination decreases the incidence of SSI in abdominal surgeries.

EP04.22: Prenatal diagnosis and clinical analysis of fetal abdominal wall defect and chromosome abnormalities

EP04.22: Prenatal diagnosis and clinical analysis of fetal abdominal wall defect and chromosome abnormalities

Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients

There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49years: 95.65%; 50-59years: 98.33%; 60-69years: 99.47%; > 69years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.

PS1289 THE ATYPICAL LYMPHOCYTE COUNT: A NOVEL PREDICTIVE FACTOR FOR SEVERE DENGUE INFECTION

Background:Dengue haemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS) are life threatening complications of DI which occur in a minority of patients. The early identification of these individuals is critical to guide clinical management. There is currently no validated laboratory test which can predict severe complications of DI. The Atypical lymphocyte count (ALC) is a research parameter generated on Sysmex FBC analysers which has been correlated with the presence of circulating atypical lymphocytes (AL). Pilot studies have suggested that the presence of AL may be associated with severe DI.Aims:We evaluated the utility of the ALC as a predictive factor for severe dengue related thrombocytopaenia as well as DHF and DSS.Methods:We prospectively collected data on patients admitted to Nawaloka Hospital Sri Lanka (NH) with DI between December 2016 and August 2018. DI was diagnosed based on a positive Non‐structural antigen 1 or dengue IgM antibody. ALC data were extracted from the Sysmex XS500i automated FBC analyzer from day of admission to day seven. Clinical data was recorded from medical records and the computerized data base maintained by NH. Statistical analyses were performed using SPSS version 20.Results:201 patients were included in the study. DSS and DHF occurred in 6.5% (n = 13) and 6% (n = 12) of patients respectively. Patients with DHF and DSS as well as those with low Glasgow Coma Scale and respiratory compromise had a higher mean ALC on each day of FBC assessment compared to those without these complications. We detected a statistically significant negative correlation between the ALC on admission and platelet count on days five to seven (the period during which nadir thrombocytopaenia is expected in DI). [Spearmen's correlation; Day 5:‐0.485, Day 6:‐0.428, and Day 7:‐0.344] (P = 0.001) We performed Receiver Operator Curve (ROC) analysis to determine the predictive value of an admission ALC more than 0.5x 103/L for severe thrombocytopaenia (defined as a platelet count less than 50 x 109/l) on day five. We found that this ALC cut off had 90% sensitivity and 70% specificity for severe thrombocytopaenia on day 5. The positive and negative predictive values were 74.4% and 91.2% respectively. We also showed that patients with cardiac and abdominal ultrasonographic abnormalities had a higher mean ALC.Summary/Conclusion:We propose that an admission ALC of greater than 0.5 x 103/L has a strong predictive value for severe thrombocytopaenia on days five to seven of DI. Our data also suggest that a higher ALC on admission maybe predictive for severe DI. ALC on admission maybe a valuable modality for early identification of patients at risk of severe dengue related complications.image