Abdominal X-ray Research Articles

Diagnosing Necrotizing Enterocolitis via Fine-Grained Visual Classification.

Necrotizing Enterocolitis (NEC) is a devastating condition affecting prematurely born neonates. Reviewing Abdominal X-rays (AXRs) is a key step in NEC diagnosis, staging and treatment decision-making, but poses significant challenges due to the subtle, difficult-to-identify radiological signs of the disease. In this paper, we propose AIDNEC - AI Diagnosis of NECrotizing enterocolitis, a deep learning method to automatically detect and stratify the severity (surgical or medical) of NEC from no pathology in AXRs. The model is trainable end-to-end and integrates a Detection Transformer and Graph Convolution modules for localizing discriminative areas in AXRs, used to formulate subtle local embeddings. These are then combined with global image features to perform Fine-Grained Visual Classification (FGVC). We evaluate AIDNEC on our GOSH NEC dataset of 1153 images from 334 patients, achieving 79.7% accuracy in classifying NEC against No Pathology. AIDNEC outperforms the backbone by 2.6%, FGVC models by 2.5% and CheXNet by 4.2%, with statistically significant (two-tailed p 0.05) improvements, while providing meaningful discriminative regions to support the classification decision. Additional validation in the publicly available Chest X-ray14 dataset yields comparable performance to state-of-the-art methods, illustrating AIDNEC's robustness in a different X-ray classification task.

Prevalence of an empty colon in patients with acute and chronic small intestinal mechanical obstruction: A retrospective radiographic study in 100 dogs and cats

Small intestinal mechanical obstruction (SIMO) is a common clinical condition, with radiographic studies typically focusing on the small intestine. However, the colon's appearance in SIMO has not been extensively studied. This retrospective study aimed to determine the prevalence of an empty colon on radiographs of dogs and cats with confirmed SIMO. Pre-surgical abdominal radiographs of 100 patients (68 dogs and 32 cats) with surgically confirmed mechanical ileus and a control group of 30 dogs and 20 cats with non-obstructive gastrointestinal (GI) disease and one without GI disease, respectively, were evaluated. The colon was assessed for content (none/collapsed, gas, faeces) and segmental distribution (ascending, transverse, descending colon) and correlated to the duration of clinical signs (acute, chronic). A colon was classified as empty when ≥2/3 was collapsed and/or gas-filled. The overall prevalence of an empty colon in cases of mechanical ileus was 61% (p=0.028), with 49/68 in dogs (72.1%) and 12/32 in cats (37.5%), p=0.001 between dogs and cats. Clinical signs duration did not influence the prevalence 28/61 (45.9%) acute, 33/61 (54.1%) chronic, p=0.522. However, acute cases had more empty colon segments (2/3 segments: 6/28, 21.4%; 3/3 segments: 22/28, 78.6%) than chronic cases (2/3 segments: 23/33, 69.7%; 3/3 segments: 10/33, 30.3%; p≤0.001). In the control groups, the prevalence of an empty colon was 64% (p=0.048) with and 38%, p=0.048) without GI disease, with no statistical difference between dogs and cats. An empty colon can be a supporting radiographic finding in diagnosing patients with GI disease, including SIMO, in addition to other established characteristic features. Dogs are more likely to have an empty colon in the presence of mechanical ileus.

External abdominal pressure radiography versus survey radiography for the diagnosis of hiatal hernia in brachycephalic dogs

Hiatal hernia (HH) is a common disorder in brachycephalic dogs with upper airway obstruction. The breathing effort results in an exaggerated transdiaphragmatic pressure gradient during inspiration that can displace the gastroesophageal junction causing gastroesophageal reflux. The diagnosis is challenging because the HH usually occurs intermittently and is often missed on survey radiography. In this retrospective study, the application of external abdominal pressure to mimic the transdiaphragmatic pressure gradient during radiographic screening for HH was evaluated in 146 dogs. Hiatal hernia was diagnosed with external abdominal pressure radiographs in 6.8% (10/146 dogs), whereas it was diagnosed via survey radiography in only 2% (3 dogs). In conclusion, the radiographic diagnosis of HH in brachycephalic dogs can be improved by performing external abdominal pressure radiographs.

An apparently healthy female British shorthair cat with a rare complication of colonic stenosis after flank approach ovariohysterectomy

BackgroundColonic stenosis is a rare postoperative complication of ovariohysterectomy in cats, leading to dyschezia and fecal diameter reduction. In cats, while there are reports of colonic stenosis after midline approach ovariohysterectomy, there are no specific reports of flank approach ovariohysterectomy.Case presentationThis report describes a severe case of a one-year-old British shorthair female cat presenting with gastrointestinal signs, including dyschezia and reduced fecal diameter, three weeks after flank approach ovariohysterectomy. Despite abdominal radiography, proctography with barium sulfate, colonoscopy, CT, and hematological analysis, the cause of colonic stenosis remained unclear. During exploratory laparotomy, an annular tissue band was found encircling the descending colon, resulting in severe local stenosis. After excision of the tissue band, the presenting clinical signs of the cat were rapidly improved. This result suggests that colonic stenosis caused by tissue band should be considered when diagnosing postoperative complications in flank approach ovariohysterectomy in cats.ConclusionColon stenosis due to annular tissue band restriction should be considered one of the differentials for postoperative complications in flank approach ovariohysterectomy in cats.

Intra-abdominal nocardiosis and scedosporiosis in a dog: case report and literature review.

A 2-y-old, intact female, mixed-breed dog was presented to the veterinary hospital with abdominal distension, anemia, and lethargy following a chronic history of nonspecific gastrointestinal signs. CBC and serum biochemistry revealed moderate nonregenerative anemia with neutrophilia, hypoalbuminemia, hyperglobulinemia, hypoglycemia, decreased urea and creatinine, and hypercholesterolemia. Abdominal radiographs and ultrasound revealed a large heterogeneous mesenteric mass and ascites. Abdominocentesis confirmed septic peritonitis with filamentous bacteria. Fine-needle aspiration of the mass yielded pyogranulomatous inflammation and hyphae. An exploratory laparotomy revealed a large cranial abdominal mass with granulomas present throughout the abdominal cavity. Due to the poor prognosis and disseminated disease, the owner elected euthanasia. Postmortem and histologic examinations detected intralesional mycetomas and bacterial colonies within the mesenteric masses. 16S ribosomal RNA gene PCR and sequencing using formalin-fixed, paraffin-embedded sections identified Nocardia yamanashiensis, Nocardioides cavernae, and Nocardioides zeicaulis. Fungal culture, PCR, and sequencing confirmed Scedosporium apiospermum. Our report highlights the importance of molecular methods in conjunction with culture and histologic findings for diagnosing coinfections caused by infrequent etiologic agents. Additionally, we provide a comprehensive literature review of Scedosporium apiospermum infections in dogs.

Pro-motility Preparation Protocol May Reduce the Rates of Failed Patency Capsule Among Patients with Crohn's Disease in Clinical Remission.

Patency capsule (PC) ingestion is commonly used to minimize capsule retention in high-risk patients with Crohn's disease (CD). However, false-positive rates remain high, precluding the use of video capsule endoscopy (VCE). We aimed to compare the efficacy of two preparation protocols in reducing failed PC rates in patients with CD. This bi-center retrospective case-control study included adult patients with small-bowel CD in clinical remission who underwent PC ingestion. The pro-motility group followed a low-residue diet, then a clear fluid diet, and took bisacodyl after ingestion, while the control group followed only a clear fluid diet. The primary outcome was failed PC, defined as the absence of PC excretion or presence on abdominal X-ray at 30 h post-ingestion. Multivariable logistic regression was used to identify predictors of failed PC. Among 273 patients (83 in the pro-motility group, 190 controls), the pro-motility group was older (median 36 [27-48] vs. 31 [24-43], p = 0.012) and had a lower rate of B2/3 disease phenotype (32.5 vs. 53.1%, p = 0.002) compared to controls. The pro-motility group also had a lower failed PC rate (12.0 vs. 24.7%, p = 0.023). Longer disease duration (adjusted odds ratio (AOR) 1.053, 95% confidence interval (CI) 1.016-1.091, p = 0.005) increased the odds of failed PC, while the pro-motility protocol was protective (AOR 0.438, 95% CI 0.200-0.956, p = 0.038), outweighing the influence of B2/3 disease phenotype (AOR 1.743, 95% CI 0.912-3.332, p = 0.093). The pro-motility preparation protocol could substantially improve the success rates of the small-bowel patency test in patients with CD undergoing PC ingestion, potentially reducing the risk of capsule retention and associated complications.

Perineal fistulation secondary to retained appendicolith: A rare complication of the unaccounted calculus

An approximately 30-year-old male patient presented with perianal fistula disease. Examination under anesthetic revealed a complex extrasphinteric tract with internal opening in the region of the anterior inferior rectum, although an internal opening was not clearly identified. This failed to heal despite defunctioning procedure and packing of the perineal tract. Specialist center review of computed tomography and magnetic resonance imaging revealed a small cavity anterior to the rectum containing a small calcific density with a long tract extending down into the perineum. Seven years earlier, the patient had presented with clinical features of appendicitis. On retrospective review, an appendicolith can be seen on ultrasound and abdominal X ray (AXR). At surgery, the appendix had disintegrated leaving an abscess cavity. The appendicolith was not appreciated or removed and subsequently migrated into the pelvis acting as a source of infection which fistulated to the perineum. Subsequent removal of the calculus resulted in complete healing.

Calculation of Aortic Arch Calcification Degree in Hemodialysis Patients Using Deep Learning

Abdominal Aortic Calcification (AAC) is a common form of vascular calcification closely associated with atherosclerosis and serves as an important marker for measuring increased risk of cardiovascular, cerebrovascular, and peripheral vascular diseases. Particularly in patients with Chronic Kidney Disease (CKD) and those undergoing dialysis, the risk of AAC significantly increases due to a combination of traditional and non-traditional risk factors. Therefore, developing a rapid and accurate method to assess the extent of AAC is crucial for preventing the progression of vascular calcification and the associated risk of cardiovascular diseases. Dialysis patients are required to undergo an abdominal X-ray annually, and the degree of calcification of the abdominal aorta is assessed manually through these X-ray images. However, these methods have limitations in identifying subtle calcifications in the abdominal aorta and the assessment process is time-consuming and depends on the experience and subjective judgment of physicians. To overcome these limitations, we propose a new method that incorporates deep learning technology to improve the accuracy of assessing the extent of AAC. Our method utilizes CNN models and attention modules to enhance the model's ability to recognize features of abdominal aortic calcification.

Acute abdomen: an atypical presentation of acquired hemophilia

Acquired hemophilia is a rare but potentially life-threatening disorder characterized by the development of acquired hemophilia A, leading to bleeding complications. Spontaneous, mild-to-life-threatening bleeding in typically elderly individuals without a personal or family history of bleeding is the hallmark of acquired hemophilia A (AHA), a rare autoimmune bleeding illness caused by the formation of auto-antibodies against endogenous factor VIII (FVIII). This hallmark represents our present case, with no obvious history related to the bleeding issue. Prompt detection and treatment of bleeding are essential for the best outcomes. We present a case of a 66-year-old male who had acute-onset severe abdominal pain and with constipation for five days, associated with nausea and loss of appetite. On physical examination, the patient appeared pale, and abdominal examination revealed diffuse tenderness with guarding. Initial evaluation revealed tachycardia and hypotension. Initial abdomen X-rays revealed features suggestive of small bowel obstruction. The patient was stabilized with intravenous fluids, referred to a surgical team, and admitted to the acute bed in the general ward for further management. Keywords: Acquired Hemophilia; Auto-Antibodies; Factor VIII; Intraabdominal Bleeding Citation: Hehsan MR. Acute abdomen: an atypical presentation of acquired hemophilia. Anaesth. pain intensive care 2024;28(5):974−976; DOI: 10.35975/apic.v28i5.2556 Received: March 19, 2024; Reviewed & Accepted: September 08, 2024

8317 Biochemical Adequacy And Renal Complications In Long-Term Management Of Patients With Postsurgical Hypoparathyroidism

Abstract Disclosure: A. Hong: None. J. Park: None. W. Choi: None. J. Yoon: None. H. Kim: None. H. Kang: None. Background: Hypoparathyroidism (HypoPT) most commonly develops after neck surgery, particularly thyroid surgery. Permanent postsurgical HypoPT necessitates calcium and active vitamin D supplementation for 12 months or more due to irreversible parathyroid damage following surgery. This study investigated the biochemical adequacy of conventional therapy (i.e., active vitamin D and/or calcium) in patients with permanent postsurgical HypoPT based on recent guidelines and assessed the incidence of renal complications. Materials and Methods: The study included 62 adult patients with permanent postsurgical HypoPT who underwent total thyroidectomy for papillary thyroid cancer at Chonnam National University Hwasun Hospital. Biochemical parameters, including albumin-adjusted serum total calcium, ionized calcium, phosphate, creatinine, parathyroid hormone, magnesium, 25-hydroxyvitamin D (25[OH]D), and 24-h urine calcium, were measured. Renal ultrasound and KUB X-ray were performed for all patients. Results: The mean age of the patients was 55.5 ± 12.4 years, with 48 (77.4%) being female. The median follow-up duration after surgery was 10.6 years (interquartile range 9.0-15.5 years). At the time of evaluation, all patients were treated with calcitriol. Additional treatment, including calcium carbonate or cholecalciferol, was received by 43 (69.4%), and 28 (45.2%) were given thiazide diuretics. Thirty-seven (59.7%) patients had values below the recommended serum calcium (albumin-adjusted or ionized) concentration, while three (4.8%) had values above the upper normal limit of serum phosphate level. Serum 25(OH)D levels were maintained within the normal range (30-50 ng/mL) in 27 (43.5%) patients, and 47 (75.8%) patients met normal serum magnesium levels. Hypercalciuria, defined as >7.5 mmol/day in men and >6.25 mmol/day in women, was observed in 12 (19.4%) patients. Nephrolithiasis and nephrocalcinosis were present in 2 (3.2%) patients each. No patient had chronic kidney disease (CKD), defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Conclusion: Conventional management for permanent postsurgical HypoPT appears suboptimal for certain patients. However, the incidence of renal complications, such as hypercalciuria, nephrolithiasis/nephrocalcinosis, and CKD, was not commonly observed in a real-world setting during the 10 years of follow-up. This observation may be associated with a higher prescription rate of thiazide diuretics. Presentation: 6/2/2024

7783 Pheochromocytoma Unusually Presenting As Intestinal Pseudo-Obstruction: A Case Report

Abstract Disclosure: J.V. Chua: None. E.C. Cunanan: None. J.G. Sazon: None. J.L. Reyes: None. Introduction: Pheochromocytoma is a rare neuroendocrine tumor that arises from the adrenal medulla. It may present with a variety of symptoms that can resemble other diseases as a result of the effects of catecholamine overproduction on the different organ systems of the body, occasionally making diagnosis difficult and delaying appropriate treatment.Intestinal pseudo-obstruction is an unusual presentation of pheochromocytoma from the effects of excessive catecholamines on the gastrointestinal system, resulting in decreased peristalsis with constriction of the sphincter muscles, consequently prolonging intestinal transit time. Currently, there is no available data on its incidence or prevalence rate. Clinical Case: This is a case of a 50-year-old Filipino male initially presenting with abdominal pain and enlargement with inability to pass stool and flatus, not relieved by laxatives, enemas, and nasogastric and rectal tube decompression. Abdominal radiograph revealed segmental ileus versus partial large bowel obstruction, while abdominal CT scan showed fecal impaction and an incidental finding of an enhancing adrenal mass on the left adrenal gland. Colonoscopy findings were unremarkable. Laboratory workup demonstrated elevated 24-hour urine metanephrine levels with a value of 44.62 mg/24 hours (normal value: 0-1.0 mg/24 hours). The patient was initially managed conservatively, but no improvement in symptoms was noted. Pre-operative preparation was done with terazosin and intravenous saline infusion, and the patient then underwent left open adrenalectomy with bowel decompression, which provided resolution of symptoms and resumption of regular bowel movement post-operatively. The final result of the histopathologic examination confirmed the diagnosis of pheochromocytoma. Conclusion: Gastrointestinal symptoms such as ileus and pseudo-intestinal obstruction are uncommon presentations of pheochromocytoma. A high index of suspicion is necessary among patients presenting with these symptoms, and pheochromocytoma should be considered as part of the differential diagnosis. Presentation: 6/1/2024

Radiographs are of limited use and low cost-effectiveness when combined with ultrasound for abdominal restaging in dogs with solid, soft tissue tumours.

The purposes of this study were to assess the frequency of detection of clinically relevant findings by abdominal radiographs and abdominal ultrasound during restaging of solid, soft tissue tumours in dogs and to determine the cost per clinically relevant finding for both modalities. The medical records of 159 dogs which underwent a total of 223 restaging episodes following a diagnosis of a solid, soft tissue tumour within, or with potential for metastasis to, the abdomen were reviewed. Data collected from the sample dogs were reviewed for clinically relevant findings, including local recurrence, lymph node or intra-abdominal metastasis, and other changes that would influence prognosis or management. The clinically relevant findings were compared between abdominal radiographs and abdominal ultrasound. The cost per clinically relevant finding was calculated per modality based on current hospital costs. Clinically relevant findings were observed in 158 restaging episodes. Ninety-two clinically relevant findings were detected with ultrasound alone, and 65 clinically relevant findings were detected with a combination of both modalities. Only one dog had a clinically relevant finding detected with radiographs alone. Findings were identified significantly more frequently with ultrasound than radiographs. Cost per clinically relevant finding was 495 USD (approx. 373 GBP/448 EUR) for abdominal radiographs and 323 USD (approx. 242 GBP/292 EUR) for abdominal ultrasound. Abdominal radiographs were of minimal use beyond abdominal ultrasound for restaging in this study, despite a higher cost per clinically relevant finding than abdominal ultrasound. This study does not support routine use of abdominal radiographs during routine restaging of solid, soft tissue tumours.

A clinical case of acute intestinal obstruction as a result of dislocation of the esophageal self-expanding nitinol stent

INTRODUCTION: Covered esophageal self-expanding stents are often used to palliate dysphagia in patients with unresectable esophageal and gastric cardia cancer. Migration of an esophageal stent is a common occurrence in these patients. One of rare complications that can be caused by stent dislocation is intestinal obstruction. The article describes a case of intestinal obstruction in result of migration of a fully covered nitinol esophageal stent. Patient K., 53 years old, was admitted to hospital in a severe condition with complaints of vomiting, abdominal pain and stool retention that had persisted for four days. The patient refused esophagogastroduodenoscopy. A plain abdominal X-ray did not reveal any free gas. In the mesogastrium, numerous pneumatized loops of small intestine with horizontal fluid levels were identified. For life indications, the patient, after preoperative preparation was taken to the emergency operating room; resection of the terminal part of small intestine was performed with placement of an ileostomy and gastrostomy. Taking into account difficulties of diagnosis (refusal of esophagogastroduodenoscopy by the patient and low informative value of X-ray examination), severity of the patient’s condition (due to a malignant neoplasm and intestinal obstruction), anatomical peculiarities (location of the esophageal stent 30 cm from the ileocecal angle, which would complicate potential application of enteroenteroanastomosis), the chosen tactics was to refuse application of enteroenteroanastomosis and exteriorize ileostomy and gastrostomy. CONCLUSION: Acute intestinal obstruction is a threatening complication of migration of an esophageal stent. Patients with placed esophageal stents require careful monitoring, use of a sparing diet and additional methods of stent fixation, which will help reduce the frequency of stent migration and associated complications.

Correlation of Necrotizing Enterocolitis (Nec) on Radiology Examination of Plain Abdomen Photo and Ultrasonography (USG)

Introduction: Necrotizing enterocolitis (NEC) is an inflammatory condition caused by infectious agents with a background of immaturity of local defense mechanisms and hypoxic-ischemic damage to the intestinal mucosa. Plain abdominal radiography can be used to examine this condition. The results of diagnostic imaging of the neonatal gastrointestinal tract have relatively limited accuracy, and limit improvements in diagnostic efforts and determine the severity. The results of the examination can also be used with ultrasound. This study aims to analyze the correlation of NEC examination using plain radiography and ultrasound. Methods: This type of research uses a retrospective cohort study. The subjects of the study were 39 patients who underwent plain radiography and ultrasound examinations related to NEC conditions. The data source for this study is secondary data obtained through an intermediary media, namely PACS. The secondary data source for this study is data that has been recorded at the Radiology Installation of Hasan Sadikin Hospital in the period January 2023-June 2024. The Spearman correlation test was used to test the hypothesis of a correlation between NEC examinations using plain radiography and ultrasound. Results: The results of the Spearman correlation test showed no significant correlation between NEC examination using plain radiographs and USG with a correlation coefficient value of 0.138. The findings that can be taken from this study are that there is an increase in grade in patients who undergo USG examination. This finding proves the importance of conducting USG examination to confirm NEC conditions more accurately. Conclusion: There is no significant correlation between NEC examination using plain radiographs and USG. Examination using USG can confirm NEC more accurately, as evidenced by an increase in grade in 43.58% of study subjects.

Utility of iron concentration two to four hours post ingestion in predicting toxicity

IntroductionIron products are widely available over the counter and have the potential to cause serious toxicity. Iron concentrations can be used to prognosticate and guide treatment during acute ingestions. Traditionally, a concentration of 350 μg/dL with symptoms, or 500 μg/dL without symptoms, is considered toxic and will likely need treatment to prevent decompensation. It is generally recommended that an iron concentration is obtained at least 4 h after exposure to provide adequate absorption time and avoid falsely low iron concentrations. Despite this, many iron overdoses have concentrations drawn immediately upon patient presentation. The utility of an iron concentration drawn before 4 h in assessing exposure risk is not clear. The purpose of this study is to determine if patients' symptoms and iron concentrations obtained between 2 and 4 h can predict the development of iron concentrations after 4 h. MethodsThis is a single-center, retrospective study of patient cases with a primary ingestion of oral iron reported to a Regional Poison Center from January 1, 2015 to January 1, 2020. The primary outcome is the incidence of an iron concentration of 350 μg/dL or greater at or beyond 4 h. Secondary outcomes include the incidence of antidotal deferoxamine administration, incidence of iron concentration > 500 μg/dL, incidence of positive findings on abdominal radiography, and time to highest reported iron concentration. ResultA total of 75 patients were included in this study. No patients who developed at most minor symptoms (abdominal discomfort, nausea, vomiting, or diarrhea without evidence of systemic toxicity) and had a 2-to-4-h concentration ≤ 300 μg/dL symptoms had a subsequent concentration > 350 μg/dL (negative predictive value [NPV] 100 %). Deferoxamine was used to treat five patients, all reached concentrations of >300 μg/dL 2–4-h post-ingestion. ConclusionPatients with only minor GI symptoms and an iron concentration of ≤300 μg/dL between 2 and 4-h post ingestion are unlikely to develop further toxicity. In this case series, a concentration of 300 μg/dL or less between 2 and 4 h was the ideal cutoff to predicting subsequent potentially toxic concentrations, with a sensitivity of 100 % and a specificity of 54 %.

Accidental ingestion of scarf/hijab pins in Muslim females of Kashmir Valley

Background: Hijab pin ingestion is common in the Kashmiri population, especially among young females. This is attributed to the tradition of wearing hijab in adolescent girls and young women. Aims and Objectives: The present study was conducted to identify the incidence of hijab pin ingestion in the Muslim females of Kashmir Valley. Materials and Methods: This study was conducted in the Department of General Surgery SKIMS Medical College, Bemina, Srinagar, from February 2022 to December 2023. It was a prospective study comprising 60 female patients above the age of 12 years having a history of accidental ingestion of hijab pins. History and clinical examination were followed by chest and abdominal radiographs. Data were collected and inferences were drawn. Results: The study included 60 patients presenting to the emergency with a history of accidental ingestion of pin. The majority of patients, that is, 30 (50%) were 25–35 years of age. Most patients 40 (67%) were asymptomatic at presentation with 20 (33.33%) patients presenting to the hospital within2–3 h of ingestion. Foreign body (FB) had reached the small intestine in 22 (36.67%) patients at the time of presentation. Moreover, 1 (1.67%) patient had extraluminal migration of the FB. In our study, 46 patients had a normal passage of FB through the gastrointestinal tract. Most of the patients, that is, 46 (76.67%) were managed conservatively. Only 2 (6.67%) patients needed surgical intervention. Conclusion: FB ingestion is common among the young females of Kashmir Valley. Adequate follow-up is necessary to prevent long-term complications.

CISTOTOMIA EM CADELA COM HIDRONEFROSE ASSOCIADA A OBSTRUÇÃO POR URÓLITOS VESICAIS: RELATO DE CASO

Urolithiasis is one of the most common diseases of the canine urinary system, which can be caused by diet, reduced water consumption by the animal, in addition to racial, age and sex predisposition. Furthermore, urolithiasis can culminate in hydronephrosis, in which the renal pelvis dilates as a result of the obstruction of urinary flow. The clinical signs of this condition vary according to the severity of the animal’s condition, but may include dysuria, polyuria and urinary incontinence. The definitive diagnosis is based on history, clinical evaluation, complementary imaging exams such as abdominal ultrasound and abdominal radiography. Treatment can be clinical or surgical and dietary management may be necessary, depending on the urinary stone analysis made. The objective of this report was to describe the clinical signs, diagnosis, treatment and prognosis of a five-year-old Shitzu female dog, with bladder uroliths and hydronephrosis as a result of this condition. After care and clinical management with laboratory and complementary exams, the treatment through cystotomy was the one of choice. The urolith was sent for analysis and allowed the establishment of an appropriate therapeutic protocol, through dietary management. Besides that, the female dog was monitored to observe the reversal of hydronephrosis. After surgical and clinical treatment, the animal presented a stable condition and the dilation of the renal pelvises were reversed, making the animal’s prognosis favorable.

STANDARD PERCUTANEOUS NEPHROLITHOTOMY VERSUS MINI-PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH RENAL STONES: A RANDOMIZED CONTROLLED TRIAL

Percutaneous nephrolithotomy (PCNL) is a widely used procedure for removing renal stones. Recent advancements have led to the development of mini-PCNL, which is believed to offer better outcomes regarding stone clearance and reduce complications. Comparing these techniques is critical to optimising treatment approaches for patients with renal stones. Objective: To compare the effectiveness of conventional PCNL and mini-PCNL in stone clearance rates in patients with renal stones. Methods: This randomised trial was conducted from July 2023 to July 2024, involving 120 patients aged 18 to 60 with renal stones. Patients were randomly assigned to two groups: Group A (n=60) underwent conventional PCNL, and Group B (n=60) underwent mini-PCNL. Stone-free rates were evaluated one month postoperatively using X-ray KUB and ultrasound. Descriptive statistics were used to summarise patient demographics, and comparative analysis between the two groups was performed using a chi-square test, with statistical significance set at P < 0.05. Results: The mean age of patients in Group A (conventional PCNL) was 38.70 ± 10.98 years, while in Group B (mini-PCNL), it was 41.87 ± 11.45 years. The stone-free rate was significantly higher in Group B, with 54 patients (90.0%) achieving stone clearance compared to 45 patients (75.0%) in Group A (P = 0.03). Additionally, mini-PCNL was associated with fewer postoperative complications. Conclusion: The study demonstrates that mini-PCNL offers a higher stone-free rate than conventional PCNL, with a significant outcome difference (P = 0.03). Mini-PCNL also exhibited a better safety profile, suggesting it is preferable for managing renal stones.

Development of Augmented Reality-Based Radiation Protection Application for Healthcare Professionals

Background: Radiodiagnosis is widely performed in medical institutions. All medical professionals, including nurses, are at risk of radiation exposure. This study developed an educational application for radiation medical professionals to visualize the distribution of scattered radiation using augmented reality.Materials and Methods: A Monte Carlo simulation code was used to simulate mobile chest and abdominal radiography. The calculation results were incorporated into an augmented reality application. The results of the Monte Carlo calculations were validated by comparing them with radiation measurements. An augmented reality application for tablet devices was developed in Unity that visualizes the scattered radiation dose.Results and Discussion: The application was developed by visualizing the distribution of scattered radiation in mobile radiography in augmented reality in three-dimensional real space. The calculation results were validated, and the error between the displayed radiation dose values and the measured radiation dose values was generally less than 10%.Conclusion: The developed application allows users to overlay quantitative values of imperceptible radiation exposure doses onto any real-world environment. This enables users to intuitively understand the relationship between the distance from a radiation source and the received dose, thereby contributing to a better understanding of radiation protection in clinical settings.

Quality improvement project aiming to reduce inappropriate use of abdominal x-rays in the ED

BackgroundThere is compelling evidence that AXRs have limited clinical value in the acute setting. Despite this, they are frequently used in many EDs. This quality improvement project (QIP) aimed to...