Combination Of Physical Examination Research Articles

Personalized Approach to Olfactory Neuroblastoma Care.

Olfactory neuroblastoma (ONB) is an uncommon neuroendocrine malignancy arising from the olfactory neuroepithelium. ONB frequently presents with nonspecific sinonasal complaints, including nasal obstruction and epistaxis, and diagnosis can be obtained through a combination of physical examination, nasal endoscopy, and computed tomography and magnetic resonance imaging. Endoscopic resection with negative margins, with or without craniotomy, as necessary, is the standard of care for definitive treatment of ONB. Regional metastasis to the neck is often detected at presentation or may occur in a delayed fashion and should be addressed through elective neck dissection or radiation. Adjuvant radiotherapy should be considered, particularly in the case of high grade or tumor stage, as well as positive surgical margins. Systemic therapy is an area of active investigation in both the neoadjuvant and adjuvant setting, with many advocating in favor of induction chemotherapy for significant orbital or intracranial involvement prior to surgical resection. Various targeted immunotherapies are currently being studied for the treatment of recurrent or metastatic ONB. Prolonged locoregional and distant surveillance are indicated following definitive treatment, given the tendency for delayed recurrence and metastasis.

Septic arthritis and transient synovitis of the hip

Differentiating between septic arthritis and transient synovitis can be challenging but is very important as alate diagnosis of septic arthritis can lead to sepsis and joint damage. For correct diagnosis and prediction of complications, the right combination of physical examination, laboratory and radiological studies is needed. Hip ultrasound is easy to learn and has ahigh sensitivity for joint effusion. Faster diagnosis and therapy are possible due to increasing use of ultrasound. Magnetic resonance imaging (MRI) is primarily used to rule out co-infections (osteomyelitis, pyomyositis) and differential diagnoses. X‑ray is typically nonremarkable in septic arthritis. Routine use of ultrasound in nontraumatic pediatric hip pain. Generous use of MRI in case of elevated inflammatory markers or inconclusive clinical findings. Using only few sequences may be appropriate to avoid sedation, primarily fluid sensitive sequences (fat-saturated T2, TIRM, STIR), in case of positive findings, accompanied by T1-weighted images.

Patient-Friendly Summary of the ACR Appropriateness Criteria: Crohn Disease-Child.

Crohn disease is a common inflammatory bowel disease that can affect children, adolescents, and adults. It is diagnosed using a combination of physical examination, blood work, endoscopy, and imaging tests.

Neglected Radial Collateral Ligament Rupture: Rare Case Report

Introduction : Rupture of the Radial Collateral Ligament (RCL) of the index metacarpophalangeal (MCP) joint is mostly related to acute local mechanical causes, which severely affect the stability of the MCP joint. Radial collateral ligament (RCL) injuries account for 10-40% of collateral ligament injuries of the thumb metacarpophalangeal joint.ere, we present an extremely rare case of chronic RCL injury.
 Patient Concern : Pain in the thumb of the right hand accompanied by weakness when trying to grasp something. Complaints are not accompanied by swelling. Patient said 2 years ago had an accident. Thumb at right hand is said to be swollen and shifting.
 Diagnosis : Based on the combination of physical examination, X-ray, and ultrasonic and magnetic resonance imaging, the patient was diagnosed with Radial Collateral Ligament rupture. Eventually, intra-operative findings confirmed the diagnosis.
 Intervention : Patient was underwent ligament reconstruction using a Palmaris Longus tendon graft.
 Conclusion : Favorable results suggest that the free tendon graft using Palmaris Longus is a suitable, safe, and technically feasible procedure for the operative treatment of chronic instability of the thumb metacarpophalangeal joint after radial hyperadduction trauma and complete rupture or deinsertion of the radial collateral ligament.

50 Years Ago in TheJournalofPediatrics: Rare Conditions and Surgical Journeys

50 Years Ago in TheJournalofPediatrics: Rare Conditions and Surgical Journeys

ORAL PRESENTATION: Eagle Syndrome: The Forgotten Entity

Elongated styloid process or Eagle syndrome is a rare condition presenting with a wide range of symptoms including throat pain, foreign body sensation, neck pain and ear pain. Establishing a diagnosis requires a high index of suspicion and understanding of this entity by the physician. Computed tomography (CT) is the gold standard to diagnose Eagle syndrome. Conservative medical treatment with analgesics, oral steroids and anticonvulsants are offered in patients who refused surgery. The mainstay of treatment is surgical resection via intraoral or cervical approaches. We describe a rare case of bilateral Eagle syndrome in a 46-year-old female who was presented with chronic foreign body sensation in the throat but aggravated following fish bone ingestion. Flexible nasopharyngolaryngoscopy (FNPLS) and cervical x-ray did not reveal any foreign body and the patient was treated conservatively. Incidentally, a cervical x-ray also revealed an elongated styloid process bilaterally. Upon follow-up, the patient was still symptomatic. Thus, a CT scan with contrast of the neck was requested, which reported no foreign body, but the presence of bilateral elongated styloid process suggesting Eagle Syndrome. The patient was subjected to transoral endoscopic assisted bilateral styloidectomy following tonsillectomy. There was a complete resolution of the symptoms postoperatively. This approach is recommended to avoid external scarring and minimize postoperative pain. Eagle syndrome is diagnosed based on a combination of physical examination and radiological findings. The treatment options may vary based on the severity of symptoms.International Journal of Human and Health Sciences Supplementary Issue: 2022 Page: S14

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence.

Acute mesenteric ischemia (AMI) is a severe condition associated with poor prognosis, ultimately leading to death due to multiorgan failure. Several mechanisms may lead to AMI, and non-occlusive mesenteric ischemia (NOMI) represents a particular form of AMI. NOMI is prevalent in intensive care units in critically ill patients. In NOMI management, promptness and accuracy of diagnosis are paramount to achieve decisive treatment, but the last decades have been marked by failure to improve NOMI prognosis, due to lack of tools to detect this condition. While real-life diagnostic management relies on a combination of physical examination, several biomarkers, imaging, and endoscopy to detect the possibility of several grades of NOMI, research studies only focus on a few elements at a time. In the era of artificial intelligence (AI), which can aggregate thousands of variables in complex longitudinal models, the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought. In the following work, we bring you a state-of-the-art literature review regarding NOMI, its presentation, its mechanics, and the pitfalls of routine work-up diagnostic exams including biomarkers, imaging, and endoscopy, we raise the perspectives of new biomarker exams, and finally we discuss what AI may add to the field, after summarizing what this technique encompasses.

Congenital Obstructive Müllerian Anomaly: The Pitfalls of a Magnetic Resonance Imaging-Based Diagnosis and the Importance of Intraoperative Biopsy.

A retrospective cohort study of the concordance between the magnetic resonance imaging (MRI) diagnosis and final diagnosis in patients with Müllerian duct anomalies (MDAs) was conducted, and diagnostic clues were suggested. A total of 463 cases of young women who underwent pelvic MRIs from January 1995 to February 2019 at Seoul Asan Medical Center were reviewed. Interventions consisted of clinical examinations, abdominal or transvaginal/rectal ultrasound, MRI, and operative procedures, including hysteroscopy and laparoscopy. The concordance of the diagnosis between the results obtained with MRI and those obtained with surgeries was evaluated. It was found that a total of 225 cases (48.6%) showed genital tract anomalies on MRI. Among them, 105 cases (46.7%) underwent reconstructive surgery. Nineteen cases (8.4%) revealed discrepancies between the final diagnosis after surgery and the initial MRI findings and eleven cases (57.9%) had cervical anomalies. Incorrect findings associated with the MRIs were particularly evident in biopsied cases of cervical dysgenesis. A combination of physical examination, ultrasound, and MRI is suitable for preoperative work-up in the diagnoses of congenital obstructive anomalies. However, it is recommended that a pathologic confirmation of tissue at the caudal leading edge be made in obstructive genital anomalies, in cases of presumptive vaginal or cervical dysgenesis.

Comparative Post-operative Outcomes between Positive and Negative Electromyography (EMG) in Patient with Tunnel Syndrome: A Retrospective Study

Category:OtherIntroduction/Purpose:Tarsal tunnel syndrome can be established using combination of physical examination and electrodiagnostic study including tenderness along tibial nerve in tarsal tunnel area, Tinel sign positive, and positive EMG. However, it has been reported that the sensitivity of the electrodiagnostic study is only 52% for diagnosis of tarsal tunnel syndrome. Therefore, although EMG is negative, some surgeons prefer to make a diagnosis base on physical examination. Conservative treatment is the first line of treatment and when this fails, surgical treatment is indicated. The purpose of this study was to compare post-operative outcomes following tarsal tunnel release in patients who had tarsal tunnel syndrome with positive and negative electrodiagnostic study.Methods:The retrospective chart review of 34 consecutive patients who had underwent tarsal tunnel release between 2015 and 2019 were enrolled in this study. The patients were classified into 2 groups based on results of electrodiagnostic study (negative EMG 15 patients and positive EMG 18 patients). All patients had been treated with conservative treatment for at least 6 months including modified inserted and shoe wear, activities modifications, NSAIDs, and gabapentin. The primary outcome was pain level using Visual Analogue Scale (VAS) while the secondary outcomes were SF-36, FAAM, recovery times (time to return to ADL, work, and sports), and complications. A paired sample t-test was used to assess statistical differences between pre- and post- operative functional outcomes (VAS, SF-36, and FAAM) in the same group of both negative and positive EMG while an independent t-test was used to compare functional outcomes (VAS, SF-36, and FAAM) between the negative and positive EMG.Results:There were 33 patients (15 male and 18 female) with mean age of 49.2 years (range, 25-71 years), mean BMI of 24.7 kg/m2 (range, 17.6-33.2 kg/m2), and mean follow-up of 17.9 months (range, 12-36 months). The mean duration of symptom before the surgery was 8.7 months and 10.2 months for EMG negative and positive respectively. Both groups demonstrated significant improvement of all functional outcomes (FAAM, SF-36, and VAS (p<0.001 all)) compared to pre-operative status; however, there was no significant difference between the two groups, (p>0.05 all). The recovery time were to return to daily activities (3.5 vs 3.6 weeks), time to return to work (5.4 vs 5.6 weeks), and time to return to sport (16.4 vs 17.1 weeks). There were no complications in both groupsConclusion:Tarsal tunnel release demonstrated significantly improvement of functional outcomes in both negative and positive electrodiagnostic study in patients as measured with VAS, SF-36, and FAAM. However, negative EMG did not demonstrate negative impact on functional outcomes after tarsal tunnel release. When clinical and physical examination suspects tarsal tunnel syndrome, tarsal tunnel release should be considered even thought there is negative on electrodiagnostic study.

Laryngeal Adenoid Cystic Carcinoma: A rare neoplasm with still undefined treatment aspects. Case report and literature review

Adenoid Cystic Carcinoma (ACC) is a rare malignant tumor, accounting for about 1% of head and neck malignancies and 10% of salivary gland cancers. The laryngeal localization of ACC is particularly rare because of the paucity of accessory salivary glands in this anatomical district. Prevalence is highest in the fifth and sixth decade of life with a slight female predilection and aetiology is unknown. Since laryngeal ACC characteristically grows slowly and occurs in the subglottis, the diagnosis, which is based on the combination of physical examination with fiberoscopy and neck-chest Computerized Tomography (CT), is often delayed. Nowadays the debate is still open about which is the best comprehensive therapy of this tumor. We present the case of a laryngeal ACC in a 68 year-old-woman, treated with total laryngectomy together with bilateral neck dissection and a literature review made with the purpose to point out the most recent advancements towards the definition of a gold-standard therapy. Laryngectomy results as the first choice treatment, while chemotherapy has minimal effects on this neoplasm and radiotherapy alone does not show the capacity to lead to complete resolution, but there is still the need of further studies to clarify the usefulness and the role played by neck dissection and postoperative radiotherapy.

The Rising Moon sign is specific and sensitive in the diagnosis of bucket handle tears of the medial meniscus.

Bucket handle tears of the meniscus are common and can lead to locking, extension deficit and functional impairment. The diagnosis is determined by a combination of physical examination and imaging, but in some cases the diagnosis may be challenging since specific clinical tests are lacking. The aim of the present study was to assess the value of a new clinical test, the elective pain at the anterior aspect of the joint line (defined as the "Rising Moon sign") in the diagnosis of bucket handle tears of the medial meniscus. Forty patients treated for a bucket handle of the medial meniscus were enrolled as the study group and were compared to a matched group of 40 patients with a posterior horn tear of the medial meniscus and 50 healthy subjects. The following aspects were investigated in the groups: body mass index, extension deficit, pain at the posterior aspect of the joint line (PPJL), at the middle joint line (PMJL), at the anterior join line (PAJL) and at combined hyperflexion of the knee and external rotation of the foot (PHE). Pain at the anterior joint line (PAJL) was defined as the Rising Moon sign. In the bucket handle group the average flexion contracture was 12° (0-30°). The average PPJL was one (0-2), the average PMJL was 1.6 (0-3), PAJL was 2.5 (1-3) and PHE was 1.6 (1-2). In the posterior horn tear group the average flexion contracture was 0.9° (-10 to 5°). The average PPJL was 2.2 (1-3), the average PMJL was 1.4 (0-3), PAJL was 0.6 (0-2) and PHE was 2.5 (1-3). The rising moon showed 95% sensitivity and 98% specificity in the diagnosis of bucket handle tears. In addition it showed a positive predictive value of 97.4% and negative predictive value of 96%. Finally it also demonstrated high inter-observer reliability (0.905). The "Rising Moon" sign has shown to be highly predictive for bucket handle tears of the medial meniscus with very high specificity and sensitivity. In addition it is easy to perform with very high inter-observer reliability. Level IV.

The Accuracy of Preoperative Axillary Ultrasound in the Diagnosis of Lymph Node Involvement at Motamed Cancer Institute, Iran

Background: Axillary lymph node (LN) status plays an important role in the local and systemic treatment of patients with breast cancer. Preoperative axillary ultrasound (AUS) is routinely used for the evaluation of axillary lymph nodes as a non-invasive method. Objectives: The purpose of this study was to evaluate the sensitivity and specificity of axillary ultrasound in comparison with pathology in a referral breast center. Methods: During a cross-sectional study all patients with breast cancer presenting to the imaging department between September 2015 and August 2016 were evaluated for axillary lymph node status by ultrasound. After comparing these results with the pathology of LNs, the sensitivity, specificity, and accuracy of the ultrasound in the diagnosis of axillary lymph node involvement were measured. Results: Overall 140 patients were enrolled in the study. The mean age of patients was 48.87 (± 10.46) years with an age range between 25 - 81 years. The sensitivity, specificity, and accuracy of the ultrasound were reported as 56%, 88%, and 76%, respectively. The highest sensitivity rate was related to AUS + Physical examination (PE) with 70%. The best specificity was for AUS, about 88%, and the accuracy of AUS+PE was the highest about 80%. Conclusions: The sensitivity of the AUS in the diagnosis of axillary involvement in the Motamed Cancer Institute was moderate and the specificity was good. The combination of physical examination and ultrasound could improve the sensitivity in comparison to each one alone. If both are suspicious, axillary dissection could be considered when fine needle aspiration (FNA) or core needle biopsy (CNB) of the lymph node is not available.

Lupus Erythematosus: Cutaneous Manifestations and Treatment

Cutaneous lupus erythematosus (CLE) includes a broad range of dermatologic manifestations, which may or may not be associated with systemic manifestations. Specific CLE - defined by the presence of an interface dermatitis on histopathological evaluation - is divided into several sub-types, namely acute CLE (ACLE), subacute CLE (SCLE) and chronic CLE (CCLE). CCLE includes discoid lupus erythematosus (DLE), as well as other rarer forms such as LE profundus (LEP). Nonspecific skin findings, such as livedo reticularis or purpura are more frequently seen in patients with systemic disease. Diagnosis requires classification of the subtype, through a combination of physical examination, laboratory studies, histology and sometimes direct immunofluorescence, at the same time ensuring to exclude systemic disease. Regarding the treatment of CLE, antimalarials and topical steroids continue to be the standard of care; however, immunosuppressants, thalidomide analogs and monoclonal antibodies are possible systemic therapies for recalcitrant disease. Patient education on proper sun protection and avoidance of triggers is crucial. This paper reviews the clinical manifestations of CLE, as well as the treatment.

Integration of Physical Examination, Old and New Biomarkers, and Ultrasonography by Using Neural Networks for Pediatric Appendicitis.

The objective of this study was to evaluate physical examinations, imaging, and laboratory analyses individually and combined using innovative statistical analysis methods for the accurate diagnosis of pediatric appendicitis. Patients admitted to hospital with symptoms of abdominal pain whose pediatric appendicitis scores greater than 3 were included in the study. Clinical, radiologic, and laboratory findings and as a new biomarker calprotectin (CPT) concentrations were evaluated individually and combined using artificial neural networks (ANNs), which revealed latent relationships for a definitive diagnosis. Three hundred twenty patients were evaluated (190 appendicitis [43 perforated] vs 130 no appendicitis). The mean ± SD age was 11.3 ± 3.6 years and 63% were male. Pediatric appendicitis scores, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP) level, procalcitonin (PCT) and CPT concentrations were higher in the appendicitis group; however, only WBC and ANC were higher in first 24 hours of pain. White blood cells and CRP were diagnostic markers in patients whose appendix could not be visualized using ultrasonography (US). On classic receiver operating characteristic (ROC) analysis, the areas under the curve (AUCs) were not strong enough for differential diagnosis (WBC, 0.73; ANC, 0.72; CRP, 0.65; PCT and CPT, 0.61). However, when the physical examination, US, and laboratory findings were analyzed in a multivariate model and the ROC analysis obtained from the variables with ANN, an ROC curve could be obtained with 0.91 AUC, 89.8% sensitivity, and 81.2% specificity. C-reactive protein and PCT were diagnostic for perforated appendicitis with 0.83 and 0.75 AUC on ROC. Although none of the biomarkers were sufficient for an accurate diagnosis of appendicitis individually, a combination of physical examination and laboratory and US was a good diagnostic tool for pediatric appendicitis.

Comparison of positive predictive value of computed tomography versus diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma

Background: Abdominal trauma can be mysterious to some practitioners. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, eFAST Scan, DPL and CT scans, patients can be quickly and efficiently evaluated. Objectives: To determine the positive predictive value (PPV) of computed tomography and diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma (BAT) taking surgical findings as gold standard. Study Design: Cross sectional study. Setting: Department of Surgery at Lahore General Hospital, Lahore. Period: Six months i.e. from 21.5.2016 to 20.11.2016. Materials and Methods: Data Collection: CT scan was performed with oral and intravenous contrast. DPL was done with sample assessment. Only those cases were included with positive findings in CT Scan or DPL. These patients underwent laparotomy under general anesthesia by a one standard surgical team. Results of surgical findings were compared between groups with CT scan and DPL. All the information was collected on predesigned proforma. Results: The mean age of the patients was 44.48±14.83 years. There were 66 (55%) males and 54 (45%) females in our study. In this study PPV for CT-scan group was 90.1% while PPV for group with DPL was 51.3%. Conclusion: PPV for CT Scan group was higher than that of DPL group for diagnosing solid organ damage in patients with BAT. Hence, evidence shows that CT Scan should be used as an initial investigation of choice in haemo-dynamically stable patients with BAT.

Pediatric Liver Injury: Physical Examination, Fast and Serum Transaminases Can Serve as a Guide

BackgroundThe aim of our study was to determine if the combination of physical examination (PE), serum transaminases along with Focused Assessment with Sonography in Trauma (FAST) would effectively rule out major hepatic injuries (HIs) after blunt abdominal trauma (BAT) in hemodynamically stable pediatric patients. MethodsWe conducted a 9-year retrospective study of pediatric patients (<18 y) with BAT. We collected data on liver enzymes (aspartate transaminase [AST] and alanine transaminase [ALT]), FAST, and PE findings. Definitive diagnosis and staging of HI were based on abdominal CT scanning. The sensitivity and specificity of ALT/AST, FAST, and PE were then calculated individually and in combination. ResultsWe identified a total of 423 pediatric patients with BAT. Mean age was 11 y, median abdominal Abbreviated Injury Scale was 3 [2-4], and mean ED-SBP was 132 mm Hg. One hundred ninety-eight patients had HI of which 107 were major HI, defined by the American Association for the Surgery of Trauma as ≥grade III. Using ROC curve analysis, optimum ALT and AST thresholds were determined to be 90 U/L and 120 U/L, respectively. The sensitivity of FAST was 50% while that of PE was 40%. Combining PE with AST/ALT and FAST had an overall sensitivity of 97%, a specificity of 95%, a positive predictive value of 87%, and a negative predictive value of 98%. ConclusionsIn hemodynamically stable pediatric blunt abdominal trauma patients, CT scanning can be avoided using a combination of readily available tests thus avoiding unnecessary radiation exposure. However, pediatric patients with positive PE, FAST, and elevated AST/ALT may eventually require CT scan to further evaluate liver injuries.

The value of peripheral perfusion index measurements for early detection of critical cardiac defects

Approximately 25% of congenital heart diseases (CHD) are estimated to be critical and require an intervention. In this study, we aimed to investigate the additional value of peripheral perfusion index (PPI) measurements to pulse oximetry screening for critical CHD (CCHD). Infants born at Ege University Hospital between May 2013 and September 2015 were prospectively included in the study. In addition to physical examination, pre- and postductal oxygen saturations and PPI values were measured with a new generation pulse oximeter before discharge from the hospital. A total of 3175 newborns (33 with an antenatal diagnosis of CCHD) were included in the study. With the combination of physical examination, pulse oximetry screening and peripheral perfusion index (PPI) measurements, all newborns with CCHD were detected in our study including three infants without an antenatal diagnosis in whom pulse oximetry screening was negative. PPI measurements may be valuable for early detection of obstructive left heart lesions where pulse oximetry screening has limitations in diagnosis.

Association between contrast-enhanced ultrasonography and histopathological findings of the metastatic lymph nodes of patients with head and neck cancer: A preliminary study.

The present study aimed to investigate the usefulness of contrast-enhanced ultrasonography (CEUS) and a newly developed analysis software for the detection of microcapillary network distribution in lymph nodes of patients with head and neck cancer (HNC) by comparing the CEUS and histopathological findings. Patients that were diagnosed with HNC between February and September 2016 were enrolled. A total of five patients underwent resection of the primary tumor and neck dissection as their initial treatment. The cervical lymph nodes of these patients were analyzed by CEUS intraoperatively, and their surgical specimens were examined histopathologically. The patients were diagnosed using a combination of physical examination, computed tomography, magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography. For CEUS examination, the microbubble contrast agent Sonazoid™ was injected into a peripheral vein. Video images of the metastatic lymph nodes were captured, and these were subjected to analysis by a newly developed image-analysis software. It was possible to perform intraoperative CEUS of metastatic lymph nodes and obtain accurate matched sections for histopathological examination. Hematoxylin and eosin and cluster of differentiation (CD)34 staining revealed that the software was able to accurately detect capillary vessels in metastatic lymph nodes. However, a number of perfusion deficits were observed in these lymph nodes. In conclusion, by using CEUS with the analysis software, the density and distribution of blood vessels in the metastatic lymph nodes of patients with HNC was revealed. Although the present study was limited and preliminary, it was concluded that this method may be useful to evaluate and to map the capillary vessels in the metastatic lymph nodes of patients with HNC.

Routine abdominal ultrasonography has limited value in the care for patients with indolent systemic mastocytosis

ABSTRACTObjectives: Systemic mastocytosis (SM) is a myeloproliferative disease characterized by the accumulation of aberrant mast cells. Since advanced subtypes of SM can lead to organ dysfunction and shortened survival, timely recognition of progressive disease is important for the adequate treatment of SM patients.Methods: Here, we report the results of our cohort study on the value of routine abdominal ultrasonography for the detection of progression of indolent systemic mastocytosis (ISM).Results: We included 88 patients with ISM, of whom 9 developed new hepatosplenomegaly during follow-up. In this group, the median serum tryptase level increased by 11.60 μg/l, compared with a decrease of −0.20 μg/l in the 79 patients with unchanged ultrasonography results (p = 0.016). A change in liver and/or spleen size never led to a change in clinical classification, nor management.Discussion: Based on the finding that a change in ultrasonography findings did not correlate to disease progression in general, it appears that isolated hepatosplenomegaly does not have prognostic implications in patients with ISM.Conclusions: Routine abdominal ultrasonography is redundant in the follow-up of patients with ISM. A combination of physical examination with serum tryptase levels can be used to screen for hepatosplenomegaly.

Modern Evaluation of Abdominal Trauma

Abdominal trauma can be mysterious to some physicians. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, ultrasound and CT scans, patients can be quickly and efficiently evaluated.