Computed Tomography Scan Examination Research Articles

A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient

Background: The surgical diagnosis of acute appendicitis is customarily made on clinical grounds alone using history, physical examination, and white blood cell count. In the atypical patient, ie, the patient with prolonged symptoms, inconsistent history, or misleading physical examination, diagnostic studies should be helpful in establishing the appropriate diagnosis. Computed tomography (CT) scan and ultrasonography (US) have demonstrated utility in diagnosing appendicitis but have not been studied in the atypical patient population. Methods: A retrospective review of 500 consecutive appendectomy patients, coupled with a review of the literature, resulted in the development of an algorithm to help the medical physician to differentiate the atypical patient requiring an imaging study from those requiring immediate surgical consultation. This patient population was entered into a prospective, randomized study of CT scan or US examination. Results: Between May 1997 and May 1999, 106 patients were enrolled in the study; 17 were later excluded from the study because of typical presentation and direct admission to surgery without diagnostic imaging. Forty-nine patients were randomly assigned to CT scan and 40 to US examination. CT scan was 100% specific and 97% sensitive ( P = 0.018). US was 90% specific and 76% sensitive. Based on the results of these imaging studies, 70 of the study patients underwent exploration for suspected appendicitis or other acute inflammatory process. Conclusion: A subset of patients presenting with possible acute appendicitis has been identified that should benefit from imaging of the appendix prior to surgical consultation. For this group, CT scan appears superior to abdominal and pelvic US in terms of diagnostic accuracy and reliability. With this approach, a low incidence of negative laparotomies was achieved.

Intravascular stenting of traumatic abdominal aortic dissection

We describe the case of a 34-year-old man with blunt abdominal trauma. Initial abdominal computed tomography scan showed retroperitoneal hematoma, pancreatic contusion, multiple fractures of the transverse process in the thoraco-lumbar spine, and infrarenal aortic dissection. Angiography revealed that the aortic dissection originated proximal to the inferior mesenteric artery and extended down to the left common iliac artery without vascular obliteration. The pancreatic trauma was managed without operation, and the dissection was treated with aortic and left iliac endovascular self-expanding Schneider Wall Stents. Immediate angiographic and computed tomography scan examination showed the obliteration of the greater part of the dissection with persistence of a short dissected segment at the level of the aortic bifurcation. Examination a week later showed thrombosis of this false lumen and complete obliteration of the dissection. Intravascular stenting allowed treatment of the dissection without open surgical procedures requiring laparotomy and aortic operation.

A long-acting repeatable form of bromocriptine as long-term treatment of prolactin-secreting macroadenomas: a multicenter study

To assess the efficacy and tolerability of monthly injections of the long-acting repeatable bromocriptine in patients with macroprolactinomas. Open and prospective trial. This multicenter trial was carried out in seven university hospitals. Forty-two patients with prolactin (PRL)-secreting macroadenomas. Fifty to 200 mg of the drug were administered intragluteally every 28 days for 6 to 24 months. The efficacy was assessed by repetitive plasma PRL measurements, visual field determinations, and computed tomography scan examinations. After the first 50-mg injection, the mean percentage decrease of PRL levels was 71% from baseline on day 14; between days 1 and 28, PRL levels were suppressed to normal in nine cases, and a clear tumor shrinkage was documented in 21% of the patients. Normalization of PRL secretion was obtained in 62%, and a clear-cut reduction in tumor size in 50% of the patients after 6 months of treatment. The long-acting repeatable form of bromocriptine was a well tolerated and quickly effective treatment in most of these patients with macroprolactinomas.

Early computed tomographic scanning after resection of brain tumors in children

Enhanced and non-enhanced computed tomography (CT) brain scans were performed within 72 h of surgery on 21 children in whom brain tumors had been resected totally or subtotally, and scans were repeated at varying intervals thereafter. Biopsies of the resection margins were performed in 12 patients at the end of the surgical procedure. The immediate CT scan showed enhancement in the resection margin in 13 of the 21 patients and in 9 of the 13, the enhancement disappeared on follow-up scans. There was discordance between the results of immediate CT scan examination and the biopsies of the resection margins in 7 of the 12 cases. The advantages and disadvantages of an immediate postoperative scan versus a more delayed CT scan are discussed.