Positive CT Scan Findings Research Articles

A prospective evaluation of computerized tomography scan findings in blunt abdominal trauma

Background and objective: Evaluating patients with blunt abdominal trauma remains one of the most challenging aspects of acute trauma care. CT scan of abdomen remains the standard imaging modality for evaluation of abdominal trauma cases. The aim of this study is to evaluate CT scan findings in blunt abdominal trauma victims with respect to solid organ injuries, hollow viscus injuries, associated thoracic and abdominal wall injuries, associated hemoperitoneum, cause of injury and type of management. Methods: A cross-sectional study was conducted among 96 hemodynamically stable patients with history of blunt abdominal trauma who underwent CT scan examination in Rozh-halat Emergency Hospital from June 2021-January 2022; using a 64 multi-detector helical slice CT scanner. Data analysis were performed on patient’s demographics, mode and type of injury, CT scan findings and severity scorings, associated injuries and type of management. Results: The mean age of enrolled cases was 28.6 ± 18.6 ranged from 4-70 years. About two third (63.5%) were males and one third were females (36.5%). The most common cause of trauma was road traffic accident (64% of cases). Out of 96 trauma cases; 87.5% of patients had positive CT findings of which 50% had hemoperitoneum, 21.9% had pneumoperitoneum, 66.7% had no hallow viscous involvement, while 33.2% had hollow viscus involvement. One third of cases had associated abdominal wall injury. 56.4% of patients had multiple organ injury. Regarding solid organ injury; 66.7% of cases had spleen injury, (36.5%) had liver injury, Pancreas was involved in 12.5% of cases. RT& LT – kidneys showed grade 2 injury in (9.4%) & (6.3 %) respectively. Half of patients with positive CT scan findings had no lower chest injury findings. This study showed that 43.8% of cases were managed conservatively, 45.9% underwent laparotomy, the incidental finding of intra-operative hemoperitoneum which was negative in CT scan was only 1%. Conclusion: CT imaging is the diagnostic tool of choice for the evaluation of blunt abdominal trauma in haemo-dynamically stable patients as it can assist in detecting and evaluating other co-existing injuries such as lower thoracic, pelvic and spine injuries apart from its main role in accurate identification of intra -abdominal injuries and associated bleeding.

Spectrum of HRCT Chest Findings in RT-PCR Positive Asymptomatic COVID-19 Patients at a COVID Designated Hospital in Nepal

Introduction: COVID-19 pandemic is grappling the world with the surge of infection time and again. Clinicians are trying to justify the ethics of public health care. Asymptomatic COVID-19 cases are going undocumented and most of them practice self-isolation. Studies have revealed significant radiological changes among RT-PCR positive asymptomatic COVID-19 cases. The aim of this cross-sectional study was to characterized chest CT findings of asymptomatic RT-PCR-positive patients in one of the COVID-designated hospitals in Nepal. Methods: This was a cross-sectional observational study where RT-PCR positive COVID-19 asymptomatic-close-contacts were subjected to HRCT chest. The HRCT images were evaluated by two radiologists for (a) characterizing the parenchymal involvement and (b) distribution of the involvement. The CT severity score (0-25) was calculated following the semi- quantitative scoring system which depends on the visual assessment of five lung lobes. Results: Out of 43, 26 (60.5%) participants had positive Chest CT scan findings consistent with COVID pneumonia. Bilateral lesions were present in 65% and 77% had multifocal lesions. The ground-glass opacities (92%), mixed (ground-glass opacities and consolidation pattern) (30.7%), and consolidation only (34.6%) were common chest CT findings. The median CT score was 3.5 (IQR; 2-6). Conclusion: Most of the RT-PCR positive COVID-19 asymptomatic patients had CT scan changes in lungs but with lower median CT score value.

Aldolase C Profiling in Serum after Mild Traumatic Brain Injury: A Prospective Cohort Study.

Background: After a traumatic brain injury (TBI), in addition to clinical indices, the serum level of neurological biomarkers may provide valuable diagnostic and prognostic information. The present study aimed to investigate the aldolase C (ALDOC) profile in serum for early diagnosis of brain damage in patients with mild TBI (mTBI) presented to the Emergency Department (ED).Methods: A single-center prospective cohort study was carried out in 2018-2019 at Imam Khomeini Hospital affiliated with Mazandaran University of Medical Sciences, Sari, Iran. A total of 89 patients with mTBI were enrolled in the study. Blood samples were taken within three hours after head trauma to measure ALDOC serum levels. Brain CT scan was used as the gold standard. Statistical analysis was performed using the Kruskal Wallis, Mann-Whitney U, and Chi square tests. The receiver-operating characteristic (ROC) curve plot was used to determine the optimal cutoff point for ALDOC. The sensitivity and specificity of the determined cutoff point were calculated. P values less than 0.05 were considered statistically significant.Results: Of the 89 patients, the CT scan findings showed a positive TBI in 30 (33.7%) of the patients and in 59 (66.3%) a negative TBI. The median ALDOC serum level in the patients with positive CT scan findings (8.35 ng/mL [IQR: 1.65]) was significantly higher than those with negative CT scan findings (5.3 ng/mL [IQR: 6.9]) (P<0.001). The optimal cutoff point for ALDOC serum level was 6.95 ng/mL, and the area under the curve was 99.6% (P<0.001). The sensitivity and specificity of the determined cutoff point were 100% and 98%, respectively. Conclusion: The ALDOC serum level in patients with mTBI significantly correlates with the pathologic findings of the brain CT scan. This biomarker, with 100% sensitivity, is a suitable tool to detect brain structural abnormalities in mTBI patients.

EVALUATION OF C - REACTIVE PROTEIN AS A PROGNOSTICATOR OF THE COURSE OF COVID 19 DISEASE

Diagnosis of COVID 19 is based on clinical manifestations, history of exposure, positive CT scan findings and laboratory tests. Inflammation plays a key role in pathogenesis of COVID 19. CRP is an acute phase protein in the serum and is also a surrogate marker for the pro inflammatory cytokine IL 6. Significant rise in CRP indicates clinically relevant inflammation. Aim and Objectives: To analyse the CRP levels in COVID 19 infected patients and to validate CRP as an indicator of the severity of SARS CoV 2 infection. Materials and Methods: This retrospective study was carried out at Chettinad Hospital and Research Institute, a tertiary care hospital situated on the outskirts of Chennai, India, for a period of 4 months. A total of 10263 patients were tested for COVID-19 by RT PCR. Viral RNA Extraction was automated and SARS CoV2 RTPCR performed with ROTOR GENE Q(QIAGEN) using SD Biosensor Real Time PCR kit. The CRP levels were measured using QDx Instacheck Fluorescence immunoassay system, Indianapolis, IN. Results: Among 10263 patients, 2694 (26.2%) patients tested SARS CoV-2 positive. CRP levels were measured for 1472 SARS CoV 2 patients (including both OP and IP). Among them 745 (50.6%) patients were found to be CRP reactive. Of the CRP reactive patients, 7 patients (0.9%) were &lt;18 years, 190 patients (25.5%) were between 18 - 45 years and 548 patients (73.5%) were &gt;45 years. Of the 592 patients with elevated CRP levels, 167 patients were from ICU and 425 patients were from non-ICU. Highly elevated CRP levels of &gt;100mg/L were found in 65% (n=109) of the COVID positive ICU patients and 23% (n=101) of the non-ICU patients. Increased CRP levels were noted in SARS CoV- 2 infected individuals. Elevated CRP was common among elder patients aged &gt;45 years and in males. Conclusion This study concludes that the significant rise of CRP levels was noted in hospitalized SARS CoV 2 positive patients aged &gt; 45 years. Thus, estimating the early rise of serum CRP levels in SARS CoV-2 patients is a well affordable and less invasive parameter to guide the clinicians that is readily available in all the health care centers.

Study of Traumatic Head Injuries Using Computed Tomography

The aim of this retrospective research was to study traumatic head injury (THI) using CT scan and to classify the types of head trauma fractures and types of hemorrhages. Methods and Results: The current study included 53 THI patients (43/81.1%) males and 10/18.9% females) with positive and negative CT scan findings. A complete clinical history and patients’ data were taken from CT reports, which included age, gender, type of trauma, associated injury, and CT findings with their percentages. The study was carried out in Taif city in King Abdelaziz Hospital and King Faisal Hospital. The distribution of various etiologies of THI has shown that the most common etiology was road traffic accident (RTA) (45.3%). The typical age for THI was between 21 to 30 years old (26.4%). The distribution of the traumatic causes for each age group is shown in Table 1. The typical age for RTA was the age group of 11-20 years (33.3%), for falls – the age groups of 0-10 years (33.3%) and over 60 years of age (33.3%). The frequency of various CT findings of THI was as follows: intracranial hemorrhage (56.6%), fracture (39.6%), pneumocephalus (22.6%), contusion (22.6%), foreign body (11.3%), and proptosis (3.8%). The distribution of fracture cases, according to their types, was as follows: a linear fracture (76.2%), comminuted fracture (23.8%), basilar fracture (14.3%), and depressed fracture (9.5%). The frontal bone was the most affected site with fractures (30.7%). Conclusion: CT is an appropriate clinical modality used in the management of THI patients in the emergency department. CT has the advantage of being fast, safe, available, sensitive to most acute post-traumatic injuries, accurate in identifying the head abnormalities such as fractures and hemorrhage during the first 24 hours after injury, which is beneficial in the early assessment, therapy planning, monitoring, and long-term patient care.

Maternal and Neonatal Outcomes in COVID-19 Infected Pregnancies: A Prospective Cohort Study

Background: In recent months and during the rapid outbreak of corona virus disease in 2019 (Covid-19) all around the world, many pregnant women, have been infected with this deadly virus. Nevertheless, no adequate data is available on the clinical characteristics, manifestations, outcomes, and complications of this virus in pregnancy. This study aimed to compare maternal and fetal consequences of Covid-19-infected pregnancies with non-infected pregnancies. Methods: In this prospective, single-center study, we included all pregnant women with COVID-19 who were admitted to Arash Hospital in Tehran, Iran from March 1 to April 20 2020. Women with positive Covid-19 PCR test and/or positive CT scan findings in the presence of very typical clinical symptoms were classified as confirmed group, women with typical clinical symptoms along with two or more of laboratory findings were classified as probable group and women who had no clinical symptoms of infection were classified as a control group. Clinical features, treatments, and maternal and fetal outcomes were assessed. Findings: One hundred and eighty-two women enrolled including 37 and 12 and 133 women in confirmed, probable and control groups prospectively. Caesarean Section was carried out in total 96 women (52.74%, 95%CI: 45.22, 68.31). No significant association was found between COVID-19 infection and preterm labour (aRR: 0.75, 95%CI: 0.30, 1.87, P=0.546), low birth weight (aRR: 1.15, 95%CI: 0.49, 2.73, P=0.737), gestational diabetes (aRR: 0.78, 95%CI: 0.26, 2.33, P=0.669), preeclampsia (aRR: 2.07, 95%CI: 0.50, 8.47, P=0.310) intrauterine growth restriction (aRR: 0.30, 95%CI: 0.02, 3.27, P= 0.327) preterm rupture of membrane (aRR: 0.38, 95%CI: 0.04, 3.30, P=0.383), stillbirth (aRR: 1.53, 95%CI: 0.15, 14.71, P=0.712), postpartum haemorrhage (aRR: 0.80, 95%CI: 0.11, 5.57, P=0.829), neonatal intensive care unit admission (aRR: 1.48, 95%CI: 0.38, 5.78, P=0.568), neonatal sepsis (aRR: 1.23, 95%CI: 0.68, 2.20, P= 0.481). Interpretation: We found no differences between Covid-19 infected and non-infected pregnant women according to delivery type, maternal and neonatal outcomes and also adverse pregnancy outcomes. Funding Statement: This research has been supported by a research grant, No: 99-1-101-47129 from Deputy of Research affairs, Tehran University of Medical Sciences, Tehran, Iran. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study has been approved by the Ethics Committee of Tehran University of Medical Sciences. The ethical code is IR.TUMS.VCR.REC.1398.1057. Written informed consent was obtained from all participants for the publication of individual data from before enrolment when data were collected prospectively.

A COMPARISON OF GLASGOW COMA SCORE WITH COMPUTED TOMOGRAPHIC FINDINGS IN CASES OF TRAUMATIC BRAIN INJURY AT TERIATRY CARE HOSPITAL BIKANER

Background: Our present study aimed at correlation of GCS score with computed tomographic findings in cases of head injury and to evaluate that GCS scoring can be used as an alternate tool in clinical management of head injuries in settings where CT scans are not available or contraindicated.&#x0D; Methods: The present study was conducted in Department of Neurosurgery, Trauma center of S. P. Medical College and A.G. of Hospitals, Bikaner. The study group consisted of a total of 100 head injury patients presenting to the Trauma center and admitted in neurosurgery ward.&#x0D; Results: Contusion was the most frequent finding in cases with positive CT scan findings. All (100%) subjects with severe head injury had positive CT scan findings.&#x0D; Conclusions: Careful clinical selection based on GCS score before ordering CT scan can help reduce radiation exposure patients and pressure on limited resources. Studies with larger sample size would be warranted&#x0D; Keywords: CT scan, head injury, Glasgow Coma Scale Score

Adherence of Emergency Physicians to Pediatric Emergency Care Applied Research Network-Clinical Decision Rule (PECARN-CDR) in Minor Head Injuries Emergency Patients

Introduction: Pediatric Emergency Care Applied Research Network (PECARN) is the best accurately identify children at very low risk of clinically important traumatic brain injuries (ciTBIs) in the Emergency Department (ED). Therefore, the implementation of evidence-based tools for clinical decision-making in the acute care setting has shown to improve quality of care as well as patients’ outcomes. This study aimed to assess the PECARN on quality of care in mild head injury children after improving competency of emergency physician. Methods: The study is a cross-sectional, prospective study included 50 Children with mild head trauma attending to the Emergency Department (ED) of the Suez Canal university Hospitals. Patients divided into two groups according to their age (less or more than 2 years). We used the Statistical Package of Social Science (SPSS) program version 20 for data analysis. Results: The most common cause of injury was direct head trauma, followed by motor car accidents and the least frequent injuries were due to fall from height. Our results regarding the adherence of residents to the PECARN CDR demonstrated that the residents were adherent largely to the rule with a level of adherence of about 92%. Conclusion: the adherence of the emergency department physicians in SCUH to the PECARN CDR while managing pediatric mild TBI. PECARN proved its effectiveness as a clinically predictive tool to understand who can safely avoid a cranial CT scan after TBI and the risk stratification provided by it was significantly associated with positive CT scan findings. Keywords: Pediatric care; Mild head injuries; Traumatic brain injuries

Aspergillus and progression of lung disease in children with cystic fibrosis

BackgroundThe impact of Aspergillus on lung disease in young children with cystic fibrosis is uncertain.AimsTo determine if positive respiratory cultures of Aspergillus species are associated with: (1) increased structural lung...

Role of MDCT Scan in the Evaluation of Pancreatic Mass with Histopathological Correlation

Diagonstic imaging plays a critical role in evaluation of the adenocarcinoma of the pancreas- the 4th leading cause of death for the cancer globally. The purpose of this study was to determine the role of multidetector computed tomography (MDCT) in evaluation of pancreatic tumors. The prospective and study was carried out in Dhaka, Bangladesh during the period of July, 2013 to December 2014. Amongst 47 publish with suspected pancreatic lesion (having positive CT scan findings). Patients underwent histopathology of their lesions, the report of which was used as gold standard for comparing the role of CT scan in evaluating such lesions. Pancreatic disease was found to be more prevalent in males. The commonest age group was 56-65 years. On the average malignant lesions were more common in elder age group than the benign ones. Head of the pancreas was the commonest site for malignant pancreatic mass. Main pancreatic duct (MPD) dilatation was found to be a harbinger for malignant condition of pancreas. 72.3% patients showed MPD dilatation most of which proved to be malignant. Some 45% patients showed common bile duct (CBD) dilatation all of which presented clinically with jaundice. Out of 47 patients 33 (60.3%) were diagnosed to have malignant lesions while 14 (39.7%) had benign lesions. Finding of the study suggest that CT scan may be a useful tool for assessing and changing of Parcrease mass lesions.

The Diagnostic Accuracy of CT Scan in Evaluation of Gallbladder Carcinoma

Objective: To determine the diagnostic accuracy of CT scan in evaluation of Gallbladder Carcinoma (GBC) taking histopathology as gold standard. Study Design: Cross sectional, Descriptive study. The study was conducted at Department of Radiology, Dow Medical Collage and Civil Hospital, Karachi from 1st January 2014 to 31st December 2014. Materials and Methods: This study comprises 434 patients of either gender, age between 30 to 70 years, with history of jaundice, pain in right hypochondrium / epigastrium and weight loss with suspicion of carcinoma gall bladder, referred to the Radiology Department of Civil Hospital Karachi over a period of 12 months. Post operated cases without CT scan and patients allergic to the contrast material were excluded from the study. Patients who fulfilled the above mentioned criteria, followed to CT scan with intravenous contrast and findings were documented. Patients were referred for surgery. During surgery sample for histopathology was taken which was used as gold standard. Data were entered and analyzed using computer program SPSS- 21. Descriptive statistics were applied to calculate mean and standard deviation for the quantitative variables. The sensitivity, specificity; positive predictive value, negative predictive value, and diagnostic accuracy of CT scan were calculated. Results: Out of 434 patients there were 183(42%) male and 251(58%) female patients in this study. The overall mean age was 53.37±7.18 years with range 28 (38–66) years. With histopathological findings gallbladder carcinoma (GBC) was found positive in 292 patients and with CT scan findings gallbladder carcinoma (GBC) was found positive in 285 patients. The mean age of patients with positive histopathological findings for gallbladder carcinoma (GBC) was 54.36±6.95 years and the mean age of patients with positive CT scan findings for gallbladder carcinoma was 53.51±7.28 years. 274 patients were true positive and 132 patients were true negative. Sensitivity, specificity, PPV, NPV and accuracy were 94.2%, 92.3%, 96.1%, 88.6%, and 93.5% respectively. Conclusion: The use of computed tomography can help early diagnosis of GBC. Contrast enhanced MDCT was effective in identifying the criteria for resectabilityof the tumor and in disease staging. The histopathological diagnosis of the present study correlated well with CT scan in diagnosis of gallbladder malignancy.

CT Findings of Early Post Operative Neurological Complication of Cardiovascular Surgeries

Introduction: The incidence of neurological complications related to cardiovascular surgeries is comparatively very high and associated with high morbidity and mortality. The aim of this study is to establish not only the use of non-contrast computed tomography in detecting the cause of neurological problems but also to evaluate the various spectrums of findings associated with various types of cardio-vascular surgeries. Method: We retrospectively analyzed all the non-contrast computed tomography head of the postoperative cardio-vascular surgeries patients done in immediate postoperative period (<7days). Result: 45 (6.7%) patients developed neurological complications in the early post-operative period which comprised of our study group. Out of 45 patients, 08 (18%) patients were of pediatric age group ranging who underwent surgeries for congenital complex cardiac disorders. Out of 45 patients presenting with neurological symptoms, 15 (33%) patients had focal deficit (stroke) and 30 (77%) patients had non-focal deficit (like seizure, delirium or cognitive impairment). Stroke patients had more possibility to have positive CT scan findings than NFD. Out of 45 patients, 40 (88%) had positive CT scan findings and five patient had normal NCCT head. The various types of positive CT scan findings were- 19 ischemic infarct, 04 intra-parenchymal hemorrhages, 17 subdural hemorrhage, 03 sub-arachnoid hemorrhage and 01 cerebro-vascular thrombosis. Conclusion: Non-contrast computed tomography of head is very useful in early postoperative neurological complication in cardio-vascular surgeries not only in diagnosing the complication but also managing accordingly.

New scoring system for intra-abdominal injury diagnosis after blunt trauma

ObjectiveAn accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. MethodsThis prospective observational study was performed from April 2011 to October 2012 on patients aged above 18years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient’s history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor. ResultsAltogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (score<8), moderate (8≤score<12) and high risk (score≥12). In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%). Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%). The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%). ConclusionThe present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.

Co-relation of CT scan findings with Glasgow coma scale scores in pediatric head injury

Background:Head injury in pediatric age is a major cause of mortality and disability. Clinical selection of cases prior to ordering CT scan would be desirable to avoid unnecessary radiation exposure and risk of malignancy.Methods: An observational study of 50 pediatric cases of head injury that underwent CT scan as part of routine diagnostic work up. Correlation of CT scan findings with GCS scores and clinical profile done.Results:Contusion was the most frequent finding in cases with positive CT scan findings and majority (94%) of patients could be managed conservatively. Among the mild head injury cases only 1 (3.8%) had positive CT scan findings whereas 16 (80%) with moderate head injury and almost all (100%) subjects with severe head injury had positive CT scan findings.Conclusions:Careful clinical selection based on GCS score before ordering CT scan can help reduce radiation exposure among pediatric patients and pressure on limited resources. Studies with larger sample size would be warranted.

Alcohol-related hospitalisations of trauma patients in Southern Taiwan: a cross-sectional study based on a trauma registry system

ObjectivesTo provide an overview of the demographic characteristics of patients with positive blood alcohol concentration (BAC) and to investigate the performance of brain CT scans in these patients.DesignCross-sectional study.SettingTaiwan.Participants2192 patients...

High Resolution Multi Detector Computed Tomography of Temporal Bone: Our Experience in a Tertiary Care Service Hospital

High resolution multi detector computed tomography (HRMDCT) is an excellent tool for evaluation of a variety of congenital and acquired conditions affecting the temporal bones. We describe our experience of HRMDCT of temporal bones of 145 patients in a tertiary care and teaching hospital of Armed Forces Medical Services of India over a period of three and half years. Hearing loss was the most frequent indication for HRMDCT and congenital bilateral profound sensorineural hearing loss for evaluation prior to possible cochlear implant formed the single largest group (62, 42%) among all indications for HRMDCT of temporal bones. Major vestibule-cochlear and semicircular canal anomalies were noted in 11 such cases. Seven patients of microtia were studied and all had positive CT scan findings. All patients of vertigo had normal HRCT study. Extent of temporal bone injuries and inflammatory conditions were clearly delineated in all cases. Thinner collimations allowing image reconstructions in planes of anatomical interest with near isotropic resolution has been a major advantage of HRMDCT of temporal bones.

Urodynamic Evaluation of Urinary Disturbances following Traumatic Brain Injury

Objectives: To identify the incidence and the type of voiding dysfunction by doing urodynamic studies (UDS) in head injury patients. The purpose of this paper is to present our findings and promote research in this field. Patients and Methods: A prospective study was conducted recruiting patients sustaining head injuries with positive CT scan findings. Clinical and radiological evaluation was done. Patients then underwent standardized UDS. The urodynamic findings were correlated with outcome and analyzed. Results: Three out of 11 patients (27.3%) had unstable bladder with multiple involuntary contractions in the filling phase. All of them had significant contusions in the right frontal region and 2 of them had subarachnoid hemorrhage. All of these patients had normal proprioception, voluntary detrusor contractions and nil post-void residue. Two out of the 3 patients had catheter in situ and 1 patient had complaints of frequency and urgency. At 1 year of follow-up, all 3 patients had a normal voiding pattern and the upper tracts were normal on ultrasound in all patients. Conclusions: Voiding dysfunction is a significant problem in patients with head injury. Bladder hyperreflexia is seen in patients with injuries above the pontine micturition center. The voiding abnormality has good prognosis and resolves spontaneously. Treatment in the acute phase may require anticholinergics for a few months.

Revisiting the interpretation of positive sinus CT findings: A radiological and symptom-based review

It is widely believed that a high percentage of normal, healthy patients without sinusitis symptoms have abnormal findings on sinus CT. Experiences of the authors of this study suggest otherwise. Cross-sectional survey. Head/sinus CT scans of 50 consecutive patients from each of three study groups were reviewed. Group 1 consisted of patients without any sinus symptoms. Group 2 consisted of patients with acute headache symptoms. Group 3 consisted of patients with complaints consistent with chronic sinusitis. CT scans were evaluated with the Lund-Mackay scoring system. In the asymptomatic patient group (group 1), six (3%) patients had positive sinus CT scan findings, compared with 11 (5.5%) in the acutely symptomatic group (group 2), and 32 (64%) in the chronically symptomatic group (group 3). In the chronically symptomatic group (group 3), 64 percent of patients were allergic compared with 18% of the acute headache group (group 2) and 8 percent of the asymptomatic patient group (group 1). Results of this study suggest that symptomatic sinus patients are much more likely to have positive sinus CT scan findings than asymptomatic patients. Conversely, normal healthy patients should not be expected to have abnormal sinus CT scans.

Case Study: Correlation between the Seat Belt Sign and Positive Abdominal Computed Tomography Findings in Pediatric Trauma Patients*

The seat belt sign is a cutaneous injury caused by a restraint during deceleration. The presence of a seat belt sign during physical exam was correlated with computed tomography findings and the presence of a blunt intestinal injury requiring operative intervention. A retrospective study of the hospital's trauma registry revealed seven pediatric patients who presented with a documented seat belt sign over a five-year period. Five of the six patients received preoperative CT scans of the abdomen and pelvis. Four of the five CT scans bad positive findings consistent with a blunt intestinal injury. Six of the seven patients bad blunt intestinal injury at laparotomy. Children presenting with a seat belt sign and positive CT scan findings of the abdomen should be considered for early exploratory laparotomy.

The impact of radioimmunoguided surgery (RIGS) on surgical decision-making in colorectal cancer.

Radioimmunoguided surgery (RIGS system) was performed in ten patients with rectal or low sigmoid colon carcinoma with the use of a hand-held gamma detector (Neoprobe 1000) intraoperatively and externally after injection of radiolabeled (125I) monoclonal antibody to detect pelvic and metastatic tumor. Fifteen procedures, including six exploratory laparotomies, four transperineal explorations, two transsacral explorations, one transvaginal biopsy, one brachytherapy, and one transanal polypectomy, were performed. Two patients had previous low anterior resection, seven abdominoperineal resection, and one a rectal polypectomy. Five patients had previous pelvic radiation therapy. Reoperation was indicated by elevated CEA levels in seven patients (70 percent), persistent pelvic pain in six (60 percent), and a suspicious radiologic study in seven (70 percent). RIGS system localized tumors verified by histopatholoy in all ten patients (100 percent); one patient with a positive CT scan and probe findings lacked histopathologic confirmation on frozen section, but had a tumor confirmed on permanent histology. Five major abdominal operations were avoided; in five patients major modifications were made in the surgical procedure based on probe findings. Six received chemotherapy or radiation therapy based on findings of the RIGS system. In six patients with negative or equivocal CT scans, the RIGS system localized histopathologically confirmed tumor. Major abdominal procedures can be avoided, the surgical approach modified, and other modes of therapy instituted earlier with the use of the RIGS system.