Radiographic Confirmation Research Articles

Randomized, Double-Blind, Placebo-Controlled Study of Anti-Mycobacterial Therapy (RHB-104) in Active Crohn's Disease.

This study, conducted between 4 October 2013, and 30 November 2018, tested the hypothesis that triple antimicrobial therapy, targeting Mycobacterium avium subspecies paratuberculosis (MAP), long considered a putative cause, would favorably affect Crohn's disease. A double-blind multicenter study of adults with active Crohn's disease, (i.e., Crohn's Disease Activity Index [CDAI] 220-450 plus C-reactive protein ≥ 1.0 mg/dL, fecal calprotectin (FCP) >162.9 µg/g stool, or recent endoscopic or radiographic confirmation of active disease) receiving concomitant standard-of-care Crohn's disease treatment (Clinicaltrials.gov: NCT01951326) were stratified by anti-tumor necrosis factor use and randomized (1:1) to anti-MAP RHB-104 (clarithromycin 95 mg, rifabutin 45 mg, and clofazimine 10 mg per capsule) (n = 166), resulting in clarithromycin 950 mg/day, rifabutin 450 mg/day, and clofazimine 100 mg/day, or placebo (n = 165) for up to 52 weeks. A greater proportion of RHB-104 versus placebo-treated patients met the primary endpoint-remission (i.e., CDAI < 150)-at week 26 (36.7% [61/166] vs. 22.4% [37/165], respectively; 95% CI for difference: 4.6, 24.0, p = 0.0048; chi-square test). Clinical response (reduction of CDAI by ≥100 points from baseline) at week 26 (first secondary endpoint) was also higher among the patients treated with RHB-104 (73/166 [44.0%]) compared with placebo (50/165 [30.3%]; 95% CI for difference: 3.4, 24.0, p = 0.0116), and it remained higher at week 52 among the patients treated with RHB-104 (59/166 [35.5%] vs. (35/165 [21.2%] for placebo; 95% CI for difference: 4.7, 23.9, p = 0.0042). A statistically significantly greater decline in FCP (another prospective efficacy endpoint) was also observed in RHB-104-treated patients, compared with placebo, at weeks 12, 26, and 52. The rates of serious adverse events were similar between groups (RHB-104: 18.7%; placebo: 18.8%). No patient died during the study. Antimicrobial therapy directed against MAP resulted in significantly greater improvement in clinical and laboratory (FCP) measures of active Crohn's disease.

Comparative Assessment of Working Length Determination: Apex Locators versus Endomotor with Built-in Apex Locator in Single-Rooted Permanent Teeth.

To compare the effectiveness of Apex Locators and Endomotor with built-in Apex Locators for determining the working length in root canal treatment. A total of 120 patients were randomly assigned to three groups: Group 1 (Root ZX Mini Apex Locator), Group 2 (Minipex Apex Locator), and Group 3 (Endopilot Endomotor with built-in Apex Locator). Working length was determined using respective devices, followed by canal preparation and radiographic confirmation with a master cone. There was no statistically significant difference in working length determination between Apex Locators and Endomotor with built-in Apex Locators. Acceptable working length was achieved in 105 out of 120 cases. The Root ZX Mini, Minipex, and Endopilot demonstrated comparable efficacy in determining working length during root canal treatment. These devices offer reliable alternatives to traditional radiographic methods, providing clinicians with accurate measurements and contributing to successful treatment outcomes.

Detection of residual stones by peroral direct cholangioscopy in patients with intrahepatic stones after hepaticojejunostomy: a prospective study (with video)

Background and AimsThe difficulty of radiographic confirmation of the presence of stones remains a challenge in the treatment of intrahepatic bile duct (IHBD) stones in patients after hepaticojejunostomy (HJ). Peroral direct cholangioscopy (PDCS) enables direct observation of the bile duct and is useful for detecting and removing residual stones; however, its effectiveness is not clearly established in this clinical context. MethodsThis single-center, single-arm, prospective study included 44 patients with IHBD who underwent bowel reconstruction with HJ during the study period. Stone removal was performed by short-type double-balloon enteroscopy (DBE). Following balloon-occluded cholangiography, the DBE was exchanged for an ultraslim endoscope through the balloon overtube for PDCS. The primary endpoint was the rate of residual stones detected by PDCS. Secondary endpoints were success rate of PDCS, residual stone removal with PDCS, procedure time for PDCS, procedure-related adverse events, and stone recurrence rate. ResultsPDCS was successful in 39/44 patients (89%), among whom residual stones were detected in 16 (41%) (95% CI: 28%–54%). Twelve patients (75%) had residual stones <5 mm. Stone removal was successful in 15 (94%) patients and median procedure time for PDCS was 16 (IQR: 10–26) min. The rate of procedure-related adverse events was 7% (3/44), all of which improved with conservative treatment. During median follow-up of 2.1 years (IQR: 1.4–3.3), the overall probability of recurrence-free status at 1, 2, and 3 years was 100%, 92%, and 86%, respectively. ConclusionsPDCS is a safe and effective procedure for complete stone removal in patients with IHBD stones after HJ.

Diagnosis and Treatment of Pneumonia in Urgent Care Clinics: Opportunities for Improving Care.

Community-acquired pneumonia is a well-studied condition; yet, in the urgent care setting, patient characteristics and adherence to guideline-recommended care are poorly described. Within Intermountain Health, a nonprofit integrated US health care system based in Utah, more patients present to urgent care clinics (UCCs) than emergency departments (EDs) for pneumonia care. We performed a retrospective cohort study 1 January 2019 through 31 December 2020 in 28 UCCs within Utah. We extracted electronic health record data for patients aged ≥12 years with ICD-10 pneumonia diagnoses entered by the bedside clinician, excluding patients with preceding pneumonia within 30 days or missing vital signs. We compared UCC patients with radiographic pneumonia (n = 4689), without radiographic pneumonia (n = 1053), without chest imaging (n = 1472), and matched controls with acute cough/bronchitis (n = 15 972). Additional outcomes were 30-day mortality and the proportion of patients with ED visits or hospital admission within 7 days after the index encounter. UCC patients diagnosed with pneumonia and possible/likely radiographic pneumonia by radiologist report had a mean age of 40 years and 52% were female. Almost all patients with pneumonia (93%) were treated with antibiotics, including those without radiographic confirmation. Hospital admissions and ED visits within 7 days were more common in patients with radiographic pneumonia vs patients with "unlikely" radiographs (6% vs 2% and 10% vs 6%, respectively). Observed 30-day all-cause mortality was low (0.26%). Patients diagnosed without chest imaging presented similarly to matched patients with cough/acute bronchitis. Most patients admitted to the hospital the same day after the UCC visit (84%) had an interim ED encounter. Pneumonia severity scores (pneumonia severity index, electronic CURB-65, and shock index) overestimated patient need for hospitalization. Most UCC patients with pneumonia were successfully treated as outpatients. Opportunities to improve care include clinical decision support for diagnosing pneumonia with radiographic confirmation and development of pneumonia severity scores tailored to the UCC.

Survival and Success of Dental Implants Placed in a University Setting

Purpose: The aim of this study was to assess the impact of experience and specialty training on the success and survival of dental implant therapy for single-unit fixed restoration of missing teeth in a university setting.&#x0D; Methods: A retrospective study was conducted using data from the electronic patient record system at the Adams School of Dentistry. The Office of Computing and Information Systems provided dental records from January 1, 2013 to December 31, 2018, following the inclusion criteria. The records were manually reviewed by one evaluator (TC). Extracted from the records were subjects’ demographics; medical, dental, and social history; implant parameters; grafting procedures; and timing of placement/restoration/loading. Also recorded were the specialty training and level of experience, i.e., pre-doctoral student, resident, and faculty; the restoration type; radiographic confirmation of osseointegration before restoration; and occlusal splint fabrication. Fisher’s Exact Test was applied to determine if the providers’ specialty training and experience had any statistical significance on implant success and survival.&#x0D; Results: A total of 501 implants were included in the study. Statistically significant were provider training (AEGD versus specialties, implant survival and success), subject’s gender (implant survival), implant type/manufacturer (implant survival and success), and immediate placement (implant survival). The overall survival rate was 97.0% while the success rate was 85.4%.&#x0D; Conclusion: The type of clinical training impacted implant outcome, only when comparing AEGD versus specialties. Operator’s experience has no significance on the results.

Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial

BackgroundDuring closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance...

Etiological factors and patterns of maxillofacial trauma among school-going children: A cross-sectional study at Khyber College of Dentistry, Peshawar

Maxillofacial trauma, such as superficial cuts and bruises, lacerations, and facial bone fractures, is a common health concern in youngsters. In this cross-sectional study, we sought to determine the prevalence and pattern of maxillofacial trauma in school-aged children (5 to 16 years) with a history of trauma. The study was conducted at the oral and maxillofacial surgery department, Khyber College of Dentistry, Peshawar. We excluded firearm injuries and maxillofacial trauma older than 15 days, whether treated or untreated, from the study. We enrolled 153 schoolchildren of both genders consecutively using non-probability sampling. To determine the etiology and nature of the trauma, we did radiographic confirmation utilizing many imaging modalities and comprehensive clinical assessments of the craniofacial region. The data was analyzed using SPSS version 22.0. The results of our study indicate that falls are the leading cause of maxillofacial injuries among school-aged children. A total of 52 (16.3%) of the patients had maxillary fractures, 30 (19.6%) had mandibular fractures, 30 (19.6%) had zygomatic-maxillary complex fractures, 23 (15%) had dentoalveolar injuries, and 45 (29.4%) had soft tissue injuries. In our study, soft tissue injuries were most prevalent among school-aged children, followed by mandibular, zygomatic-maxillary complex, and maxillary fractures. To investigate the pattern and etiology of maxillofacial injuries, we stratified the data by age, gender, and kind of school. Our findings may aid in developing effective strategies for preventing and managing maxillofacial trauma in school-aged children. These findings emphasize the necessity for focused interventions to reduce the frequency of maxillofacial trauma among school-aged children.

Lysis and covered endovascular reconstruction of the aortic bifurcation (LA CERAB) technique for chronic juxtarenal aortic occlusions.

The purpose of this study was to review early experience with catheter directed thrombolysis in the setting of chronic juxtarenal aortic occlusion as an initial therapy to allow safe definitive management with placement of aorto-iliac endografts. A retrospective review was performed of all patients with a diagnosis of chronic juxtarenal aortic occlusion treated by the author with initial catheter directed thrombolysis. In all, six patients (five males and one female, average age of 57 years) treated between 2019 and 2022 met criteria. Total duration of symptoms prior to thrombolysis ranged from 2 to 54 months (average 23 months.) Four patients (67%) had progressed to tissue loss 2 to 5 months prior to the initiation of thrombolysis (average 3.25 months). Radiographic confirmation of aortic occlusion on preoperative imaging was noted 7 to 846 days prior to the initiation of thrombolysis (average 190 days). Five of six patients (83%) had near complete resolution of aorto-iliac thrombus after 12 to 72 hours of thrombolysis to reveal underlying stenoses. The remaining patient's thrombolysis therapy was cut short at 48 hours due to behavioral issues, but had enough clearing of juxtarenal thrombus to undergo placement of aorto-iliac endografts. There were no perioperative deaths, myocardial infarctions, strokes or major complications. Temporary laboratory abnormalities (coagulopathy and/or increase in serum creatinine) were seen in four patients (67%), but all resolved by discharge without clinical sequelae. The primary patency is 100% at early follow-up of up to 15 months. In the setting of chronic juxtarenal aortic occlusions, thrombolysis can provide effective clearing of the juxtarenal aortic thrombus to allow safe definitive therapy with aorto-iliac endografts. The approach deserves consideration in patients at high risk for open reconstruction.

Predictors of dislocations after reverse shoulder arthroplasty: a study by the ASES complications of RSA multicenter research group

Instability after reverse shoulder arthroplasty (RSA) is one of the most frequent complications and remains a clinical challenge. Current evidence is limited by small sample size, single-center, or single-implant methodologies that limit generalizability. We sought to determine the incidence and patient related risk factors for dislocation after RSA, using a large, multicenter cohort with varying implants. A retrospective, multicenter study was performed involving fifteen institutions and 24 ASES members across the United States. Inclusion criteria consisted of patients undergoing primary or revision RSA between January 2013 and June 2019 with minimum 3-month follow-up. All definitions, inclusion criteria, and collected variables were determined using the Delphi method, an iterative survey process involving all primary investigators requiring at least 75% consensus to be considered a final component of the methodology for each study element. Dislocations were defined as complete loss of articulation between the humeral component and the glenosphere and required radiographic confirmation. Binary logistic regression was performed to determine patient predictors of postoperative dislocation following RSA. We identified 6,621 patients who met inclusion criteria with a mean follow-up of 19.4 months (range 3-84). The study population was 40% male with an average age of 71.0 years (range 23-101). The rate of dislocation was 2.1% (n=138) for the whole cohort, 1.6% (n=99) for primary RSAs, and 6.5% (n=39) for revision RSAs (P<.001). Dislocations occurred at a median of 7.0 weeks (IQR 3.0-36.0) after surgery with 23.0% (n=32) following a trauma. Patients with a primary diagnosis of glenohumeral osteoarthritis with an intact rotator cuff had an overall lower rate of dislocation than patients with other diagnoses (0.8% vs. 2.5%; P<.001). Patient-related factors independently predictive of dislocation, in order of the magnitude of effect, were history of postoperative subluxations prior to radiographically confirmed dislocation (Odds Ratio [OR] 19.52, P<.001), primary diagnosis of fracture nonunion (OR 6.53, P<.001), revision arthroplasty (OR 5.61, P<.001), primary diagnosis of rotator cuff disease (OR 2.64, P<.001), male sex (OR 2.21, P<.001), and no subscapularis repair at surgery (OR 1.95, P=.001). The strongest patient-related factors associated with dislocation were a history of postoperative subluxations and having a primary diagnosis of fracture non-union. Notably, RSAs for osteoarthritis showed lower rates of dislocations than RSAs for rotator cuff disease. This data can be used to optimize patient counseling prior to RSA, particularly in male patients undergoing revision RSA.

An enigmatic ectopic eruption of odontoma

Odontomas are benign non-aggressive odontogenic tumors and are most commonly regarded to be intraosseous lesions of jaw bones. A facial extraoral peripheral odontoma with an intriguing ectopic appearance is uncommon. A visual, radiographic, and histological confirmation of complex odontoma facilitates the treatment of surgical excision, which inhibits the creation of extraoral fistula and preserves esthetics.

Hip and Knee Osteoarthritis in Patients with Chronic Myeloproliferative Neoplasms: A Cross-Sectional Study.

Osteoarthritis (OA) is a progressive degenerative disease with an inflammatory background. Chronic myeloproliferative neoplasms (MPN) are clonal hematopoietic disorders characterized by chronic inflammation and a tendency for connective tissue remodeling. This study aimed to investigate the prevalence and associated risk factors of symptomatic OA (sOA) in MPN patients. A total of 100 consecutive MPN (39 essential-thrombocythemia, 34 polycythemia-vera, 27 myelofibrosis) patients treated in two community hematologic centers were cross-sectionally evaluated. Patients were required to have both symptoms attributable to hip and/or knee OA and radiographic confirmation to be considered as having sOA. The prevalence of hip and/or knee sOA was significantly higher among MPN patients than the previously reported prevalence in the general population of similar age (61% vs. 22%, p < 0.001). Hip sOA was present in 50%, knee sOA in 51% and sOA of both localizations in 41% of patients. A high proportion of MPN patients had radiographic signs of hip OA (94%) and knee OA (98%) in the presence of attributable symptoms. Among the other factors, sOA was univariately associated with the presence of JAK2 mutation, myelofibrosis phenotype, older age, higher body weight, and higher MPN-SAF score (p < 0.050 for all analyses). In the multivariate analysis, older age (odds ratio = 1.19, 95% confidence interval-CI 1.06-1.33) and higher body weight (OR = 1.15, 95% CI 1.06-1.25) were recognized as independent risk factors for sOA. On the other hand, cytoreductive treatment was a protective factor for sOA (OR = 0.07, 95% CI 0.006-0.86). The prevalence of sOA in MPN patients was higher than that in the general population and seems to correlate with older age, increased myeloproliferation and a higher inflammatory state. Whether cytoreductive treatment may postpone OA development in MPN patients warrants additional confirmation.

Small-bore feeding tubes placed with an electromagnetic imaging device leads to cost avoidance and decreased time to initiation of enteral nutrition.

The Cortrak Enteral Access System (CEAS) was previously approved by the United States Food and Drug Administration (FDA) to be used in lieu of radiographic confirmation imaging for feeding tubes placed by trained clinicians. Following an institutional protocol change in 2016, our registered dietitians had the option to forgo radiographic confirmation imaging for tubes placed using the CEAS. Our research aimed to determine the difference in the number of radiographic confirmation images for feeding tubes placed using the CEAS between preprotocol and postprotocol environments and the associated cost avoidance after the institutional policy change. We retrospectively reviewed data from 506 tube placements (n = 253 per protocol environment) in adult patients with diverse diagnoses admitted to various in-patient care units. There was a significant reduction in the mean number of radiographic images per tube placement (preprotocol = 1.10 [95% CI, 1.05-1.15]; postprotocol = 0.36 [95% CI, 0.30-0.41]; P < 0.001), leading to a cost avoidance of $67,282.80 for the 253 tube placements and a potential cost avoidance of $279,236 over the 5-year postprotocol environment. Additionally, the mean time to initiation of enteral nutrition was significantly reduced by 2.65 h in the postprotocol environment (P < 0.001). Our findings suggest that using the CEAS can reduce the number of radiographic images, provide cost avoidance, and improve nutrition outcomes. However, updated 2022 FDA regulatory changes to the use of the CEAS for tube confirmation lead to an uncertain future for this practice because of safety concerns.

Bone stress injuries

Bone stress injuries, commonly referred to as stress reactions or stress fractures, are caused by overuse and are prevalent conditions in athletes. These injuries are often seen in sports with high cumulative skeletal loading such as running, athletics, gymnastics, basketball, cricket, or soccer. The main injury pathophysiology is an imbalance between bone microdamage formation and its removal and replacement. A detailed medical history and clinical examination are important for diagnosis, with magnetic resonance imaging representing the gold standard for radiographic confirmation. Treatment and return-to-sport decisions should be individualized and based on injury location, severity, aspects of sports participation, and patient preferences. Initial management includes activity modification, protected weight-bearing, immobilization, optimizing nutrition (caloric intake, dietary calcium, and vitamin D supplementation), and in a few cases surgery. Following initial treatment, progressive loading and return-to-activity are initiated. Overall, a high rate of return-to-sports can be expected. Numerous risk factors that alter bone loading or bone health have been described and their identification is a crucial step towards prevention of future injury.

Volvulus of the Small Intestine in adults with intestinal malrotation: case report

Introduction: The volvulus of the small intestine with intestinal malrotation is a rare disease when occuring in adults, though, a surgeon’s ignorance of this diagnosis can result in potentially fatal extensive small intestinal necrosis. Presentation of case: Here, we present the case of a 57years old woman admitted and operated for a volvulus of the small intestine with intestinal malrotation after radiographic and pre-operative confirmation, whom follow up was unmarked. Discussion: The usual mechanism of obstruction in the volvulus of the small intestine with intestinal malrotation is adhesive compression of the duodenum and volvulus of the small intestine, this condition is the result of an arrest in the normal counterclockwise rotation of the cecum from the left lower quadrant to the right upper quadrant. Pre-operative diagnosis not always an easy task but the abdominal CT-scan is with a great help mainly by identifying the "WHIRL-WIND" sign. The Ladd procedure, consisting of division of Ladd’s bands, widening of the mesentery, and incidental appendectomy, is considered the worldwide standard up til now. Conclusion: This condition is rare and can be diagnosed mainly by CT-scan, however,the surgical management worldwide standard is the Ladd's procedure which can be led by laparotomy or laparoscopy and results in great outcome.

1334. Radiographic Features Associated with Increased Microbiology Culture Yields in Pediatric Orbital Cellulitis

Abstract Background Orbital cellulitis is an invasive infection defined by its location posterior to the orbital septum and can result in severe clinical manifestations. Computed tomography (CT) is the recommended imaging modality to assess for extent of disease and the Chandler classification system is used. It has 5 stages (CS): I is preseptal; II has inflammation beyond the orbital septum; III has subperiosteal abscess; IV has orbital abscess; and V has cavernous sinus thrombosis. There is limited data in its association with microbiology culture results. As part of a larger study to capture epidemiological and microbiological trends in pediatric orbital we hypothesize that culture yields and identification of a causative pathogen would increase as CS increases. Methods We performed a retrospective analysis using the US Military Health System database. ICD9/10 codes identified Individuals ≤ 21 years from June 2009 to September 2019 with orbital cellulitis. We excluded ophthalmia neonatorum and any cases without radiographic confirmation of orbital involvement. Demographic data, co-morbid diagnoses, imaging studies, microbiology results, and antibiotics prescribed were collected. CT reports were reviewed, and cases grouped by Chandler stage, (CS II-V). Descriptive statistics and χ 2 tests were used for categorical variables when appropriate. Results 130 cases met the inclusion criteria. 66.9% were male, the median age was 9 years old (IQR 4-17), and 55.4% had a prior diagnosis of sinusitis. 50.7% of cases were classified as CS II, 35.3% as CS III, 13.1% as CS IV, and 0.01% as CS V. Microbiology cultures were positive in 33.8% of cases. There was a significant difference between CS and any culture positivity with p = 0.011 and there was a significant trend between increasing CS and culture positivity with p &amp;lt; 0.003. Staphylococcus aureus and Streptococcus intermedius were the two most commonly identified pathogens, with no significant difference or trend associated with CS. Conclusion Overall, our findings demonstrated microbiology yield being low but increases with radiographic characteristics and CS stage. Identification of causative pathogens could increase the likelihood for tailored definitive antimicrobial therapy in pediatric patients with orbital cellulitis. Disclosures All Authors: No reported disclosures.

The use of plain radiography in diagnosing osteoarthritis: Asystematic review and time trend analysis.

The National Institute for Health and Care Excellence (NICE) suggest there is no role for routine radiography in the diagnosis of osteoarthritis (OA). It is not known how consistent this recommendation is across international guidelines, or the impact of UK guidance on domestic OA X-ray request rates. A systematic search identified guideline recommendations on the role of radiography in OA diagnosis. Full texts underwent dual screening and appraisal using the AGREE II tool. A narrative synthesis was performed. Consultation data were extracted from a UK primary care database: the Consultations in Primary Care Archives (CiPCA). The annual proportion of X-ray requests per 100 OA consulters from 2000 to 2012 were calculated. Joinpoint regression analysis examined if there were changes in the trend of X-ray request rates and compared these with the publication dates of UK guidelines. Eighteen evidence-based OA guidelines were included in the review. Eleven recommended a clinical diagnosis of OA without radiographic confirmation. Seven recommended routine radiography; these guidelines were predominantly for radiologists. A mean of 17.3 X-rays per 100 patients were requested in patients consulting for OA per year between 2000 and 2012. A statistically significant reduction in X-ray request rates was seen in 2003. Recommendations on the role of radiography in OA vary between medical specialty and countries. UK guidelines appear to have had a limited impact on X-ray request rates in OA.

Perspective: Lumbar adhesive arachnoiditis (AA)/ Chronic AA (CAA) are clinical diagnoses that do not require radiographic confirmation.

Our hypothesis was that lumbar adhesive arachnoiditis (AA)/chronic lumbar AA (CAA) are clinical diagnoses that do not require radiographic confirmation. Therefore, patients with these syndromes do not necessarily have to demonstrate significant radiographic abnormalities on myelograms, MyeloCT studies, and/or MR examinations. When present, typical AA/CAA findings may include; central or peripheral nerve root/cauda equina thickening/clumping (i.e. latter empty sac sign), arachnoid cysts, soft tissue masses in the subarachnoid space, and/or failure of nerve roots to migrate ventrally on prone MR/Myelo-CT studies. We reviewed 3 articles and 7 clinical series that involved a total of 253 patients with AA/CAA to determine whether there was a significant correlation between these clinical syndromes, and myelographic, Myelo-CT, and/or MR imaging pathology. We determined that patients with the clinical diagnoses of AA/CAA do not necessarily exhibit associated radiographic abnormalities. However, a subset of patients with AA/CAA may show the classical AA/CAA findings of; central or peripheral nerve root/cauda equina thickening/clumping (empty sac sign), arachnoid cysts, soft tissue masses in the subarachnoid space, and/or failure of nerve roots to migrate ventrally on prone MR/ Myelo-CT studies. Patients with clinical diagnoses of AA/CAA do not necessary show associated neuroradiagnostic abnormalities on myelograms, Myelo-CT studies, or MR. Rather, the clinical syndromes of AA/CAA may exist alone without the requirement for radiolographic confirmation.

Prehospital decompression of tension pneumothorax: Have we moved the needle?

BackgroundNeedle thoracostomy (NT) is the first-line intervention for tension pneumothorax in the prehospital setting. This study examined the effect of ATLS curriculum and EMS protocol changes on patient selection and successful performance of the procedure. MethodsThis is a retrospective chart review of all patients presenting to a Level One Trauma Center from 2015 to 2020 after undergoing prehospital NT. ResultsLateral NT placement increased significantly from 5.1% to 38.9%. Proper patient selection, defined as presence decompensated shock, respiratory distress, and diminished breath sounds increased from 23.1% to 27.8%. There was no difference in radiographic confirmation of the catheter in the pleural space. Iatrogenic injury rates decreased slightly from 28.2% to 16.7%. ConclusionsProtocol and curriculum changes have fallen short in yielding improved NT success rates or patient selection. Continued development of EMS education on the performance of NT is indicated.

PERCUTANEOUS CD FIXATION OF SPINE IN SPINAL FRACTURES/ INSTABILITY BY FREE HAND TECHNIQUE

Introduction: Lumbar spondylolisthesis is frequently found in adults as a result of spondylolysis or facet degeneration. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column and causes mechanical back pain and compression of neural structures. The initial treatment in most symptomatic patients with lumbar spondylolisthesis is nonoperative supportive care, which consists of a combination of pain medications, bracing, and physical therapy. Surgical intervention is indicated if the symptoms are disabling and they interfere with work despite supportive care, if there is progression of the slippage degree (SD) on serial radiologic examinations, or if there are overt neurological deficits 1,2. Pedicle screw placement is the most popular method in lumbar spinal instrumentation for achieving successful fusion. Recently, to reduce surgical damage to the normal muscular structures during pedicle screw placement, C-arm-guided percutaneous pedicle screw fixation (PPSF) was introduced, and it has become increasingly popular in spinal surgery. Percutaneous transpedicular fixation systems have become more widely used in recent years mainly for the treatment of dorsal, dorsolumbar, and lumbar instability. Aim &amp; Objectives: The present study is aimed at evaluating the functional outcome with percutaneous pedicle screw fixation for spinal fractures&amp; spinal instabilities by free hand technique in patients without neurological deficits. Materials &amp; Methods: The present dissertation is a study of 25 consecutive cases of spinal fractures and spondylolisthesis who attended the orthopaedic emergency or outpatient department of Andhra medical college, Visakhapatnam from 2017 to 2019. All the cases were examined clinically fallowed by radiographic confirmation. Results: In total 25 patients spinal fractures 16 and instability 9, whose mean preoperative ODI scores is 81.04% and the mean postoperative score is 22.6 %. The total postoperative moderate disability patients are15 and minimal disability patients are 10. “PERCUTANEOUS CD FIXATION OF SPINE IN SPINAL FRACTURES/INSTABILITY BY FREEConclusion: HAND TECHNIQUE” is one of the better methods and is suggested for grade 1 &amp; grade 2 spondylolisthesis and spinal fractures, also by which can reduce the morbidity and improve the function.

Delayed ischemic neurologic deficit with vasospasm in aneurysmal subarachnoid hemorrhage after negative post-bleed day 7 angiography

ObjectiveRoutine post-bleed day 7 (PBD7) angiography has been utilized to evaluate for vasospasm in aneurysmal subarachnoid hemorrhage (SAH). We sought to assess the rate of delayed-cerebral ischemia (DCI) associated with angiographic vasospasm following negative PBD7 angiography. MethodsRetrospective review of 178 aneurysmal SAH patients was performed. Patients underwent routine angiography on or around 7 days after hemorrhage. Primary variables assessed were the rate of vasospasm detection on PBD7 angiograms and rate of subsequent development of delayed-cerebral ischemia (DCI) associated with angiographic vasospasm in patients without spasm on PBD7. Statistical analysis was carried out for contributing factors. ResultsEighty-four of 178 patients (47.2 %) developed angiographically proven vasospasm during their hospital course. Seven patients (3.9 %) were clinically suspected to have vasospasm prior to PBD7 with radiographic confirmation. Sixty-nine patients (38.8%) demonstrated novel spasm on routine PBD7 angiogram, with 56.5 % of these patients showing vasospasm on angiography obtained after PBD7 for DCI. One hundred and two patients (57.3 %) had no vasospasm on routine PBD7 angiography. Eight patients in the PBD7 spasm-free subgroup went on to develop DCI with angiographic spasm. These 8 patients represent 4.5 % (8/178) of all patients, 7.8 % (8/102) of the PBD7 negative subgroup, and 9.5 % (8/84) of patients with angiographic spasm during admission. ConclusionThe majority of patients (90.4 %) with angiographic vasospasm manifested on or before PBD7. DCI with angiographically-proven spasm arouse infrequently (7.8 %) after negative PBD7 angiography. Further study of PBD7 angiography may help determine which SAH patients in whom shortened length-of-stay might safely be pursued.