Repeat Computed Tomography Scan Research Articles

Antiplatelet Reversal is not Associated With Decreased Progression of Intracranial Hemorrhage in Near-Isolated Traumatic Brain Injury: A Retrospective Clustered Analysis From Two Trauma Centers

IntroductionAntiplatelet agents (AAs) may increase the risk of intracranial hemorrhage (ICH). It is unclear whether reversal of antiplatelet effects (REV = desmopressin acetate [DDAVP] + Platelets) decreases ICH progression. The goal of the study was to determine whether REV was associated with decreased progression of ICH on repeat brain computed tomography (CT) scan. MethodsThis is a clustered study (November 2019 to March 2022) at two regionally distinct trauma centers (TCs) with differing standards of practice in patients with ICH, one reversal with DDAVP + Platelets (REV+) and the other no reversal with DDAVP + Platelets (REV−). Using electronic and manual chart review, data were collected on inpatients aged ≥ 18 y on preinjury AAs with CT proven ICH (abbreviated injury scale head ≥ 2) and no other abbreviated injury scale > 2 injuries, who had at least one repeat CT scan within 120 h of admission. ICH progression on repeat brain CT scan, mortality, and resource utilization were compared via univariate analysis (α = 0.05). ResultsOne hundred fourteen patients were enrolled: 72 REV+ at the first TC and 42 REV− at the second TC. REV+ group had fewer White patients and a lower proportion on preinjury aspirin but were otherwise similar. ICH progression rate was 24/72 (33.3%) for REV+ and 11/42 (26.2%) for REV− (P = 0.43). Isolated subarachnoid hemorrhage was the most common lesion, followed by isolated subdural hemorrhage. No patients required cranial surgery. All-cause mortality (expired + hospice) was 5/72 (6.9%) and 1/42 (2.4%), respectively (P = 0.29). ConclusionsIn this study of patients on preinjury AAs, REV was not associated with decreased ICH progression, lower mortality, or less resource utilization. These findings should be confirmed in a larger, prospective study.

Guide to extraluminal fish bone retrieval with serial computed tomography scans: a case series

BackgroundFish bone ingestion is commonly encountered in emergency department. It poses a diagnostic and therapeutic challenge particularly when it migrates extraluminally, necessitating a comprehensive and multidisciplinary approach for successful management.Case presentationHere we reported four cases of extraluminal fish bone. The first patient was a 68-year-old Chinese man who had odynophagia shortly after a meal involving fish. The second was a 50-year-old Iban man who reported a sharp throat pain after consuming fish 1 day prior. The third patient was a 55-year-old Malay woman who developed throat pain and odynophagia after consuming fish 1 day earlier. The fourth patient, a 70 year-old Iban man, presented late with odynophagia, neck pain, swelling, and fever 1 week after fish bone ingestion. These unintentional fish bone ingestions faced challenges and required repeat computed tomography scans using multiplanar reconstruction in guiding the surgical removal of the fish bone.ConclusionWe underscore the significance of multiplanar reconstruction in pinpointing the fish bone’s location, demonstrating the migratory route, and devising an accurate surgical plan.

Role of adaptive radiotherapy during concomitant chemoradiotherapy for limited-stage small-cell lung cancer.

Tumor shrinkage is frequently observed during conventionally fractionated chemoradiotherapy for limited-stage small-cell lung cancer (SCLC). The specific goals of this study are to evaluate the gross tumor volume (GTV) changes due to treatment-induced tumor reduction during the course of radiotherapy (RT) and to examine its potential use in adaptive radiotherapy (ART) for tumor dose escalation or normal tissue sparing in patients with SCLC. A total of 10 patients with SCLC eligible for chemoradiotherapy underwent computed tomography (CT) scan after Fractions 13 and 23 (at nominal doses of 23.4 Gy and 41.4 Gy, respectively). The GTV was delineated on the repeat CT scans, and two treatment plans were generated with or without adaptation to tumor shrinkage during RT for each patient. Dosimetric and volumetric analyses were performed. The average GTV reduction observed over 13 fractions was 58.5% (range: 13.2%-92.3%; P < 0.001) and over 23 fractions was 70% (range: 36.9%-84.5%; P < 0.001). Compared with the plan without adaptation, ART resulted in mean lung dose relative decreases of 8.7%, mean lung volume receiving ≥20 Gy relative decreases of 5%, mean lung volume receiving ≥5Gy relative decreases of 10%, mean medulla spinalis dose relative decreases of 21 cGy, mean esophagus volume receiving ≥50 Gy relative decreases of 19%, and mean heart volume receiving ≥42 Gy relative decreases of 13%. The benefits of ART were the greatest for tumor volumes ≥30 cm3 and are directly dependent on GTV reduction during treatment. ART for SCLC achieved a significant benefit in terms of organ at risk (OAR) and dose escalation.

Dose optimization of pancreatic enzyme replacement therapy is essential to mitigate muscle loss in patients with advanced pancreatic cancer and exocrine pancreatic insufficiency

Background & AimsExocrine pancreatic insufficiency (EPI) contributes to malnutrition, marked by muscle loss during chemotherapy for advanced pancreatic cancer (aPC). Pancreatic enzyme replacement therapy (PERT) is recommended for patients with EPI; however, it’s efficacy for attenuating muscle loss has not been demonstrated. We aimed to delineate the impact of PERT dose on muscle loss using a 7-year population-based cohort with aPC who were provided PERT at the discretion of their oncologist or dietitian according to clinical indications of EPI. MethodsAll patients treated with chemotherapy for aPC from 2013-2019 in Alberta, Canada (population ∼4.3 million) were included if they had computed tomography (CT) scans both prior to and 12 ± 4 weeks after chemotherapy initiation. Change in muscle area (cm2) was measured at 3rd lumbar level on repeated CT scans. Muscle loss was defined by measurement error (loss >2.3 cm2). Clinical and pharmaceutical data were retrieved from provincial registries. For patients who were dispensed PERT -8 to +6 weeks from chemo start (PERT users), estimated dose consumed per day was calculated as: (total dose dispensed)/(days, first to last dispensation). PERT users were categorized as high dose or low dose users according to the median estimated dose consumed. Non-users were classified as No PERT. Association between PERT use and muscle loss was analyzed with multivariable logistic regression. ResultsAmong 210 patients, 81 (39%) were PERT users. Median estimated dose consumed per day of 75 000 USP lipase units defined the cutoff between low dose and high dose uses. There were no significant differences in baseline characteristics between high dose and low dose groups. Muscle loss was more prevalent among low dose compared to both high dose and No PERT groups (88% vs. 58% and 67%, p < .05). In the multivariable model predicting muscle loss, low dose PERT was independently associated with greater odds of muscle loss (OR 5.4, p=.004) vs. high dose, independent of tumour response, disease stage, and chemotherapy regimen. ConclusionIn patients with clinical indications of EPI during chemotherapy for aPC, low doses of PERT were insufficient to prevent muscle loss. Patients with EPI consuming higher doses of PERT had similar odds of muscle maintenance to patients without clinical indications of EPI. Provider education for optimal PERT dosing in patients with EPI should be prioritized, and resources must be allocated to support dose titration.

Follow-up computed tomography and unexpected hemostasis in non-operative management of pediatric blunt liver and spleen injury.

While follow-up CT and prophylactic embolization with angiography are often conducted during non-operative management (NOM) for BLSI, particularly in a high-grade injury, the utility of early repeated CT for preventing unexpected hemorrhage remains unclear. This study aimed to elucidate whether early follow-up computerized tomography (CT) within 7 days after admission would decrease unexpected hemostatic procedures on pediatric blunt liver and spleen injury (BLSI). A post-hoc analysis of a multicenter observational cohort study on pediatric patients with BLSI (2008-2019) was conducted on those who underwent NOM, in whom the timing of follow-up CT were decided by treating physicians. The incidence of unexpected hemostatic procedure (laparotomy and/or emergency angiography for ruptured pseudoaneurysm) and complications related to BLSI were compared between patients with and without early follow-up CT within 7 days. Inverse probability weighting with propensity scores adjusted patient demographics, comorbidities, mechanism and severity of injury, initial resuscitation, and institutional characteristics. Among 1320 included patients, 552 underwent early follow-up CT. Approximately 25% of patients underwent angiography on the day of admission. The incidence of unexpected hemostasis was similar between patients with and without early repeat CT (8 [1.4%] vs. 6 [0.8%]; adjusted OR, 1.44 [0.62-3.34]; p = 0.40). Patients with repeat CT scans more frequently underwent multiple angiographies (OR, 2.79 [1.32-5.88]) and had more complications related to BLSI, particularly bile leak (OR, 1.73 [1.04-2.87]). Follow-up CT scans within 7 days was not associated with reduced unexpected hemostasis in NOM for pediatric BLSI.

Unique laparoscopic emergency management of traumatic obstructed abdominal wall hernia: A case report and review of literature

Abstract Traumatic abdominal wall hernia (TAWH) is a rare clinical occurrence, with only limited cases published since 1906. This type of hernia is primarily caused by low- or high-energy blunt force trauma, resulting in damage to abdominal wall musculature while the skin is intact. The diagnosis and management of TAWH poses a lot of challenges and complexities. Herein, we present a case of a 32-year-old male Saudi patient who sustained significant abdominal trauma as a driver involved in a front collision while wearing a seat belt. Upon arrival at the trauma center, the patient was hemodynamically stable and exhibited clinical signs of left flank bulge, seat belt sign, and abdominal bruising. First, a focused assessment with sonography for trauma (FAST) was performed, which revealed minimal free fluid in the abdomen. Subsequent contrast-enhanced IV computed tomography (CT) scan confirmed a 3.6-cm left lateral abdominal wall defect with herniation of short segments of the large and small bowel loops and adjacent subcutaneous fluid. Following initial observation, the patient developed signs of bowel obstruction. A repeat CT scan showed interval progression of the hernia, partial small bowel obstruction, and other concerning findings. An emergency laparoscopic exploration revealed a large defect at the left lumber region containing omentum and long segments of the small bowel with mild distension. The bowel and omentum were reduced. The surgical repair included herniorrhaphy and mesh placement. The patient recovered well and was discharged on the third postoperative day. This case underscores the importance of thorough evaluation and timely intervention in TAWHs. Rapid surgical management, aided by advanced imaging techniques, can lead to favorable outcomes even in complex cases involving bowel herniation and associated complications.

Evaluating the Utility of Repeat Computed Tomography Scans in Patients with Isolated Mild Traumatic Subarachnoid Hemorrhage

Background and ObjectivesTraumatic subarachnoid hemorrhage (tSAH) is a common consequence of head trauma. Treatment of tSAH patients commonly involves serial CT imaging to assess for expansile hemorrhage. However, growing evidence suggests that these patients rarely deteriorate or require neurosurgical intervention. We assessed the utility of repeat CT imaging in adult patients with isolated tSAH and an intact initial neurologic exam. MethodsPatients presenting to Mass General Brigham Hospitals with tSAH between 2000 and 2021 were eligible for inclusion in this retrospective cohort study. Patients were excluded if their SAH was non-traumatic, they experienced another form of intracerebral hemorrhage, or if they had a documented Glasgow Coma Score (GCS) of 12 or lower and/or poor presenting neurological exam. Univariate and multivariate regression models were used for statistical analysis. ResultsOverall, 405 patients were included (191 male). The most common mechanism of trauma was fall from standing (58%). The mean number of total CTs for all patients was 2.3, with 329 patients (80%) receiving two or more. 309 patients presented with no significant neurological symptoms. No patients developed acute neurologic deterioration or required neurosurgical intervention related to their bleed, although five had mild hemorrhagic expansion on follow up imaging. ConclusionIn the present study, repeat imaging rarely demonstrated meaningful hemorrhagic expansion in this cohort of neurologically intact patients with isolated tSAH. In these patients with mild TBI, excessive CT imaging is perhaps unlikely to affect patient management and may present unnecessary burden to patients and hospital systems.

Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours.

To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk-) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk- NSGCT. Observational prospective population-based study of patients diagnosed 2008-2019 with CS IIA Mk- NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk- disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer. Overall, 126 patients with CS IIA Mk- NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6-18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk- NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients. Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk- NSGCT had a high rate of cancer and a low rate of teratoma.

Chronic Neck Swelling: A Case Report of Migrating Fish Bone

Background: Foreign bodies in the upper aerodigestive tract are frequently seen in otolaryngological practice, but migration of foreign body and oesophageal penetration are rare occurrences. Most reported cases of migration in literature involve fish bones, which are usually found in the lateral neck soft tissue or thyroid lobule. This can cause serious complications if left untreated. In most cases, fish bones can be removed safely by endoscopy, but they may migrate extraluminally to the skin in rare cases. Computed tomography (CT) neck with contrast is the investigation of choice to confirm migration. Case presentation: We present a case of an elderly lady with fish bone ingestion which migrated and embedded itself over the right thyroid cartilage region that required open surgery for removal. In this case, the patient underwent two open surgeries to locate the presence of the foreign body despite the CT neck done to aid in mapping intraoperatively. We used surgical clips in the first unsuccessful operation in locating the foreign body, and later performed a repeat CT scan and the clips were used to pinpoint the exact location of the foreign body during second surgery. By doing so, we successfully managed to remove the foreign body and patient was discharged well. Conclusion: This case has illustrated how versatile surgical clips are in helping us to locate the position of the foreign body rather than blindly exploring and causing further iatrogenic injury. With supplementation from a thorough repeat CT scan, we do think that in a presenting case of foreign body migration with difficulty locating the exact foreign body location, imaging adjunct such as C arm fluoroscopy and ultrasound guidance as reported in the literature can be used to avoid unnecessary iatrogenic injury and cause more harm to the patient.

Anesthetic Challenges during Endobronchial Brachytherapy: A Case Report.

Lung cancer is the leading cause of cancer death worldwide. It may present as airway obstruction in a patient with endobronchial masses. Endobronchial brachytherapy (EBBT) has been shown to provide palliative therapy. It is the insertion of a radioactive material near the mass to reduce tumor size, thereby improving airway obstruction. This is the first case of EBBT done in our institution during the COVID-19 pandemic. A 53-year-old male, 60 kg, ASA Physical Status 2 for hypertension, smoker, malignancy, and previous pulmonary tuberculosis patient, presented with a cough and dyspnea. An endobronchial mass almost obstructing the right mainstem bronchus was seen on a computed tomography (CT) scan. He was diagnosed with squamous cell carcinoma of the lung and underwent radiotherapy and erlotinib chemotherapy. On repeat CT scan, there was no noted decrease in the size of the mass. EBBT was suggested, and a multi-disciplinary team was formed for the planned procedure. Pulmonology, radiation oncology, and anesthesiology teams were identified, and thorough planning was done prior to the actual procedure. Three fractions of EBBT were done under sedation using midazolam, fentanyl, and dexmedetomidine infusion. Lidocaine spray and transtracheal block were also performed as adjuncts prior to sedation. The procedure went as planned, and points for improvement were discussed for subsequent fractions. Due to persistent cough and discomfort from the catheter, additional ipratropium nebulization for minimization of secretions, and oral dextromethorphan for cough suppression were incorporated. After each fraction, the patient was monitored post-procedure for any side effects both from the radiotherapy and anesthetic technique. Qualitative reduction in mass size was noted in subsequent fractions. The patient was able to complete 3 fractions and was advised to follow-up after a month. EBBT is an emerging palliative and treatment modality for lung cancer, especially for intraluminal masses. Anesthetic considerations will depend on each case's characteristics such as airway anatomy, patient comfort and capacity, and procedural requirements. Conscious sedation with topical anesthesia is an adequate and appropriate anesthetic option, especially in cases where severe airway obstruction may compromise ventilation if airway reflexes are blunted. A multidisciplinary approach with different services and stakeholders is important for the proper planning, execution, and management of such patients.

A feasibility study on the implementation of head and neck adaptive radiotherapy. A single centre’s experience

Abstract Introduction: The purpose of the study is to measure anatomical and dosimetric changes experienced by patients with head and neck cancer undergoing intensity-modulated radiation therapy and evaluate the need for adaptive radiotherapy using predefined relative thresholds as benchmarks. Methods: This study involved 31 consecutive patients. Two computed tomography (CT) scans were utilized for initial treatment planning and a midpoint assessment. The study employed rigid registration and contour transfer techniques to apply primary dose calculation to midpoint CT, generating a hybrid plan, and an adaptive plan was generated on the midpoint CT. Results: The results revealed statistically significant volume reductions mainly in PTV70, PTV60 and PTV54 volumes. The volume of the parotid glands exhibited volumetric reductions in most of the patients. Hybrid plans demonstrated inferior dose coverage of the tumour regions, and comparisons between hybrid and adaptive plans showed significant variations in the maximum doses. Conclusions: Anatomical deviations necessitating a repeat CT scan, along with the application of a new immobilization mask, emerged as a primary rationale for replanning. Indicators that could potentially encompass a breach of 95% dose coverage for 95% of the tumour volume, maximum doses surpassing 50 Gy in the spinal cord and 59 Gy in the brainstem&lt;&gt;, as well as lateral neck displacement exceeding 1cm from the initial position act as benchmarks before implementing a replan.

Pathologically confirmed spontaneous regression of small cell lung cancer after computed tomography-guided percutaneous transthoracic needle biopsy followed by surgery

BackgroundSpontaneous regression of malignant tumors is a rare phenomenon, especially in primary lung cancer. The underlying mechanisms remain unclear, but they may often involve immunological mechanisms.Case presentationIn January 2020, a 78-year-old female underwent examination during follow-up of interstitial pneumonia. Chest X-ray and computed tomography (CT) scan revealed a 1.2 × 1.2 cm nodule in the left lower lobe. Based on CT-guided percutaneous transthoracic needle biopsy (PTNB), it was diagnosed as small cell lung cancer (SCLC). Immunohistochemical staining showed that tumor cells were positive for CD56, synaptophysin, and chromogranin A. Twenty-three days after the CT-guided PTNB, repeat CT scan showed that the tumor size regressed to 0.6 × 0.6 cm. The tumor showed positive uptake in fluorodeoxyglucose (FDG) positron emission tomography (PET)–CT. The maximum standardized uptake value of the nodule was 2.24. PET–CT and enhanced magnetic resonance imaging of the brain showed no distant or lymph node metastasis. The patient’s preoperative disease was diagnosed as cT1aN0M0, stageIA1, SCLC. In March 2020, she underwent left lower lobectomy and mediastinal lymph node dissection. Pathological examination of the resected specimen showed that the small tumor cells were dense with a high nucleus to cytoplasm ratio, and the morphological diagnosis was small cell carcinoma. The resected tumor size regressed to 0.05 × 0.02 cm, and no lymph node metastasis was observed. Because it was extremely small, immunohistochemical staining could not be conducted. Active fibrosis and inflammation were present around the tumor. Finally, the patient was pathologically diagnosed as SCLC pT1miN0M0, stage IA1. The patient is alive without recurrence 23 months after surgery with no adjuvant therapy.ConclusionsWe present a rare surgical case of pathologically confirmed spontaneous regression of SCLC after CT-guided PTNB. Although spontaneous regression is extremely rare, we should recognize this phenomenon.

Does thePenicillin Allergy Label Affect Outcomes of Complicated Odontogenic Infections?

Penicillins are a potent antibiotic in managing odontogenic infections, but 10% of the population is labelled as allergic to these drugs. This has limited their use and resulted in increased utilization of health care resources as well as complications associated with alternative antibiotics. The purpose of the study was to measure the association between patients labeled as penicillin allergic and treatment outcomes in a sample of patients treated for complicated odontogenic infections. Additionally, we sought to investigate antibiotic resistance patterns in these patients. A retrospective cohort study was performed at the Michigan Medicine health care system to include patients who were treated for complicated odontogenic infections by oral and maxillofacial surgery between 2016 and 2020. Complicated odontogenic infection was defined as any odontogenic infection requiring admission and surgical management in the operating room. The primary predictor variable was the penicillin allergy label, which was determined by chart review and not confirmed with formal testing.Outcomes were measures of disease severity. The primary outcome variable was hospital length of stay. Secondary outcome variables were ICU admission (yes/no), repeat computed tomography scan(s), repeat surgery (yes/no), and re-admission (yes/no). Co-variates included were age, sex (male/female), tobacco use status, diabetes, immunocompromised state, number of spaces involved, white blood cell count upon admission and insurance status. For our secondary aim, the primary predictor variable was again penicillin allergy and outcome variable was antibiotic resistance as determined by wound culture results following surgical intervention. Negative binomial regression and logistic regression analyses were performed.P < .05 was considered significant. A total of 150 patients met the inclusion criteria and of those 17.3% reported as penicillin allergic. Patients labelled as penicillin allergic did not differ significantly from patients without penicillin allergy label in terms of treatment outcomes. Age, diabetes, and immunosuppression were associated with an increased length of stay. Patients labelled as penicillin allergic were at significantly higher risk for antibiotic resistance (relative risk=2.34; 95% confidence interval, 1.66 to 3.32; P<.001), specifically clindamycin resistance (relative risk= 3.17; 95% confidence interval, 1.93 to 5.18; P<.001). Penicillin allergy was significantly associated with clindamycin resistance. There were similar outcomes amongst patients with and without a penicillin allergy label despite antibiotic differences. Delabeling efforts for patients with a reported penicillin allergy must be considered and local nomograms for antibiotic selection should be used by providers when seeking alternative antibiotics.

Would lead shielding the eye lenses during a head CT be beneficial?

The lens of the eye is one of the radiosensitive organs. Patients receiving computed tomography (CT) scanning of the head, as well as patients undergoing repeated CT scanning of the head, are at risk for this consequence. The goal of this study was to see if a lead equivalent might reduce radiation reaching the eye’s lens during regular cranial CT. The goal was accomplished by determining the ideal shielding thickness for patient applications by first evaluating the image quality using phantom measurements taken with and without lead shielding. LiF-thermoluminescent dosimeters were used to quantify the entrance surface doses (ESDs) to the eye lenses of the ATOM phantom without, with one, two, and three layers of lead shielding. The use of customized lead shields up to 0.1 mm thick might be used, according to ACR CT Phantom studies, without having a noticeable impact on the image quality for the central and posterior areas. In these experiments, 0.1 mm thick lead shielding reduces ESDs to the eye’s lens by 31%. Eye shields significantly reduced image quality in the anterior region, but just slightly in the centre and posterior regions. Given the foregoing, using modified lead shields could drastically lower dose to the lens without severely affecting image quality.

Analysis of traumatic intracranial hemorrhage and delayed traumatic intracranial hemorrhage in patients with isolated head injury on anticoagulation and antiplatelet therapy.

Anticoagulants and antiplatelet (ACAP) agents are increasingly and frequently used, especially in the elderly. The present study was carried out to assess the prevalence of delayed traumatic intracranial hemorrhage (dtICH) after a normal result on an initial head computed tomography (CT) in adults who were taking ACAP medication. The present retrospective included all adult patients who arrived in the emergency department between January 2017 and January 2021 with a history of fall from the patient's own height, while being on ACAP medication with an isolated head injury. The Institutional Review Board approved the study with a waiver of consent. The primary outcome measures were prevalence of dtICH in patients who had initial normal CT scan brain and were on ACAP medication. There were 2137 patients on ACAP medication, of which 1062 were male, and 1075 were of the female gender. The mean age of the patients was 82.1 years. About 8.2% had positive first CT scans (176/2137), while 0.023 (27/1149) had dtICH. The most common positive finding on the CT scan was subarachnoid hemorrhage followed by subdural hemorrhage. Male gender positively correlated with increased risk for first CT being positive (P = 0.033). Patient's with comorbidity of cirrhosis and chemotherapy had higher risk of dtICH (P = 0.47, 0.011). There was a very low (0.023%) prevalence of dtICH. Dual therapy or Coumadin therapy made up the majority of tICH. Cirrhosis and chemotherapy were associated with the risk of a repeat CT scan being positive with an initial CT scan negative.

Assessment of the Radiation Exposure and Cancer Risks of Disabled People Undergoing Different Computed Tomography Scans

The usage of radiological investigations is increasing rapidly in Saudi Arabia. It has been estimated that 7.1% of the populace in the Kingdom of Saudi Arabia is disabled. Out of 32.94 million citizens, 1,445,723 (52.2% males and 47.8% females) millions are considered disabled. Disabled individuals are frequently undergoing medical imaging procedures, and there are not enough studies regarding the risk of radiation exposure to disabled patients from these machines. This study aims to quantify the frequency of medical procedures and estimate the collective dose for disabled individuals to predict the overall cancer risk from medical exposure. A total of 108 computed tomography (CT) procedures were carried out for disabled patients. The procedures include the brain, chest, abdomen, pelvis, and cervical spine. A 128-slice CT machine was used in this study Philips Ingenuity (Philips, Netherlands). The CT machine is subjected to regular quality control tests to ensure compliance with national recommendations. In this study, 108 [11 (10.2%) females and 97 (89.8%) males] CT procedures were carried out for disabled patients at the radiology department, King Khalid Hospital and Prince Sultan Center. The average and standard deviation radiation dose per CT procedure [DLP (mGy.cm)] for the brain, chest, abdomen, pelvis, and cervical spine were 1183.4 ± 187, 352.8 ± 88, 654 ± 73, 803 ± 800, and 527 ± 186, respectively. The estimated cancer risk is 1 cancer per 1000 to 10,000 CT procedures. Patient doses are comparable with those of previous studies carried out for normal patients. However, the protection of disabled patients from unnecessary radiation exposure is crucial to reduce the projected radiation risks and minimize the number of repeated CT scans and unproductive radiation exposure.

Traumatic Brain Injury among Patients Admitted in Neurosurgical Unit in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Traumatic brain injuries are one of the leading causes of mortality, morbidity, and economic burden in context to Nepal. Non-contrast computed tomography is used for rapid diagnosis and repeat computed tomography helps to detect the progression and complications of cerebral injury. The aim of this study was to find out the prevalence of traumatic brain injury among patients admitted in the neurosurgical unit in a tertiary care centre. This descriptive cross-sectional study was conducted among patients admitted to the neurosurgery unit in the tertiary care centre from 1 August 2019 to 29 August 2020. Ethical approval was taken from Institutional Review Committee (Reference number: CMC-IRC/075/076-156). Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 350 patients admitted in the neurosurgical unit, the prevalence of traumatic brain injury was 140 (40%) (34.87-45.13, 95% Confidence Interval). Change in management was required among 28 (20%) when computed tomography was done within 12-24 hours. Among them, 27 (19.29%) underwent surgical intervention after a repeat computed tomography scan. The prevalence of traumatic brain injury was found to be higher than similar studies done in similar settings. contusion; craniotomy; traumatic brain injury.

Should Infants with Blunt Traumatic Brain Injuries and Intracranial Hemorrhage Have Routine Repeat Imaging?

The practice of repeat head CT imaging in infants as a distinct population is poorly studied. The purpose of this study was to evaluate the incidence and utility of repeat head CT in the infant population. A 10-year retrospective review was conducted of infants with blunt traumatic head injuries (N = 50) that presented to a trauma center. Information from the hospital trauma registry and patient medical records were extracted regarding the size and type of injury, number and results of computed tomography (CT) imaging, changes in neurological exams, and any interventions that were required. Most patients (68%) had at least one repeat CT, with 26% showing progression of hemorrhage. Decreased Glasgow Coma Scale was associated with having repeat CT scans. Nearly one in four infants had a change in management associated with repeat imaging. Repeat CT scans resulted in operative interventions in 11.8% of cases and longer intensive care unit (ICU) stays in 8.8% of cases. Repeat CT scans were associated with increased hospital length of stay, but not with increased ventilator days, ICU length of stay, or mortality. Worsening bleeds were associated with mortality, but not with other hospital outcomes. Changes in management following repeat CT appeared to be more common in this population than in older children or adults. Findings from this study supported repeat CT imaging in infants, however, further research is needed to validate results of this study.

MEDIASTINAL PSEUDOCYST: A RARE ASYLUM FOR A COMMON DISEASE

Pseudocyst is one of the commonest complications following pancreatitis. However, a mediastinal pseudocyst is a rare entity which demands a high index of suspicion for diagnosis. We report a case of a 42 years old male who presented to the emergency with cough, retro-sternal chest pain, progressive dysphagia and vomiting. He was a chronic alcoholic with multiple hospitalisations in past 4 years for recurrent episodes of severe acute pancreatitis. There was left sided pleural effusion on chest radiograph and extrinsic compression of distal oesophagus and proximal stomach from posterior aspect on endoscopy. Abdominal computed tomography (CT) revealed a large pseudocyst abutting the body of pancreas and extending superiorly into the mediastinum. Patient was treated conservatively and given total parenteral nutrition followed by Ryle's tube feeding. He improved, started accepting orally and was discharged. Patient was asymptomatic on follow up and repeat CT scan after 6 weeks showed signicant decrease in the size of collection

Multidisciplinary management in the treatment of intrahepatic cholangiocarcinoma.

Multidisciplinary management in the treatment of intrahepatic cholangiocarcinoma.