CT Scan Results Research Articles

Abstract TP377: Nurse Entered Stroke Order Sets Improve Emergency Department Metrics at a Comprehensive Stroke Center

Introduction: The Joint Commission has established time sensitive metrics for stroke care in the Emergency Department (ED) including door to initial physician evaluation, door to lab and CT order placement, door to lab resulted and door to CT interpretation. Purpose: The purpose of this quality improvement project was to assess if nurse entered protocolized order sets for stroke patients would help to improve these metrics. Methods: A code stroke order set was initiated independently by nursing staff upon symptom recognition in the ED. The order set included CBC, electrolyte panel, BUN, creatinine, glucose, troponin, PT/INR, aPTT, non-contrast CT head, EKG, swallow screen and continuous cardiac monitoring. Data was collected for 3 months pre and post intervention. All ED nurses were trained on order set entry and their skills were validated. Data was analyzed using a T-Test. Results: 60 patient pre and 52 post-implementation were evaluated. Door to initial physician evaluation was faster (7 mins pre vs. 5 mins post; p=0.029). Door to lab order placement was faster (8 mins pre vs. 3 mins post; p=0.038). Door to CT ordered was faster (8 mins pre vs. 6 mins post; p<0.01). Door to labs resulted was faster (32 mins pre vs. 27 mins post; p=0.01). Door to CT interpretation was faster (19 mins pre vs. 18 mins post; p=0.04). Conclusion: Implementation of nurse entered order sets can improve ED metrics for door to initial physician evaluation, door to lab and CT order placement. This subsequently led to faster interpretation of the CT scan and lab results.

Precision of 3D MSCT Scan Diagnostcs on Maxillofacial Trauma Compared to Stabilization and Instrumentation Operation Results

Handling standardized radiological readings of patients with maxillofacial trauma, particularly in radiology are currently absent. Appropriate and accurate of radiological reading results could be as the guideline for surgeons in determining surgical procedures. This study aimed to evaluate the diagnostic accuracy of maxillofacial fracture patients with head 3D CT scan compared to stabilization and instrumentation results as gold standard. Secondary data that derived from medical records were used as 29 patients with clinical maxillofacial trauma enrolled in this study at Radiology Section of Dr.Soetomo General Hospital from November 2012 to March 2013. The Mc Nemar test showed that there was no significant difference between the 3D CT scan results and the stabilization also instrumentation results with p = 1.000 (p> 0.05). While, the result was by calculating Kappa coefficient that a high suitability between head 3D CT scans and stabilization also instrumentation result with κ = 1.000, p = 0.000 (p <0.05).There were several complications in the form of Cranii Bone Fraktur (25%), intracranial complication (15.24%), Haematosinus (52.38%) and Soft tissue haematoma (32.38%) with most intracranial complications ICH (31.25%), then, most soft tissue complications were in the Orbita region (26.47%) and the most common Haematosinus complications regarding Sinus Ethmoid and Maksilaris (29.09%). It concluded that the 3D CT scan results were in accordance with the results of stabilization and instrumentation operations.

Investigating the agreement between the findings of multi-slice CT scan and surgical findings in the diagnosis and detection of metastasis of malignant ovarian tumors to the peritoneum and intra-abdominal organs

The present study was conducted to determine the agreement between the findings of multi-slice CT scan and surgical findings in the diagnosis and detection of metastases of malignant ovarian tumors to the peritoneum and intra-abdominal organs. In this cross-sectional study, 115 women with ovarian cancer who were hospitalized and underwent surgery in Al-Zahra Hospital during 1396 and 1397, underwent multi-slice CT scan of the abdomen and pelvis before the operation, and the presence of metastases in these areas was investigated; then the comparison of these results with the findings of the operation indicated the amount of agreement between the two methods, which was determined by the Kappa agreement test. According to the finding of the surgery, 96 patients (83.5%) and according to the findings of multi-slice CT scan, 94 patients (81.7%), had metastasis in adjacent tissues. Five patients (4.3%) had metastases in the surgical findings, but the result of CT scan was a negative. Also in 3 patients (2.6%), the presence of metastasis was negative in the surgical findings but the result of CT scan was positive. According to the Kappa agreement test, a significant agreement with the amount of 0.76 was observed between the findings of the surgery and the CT scan results. The results of this study showed that there is a favorable agreement between the findings of surgery and multi-slice CT scan in the diagnosis of metastasis of malignant ovarian tumors to abdominal and pelvic areas, However, due to the limitations of multi-slice CT scan in the diagnosis of metastases of malignant ovarian tumor to the abdomen and pelvis, including being dependent on the size and location of the tumor, the use of this diagnostic method may be helpful in cases where surgery is not possible and may be useful in determining surgical indication.

PITUITARY TUMOR: PRESENTATION, DIAGNOSIS, AND MANAGEMENT USING THE TRANSSPHENOIDAL ENDOSCOPY

Introduction: The pituitary tumor is the most common tumor found in the Sella region of the skull with varying prevalence. Although classified as benign, this tumor has a significant rate of morbidity and mortality. Case evaluation and disease courses require in determining therapy and prognosis for further cases. Material and Methods: This retrospective descriptive study used data collection methods derived from the medical records of patients with pituitary tumors at three hospitals in Makassar, South Sulawesi. Data collection was carried out based on diagnosis, gender, chief complaints, head (Computerized Tomography) CT scan results, Magnetic Resonance Imaging (MRI) results, treatment, anatomic pathology results, and patient follow-up. Results: The results showed five patients with pituitary adenoma who had the mean age of 45, three (60%) patients are male, and two (40%) are female. 20% patients with symptoms of endocrine disorders (acromegaly), and 80% patients with symptoms of the mass effect. Tumor size was measured volumetrically using the initial and the last follow-up MRI. We found that all detected masses were isointense with the most significant size 34 mm, the smallest size of 30 mm, and the mean previous tumor was 32 mm (SD = 1.79). All patients underwent transsphenoidal (TSS) procedures. 60% showed a significant improvement in visual field abnormalities and headaches after surgery. A second TSS surgery performed in 1 patient (20%) found to have tumor persistence. Conclusions: TSS remains the treatment of choice for pituitary tumors. This study shows safe and effective TSS for pituitary tumors, provided surgeons with considerable experience and expertise perform it.

Evaluation of causes of brain CT scan in patients with minor trauma

BackgroundComputerized tomography (CT) scan is one of the widely used imaging modalities for the diagnosis of anomalies and diseases. Nonetheless, increased exposure to the radiations is one of its overlooked side effects. ObjectiveThe aim of this study was to determine the causes of cerebral CT scan in patients with minor trauma. MethodIn this cross-sectional study, 550 patients with minor head trauma referred to (XXX) were evaluated. The data are collected and completed using a questionnaire comprising of variables such as age, sex, type of trauma, trauma severity, CT scan results, associated symptoms based on NEXUS II, CCHR and NOC criteria and underlying diseases. The data were analyzed using statistical tests and SPSS software version 22. ResultThe mean age of patients was 32.5 years and 62% of patients were male. 67% of the patients visited the hospital on their own. The cause of the trauma in 29% patients was car accident, 19% fall from height and 16.5% conflict. Scalp lesions were seen in 30.5%, hematomas in 4.9%, dizziness in 8.9%, history of comorbidities in 5.8%, episode of vomiting less than 2 in 7.3%, episode of vomiting more than 2 times in 1.1%, headache with score ≥7 in 5.8%, headache with score ≤7 in 23.1%, postoperative forgetfulness in 0.2%, raccoon eyes in 0.2% and nose bleeding in 1.5%. Findings of CT scan were abnormal in 0.2% of patients. The patient's condition declared cleared in 94.5% cleared and 5.5% referred to a neurosurgery. Statistically, CT scan had significant role in predicting the patient's neurosurgery counseling status (P < 0.05). ConclusionThe majority of patients with minor head trauma had normal brain CT scan and was discharged without the need for neurosurgery counseling. Therefore, it seems necessary to reduce brain CT scans without indication to reduce the radiation dose among patients with minor head trauma.

Correlations of CT scan with high-sensitivity C-reactive protein and D-dimer in patients with coronavirus disease 2019.

Objectives:To study the correlations of CT scan with high-sensitivity C-reactive protein (hs-CRP) and D-dimer in patients with coronavirus disease 2019 (COVID-2019).Methods:From January to March 2020, COVID-19 patients were divided into two groups according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial version 7), with mild and ordinary cases as Group-1 and critical and severe cases as Group-2. The chest CT scan results, hs-CRP, D-dimmer levels of the two groups from admission to discharge were compared by the χ2 test or Fisher’s exact test. The quantitative data were represented as mean ± standard deviation ( x ± s). Intergroup comparisons were performed by the independent samples t test, and the ineligible data were subjected to the nonparametric rank sum test. Binary logistic regression model was used for multivariate correlation analysis, using independent variables that were significant in univariate analysis. The correlations between the above indices were analyzed.Results:In Group-1, there were two cases of normal chest CT scan results, one case of fibrosis, and 25 cases of abnormalities during the first diagnosis, mainly manifested as single or scattered ground-glass shadows. After treatment, the CT scan results became normal. The chest CT scan of Group-2 showed abnormalities, including 21 cases of multiple ground-glass shadows, and six cases of multiple consolidations accompanied by ground-glass shadows, who were critically ill and died. In addition, there were 16 cases of multiple ground glass shadows with partial consolidation, and the CRP and D-dimer levels of Group-2 were significantly higher than those of Group-1. Chest CT scan results were significantly positively correlated with CRP and D-dimer levels (P<0.05).Conclusion:The chest CT scan results of COVID-19 patients are characteristic, being correlated with CRP and D-dimer levels. D-dimer and CRP levels significantly increase in most severe and critical patients, which are closely related to their prognosis. The indices may play predictive roles in clinical treatment and prognosis evaluation.

Severity of Coronary Artery Disease by Coronary CT Angiography in Relation to Left Ventricular Diastolic Function

Objectives: The aim of this study is to evaluate the relationship between severity of CAD by coronary mutlislice computed tomography scan and the degree of diastolic function Methods: The study consisted of 80 patients who underwent both coronary CTA and TTE within 1 year with no identifiable intervening cardiovascular event in National Heart Institute and Menoufia University Hospitals. All patients were subjected to detailed medical history, physical examination, full electrocardiography study including tissue Doppler imaging on mitral annulus, MSCT coronary angiography and different laboratory investigation as CBC, creatinine, lipid profile. Results: From 80 patients who have done both echocardiography examination and MSCT coronary angiography, the CT scan results were 38 patients with non-obstructive coronary artery disease and 42 patients with obstructive CAD, higher number of patients with diastolic dysfunction with higher values of E/E’, medial e’, lateral e’, LAVI (left atrial volume index) and TRV (tricuspid regurge velocity) were found in the group with obstructive coronary artery disease. Conclusion: Our study showed that diastolic dysfunction is more prevalent in patients with obstructive coronary artery disease with higher grade of diastolic dysfunction.

C2 Lateral Mass Vertebrae Anthropometry for Evaluating C2 Straight Lateral Mass Screw Fixation

Background: The cervical vertebra is an important vertebra as there are blood vessels in its surroundings from the brain to the entire vertebrae. Cervical injury has the most fatal consequences when it occurs as high as C1-C2. If instability occurs in the C1-C2 vertebrae and atlantoaxial joints, the procedure of surgical techniques include cervical arthrodesis or spinal fusion. C2 straight lateral mass fixation is one technique that can be used for fixation in patients with spinal cord compression and anomalous vertebral artery by inserting shorter screws in the lateral mass of the C2 vertebrae from the posterior direction. There have been not many references similar to the present study of anatomy to discover the screw characteristics needed in this technique. Aim: This study aimed to identify the length of the lateral mass in the C2 vertebra for the purposes of the C2 straight lateral mass screw fixation technique. Method: This research was an observational descriptive study with cross sectional design that observed the results of cervical CT-Scan. Observation was made using the RadiAnt DICOM Viewer application and measurements were based on a sagittal cross section. The length was measured from the posterior parallel to the posterior longitudinal ligament (PLL). The initial mean was measured on the right and left side; afterwards, the final mean is the total mean of both sides. Result: From 10 samples, there were mean long lateral masses of C2 vertebrae on the right side of 13.511 ± 1.081 millimeters, the left side of 13.444 ± 1.396 millimeters, and the final mean of 13.48 ± 1,216 millimeters. It was rounded to an average of 13.5 ± 1.2 millimeters. Discussion: The line parallel to the posterior longitudinal ligament (PLL) is more posterior than the line parallel to the foramen transversum wall which causes the measured length to be shorter. This is useful for the C2 straight lateral mass screw technique as it avoids the possibility of lesions in the vertebral artery. Conclusion: The average lateral mass length in the population of Surabaya is 13.5 ± 1.2 millimeters.

The problem of mismatches between CT scan and DXA results

Background. It is reported that radiodensity measured in Hounsfield units becomes more and more popular in bone property assessment, however also mismatch with DXA results is observed.Purpose. The aim of this study is to evaluate the relationships between the results of DXA and CT with a focus on explanations for observed discrepancies.Material and methods. This is a cross-sectional study; forty patients were enrolled, all patients underwent DXA and CT. A bone mineral density BMD (g/cm2 ) was calculated for each vertebra of a lumbar spine (L1-L4 inclusive), neck, upper neck, shaft, Wards triangle and trochanter of hip. Bone radiodensity in HU was taken from each vertebral body in the sagittal, axial and coronal planes. A total vertebra body radiodensity including cortical bone and radiodensity of only cancellous bone were calculated. To assess a potential impact on DXA and CT data agreement a mean radiodensity and square of the right and left vertebral pedicles and facet joints were measured for each vertebra.Results. A strong correlation between BMD measured using DXA and CT data was estimated with a multiply r accounting for 0,84169, p&lt;0,0001, however the most contributing parameters were those calculated for facet joints. It has been detected that both radiodensity of only a cancellous bone and total have a weak correlation with matching BMD measurements of a proximal femur.Conclusion. The results of DXA could be strongly influenced by hypertrophic changes of facet joints. Both CT and DXA measurements taken from a lumbar spine may have a mismatch with figures taken from hip.

Cognitive and functional impairment, and perception of illness in acute stroke patients

Aim of the studyObjectives Stroke, the leading cause of death and disability in Indonesia, has a substantial impact on patients’ life. However, only a few studies have assessed the psychological functioning in stroke patients. This study contributes to the need to map out psychological functioning in stroke patients by assessing their illness perception.Subject or material and methodsMethods This is a cross-sectional, descriptive-analytical study. We used a structured questionnaire which consists of a standardized collection of socio-demographic and clinical characteristics, brain CT-scan results, the severity of neurological deficit using NIH Stroke Scale (NIHSS), cognitive assessment tests, as well as Brief Illness Perception Questionnaire (BIPQ) as an instrument to assess illness perception.ResultsResults There were 56 stroke patients recruited as participants. The average age was 55.34 + 10.25, with 30.4 % had formal education less than 9-year compulsory education. Cognitive impairment in 64.3% of subjects was associated with lower coherence (p&lt;0.005). Subjects with higher education had higher personal control, treatment control and coherence (p &lt; 0.05). Subjects with mild neurological impairment had lower treatment control and coherence (p &lt; 0.05).DiscussionStroke patients with mild neurologic impairment at discharge had a more positive perception on the timeline, personal and treatment control.ConclusionsStroke patients with mild neurological impairment who had been discharged had a more positive perception on the timeline, personal and treatment control. Cognitive impairment is associated with lower coherence, which underlines the importance of establishing the cognitive baseline before assessing illness perception in stroke patients.

Novel EIF2AK4 mutations in histologically proven pulmonary capillary hemangiomatosis and hereditary pulmonary arterial hypertension

BackgroundPulmonary hypertension (PH) remains one of the rarest and deadliest diseases. Pulmonary Capillary Hemangiomatosis (PCH) is one of the sub-classes of PH. It was identified using histological and molecular tools and is characterized by the proliferation of capillaries into the alveolar septae. Mutations in the gene encoding the eukaryotic translation initiation factor 2 alpha kinase 4 (EIF2AK4) have recently been linked to this particular subgroup of PH.MethodsIn our effort to unveil the genetic basis of idiopathic and familial cases of PH in Lebanon, we have used whole exome sequencing to document known and/or novel mutations in genes that could explain the underlying phenotype.ResultsWe showed bi-allelic mutations in EIF2AK4 in two non-consanguineous families: a novel non-sense mutation c.1672C > T (p.Q558*) and a previously documented deletion c.560_564drlAAGAA (p.K187Rfs9*). Our histological analysis coupled with the CT-scan results showed that the two patients with the p.Q558* mutation have PH. In contrast, only one of the individuals harboring the p.K187Rfs9* variant has a documented PCH while his older brother remains asymtomatic. Differential analysis of the variants in the genes of the neighboring network of EIF2AK4 between the two siblings identified a couple of interesting missense mutations that could account for this discrepancy.ConclusionThese findings represent a novel documentation of the involvement of EIF2AK4 in the different aspects of pulmonary hypertension. The absence of a molecular mechanism that relates the abrogated function of the protein to the phenotype is still a major hurdle in our understanding of the disease.

Computed tomography evaluation of internal nasal valve angle and area and its correlation with NOSE scale for symptomatic improvement in rhinoplasty

IntroductionNasal obstruction is one of the most frequent otolaryngologic complaints; and the collapse of the internal nasal valve is one the main causes of the nasal air flow obstruction. ObjectiveWe aimed to evaluate internal nasal valve by using reformatted CT-scans pre- and post- rhinoplasty at 3 months and to assess its correlation to symptomatic improvement of nasal obstruction using the NOSE scale. MethodsA prospective observational study was conducted between March 2017–May 2018 in a tertiary care otorhinolaryngology center. We included patients suffering from nasal obstruction secondary to internal nasal angle collapse and nasal deformity. Patients with sinusitis, nasal polyposis, and nasal masses were excluded. ResultsTwenty consecutive patients underwent rhinoplasty, with a mean age (22.2 ± 2.8), with majority of males (n = 14; 70%). There was no significant correlation between pre- and post- CT-scans of the internal nasal valve angle/area and NOSE scores. A high significant difference was detected between mean pre- and post- NOSE scores (p < 0.0001), which was absent in CT-scan results. ConclusionReformatted CT-scans measurements of internal nasal valve area and angle were not of value. NOSE scores pre- and post- rhinoplasty had a significant value to determine degree of obstructive symptom improvement.

377 Developing a Nomogram to Enhance Point-of-Care Ultrasound Utility in Predicting Small Bowel Obstruction Diagnosis and Outcome

Predicting the diagnosis and a need for surgical intervention in patients with small bowel obstruction (SBO) can assist with emergency physicians’ decisions in selecting appropriate management strategy in the ED. We developed and validated a unique nomogram for the prediction of SBO diagnosis based on clinical features and point-of-care ultrasound (POCUS) findings. We used data from a prospective cohort of patients in a single-institution database that consisted of 125 patients with suspected SBO who underwent POCUS evaluation in the ED of a tertiary academic center. Patients’ demographic and clinical data were collected, including age, sex, history of SBO, comorbidities, prior abdominal surgery, and clinician’s pre-test probability of SBO was surveyed prior to POCUS or CT scan results. Data from this cohort were analyzed to develop a nomogram integrating age, sex, comorbidities, prior abdominal surgery, physician’s pre-test probability, and POCUS findings to determine post-test risk of SBO. The associations of relevant clinical and demographical variables and POCUS findings with SBO diagnosis were assessed using Cox proportional hazards regression models. The discriminative ability of the nomogram was tested using C statistics, calibration plots, and Kaplan-Meier curves. The derivation cohort included 125 patients with a median age of 54 years who underwent POCUS for a suspected SBO. One-fourth of the patients (25.6% [32/125]) had SBO, and (10% [12/125]) underwent a surgical intervention. Using a retrospective stepwise selection of clinically important variables with the POCUS results, the final nomogram incorporated four relevant factors for the prediction of SBO: dilated loop of small bowel of at least 2.5 cm (hazard ratio [HR], 0.10; 95% CI, 0.04-0.16; P < .001), positive inter-luminal fluid (HR, 2.10; 95% CI, 0.96-3.24; P < .001), clinician’s high pretest probability (HR, 2.42; 95% CI, 0.36-4.48; P=0.021), and patient age (HR, 0.03; 95% CI, -0.00 to 0.07; P = 0.08). The discriminative ability and calibration of the nomogram revealed good predictive ability as indicated by the C statistic of 0.89 for the SBO diagnosis. A unique nomogram was developed to utilize the function of patient age, POCUS findings of small bowel > 2.5 cm in diameter, inter-luminal fluid, and pretest probability before POCUS to accurately predict the diagnosis of SBO. The nomogram was able to stratify patients into prognostic groups and performed well on internal validation. The nomogram should be prospectively validated in a novel cohort of patients at risk for SBO.

3171 Amoxicillin-Clavulanate Related Mixed Cholestatic-Hepatocellular Injury

INTRODUCTION: Recognition of Drug-induced Liver Injury (DILI) may be challenging as it is often diagnosis of exclusion, unavailability of diagnostic test and variability in presentation. Many antibiotics can cause DILI but Amoxicillin-Clavulanate has rare adverse reaction causing mixed cholestatic-hepatocellular injury. Since amoxicillin alone does not induce liver injury, combination of amoxicillin and clavulanic acid could be responsible for this adverse reaction. It can be due to metabolic idiosyncrasy or hypersensitivity mechanism. CASE DESCRIPTION/METHODS: 64-year-old female with no pertinent PMH presented to ER with abdominal pain and jaundice. She had abdominal pain for 4-5 days. Abdominal pain was constant and located at right upper quandrant and epigastric region. She had associated complaint of nausea, vomiting, metallic taste and chills. Patient had been avoiding eating in fear of vomiting. She also had pale colored stool. Patient did not have any history of gall stones, hepatitis or alcohol use. On further inquiry, she reported being on Amoxicillin-Clavulanate for 4 days, for dental abscess, before onset of symptoms. She stopped taking antibiotic as soon as she started having above-mentioned symptoms. Patient was not on any other new medications during this time-period. On initial evaluation, patient was found to have elevated liver enzymes with T.bilirubin 6.4, AST 218, ALT 288, ALP 331. Due to broad differentials associated with elevated liver enzymes with abdominal pain, further workup was done. Abdominal CT scan and MRCP results were unremarkable. Hepatitis panel was also negative. Patient was provided with supportive care and hydration with IV fluids. Repeat labs done on 4th day after admission showed down trending LFTs – T.bill 3.8, AST 152, ALT 141, ALP 253. DISCUSSION: Amoxicillin-Clavulanate can cause hepatocellular, cholestasis or mix type of liver injuries depending upon genetic factors or pre-existing liver conditions. Early recognition and removal of offending medication is the initial mainstay of treatment along with supportive care. This case signifies proper history taking and review of medications could avoid unnecessary and expensive diagnostic tests for diagnosis. Our case emphasis importance of early recognition of this reversible condition due to Amoxicillin-Clavulanate or other medications to prevent worsening of liver faliure and its complication.

3226 Complications of Meckel's Diverticulum from Helicobacter pylori

INTRODUCTION: Meckel's diverticulum is a disease most prevalent in children. It is rare for it to present in adulthood, especially with complications. Below is a unique case of Helicobacter Pylori (H. Pylori) causing an abdominal abscess which led to the discovery of an adult male's Meckel's diverticulum. CASE DESCRIPTION/METHODS: A 26-year-old male with no past medical history presented to the emergency room complaining of intermittent midline abdominal pain in the lower quadrant for the past two weeks, with associated decrease in appetite, fever, nausea, and vomiting that started two days prior to arrival. The pain was worsened with eating and ambulation, and improved when lying down. One week ago he was in the emergency room for similar symptoms and was discharged home with given intravenous fluids, omeprazole, ranitidine, calcium carbonate and then subsequently discharged home. His pain did not improve, so three days later he went to his primary care physician's office where outpatient CT was ordered and patient was prescribed azithromycin, ciprofloxacin, and tramadol. Primary care physician contacted patient after obtaining CT scan results, and instructed him to immediately go to the emergency room. In the emergency room physical exam was significant for periumbilical and suprapubic tenderness with palpation and mild guarding. The CT scan showed a complex multiloculated 5 cm abscess in the mesentery of the midline lower abdomen. Patient was admitted and started on ceftriaxone and metronidazole. Surgery evaluated the patient and recommended laparoscopic exploration. During the procedure the perforated small bowel was resected and mesenteric abscess was suctioned. While in the hospital patient complained of a history of dyspepsia for the past three years which worsened 1-2 hours postprandially. This prompted him to be tested for H. Pylori IgG antibody and stool antigen. Serum IgG antibody was positive and stool antigen was negative. Ciprofloxacin and flagyl were continued, and he was also treated for H. Pylori with metronidazole prior to being discharged home. Etiology of patient's abdominal pain was determined to be a complicated H. Pylori infection and transmural perforation followed by auto seclusion via the mesentery. DISCUSSION: This case presents with unusual etiology for a diagnosis that is uncommonly discovered in adults. It highlights the importance of getting a thorough history with supportive diagnostic labs and imaging while maintaining a wide differential diagnosis during the initial workup.

Diagnostic flow-chart to identify bowel involvement in patients with stage IIIC-IV ovarian cancer: Can laparoscopy improve the accuracy of CT scan?

ObjectiveThis study investigates the diagnostic power of CT scan combined with exploratory laparoscopy (EXL) at identifying large bowel involvement in patients with stage IIIC-IV primary Epithelial Ovarian Cancer (EOC) by comparing with the macroscopic surgical findings at laparotomy. MethodsAll patients with FIGO Stage IIIC-IV EOC who had Visceral Peritoneal Debulking (VPD) were included in the study. Results of CT scan, EXL and laparotomy (LPT) with regards to the bowel involvement were prospectively recorded in an ad hoc study form. Setting LPT findings as the gold standard, positive and negative predictive value (PPV/NPV), sensitivity, specificity and accuracy of CT and EXL were calculated. In addition, the diagnostic power of the combination CT scan + EXL was investigated. ResultsNinety-four out of 177 patients (53.2%) had a bowel resection during VPD. CT-scan alone had sensitivity, specificity, PPV, NPV and accuracy of 56.7%, 72.4%, 70.8%, 58.5% and 63.8% respectively. EXL alone 84.4%, 93.8%, 93.8%, 84.3%, 88.8%. CT combined with EXL detected bowel involvement with a sensitivity, specificity, PPV, NPV and accuracy of 87.5%, 70.4%, 77.8%, 82.6% and 79.6% and respectively. The combined tests showed a statistically significant improvement vs. CT scan alone (p < 0001) in sensitivity, NPV and accuracy, with non-significant difference in specificity and PPV. ConclusionsCT-scan alone shows a limited diagnostic power at detecting large bowel involvement in patients with stage IIIC-IV EOC. The combination of CT scan with EXL increases the diagnostic power and enables to appropriately plan the bowel resection and consent the patients.

Usefulness of CT-scan in the management of chest stab trauma: a prospective observational study

The management of chest stab wounds necessitates to perform an efficient imaging strategy. Compared to chest X-ray, computed tomography (CT) scan has a higher sensitivity. Nevertheless, the utility of diagnosing occult injuries remains controversial. Previous studies reported very different rates of management modifications induced by CT-scan. Indeed, no study specifically addressed the issue of ruling out traumatic diaphragmatic injury (TDI) in the specific population of chest stab trauma. The aim of the study was to evaluate the rate of thoracic procedures induced or guided by the results of thoracic CT-scan in the specific population of chest stab wounds. Secondary objective was to evaluate the utility of CT-scan for the diagnosis of TDI. We conducted a prospective observational study. All consecutive patients referred to the acute care unit were included. We recorded the general characteristics of patients, the localization of wounds, all imaging tests, the final injury diagnosis, and the patients' management. We compared patients with modifications of management induced by CT-scan results to other patients. We evaluated the performance of CT-scan for the diagnosis of TDI by calculating its sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). 153 patients were included. There were 92 patients with normal chest X-ray. 67 of them received a CT-scan. 34 (51%) patients had an abnormal CT-scan, including 19 (21%) patients with thoracic new findings, with 3 (4.5%) modification of management. There were 50 patients who had an abnormal chest X-ray. 31 of them received a CT-scan, and 31 (100%) had an abnormal CT-scan, including 19 thoracic new findings, with 11 (36%) modifications of management. The diagnostic performance of CT-scan for TDI was: sensitivity 50%; specificity 95%; NPV 72%; PPV 88%. In chest stab trauma, CT-scans may be unnecessary outside the thoracoabdominal zone when chest X-ray is normal. In other cases, CT-scan seems to have an impact on the decision-making. In case of thoracoabdominal wounds, CT-scan helps to detect intra-abdominal injuries. The performance of CT-scan to diagnose TDI is not high enough to reliably rule out all TDI.

Accuracy of Focused Assessment with Sonography for Trauma (FAST) in Disaster Settings: A Meta-Analysis and Systematic Review.

Focused assessment with sonography for trauma (FAST) has been incorporated into the initial evaluation of trauma for decades. It is an important screening tool in the detection of intra-abdominal fluid. The objective of this study was to perform a systematic review of the use and accuracy of FAST as an imaging tool for blunt abdominal trauma in disaster/mass casualty settings. A systematic review of literature was conducted using key words and search terms. Two independent reviewers screened abstracts to determine inclusion using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). For studies passing QUADAS, a meta-analysis was performed calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). FAST results were compared with the gold standard, which was a combination of CT scan results, operative findings, and medical records of the clinical course. Initial database screening resulted in 133 articles, of which 21 were selected for QUADAS evaluation. Five studies passed QUADAS and were selected in the final meta-analysis, with a total of 4263 patients. The sensitivity of FAST was 92.1% (87.8-95.6), specificity 98.7% (96.0-99.9), PPV 90.7% (70.0-98.0), and NPV 98.8% (98.1-99.5) for the detection of intra-abdominal injury. In our meta-analysis, FAST was both sensitive and specific in the evaluation of trauma in the disaster setting.

The Most Important Mental Health Issue You’ve Never Heard Of

The Most Important Mental Health Issue You’ve Never Heard Of

Reconstruction strategy in isolated complete Cryptophthalmos: a\xa0case series

BackgroundThe present study sought to introduce clinical characteristics and stepwise surgical strategies of isolated complete cryptophthalmos, a rare, congenital ocular anomaly.Case presentationRetrospective, noncomparative, clinical study. Six patients with isolated complete cryptophthalmos were diagnosed at the Beijing Tongren Hospital between 2010 to 2018. The presentation age of patients ranged from 1 month to 68 years. This study includes two males and four females, and involvement was noted to be bilateral in two cases and unilateral in four cases. According to orbital CT scan and ocular CDI results, two patients were combined with ocular cyst. Reconstruction surgeries were performed in three patients, involving the eyeball enucleation, creation of fornix, eyelid reconstruction with skin flaps/amniotic membrane, and implantation of prosthesis. Besides, implantation of hydroxyapatite was performed in one pediatric patient to promote orbit development. Good outcomes in terms of cosmetic satisfaction were achieved in all patients during follow-up.ConclusionsSurgical intervention could only improve the cosmetic appearance in isolated complete cryptophthalmos. The surgical strategies may be planned to use three-stage approaches described in this study. Meanwhile, orbital development must be taken into consideration in pediatric cases.