Useful Adjunct For Detection Research Articles

Multi detector computed tomography in maxillofacial injuries

Background: Imaging is an important step after the clinical evaluation in the workup of patients with facial trauma .It helps to define the extent of injury and to plan the surgical, interventional, or conservative therapy. Multidetector computed tomography (MDCT) is the imaging technique of choice to detect and characterize the number of fractures, fragments, the degree of dislocation, and the involvement of anatomical structures. It provides a three-dimensional (3D) mapping of the smallest fractures and abnormalities in a short period of time in trauma and emergency setting.Results: The study included 30 patients with mean age of 41.07± 13.92 years with age range of 21 – 68 years. In most of the cases the mode of injury was road traffic accidents among 23(76.7%). Fracture maxilla in 63.3% followed by mandible in 56.7% was the most common bone involved in facial fractures. Hemosinus (56.7%) was the most common associated finding in the patients who presented with facial trauma. Brain contusions were the next common finding seen in 30% patients. Medial wall of the orbit was the most common wall involved in orbital fractures. The mandibular injuries were most common in the condyle and the body of the mandible. Le Fort fracture lines were identified in 17 patients with the most common Le Fort line being the Le Fort II & Le Fort III which was seen 7 patients (23.3%) each.Conclusion: The complex anatomy of the facial bones requires multiplanar imaging techniques for a proper evaluation. The main purpose of diagnostic imaging is to detect and localize the exact number, site of facial fractures and soft tissue injuries. 3D images are useful, although variable for different bones, in the assessment of complex fractures involving the face. Coronal images are useful adjunct in detection of facial fractures. MDCT offers excellent spatial resolution, which in turn enables exquisite multiplanar reformations, and 3-D reconstructions, allowing enhanced diagnostic accuracy and surgical planning.

Detection of Naegleria fowleri, Acanthamoeba spp, and Balamuthia mandrillaris in Formalin-Fixed, Paraffin-Embedded Tissues by Real-Time Multiplex Polymerase Chain Reaction.

Pathogenic free-living amebae (FLAs) cause skin, ocular, and central nervous system (CNS) infections with significant morbidity and mortality. Diagnosis of FLA infections by pathologic examination of tissue sections can be aided using molecular assays. This study investigated the performance characteristics of a multiplex real-time polymerase chain reaction (PCR) assay (FLA-PCR) for detection and differentiation of FLAs in clinical specimens. FLA-PCR was performed on 39 human specimens comprising one cutaneous, 14 corneal, and 24 CNS formalin-fixed, paraffin-embedded (FFPE) tissues with a histopathologic diagnosis of FLA infection and four CNS FFPE tissues with inflammation but no evidence of FLAs. In addition, clinical specificity and assay limit of detection were determined. FLA detection sensitivities ranged from 79% to 84% in FFPE tissues. No cross-reactivity was observed. While sensitivity is limited, FLA-PCR assay may serve as a useful adjunct for detection or confirmation of FLA infections in FFPE tissues.

Do Doppler waveforms at the common femoral artery accurately predict iliac stenosis?

Evaluate whether common femoral artery (CFA) Doppler waveform assessment predicted the presence of significant iliac artery stenosis as visualised on magnetic resonance angiography (MRA). Three-year retrospective study of patients investigated using CFA Doppler waveforms and MRA. The patients were identified from vascular/radiology databases. Waveforms were reported real time as monophasic, biphasic or triphasic. Results were compared with MRA findings. In 76 patients, 119 waveforms were assessed. MRA demonstrated 37 iliac vessels with significant stenosis. 32 (86%) had abnormal waveforms (monophasic/biphasic), 5 were triphasic. In 82 cases where MRA showed no significant stenosis, waveforms were abnormal in 35 (43%). Abnormal CFA waveforms have sensitivity of 86% and specificity of 57%. Monophasic waveforms alone were more specific (88%) but less sensitive (57%) for predicting iliac lesions. Whilst CFA waveform morphology is a useful adjunct in detection of iliac disease, normal triphasic waveforms do not exclude iliac stenosis.

Retrospective Analysis of the Quality of Urological Patient Handovers

Retrospective Analysis of the Quality of Urological Patient Handovers

MR Contrast Agents for Liver Imaging: What, When, How

The major classes of contrast agents currently used for magnetic resonance (MR) imaging of the liver include extracellular agents (eg, low-molecular-weight gadolinium chelates), reticuloendothelial agents (eg, ferumoxides), hepatobiliary agents (eg, mangafodipir), blood pool agents, and combined agents. Mechanisms of action, dosage, elimination, toxic effects, indications for use, and MR imaging technical considerations vary according to class. Gadolinium chelates are the most widely used. Ferumoxides are a useful adjunct for detection of hepatocellular carcinoma, particularly when used in combination with gadolinium to achieve improved lesion-to-liver contrast over that achievable with gadolinium alone. Mangafodipir is a prototype hepatobiliary agent that is taken up by lesions with functioning hepatocytes. It may be used for MR cholangiography as well as liver imaging. Although mangafodipir is no longer commercially available in the United States, it is currently marketed and used in Europe. Blood pool agents have not yet been approved for human use in the United States. However, a new combined MR contrast agent, gadobenate dimeglumine, recently was approved, and other agents are in various stages of development.

QT dispersion may be a useful adjunct for detection of myocardial infarction in the chest pain center

Background QT dispersion has been proposed as a noninvasive measurement of the degree of inhomogeneity in myocardial repolarization. Increased QT dispersion has been reported after myocardial infarction. We hypothesized that increased QT dispersion may be a useful adjunct for risk stratification in patients being evaluated in a chest pain center. Methods and Results Patients were admitted to the chest pain center for evaluation of chest pain. Exclusion criteria included (1) systolic blood pressure <90 mm Hg, (2) ischemia or infarction on the initial electrocardiograph (ECG), (3) elevated creatine kinase or MB fraction, and (4) chest pain associated with cocaine use. Serial creatine kinase and MB levels and ECGs were obtained at 0, 6, and 9 hours. Patients were monitored for (1) creatine kinase and MB rise, (2) ECG changes for infarction, (3) ST-segment changes, and (4) rest angina. A negative evaluation at the chest pain center led to an exercise stress test. Patients with a positive exercise stress test were admitted for further evaluation and patients with a negative exercise stress test result were discharged home. Patients were divided into 3 groups. Group 1 consisted of patients who were found to have an acute myocardial infarction (AMI), group 2 consisted of patients with prior history of coronary artery disease but no evidence of AMI, and group 3 consisted of patients without prior coronary artery disease or AMI. QT dispersion was measured on the initial ECG in all patients. A total of 586 patients were evaluated. Group 1 consisted of 13 patients with mean QT dispersion of 44.6 ± 18.5 ms, group 2 consisted of 267 patients with a mean QT dispersion of 10.0 ± 13.8 ms, and group 3 consisted of 303 patients with a mean QT dispersion of 10.5 ± 10.0 ms. Analysis of variance showed a significantly higher QT dispersion in patients who had AMI compared with other patients with chest pain ( P < .001). Conclusions QT dispersion can be a useful diagnostic adjunct for detection of AMI in patients with chest pain with a normal ECG and normal cardiac enzymes. (Am Heart J 1998;136:496-8)

Neural crest tumors: I-123 MIBG imaging in children.

To determine 24- and 48-hour distribution of iodine-123 metaiodobenzylguanidine (MIBG) and to establish an optimized pediatric imaging protocol. Seventy-seven I-123 MIBG scans obtained in 33 children undergoing evaluation for neural crest tumor were reviewed. Activity in the salivary glands, myocardium, liver, gut, and bladder was demonstrated on almost all scans. Activity was noted in the neck muscles, thyroid gland, and uninvolved adrenal gland in fewer studies. In 20 studies, abnormal uptake was present in the chest or abdomen at 24 and 48 hours, and lesion identification was improved at 48 hours in 12 studies. Detection of skeletal lesions on 14 scans was similar at 24 and 48 hours. Foci of tumor were first detected at I-123 MIBG imaging in nine studies, and in only two patients was tumor involvement initially missed on I-123 MIBG studies. Distribution of I-123 MIBG on images in children differs from that in earlier descriptions in adults. Images of the torso at 48 hours after injection are a useful adjunct in detection of lesions.

Assessment of serial carcinoembryonic antigen (CEA) assays in postoperative detection of recurrent colorectal cancer.

Monthly serial postoperative CEA determinations, three-monthly system review plus physical examination, and a battery of six-monthly laboratory and radiologic tests were compared in order to evaluate each in detection of recurrent colorectal cancer. Twelve of the 33 patients studied prospectively developed recurrent disease. In this study CEA was found not to be a substitute for careful clinical follow-up, but if used in a serial manner it was a useful adjunct for detection of early recurrent cancer, especially intra-hepatic and retroperitoneal disease recurring in patients with elevated pretreatment CEA levels. The other laboratory and radiologic tests employed were often useful to confirm progressing disease, but they did not reveal any first evidence of recurrent disease.