Diagnostic accuracy of ultrasonography in detection of blunt abdominal trauma and comparison of early and late ultrasonography 24 hours after trauma

Despite the advantages of ultrasound scan, its use as a screening tool in blunt abdominal trauma is controversial. The aim of this study was to evaluate the diagnostic value of early and late ultrasound in patients with blunt abdominal trauma [BAT]. In this study which was performed in a level I trauma center, firstly, 2418 patients with BAT had ultrasound [US] examination by two trauma expert radiologists. Results were compared with the best available gold standards such as laparotomy, CT, repeated ultrasound or clinical course follow-up. Then, 400 patients with BAT were examined by a trained residency student. In the first phase, sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasound were 97%, 98.1%, 99.7%, 83% and 98% respectively. In the second phase, they were 97.3%, 97.2%, 97.7%, 96.8% and 97.3% for the early and 98.5%, 97.6%, 98.5%, 97.5% and 98% for the late ultrasound respectively. Results obtained from this study indicate that negative ultrasound findings associated with negative clinical observation virtually exclude abdominal injury, and confirmation by performing other tests is unnecessary. High sensitivity and negative predictive value is achieved if ultrasound is performed by expert trauma radiologist

Effects of intravenous and catheter directed thrombolytic therapy with recombinant tissue plasminogen activator [Alteplase] in non-traumatic acute limb ischemia; a randomized double-blind clinical trial

Objective: To evaluate the efficacy and safety of intravenous and catheter directed thrombolysis by recombinant tissue plasminogen activator [Alteplase] in the patients with non-traumatic acute limb ischemia [ALI]

Methods: This was a randomized clinical trial being performed between 2009 and 2011 in Mashhad University of Medical Sciences. We included those patients who were<75 years, with symptoms of less than 14 days duration, ALI of grade IIa and IIb [according to Rutherford classification] and absence of distal run off. Baseline assessment of peripheral circulation performed in all the patients. Patients were randomly assigned to undergo intravenous [n=18] or catheter directed thrombolysis [n=20] with Alteplase. The primary endpoint of the study was improvement of clinical status measured by Rutherford classification, ankle brachial index [ABI], visual analogue scale [VAS] score measured at 1, 3 and 6 months. The secondary endpoint of the study was complete or near complete recanalization of the occluded artery

Results: A total number of 38 patients with mean age of 54.13 +/- 13.5 years were included in the study. There were 23 [60.5%] men and 15 [39.5%] women among the patients. Overall 3 [7.9%] patients had upper and 35 [92.1%] lower extremity ischemia. There was no significant difference between two study groups. None of the patients experienced major therapeutic side effects. Both ABI and VAS score improved in patients who have received first dose of t-PA within 24-hourof ALI. There was no significant difference between two study groups regarding the 6-month clinical grade [p=0.088], VAS score [p=0.316] and ABI [p=0.360]. The angiographic improvement was significantly higher in CDT group [p<0.001]

Conclusion: Intravenous and catheter directed thrombolysis with t-PA is a safe and effective method in treatment of acute arteriolar ischemia of extremities. However there both intravenous thrombolysis and CDT are comparable regarding the clinical outcome

Angiographic findings of patients with blunt or penetrating extremity injuries: focus on indications and contraindications

Objective: To determine the etiology, signs and symptoms, angiography indications and angiography findings in patients with limb penetrating injuries suspected to have arterial injury

Methods: This was a cross-sectional study being performed in Imam Reza Hospital affiliated with Mashhad University of Medical Sciences, Iran between September 2011 and March 2013. We included those patients with extremity blunt and penetrating injuries who were referred for angiography according to standard indications including abnormal distal pulses, complex fracture or dislocation, vascular proximity, fixed hematoma, distal nerve deficit, arterial bruit, thrill and massive soft tissue injuries

Results: During the study period, 148 patients [15 women and 133 men] with a mean age of 31+/-14.9 [11-82] years were evaluated. The most common cause of injury was motor vehicle accident [127 patients 85%]. Angiography indications included abnormal distal pulse examination [124, 83.8%], complex fracture or dislocation [7, 4.7%], near arterial trauma [4, 2.7%], fixed hematoma [3, 2%], nerve damage [1, 0.7%]. The angiography was found to be normal in 49 [33.1%] patients. In patients with abnormal angiography findings, 60 [60.6%] had cutoff with distal runoff, 21 [21.2%] had cutoff without runoff, 14 [14.1%] had arterial spasm. Other uncommon findings included active bleeding in 2 patients [2%], pseudoaneurysm in 1 [0.7%] and arteriovenous fistula in 1 [0.7%]. Out of 4 patients [2.7%] with vascular proximity, only 1 [0.7%] had abnormal angiography

Conclusion: The most important factor in prediction of result of angiography was distal arterial pulses examination. But these data confirm the low incidence of vascular injury in asymptomatic patients with proximity. So the use of angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination should be questioned

Comparison of conventional angiographic findings between trauma patients with or without runoff

Objective: To compare the conventional angiographic findings in extremity trauma patients with or without runoff

Methods: This was cross-sectional study including all the patients with extremity trauma who underwent conventional angiography during the 2 year period from 2011 to 2013 in Angiography departments of Mashhad University of Medical Sciences. Mechanism of trauma, type of injury and angiographic findings were recorded in a questionnaire for each patient. After completion of treatment and discharge, the treatment type was added. The characteristics as well as clinical findings were compared between those who were diagnosed to have arterial runoff ad those who did not

Results: One hundred and forty eight traumatic patients including 15 female with age range of 11-82 years and 133 men ranging from 25 to 40 years were enrolled. Abnormal angiographic findings were provided in 99 [66.9%] patients including cutoff with distal runoff [n=60, 60.6% of abnormalities], cut off without distal runoff [n=21, 21.2%] and spasm [n=14, 14.1%] and other findings [n=4, 4%]. Fifty one cases were treated under open surgery and amputation of traumatic limb was done for 13 patients. Amputation rate was higher in patients with cutoff and without runoff than those with cutoff and runoff [33.3% vs. 6.78%; p=0.002]

Conclusion: Causes and types of traumatic arterial injury in our study were different with other reports. It was shown that angiographic findings were less important in prognosis and management of patients. Patients with spasm in angiographic findings had a better prognosis than other patients and mostly did not need any vascular surgery. The presence or absence of a distal run off in primary angiographic findings can have a predictive value in the final amputation rate

Incidental findings in patients evaluated for pulmonary embolism using computed tomography angiography

Introduction: Pulmonary embolism [PE] is a common lethal disease that its clinical symptoms may be seen in many other diseases. Computed tomography pulmonary angiography [CTPA] is a valuable diagnostic modality for detection of PE. In addition, it can accurately detect the other diseases with clinical symptoms similar to PE. The aim of this study is to evaluate the frequency of PE and nonembolic disease with similar clinical symptoms including pulmonary, pleural, mediastinal, and cardiovascular diseases that have been detected by CTPA and to describe the importance of reporting these CT findings

Materials and Methods: In this cross-sectional study, we evaluated the medical records of CTPA in 300 patients of suspected PE between March 2012 and February 2013 in Imam Reza Hospital and Ghaem Hospital in Mashhad University of Medical Sciences, Mashhad, Iran. Demographic information and the results of CTPA of these patients were re-evaluated. One radiologist reviewed all of the CTPA and the results have been analyzed by SPSS-16 soft

Results: In this study, PE was detected in 18.7% of patients. Multiple incidental imaging findings were diagnosed as follow: pulmonary consolidation [33.2%], pleural effusion [48.7%], pulmonary nodules [10%], pulmonary masses [1.3%], pneumothorax [4.7%], mediastinal mass and lymphadenopathy [9.3%], aortic calcification [42%], coronary arteries calcification [27.3%], mitral valve calcification [2 %], cardiomegaly [30.7%], and the evidences of right ventricular dysfunction [6.7%]

Conclusion: A group of disease can cause the clinical symptoms similar to that of PE. Among them, pulmonary consolidation and pleural effusion have much higher frequency than PE. In addition, CTPA can show pathologic findings in the patients that need follow-up. It is important to detect and report these imaging findings because some of them may change the treatment and prognosis of patient who are suspected to have PE

Sexual differences of human brain

During the last decades there has been an increasing interest in studying the differences between males and females. These differences extend from behavioral to cognitive to micro- and macro- neuro-anatomical aspects of human biology. There have been many methods to evaluate these differences and explain their determinants. The most studied cause of this dimorphism is the prenatal sex hormones and their organizational effect on brain and behavior. However, there have been new and recent attentions to hormone's activational influences in puberty and also the effects of genomic imprinting. In this paper, we reviewed the sex differences of brain, the evidences for possible determinants of these differences and also the methods that have been used to discover them. We reviewed the most conspicuous findings with specific attention to macro-anatomical differences based on Magnetic Resonance Imaging [MRI] data. We finally reviewed the findings and the many opportunities for future studies

Renal biopsy in glomerulonephritis

Glomerulonephritis [GN] is responsible for 25-30% of end-stage renal disease [ESRD] among all causes. Renal biopsy is important to determine the GN treatment method and its prognosis. In some cases, renal biopsy is required for definitive diagnosis. Biopsies were used as a diagnostic method in different disease from 1930. They were performed blindly and at bedside. Complication rate varies from 2 to 20% in different reports. Percutaneous renal biopsy is a routine diagnostic procedure in nephrology nowadays, and it should be individualized for each patient depending on their age, BMI, coagulation status and the availability of skilled radiologist. In this paper, we review image-guided renal biopsy in glomerulonephritis

association between carotid intima-media thickness and the duration of type 1 diabetes in children

Carotid intima-media thickness [cIMT] has been known as a criterion of generalized atherosclerosis and a marker of cardiovascular disease progression in many studies which can be measured by ultrasound using high-resolution device. This is a case-control study. A total of 40 children [16 males and 24 females] with typel diabetes mellitus and control group consisting of equal numbers [17 males and 23 females] who were otherwise healthy were included in the study from May 2007 to January 2008. The two groups were age matched, with the mean age of 10.56 +/- 3.21 years in control group and 10.67 +/- 4.18 years in diabetic patients. Left and right cIMT were measured by ultrasound. There was a significant difference between case and control subjects in terms of mean cIMT [P<0.001]. cIMT was significantly higher in the diabetic group. Among variables including age, BMI and diabetes, diabetes was the only influential parameter in this respect The mean time length of type 1 diabetes in our diabetic group was reported 4.24 +/- 3.02 years, with a minimum of four months and a maximum of ten years. There was a statistically significant difference between the two diabetic patients with below and above four years of disease duration [P=0.03 for right carotid artery and P=0.01 for left carotid artery]. cIMT has been identified as an early indicator of atherosclerosis in many studies. It increases in patients with type 1 diabetes as the disease progresses and this can be followed by macro and microvascular atherosclerotic changes

Therapeutic effects of aerobic exercise and low-calorie diet on nonalcoholic steatohepatitis

Nonalcoholic Steatohepatitis [NASH] is part of a broad spectrum of nonalcoholic fatty liver diseases that can lead to cirrhosis. To date, there is no effective medical treatment for NASH. We aim to compare the effect of aerobic exercise in conjunction with diet to diet alone on the improvement of metabolic syndrome and insulin resistance in patients with NASH. We enrolled 23 NASH patients, ages 25-50 years, and randomly divided them into two groups, aerobic exercise plus diet [n=12] or diet alone [n=ll]. In this study, diet in both groups included 500 kilocalories of energy less than the estimated daily energy requirement. In addition to diet, the first group participated in aerobic exercises that consisted of walking, jogging and running, for a period of eight weeks, three days a week at a 55%-60% heart rate reserve. For all patients, we measured blood pressure, Waist Circumference, serum ALT, HDL, TG, FBS, insulin levels, and insulin resistance according to HOMA-IR at baseline and after eight weeks. We analyzed data with the paired and independent samples t-test, at a significance level of p<0.05. Although, there was no significant difference noted in patients in the diet only group, HOMA-IR, Systolic Blood Pressure, Diastolic Blood Pressure, FBS, ALT, and insulin levels significantly decreased in patients who underwent both diet and exercise. Serum TG levels and WC decreased significantly in both groups. In a comparison between the groups, there was a significant decrease observed in WC, FBS, and ALT. Aerobic exercise in conjunction with diet may be more effective than diet alone in the treatment of patients with NASH

Transarterial coil embolization in treatment of gross hematuria following self-inflicted stab wound in a horseshoe kidney / 中华创伤杂志(英文版)

Horseshoe kidney is an uncommon anomaly of the urinary system with an increased risk of injury during penetrating and blunt abdominal traumas. Self-inflicted abdominal stab wound, a rare type of abdominal injury, accounts for only a small percentage of suicidal attempts and may be infrequently encountered by physicians in trauma centers. Psychiatric disorders and alcohol or drug abuse are common risk factors in cases of self-stabbing. Here we report a rare case of self-stabbing of a horseshoe kidney. The case was a 19-year-old man with self-inflicted abdominal stab wound who was referred to our department of radiology due to re-occurred gross hematuria three days after exploratory laparotomy and surgical repair of injured abdominal organs. A horseshoe kidney was incidentally found in the patient's abdominal computed tomography. Renal angiography revealed active contrast extravasation from one of the segmental arteries. Selective transarterial embolization with a coil was successfully performed to control the hematuria.

Can gallbladder ejection fraction measured by fatty meal cholescitigraphy diagnose chronic cholecystitis?

Despite presence of a body of evidence in support of high accuracy of cholecystokinin cholescintigraphy [CCK-CS], for diagnosis of chronic cholecystitis[CC], some authors have claimed that gallbladder ejection fraction [GBEF] has poor predictive diagnostic values. The purpose of this study was to determine if there is any difference in GBEF between normal individuals and patients with CC. In a prospective case-control study, we studied 36 subjects as control group who did not have any abdominal symptoms, or history of abdominal disease or gallstone. Patients group were 42 with established choronic calcalous cholecystitis[CCC] who complaining of chronic biliary-like pain and had gallstone on ultrasonography. All subjects underwent gallbladder scintigraphy and GBEF was calculated at 30 and 60 minutes after fatty meal [FM] ingestion. In control group GBEF at 30-minute and at 60-minute after FM ingestion were 69.54% +/- 21.04% and 84.26% +/- 11.41% respectively while in patients group GBEF at 30-minute was 61.21% +/- 16.01% and at 60-minute was 80.22% +/- 12.57%. No significant difference was noticed between control and patient groups. GBEF didn't show significant difference between different groups based on the number of gallbladder stone, severity of chronic inflammatory [lymphoplasma] cell infiltration, wall thickness and evidence of fibrosis in the gallbladder wall. Our data are against the diagnostic value of the GBEF as measured by FM-CS in the workup of patients with CC. Thus, interpretation of GBEF should take the proper clinical context into consideration

[ case report of acute gouty arthritis in a young patient with type 1 glycogen storage disease]

Glycogen storage disease [GSDs] comprise several rare inherited diseases caused by abnormalities of enzymes that regulate the synthesis of Glycogen. A- 26 years old man admitted to the hospital because of pain and swelling in his ankles. Also, he had delay of puberty. In diagnostic evaluation, the patient had hyperuricemia, hyperlipidemia and adenomatous nodules in the liver. Liver biopsy revealed Glycogen storage disease type 1. gouty arthritis in glycogen storage disease is not uncommon; however, glycogen storage disease as a reason of gouty arthritis is rare. Because of growth failure, delayed puberty and laboratory results we strongly suspected to an underlying disease as a cause of hyperuricemia and gouty arthritis leading to glycogen storage disease diagnosis