How to proceed with patients with suspected blunt abdominal trauma and negative screening US scans

To assess outcome of patients with blunt abdominal trauma and negative screening ultrasonographic [US] scans and consequently propose a protocol for their diagnosis. A retrospective study of 460 patients with possible blunt abdominal trauma, who had negative screening US, done at the Radiology Department, in King Fahd Military Medical Complex, Kingdom of Saudi Arabia [KSA], was performed. In these patients, outcome was determined by means of retrospective review of all radiological, medical, and surgical reports. Proportions were statistically compared by means of the Pearson chi[2] and Fisher exact tests. Among the 460 patients with negative findings at screening US, 95% [n=437] had true-negative findings. Among the 437 patients with true-negative findings, 92.9% [n=406] required no additional tests and 7.1% [n=31] underwent other procedures for suspicion of abdominal trauma, which confirmed US findings. 23 patients had false-negative US findings for abdominal injury. From the missed injuries, 29 were nonsurgical [those that were treated successfully without intervention] and nine were surgical [required surgical intervention]. Cumulatively, 38 injuries were missed. The common injuries included injuries in the spleen [n=10], liver [n=9], kidney [n=7] and retroperitoneal hematoma [n=6]. The missed injuries that were identified within the first 12 hours formed 63.2% of the total injuries, including 77.8% of the surgical ones. The combination of negative US findings and negative clinical observation excludes abdominal injury in patients who are admitted and observed for at least 12-24 hours, with computed tomography [CT] indicated in cases with mismatch of clinical and negative US data

Progressive supranuclear palsy: New brain stem measurement and its clinical correlations

Objective: to detect the value of mid-sagittal MRI measurements of the midbrain and pons in the diagnosis of Progressive Supranuclear Palsy [PSP] and to differentiate it from mimics [Parkinson Disease [PD] and Multiple-System Atrophy of the Parkinson Type [MSA-P]], and to what extend these radiological measurements correlate with the clinical aspects of PSP

Methods: MRI of 13 patients with PSP, 25 patients with PD, and 10 patients with MSA-P, as well as 20 age-matched controls were prospectively studied. The areas of the midbrain tegmentum and the pons were measured on mid-sagittal MRI using the display tools. The ratio of the area of the midbrain to the area of the pons was also evaluated in all subjects. Patients were also evaluated clinically using Hoehn and Yahr Scale, UPDRS and MMSE scale in addition to full general, neurological assessment and routine laboratory investigations

Results: the average midbrain area of the patients with PSP [57 mm[2]] was significantly smaller than that of the patients with PD [101 mm[2]] and MSA-P [97.9 mm[2]] and that of the age-matched control group [116.9 mm[2]]. There was no overlap between patients with PSP and patients with PD or normal control subjects regarding midbrain area values. However, patients with MSA-P showed some overlap of the values of individual areas with values of individual areas with values from patients with PSP. The ratio of the area of the midbrain to the area of pons in patients with PSP [0.123] was significantly smaller than that in those with PD [0.207] and MSA-P [0.265] and in normal control subjects [0.235]. Also, use of the ratios allowed differentiation between PSP groups and the MSA-P group. Good significant correlation was observed between various radiological measurements studied and disease duration, staging and severity

Conclusion: the mid-sagittal MRI measurements of the midbrain area can differentiate between the PSP from PD, MSA-P and normal aging and these radiological measurements correlated well with the clinical aspects of the syndrome of PSP