Assessment of Severity of Pancreatitis by Computerized Tomography Using Revised Atlanta Classifica?on and Comparison with BISAP Clinical Scoring System

Background: Untreated acute pancrea??s can have high morbidity and mortality. It is a serious gastrointes?nal emergency. Its incidence is approximately 51.0 % and it can cause both local and systemic problems. The diagnosis usually involves laboratory tests like amylase and lipase as well as an ultrasound exam. The ideal imaging test is a contrast-enhanced CT scan. This study used scoring systems based on laboratory and radiological inves?ga?ons to determine the clinical progression and outcome. Methods : Pa?ents who were diagnosed with acute pancrea??s and in whom computed tomography was done were included. From the imaging findings, the category and subcategory of acute pancrea??s and types of fluid collec?ons were described in these pa?ents using the revised Atlanta classifica?on. BISAP score was calculated in all these pa?ents. The clinical outcome assessed in these pa?ents is the dura?on of stay in the hospital, mortality, presence of persistent organ failure, the occurrence of infec?on and need for interven?on. Finally, the correla?on between the Revised Atlanta classifica?on and BISAP score was analyzed and compared with clinical outcomes. Results: The analysis of the correla?on between Revised Atlanta classifica?on severity grade and BISAP score, among the n=57 pa?ents with mild acute pancrea??s n=56, had BISAP score less than 3 and only one had BISAP score greater or equal to three. Among the n=25 pa?ents graded as moderately severe acute pancrea??s, n=20 cases had a BISAP score of less than 3 and n=5 had BISAP score greater than or equal to three. Among the n=08 pa?ents graded as severe acute pancrea??s, n=3 had a BISAP score of less than 3 and n=5 had BISAP score greater than or equal to three. Conclusion: Standardizing nomenclature and facilita?ng proper documenta?on of a variety of imaging abnormali?es in acute pancrea??s is made possible by incorpora?ng the new Atlanta categoriza?on system into daily prac?ce. We can triage, predict, and treat pa?ents with acute pancrea??s with greater precision by integra?ng the new Atlanta classifica?on with BISAP clinical grading, significantly improving medical care.

The study by using the computerized tomography imaging in order to access to mandibular foramen while inferior alveolar nerve anesthesia

PURPOSE: This study was performed to provide an anatomical information of the mandibular ramus for the successful inferior alveolar nerve block. Three dimensional images were reconstructed from the computerized tomography (CT) and the anatomical evaluation of the mandibular ramus was done. MATERIALS AND METHODS: Sixty-four patients who had been taken the facial CT scans from 2000, Jan to 2003, June was selected. The patients who had the anterior or posterior teeth misssing, edentulous ridge, and jaw fracture were excepted. In the occulusal plane, the lingual surface angle (LSA) between the mid-sagittal plane and the mandibular molar lingual surface from the 2nd premolar to the 2nd molar, the inner ramal surface angle (IRSA), the maximum inner ramal surface angle (MxIRSA), and the outer ramal surface angle (ORSA) to the-mid sagittal plane were MEASURED: The inner ramal surface angle in the ligular tip level (IRSA-L) and the outer ramal surface angle in the ligular tip level (ORSA-L), the ramal length (RL), and the anterior ramal length (ARL) were also measured in the lingular tip level. RESULTS: In the lingular tip level, the mean IRSA-L and ORSA-L were 28.6+/-6.3 degrees and 17.9+/-4.9 degrees respectively. The larger was the IRSA, the larger was the ORSA. In the lingular tip level, the mean ramal length was 35.8+/-3.4 mm. The larger was the IRSA-L, the shorter was the ramal length. On the lingular tip level, the mean anterior ramal length from anterior ramus to lingular tip was 19.6+/-3.3 mm. when the ramal length was longer, the anterior ramal length was also longer. On the lingular tip level, there was positive correlation vetween the IRSA and the ORSA, negative correlation between the IRSA and the ramal length, and positive correlation between the ramal length and the lingular tip level to the anterior ramus. There was no statistical meaning of data between sex and age. CONCLUSION: In the clinical view of the results so far achieved, if the direction of needle is closer to posterior it is able to contact bone on lingular tip when the internal surface of ramus is wided outer.

Comparison of Computerized Tomography(CT) and Ultrasonography(US) in the Diagnosis of Nasal Bone Fracture and Medial Orbital Wall Fracture

For the diagnosis of nasal bone fracture and medial orbital wall fracture, plain radiography and computerized tomography(CT) have been utilized. But plain radiography is less reliable due to its low specificity. So CT has been given a preference to plain radiography in examining both fractures. However, CT has some disadventages; high expense, heavy radiation hazard, and coexistent injuries may restricted a patient,s positioning and so thus preventing or delaying the diagnosis. By comparison, ultrasonography(US) represents a safe, inexpensive, noninvasive, portable, and wide availability. This paper compares the relative values of CT and US in the diagnosis of both fractures. In nasal bone fracture, US proved to be more accurate than CT. Thirty-seven nasal bone fractures were diagnosed by US; whereas only thirty-two of these were revealed on CT. Compared with US, CT demonstrated 87% sensitivity. In examining medial orbital wall fracture, eight cases were diagnosed by CT; whereas seven of these were revealed on US. Compared with CT, US demonstrated 88% sensitivity. In medial orbital wall fracture, US was almost as accurate as CT. In this research, it is concluded that in the investigation of nasal bone fracture and medial orbital wall fracture, US is an accurate diagnostic modality and correlates well with CT.

Three Cases of Angioembolization in Renal Angiomyolipoma / 대한비뇨기과학회지

Renal angiomyolipomas are uncommon benign neoplasms composed of mature adipose tissue, thick walled blood vessels and smooth muscle in varying proportions. Accurate preoperative diagnosis of renal angiomyolipoma is essential if conservative resection or angiographic embolization is to be used. In recent years, abdominal computerized tomography (CT) and renal ultrasonography have resolved the diagnostic dilemma, making detection of angiomyolipomas possible in almost all cases. Recently, we performed selective renal angioembolizations in 3 patients (2 females, 1 male). After followup period of 6 months to 1 year, all patient got better in clinical symptoms. In two of them the lesions decreased in size on followup CT but one patient showed suspicious malignant change and we performed the exploration to rule out renal malignancy. In our opinion, it is appropriate to perform the selective renal angioembolization for initial treatment of renal angiomyolipomas.

Comparative Analysis of Management of Intracerebral Hematoma

Retrospective analysis of 46 patients with intracerebral hematoma showed that the attack was most frequent in sixth decade and more prevalent in female. The most common cause of the attack was hypertension(80%) and the site of hemorrhage was putamen 32%, thalamic area 15%, subcortical area 7%, cerebellum 17%, ventricle 3%, and brain stem 4%. Mortality of total cases was 36% and there was no difference of mortality in both conservatively or operatively treated group(38% in conservative group, and 35% in operative group). The prognosis of the patient was unfavorable in the group of poor pretreatment Glasgow coma scale(GCS) and those of cases demonstrated more than 30cc of hematoma on computerized tomography(CT) of the brain. The improvement of GCS after management was better in operative group than in the conservative group.

Traumatic Intraventricular Hemorrhage(TIVH)

A series of 1909 computed tomography(CT) scan performed for head injury mostly after traffic accident was retrospectively reviewed. 17 patients were found to have clearly definable traumatic intraventricular hemorrhage(TIVH). TIVH was associated with various brain lesions in most cases; Intracerebral lesions with contusional hemorrhage and subdural hematoma(Glasgow Coma Scale Score) coexisted in 6 and 5 instances. The outcome(Glasgow Outcome Scale) of this series was related with initial clinical findings, and 11 patiens survived. We have designed this study to assess the occurrence of TIVH in our series of head-injured patients in Korea, and to correlate these findngs with the clinical status, the presence of associated lesions, and their relation to final outcome of these patients, and conculsions are as follows: 1) The incidence of TIVH and its associated mortality is 0.9% and 35.3%, respectively, Most of them occurs below 5 th decade(70.6%) with male predominace(88.2%). 2) Mode of injury is mainly from traffic accident(94.1%), followed by fall down(5.9%). 3) The presence of concomitant lesions has a definite influence on poor outcome(P<0.02), whereas skull fracture or multiplicity of TIVH deos not. 4) Primary impact site to induce TIVH is primarily on frontal portion(58.9%). 5) With regard to brain stem injury in TIVH, the final outcome clearly depends on pathological demonstration on CT(P<0.005%), but not on location of hemorrhage(P<0.5%).

Clinical Study of Computerized Tomography for the Fracture of the Spine / 대한정형외과학회잡지

We have reviewed our experiences of computerized tomography(CT) in the fracture of the spine. Between December 1983 and June 1985, we treated 33 fractures of the spine in 32 patients. We have used CT for the diagnosis of fractures of the spine in 29 cases (28 patients). Also we have used Louis scoring system to evaluate the stability of the fractured spine. The results are as follows. 1. CT has many advantages that were not given from simple radiograp hies or laminagrams. It reveals the vertebral body, vertebral column, posterior compartments and surrounding soft tissues excellently, and it is easy to interpretate. Also it can be done comfortably and rapidly without the need of manipulations. 2. We could acquire many informations from post-operative or long term following up of CT examinations. 3. If the Louis score is higher than 3, we should think it is unstable, and should take internal fixation of the vertebral column. 4. There is a correlation between Louis score and neurologic signs (p < 0.01). If there was a neurologic sign with low Louis score, less than 1, the recovery was soon, less than 24 hours. 5. According to CT findings for fragmentation or location of fragment, we can alternate an anterior decompression or a posterior decompression. 6. It is necessary to use CT as a initial diagnostic procedure with the simple radiographic examination in spine fracture.

Imterhemispheric Subdural Hematoma

Subdural hematoma in the interhemispheric space is a rare entity. The authors present a case of subdural hematoma in the left interhemispheric space caused by head injury with the characteristic presenting symptom of right hemiparesis, worse in the lower than the upper extremity. Computerized tomography (CT) is the preferred diagnostic procedure and thevcoronal section delineates the extent of hematoma more clearly. It is best treated by osteoplastic craniotomy. Anatomical considerations, clinical features, value of CT scanning, recommended surgical technique, and review of the literature are presented.

A Retrospective Analysis of CT Features of 119 Cases of Epilepsy / 第三军医大学学报

In order to assess the diagnostic value of CT,EEG and conventional radiography and to probe the etiology of epilepsy,the CT films and relative materials of 119 cases of epilepsy were analyzed retrospectively.It was found that the combined examination of CT and EEG could significantly increase the accuracy of diagnosis and minimize the chances of misdiagnosis.CT was especially useful to examine those cases clinically suspected to have lesions in the frontal,parietal or temporal lobe.CT was also important to distinguish the cases of early epilepsy from those of delayed one.Early epilepsy usually resulted from benign lesions with good prognosis but lacked localization signs clinically.Delayed epilepsy mostly is caused by neoplastic or vascular lesinos with poor prognosis,and localization signs were usually present.Prompt CT examination would be helpful in its management.It was also found that early epilepsy was mostly secondary in nature.