Multiple-region scapular fractures had more severe chest injury than single-region fractures: a prospective study of 107 blunt trauma patients.

BACKGROUND: We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in blunt trauma patients. METHODS: One hundred seven consecutive patients with fractured scapulae (100 men) with a mean age of 35 (8-65) years were prospectively studied between January 2003 and December 2005. Mechanism of injury, associated injuries, Injury Severity Score (ISS), and the number of anatomic scapular regions involved in each fracture were studied. Patients were divided into single-region fracture (SRF), two-region fracture, and more than two-region fracture groups. Computer tomography was used for fracture classification in 99 patients and plain radiographs were used for the remaining 8. RESULTS: Road traffic collisions were the most common cause of scapular fracture. Ninety-five patients (89%) sustained associated injuries. The most frequent was chest injury (68 [64%]). The median ISS was 9 (4-57) for the SRF group (n = 55), 20 (4-59) for the two-region fracture group (n = 30), and 22.5 (4-54) for the more than two-region fracture group (n = 22) (p = 0.02, Kruskal-Wallis test). The median values of the Abbreviated Injury Scale for chest injuries for the three groups were 1 (0-4), 3 (0-5), and 3 (0-5), respectively (p = 0.001, Kruskal-Wallis test). The SRF group had significantly less posterior structure injury (9 of 55) compared with the multiple-region fracture group (46 of 52) (p < 0.001, Fisher's exact test). CONCLUSIONS: Associated injuries are common in patients with scapular fractures. ISS and Abbreviated Injury Scale score for chest injuries are higher and posterior structure injuries are more frequent in patients with fractures involving multiple scapular regions.

MR-angiography as a method for evaluating endovascular coiled cerebral aneurysms.

BACKGROUND: The aim was to compare digital subtraction angiography (DSA) with magnetic resonance angiography (MRA) in evaluating intracranial aneurysms embolized with Guglielmi Detachable Coils (GDCs) and to assess 3D TOF MRA source data, maximum intensity projection (MIP), and 3D iso-surface reconstruction in the follow-up of patients with cerebral aneurysms treated with GDC. MATERIAL/METHODS: 3D TOF MRA source data, MIPs, and 3D iso-surface reconstructions of 32 GDC coiled aneurysms were compared with DSA images in the follow-up of 28 patients. Images were assessed for parent and branch artery flow, the presence of neck recurrence, and aneurysm regrowth. RESULTS: In the DSA follow-ups of the 32 aneurysms there was no flow in the embolized aneurysm in 20 (62.5%), flow between the coil loops was found in 11 (34%), and the neck flow was observed in 8 (25%). There was good correlation for all these features when the 3D iso-surface MRA and source data were compared with DSA. The correlation between MIP MRA and DSA was less robust. The correlation was very good in 21 of the 32 aneurysms (65.62%), good in 6 (18.75%), acceptable in 3 (9.37%), and weak and non-diagnostic in 2 (6.25%). Additional information can be obtained by performing plain film x-rays of the skull to demonstrate a change in the coil ball configuration. MRA did not detect any residual aneurysm neck in 2 cases. CONCLUSIONS: MRA is a promising technique to evaluate GDC coiled cerebral aneurysms; however, it cannot substitute DSA.

Establishment of a course for Focused Assessment Sonography for Trauma.

OBJECTIVE: Focused Assessment Sonography for Trauma (FAST) is not widely practiced by Trauma Surgeons in the Middle East despite its international acceptance. A FAST course was established by the Trauma Group at the Faculty of Medicine and Health Sciences at United Arab Emirates (UAE) University aiming to introduce doctors who have limited experience of ultrasound to the basics of FAST. This article summarizes the content of the course; the evaluation of the participants and their recommendations. METHODS: An 8 hour FAST course was offered to 18 participants in May 2004 in the Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE. Lectures with syllabus material were used to cover the following topics: basic ultrasound physics, knobology and sonographic orientation, the FAST scan, chest and cardiac trauma sonographic evaluation, training and credentialing issues. Each participant received 3 hours of hands-on ultrasound instruction. On completion of the course participants responded anonymously to an evaluation questionnaire. RESULTS: All participants responded to the questionnaire (100% response rate). Delegates found the course well organized, relevant, met their needs and encourages them to use FAST in their own practice. The course objectives were met. Participants suggested that including actual patients and the use of animal models improve the practical sessions. CONCLUSION: Organizing a FAST course is an important step towards recognizing and implementing it in practice. Nevertheless, there is a need for appropriate quality assurance and credentialing guidelines before commencing.

Hepatocellular carcinoma directly invading the duodenum.

Recurrent gastrointestinal bleeding from hepatocellular carcinoma HCC invading the duodenum is very rare. We present a case of 50-year-old male who was admitted with a history of recurrent upper gastrointestinal tract UGIT bleeding, weight loss and anemia. The patient was known to have a chronic hepatitis C. Endoscopic examination showed grade-2 non-bleeding esophageal varices, and a large ulcerated duodenal mass partially obstructing the duodenal bulb outlet and causing recurrent UGIT bleeding. Pathological evaluation of the mass revealed HCC.

Magnetic resonance imaging of uterine version in a multiethnic, nulliparous, healthy female population.

OBJECTIVE: To determine measurement and topography of uterine position in asymptomatic women with different ethnicity. STUDY DESIGN: The angle and direction of uterine version were measured using magnetic resonance imaging in nulliparous, young volunteers from 5 ethnic groups (Emiratis, other Arabs, Indians/Pakistanis, Filipinos and Europeans/ Caucasians; N=55) and compared using Europeans/Caucasians as the reference group. RESULTS: The uterus was anteverted on the vagina in 46 (83.6%) and retroverted in 9 (16.4%) women, with no significant difference between Europeans/Caucasians and non-Caucasians. The angle of uterine version was significantly less (i.e., the cervix was more anteverted or retroverted on the vagina) in Europeans/Caucasians as compared to other women (p=0.002), particularly Indians/Pakistanis (p < 0.00001). CONCLUSION: The degree of uterine version is different in healthy, nulliparous European/Caucasian and non-Caucasian women.

Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population.

OBJECTIVE: The purpose of this study was to determine dynamic pelvic floor and bony pelvis morphologic condition in asymptomatic multiethnic women. STUDY DESIGN: Pelvic floor anthropometry, at rest and after the Valsalva maneuver, and pelvimetry were compared with the use of magnetic resonance imaging in nulliparous young volunteers from 5 ethnic groups (n=11 x 5 volunteers: Emirati, other Arab, Filipino, Indian/Pakistani, and European/white volunteers), with the white volunteers as the reference group. RESULTS: The white volunteers were significantly taller (P <.0001) than the other women. Their levator hiatus was significantly longer than the Emirati women (P=.03) and wider than the Filipino women (P=.04). The bladder neck descent on straining was also significantly greater than the other groups (P <.00001). The white women also had the longest transverse diameter of the pelvic inlet (P=.002). Their sagittal outlet diameter was significantly longer than the Emirati and Arab women (P=.02), and their interspinous diameter was significantly longer than the Arab women (P=.002). CONCLUSION: Nulliparous, healthy white women have larger levator hiatus and bony pelvis with greater bladder neck descent on straining than non-white women.