Utility of biphasic multi-detector computed tomography in suspected acute mesenteric ischemia in the emergency department.

PURPOSE: To retrospectively evaluate the utility of biphasic multi-detector computed tomography (MDCT) with arterial and portal venous phases for the detection of suspected acute mesenteric ischemia (AMI) in emergency department (ED) patients compared to limited surgical confirmation. METHODS: A research ethics board (REB)-approved retrospective review of all consecutive adult patients who underwent an emergency biphasic 64-MDCT examination of the abdomen and pelvis due to clinical suspicion for AMI over a 5-year period at a single tertiary-care institution was performed. Patients who underwent biphasic 64-MDCT scans performed for any clinical concern other than suspected acute mesenteric ischemia were excluded. Specifically, reported vascular and bowel findings were used to establish occlusive arterial, venous, and non-occlusive MDCT findings of AMI. Correlation was made with surgical findings in operatively managed patients and with serum lactate values preceding imaging assessment. Diagnostic yield and positive predictive value calculations were performed. RESULTS: Two hundred and twenty-five patients underwent MDCT for suspected occlusive AMI between 10 Jan 2011 and 31Jul 2016. Of these, 200 patients were negative for AMI and 25 patients (mean age 73.5 years; age range 48 to 94 years; 13 men and 12 women) had MDCT findings positive for bowel ischemia (yield of 11.1%). On MDCT, 18/25 (72%) had an occlusive arterial etiology for AMI, 2/25 (8%) had an occlusive venous etiology, and 5/25 (20%) had non-occlusive AMI. Twenty of 25 (80%) patients with positive MDCT findings of AMI also had an elevated serum lactate level, including 14/18 (77.8%) patients with arterial occlusive AMI on MDCT, 2/2 (100%) with venous-occlusive AMI on MDCT, and 4/5 (80%) with non-occlusive AMI on MDCT. Correlation with surgical findings led to a positive predictive value (PPV) of biphasic MDCT for surgically proven all-cause occlusive ischemia of 92.9%. Further substratification revealed PPVs of arterial and venous-occlusive ischemia of 85.7% and 7.1%, respectively. Of the 225 patients MDCT-positive for AMI, 213 had pre-imaging serum lactate assessments. Of 188 patients MDCT-negative for AMI, 85 patients had elevated serum lactate (45.2%). Twenty of the 25 patients with positive MDCT findings of AMI (80%) also had an elevated serum lactate level, including 14/18 (77.8%) patients with arterial occlusive AMI on MDCT, 2/2 (100%) with venous-occlusive AMI on MDCT, and 4/5 (80%) with non-occlusive AMI on MDCT. CONCLUSION: Emergent biphasic MDCT demonstrated low but non-trivial yield (11.1%) for the depiction of suspected acute mesenteric ischemia but was particularly low for occlusive venous AMI (0.9%). The relationship between serum lactate elevation and positive MDCT findings of AMI in our study conforms to prior work and cautiously suggests value in routine serum lactate assessment preceding imaging for patient prioritization.

Influences for Gender Disparity in the Radiology Societies in North America.

OBJECTIVE: The objective of our study was to outline the gender distribution in leadership positions in the North American radiology societies. MATERIALS AND METHODS: A review of North American radiology societies was conducted to identify committee members and those holding leadership positions. The Scopus database was queried for research productivity metrics of these individuals. Gender, university affiliation, and academic rank were identified from departmental websites. The chi-square test was used to assess for differences in gender distribution, and nonparametric analyses were applied to determine gender differences in continuous variables. RESULTS: Of 2826 radiology society committee members, men outnumbered women 67.4% (n = 1906) to 32.6% (n = 920). There were 696 society leadership positions, of which men held 501 (72.0%) and women held 195 (28.0%) (p < 0.003). Additionally, 26.3% of all men held leadership positions compared with 21.2% of all women (p = 0.0032). Overall, men had a higher median h-index (14 [range, 0-113] vs 11 [range, 0-73]), number of publications (52 [range, 2-1264] vs 35 [range, 2-428]), and number of citations (880 [range, 0-54,813] vs 483.5 [range, 0-17,332]) than women (p < 0.001). Across university academic ranks of assistant and associate professor, research productivity metrics were similar between genders, but interestingly, female representation decreased with increasing academic rank. A higher proportion of men held a university rank of professor than women (39.5% vs 33.4%; p = 0.0017) with parity at the levels of assistant and associate professors. CONCLUSION: Gender disparity exists in the leadership positions in North American radiology societies. We have attempted to study the relationship between gender, academic rank, and h-index with leadership roles in these societies.

Acceptability and tolerability of omega-3 fatty acids as adjunctive treatment for children and adolescents with eating disorders.

The objective of this study was to examine the acceptability and tolerability of omega-3 fatty acids as an adjunctive treatment for children and adolescents with eating disorders (EDs). Children and adolescents with EDs received omega-3 supplements (300 mg eicosapentaenoic acid [EPA] and 200 mg docosahexaenoic acid [DHA]/day) in addition to standard treatment for 8 weeks. Primary outcomes were dropout rate, compliance, and side effects. Secondary outcomes included percent ideal body weight, Eating Disorders Inventory-3 (EDI-3), Children's Depression Inventory-2 (CDI-2), and Multidimensional Anxiety Scale for Children (MASC). There were 21 participants with mean age of 15.29 ± 2.0 years. There were no dropouts. Omega-3 was well tolerated by all participants. Compared to baseline, at week 8 there was a significant increase in mean percent ideal body weight but no significant difference in scores on the EDI-3, CDI-2, and MASC. We conclude that omega-3 supplements are acceptable and well tolerated in the pediatric ED population.

Anorexia nervosa and gender dysphoria in two adolescents.

Little has been published about the co-occurrence of gender dysphoria (GD) and eating disorders (ED) in adults, with no cases described in the adolescent population. The emphasis on body shape in both conditions suggests that there may be some overlap in symptomatology. We report two adolescent cases initially diagnosed with anorexia nervosa who later met criteria for GD. The drive for thinness for the 16-year-old male was associated with a wish to achieve a feminine physique whereas there was an emphasis for stunted breast growth and a desire for muscularity in the 13-year-old female. Complexities in presentation, evolution of symptoms over time, and the treatment of the two cases are discussed. Clinicians should inquire about sexual issues in the presentation of ED and should monitor for symptoms of GD, not only at initial presentation, but throughout treatment, especially as weight gain progresses.

A comparison of the types of screening tool administration methods used for the detection of intimate partner violence: a systematic review and meta-analysis.

Intimate partner violence (IPV) is associated with significant health consequences for victims, including acute/chronic pain, depression, trauma, suicide, death, as well as physical, emotional, and mental harms for families and children. The objective of this systematic review and meta-analysis was to assess the rate of IPV disclosure in adult women (>18 years of age) with the use of three different screening tool administration methods: computer-assisted self-administered screen, self-administered written screen, and face-to-face interview screen. A comprehensive literature search was conducted in the MEDLINE, EMBASE, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effectiveness, and the Cochrane library databases. We identified 746 potentially relevant articles; however, only 6 were randomized controlled trials (RCTs) and included for analysis. No significant differences were observed when women were screened in face-to-face interviews or with a self-administered written screen (Odds of disclosing: 1.02, 95% confidence interval [CI]: [0.77, 1.35]); however, a computer-assisted self-administered screen was found to increase the odds of IPV disclosure by 37% in comparison to a face-to-face interview screen (odds ratio: 0.63, 95% CI: [0.31, 1.30]). Disclosure of IPV was also 23% higher for computer-assisted self-administered screen in comparison to self-administered written screen (Odds of disclosure: 1.23, 95% CI: [0.0.92, 1.64]). The results of this review suggest that computer-assisted self-administered screens leads to higher rates of IPV disclosure in comparison to both face-to-face interview and self-administered written screens.

Two ductus venosus: a previously unreported anomaly.

In early fetal life, the ductus venosus (DV) connects the umbilical vein, carrying nutrient-rich and oxygenated blood from the placenta to the inferior vena cava (IVC). We present the first ever case of a fetus with two ductus venosus. The fetus presented with a four-vessel cord and a dilated bowel at 31 weeks of gestation. Ultrasonography showed a persistent right umbilical vein. Echocardiographic investigation revealed normal cardiac anatomy with no major malformations. Two DVs with slightly different Doppler patterns were visualized anastomosing with the IVC. The baby was born uneventfully at 39 weeks of gestation with stable hemodynamics. Assuming every supernumerary umbilical vein should be connected to a DV for balanced circulation, a fetus with supernumerary umbilical veins lacking a corresponding number of DV connections is likely to be predisposed to complications such as hydrops fetalis and poor perinatal outcomes. The possibility of one or more umbilical veins lacking a DV connection warrants significant attention and regular monitoring from feto-maternal specialists, given the severity of the associated morbidity and mortality.

Similar mortality rates in hip fracture patients over the past 31 years.

BACKGROUND: Over 320,000 hip fractures occur in North America each year and they are associated with a mortality rate ranging from 14% to 36% within 1 year of surgery. We assessed whether mortality and reoperation rates have improved in hip fracture patients over the past 31 years. METHODS: 3 electronic databases were searched for randomized controlled trials on hip fracture management, published between 1950 and 2013. Articles that assessed the surgical treatment of intertrochanteric or femoral neck fractures and measured mortality and/or reoperation rates were obtained. We analyzed overall mortality and reoperation rates, as well as mortality rates by fracture type, comparing mean values in different decades. Our primary outcome was the change in 1-year postoperative mortality. RESULTS: 70 trials published between 1981 and 2012 were included in the review. Overall, the mean 1-year mortality rate changed from 24% in the 1980s to 23% in the 1990s, and to 21% after 1999 (p = 0.7). 1-year mean mortality rates for intertrochanteric fractures diminished from 34% to 23% in studies published before 2000 and after 1999 (p = 0.005). Mean mortality rates for femoral neck fractures were similar over time (~20%). Reoperation rates were also similar over time. INTERPRETATION: We found similar mortality and reoperation rates in surgically treated hip fracture patients over time, with the exception of decreasing mortality rates in patients with intertrochanteric fractures.

Surgical indications for treatment for femoroacetabular impingement with surgical hip dislocation.

PURPOSE: There is a lack of detailed information about the indications of surgical treatment for femoroacetabular impingement (FAI), particularly using open surgical dislocation. The purpose of this review was to systematically review the reported indications for surgical dislocation of the hip for FAI. METHODS: Two databases (MEDLINE and EMBASE) were screened for clinical studies involving the treatment for FAI with surgical hip dislocation. We conducted a full-text review and the references for each included paper were hand-searched for other eligible studies. Papers published until September 2011 were included in this review. Two individuals reviewed all identified studies independently, and any disagreement was resolved through consensus. RESULTS: Fifteen studies met the eligibility criteria, which included a total of 822 patients. We identified a lack of consensus for clinical and radiographic indications for surgical hip dislocation to treat FAI. The most common clinical indications reported were clinical symptoms such as hip pain in 10 papers (67 %), a positive impingement sign in 9 papers (60 %), painful/reduced range of motion in 9 papers (60 %), activity-related groin pain in 4 papers (27 %), and non-responsive to non-operative treatment in 4 papers (27 %). The most commonly reported radiographic indicators for surgical hip dislocation were a variety of impingement findings from radiographs in all 15 included papers (100 %), a combination of radiographs and MRA in 5 papers (33 %) or radiographs and MRI in 3 papers (20 %). CONCLUSIONS: These results showed that that there was an inconsistency between the clinical and radiographic indications for surgical hip dislocation as a treatment for femoroacetabular impingement. This review suggests that there is a need for the development of standardized clinical and radiological criteria that serve as guidelines for surgical treatment for FAI. LEVEL OF EVIDENCE: Systematic review, Level IV.