Caring for Patients With Adverse Childhood Experiences.

Adverse childhood experiences are associated with many poor health outcomes. Research has demonstrated associations between childhood trauma and increased incidence of heart disease, lung disease, cancer, mental health disorders, addiction, and a host of autoimmune diseases including diabetes. Current understanding of the mechanisms of injury relies on numerous theoretical frameworks and diagnostic criteria. Radiologic technologists can improve patient care by using research-validated techniques for promoting resilience when working with patients and families affected by adverse childhood experiences.

Computed Tomography of Femoral Anteversion in Children With Cerebral Palsy.

Cerebral palsy (CP) is a common childhood disability that affects musculoskeletal development. In particular, CP might contribute to increased femoral anteversion and associated difficulties in ambulation, increasing the risk of hip dysplasia and dislocation. Computed tomography provides useful information about the effects of CP on the anatomy and functionality of the femur and hip joint. Radiologic technologists should work collaboratively with other health care professionals to empower patients with CP and their caregivers to improve quality of life.

Corneal transplantation at Tenwek Hospital, Kenya, East Africa: Analysis of outcomes and associated patient socioeconomic characteristics.

PURPOSE: To review the graft survival rate, visual outcomes, and patient demographics of primary penetrating keratoplasty performed at Tenwek Hospital, a mission hospital in rural Kenya. METHODS: A retrospective review was performed of the clinical records of patients who underwent primary penetrating keratoplasty for optical purposes from January 2012 to October 2014. The graft survival rates were constructed using the Kaplan-Meier method, and the effect of clinical and socioeconomic characteristics on time to graft failure were examined using Cox regression models. RESULTS: 118 patients met the inclusion criteria. The most common indication for surgery was keratoconus (66.1%), followed by corneal scar (22.0%). Despite all patients giving a verbal commitment to do so, 40 patients (33.9%) failed to make it to followup one year postoperatively. Graft survival at one year, inclusive of all indications, was 85.8%. Of the different indications, keratoconus had the highest one-year graft survival rate of 89.9%. Compared to the preoperative uncorrected visual acuity, 85.3% achieved an improvement at one year. Compared to patients who had completed college or university, the risk of developing graft failure was 4.7 times higher among patients with less education (P = 0.01). CONCLUSIONS: Corneal transplantation at Tenwek Hospital can be performed with a reasonable chance of success at one year, particularly in cases of keratoconus and in patients with higher educational backgrounds. Adherence to followup recommendations proves to be a challenge in this patient population. Additional studies of larger patient populations with longer follow up periods in similar settings may be helpful in informing appropriate patient selection and maximizing successful outcomes of corneal transplantation in low-resource settings.

Patient-centered Radiation Safety.

Some suggest radiation safety is evolving from a provider-centered process to a more patient-centered approach. This shift places additional responsibility on radiologic technologists to educate patients about the possible risks and benefits of medical radiation exposure so patients can be equal partners in their care. This article discusses the ethics of radiation protection and the development of the patient-centered approach, and the radiologic technologist's role in ensuring patient-centered radiation safety is addressed.

CT-guided Intra-abdominal Abscess Drainage.

Intra-abdominal abscesses arise from complications of surgery and disease. Computed tomography (CT) facilitates abscess drainage procedures while reducing the risks and costs associated with surgery. These procedures require collaboration to ensure positive patient outcomes. To perform their role in CT-guided intra-abdominal abscess drainage, radiologic technologists must understand patient care, instrumentation, imaging techniques, and underlying disease processes specific to the anatomical site. Once these considerations are grasped, CT technologists can help radiologists and administrators to determine cost-effective instrumentation and quality control specific to the patient and institution.

Graded unilateral supramaximal medial rectus recession for moderate angle esotropia.

BACKGROUND AND PURPOSE: Recession of a single medial rectus muscle may be appropriate for certain cases of esotropia. However, the procedure has not been widely accepted nor widely studied, and most reports have dealt with conventional recessions (3.5-6 mm) for small angle esotropia. We reviewed our patients who underwent unilateral supramaximal (6-8 mm) medial rectus recession for both small and medium angle esotropia. DESIGN: Observational case series. METHODS: The records of 56 consecutive patients, undergoing single eye muscle surgery for esotropia, ranging in age from 1 to 11 years were selected and analyzed. All patients had a constant esotropia, despite full cycloplegic refractive correction, measuring 15-40 prism diopters (mean=25.82) at distance and 18-45 prism diopters (mean=30.71) at near. Each patient underwent a graded unilateral medial rectus recession of 6-8 mm. RESULTS: 48/56 (86%) patients achieved "successful" binocular motor alignment (defined as 0-8 prism diopters residual esotropia at the most recent postoperative visit with a minimum of 5 months and an average of 32 months postoperative followup). The average unilateral medial rectus recession performed was 7.4 mm. Five patients (9%) were overcorrected, (defined as any amount of consecutive exodeviation). CONCLUSION: Unilateral supramaximal medial rectus recession appears to be a safe and effective treatment for medium angle non-accommodative esotropia, and has advantages for both patient and surgeon.

Abducens nerve palsy from an occult high flow carotid cavernous fistula.

A 37-year-old man with a one-year history of hypertension noted pulsatile tinnitus and binocular horizontal diplopia. On examination he had left abduction weakness without proptosis or orbital congestion. Neuroimaging revealed a spontaneous high flow posterior draining carotid cavernous fistula and an internal carotid artery dissection. The mechanism of fistula formation most likely resulted from the carotid dissection with pseudoaneurysm formation and rupture into the cavernous sinus. This case illustrates a unique cause of an abducens palsy due to an occult carotid cavernous fistula. Cranial neuroimaging techniques are discussed, including computed tomography angiography, a relatively new modality used to image intracranial blood vessels.

Combined superior oblique tuck and adjustable suture recession of the ipsilateral superior rectus for long-standing superior oblique palsy.

PURPOSE: Unilateral long-standing superior oblique palsy may lead to superior rectus overaction/contracture requiring surgery of multiple extraocular muscles to correct the hypertropia. We review our technique of tucking the superior oblique combined with immediate postoperative adjustable suture recession of the ipsilateral superior rectus. METHODS: Twelve patients during the course of 2.5 years with longstanding vertical diplopia unrelated to closed head trauma or systemic disease who underwent our surgical technique were identified. The hypertropia in all patients was largest across the lower field (Knapp class 5) or nasal and lower fields (Knapp class 4). Outcome measures were primary-position hypertropia and vertical diplopia. RESULTS: The mean preoperative hypertropia in primary gaze measured 17.8 PD (range, 4 to 30). The mean 2-week postoperative vertical deviation was 1.3 PD (range, 4 PD hypotropic to 6 PD hypertrophic). The mean 6-week postoperative vertical deviation was 1.9 PD (range, 2 PD hypotropic to 12 PD hypertrophic). Diplopia in primary and down gaze, which was universally present before surgery, resolved in 11 of the 12 patients (92%). CONCLUSIONS: This combination of procedures appears to be a highly successful choice for treatment of unilateral long-standing superior oblique palsy. Advantages for both patient and surgeon include adequate exposure through a single conjunctival incision, elimination of risks to the contralateral eye, and immediate intraoperative suture adjustment of the ipsilateral superior rectus.