Major trauma with only dynamic criteria: is the routine use of whole-body CT as a first level examination justified?

PURPOSE: Risks and benefits of systematic use of whole-body CT (WBCT) in patients with major trauma when no injury is clinically suspected is still subject of controversy. WBCT allows early identification of potentially evolving lesions, but exposes patients to the risk of high radiation dose and iodine contrast agent. The study aimed to assess if WBCT could be avoided in trauma patients with negative clinical examination. MATERIALS AND METHODS: This retrospective study included polytrauma patients admitted to the Emergency Department in a six-month period, who had undergone a WBCT scan for major dynamic criteria, with hemodynamic stability, absence of clinical and medical risk factors for major trauma. The patients (n = 233) were divided into two groups according to the absence (n = 152) or presence (n = 81) of clinical suspicion of organ injury. The WBCT results were classified as negative, positive for minor and positive for major lesions. RESULTS: The average patient age was 44 years. CT scans were completely negative in 111 (47.6%) patients, whose 104 (93.7%) were in the negative clinic group. 122 (52.4%) CT scans were positive, 69 (56.6%) for minor lesions and 53 (43.4%) for major lesions. Among the 48 (39.3%) positive CT scans in patients with negative clinic, only 5 (10.4%) were positive for major lesions. We found a significant difference in the frequency of injuries between the clinically negative and clinically positive patient groups (p < 0.001). CONCLUSION: A thorough clinical examination associated with a primary radiological evaluation may represent a valid diagnostic approach for trauma with only major dynamic criteria to limit the use of WBCT.

Periostin Circulating Levels and Genetic Variants in Patients with Non-Alcoholic Fatty Liver Disease.

Circulating periostin has been suggested as a possible biomarker in non-alcoholic fatty liver disease (NAFLD) in Asian studies. In the present study, we aimed to test its still controversial relevance in a Caucasian population. In patients with histologically-proven NAFLD (N. = 74; 10 with hepatocellular carcinoma, HCC) plasma periostin concentrations were analyzed. POSTN haplotype analysis was based on rs9603226, rs3829365, and rs1029728. Hepatitis C patients (N. = 81, 7 HCC) and healthy subjects (N. = 27) were used as controls. The median plasma periostin concentration was 11.6 ng/mL without differences amongst groups; it was not influenced by age, liver fibrosis or steatosis. However, possession of haplotype two (rs9603226 = G, rs3829365 = C, rs1028728 = A) was associated with lower circulating periostin compared to other haplotypes. Moreover, periostin was higher in HCC patients. At multivariate analysis, HCC remained the only predictor of high periostin. In conclusion, plasma periostin concentrations in Caucasians NAFLD patients are not influenced by the degree of liver disease, but are significantly higher in HCC. Genetically-determined differences may account for some of the variability. These data suggest extreme caution in predicting a possible future role of periostin antagonists as a rational therapeutic alternative for NAFLD, but show a potential periostin role in the management of NAFLD-associated HCC.