Combined head and abdominal computed tomography for blunt trauma: which patients with minor head trauma benefit most?

The widespread availability of computed tomography (CT) in the diagnosis and management of blunt trauma has created the possibility of overuse without clear indications. Some clinicians believe that patients with head injury, intoxication, and/or distracting injury have an unreliable abdominal examination and should undergo combined head and abdomen CT. The objective of this study was to evaluate which patients with minor head trauma benefit most from combined head and abdomen CT. Consecutive blunt trauma patients, with a Glasgow coma scale (GCS) of 14 or 15, who underwent concomitant head and abdomen CT upon admission to a level I trauma center over a 2-year period were retrospectively reviewed. Patient demographics, mechanism of injury, physical exam, hospital course, and radiological and laboratory findings were recorded. Patients were divided into four subgroups based upon the presence or absence of intracranial and/or intraabdominal injury detected by CT. Among the 1,478 blunt head trauma patients, only 18 (1%) patients had both head and abdominal injuries detected by combined CT. One-hundred twelve (8%) patients had only head injuries, and 131 (9%) had only intraabdominal injuries detected. Patients with a GCS of 14 were more likely to have isolated head injury [odds ratio (OR) 3.1, P=0.001], while those with loss of consciousness were more likely to have combined head and intraabdominal injury (OR 6.8, P=0.03) or isolated head injury (OR 1.7, P=0.02). Abdominal tenderness was associated with increased risk of isolated intraabdominal injury (OR 1.8, P=0.0015). Hematuria was associated with increased risk of combined head and intraabdominal injury (OR 8.3, P=0.0004) or isolated intraabdominal injury (OR 7.9, P=0.0001). Patients with loss of consciousness and/or GCS of 14 frequently undergo head CT. The addition of an abdomen CT scan in this patient population should be based on objective clinical criteria such as presence of abdominal tenderness and/or hematuria.

Giant cystic abdominal masses in children.

In this pictorial essay the common and uncommon causes of large cystic and cyst-like abdominal masses in children are reviewed. We discuss and illustrate the following: mesenchymal hamartoma, choledochal cyst, hydrops of the gallbladder, congenital splenic cyst, pancreatic pseudocyst, pancreatic cystadenoma, hydronephrosis, multicystic dysplastic kidney, multilocular cystic nephroma, adrenal hemorrhage, mesenteric and omental cysts, gastrointestinal duplication cyst, meconium pseudocyst, ovarian cysts and cystic neoplasms, hematocolpos, urachal cysts, appendiceal abscess, abdominal and sacrococcygeal teratoma, and CSF pseudocyst. We also describe imaging features and clues to the diagnosis.

Interleukin 1 receptor dependence of serum transferred arthritis can be circumvented by toll-like receptor 4 signaling.

Inflammatory arthritis is associated with the release of a network of key cytokines. In T cell receptor transgenic K/BxN mice interleukin (IL)-1 plays a key role in joint swelling and destruction, as suggested by the ability of anti-IL-1receptor (IL-1R) antibody treatment to delay the onset and slow the progression of this disease. This mechanism is dependent on the signaling pathway intermediary myeloid differentiation factor 88 (MyD88), such that neither IL-1R nor MyD88-deficient mice developed visually detectable synovitis after transfer of arthritogenic sera. The Toll-like receptors (TLRs) share the same signaling pathway through MyD88 as the IL-1R. The administration of a TLR-4 ligand, lipopolysaccharide, concomitant with arthritogenic serum in IL-1 receptor-deficient mice resulted in acute paw swelling, but not in MyD88-deficient mice. Also, serum transferred arthritis was not sustained in TLR-4 mutant mice compared with controls. These results suggest that innate immune functions via TLR-4 might perpetuate inflammatory mechanisms and bypass the need for IL-1 in chronic joint inflammation.