Assuntos
Isquemia Encefálica/cirurgia , Procedimentos Endovasculares , Fibrinolíticos/administração & dosagem , Doença Aguda , Isquemia Encefálica/tratamento farmacológico , Ensaios Clínicos como Assunto , Terapia Combinada , Fibrinolíticos/uso terapêutico , Humanos , Infusões Intra-Arteriais , Seleção de Pacientes , Radiografia Intervencionista , Trombectomia/métodos , Terapia Trombolítica/métodosAssuntos
Neurorradiografia , Radiologia Intervencionista , Doença Aguda , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/terapia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/terapia , Desenho de Equipamento , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Neurorradiografia/instrumentação , Neurorradiografia/métodos , Neurorradiografia/tendências , Radiologia Intervencionista/instrumentação , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendênciasRESUMO
OBJECTIVE: To determine the utility of thoracic computed tomography (TCT) in the initial assessment of critically ill patients with chest injuries. DESIGN: Prospective observational study of cohorts. SETTING: Trauma intensive care unit (ICU) of a Spanish Level III hospital (US equivalent Level I). PATIENTS: Three hundred seventy-five patients with chest injuries were studied, grouped into two cohorts according to whether they underwent admission TCT (exposed cohort, group I, n = 104) or not (unexposed cohort, group II, n = 271). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic data, initial severity scores, and chest radiograph (CXR)-based diagnosis were collected in all patients as independent variables. In patients of group I, we also recorded the TCT-based diagnosis and any incidents, complications, or therapy changes resulting from the TCT. The need for and duration of mechanical ventilation, length of ICU stay, and ICU mortality were gathered in the whole sample as dependent variables. The admission data were similar in the two groups, except for a higher Injury Severity Score (ISS) and thoracic ISS in group I. TCT proved to be more sensitive than CXR in detecting pulmonary contusion, hemothorax, pneumothorax, and vertebral fractures and in identifying the faulty placement of chest drainage tubes. TCT findings induced therapy changes in approximately 30% of patients in group I. In the other dependent variables studied, there were no differences between the two groups. In the multivariate analysis, the TCT screening had no effects on the time on mechanical ventilation, length of ICU stay, or mortality. CONCLUSIONS: TCT detects more chest injuries in trauma patients than does CXR and induces therapy changes in a considerable number of patients. However, this does not translate into an improvement in clinical outcomes.
Assuntos
Cuidados Críticos , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , APACHE , Adulto , Estudos de Coortes , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/mortalidade , Admissão do Paciente/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Sensibilidade e Especificidade , Taxa de Sobrevida , Traumatismos Torácicos/mortalidade , Ferimentos não Penetrantes/mortalidadeRESUMO
STUDY DESIGN: The incidence of calcification in ligamentum flavum and posterior capsule demonstrated by computed tomography was reviewed in a series of 147 patients in whom 419 lumbar levels were studied. OBJECTIVES: To find a relationship between mechanical lumbar pathology and the calcification of the ligamentum flavum and posterior capsule. SUMMARY OF BACKGROUND DATA: Calcification of the ligamentum flavum and posterior capsule has been found in diffuse idiopathic skeletal hyperostosis and in metabolic disorders. Although this fact is considered a manifestation of degenerative disease of the spine, it barely has been studied, and many questions remain unresolved. METHODS: Calcifications were classified according to location as follows: 1) ligamentum flavum: upper attachment, lateral or capsular extension, caudal attachment, interlaminar portion or 2) posterior capsule. RESULTS: The following statistical associations were found: 1) degenerative facet joint disease with posterior capsule and lateral or capsular extension calcifications, 2) lumbarized vertebra with lateral or capsular extension and upper attachment calcifications, and 3) isthmic spondylolisthesis with lateral or capsular extension calcification.