Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis.

BACKGROUND AND PURPOSE: Evaluation for blunt cerebrovascular injury has generated immense controversy with wide variations in recommendations regarding the need for evaluation and the optimal imaging technique. We review the literature and determine the most cost-effective strategy for evaluating blunt cerebrovascular injury in trauma patients. MATERIALS AND METHODS: A comprehensive literature review was performed with data extracted to create a decision-tree analysis for 5 different strategies: anticoagulation for high-risk (based on the Denver screening criteria) patients, selective DSA or CTA (only high-risk patients), and DSA or CTA for all trauma patients. The economic evaluation was based on a health care payer perspective during a 1-year horizon. Statistical analyses were performed. The cost-effectiveness was compared through 2 main indicators: the incremental cost-effectiveness ratio and net monetary benefit. RESULTS: Selective anticoagulation in high-risk patients was shown to be the most cost-effective strategy, with the lowest cost and greatest effectiveness (an average cost of $21.08 and average quality-adjusted life year of 0.7231). Selective CTA has comparable utility and only a slightly higher cost (an average cost of $48.84 and average quality-adjusted life year of 0.7229). DSA, whether performed selectively or for all patients, was not optimal from both the cost and utility perspectives. Sensitivity analyses demonstrated these results to be robust for a wide range of parameter values. CONCLUSIONS: Selective CTA in high-risk patients is the optimal and cost-effective imaging strategy. It remains the dominant strategy over DSA, even assuming a low CTA sensitivity and irrespective of the proportion of patients at high-risk and the incidence of blunt cerebrovascular injury in high-risk patients.

Stylomandibular tunnel widening versus narrowing: a useful tool in evaluating suprahyoid mass lesions.

AIM: To evaluate whether qualitative and quantitative assessments of stylomandibular tunnel asymmetry are useful in lesion localization and differentiation. MATERIALS AND METHODS: The stylomandibular tunnel was measured in 60 control patients at CT to determine normal side-to-side variation. Twenty-one patients in the study group with suprahyoid neck masses were divided into two subgroups, those with widening and those with narrowing of the pathological side. Surgical and pathological findings in these subgroups were compared for site of origin and histology. RESULTS: Stylomandibular tunnel diameters in the control group had a mean variation of 0.9 mm (range: 0-3 mm, SD: 0.83 mm). Two-tailed t-test yielded a p-value of 0.018 for a variation of 3 mm and this was chosen as the threshold for disease. The widened stylomandibular tunnel group all had parotid gland lesions extending into the pre-styloid parapharyngeal space. The narrowed stylomandibular tunnel group had adenopathy, schwannomas, and paragangliomas/glomus vagale tumours arising from the post-styloid parapharyngeal space. CONCLUSION: Qualitative assessment for asymmetry of the stylomandibular tunnel surpass the 3 mm threshold for pathology. Widening of the stylomandibular tunnel is primarily from deep lobe parotid lesions extending into the pre-styloid parapharyngeal space. Narrowing of the stylomandibular tunnel can be from adenopathy, schwannomas, and paragangliomas arising from the post-styloid parapharyngeal space.

Colorectal carcinoma.

Two rare cases of colorectal adenocarcinoma seen during the last 3 years in children under 10 years of age are reported. To improve survival, emphasis is given on its early diagnosis by a thorough examination and investigation of the child in every case of prolonged bleeding per rectum, diarrhoea and other non specific abdominal symptoms.

Serum copper and ceruloplasmin in pregnancy with anaemia.

Estimation of serum copper and ceruloplasmin was done in 25 non pregnant females, 25 healthy pregnant women followed from I to III trimester and 75 pregnant women with anaemia--25 in each trimester. Anaemia was further divided into mild, moderate and severe types (27, 32 & 16 cases respectively). Normal pregnancy was associated with progressive increase in serum copper and ceruloplasmin--values being highest in III trimester. All types of anaemias in pregnancy revealed statistically significant elevation of serum copper and ceruloplasmin when compared to corresponding gestational period in normal pregnancy.