Comparison of low dose and standard dose abdominal CT scan in body stuffers.

PURPOSE: Detection of body stuffers is challenging in emergency departments. Because of the small size of baggies, plain radiograph is of little value in most suspects. On the other hand, abdomen CT scan is burdened by high cost and radiation dose. This study was performed to compare the image quality, radiation dose and accuracy of low-dose CT scan in comparison with standard dose. MATERIAL AND METHODS: In this prospective study, suspected body stuffers who were referred to the radiology department underwent two different protocols of abdominal non-contrast CT scan simultaneously: low-dose (with equivalent dose to conventional abdominal x-ray) and standard dose. Standard dose CT scan was considered as the reference. Low-dose CT scans were evaluated for detection of baggies by two radiologists blinded to the result of standard dose CT. Image quality, noise, dose-length product (DLP) and effective dose (ED) compared between two groups. RESULTS: The study consisted of 40 patients (33.38 ± 7.4 years). Standard dose CT evaluation was positive in 22 patients (55%). In comparison with standard dose CT scan, low-dose group had a sensitivity of 86%, specificity of 100%, PPV and NPV of 100% and 86%. The accuracy of low-dose CT scan for detection of baggies larger than 1 cm was 100%. However, from the 3 cases that could not be detected with low dose protocol, one had CT features suspected for baggies rupture which was intubated and later deceased. Noise average of low-dose protocol, was approximately 7 times greater than standard dose group, while DLP and ED were 9.7 times less. CONCLUSION: Low dose CT scan appears to be an appropriate screening method for body stuffers, especially when the baggies are larger than one centimeter. However, in the presence of severe clinical symptoms, a standard dose CT scan will be more helpful due to better image quality especially in suspected ruptured baggies.

Assessing the Epidemiological Data and Management Methods of Body Packers Admitted to a Referral Center in Iran.

The incidence of smuggling and transporting illegal substances by internal concealment, also known as body packing, is on the rise. The clinical approach to such patients has been changed significantly over the past 2 decades. However, despite a recorded increase in body packing in general, there are controversies in the management of these patients. We aimed to gather data regarding the demographic characteristics, treatment, and outcome of body packers, which were that referred to Loghman Hakim Hospital, Tehran, Iran.The data of all body packers admitted to Loghman Hakim Hospital during 2010 to 2014 were evaluated retrospectively. Data regarding the demographic characteristics of the patients, findings of clinical imaging, treatment, and outcome were recorded.In this study, 175 individuals with a mean age of 31 ±â€Š10 years were assessed. The most common concealed substances were crack (37%), crystal (17%), opium (13%), and heroin (6%). According to the results of surgery and imaging (abdominal radiography or computed tomography), the most common place for concealment was stomach in 33.3% and 12% of cases, respectively. Imaging findings were normal in 18% of the individuals. Forty-eight (27%) patients underwent surgery. The main indications for surgery were clinical manifestations of toxicity (79%) and obstruction of the gastro-intestinal tract (17%). The most common surgical techniques were laparotomy and gastrotomy (50%). The mean duration of hospitalization was 3.8 ±â€Š4 days. The mortality rate was 3%.Conservative treatment of body packers seems to be the best treatment method. Careful monitoring of the patients for possible signs and symptoms of intoxication and gastro-intestinal obstruction is strongly recommended.

Ilioinguinal nerve excision in open mesh repair of inguinal hernia--results of a randomized clinical trial: simple solution for a difficult problem?

BACKGROUND: Inguinodynia is the second most common complication occurring after inguinal hernia repair. This study was undertaken to evaluate the effect of ilioinguinal nerve excision, a concept previously proposed to be performed during open hernia mesh repair, on postsurgical pain and hyposthesia. METHODS: A double-blind randomized clinical trial was performed on 121 patients undergoing open anterior mesh repair of inguinal hernia in 1 center from April 2005 through June 2006. The ilioinguinal nerve was excised in half of the patients and preserved in the other half. Pain and hyposthesia at POD 1, 1 and 6 months after surgery, and 1 year after surgery was evaluated in both groups using a visual analog scale. Results were compared using chi-square analysis. RESULTS: Of the total number of 121 patients who entered the study, with an age range of 18 to 86 years (mean +/- SD 45 +/- 18), 115 (95%) were male. Sixty-one were in the nerve-excision group, and 60 were in the nerve-preservation group. One hundred patients were followed-up until the end of the first year. Using the visual analog scale to detect pain severity on postsurgical day 1, mean scores in the nerve-excision and nerve-preservation groups were 2.2 +/- .8 (range 1 to 4) versus 2.8 +/- .7 (range 2 to 4.5), respectively (P < .001). At 1 month after surgery, these scores were .7 +/- .7 (range 0 to 3) versus 1.5 +/- .7 (range 0 to 3.5), respectively (P < .001). Between 6 months and 1 year after surgery, median scores of zero were detected in both groups. After postsurgical day 1, the median score of hyposthesia was near zero in both groups. Thirteen patients developed chronic inguinodynia (13%), 10 of whom were in the nerve-preservation group. Chronic postsurgical inguinodynia was seen in 6% of patients in the ilioinguinal nerve-excision and 21% of the patients in the ilioinguinal nerve-preservation group (P = .033). COMMENTS: Neurectomy decreases postsurgical pain after elective inguinal hernia repair. Although chronic inguinodynia was less frequent in our study than reported by many previous studies, it is still wise to recommend ilioinguinal neurectomy in patients undergoing anterior inguinal hernia mesh repair.