This study evaluated the diagnostic accuracy of CT scans for detecting injuries in 100 patients with blunt abdominal trauma. CT scans had high sensitivity for liver (100%) and spleen (86.6%) injuries. Specificity was highest for retroperitoneal hematoma (100%) and kidney injuries (93.5%). The accuracy of CT scans for detecting injuries to spleen, liver, kidney, and retroperitoneal hematoma ranged from 91.6% to 96.1%. The study concluded that CT scans are a good tool for evaluating blunt abdominal trauma in teaching hospitals.
Lotti Marco MD - Cancer of the Oesophago-Gastric JunctionMarco Lotti
An analysis of the evidence about Transhiatal or Transthoracic approach for cancer of the oesophagogastric junction. Invited presentation at the 27th National Congress of the Italian Society of Young Surgeons SPIGC
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
Lotti Marco MD - Cancer of the Oesophago-Gastric JunctionMarco Lotti
An analysis of the evidence about Transhiatal or Transthoracic approach for cancer of the oesophagogastric junction. Invited presentation at the 27th National Congress of the Italian Society of Young Surgeons SPIGC
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
Role of mdct in blunt abdominal trauma Dr. Muhammad Bin Zulfiqar
Briefly Describes the role of Ct in Diagnosis of Blunt Abdominal trauma.
Major organs injuries are discussed
Co-relation of multidetector CT scan based preoperative staging with intra-op...Apollo Hospitals
To assess the accuracy of CT scan in preoperative staging, to correlate preoperative findings with operative findings and with post-operative histopathological findings of colorectal carcinoma.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
Transanal Endoscopic Microsurgery in Young Patients: A Retrospective Studysemualkaira
Local excision of rectal lesions is considered an acceptable choice for elderly and high-risk patients, yet data is scarce regarding its application in young adults
Incidence of VTE in the First Postoperative 24 Hours after Abdominopelvic Sur...semualkaira
A good number of research reports the incidence of postoperative venous thromboembolism (VTE) mostly looks at longer postoperative duration, usually days after surgery.
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
1. Chinese Journal of Traumatology 2009; 12(2):1-4 .1.
Diagnostic accuracy of CT scan in abdominal blunt trauma
Javad Salimi*, Khadyjeh Bakhtavar, Mehdi Solimani, Patricia Khashayar, Ali Pasha Meysamie and Moosa Zargar
Objective: To evaluate the sensitivity and specificity were calculated in each case.
of CT-scan findings in patients with blunt abdominal trauma Results: CT scan had the highest sensitivity for detect-
admitted to the university hospital. ing the injuries to liver (100%) and spleen (86.6%). The speci-
Methods: All the patients with blunt abdominal trauma ficity of the method for detecting retroperitoneal hematoma
admitted at a tertiary teaching trauma center in Iran between (100%) and injuries to kidney (93.5%) was higher than other
2005 and 2007 were enrolled in this study. In the absence of organs. The accuracy of CT images to detect the injuries to
any clinical manifestations, the patients underwent a diag- spleen, liver, kidney and retroperitoneal hematoma was re-
nostic CT scan. Laparatomy was performed in those with ported to be 96.1%, 94.4%, 91.6% and 91.6% respectively.
positive CT results; while others were observed for 48 hours Conclusions: The findings of the present study reveal
and discharged in case no problem was reported; otherwise that CT scan could be considered as a good choice espe-
they underwent laparatomy. Information on patients’ de- cially for patients with blunt abdominal trauma in teaching
mographic data, mechanism of trauma, indication for CT hospitals where the radiologic academic staff is not present
scan, CT scan findings, results of laparotomy was gathered. in the hospital in the night shifts.
The sensitivity, specificity and accuracy of the CT-scan Key words: Wounds, nonpenetrating; Adbominal
images in regard with the organ injured were calculated. injuries; Tomography, X-ray computed; Diagnosis
The sensitivity, specificity and accuracy of the CT scan
Chin J Traumatol 2009; 12(2):1-4
B
lunt abdominal trauma may represent a life- plaints or external signs of abdominal injury on admis-
threatening condition requiring rapid diagnosis sion to hospital.3, 4 Abdominal examination is often com-
and treatment. The diagnosis of significant in- pounded by different factors including fractures of lower
tra-abdominal injury is a challenge in the management chest ribs, contusion and abrasions of the abdominal wall,
of such patients.1, 2 Failure to recognize and treat oc- presence of fractured lumbar vertebrae with retroperito-
cult hemorrhage is a common mistake. The clinical his- neal hematoma, and reduced level of consciousness.
tory and physical examination alone are usually Rapid assessment and appropriate treatment of poten-
unreliable, as nearly half the patients may have no com- tially life-threatening conditions is therefore essential.5
The optimal method of evaluating abdominal trauma re-
mains controversial. A combination of a sensitive and
Associate Professor of Surgery, Sina Trauma & Sur- specific screening test may be a safe and efficient ap-
gery Research Center, Sina Hospital, Medical Sciences/ proach to it. Diagnostic peritoneal lavage (DPL) is an
University of Tehran, Tehran, Iran (Salimi J) acceptable method for detecting the intra-peritoneal
Assistant Professor of Radiology, Sina Hospital, Medical
fluid. It has sensitivity greater than 90% for the detec-
Sciences/ University of Tehran, Tehran, Iran (Bakhtavar K)
tion of hemoperitoneum, but it is not specific and not
General Surgeons, Sina Hospital, Medical Sciences/
University of Tehran, Tehran, Iran (Solimani M) reliable for the assessment of retroperitoneal injuries.
General Practitioner, Research and Development In addition, like any invasive procedure, DPL carries
Center, Sina Hospital, Medical Sciences/ University of some risks. 6 The use of Focused Assessment
Tehran, Tehran, Iran (Khashayar P) Sonography for Trauma (FAST) for unstable patients
Assistant Professor of Social Medicine, Medical Sci-
with intra-abdominal hemorrhage rather than injury has
ences/ University of Tehran, Tehran, Iran (Meysamie AP)
dramatically changed the methods for diagnosing blunt
Professor of Surgery, Sina Trauma & Surgery Research
Center, Sina Hospital, Medical Sciences/ University of abdominal trauma.7 CT scan is now considered as a
Tehran, Tehran, Iran (Zargar M) rapid means of assessment for the early detection of
*Corresponding authors: Tel & Fax: 98-21-66735018, intra-peritoneal injury, which is not dependent on the
E-mail :mjsalimi@sina.tums.ac.ir operator.8 As a result, this study was conducted to evalu-
2. .2. Chinese Journal of Traumatology 2009; 12(2):1-4
ate the specificity and sensitivity of CT-scan findings in injury if present, and was calculated by dividing the
patients with blunt abdominal trauma in order to verify number of true positive CT scan by the number of posi-
the accuracy of the method as a non-operator depen- tive laparotomies. The specificity was defined as the
dant method which could be used by residents in the ability of CT scan to rule out an injury none existed,
teaching hospitals where academic staff are absent and was calculated by dividing the number of true nega-
specially in the night shifts. tive CT scans by the number of patients without injury.
Finally, the accuracy of the CT scan was determined
METHODS by dividing the sum of true positive and true negative
CT scans by total number of CT scans performed. The
After approval by the Institutional Ethical Board data were entered in SPSS version 13. Student’s t-test
Committee, all the patients with blunt abdominal trauma and Chi-square analysis were used to analyze the
admitted at a tertiary teaching trauma center in Iran variables.
between 2005 and 2007 were evaluated. Those who
underwent a CT scan were enrolled in this study. Indi- RESULTS
cations for abdominal CT scan were 1) abdomen /pel-
vic pain/tenderness, 2) visible abdomen /pelvis trauma, A hundred patients were enrolled in this study, 87
3) history of homodynamic instability (SBP<80), 4) of whom were male and 13 were female. The peak age
hematuria, 5) abnormal pelvis x-ray, 6) alcohol incidence was 20-40 years (43%) and followed by pa-
intoxication, 7) unreliable examination secondary to tients aged more than 40 years (24%).Patients aged
distracting injuries, unresponsiveness and neurological 10-19 years accounted for 21% of the admissions.
injury, 8) decreased mental state (GCS<9), loss of
consciousness, 10) mechanism of injury (high speed/ Accident (63%) and fall (22%) were the most fre-
energy accident/extensive damage to vehicle/fatalities quent mechanism of trauma in these patients. The vital
involved), 11) intubations and 12) pelvic fractures. signs were revealed to be unstable at the admission
time in 77% of the patients.
CT scan images were reviewed by resident of
radiology, blind to the patients’ condition and unaware Thirty six of the patients underwent laparotomy;
of the objectives of the study. CT scan was considered sixty were discharged following close observation in 48
positive if one of the following criteria was met: 1) trauma hours and three were referred to other centers and one
of solid organs (liver, spleen, kidney, and pancreas), 2) patient died before operation.
trauma of small intestine, colon, mesentery, diaphragm
or bladder, 3) detectable amount of free fluid with hem- Totally 7 patients died during the study period, 6 of
orrhage in abdomen and pelvis. whom were operated upon. Laparotomy revealed spleen
rupture (4 cases), liver rupture (2 cases), duodenal and
Laparotomy was done for all the patients with any pancreatic rupture (2 cases), small intestine, kidney
evidences of intra-abdominal and pelvic injuries. In the and mesenteric rupture (3 cases) and retroperitoneal
absence of any clinical manifestations, the patients hematoma (2 cases). One death occurred in the emer-
underwent a diagnostic CT scan. Laparatomy was per- gency department while others happened in ICU. The
formed in those with positive CT results; while others mean time of death was reported to be 26 hours follow-
were observed for 48 hours and were discharged in case ing admission.
no problem was reported; otherwise they underwent
laparotomy. No specific findings were reported in the CT-scan of
29 of the patients. Among them, surgery was performed
Information on patients’ demographic data, mecha- in one case (3.4%). Two of these patients were referred
nism of trauma, indication for CT scan, CT scan findings, to other centers and 26 were discharged. Of the 71 pa-
results of laparatomies was gathered. The sensitivity, tients who had positive CT scan, 1 (1.4%) was referred
specificity and accuracy of the CT-scan image in re- and 1 died. Thirty-six underwent an operation, while 33
gard with the organ injured were calculated. The sensi- (44%) were discharged without being operated upon.
tivity was defined as the ability of CT scan to detect an
3. Chinese Journal of Traumatology 2009; 12(2):1-4 .3.
According to the results of the present study, CT DISCUSSION
scan had the highest sensitivity for detecting the inju-
ries to liver (100%), spleen (86.6%), kidney (80%) and In the past 20 years, CT has proved to be an excel-
stomach (80%). On the contrary, the specificity of the lent imaging modality for diagnosing and managing
CT-scan images for detecting retroperitoneal hematoma hemodynamically stable patients with abdominal injuries.9
(100%) and injuries to kidney (93.5%) and mesentery However, sonography is largely used as the preferred
(87.5%) was higher than other organs (Table 1). screening technique in many trauma centers. The value
of sonography in revealing an organ injury varies greatly
The accuracy of CT images to detect the injuries to with the location of the lesion.10, 11
spleen, liver, kidney and retroperitoneal hematoma were
reported to be 96.1%, 94.4%, 91.6% and 91.6% Many studies have stated that CT plays a critical
respectively. In general, the sensitivity, specificity and role in the identification of suspected bowel and me-
accuracy were calculated as 63.9%, 82.1% and 77.2% senteric injuries. It is worthy to note that the accuracy
respectively. of this method in diagnosing the very injuries has been
questioned.12 On the contrary, the present study docu-
The highest positive predictive value (PPV) was for mented CT scan to be more sensitive for liver, kidney
liver (83.3%) and spleen (81.2%) and overall 56.8%. and spleen injuries. According to these results, this
Similarly, liver had the highest negative predictive value diagnostic method has a low sensitivity in patients with
(NPV) (100%). Stomach (94.7%) and colon (91.3%) pancreas, mesentery and colon injury. In a study per-
were the organs with the next highest NPV. Overall formed in 2003, it was also shown that 13% of patients
NPV was 86%. Table 2 shows the PPV and NPV values. with perforated small bowel injury had a normal CT scan
Table 1. Sensitivity and specificity of CT scan preoperatively.13
Organs Sensitivity(%) Specificity(%)
Liver 100 66.6 Others have documented CT as the reference tech-
Kidney 80 93.5
nique for identification of retroperitoneal hematoma and
kidney injuries.14 Similarly, the present study supported
Spleen 86.6 85.7
the abovementioned results.
Pancreas 45.4 80
Stomach 80 58 Moreover, many researchers believe that CT scan
Duodenum 71.4 72.4 could be reserved for patients with negative findings on
Small intestine 75 75 sonography and clinical suspicious of injury. Marco et
Colon 50 81.2 al11 in their study have reported an acceptable accu-
racy for fluid and liver, splenic and renal injuries in pa-
Mesentery 25 87.5
tients with major trauma. In other words, they stated
Retroperitoneal hematoma 62.5 100
that CT had a high diagnostic accuracy for single le-
Table 2. Positive and negative predictive values of CT scan sions in both major and minor trauma. They suggested
Organs PPV(%) NPV(%) that the false negative reports in their study represented
Liver 83.3 100 lack of detail of whole body protocols and artifacts due
to patients’ condition. On the contrary, Livingston et
Kidney 66.6 86.1
al15 believe that patients with suspected abdominal in-
Spleen 81.2 90
jury should be observed in hospital for at least 24 hours
Pancreas 50 74.9
even when there is no signs of injury in CT scans
Stomach 23.5 94.7
Duodenum 38.4 91.3 It could be concluded that compared with diagnos-
Small intestine 60 85.7 tic methods such as ultrasonography, CT scan is es-
Colon 25 92.8 pecially for solid organs. On the other hand, it is not an
invasive method compared with DPL. In regard with the
Mesentery 71.4 48.2
high specificity of CT images in the absence of injury,
Retroperitoneal hematoma 100 90.3
no laparotomy is required when the CT scan images
4. .4. Chinese Journal of Traumatology 2009; 12(2):1-4
are reported to be normal. 7. Radwan MM, Abu-Zidan FM. Focused assessment
sonograph trauma (FAST) and CT scan in blunt abdominal trauma:
The findings of the present study reveal that CT scan surgeon’s perspective. Afr Health Sci 2006; 6(3): 187-190.
can be considered as a good choice especially for pa- 8. Otimo Y, Henmi H, Mashiko K, et al. New diagnostic
tients with blunt abdominal trauma in teaching hospi- peritoneal lavage criteria for diagnosis of intestinal injury. J Trauma
tals where the radiologic academic staff is not present 1998; 44(6): 991-999.
in the hospital in the night shifts. Many believe the 9. Wintermark M, Mouhsine E, Theumann N, et al. Thora-
sonography performed during these hours lack the ac- columbar spine fractures in patients who have sustained trauma:
ceptable accuracy because it is not performed by an depiction with multi-detector row CT. Radiology 2003; 227(3):
expert radiologist. Using CT scan, the residents are 681-689.
able to have the images with an acceptable sensitivity 10. Valentino M, Serra C, Zironi G, et al. Blunt abdominal
and specificity to report the abdominal injuries. trauma: emergency contrast-enhanced sonography for detection
of solid organ injuries. AJR Am J Roentgenol 2006; 186(5): 1361-
Acknowledgment: The authors of this article are indebted 1367.
to the Research and Development Center of Sina Hospital for its 11. Marco GG, Diego S, Giulio A, et al. Screening US and CT
cooperation. for blunt abdominal trauma: a retrospective study. Eur J Radiol
2005; 56(1): 97-101.
REFERENCES 12. Brofman N, Atri M, Hanson JM, et al. Evaluation of
bowel and mesenteric blunt trauma with multidetector CT.
1. Nagy KK, Roberts RR, Joseph KT, et al. Experience with Radiographics 2006; 26(4): 1119-1131.
over 2500 diagnostic peritoneal lavages. Injury 2000; 31(7): 479- 13. Fakhry SM, Watts DD, Luchette FA, et al. Current diag-
482. nostic approaches lack sensitivity in the diagnosis of perforated
2. Healey MA, Simons RK, Winchell RJ, et al. A prospective blunt small bowel injury: analysis from 275, 557 trauma admis-
evaluation of abdominal ultrasound in blunt trauma: is it useful? J sions from the EAST multi-institutional HVI trial. J Trauma 2003;
Trauma 1996; 40(6): 875-885. 54(2): 295-306.
3. Chiguito PE. Blunt abdominal injuries. Diagnostic perito- 14. Scaglione M, de Luto di Castelguidone E, Scialpi M, et al.
neal lavage, ultrasonography and computed tomography scanning Blunt trauma to the gastrointestinal tract and mesentery: is there a
injury 1996; 27(2): 117-124. role for helical CT in the decision making process? Eur J Radiol
4. Boulanger BR, Brenneman FD, McLellan BA, et al. A pro- 2004; 50(1): 67-73.
spective study of emergent abdominal sonography after blunt 15. Livingston DH, Lavery RF, Passannante MR, et al. Ad-
trauma. J Trauma 1995; 39(2): 325-330. mission or observation is not necessary after a negative abdominal
5. Brown CK, Dunn KA, Wilson K. Diagnostic evaluation of computed tomographic scan in patients with suspected blunt ab-
patients with blunt abdominal trauma: a decision analysis. Acad dominal trauma: results of a prospective, multi-institutional trial.
Emerg Med 2000; 7(4): 385-396. J Trauma 1998; 44(2): 273-280.
6. Blow O, Bassam D, Butler K, et al. Speed and efficiency in
the resuscitation of blunt trauma patients with multiple injuries: (Received August 25, 2008)
the advantage of diagnostic peritoneal lavage over abdominal com- Edited by SONG Shuang-ming
puterized tomography. J Trauma 1998; 44(2): 287-290.