Evaluation of the diagnostic value of a venous phase in CT angiography of the extremities in the setting of trauma: is vein imaging in vain?

Purpose

This study examined the value of including a venous phase in addition to the initial arterial phase in the CT angiography evaluation of extremity trauma.

Methods

CT studies from 157 patients (average age 38 years, age range 18–89 years, male 83%, female 17%) were obtained for trauma to the upper or lower extremity with both arterial and venous phases and retrospectively reviewed. The detection rate and type of vascular injury were evaluated by using the arterial phase alone and compared to the detection rate when interpreting the arterial and venous phases together.

Results

Arterial injury was identified in 35 cases (22%), and venous injury was identified in seven cases (5%). Four cases of discrepant diagnoses were identified between image interpretation of the arterial phase alone and interpretation using both phases, all of which were venous injuries that were visible only on the venous phase. None of the four cases of venous injury required a change in surgical management. Overall, no significant difference in diagnosis between the two methods of image interpretation (arterial phase alone, arterial and venous phases) was discovered (p > 0.125; CI 95%).

Conclusions

The use of a venous phase in the CT angiography evaluation of extremity trauma does not add significant arterial diagnostic or clinical management value despite its potential of increasing the diagnostic detection rate of venous injury.

     

What is the significance of haemosiderin in the lungs of deceased infants?

In infants, pulmonary haemosiderin has been put forward as a marker of previous asphyxic abuse and possible grounds for suspicion of homicide. Review of the available literature does not provide a strong enough evidence base to support this claim. Further research is needed before instigation of criminal proceedings can be justified on this pathological finding.     

Is exercise of value in the prevention of fragility fractures in men?

Exercise during growth seems to build a stronger skeleton resulting in a high peak bone mineral density (BMD) in men. Exercise during adulthood produces benefits in BMD or prevents bone loss, but the changes are of minor biological significance as regards fracture reduction. However, prospective intervention studies suggest exercise to improve muscle strength, co-ordination and balance, even in octogenarians—all traits possible to reduce the number of falls. It is virtually impossible to undertake a randomized blinded study of exercise with fracture as end point due to the large cohorts needed. Retrospective and prospective observational and case control studies suggest activity to be associated with reduced fracture risk. This may be correct, but consistently replicated sampling bias may produce the same observation. The Achilles heel of exercise is the cessation of physical activity. Biologically important benefits in BMD or improvement in muscle size and strength achieved by exercise during growth and young adulthood seem to be eroded in retirement, leaving virtually no remaining benefits in old age, the period when fragility fractures exponentially rise. On the contrary, continued exercise on a lower level may maintain some of the musculoskeletal benefit, but dose– response relationships need to quantified, as do the effects of exercise on bone size, shape, architecture and frequency of injurious falls. Absence of evidence is not evidence of absence of effect, but if we recommend exercise then should this be to children, adults, elderly men or men with fractures? What type of exercise? For how long? How many fewer fractures will result in the community from a community based exercise campaign like the anti-tobacco campaign? The higher level of proof, suggesting exercise to reduce spine and hip fractures must come from well designed and executed prospective randomized studies. Blinded studies obviously cannot be done but open trials can, and should be undertaken.     

What is the message of a meeting? Analysis and comparison of the 2458 abstracts of the EANM/WCNMB congress in Berlin and the SNM meeting in Toronto in 1998

The abstracts of the joint congress of EANM/ WCNMB in Berlin 1998 and of the 45th Annual Meeting of the Society of Nuclear Medicine in Toronto 1998 have been analysed and compared in terms of comprehensibility, composition, questions at issue, methods, patient/subject number, type of conclusion and duplication of information between the meetings. All 1362 and 1096 abstracts, respectively, were analysed from the abstract books with regard to ten ”hard” and four ”soft” variables. The dominant topics were new radiopharmaceuticals, methods of synthesis, examination methods, evaluation of examinations, investigation algorithms, technical devicesand novel use of radiopharmaceuticals. In addition to these topics, there were numerous reports about established radiopharmaceuticals and techniques, often without a specific merit mentioned. There were also many abstracts with questions outside nuclear medicine, but using such techniques. Few papers reported negative findings or dealt with quality assurance, dosimetry, and cost-effectiveness. Many of the conclusions contained hyperbole. Some abstracts were very extensive and detailed. Sixty-seven contributions conveyed identical information at both meetings. Structured and/or paragraphed abstracts promote clarity and reduce the number of lines that need to be read in order to comprehend the background and aim of the abstract. Such contributions were more frequent at the EANM/WCNMB congress while the SNM meeting covered a wider field with a greater representation of radiophysics, instrumentation, and computer evaluations.     

The place of bigamy in the pantheon of crime?

Bigamy is officially classified as a 'sex offence'. The offence is rare and attracts little criminological attention, and the reaction of the courts has become more lenient in recent years, yet the media coverage of bigamy remains quite pervasive. An analysis of the criminal career profile over 32 years (1963-94) of the 42 bigamists convicted in 1973 indicates that they had no other convictions for bigamy and only two had convictions for a sex offence. Among the 25 persons with other convictions, the crimes of theft/handling stolen goods and fraud and forgery predominate. In fact, the criminal careers of these bigamists are more similar to the criminal careers of white collar offenders than of other sex offenders. It is suggested that by looking at convicted bigamists' criminal careers one can more appropriately categorize the crime as deception, and in this context we need to consider how to respond to its perpetrators and victims.     

Do anatomic variants of the acromion shape in the frontal plane influence pain and function in calcifying tendinitis of the shoulder?

Purpose  

To evaluate the relationship of a large acromion index and calcifying tendinitis of the supraspinatus tendon at the shoulder.     

Evaluation of the ossification of the medial clavicle according to the Kellinghaus substage system in identifying the 18-year-old age limit in the estimation of forensic age—is it necessary?

International Journal of Legal Medicine - The evaluation of the ossification of the medial clavicular epiphysis being part of an assigned expert approach according to standard plays an important...     

Interventional radiology in the management of hepatic injuries

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Contrast enhanced sonography of the gallbladder: A tool in the diagnosis of cholecystitis?

RATIONALE AND OBJECTIVES: To evaluate if contrast enhanced sonography (CES) can help to detect gallbladder inflammation and differentiate between acute and chronic cholecystitis. MATERIALS AND METHODS: Thirty-three patients with clinical suspicion of acute cholecystitis were examined with CES before cholecystectomy. Thirty patients with no history of gallbladder disease served as control. CES was performed using 2.5 mL SonoVue. A small mechanical index was chosen (0.1). The enhancement pattern of the gallbladder was ranked in a three-point scale: no enhancement, low enhancement and strong enhancement. 28/33 patients underwent surgery. Sonographic findings were compared to histological results. RESULTS: In 16/20 cases with histological proven acute cholecystitis, the gallbladder wall showed a strong enhancement. Low enhancement was found in four patients with acute and in six patients with chronic cholecystitis. The gallbladder wall of two patients with chronic inflammation and all patients (30/30) of the control group showed no enhancement. CONCLUSION: CES is a feasible tool for detecting gallbladder inflammation. Differentiating between acute and chronic cholecystitis seems to be possible.     

What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?

AIM: To analyse the role played by bone scintigraphy in the diagnosis of infected joint prostheses. METHODS: The study included 77 patients, aged 32-77 years, in whom infection of a joint prosthesis (48 hip, 29 knee) was suspected. In all patients the following examinations were performed consecutively: a two-phase Tc methylene diphosphonate (Tc-MDP) bone scan, a Tc hexamethylproplyene amine oxime (Tc-HMPAO) labelled white blood cell (WBC) scan, and a Tc microcolloid bone marrow (BM) scan. The minimum interval between examinations was 48 h. The diagnoses were based on data obtained from bacteriological cultures. RESULTS: The bone scan was positive in all patients and 28 of them had an infection (sensitivity 100%, specificity 0%). The WBC scan was positive in 61 patients but only 27 had an infection. The WBC scan was negative in 16 patients, and the possibility of infection was discarded in 15 of these cases (sensitivity 96%, specificity 30%). The results of the bone marrow scan were not compatible with those of the WBC scan (suggestive of infection) in 27 patients: 26 of them had prosthesis infection. The results of both examinations were compatible in the other 34 patients and the possibility of infection was discarded in 33 of these patients (sensitivity 92.8%, specificity 98%). The addition of a BM scan to a WBC scan decreased the sensitivity from 96% to 92.8% but increased specificity from 30% to 98%. The addition of a bone scan to this dual combination did not alter the results. CONCLUSIONS: When infection of a prosthesis is suspected the diagnostic procedure should start with a WBC scan followed, if positive, by a BM scan. This procedure reduces the cost, the time required for a diagnosis, and the dose of radiation received by the patient.