Fatal abdominal injuries in a bicycle-pedestrian collision – Reconstruction using multibody simulation

Fatal bicycle-pedestrian collisions do not occur frequently and thus are rarely reported in literature. Pedestrians in bicycle-pedestrian accidents often sustain severe craniocerebral injuries caused by a collision induced fall with head impact on the road surface. We describe a case where a pedestrian crossing a road was hit by a bicycle. Hematomas of the left lower leg and of the left flank/abdomen were found to be caused by the primary impact. However, the fatal injuries were found to be contralateral with a rupture of the right renal pedicle, a rupture of the right lobe of the liver and a tear of the vena cava. Neither the bicycle impact nor a fall onto the road surface could cause these injuries. Multibody simulation (PC Crash 9.2) revealed entanglement between the bicyclist and the pedestrian followed by a contact interaction between the pedestrian laying on the road surface and the falling bicyclist. In forensic case work post-crash contact interactions between the bicyclist and the pedestrian should be considered as a potential source of severe injuries.     

Multifocal PVNS in a child – followed over 25 years

Pigmented villonodular synovitis (PVNS) is a rare disorder of unknown aetiology, characterised by a destructive fibrohistiocytic proliferation with production of villous and nodular protrusions. The disease is commonly monoarticular, and involves the knee in 80% of cases. Occurrence in a child and involvement of multiple joints are extremely unusual. We present a case of multiple joint PVNS in a patient who first presented at the age of five and was subsequently followed up for over twenty-five years. The literature on the subject is briefly reviewed.     

CT in children – dose protection and general considerations when planning a CT in a child

Today CT represents about 10% of all ionizing radiation based imaging modalities, but delivers more than 50% of the total collective dose for diagnostic imaging. Compared to adults the radiation sensitivity of children is considerable higher than in adults. Additionally children differ from adults – factors like body size, mass, density, proportions as well as metabolism have to be mentioned. Children grow and maturate – all this components have to be mapped in examination protocols by Pediatric Radiology. The total dose of a CT examination depends on the settings of several factors such as the scout view, the scan length, exposure settings including automated exposure control, type of scanning (single slice, helical, volume mode), slice thickness, pitch values as well as on image reconstruction parameters. If intravenous contrast media injection is needed bolus tracking or timing represents another source of radiation.     

Pattern approach to MR imaging in patients with end-stage hepatic failure: a proposal for a new disease entity “hepatic encephalopathy continuum”

INTRODUCTION: The purpose of this study was to evaluate the clinical features and the characteristics of MR images of patients with end-stage hepatic failure. METHODS: We reviewed the MR findings and clinical features of 31 consecutive patients (20 men, 11 women=31, mean age 58.7 years) who had been diagnosed with clinical hepatic encephalopathy. Associations between the lesion locations on each MR sequence were analyzed using a binominal test. The clinical and MR findings were compared in relation to the etiology and clinical status. RESULTS: The most frequently involved site, seen as high signal intensity on T2-W images, was the corpus callosum (20 patients), followed by the dentate nucleus (16 patients) and the globus pallidus (13 patients). Significant associations were seen between the pallidus and the crus cerebri, between the crus cerebri and the red nucleus, between the crus cerebri and the dentate nucleus, and between the red nucleus and the dentate nucleus on the T2-W and DW images (P < 0.004). The crus cerebri, red nucleus, and dentate nucleus were involved concurrently with the corpus callosum more frequently in hepatic encephalopathy grades 3 and 4. CONCLUSION: Concurrent involvement of the globus pallidus-crus cerebri-red nucleus-dentate nucleus axis was the main MR pattern in end-stage hepatic encephalopathy, which connected with various areas of the brain. We hypothesize that these overlapping MR features could be regarded as an entity denoted as the "hepatic encephalopathy continuum".     

Does variant hepatic artery anatomy in a liver transplant recipient increase the risk of hepatic artery complications after transplantation?

OBJECTIVE: Our aim was to determine whether variant hepatic artery anatomy in a liver transplant recipient increases the risk of hepatic artery complications after liver transplantation. MATERIALS AND METHODS: The study group consisted of 84 patients who underwent gadolinium-enhanced 3D MR angiography before orthotopic liver transplantation in which a branch patch arterial anastomosis at the gastroduodenal takeoff was used. MR angiography studies were retrospectively reviewed and assessed for the presence and type of variant hepatic artery anatomy. The diameter of the distal common hepatic artery was measured. The incidence of posttransplantation hepatic artery stenosis or thrombosis was assessed. RESULTS: Seven (8.3%) of the 84 patients developed hepatic artery complications after transplantation. Of the 24 patients with variant hepatic artery anatomy, five (20.8%) had posttransplantation/ hepatic artery complications. In contrast, only two (3.3%) of the 60 patients with classic hepatic artery anatomy had complications. The higher complication rate in patients with variant hepatic artery anatomy was statistically significant (p < 0.05). The odds ratio was 7.6 (95% confidence interval, 1.4-42.6). The diameter of the distal common hepatic artery was smaller in patients with variant hepatic artery anatomy compared with those with classic hepatic artery anatomy (range, 4.3-7.1 mm [mean, 5.8 mm] vs 4.0-8.9 mm [mean 6.3 mm], p < 0.05), and it was also smaller in patients who had posttransplantation hepatic artery complications compared with those who had no complications (range, 4.2-6.3 mm [mean, 5.2 mm] vs 4.0-8.9 mm, [mean, 6.2 mm], p < 0.01). CONCLUSION: Variant hepatic artery anatomy in a liver transplant recipient increased the risk of hepatic artery complications after transplantation. The smaller caliber of the native common hepatic artery may contribute to the higher risk.     

Cocaine found in a child’s hair due to environmental exposure?

We report a case of a 6-year-old boy who had been living with his parents, both cocaine smokers, and who was urgently admitted to hospital for general distress. Upon examination, cocaine and cocaine metabolites were detected in hair and urine samples. These toxicological findings most likely indicate that the child had passively consumed the drug when living in a heavily contaminated environment.     

“Guboow”—child abuse or traditional medical treatment? a case report

International Journal of Legal Medicine - The examination of children suspected of being abused poses a great challenge for forensic pathologists. The risk of misjudgment is high and can have...     

Knee dislocations—a retrospective study comparing operative versus closed immobilization treatment outcomes

Controversies over operative versus closed immobilization of traumatic complex multiple ligamentous knee injury are still debated. The aim of our study is to evaluate the outcome of reconstructive vs non-reconstructive (closed immobilization) treatment outcomes. This is a retrospective review of cases seen at our institution. All cases admitted with a diagnosis of knee dislocation, defined as patients with multidirectional knee instability in the setting of trauma, were reviewed. Twenty-nine consecutive patients from January of 1996 to June of 2002 were reviewed. Twenty-six patients (89.7%) were successfully recalled and their functional outcome analyzed. Comparing the operated group (n=15, 57.7%) with closed immobilized patients (n=11, 42.3%), there was no statistical difference in the range of motion (mean difference 8.55°, p=0.202). While the operated group had more flexion contracture (mean difference 3.9°, p=0.002), they had better stability and better overall knee function as measured by the International Knee Documentation Committee (IKDC) score (the mean difference of IKDC score was 12.13, p=0.005). In the operated group of 15 patients, we compared partial repair (n=7) with complete repair of all torn ligaments (n=8). Superior results were noted in the group with complete repair of all structures, with comparable range of motion (mean difference 0.6°, p=0.861) and flexion contractures (mean difference 1.0°, p=0.795) but better stability and IKDC score (mean difference of IKDC score 13.6, p=0.003). Our conclusion is that operative treatment with complete repair of all torn structures produces the best overall knee function with better knee stability and patient satisfaction.     

Human botfly (Dermatobia hominis) larva in a child’s scalp mimicking osteomyelitis

Furuncular myiasis caused by Dermatobia hominis is endemic throughout Central and South America. However, because of widespread travel, furuncular myiasis has become more common in North America. Misdiagnosis and mismanagement can occur owing to limited awareness of the condition outside endemic areas. We report a case of furuncular myiasis in an immigrant from El Salvador with magnetic resonance imaging findings. The case is unique because neuroimaging was obtained upon the clinical suspicion of calvarial osteomyelitis. Parasitic infestation should be included in the differential diagnosis of a new skin lesion in patients who have traveled to endemic areas.     

Consultant practitioners in radiography—a discussion paper

In 2000 the NHS Plan announced a new grade of therapist consultant. Meeting the Challenge: A Strategy for the Allied Health Professions published in 2000, set out four core functions that will be expected of the new consultants. The implementation of new therapist consultant posts was announced in an Advance Letter in September 2001. This paper explores the issues and potential impact of consultants in radiography. Functions and key tasks are suggested and are compared against the indicative functions presented in the Advance Letter. The issues and implications for the profession are discussed and a strategy on how radiography should prepare for new posts is suggested.     

Combined percutaneous radiofrequency ablation and ethanol injection versus hepatic resection for 2.1–5.0 cm solitary hepatocellular carcinoma: a retrospective comparative multicentre study

Objectives

To compare combined percutaneous radiofrequency ablation and ethanol injection (RFA-PEI) with hepatic resection (HR) in the treatment of resectable solitary hepatocellular carcinoma (HCC) with 2.1–5.0 cm diameter.

Methods

From June 2009 to December 2015, 271 patients whom underwent RFA-PEI (n = 141) or HR (n = 130) in three centres were enrolled. The overall survival (OS) and recurrence-free survival (RFS) between groups were compared with Kaplan–Meier method and log-rank tests. Complications, hospital stay and cost were assessed.

Results

The OS rates at 1, 3 and 5 years were 93.5%, 72.7%, 58.6% in RFA-PEI group and 82.3%, 57.5%, 51.8% in HR group (p = 0.021). The corresponding 1-, 3- and 5-year RFS rates were 65.8%, 41.3%, 34.3% in RFA-PEI group and 50.5%, 33.8%, 28.4% in HR group (p = 0.038). For patients with 2.1–3.0 cm tumours, the 1-, 3- and 5-year OS after RFA-PEI and HR were 98.0%, 82.3%, 74.2% and 89.4%, 65.1%, 61.9%, respectively (p = 0.024). The corresponding RFS were 79.6%, 54.7%, 45.1% in RFA-PEI group, and 57.6%, 43.9%, 31.7% in HR group, respectively (p = 0.020). RFA-PEI was superior to HR in major complication rates, length of hospital stay and cost (all p < 0.001).

Conclusion

RFA-PEI had a survival benefit over HR in the treatment of solitary HCCs, especially for those with 2.1–3.0 cm in diameter.

Key Points

? RFA-PEI provided superior survival to HR in solitary HCC with 2.1–5.0 cm in diameter. ? RFA-PEI is superior to HR in complications, length of hospital stay and cost. ? RFA-PEI might be an alternative treatment for solitary HCC within 5.0 cm in diameter.

     

Imaging trends in suspected appendicitis—a Canadian perspective

Purpose

The purpose of our study was to assess trends in the imaging of suspected appendicitis in adult patients in emergency departments of academic centers in Canada.

Methods

A questionnaire was sent to all 17 academic centers in Canada to be completed by a radiologist who works in emergency radiology. The questionnaires were sent and collected over a period of 4 months from October 2015 to February 2016.

Results

Sixteen centers (94%) responded to the questionnaire. Eleven respondents (73%) use IV contrast–enhanced computed tomography (CT) as the imaging modality of choice for all patients with suspected appendicitis. Thirteen respondents (81%) use ultrasound as the first modality of choice in imaging pregnant patients with suspected appendicitis. Eleven respondents (69%) use ultrasound (US) as the first modality of choice in patients younger than 40 years of age. Ten respondents (67%) use ultrasound as the first imaging modality in female patients younger than 40 years of age. When CT is used, 81% use non-focused CT of the abdomen and pelvis, and 44% of centers use oral contrast. Thirteen centers (81%) have ultrasound available 24 h a day/7 days a week. At 12 centers (75%), ultrasound is performed by ultrasound technologists. Four centers (40%) perform magnetic resonance imaging (MRI) in suspected appendicitis in adult patients at the discretion of the attending radiologist. Eleven centers (69%) have MRI available 24/7. All 16 centers (100%) use unenhanced MRI.

Conclusions

Various imaging modalities are available for the work-up of suspected appendicitis. Although there are North American societal guidelines and recommendations regarding the appropriateness of the multiple imaging modalities, significant heterogeneity in the first-line modalities exist, which vary depending on the patient demographics and resource availability. Imaging trends in the use of the first-line modalities should be considered in order to plan for the availability of the imaging examinations and to consider plans for an imaging algorithm to permit standardization across multiple centers. While this study examined the imaging trends specifically in Canada, there are implications to other countries seeking to streamline imaging protocols and determining appropriateness of the first-line imaging modalities.

     

Mongolian spots as a finding in forensic examinations of possible child abuse–implications for case work

International Journal of Legal Medicine - Mongolian spots (MS) are congenital dermal conditions resulting from neural crest-derived melanocytes migration to the skin during embryogenesis. MS...     

Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion—a retrospective single center experience

Introduction

The study aimed to compare efficacy and safety of aspiration thrombectomy (AT) to stentriever thrombectomy (SRT) in patients with basilar artery (BA) occlusion (BAO).

Methods

We retrospectively included patients with the following characteristics: acute BAO or occlusion of the intracranial vertebral artery (ICVA) and endovascular therapy (EVT) with stentriever (SRT) or aspiration thrombectomy (AT). Additional extra- but not intracranial EVT and intravenous thrombolysis (IVT) were allowed.

Results

Between January 2013 and April 2016, 33 patients fulfilled the criteria (13 treated with SRT, 20 with AT). Prior to EVT, 23 (70%) patients received IVT. The proximal intracranial occlusion was ICVA in 2 patients, proximal BA in 5 patients, middle BA in 20 patients, and distal BA in 6 patients. Mean time to treatment was 334 min (95% CI 276–391 min). Procedure duration differed significantly (p = 0.002) as follows: 97 min with SRT (95% CI 69–124 min) and 55 min with AT (95% CI 43–66 min). Recanalization (arterial occlusive lesion (AOL) 2/3) was achieved in 26 patients (79%). Complete recanalization (AOL 3) happened more often with AT (75% (95% CI 65–85%)) compared to SRT (46% (95% CI 32–60%)). Conversion rate 6% (two patients). Hemorrhages occurred in 12 (36%) patients, periprocedural complications in eight (three dissections, five embolizations to new territory) (no group difference). Ten patients (30%) had a favorable outcome (mRS ≤3) at discharge; mortality rate was 24% (eight deaths) (no group difference).

Conclusion

In primarily embolic BAO, aspiration thrombectomy was faster, effective and not detrimental to outcome as compared to stentriever thrombectomy. Thus, it may be justified to use aspiration thrombectomy as first-line treatment in these patients.