Comparison of radiation doses to patients undergoing standard radiographic examinations with conventional screen-film radiography, computed radiography and direct digital radiography

New flat-panel direct digital radiography equipment has recently been installed in our Accident and Emergency Department; its characteristics and versatility are well suited to the work undertaken in this environment. The aim of this study was to compare radiation doses to patients undergoing standard radiographic examinations using conventional screen-film radiography, computed radiography and direct digital radiography; entrance surface dose and effective dose were calculated for six standard examinations (a total of 10 projections) using standard patient exposure parameters for the three imaging modalities. It was found that doses for computed radiography (all examinations) were higher than the doses for the other two modalities; effective doses for direct digital radiography were approximately 29% and approximately 43% lower than those for screen-film radiography and computed radiography, respectively. The image quality met the criteria in the European guidelines for all modalities.     

A comparison between oculomotor rehabilitation and vestibular electrical stimulation in unilateral peripheral vestibular deficit

Rehabilitation therapy is proved to be effective in reducing disability in patients with persistent symptoms of disequilibrium after acute unilateral peripheral vestibular deficit. The aim of this study was to evaluate the effects of oculomotor rehabilitation (group 2) on static balance and a dizziness handicap and to compare those with the effects to vestibular electrical stimulation (group 1). Before and after therapy, we tested 28 patients, using static posturography and.the dizziness handicap inventory short form. After therapy, all subjects reported a reduction of symptoms (p = .00019). In group 1, the reductions seen in eyes-opened length of the oscillations and eyes-opened and eyes-closed surface of the body sway were statistically significant, respectively (p = .04; p = .02; p = .02). Group 2 patients revealed better stability on all parameters, and the reductions of eyes-opened length and of eyes-opened correlation function between length and surface were statistically significant (p = .01 and p = .01, respectively). Analysis of the equilibrium system subcomponents did not show any variation. Oculomotor exercises,employed in most rehabilitative protocols and including head movements to improve vestibular adaptation, have proved to reduce the perceived overall impairment and postural sway in patients with recent unilateral vestibular disorders, even though the disorders are not associated with head movements. Comparison of our two study groups did not show any significant difference, revealing that both forms of therapy are effective.     

Correlations between welfare initiatives and breastfeeding rates: a 10-year follow-up study

Aim: To evaluate the prevalence of full breastfeeding during the first 6 months of age and to discover if training programs for health caregivers and welfare initiatives at the community level could improve breastfeeding rates.
Methods: Newborn babies with gestational age ≥ 36 weeks and birth weight ≥ 2500 g, discharged from the hospital within the first week of life, without any underlying pathologies, were enrolled in 3-month long sample periods between 1997 and 2006. A questionnaire was distributed to the mothers, to be completed and submitted before hospital discharge. Data were collected from phone interviews at 1, 3 and 6 months.
Results: Full breastfeeding rates at hospital discharge showed an oscillation between 69.9% and 87%. The rate decreased in the following months and reached very low levels at 6 months of age (<24%), with the exception of the last sample period in 2006 (44.9%).
Conclusion: A simple questionnaire, combined with standardized phone interviews, can be easily reproduced and may be used as an indicator for quality of neonatal care at hospital nurseries. A social and cultural change of the whole community towards breastfeeding promotion will result in increasing breastfeeding rates.     

Rounded atelectasis of the lung

Rounded atelectasis is an uncommon but increasingly recognized form of pulmonary collapse that often mimics a pulmonary neoplasm. It is suggested that these lesions can occur many years after exposure to asbestos or exudative pleural effusions. The authors report 16 cases of rounded atelectasis seen during a period of over 10 years, 9 of which in the last 18 months. They describe the plain film, tomographic and CT appearances of the lesion. The radiographic features that allow a diagnosis are rounded or oval shadows lying along the posterior surface of the lower lobe, adjacent to thickened pleura. Lateral tomography and CT show the blood vessels and bronchi curving toward the mass and converging on one edge, like a comet tail. Differentiation of rounded atelectasis from neoplastic disease is essential in avoiding unnecessary thoracotomy.     

Laparoscopy in afferent loop obstruction presenting as acute pancreatitis.

BACKGROUND: We describe an afferent loop obstruction caused by an adhesion band in a case of distal gastrectomy with Roux-en-Y end-to-side jejunal anastomosis for cancer. METHODS: An initial clinical presentation of acute pancreatitis was ruled out by a computed tomography scan, which revealed intestinal obstruction; it was then confirmed on laparoscopy. Definitive treatment was laparoscopic adhesiolysis. A complete review of the literature concerning afferent loop obstructions is presented. RESULTS: The treatment was successful, with minimal postoperative pain, and the 5-day hospital stay was uncomplicated. The patient remains asymptomatic at 1-year follow-up. CONCLUSIONS: The authors advocate minimally invasive surgery as a complete diagnostic and therapeutic alternative to emergency laparotomy in cases where afferent loop syndrome is suspected, and acknowledge that prompt surgery has a higher rate of success and reduces operative morbidity and mortality.