Imaging of blunt pancreatic trauma : the value of initial and sequential CT examinations

Background: The purpose of the study was to assess the value of initial, repeated and sequential computed tomography (CT) in patients with blunt pancreatic trauma, and then define and correlate CT findings with endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), ultrasound (US), both laboratory and surgical findings. Material/Methods: This retrospective study covers an eight-year period from 1999 to 2007. The material includes 21 patients (17 males and 4 females) with confirmed pancreatic injury. CT was performed on admission in all cases and in 15 cases follow-up CT was performed from 24 hrs to 14 days later. US was performed in 9 cases, ERCP in 8 cases and MRCP in one case. Serum amylase level was obtained at the admission in all cases. Results: The CT at admission was positive in 17 patients (81.0%); the diagnosis was missed in 4 patients (19.0%), all performed on single row spiral CT. In all these four cases repeated CT was positive. ERCP showed rupture of the main pancreatic duct in 7 cases, one was inconclusive. One MRCP was positive. The serum amylase was elevated in 14 cases (66.7%) Specific CT features in initial and repeated examinations together were: organ fracture - 33.3%, swelling - 38.1%, haematoma/contusion - 38.1%, fluid between splenic vein and pancreas - 19.0%. Non-specific features were: thickening of anterior-renal fascia - 23.8%, fluid in lesser sac - 28.6%, extra peritoneal fluid - 42.9%, associated splenic injury - 14.3% and intraperitoneal fluid - 38.1%. On retrospective analysis, two out of four false negative CT results could have been avoided. No correlation between the CT features and the outcome of surgical and conservative management could be found in this study. Conclusions: A proper technique and accurate reading of images are mandatory for the diagnosis of pancreatic injury. When CT performed on admission is negative and there is abdominal pain and an elevated serum amylase, CT examination should be repeated within 24-48 hours

Site‐specific factors for cancer of the corpus uteri from SEER registries: Collaborative stage data collection system, version 1 and version 2

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109623/1/cncr29054.pd

Ambulatory hysteroscopy

This is the pre-peer reviewed version of the following article: Cooper, NAM, Clark, TJ. Ambulatory hysteroscopy. The Obstetrician & Gynaecologist 2013; 15: 159– 66., which has been published in final form at https://doi.org/10.1111/tog.12039. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions

Role of MRI in staging and follow-up of endometrial and cervical cancer:pitfalls and mimickers

Abstract MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis

Investigating Variation Orders Causes in Iraqi Building Construction Projects

Changes are a common phenomenon in the construction industry, impacting the project's cost, time, and performance. The purpose of this work is to a comprehensive review relating to variation order causes. Also, the aim here is to determine variation order causes in the building’s construction. More importantly, explore the relationship between these causes. However, the importance of specifying the causes for change orders is the first step in managing variation orders to reduce the harmful effect on a project. The field survey was conducted for several institutions such as health (Karkh’s health), higher education (University of Baghdad and University of Kufa). As a result, a field visit was made to the project sites. They were then, Conducting interviews with the resident engineer, the consultant, and the contractor. A developer tool called cause (variation orders) breakdown structure (CBS) included 12 causes at the first level, including 103 sub-causes. There is a relationship between the variation orders causes, which is evident in the third level. The study recommends adopting (CBS) a comprehensive reference for variation order causes in projects due to facilitating their management processes. Future research could examine the relative importance of variation order causes, in addition to using a fuzzy cognitive map to find the extent of each cause’s influence on the other