Adequateness of radiography in recognizing rib fractures in minor chest trauma: A comparison of the efficacy of sonography and radiography

Introduction: The most common injury resulting from blunt chest trauma is a rib fracture (25%) which is usually visible on radiographs. However, radiographs sometimes cannot show fractures, especially those in cartilage, unless they're densely calcified. The present study aimed to investigate the role of ultrasonography (US) in detecting rib fractures with minor blunt chest trauma and comparing its success with posteroanterior (PA) chest radiography.Methods: Patients with minor blunt chest trauma who had previously undergone US and radiography to assess suspected rib fractures, between June 2017– March 2019, were included. Radiography was obtained in the PA projection. US was performed by a radiologist who identified fractures by the disruption of the anterior margin of the rib on the US. The incidence and location of the fractures detected by US and radiography were then compared.Results: Totally 126 patients were included in the study. Ninety-eight patients (78%) were admitted to the hospital for the first time, and 28 patients (22%) for the second time (they previously admitted to the other hospitals and were evaluated as ‘normal’ by radiography). A total of 108 fractures ( in 79 patients (63%) ) were detected based on radiography and US examination, while 47 patients (37%) had no diagnostic evidence of fracture. All fractures were correctly detected by ultrasonography (100%), whereas radiography revealed 16 fractures (14.81%). A statistically significant difference in diagnostic capability was found between patients diagnosed by radiography and US (p=0.001).Conclusion: Ultrasonographic imaging is significantly superior to radiography in terms of accuracy in diagnosing rib fractures. Ultrasound was found to be significantly superior to radiography regardless of trauma site, localization, and location. Even though some rib areas are inaccessible on ultrasonographic evaluation, rapid evaluation of the most affected areas is most effective with ultrasonography when it comes to minor energy chest trauma. For this reason, the US increases the accuracy of diagnosis in minor chest traumas and rib fractures and decreases the repetitive referral of patients to health institutions by reducing the missed diagnosis.Keywords: Rib fractures, thoracic injuries, trauma, ultrasonography, radiograph

A rare cause of recurrent respiratory tract infection: isolated absence of the right pulmonary artery

Unilateral absence of a pulmonary artery (UAPA) is a rare congenital anomaly presenting with a wide spectrum of symptoms. UAPA is usually associated with cardiac anomalies. Patients with isolated UAPA may be asymptomatic or may present with recurrent pulmonary infections. In the present study, we report UAPA in a four-year-old boy presenting with recurrent respiratory tract infections

Ischaemic brain changes associated with catheter-based diagnostic cerebral angiography : a diffusion-weighted imaging study

Purpose: This study aims to evaluate the incidence of clinically silent embolic cerebral infarctions and associated risk factors following diagnostic cerebral angiography with diffusion-weighted imaging (DWI). Material and methods: A total of 71 cerebral digital subtraction angiograms (42 male, 29 female, average age: 56.0 ± 15.0) obtained using nonionic contrast material were prospectively evaluated. To assess embolic events, before and after (1-3 days) angiography, DWI was performed. The risk factors for embolic ischemic brain changes such as the patient's age and sex, atherosclerotic vessel wall disease, type of indication for catheter angiography, the number and size of the catheters, anatomic variants, selective/nonselective catheterization, contrast media volume, and time of procedure were determined. Fisher's exact tests and Student t-tests were used for the statistical analyses of outcomes. Results: Thirteen new silent ischemic lesions were identified in 7 out of 71 patients who underwent diagnostic cerebral angiography. Embolic cerebral lesions were often 6-10mm in diameter. According to the findings in this study, there was a strong correlation between diffusion abnormality and patient age, which was considered risk factors (p 0.05). Conclusions: In elderly patients, the angiographic procedures should be performed meticulously and DWI in all patients obtained routinely, even if the regular neurological examination shows they are healthy. In this way, the presence of microemboli and clinical results can be evaluated

Acute right-sided colonic diverticulitis mimicking appendicitis: A report of two cases

We describe two right-sided diverticulitis cases that presented with marked right iliac fossa tenderness with guarding and rebound and laboratory parameters resembling acute appendicitis. The imaging findings suggested diverticulitis in both cases. One of the patients underwent surgery and the other one was followed up with medical treatment. Awareness of these imaging findings may aid in the diagnosis of right-sided diverticulitis, which is frequently misdiagnosed and mistreated. (c) 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 201

Diffusion-weighted MRI and FLAIR sequence for differentiation of hydatid cysts and simple cysts in the liver

Purpose: The contribution of DWI and FLAIR to the differential diagnosis of type 1, 2, and 3 hydatid cysts and simple liver cysts was investigated according to the Gharbi classification. This study is the first report using FLAIR sequence for the differential diagnosis of liver hydatid cysts in this regard. Methods: A total of 82 hydatid cysts and 40 simple cysts were scanned with DWI (in b600-b1000 values) and FLAIR sequence. In 64 patients included in the study, a total of 122 cystic lesions were diagnosed histopatho-logically or during follow-up. FLAIR and DWI signal characteristics were evaluated, and ADC values were calculated. Results: The mean ADC value of hydatid cysts on DWI (b600) was 3.07 +/- 0.41 x 10(-3) s/mm(2), while it was 3.91 +/- 0.51 x 10(-3) s/mm(2) for simple cysts and the difference was statistically significant (p < 0.05). On b1000 DWI, the mean ADC values of hydatid and simple cysts were 2.99 +/- 0.38 x 10(-3) s/mm(2) and 3.43 +/- 0:29 x 10(-3) s/mm(2), respectively (p < 0.05). The qualitative evaluation of the signal intensity on b600-1000 DWI demonstrated the difference between the simple and hydatid cyst groups (p < 0.05). Type 2 hydatid cysts alone were distinguished from type 2-3 hydatid and simple cysts by FLAIR (p < 0.05). Conclusions: ADC values can distinguish between hydatid cyst and simple cyst. FLAIR contributes to the differ-entiation of type 2 hydatid and simple cysts

Assessment of Cerebral Arterial Flow Volume Changes with Carotid Vertebral Artery Duplex Doppler Ultrasound in Young-Middle-aged Subclinical Hashimoto Thyroiditis Patients

OBJECTIVES: To demonstrate cerebral arterial flow volume changes during the hypothyroid, euthyroid, and hyperthyroid phases and comparing between laboratory findings and cerebral arterial flow changes with carotid-vertebral duplex Doppler ultrasound (CVA-DUSG) in subclinical Hashimoto thyroiditis (HT) patients. METHODS: According to the TSH level, 3 groups were constructed between patient cases. Group 1 (n=29) was the subclinical hyperthyroid group. In this group, the TSH level was between 0.0005 and 0.3 IU/ml. Group 2 (n=175) was the euthyroid group. TSH level in this group was between 0.3 and 4.2 IU/ml. Group 3 (n=76) was the subclinical hypothyroid group. In this group, the TSH level was above 4.2 IU/ml. The control-group (group 4) (n=71) included healthy people. In this group, the TSH level was between 0.3 and 4.2 IU/ml. After obtaining at least three consecutive waves from the bilateral internal cerebral artery and bilateral vertebral artery, volume flows were calculated using CVA-DUSG. Volume flows were calculated as peak systolic velocity + end diastolic velocity/2 × mean arterial diameter. The mean ICA(Internal Carotid Artery) and VA(Vertebral Artery) diameter was measured per ICA and VA. Total cerebral artery flow volume was defined as right ICA + right VA flow volume and left ICA + left VA flow volume. We also demonstrated topographic cerebral artery blood flow changes. Total ICA flow volume was used to assess the anterior part of the brain, total VA flow volume was used to evaluate the posterior part of the brain, right ICA + right VA flow volume was used to assess the right part of the brain, and left ICA + left VA flow volume was used to verify the left part of the brain. RESULTS: There were significant differences between RVA(Right Vertebral Artery) flow volume, LICA (Left Internal Carotid Artery) flow volume, total flow volume, TSH, and T3 and T4 levels in all groups according to the Dunn's multiple comparison test.(p<0.001) Mean TSH level was 0.03 (0.005-0.06) IU/ml in group 1, 2.8 (1.8-3.97) IU/ml in group 2, 7.32 (6.14-9.93) IU/ml in group 3, and 1.76 (1.17-2.49) IU/ml in the control group. The mean T3 level was 4.18 (3.55-5.38) in group 1, 2.88 (2.63-3.16) in group 2, 2.82 (2.49-3.15) in group 3, 3.14 (2.92-3.15) in the control group. The mean T4 level was 1.92 (1.29-2.5) in group 1, 1.16(1.03-1.31) in group 2, 1.01 (0.91-1.16) in group 3, 1.12 (0.97-1.30) in the control group (group 4). Mean total flow volume was 793 (745-898) ml/min in group 1, 742 (684.25-822.5) ml/min in group 2, 747 (692-824) ml/min in group 3, and 700 (673-675) ml/min in the control group. We also demonstrated topographic cerebral arterial volume flow changes with CVA-DUSG. There was a significant difference among all groups in the right and anterior parts of the brain (p < 0.001), and there was a significant difference between groups 1 and 4 in the left part of the brain (p = 0.009). CONCLUSION: This study demonstrated that total cerebral arterial volume flow increased in the hyperthyroid phase of subclinical HT cases without any internal carotid and vertebral artery diameter changes compared with the euthyroid and hypothyroid phases of subclinical HT and healthy cases. We also verified topographic cerebral arterial blood flow changes in subclinical HT cases with a real-time, easily applicable modality (CVA-DUSG) that does not include X-ray or contrast agents. There was a significant difference between all groups in the right and anterior parts of the brain and there was a significant difference between groups 1 and 4 in the left part of the brain. Copyright© Bentham Science Publishers; For any queries, please email at [email protected]

hemodiyaliz fistüllerinin en sık sebebi olan perianastomotik anostomozlarda balon anjioplasti yeteri kadar etkin mi?

Tutkimuksen aihe on teräksisen kaksoissymmetrisestä hitsatusta I-poikkileikkauksisesta pilarista ja rakenneputkiristikosta koostuvan kehän optimointi. Työn avulla SSAB:n on tarkoitus lisätä kaksoissymmetrinen hitsattu I-poikkileikkauksinen pilari FrameCalc-laskentaohjelmaansa. Myös alustavaa tutkimusta viistetyn pilarin optimoinnista ja lisäämisestä ohjelman pilarivaihtoehdoksi on tehty. Tavoitteena on ollut selvittää, miten pilarin ja kehän optimointitehtävät on asettava ja kuinka ne kannattaisi ratkaista, jotta saavutettaisiin mahdollisimman kevyt rakenne, joka täyttää eurokoodien vaatimukset lujuudelle ja stabiilisuudelle. Optimointi ja elementtimallin luominen on tehty Python-ohjelman avulla. Työssä on tutustuttu erilaisiin algoritmeihin ja niiden toimintaan sekä käsitelty optimoinnin peruskäsitteitä. Suunnittelumuuttujina on käytetty pääasiassa I- ja neliöputkiprofiilin poikkileikkausmittoja. Ratkaisumenetelmänä on käytetty pilarilla branch-and-bound -algoritmia, jossa muuttujat ovat diskreettejä. Tässä menetelmässä on alitehtävä, joka ratkaistaan trust region -algoritmilla. Kehän ratkaisumenetelmänä on käytetty kaksivaiheista menettelyä, jossa ensimmäisessä vaiheessa käytetään binäärimuuttujia sekä seka- ja kokonaislukuista peräkkäisten lineaaristen approksimaatioiden menetelmää. Toisessa vaiheessa käytetään indeksimuuttujia ja moniympäristöhakua, jonka alitehtävä ratkaistaan geneettisellä algoritmilla. Yksittäistä pilaria on tutkittu 144 erilaisella laskentatapauksella kolmella eri teräslajilla. Diskreeteillä muuttujilla optimoitua hitsattua I-profiilista poikkileikkausluokassa 2 tai 3 olevaa pilaria on vertailtu vastaavaan käypään SHS- ja HEA-profiiliseen pilariin. Tutkimuksen laskentatulosten perusteella voidaan sanoa, että painon kannalta on järkevää käyttää hitsattuja I-profiileita pilareina. Hitsattujen I-profiilisten pilareiden painoero HEA- ja SHS-profiileihin verrattuna korostuu pisimmillä tutkituilla pilareilla. Mitä pidempi pilari on, sitä enemmän optimoinnilla saavutetaan hyötyä painon suhteen. Laskentatapausten perusteella voidaan todeta, että pilarin ratkaisemiseen käytetty menetelmä näyttää sopivan hyvin kaksoissymmetrisen hitsatun I-profiilisen pilarin ratkaisemiseen. Kehällä on tutkittu neljää erilaista laskentatapausta kahdella eri teräksellä. Kehän optimointituloksista ei voida tehdä yhtä suoria päätelmiä kuin yksittäisen pilarin optimoinnista. Kehällä ei myöskään ole tutkittu niin paljon eri tapauksia, että voitaisiin tehdä kattavia johtopäätöksiä. Laskentatapausten perusteella on todettu, että käytetyt algoritmit eivät tässä työssä olleet kehän optimointitehtävän ratkaisemiseen sopivimpia