European radiology
-
Blunt trauma victims and selected patients with penetrating trauma are systematically investigated after resuscitation and hemodynamic stabilization with cross-sectional imaging. Computed tomography is a good predictor of the need for hemostatic arteriographic embolization, based on contrast medium extravasation observed on CT. In centers admitting polytrauma patients, the CT and angiography units should be installed together within the emergency environment. ⋯ In patients with visceral bleeding, arterial embolization can obviate primary surgery or potentializes surgical intervention and contributes to changing hierarchy of injuries to be treated surgically. Failure to achieve primary hemostasis may occur according to the type of specific organ injury and coagulation and metabolic parameters of the patient. Postembolization complications are few and are usually non-life-threatening and rarely carry definitive sequelae.
-
Posttraumatic osteomyelitis is frequently characterized by chronicity and recurrent activation of infection. The diagnosis is usually made on the basis of clinical, laboratory, and imaging examinations. ⋯ A variety of more sophisticated modalities, such as modern cross-sectional imaging and radionuclide studies, are available, and the decision to choose the most suitable method can be very difficult. This review gives an overview of definition, epidemiology, and pathophysiology of chronic posttraumatic osteomyelitis and discusses the value of currently used imaging modalities.
-
Our objective was to determine the value of the Ottawa knee rules when applied by users with different levels of clinical training. We used a prospective patient survey by the medical students and surgery residents of a European university trauma centre. The study group consisted of 261 eligible patients who presented with acute knee trauma during a 6-month period. ⋯ Variable degree of medical competence of the users did not alter the accuracy of the rules. Application of the rules would have reduced knee radiography requests by 25%. The Ottawa knee rules remain highly sensitive when applied by medical users with different levels of qualification, such as encountered in a teaching setting.
-
Nonketotic hyperglycinemia (NKH) is an inborn error of amino acid metabolism caused by a defect in the glycine cleavage multienzyme complex resulting in high concentrations of glycine within the brain and spinal cord. Quantitative magnetic resonance spectroscopy ((1)H-MRS) allows measurement of absolute glycine concentrations within different parts of the brain in vivo. In addition, (1)H-MRS may be useful in monitoring treatment of NKH and to differentiate this disease from other disorders of glycine metabolism.
-
The aim of this study was to determine whether intravenous (IV) glucagon and dual positioning administered prior to CT colonography enhances colonic distention. We assessed the effect of dual positioning and IV glucagon on colonic distention in 96 patients who underwent CT colonography examinations. The CT colonography was performed in both supine and prone positions. ⋯ There was almost perfect agreement between both radiologists in their scoring of colonic distention on a per-patient basis ( k=0.9; p<0.001). Of 1480 bowel segments, 1261 (85.2%) were adequately distended in the glucagon group compared with 370 of 440 bowel segments (84%) in the non-glucagon group ( p=n.s.) Colonic distention at CT colonography is improved by dual positioning but not by the administration of intravenous glucagon. While our results suggest that other smooth muscle relaxants, including butyl scopolamine, may only have a limited role in improving colonic distention in CT colonography, further studies are required.