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  • 1
    ISSN: 1438-1435
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1438-1435
    Keywords: Key words Ultrasonography – Computed tomography – Abdominal injury – Multiple trauma patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To examine treatment decisions in multiple trauma patients and determine how often these decisions are based on abdominal ultrasonography (US) findings, and how frequently these decisions are altered by subsequent computed tomographic (CT) imaging. Methods: From August 1996 to July 1997 we prospectively performed abdominal US followed by abdominal CT in all hemodynamically stable multiple trauma victims who did not need immediate surgery. We recorded the results from both modalities, as well as the treatment decisions based on these results. We also noted how frequently therapy based on US results was altered by the subsequent CT findings. Results: Treatment decisions were influenced by either US or CT in 27 of 105 patients (25.7 %). US was interpreted as normal in 76 patients (72.4 %), including 5 (6.6 %) who were subsequently found to have therapeutically significant findings on CT. US was interpreted as abnormal in 29 (27.6 %) patients, 12 of whom (41.4 %) had their management altered by subsequent CT results. Conclusions: Abdominal CT findings prompt changes in therapy in only a small number of stable multiple trauma patients who exhibit normal abdominal US. On the other hand, CT may have an impact on acute therapy in a large number of patients who exhibit abnormal US. Our results demonstrate that a diagnostic approach in hemodynamically stable patients is possible with US serving as a decision maker to determine whether further CT imaging is needed.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Emergency radiology 7 (2000), S. 287-291 
    ISSN: 1438-1435
    Keywords: Key words Cervical spine – Radiography – Injury – Elderly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Elderly patients are known to be at increased risk of cervical spine injuries. This propensity for injury becomes more important as the population of mobile elderly individuals increases. The present study seeks to examine the incidence and spectrum of spine injury among patients aged 80 years or greater, and to examine the efficacy of a decision rule for obtaining cervical spine radiography in this extreme age group. The decision rule would determine whether imaging could be avoided in patients who have none of the following: (1) posterior midline cervical spine tenderness; (2) focal neurological deficit; (3) abnormal level of alertness; (4) evidence of intoxication; or (5) clinically apparent distracting painful injury. Methods: All blunt trauma victims presenting to participating emergency departments underwent clinical evaluation prior to radiographic imaging. The elements of the decision rule were assessed and documented in each patient prior to radiographic imaging. The presence or absence of cervical spine injury was subsequently based on the final interpretation of all radiographic studies supplemented by a review of neurosurgical and risk management logs from each participating hospital. Data on all patients aged 80 years or greater were sequestered from the main database for separate analysis. Results: The study enrolled 34,069 individuals, including 818 patients (2.4 %) with cervical spine injuries. This population contained 1,070 patients (3.1 % of all cases) aged 80 or greater, 50 of whom (4.7 %) sustained cervical spine injuries. Injuries to the craniocervical junction (particularly C2 and the odontoid) accounted for 47.3 % of the injuries in the elderly, but only 28.6 % of injuries in younger patients. Older fracture victims were also likely to have more injuries (2.54 injuries/patient) than their younger counter parts (1.78 injuries/patient). The decision rule correctly identified all very elderly cervical spine injury victims [sensitivity 100.0 %; confidence interval (CI) 92.9–100.0 %], and designated 132 patients as “low-risk,” yielding a negative predictive value of 100.0 % (CI 97.3–100.0 %). Conclusions: The very elderly are at increased risked of cervical spine injury, particularly injury to the craniocervical junction. They also tend to have more extensive injuries than younger patients. Despite the increased risk of injury, the decision rule performed well in the very elderly, and allowed correct identification of all cervical spine injury victims.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Emergency radiology 7 (2000), S. 298-301 
    ISSN: 1438-1435
    Keywords: Key words Plain film – Pneumoperitoneum – Uppermost abdomen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Even with the advent of CT, the plain film should not be neglected for the diagnosis of pneumoperitoneum. However, supine views must encompass the entirety of the peritoneal cavity, especially its uppermost areas, because those are the most likely sites of free air deposition. In actuality, the recumbent plain film so positioned is exquisitely sensitive, approaching CT in its diagnostic incisiveness.
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  • 5
    ISSN: 1438-1435
    Keywords: Key words Computed tomography Small intestine Ischemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Acute small bowel ischemia is an important clinical entity with significant morbidity and mortality. Since the clinical presentation is often nonspecific, abdominal computed tomography (CT) is frequently obtained for the evaluation of patients with equivocal or unsuspected intestinal ischemia. In this article, the direct and ancillary CT findings of acute small bowel ischemia are reviewed. Although the individual CT manifestations are rarely specific, awareness of the spectrum of CT findings of small intestinal ischemia can help to suggest the diagnosis and direct appropriate management.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Emergency radiology 7 (2000), S. 319-323 
    ISSN: 1438-1435
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1438-1435
    Keywords: Liver, CT ; Portal vein thrombosis ; Abdomen, CT ; CT, artifact
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Portal vein (PV) thrombosis may be detected on contrast medium-enhanced computed tomographic (CECT) scans of patients with acute abdominal pathology. We describe a pitfall of dynamic CECT related to the normal arched configuration of the left PV umbilical segment. On axial images, just caudal to the left PV arch, there is an apparent discontinuity in the left PV lumen filled with low-attenuation fat in the intersegmental fisure. If opacified hepatic artery branches traverse the fissure at this level, an appearance mimicking segmental PV thrombosis with mural enhancement can result. A retrospective review of 180 CECT scans in patients without PV thrombosis revealed this phenomenon in seven cases (4%). Awareness of this pitfall obviates the need for superfluous investigations that might otherwise be necessary to confirm PV patency.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1438-1435
    Keywords: Cervical root avulsion ; Magnetic resonance imaging of brachial plexus injury ; Magnetic resonance imaging of the cervical spine ; Magnetic resonance imaging in trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cervical nerve root avulsion is hard to diagnose with cervical myelography even in combination with computed tomographic scanning. Although magnetic resonance imaging may not demonstrate a root avulsion, it can demonstrate the sequelae of traumatic injury, such as pseudomeningoceles or displacement of the spinal cord, contralateral to the avulsed root. The findings in three different patients are presented and discussed.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1438-1435
    Keywords: Lateral chest x-ray ; Emergency department
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine the utility of the lateral view of the chest in emergency department patients, records of all patients who had had 2-view chest x-rays ordered in the emergency department were reviewed retrospectively. A study radiologist recorded a reading of the posteroanterior (PA) radiograph alone. The lateral radiograph was then provided, along with the PA view, and a second reading was recorded. A comparison was then made between the first and second readings. A total of 417 sets of x-rays were included. The PA view alone successfully diagnosed or suspected 92% of pulmonary nodules, 95% of effusions, 97% of cases of emphysema, 98% of pneumonias, and 100% of cases of cardiomegaly, pulmonary edema, interstitial pulmonary disease, and atelectasis. In the emergency department patient population, lateral views of the chest have minimal diagnostic yield and therefore may be used selectively to safely decrease the amount of breast radiation exposure to young women.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1438-1435
    Keywords: Aorta ; Pulmonary artery ; Injury ; Gunshot ; Acquired arteriovenous fistula ; Arteriography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This report describes a patient who presented to our hospital in stable condition after sustaining a mediastinal gunshot wound and was found by arteriography to have a traumatic fistula between the ascending aorta and the pulmonary artery. Arteriography should be considered for transmediastinal penetrating wounds when the patient is asymptomatic.
    Type of Medium: Electronic Resource
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