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Repeat head CT scan

Vikas Acharya, Suresh Chandrasekaran, Sujit Nair
INTRODUCTION: The authors present an interesting case of a 19-year-old male who presented as a polytrauma patient following a fall from a height. PRESENTATION OF CASE: He was initially managed on the intensive care unit with intracranial pressure bolt monitoring after being intubated and sedated and having his other traumatic injuries stabilized. Upon attempting to wean sedation and extubation a repeat CT scan of the head was undertaken and showed a new area suggested of cerebral infarction, this was a new finding...
October 3, 2016: International Journal of Surgery Case Reports
Gregory S Alexander, Joshua D Palmer, Madalina Tuluc, Jianqing Lin, Adam P Dicker, Voichita Bar-Ad, Larry A Harshyne, Jennifer Louie, Colette M Shaw, D Craig Hooper, Bo Lu
BACKGROUND: Pembrolizumab is a monoclonal antibody that is designed against programmed cell death protein 1 (PD-1). Pembrolizumab and other immunocheckpoint-blocking monoclonal antibodies work by modulating a patient's own immune system to increase anti-tumor activity. While immunocheckpoint blockade has shown promising results, only 20-40 % of patients experience objective clinical benefit. Differences in individual tumor biology and the presence multiple immune checkpoints present a challenge for treatment...
2016: Journal of Hematology & Oncology
Aashrai Gudlavalleti, Ryan Dean, Yuxin Liu, Amit S Dhamoon
Sinonasal neuroendocrine tumours (NETs) are rare, aggressive neoplasms with a high recurrence potential. There are no robust protocols for the management of these tumours. An 81-year-old man presented with an incidental sinonasal mass visualised on CT scan of head. Over the next few weeks he developed new onset, progressively worsening headache, right eye ptosis and restricted extraocular movements. Imaging confirmed a rapidly enlarging tumour involving the right nasal cavity and the orbit. Biopsy showed a large cell neuroendocrine carcinoma of the right ethmoidal sinus...
2016: BMJ Case Reports
Mary Ellen Zimmermann, Zachary Brown, Praise Matemavi, Gloria Melnic, Jason Sample
At many institutions, it is common practice for trauma patients with traumatic intracranial hemorrhage (ICH) to receive routine repeat head computed tomographic (CT) scans after the initial CT scan, regardless of symptoms, to evaluate progression of the injury. The purpose of this study was to assess quantifiable risk factors (age, anticoagulation, gender) that could place patients at greater risk for progression of injury, thus requiring surgical intervention (craniotomy, craniectomy) for which serial CT scanning would be useful...
September 2016: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Bo Mussmann, Søren Overgaard, Trine Torfing, Peter Traise, Oke Gerke, Poul Erik Andersen
The objective of this study was to test the precision and agreement between bone mineral density measurements performed in micro CT, single and dual energy computed tomography, to determine how the keV level influences density measurements and to assess the usefulness of quantitative dual energy computed tomography as a research tool for longitudinal studies aiming to measure bone loss adjacent to total hip replacements. Samples from 10 fresh-frozen porcine femoral heads were placed in a Perspex phantom and computed tomography was performed with two acquisition modes...
September 7, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Rosemary Nabaweesi, Raghu H Ramakrishnaiah, Mallikarjuna R Rettiganti, Chunqiao Luo, Charles M Glasier, Robert T Maxson, Mary E Aitken, Philip J Kenney, James M Robbins
PURPOSE: The long-term cancer risks for children exposed to radiologic images can be two to three times higher than for adults because children are more sensitive to radiation and have a longer lifetime in which to accumulate exposure from CT scans. Injured children often undergo repeat CT imaging if they are transferred from non-pediatric hospitals to a Level I pediatric trauma center (PTC). This study determined the impact of a statewide web-based image repository (WBIR) on repeat imaging among transferred injured children...
August 28, 2016: Journal of the American College of Radiology: JACR
Zhiliang Guo, Shuhong Yu, Lulu Xiao, Xin Chen, Ruidong Ye, Ping Zheng, Qiliang Dai, Wen Sun, Changsheng Zhou, Shuiping Wang, Wusheng Zhu, Xinfeng Liu
BACKGROUND: The neutrophil to lymphocyte ratio (NLR) has been shown to predict short- and long-term outcomes in ischemic stroke patients. We sought to explore the temporal profile of the plasma NLR in stroke patients treated with intravenous thrombolysis (IVT) and its relationship with intracranial bleeding complications after thrombolysis. METHODS: A total of 189 ischemic stroke patients were prospectively enrolled. Blood samples for leukocyte, neutrophil, and lymphocyte counts were obtained at admission and at 3-6, 12-18, and 36-48 h after IVT...
2016: Journal of Neuroinflammation
Jean-Marc Chauny, Martin Marquis, Francis Bernard, David Williamson, Martin Albert, Mathieu Laroche, Raoul Daoust
BACKGROUND: Delayed intracranial hemorrhage is a potential complication of head trauma in anticoagulated patients. OBJECTIVE: Our aim was to use a systematic review and meta-analysis to determine the risk of delayed intracranial hemorrhage 24 h after head trauma in patients who have a normal initial brain computed tomography (CT) scan but took vitamin K antagonist before injury. METHODS: EMBASE, Medline, and Cochrane Library were searched using controlled vocabulary and keywords...
July 26, 2016: Journal of Emergency Medicine
Adi Reuveni-Salzman, Guy Rosenthal, Oded Poznanski, Yigal Shoshan, Mony Benifla
OBJECTIVE: The prevalence of skull fractures after mild head trauma is 2 % in children of all ages and 11 % in children younger than 2 years. The current standard management for a child diagnosed with an isolated skull fracture (ISF), in our institute, is hospitalization for a 24-h observation period. Based on data from the literature, less than 1 % of all minor head injuries require neurosurgical intervention. The main objective of this study was to evaluate the risk of neurological deterioration of ISF cases, in order to assess the need for hospitalization...
September 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Dayu Huang, Qinyun Ma, Shaohua Wang, Qi Ouyang, Xiaofeng Chen
Tracheal diverticulum is a clinical entity rarely reported in the literature. It can be congenital or acquired in origin, and most cases are asymptomatic, usually being discovered incidentally at CT scan. Therefore, treatment has not been widely reported. We present the case of a 30-year-old man with a 6-month history of repeatedly coughing and tracheobronchitis. CT scanning revealed the lesion. The patient underwent surgical resection of the tracheal diverticulum via a transcervical approach. Symptoms resolved after surgical treatment...
July 20, 2016: Head & Neck
Charlotte L Brouwer, Roel J H M Steenbakkers, Arjen van der Schaaf, Chantal T C Sopacua, Lisanne V van Dijk, Roel G J Kierkels, Hendrik P Bijl, Johannes G M Burgerhof, Johannes A Langendijk, Nanna M Sijtsema
BACKGROUND AND PURPOSE: The aim of this study was to develop and validate a method to select head and neck cancer patients for adaptive radiotherapy (ART) pre-treatment. Potential pre-treatment selection criteria presented in recent literature were included in the analysis. MATERIALS AND METHODS: Deviations from the planned parotid gland mean dose (PG ΔDmean) were estimated for 113 head and neck cancer patients by re-calculating plans on repeat CT scans. Uni- and multivariable linear regression analyses were performed to select pre-treatment parameters, and ROC curve analysis was used to determine cut off values, for selecting patients with a PG dose deviation larger than 3Gy...
July 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Kyeong-Hyeon Park, Ji-Wan Kim, Chang-Wug Oh, Joon-Woo Kim, Jong-Keon Oh, Hee-Soo Kyung
INTRODUCTION: Reduction is urgently required in cases of traumatic hip dislocation to decrease the risk of avascular necrosis of the femoral head. However, successful reduction may not always be feasible for hip dislocations associated with femoral head fractures. This irreducibility may provoke further incidental fractures of the femoral neck with resultant Pipkin type III injuries. The purpose of this study was to describe an appropriate treatment strategy for irreducible femoral head fracture-dislocations...
August 2016: Archives of Orthopaedic and Trauma Surgery
Laura Uccella, Cesare Zoia, Francesco Perlasca, Daniele Bongetta, Roberta Codecà, Paolo Gaetani
BACKGROUND: Mild traumatic brain injury (mTBI), defined as blunt trauma to the head resulting in witnessed loss of consciousness, definite amnesia, or witnessed disorientation with a Glasgow Coma Scale (GCS) score of 14 or 15 is a common occurrence in the emergency department. In mTBI, oral anticoagulation is known to be an important risk factor for hemorrhage. Clinical guidelines recommend baseline computed tomographic (CT) scan and observation for 24 hours plus a CT scan before discharge...
September 2016: World Neurosurgery
G Nugent, T Hughes, R Hanlon, H Lewis Jones, S N Rogers
Computed tomography (CT) of the chest is an integral part of the staging of patients with oral cancer. It identifies metastases, synchronous pulmonary primaries, and detects small nodules of indeterminate character that require a follow-up scan. We aimed to find out how many patients with small nodules had had subsequent scans, and the outcome of those who did. Between 2010 and 2013, 413 patients with oral squamous cell carcinoma (SCC) were treated with curative intent or were actively monitored at the Merseyside and Cheshire Regional Surgical Head and Neck Unit...
July 2016: British Journal of Oral & Maxillofacial Surgery
Mohammad M Al-Qattan, Atif Rafique
INTRODUCTION: Type I locking of the metacarpophalangeal joint (MCPJ) is rare and is characterized by loss of extension at the MCPJ with full flexion of all joints of the digit. The condition is usually seen in the index and middle fingers when the normal osseous prominence or degenerative osteophytes of the radial condyle of the metacarpal head catches the accessory collateral ligaments of the MCPJ. PRESENTATION OF CASE: We report on a case of Type I locking of the MCPJ affecting the index finger...
2016: International Journal of Surgery Case Reports
Yana Puckett, Louis Bonacorsi, Matthew Caley, Shannon Farmakis, Colleen Fitzpatrick, Kaveer Chatoorgoon, Yosef Greenspon, Dennis W Vane
BACKGROUND: Pediatric trauma patients transferred to pediatric trauma centers (PTCs) often have imaging at the originating hospital (OH). The increased use of computed tomography (CT) raises concerns about malignancy risk from ionizing radiation leading many PTCs to adopt radiation dose reduction strategies. We hypothesized that pediatric trauma patients are exposed to excess radiation from imaging before transfer. METHODS: A retrospective review of 1,383 scans was performed on all trauma patients with CT imaging before transfer to our Level I PTC from 2010 to 2014...
August 2016: Journal of Trauma and Acute Care Surgery
Francesca Innocenti, Beatrice Del Taglia, Irene Tassinari, Federica Trausi, Alberto Conti, Maurizio Zanobetti, Riccardo Pini
The aim of this study was to investigate the utility of repeat head CT in a large population of patients with non-isolated blunt mild head trauma (MTBI), especially in the presence of intracranial injury. This is a study of a cohort of 478 non-isolated MTBI patients admitted to the High Dependency Unit of the Emergency Department of the University-Hospital of Florence from July 2008 to December 2013. Results of initial and subsequent head CT scans, and indications for repeat head CT scan (routine vs. neurologic change) were recorded...
April 4, 2016: Internal and Emergency Medicine
Brian M Howard, Rima S Rindler, Christopher M Holland, Gustavo Pradilla, Faiz U Ahmad
Data suggests that patients who present to trauma centers with mild TBI are admitted to an excessively high level of care and undergo myriad, unnecessary repeat radiographic and laboratory tests that do not affect outcome. Surprisingly, a paucity of data exists regarding the management of isolated, traumatic, parafalcine or tentorial acute subdural hematoma (aSDH). Therefore, a retrospective, cohort study was completed to analyze factors associated with outcomes in patients who present to a high-volume, urban, level-1 trauma center with isolated parafalcine or tentorial aSDH after closed head injury...
March 29, 2016: Journal of Neurotrauma
Linda Papa, Gretchen M Brophy, Robert D Welch, Lawrence M Lewis, Carolina F Braga, Ciara N Tan, Neema J Ameli, Marco A Lopez, Crystal A Haeussler, Diego I Mendez Giordano, Salvatore Silvestri, Philip Giordano, Kurt D Weber, Crystal Hill-Pryor, Dallas C Hack
IMPORTANCE: Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have been widely studied and show promise for clinical usefulness in suspected traumatic brain injury (TBI) and concussion. Understanding their diagnostic accuracy over time will help translate them into clinical practice. OBJECTIVES: To evaluate the temporal profiles of GFAP and UCH-L1 in a large cohort of trauma patients seen at the emergency department and to assess their diagnostic accuracy over time, both individually and in combination, for detecting mild to moderate TBI (MMTBI), traumatic intracranial lesions on head computed tomography (CT), and neurosurgical intervention...
May 1, 2016: JAMA Neurology
David J Thomson, William J Beasley, Kate Garcez, Lip W Lee, Andrew J Sykes, Carl G Rowbottom, Nicholas J Slevin
INTRODUCTION: Interfractional anatomical alterations may have a differential effect on the dose delivered by step-and-shoot intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). The increased degrees of freedom afforded by rotational delivery may increase plan robustness (measured by change in target volume coverage and doses to organs at risk [OARs]). However, this has not been evaluated for head and neck cancer. MATERIALS AND METHODS: A total of 10 patients who required repeat computed tomography (CT) simulation and replanning during head and neck IMRT were included...
2016: Medical Dosimetry: Official Journal of the American Association of Medical Dosimetrists
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