Unlabelled: Type I Young and Burgess anterior posterior compression (APC) pelvic injuries have been classically managed non operatively due to theoretical integrity of sacroiliac joint ligaments (SIJL), though examination under anesthesia (EUA) has been proven occult mechanical instability in up to 50% of these injuries. We sought to determine the diagnostic accuracy of magnetic resonance (MRI) for detection of occult instability on APC-I injuries when compared to EUA.
Methods: Diagnostic test study of prospectively recruited patients admitted with APC-I pelvic injuries between 2015 and 2022. All patients consented to participate in this study were subjected to MRI and EUA. The evaluators of each of these tests were blinded. On MRI evaluation, SIJL were considered compromised when unilateral injury to anterior SIJL was visualized in three or more consecutive images or in bilateral injuries, when injury to the anterior SIJL in two or more consecutive images on each side was observed. Positive EUA was considered a symphyseal diastasis over 25 mm on stress fluoroscopy. Demographic data was collected as recruited and sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. Confidence interval was set at 95%. EUA was considered the gold standard in statistical analysis.
Results: A total of 32 patients mean aged 36 (24-61) years were included. Mean symphyseal diastasis at admission was 17.58 (11 - 25) mm. The median time from injury to EUA was 5 (0-21) days. Positive EUA was observed on 20 patients and 25 patients presented compromised SIJL. MRI presented a sensitivity of 95% (75.13% - 99.87%), specificity of 50% (21.09% - 78.91%), positive-predictive value of 73% (60.61% to 82.93%), negative-predictive value of 87% (48.66% - 98.08%).
Conclusion: Injury to SIJL on MRI presented an accuracy of 77% (58.29% - 89.64%) for the detection of occult pelvic instability on EUA.
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http://dx.doi.org/10.1016/j.injury.2023.05.037 | DOI Listing |
Rev Esp Anestesiol Reanim (Engl Ed)
December 2024
Department of Anesthesiology & Critical Care, Clínica Universidad de Navarra, University of Navarra, Navarra, Pamplona, Spain.
Point-of-care abdominal ultrasound (US) has emerged as a powerful tool for clinicians and is becoming a routine bedside tool to rapidly diagnose, manage hemodynamics, monitor fluid status, and guide procedures in emergency and critical care. Extended focused assessment with sonography for trauma (eFAST), is commonly used to detect free intraperitoneal blood in the trauma setting and may also be an option in non-trauma patients. However, it has significant limitations for detecting gastrointestinal or retroperitoneal bleeding.
View Article and Find Full Text PDFClin Lung Cancer
November 2024
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH. Electronic address:
Background: With increased early detection efforts, surgery for early-stage lung cancer is expected to rise. Pafolacianine is the first FDA approved targeted optical imaging agent indicated as an adjunct for intraoperative identification of malignant and nonmalignant pulmonary lesions in adult patients with known or suspected cancer in the lung.
Methods: This is a retrospective review of the malignant and nonmalignant lesions identified by pafolacianine with intraoperative molecular imaging (IMI) in the multi-center Phase 2 and Phase 3 ELUCIDATE clinical trials.
Int J Surg Case Rep
December 2024
Department of Gynecology, Guangzhou Women and Children's Medical Center Liuzhou Hospital, Guangxi, China; State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China. Electronic address:
Introduction: Infantile vaginal yolk sac tumor (YST) is a rare and aggressive form of pediatric cancer that often presents with bloody discharge. Despite advances in chemotherapy, managing post-chemotherapy AFP level rebounds remains a challenge. This case report describes a 7-month-old girl with vaginal YST whose AFP levels rose following 3 cycles of PEB chemotherapy.
View Article and Find Full Text PDFInt J Clin Oncol
December 2024
Department of Surgical Oncology, National Cancer Institute, Cairo University, Kasr Al Eini St., Fom El Khalig Sq., P.C. 11796, Cairo, Egypt.
Background And Objective: Lymph node metastasis (LNM) in soft tissue sarcoma (STS) of the extremities is relatively rare. We aimed to evaluate the prognosis and the survival of patients with LNM and correlate them to the pattern of metastasis.
Methods: A retrospective study of patients diagnosed with STS of the extremities from 2015 to 2019.
JAMA Netw Open
December 2024
Department of Public Health, Erasmus University Medical Center, Rotterdam, South Holland, the Netherlands.
Importance: Prior studies have shown that the benefits, harms, and costs of colorectal cancer (CRC) screening at older ages are associated with a patient's sex, health, and screening history. However, these studies were hypothetical exercises and not directly informed by data on CRC risk.
Objective: To identify the optimal stopping ages for CRC screening by sex, comorbidity, and screening history from a cost-effectiveness perspective.
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