Managing Incidentalomas Safely: Do Computed Tomography Requisitions Tell Us What We Need to Know?

2017 ◽  
Vol 68 (4) ◽  
pp. 387-391
Author(s):  
Matthew Walker ◽  
Joy Borgaonkar ◽  
Daria Manos
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Tertiary Care ◽  
Clinical History ◽  
Patient Questionnaire ◽  
Prior History ◽  
Care Hospital ◽  
History Of ◽  
Patient’S History ◽  
History Of Cancer

Purpose Technological advancements and the ever-increasing use of computed tomography (CT) have greatly increased the detection of incidental findings, including tiny pulmonary nodules. The management of many “incidentalomas” is significantly influenced by a patient's history of cancer. The study aim is to determine if CT requisitions include prior history of malignancy. Methods Requisitions for chest CTs performed at our adult tertiary care hospital during April 2012 were compared to a cancer history questionnaire, administered to patients at the time of CT scan. Patients were excluded from the study if the patient questionnaire was incomplete or if the purpose of the CT was for cancer staging or cancer follow-up. Results A total of 569 CTs of the chest were performed. Of the 327 patients that met inclusion criteria, 79 reported a history of cancer. After excluding patients for whom a history of malignancy could not be confirmed through a chart review and excluding nonmelanoma skin cancer, dysplasia, and in situ neoplasm, 68 patients were identified as having a history of malignancy. We found 44% (95% confidence interval [0.32-0.57]) of the chest CT requisitions for these 68 patients did not include the patient's history of cancer. Of the malignancies that were identified by patient questionnaire but omitted from the clinical history provided on the requisitions, 47% were malignancies that commonly metastasize to the lung. Conclusions A significant number of requisitions failed to disclose a history of cancer. Without knowledge of prior malignancy, radiologists cannot comply with current guidelines regarding the reporting and management of incidental findings.

scholarly journals Death due to sickle cell anemia: autopsy diagnosis

2017 ◽  
Vol 5 (7) ◽  
pp. 3185
Author(s):  
Manjusha Shripad Dhawle ◽  
Ashwini Radhakrishan Tangde ◽  
Santosh Govind Rathod ◽  
Rajan S. Bindu
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Tertiary Care ◽  
Medical Officer ◽  
Clinical History ◽  
Care Hospital ◽  
Cell Disease ◽  
Unexpected Death ◽  
Mortality And Morbidity ◽  
History Of

Background: Sickle cell disease (SCD) is well known and is the commonest hereditary hematological disorder which is associated with increased mortality and morbidity.  They are group of inherited haemoglobinopathies caused by the occurrence of hemoglobin S (Hbs) in homozygous or heterozygous form or in combinations of Hbs with another hemoglobin such as Hbsc or beta thalassaemia (Hbs-thal). Sickle cell syndromes are remarkable for their clinical heterogenecity including their presentations as sudden and unexpected death due to sickle cell crises. While doing autopsy in cases of deaths with no apparent cause and physical over activity medical officer must keep in mind the possibility of death due to vasoocclusive crisis in sickle cell disease. Aim of the study was to create awareness among the physicians and relatives / public and to minimize future unexpected death from complications or crisis from SCD.Methods: This is a retrospective study of 10 cases carried in the department of pathology, in tertiary care hospital and covers a period from January 2009 to December 2016. These cases were brought dead to the casualty with a history of sudden death. After post mortem examination, the specimens were sent for histopathological examination.Results: The record of 10 cases was reviewed. Out of our ten cases 7 were male and 3 were females. The youngest person was 17-year female and oldest was 65 years male. In clinical history 3 cases had complains of chest pain (30%), 3 others had complained of breathlessness (30%), 2 had history of unconsciousness (20%), one case had complained of abdominal pain (10%) and one case had a history of fall and injury (10%). Microscopic examination of each organ was carried out.  Organs like lungs, liver, spleen, kidneys, heart and brain showed wide spread congested vessels which were stuffed with RBC.Conclusions: We present this study to emphasize that sickle cell crisis is one of the cause of sudden unexplained death and highlight the importance of considering sickle cell disease as a cause of death in cases with no apparent cause.

scholarly journals DERMATOPHYTOSIS PROFILE IN A MADHUBANI MEDICAL COLLEGE AND TERTIARY CARE HOSPITAL

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Shahid Hassan
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Clinical History ◽  
Epidemiologic Studies ◽  
World Population ◽  
Care Hospital ◽  
Indirect Contact ◽  
Medical College ◽  
Number Of Patients ◽  
History Of

INTRODUCTION: The current perception among dermatologists based on their experience in the outpatient’s clinics is that there is a huge change in clinical profile, both qualitative and quantitative, in the patients presenting with dermatophytosis. The prevalence of superficial mycotic infection is about 20%–25% of the world population, and dermatophytes is the leading microorganism responsible. Now there is a changing trend in the dermatophytic infections, the cases are presenting as chronic, not responding to usual treatment and also there are recurrent cases. Dermatophytosis is a contagious disease that spreads by direct or indirect contact. Until a few years ago, it had been a disease treated with ease using antifungal agents. In the recent past, there has been a failure of treatment with conventional therapy and emergence of an epidemic of recurrent and chronic dermatophytosis in India. MATERIAL AND METHODS: Our study population included 112 patients who were clinically diagnosed as dematophytosis in the Outpatient department (OPD). Clinical history of all patients was taken. Demographic data such as age, sex, occupation, duration of disease, history of recurrence, habits and associated diseases was recorded. Culture were done in all suspected cases. Nail scrapings, clippings and sub-ungual debris were collected. RESULTS: In present study there were in all 112 patients among which maximum number of patients about 33% belonged to age group 11 to 20, majority of which were males 66.96% whereas 33.04% were females. 50% were culture positive among all patients and microscopy was positive in 58.93% of cases. Trichophytonrubrum species was isolated predominantly in 57.1% cases, Trichophytonmentagrophyte was found in 23.2% of patients followed by microscoporumgypsium isolated in 12.5% cases and E.floccosum was seen isolated in 7.1% among all clinical types. Percentage of tineacorporis, tineacapitis and tineacruris was 39.3%, 18.8% and 13.4% respectively. CONCLUSION: Dermatophytosis was found to be common in second decade of life and male were commonly affected. T. rubrum was most common isolate. The need of the hour is carry out multicentric large epidemiologic studies that can effectively establish the prevalence of fungal isolates and its antifungal resistance status.

scholarly journals 1492. Comparison of Acute Cholangitis in Patients With or Without Cancer

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S543-S544
Author(s):  
Aurélien Sokal ◽  
Sylvain Chawki ◽  
Yann Nguyen ◽  
Alain Sauvanet ◽  
Philippe Ponsot ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Tertiary Care ◽  
Acute Cholangitis ◽  
Care Hospital ◽  
Reactive Protein ◽  
Cancer Management ◽  
History Of ◽  
Hospital Stays ◽  
Student’S T ◽  
History Of Cancer

Abstract Background Cancer-associated acute cholangitis (CAAC) are becoming more frequent and their characteristics may be changing with the evolution of cancer management. Our aim was to compare clinical, microbiological and outcome characteristics of CAAC to those of cancer-free acute cholangitis (CFAC). Methods All consecutive cases of acute cholangitis (AC) from November 2015 to March 2017 were collected retrospectively in a single tertiary care hospital in Clichy, France, specialized in gastroenterology. Hospital stays referred as AC by coding were screened. Patients fulfilling the 2018 Tokyo Guidelines diagnostic criteria for definite AC were included. Data were collected using a standardized form. CAAC were defined as AC that occurred in patients who had active cancer or history of cancer in the five previous years. CFAC were defined as AC in patient who no history of cancer, or in remission for more than 5 years. Comparison was made using Fisher or Student’s t-test. P < 0.05 was considered as significant. Results 156 episodes of AC in 130 patients were analyzed. 101 had CAAC and 55 had CFAC. Age and sex did not differ (table 1), but CAAC had a higher Charlson’s comorbidity index (4.4 vs. 1.7, P < 0.0001). Despite similar clinical presentation, CAAC had more pronounced cholestasis (Gamma GT 659 vs. 391UI/L; Alkaline phosphatases 526 vs. 309 UI/L; P < 0.0001 for both) and C-reactive protein level (133 vs. 97mg/L, P = 0.008, Table 2). E. coli was more common in CFAC (72.4% vs. 54% of positive blood cultures, P = 0.004). In bile cultures, Enterococci and multi-drug-resistant Gram negatives tended to be more frequent in CAAC than in CFAC (63 vs. 17%, P = 0.07 and 9.1% vs. 4.1%, P = 0.33, Table 2), respectively. CAAC more frequently required drainage (86.1% of cases vs. 43.6% in CFAC (P < 0.0001), including radiological drainage (42.5% vs. 12.5%; P = 0.008) and with multiple sessions (28.7% vs. 8.3%, P < 0.0001, Table 3). Antibiotherapy duration did not differ between the two groups. Despite similar initial severity, only 51.5% of patients with CAAC were alive, without febrile recurrence or other biliary drainage at day 28, vs. 85.5% of patients with CFAC (P < 0.0001, Table 3). Conclusion Despite comparable initial clinical presentation, management is more complex and outcome less favorable in CAAC vs. CFAC. Disclosures All authors: No reported disclosures.

scholarly journals Study of Missing Clinical Details in Computed Tomography Radiology Request Forms: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (222) ◽  
Author(s):  
Muna Badu
Keyword(s):  
Computed Tomography ◽  
Binary Data ◽  
Tertiary Care ◽  
Clinical History ◽  
Cross Sectional Study ◽  
Radiology Department ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Detailed Clinical History

Introduction: Detailed clinical history through a properly filled requisition form can help a radiologist in making a diagnosis. The objective of this study was to observe the missing clinical details of Computed Tomography requisition forms at radiology department in tertiary care hospital. Methods: This descriptive cross-sectional study was done in 196 Computed Tomography requisition forms in the department of radiology from September 2019 to October 2019. Ethical clearance from the Institutional Review Committee – Reference No. 120720194 was obtained. An informed consent from the participants was taken prior to the procedure. Convenient sampling was done. The data obtained were computed and analyzed using Statistical Package for Social Sciences to tabulate the results. The results were displayed in frequency and proportion of binary data. Results: All the request forms had name filled, however date was filled in 183 (93.4%), age was filled in 195 (99.5%), sex was filled in 193 (98.5%) and address was only in 30 (15.3%) of the forms. Clinical history and provisional diagnosis were written in 179 (91.3%) forms. Signature was found in more than half of forms 135 (68.9%) whereas the department referring the patient was filled in 92 (46.9%) of forms and the name of doctor referring the patient was not filled mostly. The handwriting was clear in 191 (97.4%) of cases and standard words were used. Use of non-standard abbreviation was found in only 2 (1%) forms. Conclusions: Clinical details were filled in most of the requisition forms however other parameters were still incompletely and inadequately filled.

Developmental Anatomy of the Eustachian Tube: Implications for Balloon Dilation

2021 ◽  
pp. 019459982199481
Author(s):  
Isabelle Magro ◽  
David Pastel ◽  
Jace Hilton ◽  
Mia Miller ◽  
James Saunders ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Eustachian Tube ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Balloon Dilation ◽  
Care Hospital ◽  
Developmental Anatomy ◽  
Nasal Floor

Objective To describe the developmental anatomy of the eustachian tube (ET) and its relationship to surrounding structures on computed tomography. Study Design Case series with chart review. Setting A tertiary care hospital. Methods ET anatomy was assessed with reformatted high-resolution computed tomography scans from 2010 to 2018. Scans (n = 78) were randomly selected from the following age groups: <4, 5 to 7, 8 to 18, and >18 years. The following were measured and compared between groups: ET length, angles, and relationship between its bony cartilaginous junction and the internal carotid artery and between its nasopharyngeal opening and the nasal floor. Results The distance between the bony cartilaginous junction and internal carotid artery decreased with age between the <4-year-olds (2.4 ± 0.6 mm) and the 5- to 7-year-olds (2.0 ± 0.3 mm, P = .001). The ET length increased among the <4-year-olds (32 mm), 5- to 7-year-olds (36 mm), and 8- to 18-year-olds (41 mm, P < .0001). The cartilaginous ET increased among the <4-year-olds (20 mm), 5- to 7-year-olds (25 mm), and 8- to 18-year-olds (28 mm, P < .0001). The ET horizontal angle increased among the <4-year-olds (17°), 5- to 7-year-olds (21°), and 8- to 18-year-olds (23°, P≤ .003), but the ET sagittal angle did not statistically change after 5 years of age. The height difference between the nasopharyngeal opening of the ET and the nasal floor increased among the <4-year-olds (4 mm), 5- to 7-year-olds (7 mm), and 8- to 18-year-olds (11 mm, P < .0001). Conclusion The ET elongates with age, and its angles and relationship to the nasal floor increase. Although some parameters mature faster, more than half of the ET growth occurs by 8 years of age, and adult morphology is achieved by early adolescence.

scholarly journals Pattern of Emergent Head Computed Tomography Findings in a Tertiary Care Hospital during off Working Hours: Retrospective Analysis

2019 ◽  
Vol 10 (02) ◽  
pp. 207-211
Author(s):  
Rajneesh K. Patel ◽  
Amit Kumar Choubey ◽  
Brijesh K. Soni ◽  
Rajeev Sivasankar ◽  
Vikash Chauhan
Keyword(s):  
Computed Tomography ◽  
Health Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Working Hours ◽  
Care Hospital ◽  
Head Ct ◽  
Total Head ◽  
Ct Head ◽  
Head Computed Tomography

ABSTRACT Introduction: Emergency head computed tomography (CT) is rising exponentially during off working hours due to evidence-based medicine, patient’s expectation and desires, easy availability and apprehension of medico-legal cases, thereby raising health-care cost. There is huge gap in demand and supply of radiologist, especially during off working hours. There is need to know the pattern of emergency head findings. Materials and Methods: A retrospective analysis of all emergent noncontrast CT head during off working hours in the Department of Radiodiagnosis of a Tertiary Care Hospital, Mumbai, India, which were performed from June 2017 to May 2018. CT findings of 308 patients were analyzed. Results: About 63.6% of total head CT showed no significant abnormality. The most common abnormality was intracranial hemorrhage which was just 9.1% followed by acute infarct which was 6.2%. Extradural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage was only 1% each of total head CT findings. No significant abnormality was detected in 74.65%, 70.21%, 89.13%, 31.37%, 100%, and 69.09% in cases of head injury, seizure, giddiness/dizziness/syncope, cerebrovascular accident, transient ischemic attack, and altered sensorium, respectively. Conclusion: Pattern analysis of emergent head CT reveals that most of the emergent CT head shows no significant abnormality. There is a need for stringent guidelines for emergent head CT, training of emergency physician as well as CT technician for common findings to bridge the radiologist demand-supply gap for providing effective health care in peripheral hospitals.

Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: A Blinded Study to Establish Baseline Acquisition Rates

2003 ◽  
Vol 24 (6) ◽  
pp. 415-421 ◽  
Author(s):  
Joel T. Fishbain ◽  
Joseph C. Lee ◽  
Honghung D. Nguyen ◽  
Jeffery A. Mikita ◽  
Cecilia P. Mikita ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Transmission Rate ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Nosocomial Transmission ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Average Hospital ◽  
Methicillin Resistant ◽  
History Of

AbstractObjective:To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.Design:A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA Risk factors associated with the likelihood of MRSA colonization on admission were investigated.Setting:Tertiary-care military medical facility.Participants:All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion.Results:Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns.Conclusions:Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.

COMPARISON OF CLINICO-SOCIAL PROFILE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN TERTIARY CARE HOSPITAL IN A RURALAREA: A RETROSPECTIVE STUDY

2021 ◽  
pp. 70-72
Author(s):  
Gaurav Santosh Nemade ◽  
Sumit Nitin Dhus ◽  
Arushi Ramesh Shetty ◽  
Neha Dhananjay Firake
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Female Ratio ◽  
Extra Pulmonary Tuberculosis ◽  
Younger Age ◽  
Tobacco Addiction ◽  
History Of ◽  
Early Case ◽  
Male To Female ◽  
Clinical Characteristic

BACKGROUND AND OBJECTIVES: The burden of tuberculosis (TB) in India is the highest accounting for 26% of the global incidence. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). India accounts for a fourth of the global burden of TB and 29% of global mortality. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristic between pulmonary TB (PTB) and extrapulmonary TB (EPTB). MATERIALS AND METHODOLOGY:Aretrospective analysis was carried of 348 patients diagnosed in DOTS centre, Pravara Rural Hospital, Loni. Characteristics of demographic and clinical characteristics were obtained from medical case records. RESULTS:Among the 348 cases, 71.3% were PTB and 28.7% were EPTB including, pleural (36%), meningeal (27%) and lymphatic (20%) cases. The male to female ratio in PTB and EPTB are 1.99 and 1.22 respectively. EPTB was more common at younger age (<25 years). Tobacco addiction (10.9%), diabetes mellitus (4.03%), HIV positivity (12.1%) and history of contact with Tb patients (17.7%) were more likely to be associated with PTB. CONCLUSION:Increased awareness of the risk factors may facilitate early case nding and better management outcomes for these patients.

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