The Predictive Value of Thromboelastogram in the Evaluation of Patients with Suspected Acute Venous Thromboembolism

2019 ◽  
Vol 143 (3) ◽  
pp. 272-278
Author(s):  
Tareq Abu Assab ◽  
David Raveh-Brawer ◽  
Julia Abramowitz ◽  
Mira Naamad ◽  
Chezi Ganzel
Keyword(s):  
Venous Thromboembolism ◽  
Emergency Room ◽  
Alpha Angle ◽  
Categorical Variables ◽  
Clot Lysis ◽  
Fisher Exact Test ◽  
Continuous Variables ◽  
Exact Test ◽  
Significant Difference ◽  
D Dimer

Introduction: The objective of this prospective study was to examine whether thromboelastogram (TEG) can predict the presence of venous thromboembolism (VTE) in patients who arrive at the emergency room with signs/symptoms that raise the suspicion of acute VTE. Methods: Every patient was tested for D-dimer and all TEG parameters, including: reaction time, clot time formation, alpha-angle, maximal amplitude, clot viscoelasticity, coagulation index, and clot lysis at 30 min. For categorical variables, χ2 or the Fisher exact test were used, and for continuous variables the t test or other non-parametric tests were used. Results: During 2016, a total of 109 patients were enrolled with a median age of 55.7 (21–89) years. Eighteen patients were diagnosed with VTE. Analyzing the different TEG parameters, both as continuous and categorical variables, did not reveal a statistically significant difference between VTE-positive and VTE-negative patients. Combining different TEG parameters or dividing the cohort according to gender, clinical suspicion of VTE (Well’s criteria), or different levels of D-dimer did not change the results of the analysis. Conclusion: The current study could not demonstrate a significant value of any TEG parameter as a predictor of VTE among patients who came to the emergency room with signs/symptoms that raise the suspicion of VTE.

scholarly journals The Predictive Value of Thromboelastogram in the Evaluation of Patients with Suspected Acute Venous Thromboembolism

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5052-5052
Author(s):  
Tareq Abu Assab ◽  
David Raveh-brawer ◽  
Julia Abramowitz ◽  
Mira Naamad ◽  
Jacob M. Rowe ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Emergency Room ◽  
Conflicts Of Interest ◽  
Alpha Angle ◽  
Categorical Variables ◽  
Clot Lysis ◽  
Bleeding Tendency ◽  
Significant Difference ◽  
Vascular Laboratory ◽  
D Dimer

Abstract The diagnosis of venous thromboembolism (VTE) is being done by imaging studies but can be ruled out by clinical probability assessment together with a D-dimer blood test. Thromboelastogram (TEG) is usually used for the evaluation of bleeding tendency but can demonstrate also hypercoagulable states. Our hypothesis was that TEG may estimate the presence of VTE more accurately than D-dimer. This prospective study recruited patients that presented to the emergency room or to the vascular laboratory with signs/ symptoms that raise the suspicion of acute VTE. TEG parameters that were examined were: Reaction time(R), Clot time formation (K), Alpha angle (α), Maximal amplitude (MA), Clot viscoelasticity (G), Coagulation Index (CI) and Clot lysis at 30 minutes (LY30). The expected values for hypercoagulable state include: short R and K and high α, MA, G, LY30 and CI. Between April and October 2016, a total of 109 patients were enrolled in the study with a median age of 55.7 (21-89) years. Their characteristics are summarized in table 1. Forty-eight percent of the patients had at least one risk factor for development of VTE. According to the Well's criteria, 54 (49.5%) patients had low probability, 46 (42.2%) - moderate and 9 (8.3%) - high probability for developing VTE. Eighteen patients were diagnosed with VTE; 12 with DVT, 7 with PE and one with both. Analyzing the different TEG parameters, both as continuous (table 2) or categorical variables (according to their normal range), did not reveal a statistically significant difference between VTE positive and negative patients. Combining different TEG parameters or dividing the cohort according to: gender, clinical suspicion of VTE based on the Well's criteria or different levels of D-dimer did not change the results of the analysis. In conclusion, the current study could not demonstrate a significant value of any TEG parameter as a predictor of VTE in a general population of patients who came to the emergency room or vascular laboratory with signs/ symptoms that raise the suspicion of VTE. Disclosures No relevant conflicts of interest to declare.

scholarly journals 0798 “Uncovering My Feet Alleviates My Restless Legs”: Impact of Different Activities and Conditions on Restless Legs Symptoms

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A303-A304
Author(s):  
E G Karroum ◽  
S Leu-Semenescu ◽  
R Amdur ◽  
I Arnulf
Keyword(s):  
Ambient Temperature ◽  
Categorical Variables ◽  
Sign Test ◽  
Fisher Exact Test ◽  
Continuous Variables ◽  
Exact Test ◽  
Restless Legs ◽  
Professional Activities ◽  
Wide Range ◽  
Activity Condition

Abstract Introduction The restless legs syndrome (RLS) is a resting wake state disorder with inactivity/decreased movement as an aggravating factor and activity/increased movement as an alleviating factor. Other activities and conditions may impact RLS symptoms but have not been systematically studied. Methods Fifty-six patients with primary severe RLS (age: 64.1±11.3; 66% women) responded about the effect of 20 activities/conditions on their RLS symptoms. Responses were assigned a numerical value: Aggravation (-1), No effect/Don’t know (0), Alleviation (+1), with calculating a mean effect score for each activity/condition and using a sign test to determine if that score was significantly above or below zero (no effect). Responses were further analyzed based on age, age at RLS onset, duration of RLS, RLS severity, gender, Familial/Non-familial RLS, and Painful/Non-Painful RLS. Association of continuous variables and categorical variables with each activity/condition was examined using Spearman correlation test and Fisher exact test, respectively. Bonferroni p threshold was set at p=0.00036. Results Activities/conditions with significant (p<0.0001) positive mean effect scores were: Feet uncovering (0.70); Leg massaging (0.63); Cold showers (0.54); and Manual activities (0.46). Activities with significant negative mean effect scores were: Vehicle passenger (-0.80); Show attendance (-0.70); Bedsheets weight on legs (-0.57); Watching TV (-0.54); High ambient temperature (-0.45); During meals (-0.39) (all p<0.0001); and Bedsheets rubbing on legs (-0.34; p=0.0002). Activities/conditions with no significant (all p>0.00036) mean effect scores were: Driving (0.00); Gambling (0.02); Professional activities (0.13); Hot showers (0.13); Using computer (0.14); Low ambient temperature (0.21); Sexual activities (0.27); Mental activities (0.29); and Sports activities (0.34). There was no significant association between each activity/condition and age, age at RLS onset, duration of RLS, RLS severity, gender, Familial/Non-familial RLS, or Painful/Non-Painful RLS. Conclusion There is a wide range of impact of different activities/conditions on RLS symptoms. These could be further considered in the non-pharmacological treatment or prevention of RLS symptoms. Support This study was not funded.

Abstract TP236: Eval to Groin Puncture Times: Efficiencies and Deficiencies of Live Physician vs Telemedicine Triage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David Rosenbaum-Halevi ◽  
Sujan T Reddy ◽  
Alyssa D Trevino ◽  
Muhammad Bilal Tariq ◽  
Mahan Shahrivari ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Specific Level ◽  
Site Specific ◽  
Exact Test ◽  
Wilcoxon Rank Sum Test ◽  
Significant Difference ◽  
A Site

Introduction: Telemedicine (TM) is increasingly implemented in community hospitals acute ischemic stroke (AIS). The efficiency of TM to facilitate thrombectomy (IAT) is unknown. We addressed this question by studying our spoke hospitals which are staffed by both in-person (IP) consultation (Day: 8am-5pm) and TM (Night: 5pm-8am) to analyze differences between TM and IP and comparing to our university hub which has IP staffing day and night. Methods: We performed a retrospective analysis from 3/2016 to 3/2019 of all IAT cases directly admitted to 4 IAT capable centers (1 hub + 3 spokes) in our system. Demographic, clinical, and time metrics were analyzed. Primary outcome was door to groin (DTG) time. Continuous variables were analyzed with Wilcoxon rank sum test, and categorical variables with chi-square or Fischer’s exact test. Results: Table 1 summarizes the cohort. Eval to tPA (ETPA) time was faster at spokes vs hub (p < 0.0001), with no significant difference in DTG between spoke and hub (p= 0.444). At spokes, while DTPA times were no different between IP and TM at spokes, IP achieved faster DTG times (p<0.0001) (Fig.1A). DTG was equal during day vs. night at the hub. At the spokes, day (IP) DTG times were faster than night (TM) at some but not all spokes (Fig.1B). TPA administration did not delay DTG at either the hub or the spokes (Fig. 1C). At spokes, TM-TPA cases were associated with faster DTG than TM-noTPA (Fig. 1D). Conclusions: While no difference is noted between TM and IP in rapid TPA treatment, our data show delayed DTG at spokes during the TM day and night service. While DTG in TM was prolonged, differences in spoke metrics imply that availability of staff and resources play a significant role. Further analysis is needed to identify factors that prolong DTG at a site-specific level.

scholarly journals A nomogramic model based on clinical and laboratory parameters at admission for predicting the survival of COVID-19 patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xiaojun Ma ◽  
Huifang Wang ◽  
Junwei Huang ◽  
Yan Geng ◽  
Shuqi Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bootstrap Method ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Model Based ◽  
Independent Risk Factors ◽  
D Dimer

Abstract Background COVID-19 has become a major global threat. The present study aimed to develop a nomogram model to predict the survival of COVID-19 patients based on their clinical and laboratory data at admission. Methods COVID-19 patients who were admitted at Hankou Hospital and Huoshenshan Hospital in Wuhan, China from January 12, 2020 to March 20, 2020, whose outcome during the hospitalization was known, were retrospectively reviewed. The categorical variables were compared using Pearson’s χ2-test or Fisher’s exact test, and continuous variables were analyzed using Student’s t-test or Mann Whitney U-test, as appropriate. Then, variables with a P-value of ≤0.1 were included in the log-binomial model, and merely these independent risk factors were used to establish the nomogram model. The discrimination of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), and internally verified using the Bootstrap method. Results A total of 262 patients (134 surviving and 128 non-surviving patients) were included in the analysis. Seven variables, which included age (relative risk [RR]: 0.905, 95% confidence interval [CI]: 0.868–0.944; P < 0.001), chronic heart disease (CHD, RR: 0.045, 95% CI: 0.0097–0.205; P < 0.001, the percentage of lymphocytes (Lym%, RR: 1.125, 95% CI: 1.041–1.216; P = 0.0029), platelets (RR: 1.008, 95% CI: 1.003–1.012; P = 0.001), C-reaction protein (RR: 0.982, 95% CI: 0.973–0.991; P < 0.001), lactate dehydrogenase (LDH, RR: 0.993, 95% CI: 0.990–0.997; P < 0.001) and D-dimer (RR: 0.734, 95% CI: 0.617–0.879; P < 0.001), were identified as the independent risk factors. The nomogram model based on these factors exhibited a good discrimination, with an AUC of 0.948 (95% CI: 0.923–0.973). Conclusions A nomogram based on age, CHD, Lym%, platelets, C-reaction protein, LDH and D-dimer was established to accurately predict the prognosis of COVID-19 patients. This can be used as an alerting tool for clinicians to take early intervention measures, when necessary.

scholarly journals 742. “Troponin Leaks” in Patients with Acute Respiratory Viral Infections Enrolled in SUPERNOVA: A Marker of Worse Clinical Outcomes

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S266-S267
Author(s):  
Ernesto Ruiz ◽  
Bashir Lengi ◽  
Tiffany Gray ◽  
Mahwish Mushtaq ◽  
Daniel Musher ◽  
...  
Keyword(s):  
Troponin I ◽  
Viral Infections ◽  
Respiratory Illness ◽  
Mortality Rates ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Specific Marker ◽  
Continuous Variables ◽  
Exact Test ◽  
Cdc 2

Abstract Background Cardiac troponin I (cTnI) is a specific marker of cardiac muscular injury. Many patients hospitalized with acute respiratory illness (ARI) have elevated cTnI levels but do not meet EKG criteria for an acute ischemic cardiac event. Troponin leaks could be due to demand ischemia or acute inflammation of the myocardium. We hypothesized that patients with viral ARI and elevated cTnI have worse cardiopulmonary outcomes than those with viral ARI and normal cTnI. Methods From November 11, 2016–September 30, 2017 nasopharyngeal swabs from patients enrolled in SUPERNOVA ARI Study, a CDC/2-VA site, active surveillance platform to evaluate the incidence of viral infection in patients hospitalized with symptoms and/or signs of ARI, were tested using a FilmArray Respiratory Panel. Based on detection of any virus, patients were categorized as positive (vPCR+) or negative (vPCR−). Patient enrolled at the Houston site with cTnI obtained &lt;48 hours of admission were included in the analysis. cTnI above upper limit of normal (&gt;0.03 ng/dL) was defined as elevated. Demographic and clinical data were abstracted from chart review. Outcomes were myocardial infarction (MI) on admission, 30- and 90-day re-admissions due to cardio-respiratory illness and 30- and 90-day all-cause mortality. For the univariable analysis of baseline factors and outcomes we used unpaired t-tests for continuous variables and χ2 or Fisher exact test for categorical variables as appropriate. Results Ninety-four of 332 cases were vPCR positive and cTnI levels on admission were available in 86. Demographics and comorbidities were all similar for the high (N = 42) and normal (N = 44) cTnI groups. Compared with normal cTnI group, those with high cTnI had similar 30- and 90-day readmission rates (14% vs. 9%, P = 0.4 and 26% vs. 16%, respectively, P = 0.2). However, 30- and 90-day mortality rates were higher for high cTnI patients (10% vs. 0% and 19% vs. 5%, P &lt; 0.03). Conclusion Troponin elevation on patients with a documented viral respiratory infection is associated with higher 30- and 90-day mortality rates. Troponin leaks should not be dismissed as a trivial finding in this group of patients. Further work on its pathogenesis is warranted. Disclosures All authors: No reported disclosures.

scholarly journals Comparison of Functional and MRI Outcomes of Microfracture with and without BioCartilage for Osteochondral Lesions of the Talus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0038
Author(s):  
Yoshiharu Shimozono ◽  
Hao Huang ◽  
Timothy Deyer ◽  
John G Kennedy
Keyword(s):  
Treatment Strategy ◽  
Cartilage Regeneration ◽  
Cartilage Tissue ◽  
Categorical Variables ◽  
Osteochondral Lesions ◽  
Fisher Exact Test ◽  
Continuous Variables ◽  
Exact Test ◽  
The Mean

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Microfracture (MF) remains a dominant treatment strategy for symptomatic osteochondral lesions of the talus (OLT). Micronized cartilage allograft (BioCartilage) is a biologic scaffold and is utilized for MF augmentation to improve the quality for cartilage regeneration. However, there is still lack of evidence on efficacy of BioCartilage as an adjunct to MF, as no comparative studies have been reported to date. The purpose of this study is to clarify the effectiveness of BioCartilage as an adjuvant to MF compared to MF alone in the treatment of OLT. Methods: A retrospective cohort study comparing patients treated with MF with BioCartilage and MF alone between 2014 and 2017 was undertaken. Patients with a minimum follow-up time of 12 months were included. All patients received concentrated bone marrow aspirate injection at the time of surgery. Clinical outcome was evaluated with the Foot and Ankle Outcome Score (FAOS) pre- and postoperatively. Postoperative MRIs were evaluated using a modified Magnetic Resonance Observation of Cartilage Tissue (MOCART) score. Comparisons between groups were made with the Man-Whitney U test for continuous variables and the Chi-squared test or Fisher exact test for categorical variables. Results: Twenty-four patients underwent MF with BioCartilage (MF-BC group) and 24 patients underwent MF alone (MF group). The mean age was 40.8 years in MF-BC group and 47.8 years in MF group (p=0.068). The mean follow-up time was 19.2 months in MF-BC group and 24.5 months in MF group (p=0.042). Both groups showed significant improvements in all FAOS subscales. No significant differences between groups were found in postoperative FAOS subscales including symptoms, pain, daily activities, sports activities and quality of life (MF-BC; 72.8, 77.8, 87.4, 60.8, 56.6, MF; 73.3, 79.3, 86.0, 60.9, 60.6, respectively, p>0.05). The mean MOCART score in MF-BC group was higher (73.2vs64.1), but not statistically significant (p=0.315). When assessing each MOCART parameter individually, MF-BC group had significant better infill in the defect (p=0.028). Conclusion: MF with BioCartilage is an effective treatment strategy for the treatment of OLT and results in similar functional outcomes compared with MF alone in the short-term. However, MF with BioCartilage provides better cartilage infill in the defect on MRI. This finding suggests that the repair seen in a cartilage defect treated with BioCartilage augmentation may be superior to treatment with MF alone. Further long-term follow-up studies are warranted.

scholarly journals Homeopathy and the COVID-19 pandemic: quasi-experimental observational study

2021 ◽  
Vol 20 (1) ◽  
pp. 09-10
Author(s):  
Carla Holandino ◽  
Adriana Passos Oliveira ◽  
Edgard Costa Vilhena ◽  
Twoany Rebecca Pedroza Sanches ◽  
Fábio de Almeida Bolognani ◽  
...  
Keyword(s):  
Severity Of Illness ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Significance Level ◽  
Exact Test ◽  
Health Authorities ◽  
Significant Difference ◽  
High Death ◽  
Quasi Experimental ◽  
Observational Cohort

Background: the number of cases of Covid-19 reached more than 11 million people in Brazil, but mostly in Caxias city (Rio de Janeiro) high death rates are very worrysome. In this scenario, homeopathy therapy, along with sanitary and therapeutic measures, should be recommended by health authorities. Aims: to evaluate the use of homeopathic complex (Bryonia alba, China officinalis and Metallum album 30cH), concerning the severity of the illness, during the coronavirus pandemic. Methodology: the complex was administrated at multiple families from Caxias, with (FW) and without (FWO) symptoms similar to COVID-19’s, therefore qualifying the project as a quasi-experimental longitudinal observational cohort study (applied in 51 families or 128 people). With this, the influence of homeopathic intervention in sick (FW) and health (FWO) groups was estimated. All volunteers used three drops of the medicine, once a day, per 60 days. The medicine was prepared accordingly to the Brazilian Homeopathic Pharmacopoeia1. The follow-up was carried out within seven days, which resulted in a total of 8 weeks, since the first interview. The data was organized and statistically analyzed with a 5% significance level, for categorical variables, by Fisher Exact test, in Excel sheet and SPSS 17.0 platform. The ethical committee approved this project under the code: CAAE 31601020.3.0000.5243. Results and Discussion: the preliminary results showed the absence of deaths in both groups (FW and FWO), without any statistically significant difference related to the severity of illness. Most of the families (98.03%) were thrilled to contribute in this particular homeopathic research and reported to have had general health symptoms’ improvements (84.31%). Despite the previous comorbidities presented in 52.9% of the families and considering that Covid-19 infected 0.020% of them, only 0.098% looked for medical assistance and none needed hospitalization. Conclusion: no differences between previous sick and health groups were detected after homeopathy intervention.

scholarly journals A nomogramic model based on clinical and laboratory parameters at admission for predicting the survival of COVID-19 patients

2020 ◽  
Author(s):  
Xiaojun Ma ◽  
Huifang Wang ◽  
Junwei Huang ◽  
Yan Geng ◽  
Shuqi Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bootstrap Method ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Model Based ◽  
Independent Risk Factors ◽  
D Dimer

Abstract BackgroundCOVID-19 has become a major global threat. The present study aimed to develop a nomogram model to predict the survival of COVID-19 patients based on their clinical and laboratory data at admission.MethodsCOVID-19 patients who were admitted at Hankou Hospital and Huoshenshan Hospital in Wuhan, China from January 12, 2020 to March 20, 2020, whose outcome during the hospitalization was known, were retrospectively reviewed. The categorical variables were compared using Pearson’s χ2-test or Fisher’s exact test, and continuous variables were analyzed using Student’s t-test or Mann Whitney U-test, as appropriate. Then, variables with a P-value of ≤0.1 were included in the log-binomial model, and merely these independent risk factors were used to establish the nomogram model. The discrimination of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), and internally verified using the Bootstrap method.ResultsA total of 262 patients (134 surviving and 128 non-surviving patients) were included in the analysis. Seven variables, which included age (relative risk [RR]: 0.905, 95% confidence interval [CI]: 0.868-0.944; P<0.001), chronic heart disease (CHD, RR: 0.045, 95% CI: 0.0097-0.205; P<0.001, the percentage of lymphocytes (Lym%, RR: 1.125, 95% CI: 1.041-1.216; P=0.0029), platelets (RR: 1.008, 95% CI: 1.003-1.012; P=0.001), C-reaction protein (RR: 0.982, 95% CI: 0.973-0.991; P<0.001), lactate dehydrogenase (LDH, RR: 0.993, 95% CI: 0.990-0.997; P<0.001) and D-dimer (RR: 0.734, 95% CI: 0.617-0.879; P<0.001), were identified as the independent risk factors. The nomogram model based on these factors exhibited a good discrimination, with an AUC of 0.948 (95% CI: 0.923-0.973).ConclusionsA nomogram based on age, CHD, Lym%, platelets, C-reaction protein, LDH and D-dimer was established to accurately predict the prognosis of COVID-19 patients. This can be used as an alerting tool for clinicians to take early intervention measures, when necessary

scholarly journals Comparing Resident Outcomes in Cataract Surgery at Different Levels of Experience: A retrospective case series

2020 ◽  
Author(s):  
Mathias Melega ◽  
Rodrigo Lira ◽  
Iuri Silva ◽  
Bruna Ferreira ◽  
Hermano Filho ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Corneal Thickness ◽  
Case Series ◽  
Statistical Analyses ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Retrospective Case ◽  
Exact Test ◽  
First Semester ◽  
Significant Difference

Abstract BackgroudTo evaluate outcomes of resident-performed cataract surgeries in different training levels in a retrospective case series.MethodsA total of 730 surgeries performed by residents were evaluated into three groups: surgeries performed during residents’ first semester of training in phacoemulsification (S1), surgeries performed during the second semester (S2), and surgeries performed during the third semester (S3). The primary outcome was the incidence of intraoperative complications in each group. Secondary outcomes were the comparisons between initial and final corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), and central corneal thickness (CCT) in each group. Descriptive statistical analyses were employed in the presentation of the results using central tendency and variance measurements. The groups’ continuous variables were compared using the t-test or ANOVA (parametric variables) or the Mann-Whitney or Kruskal-Wallis tests (non-parametric variables). Statistical analyses of the categorical variables were performed using Fisher’s exact test or the chi-squared test.ResultsThe rate of complications within six weeks of follow up was 24 out of 102 eyes (23.53%) in the S1 group, 63 out of 301 eyes (20.93%) in the S2 group, and 37 out of 327 (11.31%) in the S3 group (p = 0.001). There was no significant difference in CDVA (p = 0.298), ECD (p = 0.067), IOP (p = 0.217), or CCT (p = 0.807) between the groups.ConclusionsWhen measured by rates of complications and by the aforementioned parameters, surgical competency was found to improve as surgical experience and frequency increased. Therefore, this study identified some patterns of skill development that can be applied to teaching strategies and better assist surgeons in training.

Simple Analysis of the Computed Tomography Features of Gastric Schwannoma

2019 ◽  
Vol 70 (3) ◽  
pp. 246-253 ◽  
Author(s):  
Jian Wang ◽  
Wenming Zhang ◽  
Xiaoxuan Zhou ◽  
Junliang Xu ◽  
Hong-jie Hu
Keyword(s):  
Computed Tomography ◽  
Lymph Nodes ◽  
Growth Pattern ◽  
Gastric Body ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Continuous Variables ◽  
Gastric Schwannoma ◽  
Ct Findings ◽  
Significant Difference

Objective The objective of this study was to assess the computed tomography (CT) findings of gastric schwannoma (GS) and identify the difference between large (> 5 cm) and small (≤ 5 cm) GS. Materials and Methods CT findings of 38 pathologically proven cases of GSs were retrospectively reviewed. The CT evaluation of GS included categorical variables (location, contour, growth pattern, enhancement pattern, necrosis, ulceration, calcification, and lymph nodes) and continuous variables (size, CT value of 3 phases, and enhancement degree). The lesion was divided into 2 groups (large [> 5 cm] and small [≤ 5 cm] GS) according to the tumor size. The Fisher exact test was used for categorical variables and the Student t or Mann-Whitney U test for continuous variables. Results Of the 38 patients, there were 32 women and 6 men. The median age was 54.5 years (range 39–79). Most of patients (65.8%, [25 of 38]) had nonspecific gastrointestinal symptoms such as abdominal or gastric pain, fullness and discomfort, bleeding, and melena. The tumors were mainly located in the stomach body (71.1% [27 of 38]), and the mean diameter was 3.7 cm (range 1.5 cm-10.3 cm), of which included large (> 5 cm) (n = 8) and small (≤ 5 cm) (n = 30). All of the GSs were benign, 9 of whom had palpable perigastric lymph nodes, which confirmed by pathology for the reactive inflammatory hyperplasia. Growth pattern, pattern of enhancement, necrosis, calcification, surface ulceration, and lymph node in the CT images were found to be significant variables for differentiating large (> 5 cm) and small (≤ 5 cm) GS ( P < .05). Conclusion GSs were predominantly located at the gastric body and occurred most frequently in women between the ages of 40–70 years, and showed gradual enhancement after contrast enhancement. Palpable perigastric lymph nodes could not be considered as malignant factor of GS. There 7 computed CT criteria are significant difference between large (> 5 cm) and small (≤ 5 cm) GS.

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