scholarly journals Comparison between isolated serial clinical examination and computed tomography for stab wounds in the anterior abdominal wall

2017 ◽  
Vol 44 (6) ◽  
pp. 596-602 ◽  
Author(s):  
RICARDO BREIGEIRON ◽  
TIAGO CATALDO BREITENBACH ◽  
LUCAS ADALBERTO GERALDI ZANINI ◽  
Carlos Otavio Corso
Keyword(s):  
Computer Tomography ◽  
Predictive Value ◽  
Porto Alegre ◽  
Mortality And Morbidity ◽  
Stab Wounds ◽  
Clinical Exam ◽  
Reducing Costs ◽  
Abdominal Stab Wounds ◽  
Selection Of Patients ◽  
Selection Of

ABSTRACT Objective: to compare abdominal computer tomography (CT) with isolated serial clinical exam (SCE) in the management of anterior abdominal stab wounds. Methods: randomized prospective study performed at Hospital de Pronto Socorro de Porto Alegre involving patients with anterior abdominal stab wounds without indication of immediate laparotomy; patients were divided in two groups: CT group and SCE group, In the SCE group, patients were followed up with serial clinical exam every 6 hours, Patients of CT group were submitted to abdominal computer tomography after initial evaluation. Results: 66 patients were studied and 33 were included in each group, Of total, six were submitted to surgery, three of each group, In the SCE group, patients submitted to surgery in media waited 12 hours from arrival to diagnosis without any non-therapeutic surgeries, The remaining 30 patients of this group were discharged from hospital after 24 hours of observation, In the CT group, three patients showed alteration at CT and were submitted to laparotomy, one non-therapeutic, The others were discharged from hospital after 24 hours of observation, Abdominal computer tomography had a positive predictive value (PPV) of 67% and negative predictive value (NPV) of 100%, with 96% of accuracy, Isolated serial clinical exam showed PPV and NPV of 100% and 100% of accuracy. Conclusion: selective management of anterior abdominal stabs is safe, when a rigorous selection of patients is observed, Isolated serial clinical exam may be performed without computer tomography, without increase of hospitalization time or morbidity, reducing costs, exposure to radiation, mortality and morbidity and non-therapeutic laparotomies.

Selection of Patients with Abdominal Stab Wounds for Laparotomy

1982 ◽  
Vol 22 (6) ◽  
pp. 476-480 ◽  
Author(s):  
J H GOLDBERGER ◽  
D M BERNSTEIN ◽  
G H RODMAN ◽  
C A SUAREZ
Keyword(s):  
Stab Wounds ◽  
Abdominal Stab Wounds ◽  
Selection Of Patients ◽  
Selection Of

scholarly journals Video-Assisted Thoracoscopy is Superior to Standard Computer Tomography of the Thorax for Selection of Patients With Spontaneous Pneumothorax for Bullectomy

1995 ◽  
Vol 2 (2) ◽  
pp. 89-92 ◽  
Author(s):  
Julius P. Janssen ◽  
Richard P. Golding ◽  
Miguel A. Cuesta ◽  
Thomas Sutedja ◽  
Pieter E. Postmus
Keyword(s):  
General Anesthesia ◽  
Predictive Value ◽  
Spontaneous Pneumothorax ◽  
Ct Scans ◽  
Chest Roentgenogram ◽  
Normal Lung ◽  
Common Disease ◽  
Video Assisted ◽  
Selection Of Patients ◽  
Selection Of

Background: Spontaneous pneumothorax (SP) is a common disease of unknown cause often attributed to rupture of a subpleural bulla or bleb [in this study described as emphysema-like changes (ELC)]. Treatment of SP varies from conservative (rest) to aggressive (surgery). Patients with bullae >2 cm diameter, found either by chest roentgenogram or during thoracoscopy, are often treated surgically (bullectomy and pleurectomy, or abrasion). Thoracoscopy is frequently used as the method of choice to select patients for surgery. With the recent introduction of video-assisted thoracoscopy (VAT), it is now possible to combine a diagnostic and therapeutic procedure. However, to do this general anesthesia and a fully equipped operating theater are needed. Proper selection of patients for this costly and time-consuming procedure is necessary. We evaluated whether standard computed tomography (CT) is appropriate for selection of patients with SP who are candidates for surgical intervention.Methods: In 43 patients with SP, CT was performed after re-expanding the lung by suction through a chest tube if the lung was completely collapsed. After <48 hours VAT under general anesthesia was performed. All CT scans were scored by two investigators who were not informed about the VAT findings or the outcome of the patient. CT findings and VAT findings were compared.Results: In 16 patients (37%), CT scans of the affected lung were considered normal, while in 13 patients (30%) ELCs ≥2 cm were seen and in 14 patients (33%) ELCs <2 cm were found. VAT showed a normal lung in 11 patients (26%), in 24 patients ELCs ≥2 cm were seen, and in 8 patients ELCs <2 cm were present. Of these 32 patients, in 18 bullous degeneration of the apex of the upper lobe was found. Of the 24 patients with ELCs ≥2 cm detected during VAT, 13 were detected by CT. In no patient were ELCs ≥2 cm seen on CT scans that were not detected during VAT. The sensitivity of CT for ELCs ≥2 cm is 54%, and the specificity is 100%. The positive predictive value is 100%; the negative predictive value is 63%.Conclusions: CT detects ELCs ≥2 cm in 54% of the patients in whom VAT shows these abnormalities. If interventional therapy is deemed appropriate for first time or recurrent SP, VAT should be used since it is superior to CT in demonstrating the presence, number, and size of ELCs.

Pilot Study on Predictive Value of Plasmatic Levels of 9 Angiogenetic Biomarkers in Selection of Patients Candidate to Prostate Biopsy

2013 ◽  
Vol 80 (4) ◽  
pp. 297-301 ◽  
Author(s):  
Vincenzo Serretta ◽  
Salvatore Scurria ◽  
Nino Dispensa ◽  
Gaetano Chiapparrone ◽  
Sandro Provenzano ◽  
...  
Keyword(s):  
Pilot Study ◽  
Prostate Biopsy ◽  
Predictive Value ◽  
Selection Of Patients ◽  
Selection Of

PREDICTIVE VALUE OF M??LLER MANEUVER IN SELECTION OF PATIENTS FOR UVULOPALATOPHARYNGOPLASTY

1985 ◽  
Vol 95 (12) ◽  
pp. 1483???1487 ◽  
Author(s):  
AARON E. SHER ◽  
MICHAEL J. THORPY ◽  
ROBERT J. SHPRINTZEN ◽  
ARTHUR J. SPIELMAN ◽  
BERNARD BURACK ◽  
...  
Keyword(s):  
Predictive Value ◽  
Selection Of Patients ◽  
Selection Of

Selection of patients for portal-systemic shunts

JAMA ◽  
1966 ◽  
Vol 196 (12) ◽  
pp. 1039-1044 ◽  
Author(s):  
R. E. Hermann
Keyword(s):  
Selection Of Patients ◽  
Selection Of

Perioperative acute internal carotid thrombosis after general surgery

2020 ◽  
Vol 99 (3) ◽  
pp. 136-140
Keyword(s):  
Cardiac Surgery ◽  
Internal Carotid ◽  
Right Hemicolectomy ◽  
Diagnostic Assessment ◽  
Left Carotid Artery ◽  
Perioperative Stroke ◽  
Internal Carotid Occlusion ◽  
Acute Brain Ischemia ◽  
Selection Of Patients ◽  
Selection Of

Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

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