Comparison of emergency department throughput and process times between male and female patients: A retrospective cohort investigation by the Reducing Disparities Increasing Equity in Emergency Medicine Study Group.

Introduction: Health equity for all patients is an important characteristic of an effective healthcare system. Bias has the potential to create inequities. In this study, we examine emergency department (ED) throughput and care measures for sex-based differences, including metrics such as door-to-room (DTR) and door-to-healthcare practitioner (DTP) times to look for potential signs of systemic bias. Methods: We conducted an observational cohort study of all adult patients presenting to the ED between July 2015 and June 2017. We collected ED operational, throughput, clinical, and demographic data. Differences in the findings for male and female patients were assessed using Poisson regression and generalized estimating equations (GEEs). A priori, a clinically significant time difference was defined as 10 min. Results: A total of 106,011 adult visits to the ED were investigated. Female patients had 8-min longer median length-of-stay (LOS) than males (P < 0.01). Females had longer DTR (2-min median difference, P < 0.01), and longer DTP (5-min median difference, P < 0.01). Females had longer median door-to-over-the-counter analgesia time (84 vs. 80, P = 0.58), door-to-advanced analgesia (95 vs. 84, P < 0.01), door-to-PO (by mouth) ondansetron (70 vs. 62, P = 0.02), and door-to-intramuscular/intravenous antiemetic (76 vs. 69, P = 0.02) times compared with males. Conclusion: Numerous statistically significant differences were identified in throughput and care measures-mostly these differences favored male patients. Few of these comparisons met our criteria for clinical significance.

An assessment of post-COVID-19 infection pulmonary functions in healthcare professionals.

BACKGROUND: The medium- and long-term effects of COVID-19 infection on pulmonary function are still unknown. The present study aimed to investigate the pulmonary functions in healthcare professionals who had persistent complaints after contracting COVID-19 and returning to work. METHODS: The study included COVID-19-infected healthcare professionals from the Düzce University Medical Faculty Hospital who volunteered to participate. Medical histories, medical records, pulmonary function tests, the diffusing capacity of the lungs for carbon monoxide (DLCO) test, and the 6-minute walk test (6MWT) were used to collect data from all participants. RESULTS: The study included 53 healthcare professionals, with an average age of 38 ± 10 years (min: 24 years and max: 71 years), including 29 female (54.7%) and 24 male (45.3%) participants. Of the participants, 22.6% were smokers, 35.8% (19 individuals) had comorbidities, and 17% (9 individuals) were hospitalized. The mean length of stay was 9 ± 4 days (mean ± standard deviation). The most prevalent symptoms were weakness (88.7%), muscle aches (67.9%), inability to smell/taste (60.4%), headache (54.7%), fever (45.3%), cough (41.5%), and shortness of breath (37.7%). The mean time to return to work after a positive polymerase chain reaction (PCR) test for COVID-19 was 18 ± 13 days. The average time among post-disease pulmonary function, 6MW, and DLCO tests was 89 ± 36 days (min: 15 and max: 205). The DLCO level decreased in 39.6% (21) of the participants. Female participants had a significantly higher rate of decreased DLCO levels than male participants (25% vs. 55.2%, P = .026). DLCO levels were significantly higher in participants with long-term persistent complaints (P = .043). The later the time to return to work, the lower the DLCO value (r = -0.290 and P = .035). The 6MWT distance was positively correlated with hemoglobin and lymphocyte levels at the time of the disease onset and negatively correlated with D-dimer levels. The most prevalent symptoms during the control visits were shortness of breath/effort dyspnea (24.6%), weakness (9.5%), and muscle aches (7.6%). CONCLUSION: Significant persistent complaints (47.2%) and low DLCO levels (39.6%) were observed in healthcare professionals during control visits at a mean time of 3 months after the COVID-19 infection. Symptoms and spirometry measurements, including DLCO, may be helpful in the follow-up of healthcare professionals who contracted COVID-19. Further comprehensive studies with long-term follow-up periods are required.

A compact photonic resonator absorption microscope for point of care digital resolution nucleic acid molecular diagnostics.

Rapid, sensitive, and selective detection of nucleic acid biomarkers for health diagnostic applications becomes feasible for point of care scenarios when the detection instrument is inexpensive, simple, and robust. Here, we report the design, implementation, and characterization of a point of care instrument for photonic resonator absorption microscopy (PRAM) that takes advantage of resonant optical coupling between plasmonic gold nanoparticle tags and a photonic crystal (PC) surface. Matching the PC resonant wavelength to the gold nanoparticle's surface plasmon wavelength generates localized and efficient quenching of the PC resonant reflection intensity, resulting in the ability to clearly detect and count individual gold nanoparticles when they are captured on the PC surface. Surface-captured nanoparticles are observed by illuminating the PC at normal incidence with polarized light from a low-intensity red LED, and recording of PC reflected intensity on an inexpensive CMOS image sensor. A contrast limited adaptive histogram equalization (CLAHE) image processing algorithm was applied to derive counts of captured nanoparticles. The instrument is utilized in the context of an activate capture + digital counting (AC + DC) assay for a specific miRNA sequence, using nucleic acid toehold probes applied to gold nano-urchin (AuNU) nanoparticles to achieve 160 aM detection limits in a 30 min. assay.

Erratum: A compact photonic resonator absorption microscope for point of care digital resolution nucleic acid molecular diagnostics: publisher's note.

[This corrects the article on p. 4637 in vol. 12.].

Effects of sunflower meal supplementation in the diet on productive performance, egg quality and gastrointestinal tract traits of laying hens.

1. A trial was conducted to study the effects of additional dietary fibre (DF), resulting from partial replacement of soybean meal (SBM) with high-fibre sunflower meal (SFM), on egg production and gastrointestinal tract (GIT) traits in laying hens. 2. A total of 480 Nick Chick white laying hens (21 weeks of age) were randomly assigned to three dietary treatments and fed for 24 weeks. The hens were fed either the control diet based on corn and SBM, which contained 30 g/kg crude fibre (CF) without SFM, or test diets containing 40 g more CF/kg from adding 47 g/kg SFM or 50 g more CF/kg from adding 97 g SFM/kg. Each dietary treatment was replicated eight times (20 hens per replicate). 3. Body weight (P < 0.05), egg production rate (P < 0.05), egg weight (P < 0.01) and egg mass (P < 0.01) linearly increased but feed conversion ratio linearly decreased (P < 0.01) with increasing SFM supplementation. Feed intake, cracked/broken egg ratios and shell less egg ratios were comparable amongst the groups. 4. The egg quality indices were not influenced by dietary treatments, except for the Haugh units, which decreased (linear, P < 0.01; quadratic P < 0.05) when SFM was added. 5. Digestive organ size was not affected by the dietary treatments, but caecum length increased in hens fed SFM (P < 0.05). Digesta pH in the ileum and caecum was reduced linearly (P < 0.01) with SFM supplementation. 6. Small intestine morphology traits improved with 47 g SFM/kg supplementation, whereas negative effects were observed with 97 g SFM/kg. 7. Productive performance of laying hens improved with 40 or 50 g/kg more CF in feed, mostly from SFM supplementation. It was concluded that this performance increase was attributed mostly to the increase in fat content, rather than DF level, when high-fibre SFM was included in layer diets.

Influence of sunflower meal utilisation on growth performance and digestive tract traits of white strain pullets fed from 29 to 112 d of age.

1. A trial was conducted to study the effects of partial replacement of sunflower meal (SFM) for soybean meal (SBM) on growth performance and gastrointestinal tract traits (GIT) in pullets.2. A total of 600 pullets (29 d of age) was randomly assigned to three dietary treatments and fed for 84 d. The birds were fed a practical diet with a low level of crude fibre (CF; LF) or test diets containing a medium or high level of CF (MF and HF) by partial (50% to 75%) replacement of SBM with SFM. Accordingly, the grower diets contained 29, 40 and 51 g CF/kg, which corresponded to 31, 45 and 59 g CF/kg in developer diets. Each dietary treatment was replicated 8 times (25 pullets per replicate).3. Body weight did not differ significantly among treatments at d 29, 84 and 112 d but increased (P < 0.05) with SFM supplementation at d 54. From 29 to 112 d of age, daily feed and energy intake linearly increased (P < 0.01) with SFM supplementation, but body weight gain and feed conversion ratios were comparable amongst the groups.4. Digestive organ size was not affected by the dietary treatments, but gizzard weight increased in pullets fed MF and HF diets (P < 0.01). Digesta pH in the gizzard, duodenum, jejunum and ileum were reduced linearly (P < 0.01) with SFM supplementation, while a quadratic response was observed for proventriculus pH (P < 0.05).5. Small intestine morphology traits improved with a moderate level of CF intake, whereas no benefit was observed with a high level of CF consumption.6. The results showed that use of SFM up to 140 g/kg can be recommended for pullets fed diets based on corn and soybean meal. However, smaller intestinal absorptive capacity with higher SFM supplementation may occur.

Influence of the particle size and form of feed on growth performance, digestive tract traits and nutrient digestibility of white egg-laying pullets from 1 to 112 D of age.

The influence of the grinding and physical form of diets on growth performance, gastrointestinal tract (GIT) development and nutrient digestibility was studied in layer pullets from hatch to 112 d of age. Diet formed a 2 × 2 factorial with 2 hammer mill screen sizes to grind cereals (4 and 8 mm) and 2 forms (mash and crumble). A total of 864 1-day-old layer chickens were randomly assigned to 1 of the 4 treatment groups with 8 replicates (27 birds per replicate). Cumulatively, pullets fed crumbles consumed less feed (P < 0.05) and had better feed conversion ratio (FCR; P < 0.01) than those fed mash. Coarse grinding cereals (CG) improved FCR (P < 0.05) without significant change in cumulative feed consumption compared to that of fine grinding (FG). With regard to body weight gain (BWG), pullets benefited from crumbles from 1 to 56 d of age (P < 0.01). There were interactions (P < 0.05) between screen size and feed form in relation to FCR (1 to 28 d) and overall BWG. At 112 d of age, the relative weight (RW, g/100 g body weight) of the crop, gizzard, pancreas, and liver of crumble-fed birds were lower (P < 0.05) than those for birds fed mash. Pullets fed coarsely ground feed had higher RW of the crop, proventriculus, gizzard, liver, and caecum compared to those fed finely ground feed. Compared to mash feeding, pullets fed crumbles increased (P < 0.05) total tract digestibility of ether extract and crude protein and the activities of pancreatic amylase and lipase. Digestibility of ether extract (P < 0.05) and pancreatic amylase activity (P < 0.01) were higher in birds fed a CG diet than in birds fed the FG regimen. Regarding the nutrition of egg-laying pullets, crumbles might be preferred to mash feed when the main objective is to improve FCR. Data also suggested that cereals used for pullet feed can be ground more coarsely than is in current practice.

Influence of feed particle size and feed form on productive performance, egg quality, gastrointestinal tract traits, digestive enzymes, intestinal morphology, and nutrient digestibility of laying hens reared in enriched cages.

A total of 640 Lohmann LSL hens were randomly allotted to 4 dietary treatments arranged in 2 × 2 factorial with 2 feed particle sizes (fine and coarse) and 2 feed forms (mash and crumble). The 2 particle sizes were achieved by grinding whole corn and wheat in the hammer mill to pass through 4- and 8-mm sieves. The laying hen diet was isonutritive, and each diet was fed to 8 enriched cages of 20 hens from 21 to 52 wk of age. Screen size and feed form did not affect feed intake, egg production, egg weight, egg mass, and quality traits of the eggs, except for yolk color score, which decreased with crumbling of the feed. Feed conversion ratio was greater (P < 0.01) in hens fed the coarsely ground diet than in hens fed the finely ground diet. Crumbling the feed increased (P < 0.01) feed intake and feed conversion ratio compared to those after mashing. The relative weight of the liver and length of the small intestines were greater (P < 0.05) in hens fed crumble than in hens fed mash. Finely grinding cereals decreased (P < 0.01) the pancreas and gizzard weight compared to those after coarse grinding. The pH of digestive organs showed significant responses to feed form. Crumbling resulted in increased (P < 0.01) pancreatic activities of amylase, while lipase secretion was not affected by the manipulations in screen size and feed form. Ileal villus measurements (villus height, villus height/crypt depth ratio, villus surface area) were greater (P < 0.01) in hens fed crumble than in hens fed mash, whereas particle size had no effect. Total tract digestibility coefficients of crude ash and ether extracts were improved narrowing screen size from 8 to 4 mm. Data illustrated that grinding cereals to pass through a 4-mm screen could improve the efficiency of feed conversion. However, feeding crumbles provided no benefit to productive performance and egg quality, although the absorptive capacity of laying hens increased.

Effects of a meal feeding regimen and the availability of fresh alfalfa on growth performance and meat and bone quality of broiler genotypes.

1. The aim of this study was to identify a feeding regimen that encourages good pasture use in slow (SG) and fast (FG) growing broiler genotypes under free-range management. 2. SG and FG birds fed on either an ad libitum (ADB) or a meal feeding (MEF) programme were given free outdoor access with or without fresh alfalfa from day 22 to 72 and from day 22 to 45, respectively. In two consecutive trials, 800 birds of each genotype were included in a factorial design using groups of 40 birds replicated 5 times. 3. Fresh alfalfa consumption did not improve growth performance and meat quality attributes, whereas the feeding regimen had significant implications. When compared with their ad libitum-fed counterparts, meal-fed birds showed a significantly lower body weight at a considerably lower feed consumption rate, leading to a more favourable feed conversion ratio (FCR) during the course of the experiment. 4. The MEF regimen with a strong feed limitation significantly increased crop and gizzard weight in both genotypes. In FG birds, water holding capacity, drip loss, cooking loss and pH 45 in the breast and thigh meat were adversely affected by MEF; however, feed restriction demonstrated benefits with significant decreases in muscle fat accumulation. In SG birds, decreases in protein and dry matter content of the breast and thigh muscle with meal feeding were conclusive. 5. In both genotypes, there was no treatment-related effect on meat yield, mineral composition of the meat or bone mechanical properties. 6. In conclusion, MEF, irrespective of alfalfa intake, may provide a viable method to decrease FCR; it may be able to contribute to the production of chickens with lean carcasses but it was not capable of improving overall meat quality.

Effects of enhancing vitamin D status by 25-hydroxycholecalciferol supplementation, alone or in combination with calcium and phosphorus, on sternum mineralisation and breast meat quality in broilers.

1. The aim of the present study was to examine the effects of improving vitamin D status in broiler diets by supplementary 25-hydroxycholecalciferol (25OHD3), alone or in combination with calcium (Ca) and available phosphorus (aP), on live performance, sternum mineralisation and breast meat quality in broilers. 2. A total of 936 1-d-old Ross 308 broilers were used in the study. After gender determination at the hatchery, chicks from each sex were randomly distributed into three dietary treatments. The following dietary treatments were used in the experiment from hatch to 38 d: (1) A control diet formulated to meet all of the nutrient requirements of broiler chicks according to the management guide; (2) The control diet supplemented with 18.7-15.0 µg/kg of 25OHD3; and (3) The control diet supplemented with 18.7-15.0 µg/kg of 25OHD3 plus Ca + aP. 3. Improvement in vitamin D status by 25OHD3 supplementation, alone or in combination with Ca and aP, had no effect on body weight and feed conversion ratio of broilers. 4. The serum 25OHD3 concentration significantly increased with 25OHD3 and 25OHD3 plus Ca + aP supplementation (P < 0.05), whereas the ionised Ca and Mg concentrations remained unchanged. 5. Sternum absolute weight, ash content and the concentrations of Ca and P significantly increased (P < 0.01) with supplementation of 25OHD3, alone or in combination with Ca + aP. 6. Supplemental 25OHD3, alone or in combination with Ca + aP, slightly increased pH24 (P = 0.05) and decreased (P < 0.01) squeezable water loss in breast meat, whereas it had no significant effect on lightness, yellowness and sarcoplasmic protein solubility. 7. In conclusion, the results suggested that enhancing vitamin D status by 25OHD3 supplementation alone or in combination with Ca + aP may improve sternum structure and mineral accretion. Furthermore, supplemental 25OHD3, even in a nutritionally complete diet, may offer an effective way to improve protein solubility in female broilers.

Comparative evaluation of dietary supplementation with mannan oligosaccharide and oregano essential oil in forced molted and fully fed laying hens between 82 and 106 weeks of age.

The aim of this study was to investigate the efficacy of feed-grade preparations of mannan oligosaccharides ( MOS: ) and oregano essential oil ( OEO: ) in forced molted or fully fed 82-week-old, laying hens. A 2 × 3 factorial experiment investigated the influence of molting vs. full feeding and dietary supplements [i.e., unsupplemented control, MOS (1 g/kg) diet, and OEO (24 mg/kg) diet] on production parameters, egg quality, serum stress indicators, blood constituents, tibial characteristics, liver antioxidant status, and cecal microflora composition. A total of 864 Single Comb White Leghorn hens were randomly assigned to 6 treatments, each with 6 replicates of 24 hens each, and studied for 25 wk. Hens were fed a molt diet containing of 50% alfalfa and 50% wheat bran ( AA+WB: ) for 12 d, then returned to the laying ration. Results indicate that molt vs. full feed impacted more on most variables measured than supplementation or supplement type. Significant (P < 0.01) interactions between molting and diet were observed for the egg production, egg weight, egg mass, and feed conversion ratio ( FCR: ). In fully fed hens, MOS supplementation improved (P < 0.01) the egg production, egg weight, and FCR, and an OEO addition significantly improved the egg production and FCR in forced molted hens. Molting improved egg quality despite the significant regression in ovary and oviduct weight (P < 0.01), though supplements showed no influence. The bone ash (P < 0.01) and mineral content (P < 0.05) of molted hens were significantly lower than those of fully fed counterparts; however, poor mineralization was not reflected in the bones' mechanical properties. No significant differences were observed among treatments for hematological characteristics. Both the MOS and particularly the OEO supplementation improved (P < 0.01) liver antioxidant status and mitigated the significant increase in cecal pathogenic bacteria after molt. Our results indicate that full feeding with an aa+wb diet is an effective non-feed-removal method for molted hens, the benefit of which can be improved with MOS and OEO supplementation.

Effect of anticoccidial monensin with oregano essential oil on broilers experimentally challenged with mixed Eimeria spp.

Essential oil of oregano ( OEO: ) has proven to be a potential candidate for controlling chicken coccidiosis. The aim of the current study is to determine whether OEO and an approved anticoccidial, monensin sodium ( MON: ), as in-feed supplements could create a synergism when combined at low dosages. Day-old broiler chickens were separated into six equal groups with six replicate pens of 36 birds. One of the groups was given a basal diet and served as the control ( CNT: ). The remaining groups received the basal diet supplemented with 100 mg/kg MON, 50 mg/kg MON, 24 mg/kg OEO, 12 mg/kg OEO, or 50 mg/kg MON + 12 mg/kg OEO. All of the chickens were challenged with field-type mixed Eimeria species at 12 d of age. Following the infection (i.e., d 13 to 42), the greatest growth gains and lowest feed conversion ratio values were recorded for the group of birds fed 100 mg/kg MON (P < 0.05), whereas results for the CNT treatment were inferior. Dietary OEO supplementations could not support growth to a level comparable with the MON (100 mg/kg). The MON programs were more efficacious in reducing fecal oocyst numbers compared to CNT and OEO treatments (P < 0.05). Serum malondialdehyde and nitric oxide concentrations were decreased (P < 0.01), whereas superoxide dismutase (P < 0.05) and total antioxidant status (P < 0.01) were increased in response to dietary medication with MON and OEO. All MON and OEO treatments conferred intestinal health benefits to chickens by improving their morphological development and enzymatic activities. The results suggest that OEO supported the intestinal absorptive capacity and antioxidant defense system during Eimeria infection; however, it displayed little direct activity on the reproductive capacity of Eimeria This might be the reason for inferior compensatory growth potential of OEO compared to that MON following the challenge. Combination MON with OEO was not considered to show promise for controlling chicken coccidiosis because of the lack of a synergistic or additive effect.

Obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma.

OBJECTIVE: To investigate the prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma. DESIGN: Case series. SETTING: School of Medicine, Düzce University, Turkey. PATIENTS: Twenty-one consecutive primary open-angle glaucoma patients (12 females and 9 males) who attended the out-patient clinic of the Department of Ophthalmology between July 2007 and February 2008 were included in this study. All patients underwent polysomnographic examination. RESULTS: The prevalence of obstructive sleep apnoea syndrome was 33.3% in patients with primary open-angle glaucoma; the severity of the condition was mild in 14.3% and moderate in 19.0% of the subjects. The age (P=0.047) and neck circumference (P=0.024) in patients with obstructive sleep apnoea syndrome were significantly greater than those without the syndrome. Triceps skinfold thickness in glaucomatous obstructive sleep apnoea syndrome patients reached near significance versus those without the syndrome (P=0.078). Snoring was observed in all glaucoma cases with obstructive sleep apnoea syndrome. The intra-ocular pressure of patients with primary open-angle glaucoma with obstructive sleep apnoea syndrome was significantly lower than those without obstructive sleep apnoea syndrome (P=0.006 and P=0.035 for the right and left eyes, respectively). There was no significant difference in the cup/disc ratio and visual acuity, except visual field defect, between primary open-angle glaucoma patients with and without obstructive sleep apnoea syndrome. CONCLUSIONS: Although it does not provide evidence for a cause-effect relationship, high prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma in this study suggests the need to explore the long-term results of coincidence, relationship, and cross-interaction of these two common disorders.

Efficacy of in-feed preparations of an anticoccidial, multienzyme, prebiotic, probiotic, and herbal essential oil mixture in healthy and Eimeria spp.-infected broilers.

The efficacies of 5 widely used dietary supplements were investigated on performance indices, fecal oocyst excretion, lesion score, and intestinal tract measurements in healthy and Eimeria spp.-infected birds by using a comparative model. This study included 2,400 sexed Ross 308 broiler chicks that were equally divided in 2 groups: the infected group, experimentally infected with oocysts of mixed Eimeria spp. at 14 d of age, and the healthy controls. The birds in both groups were further divided equally into 6 groups, of which one was fed a basal diet and served as control without treatment and the other 5 served as experimental treatments. These 5 groups were fed 5 diets containing preparations of 60 mg/kg of anticoccidial salinomycin (SAL), 1 g/kg of multienzyme (ENZ), 1 g/kg of probiotic (PRO), 1 g/kg of prebiotic (PRE), and 40 mg/kg of an herbal essential oil mixture (EOM). Body weight gain and feed conversion ratio (FCR) showed significant improvement in the infected animals, which indicates that dietary supplemental regimens with SAL, ENZ, PRO, and PRE initiated in 1-d-old chicks reduced adverse effects after challenge with coccidiosis; however, chicks that were administered EOM failed to show such improvement. Uninfected chickens showed significant improvement in FCR with supplements SAL, PRE, and EOM, which signifies significant (P < 0.01) infection by supplement interactions for BW gain and FCR. In the infected group, all of the supplements reduced the severity of coccidiosis lesions (P < 0.01) induced by mixed Eimeria spp. through the middle and lower regions of the small intestines, whereas supplementation with SAL or EOM alone was effective (P < 0.01) in reducing oocyst excretion compared with the control treatment. The data indicated that use of these subtherapeutically efficacious supplements (except EOM) in broiler production can lessen the depression in growth due to coccidial challenge.

Can computed tomography scout radiography replace plain film in the evaluation of patients with acute urinary tract colic?

PURPOSE: To determine the sensitivity of computed tomography (CT) scout view in detecting ureteral stones and whether CT scout radiography can replace plain film in the evaluation of patients with acute urinary tract colic. MATERIAL AND METHODS: Between January 2000 and 2002, 110 patients with ureterolithiasis were prospectively evaluated for the detection of ureteral stones on CT scout radiographs. The findings were compared with those of plain films. All patients were examined with plain film, CT scout radiography, and unenhanced helical CT. CT scans were performed within 24 h of plain films. Each CT scout radiograph was interpreted without knowledge of the findings on plain film. RESULTS: 111 stones were detected by unenhanced helical CT. Mean stone size was 3.9 mm (range 1-10 mm). Of all stones, 57 (52%) were visible on plain film; 44 (40%) were seen on CT radiographs. The sensitivity of 79 small stones (< 5 mm) on CT scout radiography was 29% and of abdominal radiography 37%. For 32 big stones (> 5 mm), the sensitivity of CT scout radiography was 66% and of abdominal radiography 87.5%. CONCLUSION: In this study, plain film was more sensitive than CT scout radiography in revealing ureteral calculi. However, the detection of stones 5 mm or larger had a sensitivity of 66% on CT scout radiographs; 77% (44/57) of the stones visible on plain films were also seen on CT scout radiographs. We therefore believe that CT scout radiography can be used as a baseline study in most patients with big ureteral stones.

Acute ureterolithiasis: incidence of secondary signs on unenhanced helical CT and influence on patient management.

AIM: The purpose of this study was to determine the incidence of secondary signs associated with ureteral stones on unenhanced helical computed tomography (CT) of patients with acute renal colic, and to correlate these with patient management and outcome. MATERIALS AND METHODS: One hundred and ten patients with ureterolithiasis were evaluated prospectively for the secondary signs of obstruction on unenhanced helical CT. Our attention was focused primarily on the presence or absence of seven secondary signs on unenhanced helical CT, including hydronephrosis, unilateral renal enlargement, perinephric oedema, unilateral absence of the white pyramid, hydroureter, periureteral oedema and lateroconal fascial thickening. RESULTS: Of the 110 patients, 91 (82.7%) had hydroureter, 88 (80%) had hydronephrosis, 65 (59%) had periureteric oedema and 63 (57.2%) had unilateral renal enlargement. Ninety stones passed spontaneously and 21 required intervention. CONCLUSION: Secondary signs of urinary tract obstruction are useful and supportive findings in interpretation of the CT examination. In our experience, the most reliable signs indicating ureteral obstruction are hydroureter, hydronephrosis, periureteral oedema and unilateral renal enlargement, respectively. In addition, stones larger than 6 mm, located within the proximal two thirds of the ureter, and seen associated with five or more the secondary signs of obstruction, are more likely to require endoscopic removal and/or lithotripsy.

Heating-pad burn as a complication of abdominoplasty.

As the sensory nerves supplying the abdominal wall are divided during abdominoplasty, sensory changes occur in the abdominal skin after surgery, which are troublesome for some patients. These sensory changes can lead to burn injury in uninformed patients. We report the case of a patient who sustained a second-degree burn to the anterior abdominal skin following the application of a heating pad after an abdominoplasty. This burn healed with conservative treatment. Burn injuries due to sensory loss in the abdominal skin following abdominoplasty must be kept in mind, and patients must be informed about this complication.

Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis.

Clinical diagnosis of appendicitis is usually made on the basis of history, physical examination and laboratory studies. Approximately 30-45% of patients with suspected appendicitis present with atypical clinical and laboratory findings. Recently graded compression ultrasound and thin section unenhanced helical CT have been used to establish diagnosis for patients with suspected acute appendicitis. The purpose of this study was to determine the diagnostic accuracy of thin section unenhanced helical CT protocol in adult patients with suspected acute appendicitis. CT scans obtained when patients presented with right lower quadrant pain and the clinical impression was equivocal for appendicitis were evaluated. Of 296 patients referred for CT, 123 patients subsequently underwent surgery. Appendicitis had been correctly predicted in 104 of 108 patients surgically proven to have appendicitis. Unenhanced helical CT in the diagnosis of acute appendicitis had a sensitivity of 96%, specificity of 98%, positive predictive value of 97% and negative predictive value of 98%. If no definite inflammatory changes are detected, on the basis of our experience we recommend that the patient be monitored clinically, and that thin section unenhanced helical CT is the optimal technique to detect acute appendicitis in adult patients.