RESUMEN
PURPOSE: Management of traumatic splenic injury may be operative or non-operative (including embolization and conservative management). Traditionally, haemodynamic instability has been an indication for operative intervention. We aimed to report our experience of managing traumatic splenic injury at a regional major trauma centre in the UK over a 4-year period, with a particular focus on the non-operative management (NOM) of haemodynamically unstable patients. METHODS: All patients with splenic injuries admitted to North Bristol NHS Trust from April 2012 to March 2016 were included. Patients were classified for analyses by injury severity (low or high grade), haemodynamic instability (defined as a reverse shock index < 1) and management category (operative or non-operative). RESULTS: 106 patients were included. Overall 85.8% of patients received NOM: 79.2% conservative and 6.6% interventional radiology. Two patients (2.4%) managed conservatively required further intervention. Haemodynamically stable and unstable patients were equally likely to receive NOM (89.7 and 81.3% respectively, p = 1). All unstable patients with low-grade injuries were managed conservatively and only one (2.7%) required further intervention. Two unstable patients with high-grade injuries (28.6%) underwent NOM successfully. CONCLUSIONS: These data support the safe application of non-operative management to haemodynamically unstable patients with traumatic splenic injury, particularly in those with low-grade injuries. Additional prospective work is required to define the subgroup of patients for whom this is appropriate and to determine the long-term outcomes of NOM.
Asunto(s)
Traumatismos Abdominales/terapia , Tratamiento Conservador , Bazo/lesiones , Centros Traumatológicos , Heridas no Penetrantes/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemodinámica , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Reino Unido , Adulto JovenRESUMEN
We present a rare case of giant adrenal pseudocyst as a cause of right upper quadrant (RUQ) pain and highlight the typical multimodality imaging features. The case demonstrates the imaging features associated with giant adrenal pseudocysts to aid accurate and timely diagnosis. Despite the rarity of these lesions they are important to consider as benign lesions can closely mimic malignant ones. Unenhanced and contrast-enhanced CT is the imaging of choice for adrenal cysts. However, MRI can provide more exquisite assessment of cystic, solid and enhancing components. Pseudocysts can be purely cystic, mixed or solid. Classically, adrenal pseudocysts are described as cystic lesions (of homogenous water density) with a fibrous wall and thin internal septations. Mural/septal calcification is commonly demonstrated due to haemorrhage, this is discernible from central/amorphous calcification seen in malignant disease. As in this case, pseudocysts can contain solid components or layering secondary to haemorrhage. The key to differentiating organised haematoma from tumour is the lack of enhancement. If serial imaging is undertaken in these patients rapid changes in the solid components may be seen reflecting resolving haematoma. Adrenal pseudocysts are rare and have a wide differential. Cystic adrenal lesions warrant multimodality assessment as their imaging features aid diagnosis and differentiation from malignant disease. We suggest that MRI plays a complimentary role to CT. CT is superior at demonstrating mural/septal calcification but MRI aids in determining cystic components and differentiating haemorrhage from tumour.
Asunto(s)
Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Quistes/diagnóstico por imagen , Dolor Abdominal , Enfermedades de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Adulto , Quistes/cirugía , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
BACKGROUND: There is disagreement but few objective data on the relative quality of publicly or privately funded research. Cochrane reviews of randomized trials provide a good comparison opportunity because there is widespread agreement on how trial quality should be assessed and the Cochrane reviewers routinely do this. AIMS: To compare the quality of publicly or privately funded randomized controlled trials. METHODS: A total of 105 trials included in two Cochrane reviews were studied. Their quality assessments were abstracted from the relevant review and information about their funding source was collected from the original trial publications. MAIN RESULTS: Funding information was obtained for 87 trials. Of these, trials funded by pharmaceutical companies were larger (median sample size 126 vs. 45, P<0.001), more likely to have avoided ascertainment bias 11/14 vs. 15/41 (P=0.05). Non-significant trends in avoiding entry bias 19/19 vs. 35/37 and performance bias 13/22 vs. 14/48 also favoured the commercial trials. Commercial trials also had higher recorded attrition rates (median 6% vs. 1%, P=0.007), but this difference was entirely caused by more non-commercial trials reporting a zero attrition rate. DISCUSSION: The apparently lower attrition rate in the non-commercial trials should be interpreted with caution. Zero attrition in clinical trials with follow-up of many months is somewhat implausible. MAIN CONCLUSION: Commercially funded randomized trials tend to be of higher methodological quality than government-funded ones.