Incidence of Appendicitis in Adults

Background: Appendicitis is a common infection which can lead to serious illness in children as well as adults. Objective: To assess the incidence of appendicitis in adults. Study Design: Retrospective study. Place and Duration of Study: Department of General Surgery, Shalamar Medical & Dental College, Lahore from 1st January 2020 to 30th June 2021. Methodology: One hundred and eighty cases registered for abdominal pain in right iliac fossa. The appendectomy cases of adults (>45 years) were scrutinized from these cases. Demographic and clinical information was gathered from each appendicitis patient with diagnostic symptoms as well as histopathology and radiology imaging. Result: Eighty seven were confirmed acute appendicitis with 48 males and 39 females within the age group of 45-75 years. Gangrenous appendicitis was presented in 11.5% and perforated appendicitis was noticed in 31.03% of the total patients. Conclusion: The incidence of appendicitis was 48.33% in adults. Keywords: Appendectomy, Perforated, Misdiagnosis

450 Low Dose CT Protocols - The Future for Paediatric Foreign Body Aspiration?

Aim Suspected foreign body aspiration is a common attendance at the paediatric emergency department. Low dose Computer tomography (CT) protocols (0.06-2mSv) have been developed to be able to diagnose these patients more effectively. Method All paediatric low dose CT protocols for foreign body aspiration from a large tertiary level hospital were identified retrospectively over a year. Data was collected on prior imaging, result, further intervention and subsequent follow up of patients. Results Eight patients were identified. Three (37.5%) identified a foreign body on CT. All three had subsequent microlaryngoscopy and all found a foreign body present. Of the five negative scans, none re-presented or had any associated symptoms of a foreign body at follow up. Five had previous Chest X-ray, all of which were inconclusive. Conclusions Although need for ongoing research into the area, low dose CT thorax protocols for suspected foreign body aspiration is a promising and effective tool. Its use across the country will likely lead to reduced negative microlaryngoscopy rates with huge associated benefits for both the patient and the ENT department.

Comparing Reliability Between 3D Imaging And 2D Photography For External Nasal Anthropometry

Background: This study investigates and compare the reliability and reproducibility of two facial anthropometric methods about external nasal angles, 3D imaging and conventional 2D photography. Methods: 2D photograph images and 3D images about external nose of 30 volunteers were taken using digital camera and Morpheus 3D scanner. To evaluate intra-rater reliability, each images were taken over two different days for each subject by the same researcher. To evaluate inter-rater reliability, another researcher took each images for each subject on the first day. The reliability of each method for measuring 4 external nasal angle is obtained using intraclass correlation coefficient (ICC) and compared.Results: Inter-rater and intra-rater reliability of both 3D imaging and 2D photography had excellent agreement in all 4 nasal angles. In the nasofacial angular parameter, Inter-rater ICC, 2D photography was significantly higher than 3D imaging. Result of intra-rater ICC also showed both 3D imaging and 2D photography had good reliability in all 4 nasal angles. Similar to those of inter-rater ICC, nasofacial angular parameter showed statistically significant differences between 3D imaging and 2D photography.Conclusion: In terms of reliability, both 2D and 3D showed appropriate anthropometric results and considering its own advantage, each methods can be used complementarily.

Amplitude-Preserved Wave Equation: An Example to Image the Gas Hydrate System

Natural gas hydrate is an important energy source. Therefore, it is extremely important to provide a clear imaging profile to determine its distribution for energy exploration. In view of the problems existing in conventional migration methods, e.g., the limited imaging angles, we proposed to utilize an amplitude-preserved one-way wave equation migration based on matrix decomposition to deal with primary and multiple waves. With respect to seismic data gathered at the Chilean continental margin, a conventional processing flow to obtain seismic records with a high signal-to-noise ratio is introduced. Then, the imaging results of the conventional and amplitude-preserved one-way wave equation migration methods based on primary waves are compared, to demonstrate the necessity of implementing amplitude-preserving migration. Moreover, a simple two-layer model is imaged by using primary and multiple waves, which proves the superiority of multiple waves in imaging compared with primary waves and lays the foundation for further application. For the real data, the imaging sections of primary and multiple waves are compared. We found that multiple waves are able to provide a wider imaging illumination while primary waves fail to illuminate, especially for the imaging of bottom simulating reflections (BSRs), because multiple waves have a longer travelling path and carry more information. By imaging the actual seismic data, we can make a conclusion that the imaging result generated by multiple waves can be viewed as a supplementary for the imaging result of primary waves, and it has some guiding values for further hydrate and in general shallow gas exploration.

Magnetic Seed Localisation for Non-Palpable Breast Lesions: A Comparison with Hooked-Wire

Introduction: Screening programs and improved imaging result in higher frequency of non-palpable breast lesions, requiring preoperative localisation. Several localisation methods have been developed, with Magseed® among the more recent techniques. This observational study registered safety, effectiveness and surgeon satisfaction of Magseed® localisation. Data were compared with hooked-wire procedure. Methods: Data regarding safety, effectiveness and surgeon satisfaction of 100 patients who underwent Magseed® localisation were prospectively collected between September 2018 and April 2019, and compared with retrospectively collected data of 91 patients who underwent hooked-wire localisation between March 2018 and September 2018. Results: In total, 103 seeds and 102 wires were included. All magnetic seeds were placed under ultrasound guidance, with a median of two days preoperative. Complication rate did not significantly differ between Magseed® and hooked-wire (2.97% vs. 2.13%; p = 1.000). 94.06% of the seeds were detected with Sentimag®, with a retrieval rate of 100%. Positive margin rate was lower for Magseed®, although not significant (4.76% vs. 10.39%; p = 0.233). Due to positive margins, 1 additional mastectomy was performed, in contrast with 3 mastectomies and 1 additional re-excision in the hooked-wire group. Surgeons scored 81% of the Magseed® procedures as ’easier than hookedwire’. Conclusion: Rate of positive margins and re-excision/mastectomy showed a tendency to be lower with Magseed® localisation compared to hooked-wire localisation. Complication rate was equal. Moreover, high surgeon satisfaction and logistical advantages designate Magseed® as preferable over hooked-wire.

The Challenge of Managing Patients Suffering from TBI: The Utility of Multiparametric MRI

Traumatic brain injury (TBI) is a complex phenomenon affecting multiple areas of the brain in multiple ways. Both right and left hemispheres are affected as well as supratentorial and infratentorial compartments. These multifocal injuries are caused by many factors including acute mechanical injury, focal intracranial hemorrhage, blunt and rotational forces, epidural and subdural hematoma, hypoxemia, hypotension, edema, axonal damage, neuronal death, gliosis and blood brain barrier disruption. Clinicians and patients benefit by precise information about the neuroanatomical areas that are affected macroscopically, microscopically and biochemically in an individual patient.Standard imaging studies are frequently negative or grossly underestimate the severity of TBI and may exacerbate and prolong patient suffering with an imaging result of “no significant abnormality”. Specifically, sophisticated imaging tools have been developed which reveal significant damage to the brain structure including atrophy, MRI spectroscopy showing variations in neuronal metabolite N-acetyl-aspartate, elevations of membrane related Choline, and the glial metabolite myo-inositol is often observed to be increased post injury. In addition, susceptibility weighted imaging (SWI) has been shown to be more reliable for detecting microbleeds versus calcifications.We have selected two TBI patients with diffuse traumatic brain injury.The first patient is a 43-year-old male who suffered severe traumatic brain injury from a motorcycle accident in 2016. Following the accident, the patient was diagnosed with seizures, major depression, and intermittent explosive disorder. He has attempted suicide and has neurobehavioral disinhibition including severe anger, agitation and irritability. He denies psychiatric history prior to TBI and has negative family history. Following the TBI, he became physically aggressive and assaultive in public with minimal provocation. He denies symptoms of thought disorder and mania. He is negative for symptoms of cognitive decline or encephalopathy.The second patient is a 49-year-old male who suffered at least 3 concussive blasts in the Army and a parachute injury. Following the last accident, the patient was diagnosed with major depressive disorder, panic disorder, PTSD and generalized anxiety disorder. He denies any psychiatric history prior to TBI including negative family history of psychiatric illness. In addition, he now suffers from nervousness, irritability, anger, emotional lability and concurrent concentration issues, problems completing tasks and alterations in memory.Both patients underwent 1.5T multiparametric MRI using standard T2, FLAIR, DWI and T1 sequences, and specialized sequences including susceptibility weighted (SWAN/SWI), 3D FLAIR, single voxel MRI spectroscopy (MRS), diffusion tensor imaging (DTI), arterial spin labeling perfusion (ASL) and volumetric MRI (NeuroQuant). Importantly, this exam can be performed in 30–45 minutes and requires no injections other than gadolinium in some patients. We will discuss the insights derived from the MRI which detail the injured areas, validate the severity of the brain damage, and provide insight into the psychological, motivational and physical disabilities that afflict these patients. It is our expectation that this kind of imaging study will grow in value as we link specific patterns of injury to specific symptoms and syndromes resulting in more targeted therapies in the future.

An Ice Core Slice Scanning Tool based on Line-scan Camera

The ice core from polar ice sheet is one of the most valuable archives of past climate and environment. The ice core visual stratigraphy, based on optical scanning analysis, provides the most intuitive information of the micro-particles and/or air bubbles in the ice. At present, only few labs can perform high quality visual stratigraphy analysis in the world. Here, we develop an ice core slice scanning tool based on line-scan camera. The machine uses the high-resolution characteristics of the line-scan camera to complete high-resolution imaging of the ice core slices through linkage with the linear light sources. A motor drive and control system is developed to complete the uniform scanning control of the line-scan camera and light sources. A special control program and human-computer interaction interface are developed to realize the parameter setting, motor control and imaging result display. The test results show that the proposed ice core slice scanning tool meets the design requirements and its imaging results are significantly better than area-scan cameras under the same conditions.

Noncontact laser vibrometry-based fence-like arrays with wavefield filtering-assisted adaptive imaging algorithms for detecting multiple pits in a compact cluster

Pitting corrosion presents challenges for ultrasonic nondestructive evaluation due to the small pit dimension. Few Lamb wave-based techniques have achieved the identification of individual pits as subwavelength wave scatterers that are densely packed in a small cluster. In this article, noncontact laser vibrometry-based fence-like arrays with wavefield filtering-assisted adaptive imaging algorithms are developed for detecting and identifying small pits in a cluster. Signals of back scattering waves induced by a cluster of subwavelength scatterers are acquired by noncontact laser Doppler vibrometry at sensing points and form a fence-like array surrounding the area of inspection. The signals are then processed by our array imaging algorithms to construct inspection images which take advantage of three techniques, including the wave mode and wave direction filters to extract single-mode back scattering Lamb waves induced by subwavelength scatterers, the pseudo-reversal propagation of back scattering waves to address the dispersion effect and improve the radial imaging resolution, and the adaptive weighting to improve the angular imaging resolution. Moreover, this work introduces the wave diffraction-related Rayleigh and Abbe limits that are conventionally used for characterizing optic lenses, for characterizing the resolution limit of Lamb wave-based arrays, and optimizing the array configuration. To validate our array imaging approach, a proof-of-concept experiment has been performed to detect a cluster of 3 × 3 pits with the pit diameter of 2 mm and the interval of 2 mm in a 3.2-mm thick aluminum plate; the experimental imaging result shows that our method can identify most pits except the one at the center of the pit cluster. We believe this study will benefit the design, characterization, and optimization of Lamb wave-based arrays for subwavelength resolution imaging and enable potential applications for the noncontact inspection of hidden pitting corrosion in civil, petrochemical, nuclear, and aerospace structures.

An efficient super-virtual shot encoding scheme for multisource reverse time migration

Reverse time migration (RTM) is a powerful seismic imaging tool that suffers from high computational complexity when dealing with massive data. The simultaneous-shot method can effectively reduce the amount of migration by assembling several sources, although it adds crosstalk noise, which seriously affects the quality of the RTM results. To avoid this problem, we have adopted a time-domain scheme that combines time-delay encoding and amplitude encoding to reduce crosstalk artifacts in simultaneous-source imaging results. This scheme modulates the wavefields of multiple sources to fit the wavefield of a suspended super-virtual shot (SVS), which can eliminate crosstalk artifacts because they are absent in single SVS migration. Numerical examples on a steeply dipping model and the 2D SEG/EAGE salt model show the feasibility of the proposed method. SVS encoding can generate a qualified imaging result and takes less time than plane-wave encoding in the migration process.