Predictive value of a false-negative focused abdominal sonography for trauma (FAST) result in patients with confirmed traumatic abdominal injury

Objective To investigate if patients with confirmed traumatic abdominal injury and a false-negative focused abdominal sonography for trauma (FAST) examination have a more favorable prognosis than those with a true-positive FAST. Methods This study included 97 consecutive patients with confirmed traumatic abdominal injury (based on computed tomography [CT] and/or surgical findings) who underwent FAST. Results FAST was false-negative in 40 patients (41.2%) and true-positive in 57 patients (58.8%). Twenty-two patients (22.7%) had an unfavorable outcome (defined as the need for an interventional radiologic procedure, laparotomy, or death due to abdominal injury). Univariately, a false-negative FAST (odds ratio [OR] 0.24; p = 0.017) and a higher systolic blood pressure (OR, 0.97 per mmHg increase; p = 0.034) were significantly associated with a favorable outcome, whereas contrast extravasation on CT (OR, 7.17; p = 0.001) and shock index classification (OR, 1.89 for each higher class; p = 0.046) were significantly associated with an unfavorable outcome. Multivariately, only contrast extravasation on CT remained significantly associated with an unfavorable outcome (OR, 4.64; p = 0.016). When excluding contrast extravasation on CT from multivariate analysis, only a false-negative FAST result was predictive of a favorable outcome (OR, 0.28; p = 0.038). Conclusion Trauma patients with confirmed abdominal injury and a false-negative FAST have a better outcome than those with a positive FAST. FAST may be valuable for risk stratification and prognostication in patients with a high suspicion of abdominal injury when CT has not been performed yet or when CT is not available.

The Genotoxic Effect of Interventional Cardiac Radiologic Procedures on Human Chromosomes

In recent years, an important part of the ionizing radiation (IR) that human have been exposed for diagnostic purposes are interventional radiologic procedures. The X-rays and contrast media are used in angiography. The patients and staff members are exposed to X-ray during these procedures. While it is known that X-rays cause DNA damage and carcinogenesis, the effect of the contrast agent is still unknown. The aim of this study was to investigate the effect of X-rays and contrast agent on chromosomes of human patients. Peripheral blood samples were taken from 50 patients (30 males, 20 females, ages between 38-75 years). Chromosome analysis of peripheral lymphocytes in 50 patients were performed at 3 different periods; before the interventional radiologic procedure, 24 hours and 1-3 months after the procedure. Also, chromosome analysis was performed on 17 staff members working during interventional radiological procedures to investigate the effect of X-rays. Standard cytogenetic analysis techniques were used for this study. The frequency of chromosomal aberrations (CAs) was significantly higher in patients 24 hours after the interventional radiologic procedures than pretreatment (p=0,000). At the same time, CAs after 24 hours compared with those taken 1-3 months later, shown that the CAs were significantly reduced after 1-3 months (p=0,000). We also found that the frequency of CAs was also statistically higher in patients exposed to high radiation doses (p=0,042). Compared with the control group (n=30), CAs were found significantly higher in workers exposed to radiation. Our findings have shown that X-rays and contrast agents that used in interventional radiological cause chromosomal damage. For this reason, the dose of radiation to be given to the patient must be carefully selected. Due to the potentially high genetic damage of patients with coronary artery disease (CAD), the type and amount of medication to be given and the frequency of radiological diagnostic procedures to be performed should be meticulously adjusted.