Spiral intestines of 12 specimens of the dwarf whipray, Himantura walga, collected from Malaysian Borneo in 2002 and 2003, were examined for cestodes. These yielded a new species of Acanthobothrium (Tetraphyllidea) and a new species of Echinobothrium (Diphyllidea), both of which are described. Acanthobothrium marymichaelorum n. sp. is a category 1 species. It differs from all but 4 of its category 1 congeners in its possession of postovarian testes. It also differs from these 4 species in its possession of fewer testes, shorter length, fewer proglottids, and/or shorter posterior loculus. Echinobothrium minutamicum n. sp. differs from its congeners in its possession of outer hooks in the dorsal and ventral rostellar groups that are trifid; it is also the smallest member of its genus. The spiral intestine of H. walga consisted of 12 mucosal chambers. Most (89%) of the 35 specimens of E. minutamicum n. sp. for which chamber data were generated were found in chambers 2-4. In contrast, the 57 specimens of A. marymichaelorum n. sp. occurred throughout chambers 5-12, with 86% in chambers 6-10. The modes of attachment of both cestode species were similar, i.e., both embedded their scolex within the lumen of a mucosal crypt with the hooks and/or spines penetrating the lamina propria. Both also eroded the epithelial lining of the crypts and caused modest expansion of crypt diameter. Although the configuration of the mucosal surface may explain sites in which both species were able to attach, it does not explain their absence from other regions; histological sections and scanning electron microscopy showed the mucosal surface to be similar in configuration throughout the length of the spiral intestine. The cestode fauna of H. walga also included at least 1 species of rhinebothriine, 2 lecanicephalidean species, a trypanorhynch species, and 1-2 additional new species of Acanthobothrium. However, formal description of these species must await the collection of additional material, mature material, and/or the erection of the new genera. It is of note that the fauna of the dwarf whipray consists of a suite of unusually small taxa. Although the cestode genera reported here are generally consistent with those reported from other Himantura species, they are completely inconsistent with previous records from H. walga (as Trygon walga) in Sri Lanka. This suggests that either the original host identifications are suspect or that differences exist in the faunas of H. walga between these 2 localities.
IntroductionChest x-rays (CXR) are routinely obtained on blunt trauma patients. Many patients also receive additional imaging with thoracic computed tomography scans for other indications. We hypothesized that in hemodynamically normal, awake and alert blunt trauma patients, CXR can be deferred in those who will also receive a TCT with significant cost savings.MethodsWe retrospectively reviewed the charts of trauma patients from 1/1/2010 to 12/31/2010 who received both a CXR and TCT in the trauma room. Billing and cost data were collected from various hospital sources.Results239 patients who met inclusion and exclusion criteria and received CXR and TCT between 1/1/2010 and 12/31/2010. The sensitivity of CXR was 19% (95% CI: 10.8% to 31%) and the specificity was 91.7% (95% CI: 86.7% to 95%). The false positive rate for CXR was 35.8% (95% CI: 21.7% to 52.8%) and the false negative rate was 24.5% (95% CI: 18.8% to 31.2%). The precision of CXR was 42.3% (95% CI: 25.5% to 61.1%) and the overall accuracy was 74.1% (95% CI: 68.1% to 79.2%). If routine chest xray were eliminated in these patients, the estimated cost savings ranged from $14,641 to $142,185, using three different methods of cost analysis.ConclusionsIn patients who are hemodynamically normal and who will be receiving a TCT, deferring a CXR would result in an estimated cost savings up to $142,185. Additionally, TCT is more sensitive and specific than CXR in identifying injuries in patients who have sustained blunt trauma to the thorax.
Multidetector Computed Tomography (MDCT) technology plays an important role in the evaluation of injured patients. At our institution pelvic X-ray (PXR) is obtained routinely on trauma patients. Many also receive MDCT of the abdomen and pelvis for other indications. We hypothesized that there would be a substantial cost savings in adopting a policy of deferring PXR in a hemodynamically normal patient who will also proceed to MDCT for other indications. We retrospectively reviewed the charts of trauma patients from February 1, 2008 to February 1, 2009. We reviewed whether a PXR was done, the result, whether an MDCT was also done, and the presence or absence of pelvic fractures. We collected billing and cost data from various hospital sources. We identified 1,330 patients with PXR between February 1, 2008 and February 1, 2009. Of those patients, 810 (61%) had MDCT after PXR. Sixty-six patients (8.0%) had pelvic fractures; 39 were correctly identified on PXR (59% of fractures). Twenty-seven were detected only by MDCT (41% of fractures); all pelvic fractures were identified on MDCT. Seven hundred and forty-four patients (92% of patients with both PXR and MDCT) had negative PXR and negative MDCT. Using three methods of cost analysis, the estimated cost savings range is from $77,011 to $331,080. MDCT of the pelvis is more sensitive and more specific than PXR. In patients who are hemodynamically normal and asymptomatic, forgoing routine PXR could result in an estimated savings from $77,011 to $331,080, depending on the method used to calculate costs.
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