Dexamethasone Decreased Postoperative Complications in Tonsillotomy.

PURPOSE: Tonsillotomy (TT) is a new and popular method with partial resection of the tonsils. Dexamethasone is often used during surgery for its anti-inflammatory, antiemetic, and analgesic properties. In this study, we aimed to explore the effect of systemic steroids use on postoperative vomiting, pain, and bleeding in TT. DESIGN: A randomized controlled trial. METHODS: We enrolled 240 children aged 2 to 18 years who had undergone TT or adenotonsillotomy at our center from July 2020 to July 2021. Dexamethasone or 0.9% normal saline was administered before the start of surgery. Postoperative hemorrhage, vomiting, and nausea were recorded and compared between groups. FINDINGS: The dexamethasone group had a 2.5% (3/119) rate of postoperative bleeding, while the rate was 1.6% (2/119) in the control group. No patients required multiple operations for control of bleeding. The degree of postoperative pain (2.1 ± 0.5 vs 3.4 ± 0.9) and the occurrence of postoperative nausea (21% vs 31.9%), as well as vomiting (15% vs 24.4%) in the dexamethasone group, was significantly lower compared with the placebo group. CONCLUSIONS: The rate of postoperative bleeding between the dexamethasone group and the control group had no significant difference, suggesting the high safety of dexamethasone use in TT. Dexamethasone use in TT improved postoperative pain, nausea, and vomiting significantly.

Cold snare endoscopic resection for subepithelial tumors of the upper third of the esophagus.

Although most esophagus subepithelial tumors are benign, the possibility of malignancy cannot be completely ruled out and it can gradually increase, leading to symptoms such as dysphagia, so removal is still recommended. The narrow cavity and thin walls of the upper esophagus, as well as movement caused by breathing and heartbeat, makes it difficult to perform operation by endoscopy or surgery. Cold snare pulpectomy may been used to remove subepithelial tumors of the upper third of the esophagus due to a low risk of adverse events and short procedure time.

Focal hemolymphangioma of the rectum: A case report and literature review.

RATIONALE: Gastrointestinal hemolymphangiomas are very rare, especially in the rectum. Only 3 cases of rectal hemolymphangioma, all of which are diffuse lesions, have been reported in the English literature on PubMed. Our case is the first focal lesion of the rectum. It is important for radiologists to correctly identify the imaging features of rectal hemolymphangiomas. PATIENT CONCERNS: A 51-year-old woman visited our hospital because of intermittent constipation for 3 years. DIAGNOSES: Colonoscopy revealed a prominent lesion on the left anterior wall of the lower rectum. Transvaginal color Doppler ultrasonography showed that the posterior vaginal wall area had a mixed-echo mass, and blood flow signals of the dots and stripes could be seen. Pelvic magnetic resonance imaging showed that the cystic space-occupying lesion in the region between the left anterior wall of the lower rectum and the posterior wall of the middle and lower vagina had a clear boundary. INTERVENTIONS: The patient underwent surgery to remove the rectal lesions. The surgical specimen was finally diagnosed as local hemolymphangioma by pathological analysis. LESSONS: Localized hemolymphangioma of the rectum is very rare, and imaging examination is essential for the diagnosis and evaluation of the extent of lesion invasion.

Coincidently oral lesions in Crohn's disease.

A 21-year-old patient with Crohn's disease, who was undergoing Infliximab treatment, presented at the hospital due to a painful oral mass. After confirming the absence of malignant cells through frozen sections, a complete excision of the infiltrated bone surrounding the lesion was performed. The postoperative pathology confirmed the presence of Central type giant cell granuloma in the mandible, which is distinct from non-caseating granulomas in oral CD and Infliximab-induced Sarcoidosis. As far as we are aware, this is the first to report an association between CGCG and both CD and anti-tumor necrosis factor therapy treatment.

Successful treatment of Morbihan disease with total glucosides of paeony: A case report.

BACKGROUND: Morbihan disease is a rare cutaneous disorder characterized by non-pitting edema and erythema of the upper two-thirds of the face. In severe cases, orbital and facial contour changes may affect the visual field, and there is no guideline for the standard treatment of this disease. Existing treatment methods have been reported to be associated with long medication cycle, easy recurrence after drug withdrawal, and multiple adverse reactions. CASE SUMMARY: A 55-year-old Chinese woman presented to our hospital with non-pitting edema and erythema of the upper two thirds of her face for 5 mo. Physical examination showed obvious edema and erythema on the upper face. The boundary was unclear, the lesions were hard and non-pitting, and infiltration was obvious by touch. Pathological examination revealed mild hyperkeratosis of the epidermis, nodular inflammatory lesions in the dermis, epithelioid granuloma, and inflammatory cell infiltration with lymphocytes and histiocytes around skin appendages and blood vessels. Alcian blue staining, acid fast staining, silver staining and periodic acid-Schiff staining were negative. The patient was diagnosed with Morbihan disease. She was treated with prednisone acetate and tripterygium wilfordii polyglycoside tablets for 4 mo, and the edema was slightly reduced, but transaminase levels were significantly increased. Compound glycyrrhizin capsules were administered for liver protection for 1 mo; however, facial edema did not significantly improve and transaminase levels continued to increase. Total glucosides of paeony capsules were then administered for 4 mo, and transaminase level returned to normal and the patient's facial edema disappeared completely. CONCLUSION: Total glucosides of paeony has a remarkable effect in Morbihan disease, without adverse reactions.

Photonic crystal enhanced fluorescence emission and blinking suppression for single quantum dot digital resolution biosensing.

While nanoscale quantum emitters are effective tags for measuring biomolecular interactions, their utilities for applications that demand single-unit observations are limited by the requirements for large numerical aperture (NA) objectives, fluorescence intermittency, and poor photon collection efficiency resulted from omnidirectional emission. Here, we report a nearly 3000-fold signal enhancement achieved through multiplicative effects of enhanced excitation, highly directional extraction, quantum efficiency improvement, and blinking suppression through a photonic crystal (PC) surface. The approach achieves single quantum dot (QD) sensitivity with high signal-to-noise ratio, even when using a low-NA lens and an inexpensive optical setup. The blinking suppression capability of the PC improves the QDs on-time from 15% to 85% ameliorating signal intermittency. We developed an assay for cancer-associated miRNA biomarkers with single-molecule resolution, single-base mutation selectivity, and 10-attomolar detection limit. Additionally, we observed differential surface motion trajectories of QDs when their surface attachment stringency is altered by changing a single base in a cancer-specific miRNA sequence.

Tollip Orchestrates Macrophage Polarization to Alleviate Intestinal Mucosal Inflammation.

BACKGROUND AND AIMS: Regulation of macrophage polarization is a promising strategy for treating inflammatory bowel disease [IBD]. Tollip is an important negative regulator of Toll-like receptor [TLR]-mediated innate immunity with downregulated expression in the colon tissues of patients with IBD. This study aimed to regulate the expression of Tollip to affect macrophage polarization. METHODS: A molecular, targeted immunotherapy method was developed by linking mannose-modified trimethyl chitosan [MTC] with Tollip-expressing plasmids via ionic cross-linking, forming MTC-Tollip nanoparticles with a targeting function. MTC-Tollip selectively targeted mouse intestinal macrophages to regulate the polarization of macrophages for mucosal repair. RESULTS: Orally administered MTC-Tollip significantly elevated Tollip expression in intestinal tissue. Compared with MTC-negative control [NC]-treated mice in which colitis was induced with dextran sodium sulphate [DSS], the MTC-Tollip nanoparticle-treated mice exhibited decreased body weight loss and colon shortening, lower proinflammatory cytokine expression in colon tissues, and greater mucosal barrier integrity. MTC-Tollip treatment decreased TNF-α and iNOS expression but increased CD206 and Arg-1 expression in colon tissue. Tollip overexpression in mouse peritoneal macrophages inhibited lipopolysaccharide [LPS]-induced proinflammatory cytokine production and promoted IL-4-induced M2 expression. The progression of peritoneal macrophages extracted from Tollip-/- mice confirmed the effect of Tollip on macrophage polarization. Western blots showed that Tollip overexpression attenuated the upregulation of TLR pathway-associated targets in M1 macrophages. CONCLUSIONS: MTC nanoparticles can be 'intelligent' carriers in immunotherapy. The modulation of Tollip expression in macrophages may be a novel treatment approach for IBD.

Plant Chemistry Determines Host Preference and Performance of an Invasive Insect.

Understanding how host plant chemistry affects invasive insects is crucial for determining the physiological mechanism of host use and predicting invasive insect outbreak and damage on hosts. Here, we examined the effects of plant nutrition and defensive chemicals on host preference and performance of adults and larvae of the invasive potato tuberworm, Phthorimaea operculella (Zeller; Lepidoptera: Gelechiidae), on four native (Solanum tuberosum, Nicotiana tabacum, Datura stramonium, and Solanum lycopersicum) and three new (Solanum melongena, Physalis alkekengi, and Lycium barbarum) host plants. We found that adults preferred to oviposit on S. tuberosum and N. tabacum leaves and the soil around these native host plants over other hosts. Larvae performed well on S. tuberosum and N. tabacum, reaching higher pupa weight and having better survival. Larvae performed poorly on S. melongena, S. lycopersicum, P. alkekengi, D. stramonium, and L. barbarum, with lower pupa weight and lower survival. Solanum tuberosum and N. tabacum had higher leaf soluble proteins than other plants and lower leaf total phenolics than S. lycopersicum, D. stramonium, and L. barbarum. Moreover, carbon content and soluble protein were positively associated with larval survival, while defensive traits (lignin and total phenolics) negatively affected larval survival. These findings provide insights into understanding of biochemical mechanisms of interactions between invasive insects and host plants, indicating the importance of considering plant chemistry when assessing invasive insect host use and damage.

Programmable low-cost DNA-based platform for viral RNA detection.

Detection of viruses is critical for controlling disease spread. Recent emerging viral threats, including Zika virus, Ebola virus, and SARS-CoV-2 responsible for coronavirus disease 2019 (COVID-19) highlight the cost and difficulty in responding rapidly. To address these challenges, we develop a platform for low-cost and rapid detection of viral RNA with DNA nanoswitches that mechanically reconfigure in response to specific viruses. Using Zika virus as a model system, we show nonenzymatic detection of viral RNA with selective and multiplexed detection between related viruses and viral strains. For clinical-level sensitivity in biological fluids, we paired the assay with sample preparation using either RNA extraction or isothermal preamplification. Our assay requires minimal laboratory infrastructure and is adaptable to other viruses, as demonstrated by quickly developing DNA nanoswitches to detect SARS-CoV-2 RNA in saliva. Further development and field implementation will improve our ability to detect emergent viral threats and ultimately limit their impact.

A targeted promotional DVD fails to improve Maori and Pacific participation rates in the New Zealand bowel screening pilot: results from a pseudo-randomised controlled trial.

BACKGROUND: New Zealand's Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test. As a pilot it offered opportunities to test interventions for reducing ethnic inequities in colorectal cancer screening prior to nationwide programme introduction. Small media interventions (e.g. educational material and DVDs) have been used at both community and participant level to improve uptake. We tested whether a DVD originally produced to raise community awareness among the Maori population would have a positive impact on participation and reduce the proportion of incorrectly performed tests (spoiled kits) if mailed out with the usual reminder letter. METHODS: The study was a parallel groups pseudo-randomised controlled trial. Over 12 months, all Maori and Pacific ethnicity non-responders four weeks after being mailed the test kit were allocated on alternate weeks to be sent, or not, the DVD intervention with the usual reminder letter. The objective was to determine changes in participation and spoiled kit rates in each ethnic group, determined three months from the date the reminder letter was sent. Participants and those recording the outcomes (receipt of a spoiled or non-spoiled test kit) were blinded to group assignment. RESULTS: 2333 Maori and 2938 Pacific people participated (11 withdrew). Those who were sent the DVD (1029 Maori and 1359 Pacific) were less likely to participate in screening than those who were not (1304 Maori and 1579 Pacific). Screening participation was reduced by 12.3% (95% CI 9.1-15.5%) in Maori (13.6% versus 25.9%) and 8.3% (95% CI 5.8-10.8%) in Pacific (10.1% versus 18.4%). However, spoiled kit rates (first return) were significantly higher among those not sent the DVD (33.1% versus 12.4% in Maori and 42.1% versus 21.9% in Pacific). CONCLUSION: The DVD sent with the reminder letter to BSP non-responders reduced screening participation to an extent that more than offset the lower rate of spoiled kits. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12612001259831 . Registered 30 November 2013.

The impact of health on professional diver attrition.

INTRODUCTION: Approximately 77% of professional divers leave the industry within five years of entry, for reasons that are uncertain. One possibility is that attrition is due to ill-health. The health of New Zealand occupational divers is surveyed by a comprehensive medical examination every five years and by a health questionnaire in the intervening years. Divers are thereby confirmed 'fit' annually. The aim of this study was to determine if divers quit the industry due to a health problem not identified by this health surveillance system. METHOD: 601 divers who had left the industry within five years of entry medical examination ('quitters') were identified from a computerised database. One hundred and thirty-six who could be contacted were questioned about their principal reason for quitting. Comparison was made between the health data of all those defined as 'quitters' and a group of 436 'stayers' who have remained active in the industry for over 10 years. RESULTS: Health was the principal reason for abandoning a diving career for only 2.9% of quitters. The overwhelming majority (97.1%) quit because of dissatisfaction with aspects of the work, such as remuneration and reliability of employment. Besides gender, the only significant difference between the health data of quitters and stayers was that smoking was four times more prevalent among quitters. CONCLUSIONS: The key determinant of early attrition from the New Zealand professional diver workforce is industry-related rather than health-related. The current New Zealand diver health surveillance system detects the medical problems that cause divers to quit the industry.

The impact of diving on hearing: a 10-25 year audit of New Zealand professional divers.

INTRODUCTION: Surveillance of professional divers' hearing is routinely undertaken on an annual basis despite lack of evidence of benefit to the diver. The aim of this study was to determine the magnitude and significance of changes in auditory function over a 10-25 year period of occupational diving with the intention of informing future health surveillance policy for professional divers. METHODS: All divers with adequate audiological records spanning at least 10 years were identified from the New Zealand occupational diver database. Changes in auditory function over time were compared with internationally accepted normative values. Any significant changes were tested for correlation with diving exposure, smoking history and body mass index. RESULTS: The audiological records of 227 professional divers were analysed for periods ranging from 10 to 25 years. Initial hearing was poorer than population norms, and deterioration over the observation period was less than that predicted by normative data. Changes in hearing were not related to diving exposure, or smoking history. CONCLUSION: Audiological changes over 10 to 25 years of occupational diving were not found to be significantly different from age-related changes. Routine annual audiological testing of professional divers does not appear to be justifiable.

Lifetime risk of primary total knee replacement surgery in New Zealand from 2000 to 2015.

AIM: To estimate the lifetime risk of total knee replacement surgery (TKR) including unicompartmental knee replacement surgery (UKR) for osteoarthritis (OA) in New Zealand, and to identify if lifetime risk is changing over time. METHOD: Data on primary TKR procedures performed for OA from 2000 to 2015 in New Zealand was obtained from the New Zealand joint registry. Life tables and population data were sourced from Statistics New Zealand and the Ministry of Health of New Zealand. Lifetime risk of TKR was calculated for each year from 2000 to 2015 using registry population data and life tables. RESULTS: The overall lifetime risk of TKR in New Zealand increased markedly from 2000 to 2015, with females having an overall greater lifetime risk increasing from 9.4% in 2000 to 16.8% in 2015, a relative increase of 78%. However, males showed the greatest increase in risk from 8.1% in 2000 to 16.0% in 2015, a relative increase of 97%. CONCLUSIONS: Current lifetime risk of knee replacement in New Zealand is approximately one in six for males and females. This lifetime risk has increased significantly from 2000 to 2015. These results can be used to guide public health policy planning and division of public health resources.

Role of leptin in allergic rhinitis during sublingual immunotherapy.

OBJECTIVE: Increasing evidence suggests that leptin is upregulated during allergic reactions in the airway and related to the severity of disease in allergic rhinitis (AR). In this study, we aimed to investigate the expression of leptin during sublingual immunotherapy (SLIT) in AR patients. METHODS: Forty AR patients without obesity were recruited in this study. Twenty patients received house dust mite (HDM) allergen extract for SLIT and twenty patients received placebo randomly. Protein expression of leptin in serum and nasal lavage was tested by enzyme-linked immuno sorbent assay (ELISA) 1 and 2 years after SLIT treatment, respectively. Peripheral blood mononuclear cells (PBMCs) and human nasal epithelial cell were prepared and stimulated by recombinant leptin after 24 months' SLIT treatment and the induction of Th2 cytokines (IL-4/IL-5/IL-13) were detected by ELISA. RESULTS: SLIT treatment decreased the expression of leptin protein in serum and nasal lavage significantly compared with placebo group 1 and 2 years after SLIT treatment. Nasal leptin level was correlated to decreased Th2 response (IL-4/IL-5/IL-13) and enhanced Treg (IL-10/TGF-beat) response after 2 years' SLIT. We also found that SLIT decreased the ability of leptin in promoting Th2 cytokines expression by PBMCs and human nasal epithelial cell after 2 years' SLIT treatment. CONCLUSION: Changes of leptin expression in serum and nasal lavage may be correlated with Th2/Treg regulation during SLIT. Our results suggested that leptin served as an important biomarker during SLIT.

Epidemiology of melanoma in situ in New Zealand: 2008-2012.

AIM: The incidence of melanoma in situ varies throughout the world. It is associated with excellent outcomes, however many of those untreated will go on to develop invasive melanoma with a worse prognosis. There is no previously published data on melanoma in situ (MIS) in New Zealand. Further information is needed to enable better understanding of the disease spectrum. METHODS: De-identified data were obtained from the New Zealand Cancer Registry (NZCR) by way of computerised search for MIS diagnosis. A separate search was performed to identify all patients with invasive melanoma. World Health Organization standard population was used for calculating age standardised rates. RESULTS: There was a trend to increasing cases of MIS, but a relative plateauing of invasive melanoma. The number of cases for MIS overtook invasive melanoma in 2012. Overall, men had a significantly higher incidence compared to women. Incidence rates varied markedly between different regions of the country. CONCLUSIONS: This paper provides new information about the epidemiology of MIS in New Zealand and its relevance to clinical practice. Public education strategies may be beginning to show effect with the goal of increasing prevention and earlier detection and treatment to enable decrease in melanoma mortality.

Long-term changes in spirometry in occupational divers: a 10-25 year audit.

AIM: To determine whether long-term engagement in occupational diving causes significant changes in spirometric measurements. METHOD: All divers with adequate spirometric records spanning at least 10 years were identified from the New Zealand occupational diver database. Changes in lung function over time were compared with normative values derived using published prediction equations. Any significant changes were tested for correlation with age, duration of occupational diving, gender, smoking history and body mass index (BMI). RESULTS: Spirometry data spanning periods of 10 to 25 years were analysed for 232 divers. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) declined with increasing duration of diving, but slightly less than predicted with increasing age, while peak expiratory flow (PEF) declined more than expected for age in longer-term divers. The changes in PEF were statistically significant, and correlated with duration of diving exposure, initial age and final BMI. Nevertheless, the changes were small and probably clinically insignificant. CONCLUSION: We compared changes in spirometric parameters over long periods of occupational diving with normative data and found no clinically significant differences that could be attributed to diving. We found no justification for routine spirometry in asymptomatic divers.

Laparoscopic gastric bypass surgery: a safe and effective operation for the ≥60s?

BACKGROUND: The perceived benefits of Roux-en-Y laparoscopic gastric bypass (LRYGB) surgery in the ≥60s are regarded as being significantly less than in the younger population. This study examined a New Zealand population who underwent LRYGB and analysed the mortality rate, complications and postoperative weight loss. METHODS: This was a retrospective cohort study of patients who underwent LRYGB over a 12-year period and had attended up to 1 year of follow-up clinic. The study population was from a single centre in New Zealand. RESULTS: A total of 1362 patients were eligible. Demographic analysis showed the <60 to have 83% female majority, mean age of 43 years and a mean body mass index of 46. The ≥60 group had a 76% female majority, mean age of 63 years and a mean body mass index of 45. The % excess weight loss, % weight loss and weight loss at 1 year all showed a significant difference. Analysis of the % excess weight loss at 1 year in the ≥60s showed a mean of 79% and a median of 78% (95% confidence interval: 69%, 85%). In the <60s the mean was 84% and the median 84% (95% confidence interval: 83%, 85%). Comparison between the groups showed a significant difference (Kruskal-Wallis test, P = 0.0064). The complication frequency of the groups was not significantly different (chi-square test, P = 0.7605). CONCLUSION: LRYGB is an effective weight loss operation in the <60s and ≥60s. LRYGB is safe, with a low complication rate and 30-day postoperative mortality rate. LRYGB should not be restricted on the basis of age alone.

Effect of sublingual immunotherapy on platelet activity in children with allergic rhinitis / Efeito da imunoterapia sublingual sobre a atividade plaquetária em crianças com rinite alérgica

Abstract Introduction: The role of platelet activation in allergic inflammation is receiving increasing attention. Sublingual immunotherapy for allergic rhinitis can modify the immunological process to an allergen, rather than simply treating symptoms. Objective: The aim of this study was to explore the role of platelet activation during sublingual immunotherapy in children with allergic rhinitis. Methods: Forty-two House Dust Mite - sensitized children with allergic rhinitis were enrolled and received House Dust Mite allergen extract for sublingual immunotherapy or placebo. Serum of different time points during treatment was collected and used for detection of Platelet Factor-4 and Beta-Thromboglobulin concentration by Enzyme-Linked Immuno Sorbent Assay. Results: Our data showed decreased expression of Platelet Factor-4 and Beta-Thromboglobulin protein after one year's sublingual immunotherapy. In addition, the decrease of symptom scores and serum Platelet Factor-4 and Beta-Thromboglobulin protein concentrations was positively related. Conclusion: During sublingual immunotherapy, platelet activation was inhibited significantly. Our results might indicate that inhibition of platelet activation within the systemic circulation is an important mechanism during sublingual immunotherapy.

Resumo Introdução: O papel da ativação de plaquetas na inflamação alérgica recebeu atenção crescente. A imunoterapia sublingual para rinite alérgica pode modificar o processo imunológico a um alérgeno, em vez de tratar os sintomas simplesmente. Objetivo: Explorar o papel da ativação plaquetária durante a imunoterapia sublingual em crianças com rinite alérgica. Método: Quarenta e duas crianças com rinite alérgica sensibilizadas por ácaros de poeira domiciliar (APD) foram inscritas e receberam extrato de alérgeno de APD para imunoterapia sublingual ou placebo. O soro de diferentes pontos no tempo durante o tratamento foi recolhido e usado para a detecção de fator 4 plaquetário e concentração de beta-tromboglobulina por ensaio imunoenzimático. Resultados: Nossos dados mostraram diminuição da expressão de fator 4 plaquetário e proteína beta-tromboglobulina após imunoterapia sublingual de um ano. Além disso, a diminuição dos escores de sintomas e o fator 4 plaquetário sérico e concentrações de proteína beta-tromboglobulina foram relacionados de maneira positiva. Conclusão: Durante imunoterapia sublingual, a ativação plaquetária foi inibida significativamente. Os nossos resultados podem indicar que a inibição da ativação de plaquetas dentro da circulação sistêmica é um mecanismo importante durante imunoterapia sublingual.

Combination of mometasone furoate and oxymetazoline for the treatment of adenoid hypertrophy concomitant with allergic rhinitis: A randomized controlled trial.

In the clinic, approximately 30% of children with adenoid hypertrophy (AH) concomitant with allergic rhinitis (AR) report poor responses to intranasal steroids. To determine whether the combination of mometasone furoate (MF) and oxymetazoline (OXY) is more effective than either agent alone, we performed a two-stage, parallel, randomized, double-blind, double-dummy, clinical trial with 240 AH children with concomitant perennial AR. During the first stage, all children were randomly assigned to the MF or control group for six weeks of treatment. During the second stage, the non-responders from stage one were randomly assigned to 4 groups for 8 weeks of treatment that involved receiving the following treatments: MF/OXY, MF/placebo, placebo/OXY, or placebo/placebo. During the first stage of treatment, 39% of the responders treated with MF achieved greater reductions in total and individual symptom scores than did those on placebo. During the second stage of treatment, the nasal congestion scores of the MF/OXY group significantly decreased. The adenoid/choana ratio of the MF/OXY-treated group decreased and the nasal volume increased significantly. Our results suggest that the combination of OXY and MF is effective and safe for the treatment of AH children with concomitant AR and has a rapid onset of action.

Indeterminate CT pulmonary angiogram: Why and does it matter?

INTRODUCTION: This study assessed the rate of indeterminate CT pulmonary angiogram (CTPA) in a general hospital and evaluated potential contributing factors to an indeterminate CTPA and patients' eventual clinical outcome. METHODS: Four hundred and three consecutive CTPA and their finalised report from 01/08/2012 to 05/12/2012 at Waitemata DHB were reviewed retrospectively. Patient demographics, scan parameters and average Hounsfield unit (HU) of the main pulmonary trunk (PT) and likely cause of indeterminate study were documented. Studies were categorised into diagnostic, suboptimal or non-diagnostic studies. Univariate and multiple regression analyses were employed. RESULTS: Six per cent (n = 24) of the studies were deemed indeterminate which included suboptimal and non-diagnostic studies. Seven pregnant patients were scanned during the study period and four of the seven studies were deemed indeterminate. In univariate analysis, predictors of indeterminate studies included 'weight' (P = 0.022), 'average HU of PT' (P < 0.0001) and 'effective dose' (P = 0.0003). In the multivariate logistic regression model, only 'average HU of PT' was associated with indeterminate studies (OR = 0.99, 95%CI: 0.99, 1.00). Twelve of 24 indeterminate studies had suboptimal pulmonary enhancement with causes including suboptimal timing of contrast bolus, hyperdynamic state due to pregnancy and transient interruption of contrast. Three patients had excessive noise due to body habitus. Eight studies had motion artefacts and one patient had left lower lobe pneumonia which decreased the accuracy. A third of the indeterminate studies were clinically considered as negative by referring clinicians. CONCLUSIONS: Pulmonary trunk average Hounsfield unit is a predictor of indeterminate CT pulmonary angiogram.