Morphometric examination of the trachea and bronchi in follow-up computed tomography scans of COVID-19 patients / Examen morfométrico de la tráquea y los bronquios en tomografías computarizadas de seguimiento de pacientes con COVID-19

SUMMARY: The purpose of this study is to evaluate changes in the trachea and bronchi using 3-dimensional reconstruction images obtained from the initial and follow-up computed tomography (CT) scans of COVID-19 patients. A hundred COVID-19 patients over the age of 18 were included in our study. CT images were transferred to Mimics software, and a 3-dimensional reconstruction of the trachea and bronchi was performed. The initial and follow-up CT images of COVID-19 patients were graded as none (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3) according to the total lung severity score. The patients were divided into progression and regression groups according to the grade increase/decrease between the initial and follow-up CTs. Moreover, the patients were divided into groups as 0-2 weeks, 2-4 weeks, 4-12 weeks, and over 12 weeks according to the duration between the initial and follow-up CTs. The mean cross-sectional area, circumference, and diameter measurements of the right upper lobar bronchus, intermediate bronchus, middle lobar bronchus, and left lower lobar bronchus decreased in the follow-up CTs of the progression group. This decrease was not found to be statistically significant. In the follow-up CTs of the regression group, the left upper lobar bronchus and left lower lobar bronchus measurements increased but not statistically significant. Upon comparing the onset of the disease and the follow-up period, statistically significant changes did not occur in the trachea, main bronchus, and lobar bronchus of COVID-19 patients.

El propósito de este estudio fue evaluar los cambios en la tráquea y los bronquios utilizando imágenes de reconstrucción tridimensionales obtenidas de las tomografías computarizadas (TC) iniciales y de seguimiento de pacientes con COVID-19. En nuestro estudio se incluyeron 100 pacientes con COVID-19 mayores de 18 años. Las imágenes de TC se transfirieron al software Mimics y se realizó una reconstrucción tridimensional de la tráquea y los bronquios. Las imágenes de TC iniciales y de seguimiento de los pacientes con COVID-19 se calificaron como ninguna (grado 0), leve (grado 1), moderada (grado 2) y grave (grado 3) según la puntuación total de gravedad pulmonar. Los pacientes se dividieron en grupos de progresión y regresión según el aumento/disminución del grado entre las TC iniciales y de seguimiento. Además, los pacientes se dividieron en grupos de 0 a 2 semanas, de 2 a 4 semanas, de 4 a 12 semanas y de más de 12 semanas según la duración entre la TC inicial y la de seguimiento. Las mediciones medias del área transversal, la circunferencia y el diámetro del bronquio lobar superior derecho, el bronquio intermedio, el bronquio lobar medio y el bronquio lobar inferior izquierdo disminuyeron en las TC de seguimiento del grupo de progresión. No se encontró que esta disminución fuera estadísticamente significativa. En las TC de seguimiento del grupo de regresión, las mediciones del bronquio lobar superior izquierdo y del bronquio lobar inferior izquierdo aumentaron pero no fueron estadísticamente significativas. Al comparar el inicio de la enfermedad y el período de seguimiento, no ocurrieron cambios estadísticamente significativos en la tráquea, el bronquio principal y el bronquio lobar de los pacientes con COVID-19.

Traumatic Intracerebral Hematoma

During a 36-month period, clinical outcome in 170 patients with traumatic intracerebral hematoma(TICH) was analysed. These patients represented 5.1% of 3328 consecutive patients with head injuries admitted to the Soonchunhyang University Chunan Hospital. The overall mortality was 33.5%. A significant number of patients(52.6%), who were not comators at the time of admission(GCS0.005) ; 2) the presence of associated lesions(p>0.01) ; 3) time delay of two hours or more from admission to operation(p>0.05) ; 4) actual midline shift of 4.5mm or above on initial CT scan(p>0.005) ; 5) obliteration of suprasellar cistern(p>0.005) ; 6) the presence of delayed traumatic intracerebral hematoma(DTICH) in non-surgical patients with GCS score of 8 or above(p>0.01). Age and location of hematoma did not affect outcome, but the patients with multiple located hematoma showed higher mortality than the others. Time delay in the treatment of TICH and DTICH contribute significantly to poor outocme. Rapidly progressive DTICH within 48 hours after trauma is high in mortality. Follow-up CT scan might as well be performed till 48 hours after injury and 8 hours after initial operation, even though neurological status did not alter for the worse.

A Clinical Analysis of Chronic Subdural Hematoma with Special Reference to the Follow-up CT-scan and Osmolarity of Hematoma

A series of 70 patients with chronic subdural hematoma, admitted to the Department of Neurosurgery of Kyung Hee University Hospital from Aug. 1, 1977 to July 31, 1982 is presented. The following results were obtained. 1) Males were more frequently involved than female with the ratio of 4.8 : 1. Peak age incidence was 6th and 7th decade. Bilateral subdural collections were only 4 cases and others were unilateral. 2) Older age(more than 50) had more frequently focal neurologic deficit such as hemiplegia, however younger age(less than 50) presented as increased intracranial pressure signs such as headache and vomiting. 3) The hematoma density of CT-scan on admission was hypertense, 3 cases(4.9%); mixed density, 20 cases(32.8%); isodense, 18 cases(29.8%); and hypodense, 20 cases(32.8%) respectively. 4) The operative method between simple burr hole drainage and craniotomy with membranectomy didn't affect the postoperative results. The operative mortality was 2.9%. 5) Follow-up CT scanning was performed in 32 patients, only 8 of them showed normal CT findings within one month after operation. One patient still showed remnant of hematoma on 50th postoperative day. 6) Osmolarities of the hematoma and systemic venous blood were measured simultaneously 10 times in 8 cases. Hematoma osmolarities were isosmolar 1, hyperosmolar 6 and hyposmolar 3 compared with systemic venous blood.