CT features of acute COVID-19 and long-term follow-up.

Since the first few cases of pneumonia attributed to infection with the highly contagious novel coronavirus 2 (SARs-CoV-2) were detected in Wuhan, China, in December 2019, imaging has proven an invaluable diagnostic tool throughout the resulting global pandemic. This review describes the imaging features of severe pulmonary disease caused by SARs-CoV-2, named COVID-19 by the World Health Organization (WHO), particularly focussing on computed tomography (CT). CT plays an important role in understanding the pathology behind the progression of disease, as well as helping to identify the potential complications of COVID-19 pneumonia and recognising possible alternative or concurrent diagnoses. This review also focusses on follow-up imaging of survivors of COVID-19, which continues to contribute substantially to our understanding of the longer-term pulmonary changes in patients who have survived severe COVID-19 pneumonia.

The relationship between hyoid and laryngeal displacement and swallowing impairment.

OBJECTIVES: Reduced range of hyoid and laryngeal movement is thought to contribute to aspiration risk and pharyngeal residues in dysphagia. Our aim was to determine the extent to which movements of the hyoid and larynx are correlated in the superior and anterior directions in swallowing, and whether movement range is predictive of penetration-aspiration or pharyngeal residue. DESIGN: Prospective, single-blind study of penetration-aspiration and pharyngeal residue with objective frame-by-frame measures of hyoid and laryngeal excursion from videofluoroscopy. SETTING: Tertiary hospital and rehabilitation teaching hospital. PARTICIPANTS: Twenty-eight participants referred for videofluoroscopy: 13 women, aged 57-77; 15 men, aged 54-70. Individuals with known neurodegenerative diseases or prior surgery to the neck were excluded. Each swallowed three boluses of 40% w/v thin liquid barium suspension. OUTCOMES: Two speech-language pathologists independently rated penetration-aspiration, vallecular and pyriform sinus residue. Cervical spine length, hyoid and laryngeal displacement were traced frame-by-frame. Predictive power was calculated. RESULTS: Cervical spine length was significantly greater in men. Hyoid displacement ranged from 34-63% of the C2-4 distance. Arytenoid displacement ranged from 18-66%, with significantly smaller anterior displacement in men. Positive hyoid-laryngeal movement correlations in both axes were the most common pattern observed. Participants with reduced displacement ranges (≤ first quartile) and with abnormal correlation patterns were more likely to display penetration-aspiration. Those with reduced anterior hyoid displacement and abnormal correlation patterns had a greater risk of post-swallow pharyngeal residues. CONCLUSIONS: It is difficult for clinicians to make on-line appraisals of the extent to which hyoid and laryngeal movement may be contributing to functional swallowing consequences during videofluoroscopy. This study suggests that it is most important for clinicians to discern whether reduced anterior displacement of these structures is contributing to a patient's swallowing impairment. Measures of structural displacement in thin liquid swallowing should be corrected for variations in participant height. Reductions in anterior hyoid and laryngeal movement below the first-quartile boundaries are statistically associated with increased risk for penetration-aspiration and post-swallow residues.

Pentazocine abuse. Report of a case with pulmonary arterial cellulose granulomas and pulmonary hypertension.

We report a patient who developed pulmonary hypertension following repeated intravenous injection of dissolved pentazocine tablets. Through analysis of lung biopsy material, this was shown to be due to embolization of the cellulose filler in the tablet and the tissue reaction it produced. Administration of prednisone appeared to improve the patient's clinical state.

Assessing whether the plane of section on CT affects accuracy in demonstrating facial fractures in 3-D reconstruction when using a dried skull.

CT slice thickness and threshold value are well-known determinants of accuracy in three-dimensional (3-D) CT image reconstruction. The purpose of this study was to assess whether the plane selected for primary CT data acquisition, axial vs coronal, might also contribute to the accuracy and ease of identification of abnormalities in 3-D image reconstruction independent of the 3-D processing system used. Two sets of 10 observers evaluated fractures created in a dried skull and corresponding 3-D image data. A General Electric 9800 scanner was used to acquire the two-dimensional CT data. The 3D98 Quick software and ISG Camra Allegra workstation were used for two sets of 3-D reconstructions. The expected result was that fractures oriented perpendicularly to the initial plane of CT section would be better reconstructed on 3-D than when the initial plane of CT imaging paralleled the fracture. Our results indicate that Le Fort fractures (types I and III) are better displayed with coronal CT data and that zygomatic tripod fractures may be better displayed in 3-D with axial CT image data.

The performance of autoclaved high-speed dental handpieces.

High-speed dental handpieces, which are used so extensively in modern dental practice, may be a source of cross-contamination between patients. A standard autoclave procedure of 121 C for 15 minutes will sterilize the handpieces evaluated in this report. The performance in a standardized laboratory trial showed deterioration of speed in the simulated three-month period. Clinical evaluations for three months showed some minor mechanical problems. These dental handpieces should be used in conjunction with a formal daily and three-month maintenance program.

Looking for the uninsured in Massachusetts? Check opioid dependent persons seeking detoxification.

BACKGROUND: We examined the rate of uninsurance among persons seeking detoxification at a large drug treatment program in Massachusetts in 2013, five years after insurance mandates. METHODS: We interviewed three hundred and forty opioid dependent persons admitted for inpatient detoxification in Fall River, Massachusetts. Potential predictors of self-reported insurance status included age, gender, ethnicity, employment, homelessness, years of education, current legal status, and self-perceived health status. RESULTS: Participants mean age was 32 years, 71% were male, and 87% were non-Hispanic Caucasian. Twenty-three percent were uninsured. In the multivariate model, the odds of being uninsured was positively associated with years of education (OR=1.22, 95% CI=1.03; 1.46, p<.05), higher among males than females (OR=2.63, 95% CI=1.33; 5.20, p<.01), and inversely associated with age (OR=0.94, 95% CI=0.90; 0.98, p<.01). CONCLUSION: Opioid dependent persons recruited from a detoxification program in Massachusetts are uninsured at rates far above the state average. With the arrival of the Affordable Care Act, drug treatment programs in Massachusetts and nationally will be important sites to target to expand health coverage.

Computed tomography of calcaneal fractures: anatomy, pathology, dosimetry, and clinical relevance.

Eighteen CT examinations were performed in 10 patients for the evaluation of acute intraarticular fractures and their follow-up. Fractures comparable to those in the patients were created in cadavers. The normal anatomy and the traumatically altered anatomy of the calcaneus in the axial, coronal, and sagittal planes are demonstrated by CT and corresponding anatomic sections. Scanning was performed in the axial plane, with subsequent reconstruction in the coronal and sagittal planes. The axial scans show disruption of the inferior part of the posterior facet, calcaneocuboid joint involvement, and widening of the calcaneus. The coronal scans show disruption of the superior part of the posterior facet, sustentaculum tali depression (involvement of middle and anterior facets), peroneal and flexor hallucis longus tendon impingement, and widening and height loss of the calcaneus. The sagittal scans show disruption of the posterior facet, calcaneocuboid joint involvement, and height loss of the calcaneus and allow the evaluation of Boehler's and Gissane's angles. All three planes show the position of major fracture fragments. Radiation dose to the foot was measured to be 0.1 rad (0.001 Gy) for plain film radiography (five exposures), 18 rad (0.18 Gy) for conventional tomography (20 cuts), and 2.6 rad (0.026 Gy) for axial CT examination.