Multislice Computed Tomography Scan Research Articles

ROLE OF HRCT IN EVALUATION OF PATHOLOGIES OF TEMPORAL BONE AND ITS SURGICAL INTERVENTION

Background:Advanced medical imaging techniques like CT and HRCT help diagnose pathologies in the temporal bone, providing detailed visualization and insights into pathological conditions, particularly soft tissue density eg. cholesteatoma, which is difficult to diagnose through clinical examination alone. Aims and Objectives: The study aims to identify temporal bone changes in chronic suppurative otitis media patients using HRCT, correlate surgical intervention with HRCT findings, and confirm diagnosis through intraoperative findings. Methods: Total 100 patients with temporal bone pathologies. The patients were aged 10-60 years and provided clinical data. They underwent a Siemens Somatom AS 128 Slice multislice CT scan, revealing ear ossicle erosion, dural plate erosion, mastoid sclerosis, and scutum erosion. Surgical procedures were scheduled based on HRCT findings. The study compared HRCT and intraoperative findings to determine their correlation, using IBM SPSS 23rd version software and Chi-square test. Results: The study analyzed 100 patients with ossicular abnormalities, with incus erosion being the most common. Other common conditions included scutum, malleus, and stapes erosion. Sinus plate erosion was rare, while mastoid sclerosis was common but not as prevalent. Soft tissue/fluid attenuation was prevalent during intraoperative procedures, with the epitympanum having the highest prevalence at 98%, indicating density-related abnormalities. Conclusions: The data offers crucial insights into ossicular and mastoid health conditions, aiding clinicians in comprehensive assessments, accurate diagnoses, and effective treatment strategies, ultimately improving patient care and outcomes in otolaryngology.

Cross-Domain Denoising for Low-Dose Multi-Frame Spiral Computed Tomography.

Computed tomography (CT) has been used worldwide as a non-invasive test to assist in diagnosis. However, the ionizing nature of X-ray exposure raises concerns about potential health risks such as cancer. The desire for lower radiation doses has driven researchers to improve reconstruction quality. Although previous studies on low-dose computed tomography (LDCT) denoising have demonstrated the effectiveness of learning-based methods, most were developed on the simulated data. However, the real-world scenario differs significantly from the simulation domain, especially when using the multi-slice spiral scanner geometry. This paper proposes a two-stage method for the commercially available multi-slice spiral CT scanners that better exploits the complete reconstruction pipeline for LDCT denoising across different domains. Our approach makes good use of the high redundancy of multi-slice projections and the volumetric reconstructions while leveraging the over-smoothing issue in conventional cascaded frameworks caused by aggressive denoising. The dedicated design also provides a more explicit interpretation of the data flow. Extensive experiments on various datasets showed that the proposed method could remove up to 70% of noise without compromised spatial resolution, while subjective evaluations by two experienced radiologists further supported its superior performance against state-of-the-art methods in clinical practice. Code is available at https://github.com/YCL92/TMD-LDCT.

A Comparison of Effective doses for the 16, 64, and 128-slice Computed Tomography Scanners: A First Health Cluster Study in Riyadh

Abstract Objective: This study aimed to compare the effective doses among 16, 64, and 128-slice computed tomography (CT) scanners. Several strategies have been implemented to reduce the radiation dose from CT, including a low tube voltage, a high pitch protocol, automatic tube current modulation, and iterative reconstruction algorithms. These strategies have reduced the radiation dose from the previously reported >20 mSv to <3–5 mSv or even <1 mSv. This study compared the radiation doses associated with routine CT scans performed using various multi-slice CT scanners. Materials and Methods: A total of 330 patients who underwent CT scans as part of their routine clinical diagnoses from December 4, 2018, to March 26, 2019, were screened cross-sectionally. CT scans were performed using 16-slice GE HealthCare BrightSpeed, 64-slice GE HealthCare Discovery CT750 HD, and 128-slice Siemens Healthineers SOMATOM Definition Flash CT scanner systems. The parameters considered in the analysis were age, sex, body region, scanner type (16, 64, and 128 slices), dose length product, and the estimated mean ED. The effective radiation dose was calculated using the dose length product and compared among the scanner types. Results: We evaluated the CT scans of 166 men (50.3%) and 164 women (49.7%) patients. Among the three types of CT scanners used, the 16-slice CT scanner had the highest effective radiation dose for brain (P = 0.024), paranasal sinus (P = 0.027), cervical spine (P = 0.04), chest (P < 0.001) and pelvis (P = 0.014). Conclusion: The 16-slice CT scanner has the highest effective radiation dose compared to the 64 and 128-slice scanners. When performing routine CT scans with low-end CT scanner systems, dose-reduction strategies should be considered.

Radiomics parameters of epicardial adipose tissue predict mortality in acute pulmonary embolism

BackgroundAccurate prediction of short-term mortality in acute pulmonary embolism (APE) is very important. The aim of the present study was to analyze the prognostic role of radiomics values of epicardial adipose tissue (EAT) in APE.MethodsOverall, 508 patients were included into the study, 209 female (42.1%), mean age, 64.7 ± 14.8 years. 4.6%and 12.4% died (7- and 30-day mortality, respectively). For external validation, a cohort of 186 patients was further analysed. 20.2% and 27.7% died (7- and 30-day mortality, respectively). CTPA was performed at admission for every patient before any previous treatment on multi-slice CT scanners. A trained radiologist, blinded to patient outcomes, semiautomatically segmented the EAT on a dedicated workstation using ImageJ software. Extraction of radiomic features was applied using the pyradiomics library. After correction for correlation among features and feature cleansing by random forest and feature ranking, we implemented feature signatures using 247 features of each patient. In total, 26 feature combinations with different feature class combinations were identified. Patients were randomly assigned to a training and a validation cohort with a ratio of 7:3. We characterized two models (30-day and 7-day mortality). The models incorporate a combination of 13 features of seven different image feature classes.FindingsWe fitted the characterized models to a validation cohort (n = 169) in order to test accuracy of our models. We observed an AUC of 0.776 (CI 0.671–0.881) and an AUC of 0.724 (CI 0.628–0.820) for the prediction of 30-day mortality and 7-day mortality, respectively. The overall percentage of correct prediction in this regard was 88% and 79% in the validation cohorts. Lastly, the AUC in an independent external validation cohort was 0.721 (CI 0.633–0.808) and 0.750 (CI 0.657–0.842), respectively.InterpretationRadiomics parameters of EAT are strongly associated with mortality in patients with APE.Clinical trial numberNot applicable.

Association between psychological stress and mandibular condyle structure: an analytical cross-sectional study

ObjectiveThe potential influence of psychological factors on temporomandibular joint disorders has been clinically documented. To date, all research examining the impact of psychological stress on the temporomandibular joint has been conducted on animals. This study aims to explore the relationship between psychological stress and the structure of the human mandibular condyle.MethodsThis cross-sectional study was performed on individuals, who were referred to the radiology division of 5th Azar Hospital for head and neck Computed Tomography (CT) scans. All participants completed a perceived stress questionnaire to determine their level of stress. Bone density and cortical bone thickness were measured as indicators of mandibular condyle structure. Based on multi-slice CT scan data, bone density was calculated in the anterior, middle, and posterior mandibular condyle. The cortical bone thickness was also measured at the anterior and posterior mandibular condyle. Statistical analysis was performed in R 4.0.2 software.ResultsSeventy individuals, aged 18–59 years, participated in this study. The CT scans revealed a decrease in Hounsfield units (HU) and bone mineral density (BMD) in both the anterior and posterior regions. However, in the high-stress group, there was no significant difference in cortical bone thickness in the anterior and posterior regions of the condyle, nor in HU and BMD in the middle region of the condyle. An inverse correlation was observed between BMD and perceived stress in the anterior, middle, and posterior regions of both condyles.ConclusionThe current findings indicate that recent psychological stress is associated with changes in the structure of the condyle.

The Photon-Counting CT Enters the Field of Cochlear Implantation: Comparison to Angiography DynaCT and Conventional Multislice CT.

Cochlear duct length (CDL) measurement plays a role in the context of individualized cochlear implant (CI) surgery regarding an individualized selection and implantation of the CI electrode carrier and an efficient postoperative anatomy-based fitting process. The level of detail of the preoperative temporal bone CT scan depends on the imaging modality with major impact on CDL measurements and CI electrode contact position determination. The aim of this study was to evaluate the accuracy of perioperative CDL measurements and electrode contact determination in photon-counting CT (PCCT). Ten human fresh-frozen petrous bone specimens were examined with a first-generation PCCT. A clinically applicable radiation dose of 27.1 mGy was used. Scans were acquired before and after CI insertion. Postoperative measurement of the CDL was conducted using an otological planning software and 3D-curved multiplanar reconstruction. Investigation of electrode contact position was performed by two respective observers. Measurements were compared with a conventional multislice CT and to a high-resolution flat-panel volume CT with secondary reconstructions. Pre- and postoperative CDL measurements in PCCT images showed no significant difference to high-resolution flat-panel volume CT. Postoperative CI electrode contact determination was also as precise as the flat-panel CT-based assessment. PCCT and flat-panel volume CT were equivalent concerning interobserver variability. CDL measurement with PCCT was equivalent to flat-panel volume CT with secondary reconstructions. PCCT enabled highly precise postoperative CI electrode contact determination with substantial advantages over conventional multislice CT scanners.

Nonmetric sex estimation in a contemporary Indonesian population: a validation study using clinical pelvic MSCT scans

Klales et al. (2012) is a popular standard for the estimation of skeletal sex. Since its publication, a number of studies have demonstrated that population-specific applications of Klales improve classification accuracy. However, it has also been shown that age appears to affect the expression of dimorphism in the pelvis across the lifespan. As such, the present study examines the accuracy of Klales, and the modified global standard of Kenyhercz et al. (2017), in a contemporary Indonesian population, including quantifying the effect of age. Pelvic multi-slice CT scans of 378 individuals (213 female; 165 male) were analysed in OsiriX®. Both standards were tested and Indonesian-specific models thereafter derived.When applied to the Indonesian sample, both the Klales and Kenyhercz standards resulted in lower classification accuracy relative to the original studies. In considering the Indonesian-specific models, the ventral arc was the most accurate for the classification of sex, at 93.3% with a − 3.0% sex bias. The accuracy of the three-trait model was 94.4%, with a − 5.5% sex bias. Age was shown to significantly affect the distribution of pelvic trait scores. As such, age-dependent models were also derived, with the standard for individuals between 30 and 49 years the most accurate, at 93.1% and a sex bias of − 4.0%. Accuracy was lower in individuals aged ≥ 50 years, at 91.3% and a sex bias of 4.1%. These findings support the importance of establishing population-specific standards and to facilitate improved accuracy and capabilities for forensic practitioners in Indonesia.

Bone Density of the Midpalatal Suture After Surgically Assisted Rapid Maxillary Expansion: A Retrospective Cohort Study

Objectives: To evaluate the bone density in the midpalatal suture after 10 months of surgically assisted rapid maxillary expansion (SARME) with the separation of the maxilla into 2 segments. Methods: Sixty multislice computed tomography (MCT) from 20 patients undergoing SARME were analyzed in 3 periods of time (1 MCT per patient on each occasion): (1) 1 week before surgery, (2) postsurgery immediately after completing the expander activation, and (3) 10 months after the expander activation. On all occasions, the bone density was measured in Hounsfield units on MCT scans in axial and coronal sections, in the anterior (A1), middle (A2), and posterior (A3) regions of the midpalatal suture. Results: The mean percentage values of bone density in Hounsfield units, from the 10-month postactivation period to preoperative in the A1, A2, and A3 regions were 68.38%, 38.21%, and 55.90%, respectively, in the axial norm, and 64.06%, 36.81%, and 55.50% in coronal norm (A1 = A3>A2), with no significant difference in the tomographic cuts (P >0.05). There was no correlation between patient age or amount of expansion in the expander and bone density. Conclusions: The bone density in the midpalatal suture 10 months after SARME is lower than preexpansion. A denser new bone formation along the suture concentrates closer to the extremities rather than in the central region. Although the maturation of the new bone formation in the midpalatal suture is lower 10 months after SARME, it appears to be sufficient for satisfactory clinical results, regardless of patient age or the amount of expansion in the expander.

Radiological image analysis based on the combined application value of multislice spiral CT and abdominal lavage in patients with acute purulent appendicitis

ObjectiveThe primary objective of this study is to conduct a clinical investigation involving abdominal lavage in patients with acute purulent appendicitis. The study aims to systematically assess the impact of abdominal lavage on complications within one week post-surgery and, in particular, focuses on the application value of multislice spiral CT in confirming these complications. By delving into the effects of different lavage timings on surgical outcomes and postoperative recovery, the study aims to provide scientific evidence for improving the efficacy of surgical treatment for acute purulent appendicitis. MethodsA total of 150 patients diagnosed with purulent appendicitis were selected for this study. They were divided into three groups: one group underwent preoperative abdominal lavage, another group underwent postoperative abdominal lavage , and a third group did not undergo abdominal lavage. The study aimed to compare the therapeutic outcomes among the three groups of patients. Additionally, the efficacy of the treatments was assessed by utilizing multislice spiral CT scans to confirm factors such as the abdominal abscess rate and the maximum diameter of abdominal abscesses one week postoperatively. ResultsThe operative time for patients in the experimental group showed no significant difference compared to the control group. However, postoperative pain scores were significantly lower in the experimental group (p<0.05), and the recovery time for gastrointestinal function was shortened (p<0.05) compared to the control group. The incidence of postoperative complications significantly decreased in the experimental group (p<0.05), while the control group exhibited higher complications. Additionally, the postoperative recovery status of patients in the experimental group was superior to that of the control group. ConclusionPerforming abdominal lavage in cases of purulent appendicitis can significantly alleviate postoperative pain, facilitate the recovery of gastrointestinal function, reduce the incidence of postoperative complications, and enhance overall surgical recovery. Therefore, we recommend using abdominal lavage during laparoscopic appendectomy to improve the surgical outcomes and postoperative recovery quality for patients. However, further large-scale studies are necessary to validate these results.

The role of radiological diagnostic methods in complicated combat chest trauma

Objective. To evaluate the effectiveness of radiation methods for diagnosing combat chest trauma at the stage of specialised surgical care. Materials and methods. The results of diagnostic measures performed on 51 wounded with bilateral combat chest trauma were analysed. All the wounded underwent chest radiography (if necessary, in two projections). Ultrasound examination of the chest cavity was performed in real time. Spiral computed tomography was performed on multislice computed tomography scanners. Video thoracoscopy was performed in 20 (83.3%) of 24 wounded patients treated at the Department of Thoracoabdominal Surgery of the Zaitsev Institute of General and Emergency Surgery in 2022­2023. In 27 patients treated in the same department and the polytrauma department of the Kharkiv City Clinical Hospital of Emergency Medical Care named after Prof. O. I. Meshchaninov in 2014­2016, video thoracoscopy was not used as a diagnostic method. Results. An important advantage of spiral computed tomography was that this method makes it possible to accurately determine the nature of damage to the chest cavity organs, the bone skeleton of the chest, post­traumatic complications and plan surgical treatment (correction) of existing injuries at the stage of providing specialised thoracic surgical care, in particular, using thoracoscopic access. Conclusions. Combat chest trauma is a severe injury that should be considered within trauma protocols, where clinical signs are only informative in the early diagnostic stages for potentially fatal injuries.

Automated CT Analysis of Body Composition as a Frailty Biomarker in Abdominal Surgery

Prior studies demonstrated consistent associations of low skeletal muscle mass assessed on surgical planning scans with postoperative morbidity and mortality. The increasing availability of imaging artificial intelligence enables development of more comprehensive imaging biomarkers to objectively phenotype frailty in surgical patients. To evaluate the associations of body composition scores derived from multiple skeletal muscle and adipose tissue measurements from automated segmentation of computed tomography (CT) with the Hospital Frailty Risk Score (HFRS) and adverse outcomes after abdominal surgery. This retrospective cohort study used CT imaging and electronic health record data from a random sample of adults who underwent abdominal surgery at 20 medical centers within Kaiser Permanente Northern California from January 1, 2010, to December 31, 2020. Data were analyzed from April 1, 2022, to December 1, 2023. Body composition derived from automated analysis of multislice abdominal CT scans. The primary outcome of the study was all-cause 30-day postdischarge readmission or postoperative mortality. The secondary outcome was 30-day postoperative morbidity among patients undergoing abdominal surgery who were sampled for reporting to the National Surgical Quality Improvement Program. The study included 48 444 adults; mean [SD] age at surgery was 61 (17) years, and 51% were female. Using principal component analysis, 3 body composition scores were derived: body size, muscle quantity and quality, and distribution of adiposity. Higher muscle quantity and quality scores were inversely correlated (r = -0.42; 95% CI, -0.43 to -0.41) with the HFRS and associated with a reduced risk of 30-day readmission or mortality (quartile 4 vs quartile 1: relative risk, 0.61; 95% CI, 0.56-0.67) and 30-day postoperative morbidity (quartile 4 vs quartile 1: relative risk, 0.59; 95% CI, 0.52-0.67), independent of sex, age, comorbidities, body mass index, procedure characteristics, and the HFRS. In contrast to the muscle score, scores for body size and greater subcutaneous and intermuscular vs visceral adiposity had inconsistent associations with postsurgical outcomes and were attenuated and only associated with 30-day postoperative morbidity after adjustment for the HFRS. In this study, higher muscle quantity and quality scores were correlated with frailty and associated with 30-day readmission and postoperative mortality and morbidity, whereas body size and adipose tissue distribution scores were not correlated with patient frailty and had inconsistent associations with surgical outcomes. The findings suggest that assessment of muscle quantity and quality on CT can provide an objective measure of patient frailty that would not otherwise be clinically apparent and that may complement existing risk stratification tools to identify patients at high risk of mortality, morbidity, and readmission.

A study of third and fourth ventricular sizes in Bangladeshi adults using computed tomography scan

Background: The assessment of normal measurements of cerebral ventricles in living humans holds significant importance for diagnosing and monitoring various pathologies. Current digital computed tomography (CT) scan machines enable the direct visualization of ventricles in cross-sectional images, allowing real-time measurement of different ventricular dimensions, thereby aiding in comprehending their anatomy. This research aims to create baseline reference values for the sizes of the third and fourth ventricles in normal Bangladeshi adults using CT scans. Methods: This was a retrospective study conducted in the department of radiology and imaging, Shaheed Monsur Ali Medical college hospital, Dhaka, Bangladesh, from January 2023 to December 2023. A total of 408 adult patients with clinical symptoms or history suggestive of neurological ailment were analyzed. CT scans of the brain of all the patients were performed in Supria 128 Fujifilm multi-slice CT scanner and the studies were analyzed retrospectively on Synapse 3D workstation. Measurements were taken with inbuilt linear calipers. The greatest width of the third ventricle (3V) and fourth ventricle (4V) on axial images using a linear approach were measured. Statistical analysis was performed by SPSS version 22.0. Result: The study found that the mean measurements of the 3V were 4.27±1.22 mm in males and 3.73±1.03 mm in females, with an overall mean of 3.92±1.13 mm. For the 4V, the mean measurements were 11.73±1.27 mm in males and 10.67±1.07 mm in females, resulting in an overall mean of 11.03±1.25 mm. The largest dimensions in both ventricles were consistently observed in individuals aged 60 years and above, regardless of gender. Additionally, on average, the measurements of both ventricles were higher in males compared to females. Statistical analysis revealed significant differences in the sizes of both ventricles between male and female subjects. Conclusions: This study concludes normal third and fourth ventricular sizes in Bangladeshi adults using CT scans. These can serve as baseline reference values in our hospital in routine practice.

Sialolithiasis in children

Introduction: Sialolithiasis is a disease in which calcified substances accumulate in the ducts or parenchyma of the salivary glands. This disease can occur in people of all ages but is mostly seen in middle-aged adults and rarely in children. This case report aimed to describe a case of sialolithiasis in children Case Report: A 3-year-old girl presented with a lump that enlarged progressively on the right side of the neck since 1 year ago. The patient also complained of painful swallowing. Palpation of the right submandibular revealed a solid, mobile mass measuring 0.5x0.5cm without tenderness or hyperemia. A neck ultrasound showed an enlarged submandibular gland and right parotid gland. A midface and neck multi-slice computed tomography scan (MSCT) supported the diagnosis of sialolithiasis. The patient underwent stone removal with an extraoral approach and general anesthesia. The patient then was discharged with cefixime, methylprednisolone, and paracetamol. Discussion: Sialolithiasis that cannot be removed by opening the canal can be removed by trans-oral or extra-oral sialolithotomy, extracorporeal lithotripsy, sialendoscopy, or laser treatment. Submandibular stones can be removed surgically by intraoral or extraoral approaches. Extraoral approaches are indicated for intra-glandular stones and stones embedded in the hilum of the gland. Conclusion: The diagnosis of sialolithiasis in this patient was confirmed through history taking, physical examination, ultrasound, and a CT scan. Management of sialolithiasis focuses on removing the stone and maintaining salivary gland function. In this case, the stone was removed using an extraoral approach under general anesthesia which resulted in a good outcome

The utility of cone-beam computed tomography and multislice computed tomography scan for the evaluation of invasion versus erosion by mandibular squamous cell carcinoma as viewed on medical PACS

Introduction The degree of bone involvement in mandibular squamous cell carcinoma has a significant impact on surgical planning. The purpose of this study was to determine the utility of cone-beam computed tomography (CBCT) for the evaluation of invasion by mandibular squamous cell carcinoma. Methods A retrospective review was conducted to identify subjects treated for oral squamous cell carcinoma (OSCC). All subjects had OSCC adjacent or fixed to the mandible, received preoperative CBCT and multislice computed tomography scan (MSCT), and had resection specimens that included bone. Results Twenty-one subjects met the inclusion criteria. The sensitivity of CBCT was 100% (95% CI 0.75–1), the specificity was 75% (95% CI 0.35–0.97), the positive predictive value was 87% (95% CI 0.66–0.98), and the calculated test accuracy was 91%. The sensitivity of MSCT was 92% (95% CI 0.64–1), the specificity was 100% (95% CI 0.63–1), and the calculated test accuracy was 95%. Discussion CBCT provides meaningful data that may be useful in identifying bony involvement in patients with mandibular squamous cell carcinoma. The utility in delineating erosion versus invasion is limited.

Our Experience in Carotid Endarterectomy. A Retrospective Study

Introduction: Carotid endarterectomy (CEA) operations have been more frequent in our practice in recent years, primarily for asymptomatic patients. In this article, we present our experience in this field.&#x0D; Ojectives. Primary endpoints were death and stroke within 30 days of the procedure for asymptomatic patients. Secondary endpoints were acute myocardial infarction within 30 days of the process and peripheral nerve injury in all patients.&#x0D; Patients and Method: This is a retrospective review of our recent experience. Data of 219 consecutive CEA, 177 in asymptomatic patients, operated on from January 2004- February 2009 by our equip are collected; all the patients were diagnosed with Duplex scanner and confirmed with multi-slice CT scanner angiography. Endarterectomy was performed either with loco-regional or general anesthesia with selective use of a shunt. Combined anti-aggregation with Clopidogrel and Aspirin was the rule at discharge. Patients were controlled for new neurological and cardiac events 30 days after the operation.&#x0D; Results: One asymptomatic patient had a major stroke and died. In this group, the stroke and mortality rate is 1,69%. No peri-operative new acute myocardial infarction happened in any patient. Peripheral nerve lesions occurred in 2,7 %of all procedures.&#x0D; Conclusions: CEA is a safe treatment for asymptomatic internal carotid stenoses in the hands of an experienced vascular surgeon. Our results for asymptomatic carotid stenoses are according to international guidelines' recommendations.&#x0D;

Evaluation the Quality Three Different Obturation Technique Using Multi-Slice Computed Tomography: An In-Vitro Study

After endodontic space has been completely cleaned, shaped and disinfected, a three-dimensional obturation of this space will be the ultimate objectiv e of endodontic therapy. With a durable three dimensional obturation any communication with the periodontium will be eliminated and prevented. The aim of this study was to use multi-slice CT scanning to determine: (i) number of voids (ii) diameter or length of voids and (iii) presence of voids at material/tissue interfaces in root canals obturated with: (a) E &amp; Q Master (b) Lateral Condensation, and (c) Soft Core system. Thirty freshly extracted human mandibular premolar teeth were used in this study. After pr eparation of the root canals, the teeth were divided into three groups with 10 teeth in each groups. G1 obturated with E&amp;Q master, G2 obturated with Lateral Condensation, and G3 was obturated with Soft Core. GuttaFlow was used as sealer for all groups. After obturation all the specimen were analyzed with multi-slice CT, the data obtained was statistically analyzed us ing ANOVA test followed by Duncan's multiple range test ,a val ue of p&lt; 0.05 was considered statistically significant.Voids are obs erved in all groups, Neither technique was free of voids or p erfectly smooth. Overall, the canals that obturated with E&amp;Q mas ter showed the lowest number of voids (3.0), whereas those ob turated with lateral condensation showed the highest number (3.9) and the differences was statistically significant. The canals t hat obturated with Soft core showed the highest mean of voids diameter ( 0.77 mm) , whereas those obturated with E&amp;Q m aster and lateral condensation had the lowest mean (0.62 mm and 0.61 mm) respectively, and the differences were statisti cally significant. The percentage of outer voids was higher for a ll techniques than the inner voids. The presence of inner voids was the highest in canals that obturated with soft core system (9.230%). Conclusion: E&amp;Q master of obturation show the low est number of voids. Obturation with Soft core show the highest m ean of voids diameter. In all obturation techniques, the outer voi ds was higher than inner voids.

Association between allergic rhinitis and chronic rhinosinusitis on multislice computed tomography scan paranasal sinuses

Rhinosinusitis is inflammation sinus mucosa, which is generally triggered by rhinitis, therefore it’s often called rhinosinusitis. Some predisposing factors include acute respiratory infection due to viruses, various rhinitis, especially allergic rhinitis. As many as 50 patients underwent MSCT-Scan SPN examinations in 2022 at PKU Muhammadiyah Bantul. This research uses quantitative research methods with a cross-sectional analytical approach. The sampling technique in this research used total sampling. The data analysis used is univariate and bivariate analysis with the chi-square statistical test. From 47 samples, 25 people (53.2%) suffered from allergic rhinitis, 42 people (89.4%) suffered from chronic rhinosinusitis. Female patients showed the most chronic rhinosinusitis features on MSCT-Scan Paranasal Sinuses examination as many as 24 people (57.31%), with the highest age being 36-45 years as many as 14 people (33.3%). The highest frequency of chronic rhinosinusitis features was the unilateral maxillary type with 31 cases (18.6%). The calculation results of the relationship between chronic rhinosinusitis show a P-Value of 0.352. We highlighted that there is no significant relationship between allergic rhinitis and chronic rhinosinusitis on MSCT-Scan Paranasal Sinuses at PKU Muhammadiyah Bantul for the period January-December 2022.

Evaluation of Factors Influenced on the Effectiveness of Percutaneous Nephrolithotomy.

Generally, there are many methods for the treatment of urinary stones, of which percutaneous nephrolithotomy (PCNL) is a minimally invasive and highly effective method, and now become the first-line management for urinary stones, especially in the cases of complex stones and staghorne calculi. Accurate assessment of stone location, stone morphology, degree of hydronephrosis as well as urinary system abnormalities is extremely important in the percutaneous nephrolithotomy strategy. The aim of this study was to evaluate the S.T.O.N.E score as well as other factors that influenced the effectiveness of PCNL. Descriptive study on 71 patients with kidney stones, who underwent multi-slice CT scan of the urinary system before PCNL and then PCNL at Hanoi Medical University Hospital from July 2022 to July 2023. All patients received the informed consent and agreed to participate in the study. The factors included the stone area, the track length (from the skin surface to the stone central), the degree of urinary tract dilatation, the number of involved calyces, the density of stone, the renal parenchyma thickness, the ureteral wall thickness and fat infiltration measured on MSCT non-contrast phase. These factors were used to predict the effectiveness of PCNL including the stone clearance rate (SCR) and the operation time. The mean age of the patient group was 53.8±12.3. The male/female ratio was 1.54. There was a significant difference (p<0.05) between the following factors and the operation time: the stone area (<400, 400-799, 800-1599 and >1600 mm2), the degree of urinary tract dilatation (no or might and moderate or severe dilatation), the number of involved calyces (≤ 2, 3 and staghorne calculi), the renal parenchyma thickness (<18 mm and ≥18mm). In contrast, there were no significant differences between the following factors and the surgery time (p>0.05): the track length (<100 and ≥100 mm), and the stone density (<950 and ≥950 HU). Regarding the S.T.O.N.E score (included five factors: Size, Track length, Obstruction, Number of involved calyces, and Evaluation of stone density), there was a strong correlation between S.T.O.N.E score and the surgery time (p<0.001, r=0.94), and the SCR (p=0.001, r=-0.97). The evaluation of these factors played an important role in the prediction of the effectiveness of PCNL.

Anesthetic challenges during repairing left pulmonary artery sling without cardiopulmonary bypass: a case report

Left pulmonary artery sling (LPAS) is a rare vascular anomaly. The general surgical technique to correct it is through median sternotomy under cardiopulmonary bypass (CPB). In this case, we discuss the anesthetic management of left pulmonary artery (LPA) reimplantation without CPB to improve the understanding and provide an overview for practitioners in managing patients with this rare vascular anomaly. Patient was a 10 months old baby, with main complaints of shortness of breath since he was 4 months old, and diagnosed with LPAS from cardiac multi-slice CT scan (MSCT) examination. Intraoperatively, when the LPA was clamped, the blood pressure decreased due to decreased preload, and the end-tidal CO2 increased to 70 mmHg due to increased dead space, which was successfully managed. Postoperatively, the patient suffered from ventilator acquired pneumonia (VAP). Evaluating and assessing the potential complications that can occur during the perioperative period will help prepare for management and improve the success of anesthetic management.&#x0D; Abbreviations: CPB- Cardiopulmonary Bypass; ETT- Endotracheal Tube; LPA- Left Pulmonary Artery; LPAS- Left Pulmonary Artery Sling; MSCT- Multi-Slice CT Scan; RPA- Right Pulmonary Artery; VAP- Ventilator Acquired Pneumonia&#x0D; Key words: Left Pulmonary Artery; Anesthesia Management; Pulmonary Sling; Cardiopulmonary Bypass&#x0D; Citation: Arifin A, Perdana A. Anesthetic challenges during repairing left pulmonary artery sling without cardiopulmonary bypass: a case report. Anaesth. pain intensive care 2023;27(6):776−779; DOI: 10.35975/apic.v27i6.2352&#x0D; Received: August 10, 2023; Reviewed: October 16, 2023; Accepted: October 30, 2023

The macrostructure of lungs on multislice computed tomography scans in the long-term period after COVID-19 pneumonia

The purpose of the study using MSCT monitoring data was to investigate the semiotics of residual changes in the lungs in the long-term period (up to 2 years) after pneumonia associated with COVID-19 (COronaVIrus Disease 2019).Methods. A comparative analysis of MSCT data of the chest organs was carried out in 146 patients with a confirmed diagnosis of COVID-19-associated pneumonia in 2020 – 2021 and subsequent MSCT monitoring data until 2023. MSCT was performed using a 64-slice computed tomography scanner with data post-processed on the workstation.Results. Based on the analysis, 4 groups of patients were identified that differed in the severity of viral pneumonia and the prevalence of lung lesions. The first group of patients had the most beneficial course. In 90% of cases, there was a complete resolution of the consequences of viral pneumonia in terms macroscopic changes in lung tissue by the second year of observation. In the second group, which consisted primarily of older people, 27 (52.94%) patients in year 1 and in 33 (64.7%) patients in year 2 showed a recovery of macrostructure. This group demonstrated fibrous cords, reticular changes, reactions of pleura, and residual lesions (“ground glass”). A similar trend, but in a more severe form, was observed in group 3 patients. 40 patients (86.95%) had residual changes similar to those in group 2 (middle, elderly age and older people) with the addition of bronchial wall thickening and bronchiectasis. Only in 2 (22.22%) of 9 patients with atypical manifestations of COVID-19 pneumonia in the form of “crazy paving” changes in the form of reticular seals, fibrous cords, localized thickening of the pleura and lymphadenopathy persisted up to 2 years of observation.Conclusion. MSCT monitoring of the lungs of patients suffering from COVID-19-associated pneumonia up to 2 years after recovery showed that the prevalence and severity of post-COVID changes in the lungs depends on the severity of the disease (degree and nature of damage to the pulmonary parenchyma) and the patient’s age.