Bilateral Pneumothorax and Pneumomediastinum Following Total Thyroidectomy with Central Neck Dissection

We describe a 60-year-old woman who developed extensive emphysema, bilateral pneumothorax, and pneumomediastinum after total thyroidectomy and central neck dissection with sacrifice of a recurrent laryngeal nerve. In this report, we discuss the possisle etiology of those rare complications

Selection Criteria and Referral Patterns of Clinicians Utilizing CBCT at UCONN Health Center

The most recent Food and Drug Administration (FDA)/American Dental Association (ADA) guidelines on dental radiograph examinations were released in 2012.1 Cone beam computed tomography (CBCT) is a three dimensional radiographic exam first introduced in the in the early 2000s.7 In the 2012 guidelines, CBCT was excluded from the criteria; the guidelines were meant only for “standard dental imaging techniques of intraoral and common extraoral examinations, excluding cone-beam computed tomography.”1 CBCT is in the armamentarium of radiographs utilized in general dentistry and can be ordered by a dentist, a dental specialist, or dental student. There is a large void in the literature regarding the imaging patterns of CBCT. More data is needed on the clinical indications referred for CBCT, the types of dentists utilizing CBCT, and the patient profiles receiving CBCT exams; this information is essential to updating the FDA/ADA guidelines, for clinicians to understand the spectrum of clinical applications of CBCT, and for the oral and maxillofacial radiologist to understand the patterns and profiles of their referring clinicians. The objective of this survey is to develop a profile of the clinicians referring patients for CBCT in an academic dentistry setting, the indications for which CBCT exams are being utilized, and patient profiles referred for CBCT. The requisition forms for all CBCT exams acquired at UCONN Health Center were retrospectively analyzed during the time period of June 1, 2015 to May 31, 2016, a total of 590 requisition forms. Overall, the majority of CBCT exams are ordered for implant treatment planning. The second most common indications for CBCT scans was for endodontic diagnosis and treatment planning. The average age of a patient referred for CBCT is 53 years old; however, pediatric patients account for approximately 10% of the CBCT scans. The most frequent referring specialist were from residencies that often placed implants, namely periodontics and prosthodontics residents

Tea Time

pink tea tray with three teacup

Fibrosing alveolitis in patients with rheumatoid arthritis as assessed by high resolution computed tomography, chest radiography, and pulmonary function tests

BACKGROUND—Fibrosing alveolitis (FA) is a common and serious complication of rheumatoid arthritis (RA). Before the availability of high resolution computed tomographic (HRCT) scanning, it was difficult to diagnose accurately without recourse to biopsy. Prospective studies have reported a prevalence of interstitial lung disease (ILD) of 19-44%. The term ILD used by these authors encompasses a variety of appearances on HRCT scans. This prospective study used HRCT scanning to determine the true prevalence of FA in hospital outpatients with RA, and to study associated clinical characteristics.
METHODS—One hundred and fifty consecutive patients with RA were selected from a hospital outpatient department, irrespective of the presence or absence of chest disease. All underwent a detailed clinical assessment, chest HRCT scanning, and conventional chest radiography within 4 weeks of full pulmonary function tests.
RESULTS—Seventy percent of patients were current or reformed cigarette smokers. Twenty eight (19%) had FA, most frequently of reticular pattern, and 12 of this group (43%) also had emphysematous bullae. None of the previously suggested risk factors for developing FA were confirmed. Fifty four percent of patients with HRCT evidence of FA had bilateral basal chest crackles, 82% had a reduced carbon monoxide transfer factor (TLCO), 14% had restrictive pulmonary function tests, and 14% had bilateral chest radiographic signs of FA.
CONCLUSIONS—HRCT evidence of FA was present in 19% of hospital outpatients with RA. Abnormalities on chest examination or on full pulmonary function tests, even without restrictive changes or chest radiographic abnormalities, should prompt physicians to request a chest HRCT scan when investigating dyspnoea in patients with RA.


Predictors of progression of HRCT diagnosed fibrosing alveolitis in patients with rheumatoid arthritis

Background: Fibrosing alveolitis (FA) is the most serious pleuropulmonary extra-articular feature of rheumatoid arthritis (RA). Features that predict progression of FA in patients with RA have not yet been determined. Objective: To identify clinical features that predict progressive FA in patients with RA. Methods: An unselected cohort of 29 patients with RA and FA confirmed by high resolution computed tomography (HRCT) were studied prospectively for 24 months. Three monthly clinical assessment, four monthly pulmonary function tests, and yearly HRCT scanning was undertaken on these patients. Progressive FA was defined as >15% fall in carbon monoxide transfer factor (TLCO) with evidence of increasing FA on HRCT or death as a result of FA. Results: During 24 months of follow up 10/29 (34%) patients had progressive FA. Progression on HRCT was seen as acute ground glass exacerbations or increasing reticular pattern lung involvement. Progressive FA was associated with the presence of bibasal crackles (p=0.041), TLCO (p=0.001), and extent (p=0.026) and distribution (p=0.031) of lung involvement on HRCT at initial presentation. When multiple logistic regression was used, only TLCO remained significant. Receiver operator curve analysis was employed to identify presenting TLCO of progressive FA. A TLCO <54% of the predicted value demonstrated 80% sensitivity and 93% specificity in predicting progressive FA. Conclusions: A TLCO <54% of the predicted value is a highly specific predictor of disease progression

Facebooking for health: An examination into the solicitation and effects of health-related social support on social networking sites

•We looked at people’s use of Facebook to seek health-related social support.•Overall, about 40% had sought health-related support from others on Facebook.•People with health concerns had sought support from others on Facebook more often.•Emotional support was perceived more often than other supports on Facebook.•Emotional support was positively related to health self-efficacy. The current study investigates people’s use of social networking sites for health purposes and its impact on their perception of social support and their health self-efficacy. A structural model was fitted to test hypothesized relationships between having a health concern, seeking online health information, seeking health-related social support on Facebook, perceived social support from Facebook friends, and health-related self-efficacy. The study also looks at the relative significance of social support dimensions including: emotional, informational, tangible, and esteem dimensions. An analysis of 291 respondents revealed a positive relationship between having health concerns and seeking health-related social support. Seeking support was significantly associated with all four social support dimensions. Among the four support dimensions, emotional support was the only significant predictor of health self-efficacy. Also, emotional support was the dimension that was most prevalent in Facebook contexts. Health information seeking was also positively associated with health self-efficacy but was not significantly related to having a health concern