Radiological score of computed tomography scans predicts revision surgery for chronic rhinosinusitis

Objective. Evaluate computed tomography (CT) signs that predict need for revision endoscopic sinus surgery (ESS) of chronic rhinosinusitis (CRS). Methods. CRS patients (n = 48) underwent routine sinus CT scans and baseline ESS in 2006-2011. Lund-Mackay (LM) scores and 43 other CT signs were analysed blinded from both sides. Patients filled in a questionnaire during the day of CT scanning. Follow-up data were collected from hospital records until January 2018. Associations were analysed by Fisher's exact, Mann Whitney U, Kaplan-Meier method with logrank test and Cox's proportional hazard model. Results. Total LM score was not significantly associated with the need for revision ESS. The best predictive model was a sum of CT signs of non-detectable anatomy of inferior/middle turbinates, obstructed frontal recess, and previous sinus surgery. Using these CT findings, we formed a Radiological Score (RS) (min-max, 0-3 points). Having at least one RS point was significantly associated with the need for revision ESS during the average follow-up of 10.7 years (p = 0.008, Logrank test). Conclusion. We identified a radiologic score that was able to predict the need for revision ESS, which is probably useful in predicting CRS outcomes.Peer reviewe

Reproducibility of 3 mm-Slice-Thick Reconstruction of Paranasal Sinus Computed Tomography Scans

Peer reviewe

Iskeemiset aivoverenkiertohäiriöt ja kaulasuonten ultra-äänituktimus.

Syventävä työ ei kirjastoss

Iskeemiset aivoverenkiertohäiriöt ja kaulasuonten ultra-äänituktimus.

Syventävä työ ei kirjastoss

Ehdotus luopua rutiininomaisista streptokokkitesteistä hämmentää

Kommentti Timo Koskenkorvan artikkeliin SLL 71(44):2882-2884, 201

”Se yöllä tullut laryngiittipotilas”. Tapausselostus

Lasten rokotukset ovat olleet terveydenhuollon menestystarina, ja moni aiemmin merkittävää taakkaa aiheuttanut sairaus on muuttunut erittäin harvinaiseksi tai kadonnut kokonaan. Rokotuskattavuuden ollessa riittävä muodostuu myös rokottamatonta väestöä suojaava laumaimmuniteetti, koska taudinaiheuttajan kierto väestössä estyy. Kansalaisille saattaa syntyä virheellinen käsitys, että nämä taudit on voitettu ja kuuluvat historiaan. Tämä voi luoda maaperää rokotusohjelman laiminlyömiselle ja yhdessä haittoja korostavan uutisoinnin kanssa jopa rokotusvastaisuudelle... Tapaus päättyi potilaan kannalta onnellisesti: epiglottiitin mahdollisuus tuli mieleen, korvatautien päivystäjä oli paikalla, ja edellisen yön päivystänyt lastenanestesiologi oli myöhästynyt junasta ja odotti kotimatkaa sairaalalla. Oltiin kuitenkin hyvin lähellä rokottamattomuuden aiheuttamaa kuolemantapausta. Hemofilus tyyppi B ei ole kadonnut väestöstämme, eikä laumaimmuniteettiin voi rajattomasti luottaa. Rokotuskriittinen ilmapiiri saattaa tuoda päivystyksiin potilasryhmiä, jotka mielellämme jättäisimme lääketieteen historian sivuille

Reproducibility of 3 mm-Slice-Thick Reconstruction of Paranasal Sinus Computed Tomography Scans

Background: After the failure of medical treatment, the surgery of chronic rhinosinusitis (CRS) is planned according to endoscopic and paranasal sinus computed tomography (CT) findings. Objective: The aim of this prospective study was to evaluate whether this study method might be eligible in studies aiming at radiation dose reduction. Sinus CT scans were chosen as a model because of the high variation of the radiological anatomy of surgically important sinonasal structures. We hypothesized that 3 mm-slice-thick reconstruction CT had poor reproducibility. Methods: 59 CRS patients underwent routine multi-detector sinus CT (CTMD). CT3mm was reconstructed from CTMD data-sets. Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. Agreement was studied between CTMD and CT3mm (intra-observer reproducibility), and between three observers (inter-observer reproducibility) by using Cohen’s kappa. Results: The inter-observer agreement was moderate (kappa 0.4 - 0.6, p < 0.01) in the majority of structures of CT3mm scans. The intra-observer reproducibility of CT3mm scans was very good in most structures, however, it was poor in important structures such as frontal and spheno-ethmoid recess, lamina pa-pyracae, and location of optic nerve or anterior ethmoidal artery. The grade of surgeon’s confidence of CT3mm in comparison to CTMD was lower (kappa 0.2 - 0.4, P < 0.05). Conclusion: This methodology might have some use in studies aiming at radiation dose reduction. As was expected, 3 mm-slice-thick reconstruction CT had poor reproducibility and surgeon’s confidence. More recent methods such as cone beam computed tomography scans have nowadays more relevant dose reduction potentia