Pathologies of Paranasal Sinuses on MDCT

Pathologies of Paranasal Sinuses on MDCT MATERIAL AND METHODS The study was conducted at the Department of Radio-diagnosis and Imaging in collaboration with the Department of ENT, Department of Pathology, and Department of Microbiology, Batra Hospital and Medical Research Centre. STUDY DESIGN: Observational study. CT PNS of the patients was evaluated for the cause of sinus complaints. Causes deduced from CT PNS were correlated with clinical/histopathological/surgical/ microbiological findings. STATISTICAL METHODS: Sensitivity, specificity, positive predictive value and negative predictive value were calculated, followed by use of Fischer Exact test. The research hypothesis and statistical methods were formed in consultation with the Biostatistician. SAMPLE SIZE (Annexure 6): 100 patients referred for evaluation of sinus complaints were enrolled in the study after fulfilling the inclusion and exclusion criteria and taking written/verbal informed consent, over a period of July 2013 to April 2015. INCLUSION CRITERIA: Patients with complaints like headache/nasal obstruction/discharge/hyposmia /swelling over cheek and with clinically suspected paranasal sinuses lesions referred for MDCT PNS evaluation. EXCLUSION CRITERIA: Acute sinonasal inflammatory disease. Previous evidence of sinonasal surgery. All cases of trauma. ETHICAL ISSUES: The study was conducted after necessary approval from the Institutional review board and ethics committee. MDCT is a non-invasive modality. All safety and screening measures were undertaken as per the American College of Radiology practice guidelines for performing Computed Tomography. INSTRUMENTATION: Light VCT 64 slice MDCT of GE radical system with advanced workstation 4.3 GE. Protocol followed for MDCT PNS: 1. Scout : Lateral kV : 120 mA : 10 Scout Plane : 900 2. Axial Images kV : 120 mA : 120 Start/End : 0 to 74.3 Total Exposure Time : 5.4 sec Gantry tilt : 0 Interval : 0.625 mm Slice thickness : 0.625 mm Helical Scan Rotation Time : 0.6 sec Rotation Length : Full Pitch and Speed : 0.531:1 10.62 mm/rotation Detector Coverage : 20 mm SUMMARY The present study was conducted in Department of Radiodiagnosis, Batra hospital and medical research centre, New Delhi in close association with the department of ENT from July 2013 to April 2015. The aims and objectives of our study were to characterize pathologies of paranasal sinuses on MDCT, to delineate their anatomical location, extension and bony involvement and to correlate the multi detector computed tomography findings with clinical/surgical/histopathological/ microbiological findings. A total of 100 patients who came with complaints referring to nose and paranasal sinuses were included in the study. All patients were subjected to MDCT PNS after detailed clinical examination. The imaging findings are correlated with other investigations. Key imaging features considered were significant anatomical variations, site of involvement, bony and soft tissue changes, invasion of surrounding structures, pathognomic features and correlation with clinical complaints/surgical/pathological/microbiological findings. Among 100 patients in our study, there were 15 patients in 0 20 years age group, 36 patients in 21 40 years age group, 37 in 41 60 years age group and 12 were greater than 60 years. The age group of patients ranged from minimum of 9 months to maximum of 81 years. The highest number of patients were in 41 60 years age group. The study comprised of 65 males and 35 females. The number of male patients were higher than the female patients. The patients were divided into five categories: bacterial sinusitis, fungal sinusitis, benign tumors, malignant tumors, and miscellaneous. 84 patients presented with sub acute or chronic bacterial sinusitis, 4 patients were of fungal sinusitis, 4 patients presented with benign tumors, 3 patients with malignant tumors and 5 patients with other miscellaneous conditions. Various anatomical variations were encountered during our study. One or the other anatomic variation was found in 99 cases ( 99% ). Of the structures around ostiomeatal unit, giant bulla ethmoidalis was found in 35 cases, middle turbinate pneumatisation in 33 cases, paradoxical curvature of middle turbinate in 19 cases. Haller cell was found in 15 cases. Type 1 frontal sinus drainage pathway in 78 cases, type 2 frontal sinus drainage pathway in 21 cases. Deviated nasal septum with or without septal spur in 55 cases, inferior turbinate hypertrophy in 30 cases, accessory maxillary ostia in 26 cases, and agger nasi cell in 93 cases. Type 1 optic nerve course was found in 53 cases, type 2 in 14 cases, type 3 in 9 cases, and type 4 optic nerve course along with Onodi cells in 23 cases. Type 1 anterior clinoid process pneumatisation was found in 10 cases, type 2 pneumatisation in 1 case. Sphenoid septum lateral attachment in 7 cases, and sphenoid sinus septum pneumatisation in 14 cases. Among 84 patients with bacterial sinusitis, 26 patients presented with sporadic pattern, 23 patients with infundibular pattern, 23 patients with ostiomeatal unit pattern, 8 patients with polyposis pattern, and 4 patients with sphenoid recess pattern. The various causative factors which came across in infundibular pattern were Haller cells in 6 cases, giant bulla ethmoidalis in 6 cases, uncinate process pneumatisation in 1 case, and mucoperiosteal thickening in 10 cases. The various causative factors for ostiomeatal pattern which were found during our study were: inferior turbinate hypertrophy in 6 cases, giant bulla ethmoidalis in 6 cases, deviated nasal septum with or without septal spur in 4 cases, concha bullosa in 3 cases, concha lamella in 2 cases, agger nasi cell in 1 case, and paradoxical middle turbinate in 1 case. The various findings which were encountered in bacterial sinusitis in our study were: mucoperiosteal thickening in 84 cases, ostiomeatal unit block in 31 patients, bone thickening in 20 patients, bone thinning in 8 cases, and bone sclerosis in 6 patients. Among 4 patients with fungal sinusitis, the various findings were: bilateral / multisinus involvement was found in 4 cases, expansion of any involved sinus was found in 4 cases, intrasinus hyperdensity was found in 4 cases. Bony thinning was found in 4 cases, bony erosions and nasal cavity involvement was found in 3 cases. The various findings in 4 cases of benign tumors seen ( 1 inverted papilloma, 1 juvenile angiofibroma and 2 ivory osteomas ) were: bony thinning in 2 cases, bony remodelling in 2 cases, multisinus involvement in 2 cases, intracranial extension in 1 case, and intra orbital extension in 1 case. Bony destruction, bone thickening/sclerosis, and calcification were not seen in any of the cases. Among 3 cases of malignant tumors (squamous cell carcinoma, embryonal rhabdomyosarcoma, and esthesioneuroblastoma), various findings were: : Bony destruction in 3 cases, bony thinning in 3 cases, bony remodelling in 0 cases, multisinus involvement in 2 cases, intracranial extension in 2 cases, and intra orbital extension in 2 cases. Bone thickening/sclerosis, and calcification were not seen in any of the cases. Under miscellaneous category we encountered one case each of periapical cyst, oro-antral fistula, granulomatous polyangitis, monostotic fibrous dysplasia, and Langerhans cell histiocytosis. In our study we found sensitivity and specificity for bacterial sinusitis as 100% and 94.11% respectively. The fungal sinusitis had sensitivity and specificity of 75% and 100% respectively. Benign, malignant tumors and others had sensitivity and specificity of 100%. The diagnostic accuracy for bacterial sinusitis and fungal sinusitis was 99%, and the diagnostic accuracy of benign, malignant tumors and other miscellaneous conditions was 100%. The p value was obtained after applying Fischer Exact test. The p value obtained was statistically significant for all the disease conditions. Based on the statistical values it can be inferred that multi detector computed tomography is useful to characterize paranasal sinuses lesions and also delineation of anatomical location, extension and bony involvement. There are certain limitations in our study. Our findings cannot be generalised to the whole population because of the limited sample size. However, our findings add value to the research done. The role of contrast cannot be adequately studied. The role of MRI in various paranasal sinus pathologies was not evaluated. CONCLUSION Paranasal sinus diseases are very commonly encountered problems in clinical practice. Clinical assessment alone is not sufficient to reach a diagnosis, as the presentation of most of the conditions is nonspecific. Imaging forms the mainstay not only in making correct diagnosis, but also to know the extent of lesion, pre-operative assessment of the sinonasal anatomy and commonly encountered anatomic variations. X ray has low sensitivity, specificity, positive and negative predictive values. CT is highly sensitive and specific in determining the presence of paranasal sinus pathology and clearly demonstrates the complex anatomy. The introduction of multi detector CT has transformed the axial imaging modality into a volumetric one and allows the pathology to be displayed in any desired plane. The capability of thin-section acquisition improves visualisation of tiny pathological details, and the isotropic nature of high spatial resolution data sets enables display in multiple planes, obviating image acquisition in prone or hyper extended patient position. Recommendations: 1. MDCT has proved to be highly sensitive in classifying the lesions into clinically relevant categories, making diagnosis and more so in knowing the extent of involvement with a high diagnostic accuracy. 2. MDCT is an indispensible tool before Functional Endoscopic Sinus Surgery (FESS) to accurately delineate the fine bony details that contribute to disease and also can predispose to complications which can be fatal. 3. MDCT is very useful in predicting the diagnosis of fungal sinusitis by the presence of intrasinus hyperdensity, granulomatous diseases by the presence of nasal septal perforation and intracranial or intraorbital invasion, malignancy by bone destruction and invasion. 4. MDCT can tailor the surgery according to the extent of disease. It helps in determining the prognosis of the malignant tumors depending on the site and extent of the disease. It can also obviate the need for surgery in certain conditions like polyposis. 5. MRI can be problem solving tool in differentiating inflammatory sinonasal diseases from tumors, and also for the presence of intracranial or intraorbital extension. 6. However, MRI alone cannot be performed in the evaluation of paranasal sinus diseases because of the problem of signal voids. It has to be supplemented by CT. 7. MDCT is the preferred initial modality of all imaging studies available because of its ease, availability, accuracy, precision and low cost. 1

Funding the Rising Cost of U.S. Health Care Essay

Give your opinion of the rising cost of health care’s overall impact on the U.S. economy It is more expensive for individuals, families and employers to have health care coverage because of the rising cost. Spending on the use of new technologies, treatment, and high cost for medical services. There has also been a high cost on local, federal and state government which led to high cost on to medical and Medicaid. This spending of health care has affected the economy and now people have to choose between a need for health care of the need to have shelter, food, or not having sufficient funding. Health care spending is moving faster than the economy is growing. High health care rising cost is causing the government to re-examine eligibility for public health and rising taxes on the consumers is leading to reduce investments. The U.S. will not be able to compete in the economic global market. These rising cost in health care will affect business, house wholes, providers, employees, health status, income levels, age, and increase premiums. (Rising Health Care Costs ) http://www.ahip.org/Issues/Rising-Health-Care-Costs.aspx â€Å"Health plans are playing a vital role in reducing the cost of care and improving value†¦Ã¢â‚¬  – Karen Ignagni, President & CEO, America’s Health Insurance Plans Health Plan Innovations in Delivery System Reforms, American Journal of Managed Care Compared and contrasted at least two (2) areas of the economy that the new health care act impacts. Small business and middle class families are two areas that the new health care act will impact. It used to be the economic strength in the U.S. was the small business owner. Small business has been strength to the economic by bring diversified groups opportunities of people to the workforce. Small business bring products have that are innovative to the services market. Small business has been able to create new jobs for the economic. However since the housing bubble in 2007 and 2008 small businesses are struggling very hard from the bank credits. Small businesses are the back bone to job growth and innovation for the economy. Small business owners who offer health care insurance to their workers are facing a hit by heavy taxes and high premiums for the employer. Small business pays up to 18% more per worker for health insurance than larger firms. This is a tax disadvantage for small business. Which cause profits to be eaten  up by higher health insurance cost and workers working for lower wages makes the small business workers, product, and market at a disadvantage. Small business(less than 50 workers) is less likely to provided health insurance. Back in the 50s and 60s a middle class family of three could live off a one person income which was the father. Mothers were house wives and people could purchase a home, car, and have a small savings. Families could go on vacation and own a late model car. The burden for middle class families today is the high cost for health care insurance and premiums. There have been an increase in unemployment and employees are scaling back on wages. Credit card debt gone up and slow job creation. Increase in bankruptcy files, income inequality and out-sourcing of America business has been causing problems for the middle class families. This growth in health care spending has change priorities for middle class life style. With saving money, retirement benefit pension, and 401K plans shifting. Middle class person who have been working all their lives, now rick the chance of not having sufficient funds to maintain middle class life style. Will the middle class be able to retire and live a middle class style? Middle class families are not sure if there will be available income for retirement. (http://www.aarp.org/research/ppi/security/impact-of-rising-healthcare-cost-AARP) Debated the main pros and cons of using private insurance versus using the new affordable insurance.  Our population in this country has increase over the last 30 years and because of healthier life style and medical advances people are living longer. This can be a disadvantage to the patients who are using private insurance. This has put a strain on the private health insurance because most companies don’t cover previous medical conditions that cover injuries and short-term illness. Illness is something that happens on its own and worrying whether or not your condition is cover can add stress. After receiving a referral from the internal doctor the patient has to act as its own administrator who calls the insurance company to check, if the cost is cover before they can see a consultant for treatment. If you want more coverage you pay higher premiums. There also a disadvantage of having so  many private health insurance companies to pick from. Each representative only disc usses their company policies and not how their policy compares with others. Leaving the patient not knowing which one is the best offer for you. Private insurance advantages is you can choose where you want to be treated without a long wait. There are specialist teams that will deal with specifically types of conditions. There continuity cares that allows you to be seen by the same consultant until the end of your treatment. The new affordable insurance covers families, small business, and individuals with the cost assistance through the market place program. There are no limits on life time health care which this will cut down on large medical bills for long term illness. This will keep people out of debt. If you make a mistake on your application or if you are sick an insurance company can’t drop you. A person with pre-existing condition can’t be denied care or charge a higher premium. The new affordable insurance allows for parents to keep their children on their plan until the age 26 years old whether they live at home, married, or attend school. The affordable insurance has free preventive care for checkups, well woman visits, mange care to control chronic illness before they become costly to treat or complex. http://obmacarefacts.com/benefitsofobamacare.php) OBMA CARE FACTS dispelling the myths Analyzed the major impact this new health care system may have on different immigrant demographics; Predicted the cost associated with the changing the accommodation to facilities having to review organizational planning in order to actualize these changes

The Shallows by Nicholas Carr - 1469 Words

In The Shallows by Nicholas Carr, he asserts that the evolution of information and communication technology (ICTs) is having a detrimental impact on our brains despite the many benefits and advances we have made with it. His main focus is on the internet which he commonly refers to as the â€Å"universal medium† (92). Carr presents a very detailed but biased argument in which he views the internet and other technologies as the adversary of critical thinking and progress. To Carr, we are sacrificing our ability to think logically because we are choosing a simpler way to gain knowledge. Carr mentions the effect that technology has on the neurological processes of the brain by explaining the concept of plasticity. Plasticity is described as the brain’s response through neurological pathways through experiences. The brain regions â€Å"change with experience, circumstance, and need† (29). Carr explains that brain plasticity also responds to experiences that cause damage to the nervous system. Carr describes the process in which injuries sustained in accidents â€Å"reveal how extensively the brain can reorganize itself† (29).I have heard stories in which amputees are said to have a reaction to their amputated limb; it is known as a phantom limb. These types of studies are helpful in supporting the claim that the brain can be restructured. Carr asserts that the internet is restructuring our brains while citing the brain plasticity experiments and studies done by other scientists. I haveShow MoreRelatedThe Shallows By Nicholas Carr1189 Words   |  5 PagesNicholas Carr covers an unprecedented amount of material in his novel, â€Å"The Shallows.† He delves into subjects ranging from the history of the book to the business of Google to the psychological concept of neuroplasticity. 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Replacing a Lost or Stolen Canadian Passport

Whether you lose your Canadian passport or if it is stolen, dont panic. Its not an ideal situation, but there are steps you can take to replace your passport, and you may able to get a replacement passport for a limited time. The first thing to do when you discover your passport is missing is to contact local police. Next, youll want to get in touch with the Canadian government. If youre within Canada, call 1-800-567-6868 to report the circumstances of the loss or theft to the Canadian Passport Office. If youre traveling outside of Canada, find the nearest Government of Canada office,  either an embassy or a consulate.   Police or other law enforcement officers will conduct an investigation, which is especially important if youre reporting your passport stolen. It may be a good idea to contact your credit card companies and bank, even if your passport is the only thing missing. Theres the potential for identity thieves to do a lot of damage with a stolen passport, so keep an eye on your financial information until its located, or until you receive a new one. Once the investigation is completed, if authorized,  you can then apply for a replacement passport which may be valid for a limited time until you have to apply for a new passport.   Submit a completed application form,  photos,  fee,  proof of citizenship, and a Statutory Declaration Concerning a Lost, Stolen, Inaccessible or Destroyed Canadian Passport or Travel Document. Canadas Passport Rules Canada shrunk the size of its passports from 48 pages to 36 pages in 2013 (to the consternation of frequent travelers). However, it extended the expiration date, making passports valid for 10 years. Its also important to know that Canada is one of the few countries that dont allow citizens to hold a secondary passport (unless he or she can claim dual citizenship in Canada and another country). What If My Canadian Passport Is Damaged? This is another circumstance when youll need a new Canadian passport. If your passport has water damage, is torn on more than one page, looks like its been altered, or the identity of the passport holder is impaired or illegible, you may be denied by an airline or at a point of entry. Canadian rules dont allow you to get a replacement for a damaged passport; youll need to apply for a new one. What If I Find My Lost Passport? If you find your lost passport, report it immediately to the local police and the passport office since you cant hold more than one passport at a time. Contact the passport office for specific exceptions, as they vary on a case-by-case basis. Its worth noting that Canadians who have had multiple passports damaged or reported lost or stolen may face restrictions when applying for a new passport.