The contrast material-enhanced computed tomographic (CT) scans of 18 patients at risk for acquired immunodeficiency syndrome (AIDS) who had painless facial swelling were reviewed. All scans demonstrated parotid cysts and diffuse homogeneous cervical adenopathy. The cysts were bilateral in all but three cases. Eleven of 13 patients tested had antibodies to the human immunodeficiency virus (HIV), and two of the five untested patients later developed AIDS. The authors believe that the CT findings of multiple parotid cysts and cervical adenopathy suggest that the patient may be infected with the HIV virus, and the radiologist should alert the referring physician so that appropriate precautions and treatment may be initiated.
Evaluation of patients before transsphenoidal hypophysectomy for large intrasellar mass lesions has required bilateral internal carotid artery angiography. Using intravenous injection of contrast medium, a method has been developed to visualize the parasellar carotid arteries with rapid sequence sequential computed tomographic scanning. In 18 patients, the cavernous segments of the internal carotid arteries were well seen in 27 of 28 instances with technically complete examinations. The vascularity of the mass lesions and vascular encasement was also demonstrated.
Historic methods of classifying temporal bone fractures have been shown to poorly correlate with clinical findings. Due to the mechanisms of injury associated with these fractures, complete examination of patients can be difficult. An effective and simple way of correlating radiological findings in temporal bone fractures with complications like facial nerve weakness and paralysis will better guide physicians in treatment of their patients. We hypothesize that a classification system based on the medial extent of a fracture will best predict facial nerve injuries.
Study Design and Methods
A retrospective chart review identified 109 patients with 131 temporal bone fractures. Temporal bone CT scans and a record of facial nerve evaluation was available in 115 fractures (99 patients). CT scans were reviewed and fractures were classified by our proposed system and by the traditional system (longitudinal, transverse, and mixed). Our proposed system is as follows: Group A is a lateral fracture involving the mastoid, external auditory canal, and/or temporomandibular joint; Group B involves the tympanic cleft; Group C involves the course of the facial nerve; and Group D involves the otic capsule. A final rating of A-D was given based on the medial most extent of the fracture line. Fractures were grouped according to the classification schemes and correlated with clinical reports of facial nerve dysfunction.
Results
In 115 temporal bone fractures, 16 patients with facial nerve weakness or paralysis were identified. Using the new classification scheme, facial nerve injury was present as follows: Group A fractures - 0/20, Group B - 5/55 (9%), Group C - 6/31 (19%), Group D - 5/9 (56%). Using the traditional classification system, facial nerve dysfunction was present as follows: 11/72 (13%) of longitudinal fractures, 4/21 (19%) of transverse fractures, and 3/22 (14%) of mixed fractures.
Conclusion
When compared to the traditional classification system for temporal bone fractures, these results demonstrate that the new system appears to have a higher predictive value with facial nerve function. This simple system can help physicians to triage patients and guide treatment even if a complete examination of the patient is not possible.
Basic principles of Magnetic Resonance Imaging technology considerations in magnetic Resonance Imaging of the spine neoplastic disease of the spine degenerative disc disease inflammatory and degenerative diseases of the spine spinal trauma Magnetic Resonance evaluation of the post-treatment spine the pediatric spine.
Abstract Background Emotional stress stemming from the complex grief associated with dementia care takes a greater toll on a family caregiver’s health than the physical effort of providing care. Finding Meaning and Hope is a 10‐week workshop for caregivers of persons with dementia, designed to promote understanding of grief and teach self‐care concepts that help mitigate stress. Each video session features Dr. Pauline Boss, author of Loving Someone Who Has Dementia: How to Find Hope While Coping with Stress and Grief, sharing self‐care strategies with real‐life caregivers, and is followed by a facilitator‐led discussion. Home practice activities help caregivers incorporate focal self‐care strategies into their daily lives. This research aimed to assess the relationship between participating in the workshops and caregiver outcomes in stress and well‐being. Methods 108 caregivers, 85 percent age 60 and older, completed the workshops during 2019. Two standardized instruments were administered before and after workshop participation: the 12‐item Caregiver Self‐Assessment Questionnaire (American Medical Association, 2015) and the 11‐item Sense of Competence Questionnaire (Vernooij‐Dassen, 2008). Changes in scores were assessed using Analysis of Variance or Difference of Proportions. Results Participation in more than half the sessions had a positive impact on stress management, emotional well‐being, and coping, but fewer gains were made by caregivers with health limitations and those who began the workshops with lower emotional well‐being. The workshops can be strengthened by supporting consistent session attendance and individually tailoring self‐care strategies to caregivers’ unique needs. Conclusion Family caregivers’ mental and emotional health has been negatively impacted by the COVID‐19 pandemic (Czeisler et al. 2020). Strategies that foster caregivers’ ability to manage stress and bolster well‐being are vital in enabling them to continue care provision during a time when isolation may exacerbate the challenges of caregiving. Interventions like Finding Meaning and Hope offer a promising approach.
Two pediatric primary care services in Ofakim, Israel, were compared with respect to their use of hospital emergency room facilities and hospitalizations. The services compared were a community-based university pediatric clinic in which preventive and curative care were merged and a traditional service in which preventive and curative care were provided by different agencies. The university clinic had a considerably lower rate of emergency room visits/1,000 children in the population. The proportion of children who were admitted to hospital, among those referred to the emergency room, was much higher for the university clinic. Consistent differences were not found in the number of hospital admissions/1,000 children in the population, nor in the mean duration of stay of hospitalized children.
Radiologic Evaluation of Attempted Suicide by HangingCricotracheal Separation and Common Carotid Artery DissectionKen F. Linnau1 and Wendy A. CohenAudio Available | Share
