Background
The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and ...reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology’s central role; this may have future negative consequences for resource allocation.
Methods, findings and interpretation
This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the healthcare value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
Spontaneous pneumothorax (SPT) and pneumomediastinum (SPM) have been reported as uncommon complications of coronavirus disease (COVID-19) pneumonia. The exact incidence and risk factors are still ...unrecognized. We report 6 nonventilated, COVID-19 pneumonia cases with SPT and SPM and their outcomes. The major risk factors for development of SPT and SPM in our patients were male gender, advance age, and pre-existing lung disease. These complications may occur in the absence of mechanical ventilation and associated with increasing morbidity (chest tube insertion, sepsis, hospital admission) and mortality. SPT and SPM should be considered as a potential predictive factor for adverse outcome and probable cause of unexplained deterioration of clinical condition in COVID-19 pneumonia.
Lobar torsion is a rare, challenging diagnosis that requires a high index of suspicion and prompt investigation and management. Detection and urgent fixation or lung resection are critical to avoid ...catastrophic sequelae of lung necrosis, bronchopleural fistulae, and death.
A case of lobar torsion following open repair of a type B aortic dissection and thoraco-abdominal aortic aneurysm in a patient with Marfan syndrome is presented. After a non-specific constellation of symptoms, the diagnosis was confirmed with computed tomography and bronchoscopic findings and the patient underwent detorsion and plication of a torted, yet viable, left upper lobe on post-operative day 6. The patient is currently being followed with serial imaging to follow a necrotic consolidation of the left upper lobe.
This was a case of lobar torsion in a patient with Marfan syndrome and the degree of connective tissue disease may have predisposed the patient to this rare surgical complication. The case presents a challenging dilemma due to the risks associated with exposing a synthetic aortic graft to a potentially infected space if lobar resection or a pneumonectomy was performed.
•This report involves the multidisciplinary diagnostic and surgical approach to a case of post-operative lobar torsion following a thoraco-abdominal aortic aneurysm repair in a patient with Marfan syndrome.•Faced with the dilemma of exposing a synthetic aortic graft to a potentially infected space, a decision was made to proceed with lung detorsion and plication rather than lobar resection or total pneumonectomy.•Despite radiological evidence of lung involution and fibrosis, the patient is clinically doing well and not requiring long term antimicrobial therapy.•This is the first reported case of lobar torsion in a patient with Marfan syndrome. It is speculated that the presence of abnormal connective tissue may have potentiated this complication.
Background:
The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of ...and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology’s central role; this may have future negative consequences for resource allocation.
Methods, findings and interpretation:
This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
Imaging Features of Carcinoid Heart Disease Bradette, Simon; Papas, Konstantin, MD; Pressacco, Josephine, MD, PhD
Canadian Association of Radiologists journal,
08/2014, Letnik:
65, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Abstract This article reviews the basic and clinical features of heart disease associated with carcinoid syndrome, with an emphasis on its principal imaging modalities.
Abstract Atherosclerosis exacts a large toll on society in the form of cardiovascular morbidity, mortality, and resource use and is exacerbated by the epidemics of obesity and diabetes. Consequently, ...there is a critical need for more-effective methods of diagnosis, treatment, and prevention of the complications of atherosclerosis. Careful and well-conducted large population studies are needed in order to truly understand the natural history of the disease, its imaging biomarkers, and their links to patient outcomes. The Canadian Atherosclerosis Imaging Network (CAIN) is a unique research network funded by the Canadian Institutes of Health Research and the Canada Foundation for Innovation and designed to address these needs and to enable large population-based imaging studies. The central objective of CAIN is to move innovations in imaging toward their broad application in clinical research and clinical practice for the improved evaluation of cardiac and neurologic vascular disease. CAIN is established as an international resource for studying the natural history, progression, and regression of atherosclerosis, as well as novel therapeutic interventions aimed at atherosclerosis. The network represents Canada's leading atherosclerosis imaging experts, embodying both basic imaging science and clinical imaging research. The network is improving methods of detection and treatment of atherosclerosis and, through a better understanding of the underlying disease itself, improving strategies for disease prevention. The benefits are expected to appear in the next 2 to 3 years. CAIN will drive innovation in imaging technology within the field of cardiology and neurology and improve health outcomes in Canada and worldwide.
We describe a simple and reproducible technique permitting both effective left atrial reduction plasty and safe mitral annulus reconstruction, using a patch of left atrium tissue. In a 64-year-old ...patient undergoing redo mitral valve replacement for mechanical prosthesis disinsertion, a giant left atrium and extensive calcification of the mitral annulus were noted. This technique permitted a safe mechanical mitral prosthesis re-replacement and a significant reduction of left atrial volume by 70%.
Psoriasis is a chronic inflammatory disease associated with increased risks of myocardial infarction and stroke. Systemic treatments for moderate to severe psoriasis can reduce skin and joint ...inflammation; however, their effects on vascular inflammation are unknown.
This randomized, controlled trial included 30 patients with moderate to severe psoriasis and a history, or multiple risk factors, of coronary atherosclerosis. Patients were randomized (2:1) to receive either adalimumab subcutaneously for 4 months or to control nonsystemic treatment (topical therapies or phototherapy). Vascular inflammation was measured in the carotid artery and ascending aorta at baseline and week 15, by (18)F-fluorodeoxyglucose uptake on positron emission tomography. The change in target:
=0.004) but not for the control group (-0.10 95% CI, -0.32 to 0.12; P=0.35). The difference between study arms for this primary end point did not reach statistical significance (-0.13 95% CI, -0.01 to 0.14; P=0.32). The change in target:
=0.021) and in carotid arteries (-0.32±0.15, P=0.037) when analyzed separately (secondary end points). Changes in other positron emission tomography indices also improved significantly with adalimumab compared with controls in the ascending aorta and carotids. High-sensitivity C-reactive protein decreased by 51% at week 16 with adalimumab compared with 5% in controls (P=0·002).
The study did not meet its primary end point because the change in target:background ratio in patients randomized to adalimumab was not different from controls. Although adalimumab may reduce vascular inflammation in patients with moderate to severe psoriasis, this effect is not large enough to be demonstrated in a study with a small sample size.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00940862.
Abstract During the past decade, cardiac magnetic resonance has gained increasing popularity in the diagnosis of hypertrophic cardiomyopathy because of its greater accuracy and better ...characterization of cardiac morphology compared with other imaging modalities. In this pictorial essay, a global clinical portrait of hypertrophic cardiomyopathy will be drawn. The various radiologic findings associated with each variant of hypertrophic cardiomyopathy, and the clinical edge offered by cardiac magnetic resonance will be discussed.
PDF
