Four-Month High-Dose Rifampicin Regimens for Pulmonary Tuberculosis.

BACKGROUND: Shorter but effective tuberculosis treatment regimens would be of value to the tuberculosis treatment community. High-dose rifampicin has been associated with more rapid and secure lung sterilization and may enable shorter tuberculosis treatment regimens. METHODS: We randomly assigned adults who were given a diagnosis of rifampicin-susceptible pulmonary tuberculosis to a 6-month control regimen, a similar 4-month regimen of rifampicin at 1200 mg/d (study regimen 1 [SR1]), or a 4-month regimen of rifampicin at 1800 mg/d (study regimen 2 [SR2]).

COVID-19: using chest CT of major trauma patients to monitor and evaluate the second wave in London and the development of routine monitoring in practice.

Aim: To follow-up previous work evaluating incidental findings of COVID-19 signs on computed tomography (CT) images of major trauma patients to include the second wave prior to any major effects from vaccines.

Materials And Methods: The study population included all patients admitted following major trauma between 1 January 2020 and 28 February 2021 with CT including the lungs (n=1776). Major trauma patients admitted pre-COVID-19 from alternate months from January 2019 to November 2019 comprised a control group (n=837).

COVID-19: using chest CT of major trauma patients to monitor and evaluate the effect of lockdown and the importance of household size.

Aim: To use theory and practice to show how disease progression and regression can be described pre- and post-lockdown using an attack-sustain-decline-respite (ASDR) model and investigate how pre-lockdown disease prevalence and household size impacts on the effectiveness of lockdown.

Materials And Methods: Computed tomography (CT) scans from major trauma patients (considered as a random population sample) from the radiology department of St George's University Hospitals NHS Trust, London, have been used to explore COVID-19 disease at the population level.

Results: At lockdown on 23 March 2020 in the catchment area of St George's University Hospitals NHS Trust, an earlier paper showed that there was a high prevalence of disease of >20%.

COVID-19: could CT provide the best population level biomarker? Incidental COVID-19 in major trauma patients suggests higher than predicted rates of infection in London.

Aim: To evaluate incidental findings in major trauma patients, and to explore whether computed tomography (CT) could be used to assess prevalence and estimate disease spread in the general population.

Materials And Methods: The study population included all patients admitted following major trauma between 1 January 2020 and 30 April 2020 with CT including the lungs (n=523). Major trauma patients admitted pre-COVID-19 from 1-31 January and 1-31 March 2019 comprised a control group (n=252).

Can the completeness of radiological cancer staging reports be improved using proforma reporting? A prospective multicentre non-blinded interventional study across 21 centres in the UK.

Objectives: Following a diagnosis of cancer, the detailed assessment of prognostic stage by radiology is a crucial determinant of initial therapeutic strategy offered to patients. Pretherapeutic stage by imaging is known to be inconsistently documented. We tested whether the completeness of cancer staging radiology reports could be improved through a nationally introduced pilot of proforma-based reporting for a selection of six common cancers.

Diagnosing acute pulmonary embolism with computed tomography: imaging update.

Acute pulmonary embolism is recognized as a difficult diagnosis to make. It is potentially fatal if undiagnosed, yet increasing referral rates for imaging and falling diagnostic yields are topics which have attracted much attention. For patients in the emergency department with suspected pulmonary embolism, computed tomography pulmonary angiography (CTPA) is the test of choice for most physicians, and hence radiology has a key role to play in the patient pathway.

Idiopathic inflammatory myositis-associated interstitial lung disease: ethnicity differences and lung function trends in a British cohort.

Objective: Interstitial lung disease (ILD) is an important feature of idiopathic inflammatory myositis (IIM). Factors associated with its development and progression remain incompletely understood. The authors report ethnicity differences and lung function trends that characterize the predilection for and natural history of ILD in a group of British patients with IIM.

Revisions to the TNM staging of non-small cell lung cancer: rationale, clinicoradiologic implications, and persistent limitations.

The International Association for the Study of Lung Cancer proposed changes to the 7th edition of the Tumor, Node, and Metastasis (TNM) staging manual of non-small cell lung cancer (NSCLC) to improve the prognostic relevance of its descriptors. These changes include the subdivision of T1 and T2 disease according to size cut points; reassignment of the T and M categories of same-lobe, ipsilateral, and contralateral malignant pulmonary nodules; reassignment of pleural disease to metastatic disease; and introduction of intra- and extrathoracic metastatic disease. Because of movement between T and M descriptors and resultant stage migration, new stage groupings that contain TNM subsets different from those of the previous edition were created.

A diagnostic approach to mediastinal abnormalities.

A number of mediastinal reflections are visible at conventional radiography that represent points of contact between the mediastinum and adjacent lung. The presence or distortion of these reflections is the key to the detection and interpretation of mediastinal abnormalities. Anterior mediastinal masses can be identified when the hilum overlay sign is present and the posterior mediastinal lines are preserved.

HRCT diagnosis of diffuse parenchymal lung disease: inter-observer variation.

Background: This study was designed to measure inter-observer variation between thoracic radiologists in the diagnosis of diffuse parenchymal lung disease (DPLD) using high resolution computed tomography (HRCT) and to identify areas of difficulty where expertise, in the form of national panels, would be of particular value.

Methods: HRCT images of 131 patients with DPLD (from a tertiary referral hospital (n = 66) and regional teaching centres (n = 65)) were reviewed by 11 thoracic radiologists. Inter-observer variation for the first choice diagnosis was quantified using the unadjusted kappa coefficient of agreement.

Nutrient partitioning during treatment of tuberculosis: gain in body fat mass but not in protein mass.

Background: Tuberculosis is an important cause of wasting. The functional consequences of wasting and recovery may depend on the distribution of lost and gained nutrient stores between protein and fat masses.

Objective: The goal was to study nutrient partitioning, ie, the proportion of weight change attributable to changes in fat mass (FM) versus protein mass (PM), during antimycobacterial treatment.

Pulmonary manifestations of systemic autoimmune disease.

Patients with systemic autoimmune disease may present with a number of different pulmonary manifestations. In order to recognise, diagnose and manage these manifestations, it is necessary to have a working knowledge of the anatomy and physiology of the thorax. This chapter will describe the clinical symptoms and clinical examination findings in patients who may have underlying pulmonary disease.

High-resolution CT and CT angiography of peripheral pulmonary vascular disorders.

Peripheral pulmonary vascular disorders that can be evaluated with computed tomography (CT) include various disease entities with overlapping imaging features and a wide range of clinical manifestations. The overall accuracy of CT in the diagnosis of pulmonary vascular disorders increases with improved spatial resolution, administration of a high-flow contrast material bolus, and the use of cardiac gating. The integration of high-resolution CT and CT angiographic techniques into one scanning protocol has important clinical implications for multisection CT and makes it the imaging modality of choice in the evaluation of this complex group of disorders.

MR evaluation of normal retroperitoneal and pelvic lymph nodes.

Purpose: To establish guidelines for normal retroperitoneal and pelvic lymph node size at magnetic resonance imaging (MRI) by correlation with computed tomographic (CT) and lymphangiographic (LAG) data.

Materials And Methods: Twelve patients previously studied with pre- and post-LAG CT to determine normal pelvic lymph node size [ 1 ] were examined with MRI. All were on surveillance for stage I testicular tumour (minimum follow-up 10 years).

Comparative efficacy of and sequence choice for two oral contrast agents used during MR imaging.

Objective: Our objective was to compare the efficacy of a positive and a negative oral contrast agent and to determine the optimal sequence choice for use in pelvic MR imaging.

Subjects And Methods: We undertook a prospective randomized trial of 57 patients with pelvic cancer who were examined with MR imaging after oral administration of a positive contrast agent (27 patients) or a negative contrast agent (30 patients). T1- and T2-weighted breath-hold and non-breath-hold gradient-recalled echo and turbo spin-echo sequences were obtained.

Evaluation of the pullback atherectomy catheter in the treatment of lower limb vascular disease.

Purpose: To evaluate prospectively the Pullback Atherectomy Catheter (PAC) in terms of its technical success and 1-year patency in the treatment of lower limb vascular disease.M ETHODS: Thirty-nine PAC procedures were performed in 34 patients to treat atherosclerotic disease (occlusive in 51%) of the femoropopliteal arteries, including four cases of graft neointimal hyperplasia and three dissection flaps. Follow-up was by ankle-brachial indices at 24 hr and 1 month, and arteriography at 6 and 12 months.