Evaluation of an acetated Ringer-based contrast material mixture for postmortem computed tomography angiography

PurposeThe purpose of this study was to compare an established postmortem contrast medium mixture based on polyethylene glycol (PEG) to an isotonic crystalloid with acetated Ringer solution (AR) as the base, both mixed with water-soluble iodinated contrast medium for postmortem computed tomography angiography (PMCTA) with the aim to avoid alterations of the corpse during autopsy.Materials and methodsThe study included 20 cadavers; 10 had PMCTA with AR and 10 with PEG. PMCTA images were analyzed with respect to image quality, vascular contrast patterns and artifacts. Autopsy was evaluated for visual, organ, vessel and haptic alterations. The Wilcoxon rank sum test was used to search for differences in image quality between the two groups. Statistical significance was set at P < 0.05.ResultsAR provided excellent contrast within the right coronary artery (P < 0.001) but a lack of contrast within the left coronary artery (P = 0.008) whereas PEG showed the opposite. A better image quality was observed in the PEG group by comparison with the AR group for right common carotid artery (P = 0.03), left common carotid artery (P = 0.01) and left coronary artery (P = 0.008). No differences were found for ascending aorta (P = 0.65), aortic arch (P = 0.09), right circle of Willis (P = 0.17), left circle of Willis (P = 0.08), inferior vena cava (P = 0.07) and abdominal aorta (P = 0.08). Severe extravasation occurred in all (10/10; 100%) cadavers in the AR group but in none (0/10; 0%) in the PEG group (P < 0.001). At autopsy, visual alteration with lilac discoloration of the face was observed in 4/10 cadavers (40%) in the AR group and in 9/10 cadavers (90%) in the PEG group (P = 0.057). Haptic alterations were observed in 3/10 cadavers (30%) in the AR group and 10/10 cadavers (100%) in the PEG group (P = 0.003).ConclusionAR results in contrast medium mixture extravasation in all cadavers, but PEG altered the autopsy more severely. Both carrier substances result in specific substance-related artifacts and dependent opacification of the coronary arteries, but PEG is recommended for PMCTA exclusively with regard to diagnostic imaging.     

Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors

IntroductionThe goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors.ObjectiveAnalyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery.MethodsCharts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz.ResultsReconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB.ConclusionWe achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.     

Radiological-audiological correlation in type II tympanoplasty with glass ionomer cement

AimTo assess the CT scan aspect of cement bridges used to repair incudostapedial joint discontinuity (ISD) and correlate these observations to audiometric data over time.Material and methodsA retrospective study in 12 patients with cement rebridging for ISD compared pre- and post-operative pure-tone average thresholds, Hounsfield units (HU), and bridge size and position on postoperative CT scans.ResultsMean pre- and post-operative air-bone gap (ABG) was 24.5 and 16 dB, respectively. HU did not vary over time post-surgery, with no significant correlation between HU and time to postoperative CTnscan up to 24 months (p = 0.219). However, a “suggestive” correlation was found between postoperative ABG and HU (p = 0.004, r = −0.7). High cement density correlated with good functional outcome: HU < 500 indicating functional failure and > 1000 indicating ABG closure.ConclusionImmediate cement polymerization quality (high HU) was stable over time and a marker of ossiculoplasty success, correlating with good functional outcome. Particular care should be taken in preparing the cement, and solidification needs to be on dry mucosa-free ossicles.     

A cross-national comparison of the Twitter feeds of popular alcohol brands in India and Australia

Aims: To evaluate (i) the types of techniques alcohol marketers utilise to facilitate user engagement with content on leading Indian and Australian Twitter alcohol brand pages and (ii) the extent to which users engage with this content in two diverse national contexts.

Methods: The 10 alcohol brands per country with the greatest Twitter presence were identified based on the number of ‘followers’. Number of tweets, photos, and videos were collected and the type of content noted for each brand between 1 January 2016 and 29 February 2016. The data were analysed via an inductive coding approach using NVivo10.

Results: In total, the brands had accumulated up to 150,386 followers (Indian: 110,032; Australian: 40,354). The techniques utilised were a mix of those that differed by country (e.g. India: sexually suggestive content versus Australia: posts related to the brand’s tradition or heritage) and generic approaches (e.g. alcohol sponsorship of sport, music, and fashion; offering consumption suggestions; organising competitions; giveaways; and use of memes).

Conclusions: The flexibility of Twitter, which complements traditional marketing, allows brands to adapt and deliver their online alcohol content in specific national contexts and to capitalise on the cultural meanings users invoke in their interactions with the brands.     

The underside of medicalisation: the portrayal of medical error over time in North American popular mass magazines

In this article, I examine the changing representation of medical error in high circulating North American popular magazines in three time periods 1980–1989, 1990–1999 and 2000–2014. Although there were stories of medical error in all the time periods they differed both in their frequency and in the dominant discourses. In the first decade, medical error was represented as an occasional, unique and unusual event. In the next two and a half decades and progressively over time, medical error was represented as commonplace in all parts of the health care system, at all stages of life and from pre-diagnosis to death. Readers are increasingly expected to take responsibility for managing the risk of such errors by continuous, assiduous monitoring of the possible dangers of mistakes made by doctors, in hospitals, in laboratories, that is everywhere in the medical care system. This changing representation of medical error can be linked to the changes in the health care associated with the medicalisation of everyday life, the implementation of neo-liberal ideology and the expansion of the risk society. The individualisation of citizens as isolated, separate units is a bedrock value and assumption of all three of these major discourses. Medicalisation is based on the assumption that health problems develop in the individual body and the individual should follow medical advice to prevent them and should seek medical treatment if such prevention fails. Neo-liberalism devalues the role of the state in ensuring social welfare, emphasising the importance of individual initiative and self-responsibility for health and well-being. In the risk society, the individual is responsible for identifying and managing the risks of everyday life.     

Who ‘likes’ alcohol? Young Australians' engagement with alcohol marketing via social media and related alcohol consumption patterns

Objective: To describe patterns of ‘liking’ alcohol marketing social media pages, and determine related alcohol consumption patterns among young Australians. Methods: Participants were 1,001 Australians aged 15–29 years who completed a cross‐sectional online survey. Logistic regression and ordinal logistic regression were used. Results: A quarter (249/1001, 24.9%) liked at least one of the alcohol marketing social media pages, most commonly brands of spirits, cider and alcohol retailers. Underage participants were as likely as older participants to report liking these pages. Alcohol marketing social media use was significantly and independently associated with male gender, living outside a major city, ever using illegal drugs and early age of first alcohol consumption (all p<0.05). Alcohol marketing social media use (OR 2.1, 95% CI 1.5–2.8, p=<0.001) was independently associated with higher categories on the AUDIT‐C, indicating riskier alcohol consumption. Conclusions: Liking or following alcohol marketing pages is common regardless of age, and associated with riskier alcohol consumption, among young Australians. Implications: There is a need to develop strategies to reduce the exposure to, and potential impact of, alcohol marketing social media pages on young Australians, and ensure these pages are neither accessible to nor targeting underage social media users.