Information content and clarity of radiologists' reports for chest radiography

RATIONALE AND OBJECTIVES

We systematically characterized the information provided by chest radiography reports on a nationally representative sample of 822 elderly patients hospitalized in 297 acute-care hospitals in five states who had an admission diagnosis of congestive heart failure, acute myocardial infarction, or pneumonia.

METHODS

We studied the content of radiography reports, including mention of the type or adequacy of radiography; the presence or absence of a prior radiograph; comments about bones, the aorta, the mediastinum, and pleura and notation of the laterality of findings; and the presence of diagnosis. Two physicians reviewed each patient's report, and a third assigned the final rating when they disagreed.

RESULTS

Our analysis found wide variation in content of chest radiography reports, extensive variation in terms used to identify the presence or absence of abnormal findings, and a large degree of uncertainty in what was found.

CONCLUSION

With most hospitals introducing new information systems in response to technological advances and the need to generate more formal hospitalwide reports, the time is right to improve the quality of chest radiography reporting.

Reliability of carnitine concentrations measured in single postprandial urine samples from dogs

OBJECTIVE

To evaluate the reliability of urine carnitine concentrations measured in single postprandial samples, compared with carnitine concentrations measured in 24-hour urine samples.

ANIMALS

19 healthy Beagles.

PROCEDURE

After emptying the urinary bladder by catheterization, dogs were fed a canned canine maintenance diet. Approximately 8 hours later, urine, plasma, and serum samples were obtained for determination of urinary carnitine fractional excretion and urine carnitine-to-creatinine concentration ratio. Results were compared with 24-hour urinary carnitine excretion rate.

RESULTS

Fractional excretion of carnitine and urine carnitine-to-creatinine ratios correlated poorly with 24-hour urinary carnitine excretion.

CONCLUSION

Determination of 24-hour urinary carnitine excretion is recommended to measure urine carnitine concentrations in dogs.

A mural thrombus of an infrarenal aortic aneurysm demonstrated as photon deficiency in a radionuclide study

Radionuclide angiogram (RNA) and aortogram may underestimate external aneurysmal diameter. Photon deficient areas are not uncommon along the abdominal aortic aneurysm (AAA) on RNA. To determine whether or not photon deficient areas along the aneurysm could represent a large thrombus, we studied radionuclide aortic angiography in thirty-eight patients during a preoperative cardiac gated study. All the patients (men, ages from 60 to 78) had CT, US, and/or aortogram for comparison. The presence of a thrombus was determined by CT, US, and/or surgical findings. Twelve of 38 (32%) patients' RNA and blood pool images showed photon deficient areas along the aneurysmal walls having a large concentric or eccentric thrombus of the AAA. A large photon deficient area could be detected along the narrowing calibre of the aorta lumen. This finding results from a large mural thrombus being interposed between the left or right bowel/mesentery activity and the activity of the aneurysms functioning patent lumen. We concluded that a photon deficient area along an inferorenal aortic aneurysm may indicate a large thrombus of either eccentric or concentric type within an AAA.

Structural changes of thermally sprayed hydroxyapatite investigated by Rietveld analysis

Hydroxyapatite (HA) coatings were prepared by three thermal spraying methods: flame spraying, high velocity oxygen fuel spraying and plasma spraying. The HA was then examined by Rietveld analysis using the General Structure Analysis Software package (GSAS) and the results compared with those for the precursor powder. A comparison between HA before and after spraying showed that all three spraying methods caused a distortion in the unit cell in the form of a unit cell a-axis length decrease and a c-axis increase. Overall unit cell volumes showed a difference between the three thermal methods, with flame spraying and high velocity oxygen fuel methods giving a unit cell volume increase and the air plasma spraying method showing a decrease, compared to the starting powders. The two different starting powders used each showed a high oxygen occupancy for the hydroxyl oxygen. When thermally sprayed, both powders gave a reduction in occupancy, which suggested carbonate substitution for the OH group, but this was subsequently removed when thermally processed. The spraying also formed oxyapatite, indicated both by spectral analysis showing a reduction in the hydroxyl peak and by the hydroxyl oxygen occupancy falling to a level below 0.5. Major differences between the three spraying methods could be seen in the distortion index calculations. The thermal spraying techniques gave an increase in the distortion index, but it was significantly higher for the plasma-sprayed coating.

Isolation and characterization of a new basic antigen from short ragweed pollen (Ambrosia artemisiifolia)

A new basic antigen with a molecular weight of 36.5 kDa and a pI of 8.65 was purified from short ragweed pollen using ammonium sulfate precipitation, Q-sepharose chromatography and S-sepharose chromatography. The purified protein, herein referred to as Ambrosia artemisiifolia basic antigen (AaBA), migrated as a single band in SDS-polyacrylamide gel electrophoresis and isoelectric focusing, and as a single peak on reverse phase HPLC. AaBA reacted with sera from humans allergic to ragweed pollen including pooled NIH serum. AaBA and two major acidic allergens, Amb a I (antigen E) and Amb a II (antigen K), displayed immunological cross-reactivity inasmuch as they competed significantly with each other in a competition ELISA. This suggests that at least some major epitopes in all three antigens are similar; however, other possibilities like adjacent location of different epitopes cannot be ruled out at this time. Molecular weight, amino acid composition and sequence data suggest that AaBA is very similar to Amb a II whereas it is significantly different from other basic antigens purified from ragweed pollen.

Arthritis after hepatitis B vaccination. Report of three cases

Side effects of hepatitis vaccination are rare. Only a few cases of arthritis after hepatitis vaccination have been published. We report on three cases of vaccination-induced arthritis with different resulting disease. Two cases show the pattern of reactive arthritis. None of them was associated with HLA-B27. In the third case onset of rheumatoid arthritis was triggered by hepatitis vaccination. These three cases show that arthritis after hepatitis B vaccination probably is more common than reported so far, especially in a genetically predisposed subject (two of our patients expressed HLA-DR4).

Prevalence of MS in south Estonia. Evidence of a new border of the Fennoscandian focus

A population-based study of MS was carried out in South Estonia in 1988-1989. Cases were identified from the Tartu University Hospital archives where all MS cases in South Estonia are diagnosed, from all neurologists and nursing homes of the region, and from the local Multiple Sclerosis Society. The prevalence in South Estonia is 51 per 100,000, for native Estonians 55, for Russians 29, for other nationalities 42 per 100,000. The prevalence rate in different counties was demonstrated as low as 31 per 100,000 in the County of Tartu, to 72 per 100,000 in Pôlva County; 55% of patients have retired because of their handicap and only 2 patients (1%) were living in nursing homes.

Characterization of enamel exposed to 10% carbamide peroxide bleaching agents

The purpose of this investigation was to evaluate the effect of three 10% carbamide peroxide bleaching agents on enamel microhardness and surface morphology. Seventy-two enamel slabs were subjected to one of three carbamide peroxide solutions or an artificial saliva solution for 15 hours a day for 2- and 4-week periods. During the remaining 9 hours, slabs were exposed to human saliva in vivo. Although differences were not statistically significant, microhardness values of all treated specimens 2 weeks after treatment were less than those of control specimens. These trends, however, were not evident at 4 weeks. Scanning electron microscopic evaluation revealed significant surface alterations in enamel topography for slabs treated with the bleaching solutions for 4 weeks. The most severe alterations were found in slabs exposed to the lower-pH solutions.

Prostate adenocarcinoma using Gleason scores correlates with prostate-specific antigen and prostate acid phosphatase measurements

To evaluate a relationship between Gleason scores of histopathology of prostate carcinoma and concurrent serum prostate-specific antigen (PSA) and prostate acid phosphatase (PAP) values, 65 men with prostate carcinoma were studied. These patients' cumulative Gleason scores were obtained by totaling the primary and secondary patterns, resulting in two groups: 42 patients received high (6-10) and 23 received low (2-5) Gleason scores. Serum PSA and PAP values were measured by radioimmunometric assay 1 to 7 days before surgical procedures or biopsy for prostate carcinoma. Mean serum PSA for patients in the high Gleason score group was 134.39 ng/mL (normal range: 0 to 4), and the mean serum PSA for patients in the low Gleason score group was 23.62 ng/mL. Mean serum PAP for patients with high scores was 28.08 ng/mL (normal range: 0 to 5), and the mean serum PAP for patients with low scores was 18.19 ng/mL. Patients with high Gleason scores showed significantly greater elevation of serum PSA than those with low Gleason scores (P = .047), using two samples to test for groups having unequal variants. Prostate acid phosphatase levels of patients with high scores were not significantly higher than the levels in patients with low scores (P = .60). These results indicate that PSA levels but not PAP levels correlate with Gleason scores.

Enlisting the eccentric photoscreener in a public hospital eye department

We analysed retrospectively non-acute new referrals of children to Waikato Hospital over one year. It was found that children were required to wait unacceptably long to be seen. Almost half the children with established amblyopia were not seen until after the age of five years (42% were not referred until after that age). On the other hand, half the children seen had no significant pathology, and the high level of non-attendance also wasted clinic time. An attempt was made to address these problems by holding regular screening clinics using a photoscreener, assessing all children within three weeks of referral so that children with pathology could be examined and treated promptly. Preliminary investigations into mass community photoscreening produced an average recall rate of 11% (54% of whom fell into our definition of pathological). We feel that enlisting the photoscreener has provided a much more efficient paediatric service, which it is hoped will lead to a reduction in visual loss due to amblyopia.

The effects of subgingival irrigation with chlorhexidine and stannous fluoride. A preliminary investigation

This pilot study compared the effectiveness of subgingival irrigation with 0.12% chlorhexidine, 1.64% stannous fluoride, and sterile saline, in addition to scaling and root planing, on levels of Bacteroides porphyromonas and the clinical parameters bleeding tendency, probing depth, and attachment level. A convenience sample of eight patients, exhibiting 32 sites with moderate periodontal disease, was randomly assigned to receive all treatments according to a four-quadrant treatment design. Subgingival irrigation was performed at 0, 1, 2, and 3 weeks following scaling and root planing. Clinical and microbial assessments were measured at baseline, 4, 8, and 12 weeks. Data were analyzed using a two-factor repeated measure analysis of variance, and the Newman-Keuls sequential range test or Friedman test and Kruskal-Wallis test revealed statistically significant (p less than .01) improvements in probing depths, attachment levels, and Bacteroides porphyromonas for all groups at 12 weeks when compared to baseline values. No statistically significant differences occurred between any of the treatment groups at any time period. Based on the findings of this investigation, it has been concluded that four weekly irrigations with 0.12% chlorhexidine, 1.64% stannous fluoride, or saline irrigation did not enhance the beneficial effects of scaling and root planing alone.

Malignant acrospiroma

A 76-year-old woman was referred after results of the biopsy of an ulcerated mass of the right long finger suggested poorly differentiated squamous cell carcinoma. Excision and skin grafting were done and a diagnosis of malignant acrospiroma was established. These tumors are aggressive and 5-year survival rate may be as low as 30%. A ray amputation was subsequently done and the specimen was without residual tumor. At 14 months follow-up, the patient remains free of disease.

Comparative study: the effects of latex and vinyl gloves on the tactile discrimination of first year dental hygiene students

The purposes of this study were to determine 1) if there was a significant difference in the tactile discrimination of first year dental hygiene students wearing a vinyl glove as compared to a latex glove; 2) if the subjects' perceptions of their ability to accurately discriminate between surface textures differed when wearing either one of the two gloves; and 3) the individual characteristics of the gloves preferred by the subjects. Twenty-nine first year dental students were randomly assigned to one of the two glove treatment groups. The tactile discrimination ability of each subject was assessed at baseline and three weeks after using the Roughness Discrimination Test (RDT). The subjects wore their assigned gloves when performing laboratory and clinical procedures during the 3-week period. Following this period the RDT was again administered. Subjects then switched gloves for an additional 3-week period, at which time data were collected regarding perceived discrimination ability and glove preference. Data were analyzed using a repeated-measures analysis of variance. Results revealed no significant difference (p less than 0.05) in subject's tactile discrimination ability while 29% indicated that the latex glove had an inhibitory effect. The subjects most frequently preferred the latex glove, citing specific favorable characteristics such as size, fit, comfort and durability while performing clinical procedures. However, the vinyl glove was favored for durability after washing.

The effectiveness of two sonic and two ultrasonic scaler tips in furcations

This study compared the effectiveness of two sonic and two ultrasonic scaler tips on artificial calculus removal from the furcations of mandibular first and second molars. Twenty-four extracted mandibular molars were cleaned and randomly assigned to one of four treatment groups. Teeth were split buccal lingually, artificial calculus was placed in the furcation areas, and the teeth were photographed with a stereo camera. Teeth were reconnected with bonding material and mounted in a typodont with simulated gingiva and attached to a dental chair. Teeth were instrumented with either a Cavitron TFI10 tip, Cavitron EWPP tip, Titan-S Universal tip, or Titan-S Sickle tip by a licensed dental hygienist until each tooth was judged calculus free to the touch with a CH3 explorer. Time for each instrumentation period was recorded. Following instrumentation, the teeth were again split and photographed. Stereophotogrammetry was used to produce tracings of the teeth with initial calculus and remaining calculus. Pre-instrumentation and post-instrumentation amounts of calculus on the surface area were computed using the Bioquant system. A two factor analysis of variance was conducted followed with a Newman-Keuls Multiple Comparison Technique to test for within and between differences. Significant differences (P less than or equal to 0.01) were found between pre- and post-amounts of calculus for all tips. No significant differences (P less than or equal to 0.05) were found between the four instrument tips with respect to percentage of furcation surface with calculus remaining. No differences were found between tips with regard to the time required to clean the test surfaces.