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Accuracy of treadmill exercise electrocardiography in detecting restenosis following single-vessel percutaneous transluminal coronary angioplasty.

To develop an improved method for diagnosing restenosis using treadmill exercise electrocardiography (ECG) following percutaneous transluminal coronary angioplasty (PTCA), we prospectively evaluated 46 patients who underwent PTCA for the treatment of single-vessel coronary artery disease and who did not have a history of myocardial infarction. Treadmill exercise ECG and coronary angiography were performed 3 months after PTCA to determine their accuracy in diagnosing restenosis based on standard ST-segment depression criteria, the difference between the maximum ST-segment depression before and 3 months after PTCA (< or =0.5 mm: positive; >0.5 mm: negative), and the difference between sigmaST-segment depression before PTCA and 3 months after PTCA (< or = 1.5 mm: positive; > 1.5 mm: negative). The sensitivity, specificity, and diagnostic accuracy of standard ST-segment depression criteria were 65%, 66%, and 65%, respectively. The sensitivity, specificity, and accuracy for the difference in maximum ST-segment depression were 77%, 76%, and 76%, respectively, whereas the values for the difference in sigmaST-segment depression were 77%, 83%, and 80%, respectively. Based on these results, we conclude that using the difference between ST-segment depression before and after PTCA improves the accuracy of treadmill exercise ECG for diagnosing restenosis.

Aged↗

Academic calculations versus clinical judgments: practicing physicians' use of quantitative measures of test accuracy.

PURPOSE: To determine how often practicing physicians use the customarily recommended quantitative methods that include sensitivity, specificity, and likelihood ratio indexes; receiver operator characteristic (ROC) curves; and Bayesian diagnostic calculations. PARTICIPANTS AND METHODS: A random sample of 300 practicing physicians (stratified by specialty to include family physicians, general internists, general surgeons, pediatricians, obstetrician/gynecologists, and internal medicine subspecialists) were briefly interviewed in a telephone survey. They were asked about the frequency with which they used the formal methods, the reasons for non-use, and if they employed alternative strategies when appraising tests' diagnostic accuracy. RESULTS: Of the 300 surveyed physicians, 8 (3%) used the recommended formal Bayesian calculations, 3 used ROC curves, and 2 used likelihood ratios. The main reasons cited for non-use included impracticality of the Bayesian method (74%), and nonfamiliarity with ROC curves and likelihood ratios (97%). Of the 174 physicians who said they used sensitivity and specificity indexes, 165 (95%) did not do so in the recommended formal manner. Instead, the physicians directly estimated tests' diagnostic accuracy by determining how often the test results were correct in groups of patients later found to have, or to be free of, the selected disease. CONCLUSIONS: The results indicate that most practicing physicians do not use the formal recommended quantitative methods to appraise tests' diagnostic accuracy, and instead report using an alternative direct approach. Although additional training might make physicians use the formal methods more often, the physicians' direct method merits further evaluation as a potentially pragmatic tool for the determination of tests' diagnostic accuracy in clinical practice.

Adult↗

Impact of visual function on computer task accuracy and reaction time in a cohort of patients with age-related macular degeneration.

PURPOSE: To investigate the impact of visual function parameters on computer task performance in patients with age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: Eighteen patients with visual impairment due to age-related macular degeneration underwent evaluation of visual acuity using the Early Treatment Diabetic Retinopathy Study protocol, contrast sensitivity using a Pelli-Robson chart, binocular simultaneous visual field using the Esterman program on an automated perimeter, and color vision using Farnsworth D-15. Each subject then completed 125 computer icon identification tasks. Relationships between computer task performance (accuracy and speed) and visual function parameters (visual acuity, contrast sensitivity, visual field, and color vision) were analyzed. RESULTS: Visual acuity and contrast sensitivity in the better eye, weighted average contrast sensitivity, and color vision defects are significantly associated with computer task accuracy. Visual acuity in the better eye, weighted average visual acuity, and color vision defects are significantly associated with performance speed. Visual function parameters and clinical features significantly associated with computer task accuracy in a multiple regression model include weighted average contrast sensitivity (P = 0.001), protan color vision defect (P = 0.002), cataract severity in the better-seeing eye (P = 0.036), and geographic atrophy outside the central macula (P = 0.046). Visual function parameters and clinical features significantly associated with computer task speed in a multiple regression model include color vision defects (deutan, P < 0.001; protan, P < 0.001) and gender (P = 0.05). CONCLUSIONS: Among this cohort of patients with AMD, visual acuity, contrast sensitivity, and color vision defects are significant predictors of computer task performance. Visual function parameters of the better eye played a more significant role than parameters of the worse eye, and contrast sensitivity is the most significant predictor of computer task accuracy.

Activities of Daily Living↗

The diagnostic accuracy of mammography in the evaluation of male breast disease.

BACKGROUND: The role of mammography in the evaluation of male patients presenting with breast disease is controversial. This controversy is a function of the lack of specific data concerning the diagnostic accuracy of mammography when used in this clinical setting. The purpose of this study was to define the diagnostic accuracy of mammography in the evaluation of male breast disease. METHODS: One hundred and four prebiopsy mammograms from 100 patients with tissue diagnoses were read blindly by two independent radiologists, and placed into one of five predetermined categories: definitely malignant, possibly malignant, gynecomastia, benign mass, and normal. Radiologic/pathologic correlation was performed and the sensitivity (Sn), specificity (Sp), positive (Ppv) and negative predictive value (Npv), and accuracy (Ac) for each of the mammographic diagnostic category determined. RESULTS: The pathologic diagnoses were 12 cancers, including 1 patient with bilateral breast cancer, 70 cases of gynecomastia, 16 benign masses, and 6 normals. The accuracy data for the mammographic diagnostic categories are as follows: malignant (combined definitely and possibly malignant), Sn 92%, Sp 90%, Ppv 55%, Npv 99%, Ac 90%; and overall benignity (combined gynecomastia, benign mass, and normal), Sn 90%, Sp 92%, Ppv 99%, Npv 55%, Ac 90%. Six cancers (50%) coexisted with gynecomastia. CONCLUSIONS: Mammography can accurately distinguish between malignant and benign male breast disease. Although not a replacement for clinical examination, its routine use could substantially reduce the need for biopsy in patients whose mammograms and clinical examination suggest benign disease.

Breast Neoplasms, Male↗

Accuracy of computed tomography in determining resectability for locally advanced primary or recurrent colorectal cancers.

AIM: To determine the accuracy of computed axial tomography (CT) in determining tumor resectability in patients with locally advanced primary (T4) or locally recurrent colorectal cancer. METHODS: Computed tomography scans of 84 patients with "resectable" locally advanced primary rectal cancer (n = 12) or recurrent colorectal cancer (n = 72) were compared with the operative findings to assess the accuracy of abdominal and pelvic CT in determining extent of disease and resectability. RESULTS: At surgery, disease was confined to the pelvis in 63 patients, the abdomen in 7, and involved both the pelvis and abdomen in 14. Computed tomography correctly identified these anatomic sites of tumor in 87% of patients, with 89% and 80% accuracies for pelvic and abdominal disease, respectively. Tumor resection was performed in 71 patients (85%), but was not in 13 patients because of locally unresectable disease in 8 and metastatic disease in 5. The accuracy of predicting tumor-related operability was 85%. With regard to adjacent organ resection, CT was accurate in determining the need for sacrectomy or hysterectomy, but overestimated the need for urinary organ resection. Based on histological examination of resection margins, CT correctly staged (n = 45) or overstaged (n = 9) 54 patients (64%) and understaged the remaining 30. The ability of CT to preoperatively predict a locally advanced tumor after preoperative radiation therapy as not being fixed was 30%, fixed but resectable 75%, and fixed but not resectable 25%. CONCLUSIONS: Computed tomography is generally reliable at identifying disease as being confined to one region, and for predicting the need for adjacent organ resection. It is less discriminating for predicting local tumor resectability.

Adult↗

Evaluation of the accuracy of preoperative staging in thoracic esophageal cancer.

BACKGROUND: Exact clinical staging before treatment of esophageal cancer has become increasingly important in the evaluation and comparison of the results of different treatment modalities, including surgery, chemotherapy, and radiotherapy. METHODS: The accuracy of preoperative tumor staging by using an esophagography, esophagoscopy, percutaneous and endoscopic ultrasonography, and computed tomography was assessed in 224 patients with resectable esophageal cancer. The results of tumor staging by these tests were compared prospectively with the pathologic stage of the esophagectomy specimens with respect to the T and N categories defined by the International Union Against Cancer TNM classification. RESULTS: For the T category, the overall accuracy was 80%. For the N category, overall accuracy was 72%, with a sensitivity of 78%, a specificity of 60%, and a positive predictive value of 78%. Overall, the accuracy of stage grouping was 56%. CONCLUSIONS: Either the T or N categories can be predicted reliably by clinical staging techniques. However, the preoperative stage grouping might not be valid in resectable, localized esophageal cancer.

Adult↗

Comparing the effect of different design of desks with regard to motor accuracy in writing performance of students with cerebral palsy.

This study was conducted to examine the effect of ergonomic desk design for improving motor accuracy in the writing performance of cerebral palsy students. Thirty-two cerebral palsy students were tested in four workstations. The test order was randomized. Work surface design involved a regular work surface and a cutout work surface, and desk angle design included a horizontal desk top and a 20 degrees inclined desktop. The height of the desk and chair were adjusted relatively to each subject's height and popliteal height. Writing performance while using the four workstations were compared by administering the Motor Accuracy Test. Motor writing accuracy adjusted for speed was significantly better at the cutout work surface than at the regular work surface. Students with athetoid quadriplegia benefited more from the cutout surface. Although the inclined desktop was more appropriate for better vision and less neck flexion, there were no differences in accuracy scores and adjusted scores between the horizontal desk and the inclined desk. These findings support the hypothesis that the cutout work surface, which was accommodated to the anterior trunk, facilitates trunk control and provides forearm support in addition to improving writing performance.

Adolescent↗

An assessment of inter-observer agreement and accuracy when reporting plain radiographs.

This study investigates the inter-observer agreement and accuracy of plain radiograph reporting. Five consultant radiologists were asked to report 50 plain radiographs where the diagnosis had been established. Thirty-one of the radiographs showed an abnormality; 19 were normal. The radiographs were viewed on two separate occasions, 5 months apart. Initially clinical details were omitted but on the second occasion they were available. The accuracy of the report to the known diagnosis was assessed using McNemar test and inter-observer agreement was assessed using Kappa statistics. The precision (mean accuracy) improved in the light of the clinical information from 77% (range 62% to 86%) to 80% (range 78% to 84%), although this improvement did not reach statistical significance. Sensitivity improved from 80% to 83% and specificity from 72% to 76%. The Kappa value for inter-observer agreement improved from 0.31 to 0.58 for all radiographs, from 0.40 to 0.70 for the abnormal radiographs and from 0.24 to 0.43 for the normal radiographs. There was a trend to improved accuracy of diagnosis and inter-observer agreement with knowledge of clinical details.

Consultants↗

The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis.

AIM: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and ultrasound (US) in the diagnosis of choledocholithiasis in a large group of patients with bile duct stones confirmed at direct cholangiography. Also, to compare bile duct stones confirmed at direct cholangiography. Also, to compare bile duct stone characteristics using the three different investigations, endoscopic retrograde cholangiopancreatography (ERCP), MRCP and US. MATERIALS AND METHODS: 191 patients (M:F, 76:115; mean age, 66 years; range, 24-92 years) were investigated by direct cholangiography, MRCP and US. Their final diagnosis as determined at direct cholangiography were choledocholithiasis (n = 34), strictures (n = 47) and normal ducts (n = 110). The direct cholangiographic methods used for diagnosis of choledocholithiasis were ERCP (n = 29), intraoperative cholangiography (n = 3) and percutaneous transhepatic cholangiography (n = 2). The bile duct stone characteristics were compared using ERCP, MRCP and US in the 29 patients in whom stones were exclusively diagnosed by ERCP. RESULTS: Compared with the final diagnosis, MRCP had a sensitivity, specificity and diagnostic accuracy of 91%, 98% and 97%, respectively, in the diagnosis of choledocholithiasis. MRCP resulted in three false-negative and three false-positive findings, four of which occurred due to confusion with lesions at the ampulla. US had a sensitivity, specificity and diagnostic accuracy of 38%, 100% and 89%, respectively, in the diagnosis of choledocholithiasis. ERCP diagnosed more stones and the stones were more proximally distributed within the bile duct at ERCP when compared with MRCP. CONCLUSION: MRCP has a high diagnostic accuracy (97%), similar to that at direct cholangiography, in the diagnosis of choloedocholithiasis. It has the potential to replace diagnostic ERCP and select patients with choledocholithiasis for therapeutic ERCP.

Adult↗

Comparison of hysteroscopic and hysterectomy findings for assessing the diagnostic accuracy of office hysteroscopy.

OBJECTIVE: To assess the diagnostic accuracy of office hysteroscopy by comparing the hysteroscopic findings with the histologic findings on the hysterectomy specimens. DESIGN: Retrospective clinical study. SETTING: University-affiliated hospital. PATIENT(S): Review of the hospital records of 443 patients who underwent office hysteroscopy and, within 2 months, hysterectomy. INTERVENTION(S): We compared the hysteroscopic findings (including targeted biopsies) with the histologic findings that were obtained after hysterectomy. The results of this study were then compared with those of a previous study in which we examined the diagnostic accuracy of dilatation and curettage (D&C). MAIN OUTCOME MEASURE(S): We evaluated the diagnostic accuracy of office hysteroscopy. RESULT(S): When compared with the histologic diagnosis of the uterus, the hysteroscopic findings showed a diagnostic sensitivity of 98%, a specificity of 95%, a positive predictive value (PPV) of 96%, and a negative predictive value (NPV) of 98%. Hysteroscopy was found to have a greater diagnostic accuracy than D&C: the sensitivity and the NPV of the two diagnostic procedures were statistically different. CONCLUSION(S): Office hysteroscopy is confirmed as a powerful diagnostic tool, but targeted biopsies, performed with a small diameter operative hysteroscope, must be performed in cases of suspect endometrium to confirm the image-based diagnosis.

Dilatation and Curettage↗

Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases.

OBJECTIVE: To evaluate the diagnostic accuracy of sonohysterography (SHG) in uterine cavity diseases in infertile patients, comparing its results with those of hysterosalpingography (HSG) and transvaginal sonography (TVS). Hysteroscopy was the gold standard. DESIGN: Descriptive, prospective study. SETTING: A tertiary university referral center. PATIENT(S): Sixty-five infertile women 19 to 43 years of age. INTERVENTION(S): Patients underwent SHG, conventional TVS, HSG, and hysteroscopy. MAIN OUTCOME MEASURE(S): The results of each examination were compared with those obtained by the gold standard. The following diagnoses were considered separately: polypoid lesions, uterine malformations, intrauterine adhesions, and endometrial hyperplasia (EH). Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and 95% confidence intervals were calculated. RESULT(S): Sonohysterography had the same diagnostic accuracy as the gold standard for polypoid lesions and EH, with no equivocal diagnosis. Hysterosalpingography showed a sensitivity of 50% and a PPV of 28.6% for polypoid lesions and a sensitivity of 0% for EH. Transvaginal sonography had both sensitivity and PPV of 75% for polypoid lesions and EH. For uterine malformations, SHG had a sensitivity of 77.8%, whereas TVS and HSG both had a sensitivity of 44.4%. Sonohysterography and HSG had a sensitivity of 75% in the detection of intrauterine adhesions and respective PPVs of 42.9% and 50%. Transvaginal sonography showed sensitivity and PPV of 0% for this diagnosis. CONCLUSION(S): Sonohysterography was in general the most accurate test. Its diagnostic accuracy was markedly superior for polypoid lesions and EH, with total agreement with the gold standard. In diagnosis of intrauterine adhesions, SHG had limited accuracy, similar to that obtained by HSG, with a high false-positive diagnosis rate.

Adult↗

Gastroesophageal endoscopic signs of cirrhosis: independent diagnostic accuracy, interassociation, and relationship to etiology and hepatic dysfunction.

BACKGROUND: The main objective of this prospective study was to evaluate the independent diagnostic accuracy of gastroesophageal endoscopic signs for cirrhosis. METHODS: Endoscopic signs were evaluated in vivo by one observer and on standardized videotape recordings by a consensus opinion of two endoscopists, with the stomach and esophagus examined both separately ("blind video") and together ("unblind video") in 168 consecutive patients with cirrhosis (n = 91), with non-cirrhotic liver disease (n = 29), and without liver disease (n = 48). The results were then tested in 149 different patients. RESULTS: Discriminant analysis of the "blind video" examination, considered to be the reference examination, showed that esophageal varices and portal hypertensive gastropathy had independent diagnostic accuracy (> or = 87%) for cirrhosis regardless of control group. However, in the "unblind video" and in in vivo examinations with different control groups, these results were altered. Prior knowledge of gastric patterns influenced the assessment of esophageal patterns. There was no independent association between portal hypertensive gastropathy or esophageal varices and the etiology of liver disease or the Child-Pugh score. CONCLUSIONS: When methodologic biases are eliminated, esophageal varices and portal hypertensive gastropathy have independent diagnostic accuracy for cirrhosis: esophageal varices had a diagnostic accuracy of 77% at the first step and increased to 89% with portal hypertensive gastropathy at the second step.

Adult↗

NACOB presentation to ASB Young Scientist Award: Postdoctoral. The impact of boundary conditions and mesh size on the accuracy of cancellous bone tissue modulus determination using large-scale finite-element modeling. North American Congress on Biomechanics.

The apparent properties of cancellous bone are determined by a combination of both hard tissue properties and microstructural organization. A method is desired to extract the underlying hard tissue properties from simple mechanical tests, free from the complications of microstructure. It has been suggested that microCT voxel-based large-scale finite element models could be employed to accomplish this goal (van Rietbergen et al., 1995, Journal of Biomechanics, 28, 69-81). This approach has recently been implemented and it is becoming increasingly popular as finite element models increase in size and sophistication (Fyhrie et al., 1997, Proceedings of the 43rd Annual Meeting of the Orthopaedic Research Society, San Francisco, CA, p. 815; van Rietbergen et al., 1997, Proceedings of the 43rd Annual Meeting of the Orthopaedic Research Society, San Francisco, CA, p. 62). However, no direct quantitative measurements of the accuracy of this method applied to porous structures such as cancellous bone have been made. This project demonstrates the feasibility of this approach by quantifying its best-case accuracy in determining the trabecular hard tissue modulus of analogues fabricated of a material with known material properties determined independently by direct testing. In addition we were able to assess the impact of mesh size and boundary conditions on accuracy. We found that the assumption of a frictionless boundary condition in the parallel plate compression loading configuration was a significant source of error that could be overcome with the use of rigid end-caps similar to those used by Keaveny et al. (1997 Journal of Orthopaedic Research, 15(1), 101-110). In conclusion, we found that this approach is an effective method for determining the average trabecular hard tissue properties of human cancellous bone with an expected practical accuracy level better than 5%.

Awards and Prizes↗

Improving the accuracy of Kováts' retention indices in isothermal gas chromatography.

Isothermal Kováts' retention indices are currently reported as whole numbers, and are frequently deduced from a linear least mean squares fitting of the logarithms of adjusted retention times of a number of n-alkanes versus carbon number, following an iterative method that minimises errors. The currently accepted accuracy is about one retention index unit for apolar stationary phases, and lower for polar stationary phases. This paper presents results that show how the accuracy of the retention index may be safely reported to one-tenth of a retention index unit by the use of a non-linear equation, with present day gas chromatographs without electronic flow controllers. Results are presented that prove the correctness of the retention indices found for several substances on one particular capillary column. Hints on the minimum retention times needed to achieve the 0.1 retention index accuracy are mentioned, for retention times recorded in minutes and in seconds. According to results of this paper, two chromatograms, run under the appropriate conditions, are sufficient to obtain the desired accuracy. The method proposed in this paper does not require knowledge of the hold-up time of the chromatogram.

Chromatography, Gas↗

The accuracy of abbreviated esophageal pH monitoring in children.

Extended (18 to 24 hour) esophageal pH monitoring establishes the diagnosis of gastroesophageal reflux (GER) utilizing a pH score, and relates respiratory symptoms to GER when the mean duration of sleep reflux (ZMD) is prolonged. A disadvantage of this method is the expense of overnight hospitalization. We performed extended esophageal pH recordings in 66 consecutive children (1 week to 15 years old) being evaluated for GER. Six portions of the 18- to 24-hour esophageal pH recording were compared to the complete record in an attempt to define the relative accuracy of abbreviated monitoring periods. The abbreviated monitoring periods included the 30 minutes after apple juice feedings (30 minutes AJ), the 2 hours after apple juice feedings (2 hours PC AJ), the 2 hours after milk-formula feedings (2 hours PC MF), the 8 hours with two feedings of apple juice (8 hours AJ), the 8 hours with two feedings of milk formula (8 hours MF), and the first 12 hours of recording (1st 12 hours). The accuracy relative to the 18- to 24-hour recording was poor for 30 minutes AJ, 2 hours PC AJ, and 2 hours PC MF periods (30% to 58%). An improved accuracy occurred during 8-hour AJ periods (29/31, 94%) in children without respiratory symptoms. Although the accuracy in patients with respiratory symptoms was best during 8-hour MF (31/35, 89%) and 1st 12-hour (33/35, 94%) periods, a high false-negative rate for the ZMD (31% to 41%) during abbreviated pH monitoring indicates that many patients with reflux-induced respiratory symptoms will be unrecognized.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

A clinical study comparing the three-dimensional accuracy of a working die generated from two dual-arch trays and a complete-arch custom tray.

STATEMENT OF PROBLEM: Dual-arch trays are often used by the dentists to make crown impressions of opposing quadrants simultaneously. Metal and plastic trays are available, but little is known about the accuracy of the impressions and resultant working dies. PURPOSE: The purpose of this study was to conduct a clinical trial to compare the accuracy of gypsum working dies made from impressions with metal dual-arch, plastic dual-arch, and complete-arch custom trays. MATERIAL AND METHODS: Eight patients requiring a posterior single tooth implant restoration were selected on the basis of inclusion and exclusion criteria. A customized abutment was measured in 3 dimensions (buccolingual, mesiodistal, and occlusogingival) by use of a measuring microscope. Three polyvinyl siloxane impressions were made of the abutment with a complete-arch custom tray, a plastic, and a metal dual-arch tray. Each impression was poured with type IV improved dental die stone. The diameter (buccolingual and mesiodistal), from gingivoaxial to gingivoaxial point angle, and height (occlusogingival), gingivoaxial to occlusoaxial point angle of the abutment standard was determined by measuring each dimension several times to obtain a mean. These 3 mean values served as the controls and were compared with the same measurements of the gypsum dies generated by the 3 different impression techniques. The patient was asked to rank the 3 impressions in order of overall comfort. A multivariate repeated measures single factor ANOVA was used in the statistical analysis (alpha=.05). When main effects were significant, a pairwise comparison of mean values was conducted with Bonferonni adjustment for multiple comparisons. RESULTS: There were no significant differences in die accuracy among the 3 trays for the mesiodistal (3.507 mm) and occlusogingival (3.584 mm) dimensions of the implant abutment. Dies were smaller than the standard for these 2 dimensions and larger in the buccolingual dimension. There was a significant difference in accuracy between the metal and plastic dual-arch trays. The dies produced from the metal dual-arch tray were 20 microm larger than the abutment standard compared with 3 microm larger for the plastic tray. The occlusogingival dimension of the working dies was 30 to 40 microm shorter than the implant abutment. Seven of the 8 patients ranked the plastic dual-arch impression as the most comfortable and the complete-arch custom tray as the least comfortable. CONCLUSIONS: Within the limitations of this study, the dimensions of working dies from a custom tray impression did not differ significantly from those created with dual arch trays. However, working dies from a plastic dual-arch tray were more accurate buccolingually than those from metal dual-arch trays.

Crowns↗

Accuracy of combined computerized tomography and fine needle aspiration cytology in lymph node staging of localized prostatic carcinoma.

The sensitivity and accuracy rate of computerized tomography (CT) in lymph node staging of localized prostatic carcinoma is commonly considered to be low. Fine needle aspiration cytology of pathological lymph nodes seen on radiological staging can enhance this low accuracy rate. We prospectively investigated the accuracy of CT and fine needle aspiration cytology in lymph node evaluation of 285 patients with clinically locally confined prostatic carcinoma. The sensitivity, specificity and accuracy rates of this combined method were 77.8%, 100% and 96.5%, respectively. False-negative staging results were found in only 10 patients with minimal nodal disease. Although in contrast with previous reports, combined CT and fine needle aspiration cytology in our hands seems to be a highly efficient staging method for lymph node involvement. This method could be considered as an alternative to surgical lymphadenectomy in the preoperative evaluation of the nodal status of patients with localized prostatic carcinoma who are scheduled for radical prostatectomy or curative radiotherapy.

Aged↗

Ensuring the accuracy of digital sphygmomanometers for home use.

OBJECTIVE: To describe the techniques for assessing the accuracy of digital sphygmomanometers. DESIGN: The necessary equipment and the recommended procedures for determining the accuracy of digital units by comparison with a mercury sphygmomanometer were reviewed. RESULTS: Evaluation of the accuracy of digital sphygmomanometers is a simple two-phase process: (1) comparison of the pressure sensors against a mercury column and (2) assessment of the ability to detect Korotkoff sounds. The only equipment needed is a mercury column, a Y tubing, a "dummy" arm, two male-female adapters, and a stethoscope. The two short ends of the Y tubing are used to connect the mercury sphygmomanometer and the digital unit, and the long end of the Y tubing is attached to the cuff of the digital unit. The inflation mechanism of the digital unit (manual or automatic) influences the approach used for comparing the two units. For both manually and automatically inflatable digital units, the digital display should be within +/- 4 mm Hg of the mercury level; likewise, a properly functioning digital unit should detect Korotkoff sounds (both systolic and diastolic readings) within +/- 4 mm Hg of the auscultated blood pressure measurements. If the digital sphygmomanometer is judged to be accurate, 6-month reevaluations are suggested. CONCLUSION: With use of minimal equipment, digital sphygmomanometers (except the new finger blood pressure monitors) can easily be assessed for accuracy by comparing the pressure sensors against a mercury unit and testing the sensitivity for detecting Korotkoff sounds. Self-monitoring of the blood pressure is helpful in assessing blood pressure changes over time and in evaluating antihypertensive therapy.

Blood Pressure Monitors↗