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PubMed2000

Observer variation and the performance accuracy gained by averaging ratings of abnormality.

Six radiologists used continuous scales to rate 529 chest-film cases for likelihood of five different types of abnormalities (interstitial disease, nodule, pneumothorax, alveolar infiltrate, and rib fracture) in each of six replicated readings, yielding 36 separate ratings of each case for the five abnormalities. Separate data analyses of all cases and subsets of the difficult/subtle cases for each abnormality estimated the relative gains in accuracy (linear-scaled area below the ROC curve) obtained by averaging the case-ratings across (a) six independent replications by each reader (25% gain), (b) six different readers within each replication (34% gain), or (c) all 36 readings (48% gain). Although accuracy differed among both readers and abnormalities, ROC curves for the median ratings showed similar relative gains in accuracy, somewhat greater than those predicted from the measured rating correlations. A model for variance components in the observer's latent decision variable could predict these gains from measured correlations in the single ratings of cases. Depending on whether the model's estimates were based on realized accuracy gains or on rating correlations, about 48% or 39% of each reader's total decision variance (summed variance for positive and negative cases) consisted of random (within-reader) error that was uncorrelated between replications, another 10% or 14% came from idiosyncratic responses to individual cases, and about 43% or 47% was systematic variation that all readers found in the sampled cases.

Humans↗
PubMed2001

A constrained formulation for the receiver operating characteristic (ROC) curve based on probability summation.

We propose a principled formulation of the ROC curve that is constrained in a realistic way by the mechanism of probability summation. The constrained and conventional ROC formulations were fitted to 150 separate sets of rating data taken from previous observer studies of 250 or 529 chest radiographs. A total of 20 different readers had used either discrete or continuous rating scales to evaluate those chest cases for likelihood of separate specified abnormalities: interstitial disease, pulmonary nodule, pneumothorax, alveolar infiltrate, or rib fracture. Both ROC formulations were fitted separately to every set of rating data using maximum-likelihood statistical procedures that specified each ROC curve by normally distributed latent variables with two scaling parameters, and estimated the area below the ROC curve (Az) with its standard error. The conventional and constrained binormal formulations usually fitted ROC curves that were nearly indistinguishable in form and in Az. But when fitted to asymmetric rating data that contained few false-positive cases, the conventional ROC curves often rose steeply, then flattened and extrapolated into an unrealistic upward "hook" at the higher false-positive rates. For those sets of rating data, the constrained ROC curves (without hooks) estimated larger values for Az with smaller standard errors. The constrained ROC formulation describes observers' ratings of cases at least as well as the conventional ROC, and always guarantees a realistic fitted curve for observer performance. Its estimated parameters are easy to interpret, and may also be used to predict observer accuracy in localizing the image abnormalities.

Databases as Topic↗
PubMed1976

Achondrogenesis type I. A familial subvariant?

The clinical, pathological, and radiological features of 2 male sibs with a severe and lethal form of micromelic dwarfism are desribed. The family also includes 2 normal sibs. The histological and radiological appearances suggested a diagnosis of achondrogenesis type I, but the markedly deficient ossification of the skull and the presence of intrauterine rib fractures were atypical. These changes have been observed in two other families with 2 or more infants with suspected achondrogenesis, raising the possibility that these familial cases may be a subvariant of achondrogesis or even a distinct disease entity. The disease appears to be inherited as an autosomal recessive and death occurs shortly after birth because of severe pulmonary hypoplasia.

Achondroplasia↗
PubMed2006

Road traffic injuries in the elderly.

OBJECTIVE: Elderly victims of motor vehicle collisions are increasing with the aging population. This study aimed to investigate the injury pattern of elderly victims involved in motor vehicle collisions. METHODS: This was a retrospective study using data from the Victorian State Trauma Outcome Registry and Monitoring Group (VSTORM) from June 2001 to July 2003, Australian Bureau of Statistics year 2001 population estimates, and Victoria Transport Accident Commission year 2001 total road death toll. Elderly victims were defined as age 65 and above. Comparison of fatality rates and general injury patterns for the elderly and young victims was undertaken. RESULTS: The total fatality rate of the elderly group was almost double that of the younger group. The elderly victims had a higher rate of chest injuries (23.42% v 18.17%; p = 0.003). The three most common chest injuries of the elderly victims were rib fractures (23.58%), flail chest (9.55%), and sternum fractures (5.97%). Elderly chest injured patients also had longer intensive care unit stay compared with the younger group (7.96 days v 5.31 days; p = 0.048). CONCLUSIONS: Elderly victims of motor vehicle collisions have a higher risk of chest injuries, especially of chest wall injuries. Age specific injury patterns are important in determining primary and secondary prevention strategies.

Accidents, Traffic↗
PubMed1988

Toward earlier diagnosis of splenic injury?

A series of patients who were found at operation to have sustained splenic rupture is described and their immediate presenting features are detailed. Signs of peritoneal irritation were not always present and patients were not often 'shocked' when first seen. Helpful early signs included a low haemoglobin and pallor. There is a tendency to underestimate the significance of left quadrant pain in the presence of rib fractures. Peritoneal lavage and ultrasound should be more readily employed. Text book features should not be expected early and this must be taught to junior doctors who work in accident and emergency medicine.

Adolescent↗
PubMed2004

Effect of oral bisphosphonates on bone mineral density and body composition in adult patients with cystic fibrosis: a pilot study.

BACKGROUND: Approximately two thirds of adult patients with cystic fibrosis have reduced bone mineral density and up to one quarter have osteoporosis at one or more sites. Any bone mineral deficits are likely to be exacerbated in patients following lung transplantation by their immunosuppressive regimen. Vertebral collapse and rib fractures will impair the ability to cough and the efficacy of physiotherapy treatments. METHODS: Patients attending the Leeds Regional Adult Cystic Fibrosis Unit with either osteopenia or osteoporosis on dual energy x ray absorptiometry (DXA) scanning were offered treatment with oral bisphosphonates after exclusion of abnormal vitamin D, calcium, or phosphate levels, abnormal thyroid function, or hypogonadism. Those declining treatment or patients with a normal initial DXA scan formed the control group. A second DXA scan was performed after a mean of 2.4 years in the treatment group and 2.9 years in the non-treatment group. Patients in the active group were asked to complete a short questionnaire detailing their adherence to treatment. RESULTS: The medians of the differences in annual changes in bone parameters between treatment and control groups showed significant differences in bone mineralisation in favour of the treatment group at the lumbar spine (L2-L4), the femoral neck, and for total body measurements. There were no significant differences in weight, height, or body composition in either patient group. Most treated patients stated that they adhered to treatment most of the time. CONCLUSION: Treatment with oral bisphosphonates may improve bone mineralisation in adult patients with cystic fibrosis. The results of this pilot study need to be further explored in a randomised controlled trial.

Absorptiometry, Photon↗
PubMed1993

Neonatal mortality in a pair of identical twin calves: clinical and post mortem observations.

Parturition was induced, on day 278 of pregnancy, of identical twin male Blonde d'Aquitaine calves; the parturition was assisted by gentle traction. The calves died approximately four minutes and eight hours after birth. Detailed post mortem examinations revealed soft tissue haemorrhage, fractured ribs and intrapulmonary amniotic material. The calf which lived for four minutes had persistent fetal atelectasis and a solitary cartilage embolus in a meningeal vein. Atrioventricular valvular telangiectases were incidental findings in both calves. The observations suggest first that parturient trauma may contribute to neonatal mortality, secondly that the need for intensive neonatal care may be greater than is usually considered appropriate, thirdly that a post mortem examination may reveal unexpected lesions whose effects may contribute to the calves' failure to thrive, and finally that a critical assessment of neonatal pathology is restricted by the lack of data on the perinatal physiological status of the bovine dam and fetus.

Animals↗
PubMedDate not supplied

Transthoracic US of the chest: clinical uses and applications.

Transthoracic ultrasound (US) of the chest is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space. The technique lends itself to bedside use in the intensive care unit, where suboptimal radiography may mask or mimic clinically significant abnormalities. The authors discuss the uses, techniques and applications of US of the chest. The sonographic appearances of pleural diseases (pleural effusion, pneumothorax, pleural mass, and mesothelioma), parenchymal diseases (pneumonia, neoplasms, heart failure, infarct, and rounded atelectasis), chest wall abnormalities (chest wall tumor and rib fracture), and diaphragmatic paralysis are discussed. The use of US in guiding biopsy, thoracocentesis, and other interventional procedures of the lung, pleural space, and mediastinum are also reviewed.

Biopsy↗
PubMed2004

Non-small cell lung cancer: evaluation of pleural abnormalities on CT scans with 18F FDG PET.

PURPOSE: To evaluate the accuracy of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in differentiation of pleural malignancy and cancer-unrelated pleural disease in patients with non-small cell lung cancer (NSCLC) and pleural abnormalities at computed tomography (CT). MATERIALS AND METHODS: In 92 patients, pleural abnormalities were detected at contrast material-enhanced thoracic CT, which was performed for newly diagnosed NSCLC (n = 41) or restaging (n = 51). CT findings were negative for pleural malignancy when pleural effusion with attenuation of 10 HU or less and/or rib fractures with no evidence of pathologic fracture were present; findings were indeterminate when pleural effusion with attenuation greater than 10 HU and/or solid pleural abnormalities without osseous destruction of the chest wall were present; and findings were positive if any osseous destruction of the chest wall adjacent to a pleural mass was present. All patients underwent FDG PET. Findings were negative for pleural malignancy if pleural activity was absent, equal to, or less than mediastinal background activity; findings were positive if pleural activity was higher than mediastinal background activity. Reading of CT and FDG PET scans was first performed separately and then was combined. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPP), and accuracy were calculated for CT and FDG PET separately and for CT and FDG PET combined, with cytologic and/or histologic analysis as standard of reference. RESULTS: In detection of pleural malignancies, CT findings were indeterminate in 65 (71%) patients and true-negative in 27 (29%). Respective sensitivity, specificity, PPV, NPV, and accuracy of FDG PET in detection of pleural malignancies were 100%, 71%, 63%, 100%, and 80%; and those of CT and FDG PET combined, 100%, 76%, 67%, 100%, and 84%. CONCLUSION: Findings suggest that a negative FDG PET scan for indeterminate pleural abnormalities at CT indicates a benign character, while positive findings on an FDG PET scan are sensitive for malignancy.

Adult↗
PubMed1981

Computed tomography of chest trauma.

Computed tomography (CT) and radiography were used to study 20 patients with chest injuries. Excluding rib fractures, CT revealed 50 traumatic lesions ranging from extrapleural hematomas to pericardial fluid collections. In contrast, only 12 lesions were detected on the corresponding radiographs. While many of the processes demonstrated on CT were not life-threatening, substantial abnormalities such as pericardial effusion and diaphragmatic rupture were detected.

Diaphragm↗
PubMed2006

Late toxicity is not increased in BRCA1/BRCA2 mutation carriers undergoing breast radiotherapy in the United Kingdom.

PURPOSE: To undertake the first substantial clinical study of breast radiotherapy toxicity in BRCA1 and BRCA2 mutation carriers in the United Kingdom. EXPERIMENTAL DESIGN: Acute and late radiation effects were evaluated in a retrospective study of 55 BRCA1 and BRCA2 mutation carriers treated with radiotherapy for breast cancer at four centers between 1983 and 2002. Individual matching with controls who had sporadic breast cancer was undertaken for age at diagnosis, time since completion of radiation, and treatment variables. Detailed assessments were undertaken by one examiner. Median follow-up was 6.75 years for carriers and 7.75 years for controls. Rates of late events (rib fractures, lung fibrosis, necrosis of soft tissue/bone, and pericarditis) as well as LENT-SOMA scores and clinical photography scores of breast size, shape, and skin telangiectasia were the primary end points. RESULTS: No increase in clinically significant late toxicity was seen in the mutation carriers. CONCLUSIONS: These data add substantial weight to the evidence that the outcomes in the treated breast from radiotherapy in women with BRCA1 or BRCA2 mutations are comparable with those in women with sporadic breast cancer.

Adult↗
PubMed1979

Effect of calcitonin on bone lesions in chronic dialysis patients.

The effects of synthetic salmon CT, administered subcutaneously and intermittently (1 MRC U/kg/day for 15 days/month over 6 months) were investigated in 15 uremic patients on regular dialysis treatment (RDT), all presenting various degrees of osteodystrophy. Clinically, osteoarticular pain disappeared in 8 out of 10 cases; 1 patient with rib fractures had a rapid calcification of the bone fracture repair tissue. No significant changes were found in serum calcium and PTH levels. Phosphotemia showed a significant decrease within the first 20 days. The varying individual hypophosphatemic response proved to be related to the initial level of phosphatemia. The alkaline phosphatase, when increased, showed a decrease to the normal range. A significant decrease in osteoclastic hyperactivity (active resorption surface, osteoclast index) and a slight increase in osteoblastic pool (active osteoid surface) were documented. No change was noted when osteomalacia predominated. Side effects included: anorexia, nausea, vomiting, face flushing. Our data suggest that salmon CT may be usefully employed in chronic uremic patients on RDT, when secondary hyperparathyroidism predominates.

Adult↗
PubMed1998

Hypoglycaemic shock: normal or abnormal response to injury?

We report a case of hypoglycaemic shock which occurred in a patient 18 h after injury. The patient was involved in a road traffic accident and sustained multiple rib fractures and bruising in the (R) lumbar region. Eleven hours after his last meal he developed sudden weakness, profuse sweating, air hunger, thirst, disorientation and suddenly lapsed into coma 18 h after admission. Administration of 50 ml of 50% dextrose resulted in immediate restoration of consciousness. This case shows that this complication can occur in trauma patients even though the metabolic response to trauma is usually assumed to be hyperglycaemic.

Accidents, Traffic↗
PubMed2005

Score-celebration injuries among soccer players: a report of 9 cases.

BACKGROUND: Professional and amateur soccer players often perform dramatic on-field feats of celebration after scoring a goal. Injuries may occur during these activities. PURPOSE: With the aim of preventing such "score-celebration injuries" in the future, the authors examine these events in professional soccer players and discuss potential avenues for prevention. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Over the course of 2 seasons (1996-1998), 152 soccer players were evaluated at an orthopaedic clinic for injuries incurred during matches. Nine players (6%) had injured themselves while celebrating after scoring goals in a match. The type of celebration, injury type, treatment, and mean duration of recovery were noted. RESULTS: Seven of the 9 patients were male professional soccer players with ages ranging between 17 and 29 years (mean age, 24 years). The injuries occurred when the playing ground was natural turf in 8 cases; most injuries occurred in the second half of the game. The types of celebration maneuvers were sliding (prone or supine) and sliding while kneeling in 5 cases, piling up on jubilant teammates in 3 cases, and being tackled while racing away in 1 case. Injuries included ankle, clavicle, and rib fractures; medial collateral ligament sprain; low back strain; hamstring and adductor muscle strain; quadriceps muscle sprain; and coccyx contusion. The mean duration for recovery was 6.2 weeks. Rival team players were usually not responsible for such trauma. CONCLUSION: Exaggerated celebrations after making a goal, such as sliding, piling up, and tackling a teammate when racing away, can result in serious injury. In addition to general measures for preventing soccer injuries, coaches and team physicians should teach self-control and behavior modification to minimize the risk of such injuries. More restrictive rules, which penalize such behavior, may assist in the prevention of score-celebration injuries.

Adolescent↗