RESUMEN
PURPOSE: Chest radiographs in critically ill patients can be difficult to interpret due to technical and clinical factors. We sought to determine the agreement of chest radiographs and CT scans, and the inter-observer variation of chest radiograph interpretation, in intensive care units (ICUs). METHODS: Chest radiographs and corresponding thoracic computerised tomography (CT) scans (as reference standard) were collected from 45 ICU patients. All radiographs were analysed by 20 doctors (radiology consultants, radiology trainees, ICU consultants, ICU trainees) from 4 different centres, blinded to CT results. Specificity/sensitivity were determined for pleural effusion, lobar collapse and consolidation/atelectasis. Separately, Fleiss' kappa for multiple raters was used to determine inter-observer variation for chest radiographs. RESULTS: The median sensitivity and specificity of chest radiographs for detecting abnormalities seen on CTs scans were 43.2% and 85.9% respectively. Diagnostic sensitivity for pleural effusion was significantly higher among radiology consultants but no specialty/experience distinctions were observed for specificity. Median inter-observer kappa coefficient among assessors was 0.295 ("fair"). CONCLUSIONS: Chest radiographs commonly miss important radiological features in critically ill patients. Inter-observer agreement in chest radiograph interpretation is only "fair". Consultant radiologists are least likely to miss thoracic radiological abnormalities. The consequences of misdiagnosis by chest radiographs remain to be determined.
Asunto(s)
Unidades de Cuidados Intensivos , Variaciones Dependientes del Observador , Radiografía Torácica , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , Humanos , Radiografía Torácica/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Femenino , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Persona de Mediana Edad , Enfermedad Crítica , AncianoRESUMEN
The authors report a case of amyloidosis-induced macroglossia treated with surgical reduction of the tongue using a keyhole to inverted T method with particular emphasis on the postoperative sequelae. Significant tongue swelling persisted for longer than anticipated requiring tracheostomy to remain in situ for 14â days.
Asunto(s)
Amiloidosis/complicaciones , Macroglosia/cirugía , Femenino , Humanos , Macroglosia/etiología , Persona de Mediana Edad , Lengua/cirugíaRESUMEN
Over a 2-year period we reviewed patients who presented to a UK maxillofacial unit with facial injuries sustained at work. We looked at links between the mechanism, injury, and characteristics of such injuries.
Asunto(s)
Traumatismos Maxilofaciales/epidemiología , Traumatismos Ocupacionales/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Adulto , Factores de Edad , Inglaterra/epidemiología , Huesos Faciales/lesiones , Femenino , Servicios de Alimentación/estadística & datos numéricos , Humanos , Masculino , Mercadotecnía/estadística & datos numéricos , Ocupaciones/estadística & datos numéricos , Policia/estadística & datos numéricos , Estudios Retrospectivos , Factores Sexuales , Fracturas Craneales/epidemiología , Violencia/estadística & datos numéricos , Adulto JovenRESUMEN
The government changed the system of payment to general dental practitioners on 1 April 2005 from a fee/item to a banding system. The figures collected have shown that there has been a 62% increase in the number of patients who require admission for surgical treatment of spreading odontogenic infections compared with the 3-year period before this date.
Asunto(s)
Atención Odontológica/organización & administración , Infección Focal Dental/cirugía , Política de Salud , Admisión del Paciente/estadística & datos numéricos , Mecanismo de Reembolso , Odontología Estatal/organización & administración , Absceso/cirugía , Adulto , Factores de Edad , Niño , Contratos , Atención Odontológica/economía , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Londres , Masculino , Cuello/cirugía , Pautas de la Práctica en Odontología/estadística & datos numéricos , Estudios Retrospectivos , Factores Sexuales , Odontología Estatal/economíaRESUMEN
This unusual case of a facial injury caused by being shot with a diver's harpoon gun highlights the importance of good radiological assessment and careful planning before removal of the harpoon, and emphasises the need to control the barb.
Asunto(s)
Traumatismos Faciales/cirugía , Heridas Punzantes/cirugía , Adulto , Vértebras Cervicales/lesiones , Humanos , MasculinoRESUMEN
We report a case of a Maxillary sinus aspergilloma, which presented after 2 years of symptoms of chronic sinusitis. There was an isolatable triggering event of extrusion of an amalgam filling material into the sinus. This was a complication of surgical extraction of the upper right second molar by his general dental practitioner.