RESUMO
With the widespread use of the Internet, standard browsers are widely available in radiological and clinical departments. So far the limited speed of the Internet has made teleradiology via the Internet too slow for practical use, but many hospital LANs are now connected to the World Wide Web through high speed access. The new JavaScript technology has made it possible to view examinations with web browsers as simple images instead of sending the full examination data. The full data from the examination remains on the server in the radiology department. If changes in window, level, size, zoom factor etc. are required, corrections are made locally in the web browser with JavaScript, and a new simple image is sent from the server. Web browser technology is now offered by most PACS companies and a new de facto standard for image viewing is emerging.
Assuntos
Internet , Sistemas de Informação em Radiologia , Telerradiologia , Previsões , Humanos , Internet/instrumentação , Linguagens de Programação , Telerradiologia/métodosRESUMO
OBJECTIVE: To evaluate the diagnostic accuracy of clinical judgment and diagnostic ultrasonography (US) used routinely and to create a scoring system to aid diagnosis. DESIGN: Prospective, double-blind study. SETTING: University hospital, Denmark. SUBJECTS: 222 Consecutive patients suspected of having acute appendicitis admitted between 0800 and midnight from June 1990 to June 1992. INTERVENTIONS: 148 Patients (67%) underwent appendicectomy and the remaining 74 patients were observed. 193 Patients (87%) had a diagnostic US examination. 21 Predictive variables were collected prospectively to create a scoring system. MAIN OUTCOME MEASURES: Results of surgical pathological findings, clinical outcome (observed group), diagnostic US, and values of diagnostic score. RESULTS: The decision to operate was made by a junior surgeon solely on the clinical examination, which yielded a diagnostic accuracy of 76%, specificity of 58%, and negative appendicectomy rate of 36%. 193 Patients underwent diagnostic US conducted by the radiologist on call of whom 123 were operated on, 78 for histologically proven appendicitis. US had a diagnostic accuracy of 72%, sensitivity of 49%, and specificity of 88%. Of the 21 predictive factors for acute appendicitis 11 were significant (p < 0.05): total white cell count (WCC) (>10 x 10[9]/1), migration of pain to the right lower quadrant, gradual onset of pain, increasing intensity of pain, pain aggravated by movement, pain aggravated by coughing, anorexia, vomiting, indirect tenderness (Rovsing's sign), muscle spasm, and sex. These 11 predictors were assigned an appropriate weight, based on the likelihood ratio, and used to create a scoring system. The score performed poorly if it was used to separate patients for observation and those for appendicectomy. However, if the score was used with two cut-off points resulting in three test zones (low, intermediate, and high risk of having acute appendicitis), some diagnostic benefit was seen for those patients within the zones of high and low probability. CONCLUSION: The clinical judgment of a junior surgeon was disappointing, and diagnostic aids are desirable to reduce the negative appendicectomy rate. Diagnostic US performed poorly as a routine procedure. Application of an up to date scoring system might be of some help to patients with a high or low probability of acute appendicitis, but any conclusion about its clinical application cannot be drawn from this study.
Assuntos
Apendicite/diagnóstico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/diagnóstico por imagem , Criança , Pré-Escolar , Tomada de Decisões , Diagnóstico Diferencial , Erros de Diagnóstico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , UltrassonografiaRESUMO
From May to September 1991, 49 patients were examined by ultrasound (Picker CS 9000, 3.5 MHz curved array transducer) before and 30 minutes after drinking 150 ml of water. The volume of the gallbladder decreased significantly from a mean of 23.4 ml to 20.1 ml (p = 0.04). No significant change was found either between the visualisation of the gallbladder and bileducts (0.20 > p > 0.10) or the visualisation of the pancreas (0.40 > p > 0.30). However in 10 patients with cholelithiasis, the calculi were only seen in eight patients after drinking water. Thus, it must still be recommended that patients neither eat nor drink for four hours prior to an ultrasound examination of the gallbladder.
Assuntos
Ductos Biliares/diagnóstico por imagem , Ingestão de Líquidos , Jejum , Vesícula Biliar/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Método Duplo-Cego , Humanos , Estudos Prospectivos , UltrassonografiaRESUMO
Measurements of carpal bone angles on lateral wrist radiographs can be of assistance in the diagnostic evaluation of wrist malalignment. A series of 75 normal wrists was examined by use of a standardized radiographic technique. The normal carpal bone angles were determined using the bone axes with the least observer variability (mean and range): radiolunate, -1.02 (-10 to 12), radioscaphoid, 51.80 (35 to 65), and scapholunate, 50.77 (36 to 66). Normal mean values and ranges for intercarpal bone angles may be of assistance in the diagnostic evaluation of ligamentous injury to the wrist.
Assuntos
Ossos do Carpo/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Punho/diagnóstico por imagem , Adulto , Artrografia/instrumentação , Humanos , Valores de ReferênciaRESUMO
Determinations of carpal bone angles are used in the clinical evaluation of carpal malalignment. Eleven frequently referred radiological measures in lateral projection of the wrists in 23 wrists were assessed using different definitions of axes. Interobserver- and intraobserver variations were calculated. The standard deviation of the interobserver variation ranged from 2.60 degrees to 18.15 degrees, and the intraobserver variation from 1.89 degrees to 4.66 degrees depending on the angles measured. The use of three angles for the least observer variability in assessment of carpal alignment is recommended. These angles were defined from the following carpal bone axes: radius, the line through the center of the medullary canal at 2 cm and 5 cm proximal to the radiocarpal joint; lunate, the line perpendicular to the tangent of the two distal poles; scaphoid, the tangent of the palmar proximal and distal margins, and capitate, the tangent of the dorsal margin of the diaphysis of the third metacarpal bone (substitute axis).
Assuntos
Ossos do Carpo/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Punho/diagnóstico por imagem , Adulto , Humanos , Instabilidade Articular/epidemiologia , Variações Dependentes do Observador , RadiografiaRESUMO
The investigation consisted of a double-blind cross-over study of the effect of 75 mg indometacin, 500 mg naproxen or a placebo in 63 patients with rheumatoid arthritis accompanied by night pain and morning stiffness. All the patients received day treatment with 250 mg naproxen b.i.d. Only a few patients benefitted from the treatment at night and no differences in the effect of indometacin and naproxen were observed. Naproxen was better tolerated than indometacin. Day treatment with naproxen, which has a relatively long half life time decrease the need for supplementary treatment at night.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Indometacina/administração & dosagem , Naproxeno/administração & dosagem , Adolescente , Adulto , Idoso , Ritmo Circadiano , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A new, simple and quick method for assessment of impaired grip function was evaluated in a rheumatology department, 208 of 211 patients with definite rheumatoid arthritis were unable to do the test, 48 of these patients had regarded their hands as unaffected when questioned. The impairment of grip function was closely related to clinical and functional observations but not related to the most common laboratory tests. The study confirms the hypothesis that almost all patients with RA are unable to do the hand test, even those who consider their hand function as normal.
Assuntos
Artrite Reumatoide/fisiopatologia , Mãos/fisiopatologia , Reumatologia/métodos , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Feminino , Mãos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Sinovite/complicaçõesRESUMO
This paper describes a hand test consisting of three steps to test the subject's ability to grasp firmly another person's hand to hold a pencil firmly with fingers II-V with straight knuckles and maximally flexed finger joints, while the investigator pulls the pencil to hold on to a piece of paper with a rounded pinch grip between thumb and index finger while the investigator pulls the paper with a rounded pinch grip with submaximal strength. All three steps must be performed with each hand without causing pain. The test was an adequate parameter for the grip function, and at the same time could register work-load elicited pain, strength, and mobility. The test can be carried out by healthy subjects, but not by patients with rheumatoid arthritis. The test is logically constructed and has a high validity and reliability.
Assuntos
Artrite Reumatoide/diagnóstico , Mãos/fisiopatologia , Contração Muscular , Esforço Físico , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/fisiopatologiaRESUMO
A number of methods exist for determination of carpal bone angles on lateral wrist radiographs. However, there is no general or precise definition of the angles measured. In this study the positioning of the wrist is emphasized and a device used to obtain standardized radiographs is presented. An analysis of variance of two series of patients revealed no radiological difference between the contralateral wrists in the same person. We conclude that the asymptomatic wrist can be used as normal reference in the assessment of carpal bone angles in the pathological wrist and a difference between the carpal bone angles in the two wrists in the same person exceeding 5 degrees can be considered significant.
Assuntos
Radiografia/instrumentação , Punho/diagnóstico por imagem , Adulto , Fenômenos Biomecânicos , Ossos do Carpo/diagnóstico por imagem , Humanos , Masculino , Radiografia/métodosAssuntos
Mãos/fisiopatologia , Artropatias/diagnóstico , Adulto , Idoso , Feminino , Humanos , Artropatias/fisiopatologia , Masculino , Métodos , Pessoa de Meia-Idade , Contração MuscularRESUMO
Measurement of the aminoterminal type III procollagen peptide in serum has been suggested as a marker of the biosynthesis of collagen type III, a major connective tissue component in repair processes. In the present study the propeptide level correlated with the inflammatory synovial mass in rheumatoid arthritis and osteoarthritis. This implies that the propeptide level reflects the collagen type III synthesis occurring in the synovial repair processes, whether they were caused by inflammatory or degenerative rheumatic disorders. Physical activity did not enhance the transition of the propeptide from the synovial fluid or the inflamed synovial membrane to the blood. Normal serum propeptide values were observed in most patients with ankylosing spondylitis and degenerative diseases of the spine. This may reflect the lower amount of inflammatory tissue in these diseases and hence the sensitivity of the assays.
Assuntos
Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Doenças Reumáticas/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/sangue , Artrite Reumatoide/fisiopatologia , Fenômenos Químicos , Química , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Osteoartrite/sangue , Doenças Reumáticas/fisiopatologia , Doenças da Coluna Vertebral/sangue , Espondilite Anquilosante/sangueRESUMO
We studied families of 23 unrelated HLA-B27 positive probands with definite ankylosing spondylitis to investigate the occurrence of rheumatoid arthritis. The prevalence of RA among these relatives was significant higher (2.91%; 0.02 less than p less than 0.05) than in the control group of 28 healthy individuals (1.02%). These data suggest an increased relative risk of RA in relatives of patients with AS.
Assuntos
Artrite Reumatoide/genética , Espondilite Anquilosante/genética , Adulto , Feminino , Antígenos HLA , Antígeno HLA-B27 , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Espondilite Anquilosante/imunologiaRESUMO
A method to determine antikeratin antibodies (AKA) is described. AKA were detected by indirect immunofluorescence technique on rat esophagus as antigen in sera of patients with definite rheumatoid arthritis (RA). The frequency of AKA in rheumatoid factor (SCAT/Waaler-Rose) positive RA was 64% and in SCAT-negative RA, 28%. Of 61 control patients with non-RA rheumatic diseases, none was AKA-positive. Of healthy controls, 2.5% were AKA-positive. In serum from 88 definite RA patients, AKA were compared with precoded clinical features. A highly significant correlation to AKA was found with the presence of rheumatoid hand deformity. Some correlation to positive SCAT titre and s-Haptoglobin was observed. Our study suggests that determination of AKA will be of value in the diagnosis of RA, especially in rheumatoid factor negative cases and that the presence of AKA indicates a more aggressive form--or results of an aggressive course--of the disease.