An X-ray template assessment for distal radial fractures.

BACKGROUND: The current method for radiological measurements on plain X-rays of distal radius fractures is unreliable. We examined the reproducibility of a new X-ray assessment technique-where the uninjured side is used as a template for the injured side-compared to the conventional assessment technique. METHODS: X-rays of 30 patients with a unilateral distal radial fracture were included reflecting the prevalence of AO fracture types in clinical practice. Eight experienced observers assessed these X-rays on two separated occasions (2-month interval) using the traditional measurement technique and the template technique. Reproducibility of the X-ray assessments was quantified by intraclass correlations and weighted kappa coefficients. RESULTS: The reproducibility of the radial length measurement did not improve nor did the volar angulation measurement. However, marked improvement in reproducibility was observed for the radial inclination measurement, the kappa increased from 0.36 (95 % CI; 0.30-0.41) to 0.49 (95 % CI; 0.43-0.55) in the template technique. As a result, the classification of the reduction results (Lidström score) greatly improved. The overall kappa for the Lidström score improved from 0.37 (95 % CI; 0.31/0.43) to 0.59 (0.52/0.63). CONCLUSION: The assessment technique using the uninjured side as a template for the injured side resulted only in an improved reproducibility of the radial inclination measurement which in turn resulted in an improved classification reproducibility of the reduction results.

[Results of 25-year pheochromocytoma treatment in the Groningen Academic Hospital]. / Resultaten van 25 jaar feochromocytoombehandeling in het Academisch Ziekenhuis Groningen.

OBJECTIVE: To evaluate 25 years' experience with the localisation techniques, operative management and results of treatment for phaeochromocytoma. DESIGN: Retrospective SETTING: Groningen University Hospital, the Netherlands. METHOD: Localisation results, per- and postoperative morbidity, mortality and treatment results were evaluated in all 59 patients treated for phaeochromocytoma in the period 1970-1995; 41 patients underwent unilateral adrenalectomy, 18 underwent bilateral adrenalectomy. RESULTS: From the introduction of MIBG scintigraphy all tumour sites were correctly diagnosed preoperatively. The transabdominal operation lead to considerable morbidity and minimal mortality. All MEN type 2 patients (n = 5) treated with unilateral adrenalectomy developed phaeochromocytoma in the contralateral gland and needed total adrenalectomy 7 to 14 years after the initial operation. CONCLUSION: A retroperitoneal approach in surgical treatment of phaeochromocytoma is to be preferred. In MEN type 2 patients bilateral adrenalectomy is still mandatory.