RESUMEN
OBJECTIVES: To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctor's degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. DESIGN: A three-year prospective study was conducted between September 2011 and December 2014. SETTING: Two primary care settings in Linköping, Sweden. SUBJECTS: A total of 103 adult patients with suspected pneumonia in primary care. MAIN OUTCOME MEASURES: The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. RESULTS: Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p < 0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP) ≥ 50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p < 0.001). CONCLUSION: This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on one's judgement without ordering CXR. KEY POINTS: There are different guidelines but no consensus on how to manage community-acquired pneumonia in primary care. When the physician is sure of the diagnosis the judgement is reliable without chest X-ray and antibiotics can be safely prescribed. Chest X-ray can be useful in the assessment of pneumonia in primary care, when the physician is not sure of the diagnosis.
Asunto(s)
Proteína C-Reactiva/metabolismo , Toma de Decisiones Clínicas/métodos , Infecciones Comunitarias Adquiridas/diagnóstico , Neumonía/diagnóstico , Atención Primaria de Salud , Radiografía Torácica/métodos , Antibacterianos/uso terapéutico , Competencia Clínica , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Femenino , Humanos , Juicio , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico por imagen , Estudios Prospectivos , Suecia , IncertidumbreRESUMEN
Contrast media (CM) are reported to possess both prothrombotic and anticoagulant properties. The mechanisms are not clearly understood, and early reports are contradictory. To study the effects of CM on haemostasis, we analysed the ex vivo effects of ioversol and iodixanol on platelet adhesion and P-selectin expression, and the in vitro effects of ioversol, iodixanol and ioxaglate on platelet adhesion, P-selectin expression and plasma coagulation. A novel enzymatic assay was used to measure platelet adhesion to protein surfaces, and an enzyme-linked immunosorbent assay was used to measure platelet P-selectin surface expression. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were used to measure plasma coagulation. The ex vivo study consisted of blood from 27 outpatients administered ioversol and 9 patients administered iodixanol intravenously. Samples were collected before and 5 min after CM administration. Healthy donors were used for the in vitro studies on the effects of CM. The ex vivo study showed significantly (p<0.05) decreased platelet adhesion and P-selectin expression after administration of ioversol and iodixanol. Adhesion was more affected than P-selectin expression. The in vitro study showed that ioversol, iodixanol and ioxaglate significantly (p<0.05) and dose-dependently (beginning at 3 mg ml(-1)) decreased platelet adhesion and P-selectin expression. APTT and PT were significantly (p<0.01) prolonged at concentrations of 10 mg ml(-1) and 30 mg ml(-1), respectively. In conclusion, ioversol, iodixanol and ioxaglate inhibit platelet adhesion and P-selectin expression, as well as plasma coagulation. Platelets are more sensitive in relation to the inhibiting effect on plasma coagulation.
Asunto(s)
Coagulación Sanguínea/efectos de los fármacos , Medios de Contraste/farmacología , Selectina-P/metabolismo , Adhesividad Plaquetaria/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Pruebas de Enzimas , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Técnicas In Vitro , Ácido Yoxáglico/farmacología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Ácidos Triyodobenzoicos/farmacologíaAsunto(s)
Aneurisma/etiología , Arteria Braquial , Enfermedad Iatrogénica/etiología , Punciones/efectos adversos , Diálisis Renal , Aneurisma/diagnóstico por imagen , Arteria Braquial/diagnóstico por imagen , Humanos , Enfermedad Iatrogénica/diagnóstico por imagen , Masculino , Persona de Mediana Edad , RadiografíaAsunto(s)
Premio Nobel , Radiografía/historia , Alemania , Mano/diagnóstico por imagen , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Suiza , Rayos XAsunto(s)
Angiografía Coronaria/efectos adversos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , SueciaAsunto(s)
Quemaduras Químicas/etiología , Trastornos de Deglución/etiología , Estenosis Esofágica/inducido químicamente , Comprimidos/efectos adversos , Anciano , Trastornos de Deglución/diagnóstico por imagen , Estenosis Esofágica/diagnóstico por imagen , Femenino , Humanos , Masculino , RadiografíaAsunto(s)
Aneurisma Falso/etiología , Endocarditis Bacteriana/complicaciones , Rotura Cardíaca/etiología , Ventrículos Cardíacos , Infecciones Estafilocócicas/complicaciones , Adulto , Aneurisma Falso/diagnóstico , Aneurisma Falso/cirugía , Antibacterianos/uso terapéutico , Ecocardiografía Doppler , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Femenino , Rotura Cardíaca/diagnóstico , Rotura Cardíaca/cirugía , Ventrículos Cardíacos/lesiones , Ventrículos Cardíacos/cirugía , Humanos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológicoAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Enfermedad Coronaria/terapia , Revascularización Miocárdica , Anciano , Angina de Pecho/diagnóstico , Angina de Pecho/cirugía , Angina de Pecho/terapia , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/métodos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/cirugía , Infarto del Miocardio/terapia , Revascularización Miocárdica/efectos adversos , Revascularización Miocárdica/métodos , Complicaciones Posoperatorias/diagnóstico , Pronóstico , Estudios Prospectivos , RecurrenciaAsunto(s)
Angioplastia Coronaria con Balón/estadística & datos numéricos , Procedimientos Quirúrgicos Cardiovasculares/estadística & datos numéricos , Enfermedad Coronaria/cirugía , Angioplastia Coronaria con Balón/normas , Procedimientos Quirúrgicos Cardiovasculares/normas , Servicios Centralizados de Hospital/organización & administración , Servicios Centralizados de Hospital/normas , Servicios Centralizados de Hospital/estadística & datos numéricos , Competencia Clínica , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/diagnóstico por imagen , Necesidades y Demandas de Servicios de Salud , Humanos , Garantía de la Calidad de Atención de Salud , Suecia , Procedimientos Quirúrgicos Torácicos/normas , Procedimientos Quirúrgicos Torácicos/estadística & datos numéricosRESUMEN
This study investigates relationships between platelet reactivity and coronary blood flow obstruction in stable angina pectoris. Consented were 36 patients with single-vessel disease. The subjects were divided into two groups. One group (n=14) had less severe (<=80%) and the second group (n=22) had severe coronary flow impairment (90%). Before elective coronary angiography platelet in vitro reactivity in venous whole blood was determined using a flow cytometry technique. A thrombin-receptor activating peptide (TRAP-6) (0.77 and 0.06 g/l) and ADP (8.5 and 1.7 micromol/l) were used to activate platelets. The number of fibrinogen positive cells (%) i.e., activated platelets after stimulation was employed as experimental parameter. Less severe flow obstruction was associated with more reactive platelets. When stimulating with 0.77 g/l TRAP-6 the number of activated platelets was 64+/-15 (SD)%. The corresponding value for the group with severe flow obstruction was 40+/-17(SD)%. The difference is significant (P<0.001). 0.06 g/l TRAP-6 yielded similar results (P<0.01). Also when using 8.5 micromol/l ADP to challenge platelets less severe flow obstruction was associated with enhanced reactivity (P<0.01). 1.7 micromol/l ADP generated comparable results (P<0.05). Thus, in stable angina pectoris coronary flow obstruction is inversely related to platelet reactivity.
Asunto(s)
Angina de Pecho/sangre , Enfermedad Coronaria/sangre , Activación Plaquetaria , Adenosina Difosfato/farmacología , Anciano , Angina de Pecho/diagnóstico , Circulación Coronaria , Enfermedad Coronaria/diagnóstico , Femenino , Fibrinógeno/análisis , Citometría de Flujo , Humanos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/farmacologíaRESUMEN
The ligaments of the proximal row of carpal bones and the triangular fibrocartilage (TFC) strongly influence the function and stability of the wrist. Injury to the ligaments may result in chronic wrist pain or instability. Wrist arthrography is valuable in the investigation of such damage when surgical intervention is considered and plain radiography is unrewarding. There are also several technical modifications of the standard radiocarpal arthrography available. Owing to the possibility of congenital perforations and degenerative changes in these ligaments the arthrographic findings should be related to the clinical signs and the age of the patient. CT has less diagnostic importance in this respect while MR imaging is an alternative and may become the method of choice. Both these methods have great potential in the evaluation of soft tissues of the wrist other than the TFC.
Asunto(s)
Artrografía/métodos , Articulación de la Muñeca/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Humanos , Traumatismos de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/anatomía & histologíaRESUMEN
Evaluation of pacemaker wires were performed by comparing Advanced Multiple Beam Equalization Radiography (AMBER) with conventional chest radiography. The scanning equalization technique of the AMBER unit makes it superior to conventional technique in the depiction of different structures in the mediastinum or in the pleural sinuses. So far motion artifacts have not been considered clinically important. The longer exposure time, however, may impair the assessment of pacemaker wires. The motion artifact described may not only make adequate evaluation impossible but may even give a false impression of a lead fracture. The difference between the two systems was significant.
Asunto(s)
Corazón/diagnóstico por imagen , Marcapaso Artificial , Radiografía Torácica/métodos , Artefactos , Humanos , Intensificación de Imagen RadiográficaRESUMEN
Coronary angiography is in general regarded as a safe investigation with a low risk of serious complications. Unfortunately, a risk of serious complications exists, especially in patients with left main coronary artery disease or 3-vessel disease. The mortality rate ranges in different studies between 0.10% to 0.25%. The present series, reflecting nine years experience, shows an overall mortality of 0.16%. This figure is influenced by the relatively high mortality rate in the first year of the study. The recent mortality rate of 0.07% has not changed in the last 3 years and almost all deaths occurred in the patients known to be at higher risk.
Asunto(s)
Angiografía Coronaria/mortalidad , Enfermedad Coronaria/diagnóstico por imagen , Anciano , Angiografía Coronaria/efectos adversos , Enfermedad Coronaria/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Suecia/epidemiologíaRESUMEN
PURPOSE: To prospectively register fluoroscopic and cine times in a random fashion, and to measure patient radiation exposure from routine coronary angiography and coronary balloon angioplasty. We also evaluated an optional dose reduction system used during interventions. MATERIAL AND METHODS: The incident radiation to the patient was measured as kerma area product (KAP) in Gycm(2), obtained from an ionisation chamber mounted on the undercouch tube during 65 coronary angiography procedures and another 53 percutaneous transluminal coronary angioplasties (including 29 stent procedures), mostly directly following complete coronary angiography. RESULTS AND CONCLUSION: The values from coronary angiography were comparable to other reports with a mean fluoroscopic time of 4.4 min and a mean KAP value of 62.6 Gycm(2). The corresponding figures from coronary balloon angioplasty without stenting were lower than otherwise reported, with 8.2 min and 47.9 Gycm(2), respectively. The use of coronary stents did prolong the mean fluoroscopic time (10.5 min) but did not significantly enhance the patient mean radiation dose (51.4 Gycm(2)). The dose reduction technique resulted in a significant KAP value reduction of 57%. In conclusion, with regard to radiation exposure, coronary angiography and balloon angioplasty are considered safe procedures.