Reliability of frontal chest x-ray in diagnosing pulmonary opacities in children.

RATIONALE AND OBJECTIVES: The World Health Organization recommends that the routine investigation of children with suspected pneumonia should not include lateral chest x-rays. However, the reliability of the frontal view alone in the diagnosis of pulmonary opacities has not been reported. METHODS: The authors studied prospectively 373 consecutive chest x-rays of children, ranging in age from 0 to 17 years, who were examined for suspected pneumonia. One radiologist interpreted the frontal view, and the diagnoses were compared with those of three radiologists who interpreted both frontal and lateral x-rays. RESULTS: William's index for rater reliability was 0.98 for all ages (95% confidence interval: 0.94, 1.00). Thus, a radiologist using only a frontal view would agree with members of an independent group using both frontal and lateral views as often as an isolated member of that group would agree with the other group members. CONCLUSIONS: Detecting a definite pulmonary opacity on the frontal view alone predicts its presence on frontal-lateral views. However, the interpretation of bronchial thickening and peribronchial alveolar confluences as opacities is a problem remaining on either frontal or frontal-lateral views.

Temporal intermittent rhythmic delta activity (TIRDA) in the diagnosis of complex partial epilepsy: sensitivity, specificity and predictive value.

Temporal interictal rhythmic delta activity or TIRDA was found in 45 of the 127 recordings of patients with complex partial epilepsy (CPE) referred for both awake and sleep EEG. TIRDA was more abundant during drowsiness and light sleep; it occurred more characteristically as trains of 50-100 microv sinusoidal or saw-toothed 1-4Hz activity, recorded predominantly from anterior temporal regions. When occurring bilaterally and independently, TIRDA varied from side to side. TIRDA is often found in association with anterior temporal spikes or sharp waves (TS) particularly during sleep, as observed in 43 out of 45 EEGs. TIRDA can nevertheless occur as an isolated abnormality, as noted in two sleep and 12 awake study recordings. Because of its high specificity and positive predictive value over a large range of prevalence, TIRDA should be singled out as an accurate interictal indicator of CPE. In patients with isolated TIRDA, the cost of prolonged EEG recording during sleep for the purpose of activating TS has to be weighed against the yield of eventually confirming the obvious.

Correlates of suicidal ideation in French-Canadian adolescents: personal variables, stress, and social support.

Two hundred seventy-two French-Canadian adolescent males and 286 females participated in a study of the relationship between suicidal ideation and selected personal variables, stress, and social support. Results of multivariate analyses indicated that suicidal ideation was positively related to depression, negative stress, and drug and alcohol use, and negatively related to self-esteem, satisfaction with social support, and school absenteeism.

Parent-child relationships and suicidal ideation in French-Canadian adolescents.

French-Canadian adolescent boys (n = 272) and girls (n = 286) participated in a study of the relationship between suicide ideation and selected familial variables. Results of a multivariate analysis indicate that suicide ideation in adolescent boys and girls is related to a parental child-rearing regime that is characterized by control and a lack of sufficient maternal and paternal social support.

Correlates of anomie in French-Canadian adolescents.

French-Canadian adolescent boys (n = 272) and girls (n = 286) participated in a study of the relationship between anomie and selected personal variables. Results of a multivariate regression analysis indicate that adolescents who suffered from anomie tended to be younger boys and girls with low self-esteem who believed that they were subject to chance or fate and who had experienced a number of recent negative life events.

Parental control in child rearing and multidimensional locus of control.

272 French-Canadian adolescent boys and 286 girls took part in a study of the association between parental control in child-rearing and Levenson's locus of control dimensions. Analysis showed relations between parental control and the two external dimensions but not with the internal one. Age and gender did not contribute to the various relationships.

Parental control and anomie in French-Canadian adolescents.

110 French-Canadian adolescents (60 boys, 50 girls) participated in a study of the relationship between parental control in child-rearing and anomie. Correlational analysis indicated that subjects coming from family backgrounds high in parental control generally reported greater feelings of anomie.

Retrospective inventory of EEG abnormalities in partial status epilepticus.

In this retrospective study, EEG activity in partial status epilepticus (PSE) was classified into different patterns from analysis of both ictal and interictal discharges. In 64 patients with recorded PSE, continuous seizures and closely spaced seizures interrupted by only brief flat periods were uncommon. PLEDs, defined as classic periodic lateralized epileptiform discharges, and PLEDs Plus, defined as PLEDs associated with stereotyped low amplitude, were the most common abnormalities. PLEDs and PLEDs Plus can each occur alone or sequentially (sequential PLEDs) between consecutive seizures. The quantity of ictal activity was significantly lower with PLEDs, sporadic spikes and with the absence of epileptiform abnormalities than with PLEDs Plus and sequential PLEDs. EEG monitoring is important to gauge the effectiveness of treatment, particularly in patients with patterns associated with a high incidence of seizure activity, namely continuous seizures with or without flat periods, sequential PLEDs and PLEDs Plus. From serial recordings, a sequence was reconstructed which may be relied upon to further assess the need for additional energetic therapeutic measures. The reconstructed sequence differed in patients with chronic lesions since sequential PLEDs and PLEDs Plus were identified exclusively in patients with acute or subacute lesions.

The reliability of routine pathologic diagnosis of colorectal adenocarcinoma.

The diagnosis of colorectal adenocarcinoma is generally considered as being reliable. However, the reproducibility of the classification of specific histologic patterns and the interrater agreement on the gradings have not been firmly established. A panel of three independent expert pathologists reviewed histologic sections from 128 patients selected among 1848 with colorectal cancer, diagnosed in 11 hospitals of the same region. The panel agreed with 92.6% of the original diagnoses of colorectal adenocarcinoma. As for agreement between panel members, the kappa value was 0.78 for the diagnosis of adenocarcinoma and 0.62 for confirmation of colorectal origin. The intraclass correlation coefficient for tumor differentiation features was 0.75. The proportion of villous and adenomatous components also generated good agreement. However, the grading of mucin secretion showed poor agreement (intraclass correlation coefficient = 0.44). Results confirm the reliability of routine pathological diagnosis and also demonstrate the reproducibility of basic diagnostic categories and pathognomonic features. Thus, to obtain reliable information from medical records for epidemiologic and clinical studies, data should be limited to well-defined diagnostic and histopathologic categories.

Suicidal ideation in high school students: depression and other correlates.

English-Canadian high school students (129 boys, 117 girls) participated in a study of the relationship between suicidal ideation and selected personal variables, stress, and social support. Associations were found between suicidal ideation and the variables of gender, self-esteem, locus of control, depression, drug use, stress, perception of health, family status, academic performance, social support, and anomie. Multiple regression analysis identified depression and alcohol use as best individual predictors among these variables. Semi-partial correlation analyses showed that removal of the effect of depression resulted in a loss of initially significant relationships between suicidal ideation and the other variables except for alcohol use, drug use, and health satisfaction.

Partial status epilepticus: short-term prediction of seizure outcome from on-line EEG analysis.

Several combinations of ictal and interictal EEG abnormalities have previously been identified in partial status epilepticus (PSE). Some are associated with a consistently higher seizure index than others. On-line analysis of the initial segments of the EEG monitoring and familiarization with seizure indices corresponding to each combination may provide useful clues to rapidly foretell short-term seizure recurrence in patients with PSE. Referring to matrices reconstructed from an analysis of the initial min of the monitoring in 64 patients with recorded PSE can help to identify quickly those patterns which are most often associated with the highest probability of relapsing seizures. Awareness of the probability range of recording additional seizures observed with each of these various patterns may provide guidelines for judicious patient enrollment and for meaningful assessment of results in prospective studies of treatment efficacy in PSE.

Do symptoms and initial clinical probability predict the radiological diagnosis of acute sinusitis in children?

OBJECTIVE: To evaluate the value of signs and symptoms in children for the radiological diagnosis of acute sinusitis. DESIGN: Prospective cohort study. SETTING: University-affiliated tertiary care hospital. PATIENTS: All children presenting with symptoms suggestive of acute sinusitis for whom sinus radiographs were ordered. METHODS: Data were collected on the presence of specific symptoms and the initial probability of sinusitis. Criterion-based radiological diagnoses were made. RESULTS: Three hundred ninety-two consecutive children were seen; 257 children had a radiological diagnosis of acute sinusitis (66%), 128 patients (33%) presented with complete opacity of at least one sinus and 14 (4%) children had an air-fluid level. Sensitivity, specificity, predictive values and likelihood ratios were measured for clinical findings. Classical symptoms (rhinorrhea lasting more than 10 days and purulent rhinorrhea) increased the likelihood ratios the most (1.3 and 1.34, respectively). Logistic regression showed two independent predictors: purulent rhinorrhea (odds ratio 2.0) and the presence of acute otitis media (odds ratio 2.6). The initial clinical probability was more accurate than any other single finding: high probability (likelihood ratio 2.0), intermediate probability (likelihood ratio 1.1) and low probability (likelihood ratio 0.6). CONCLUSION: Classical symptoms are predictive of the presence of acute sinusitis as diagnosed on sinus radiographs. The physician's overall clinical impression, expressed as an initial probability, was superior to any single historical or examination finding in the diagnosis of acute sinusitis.

Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures.

Low amplitude rhythmic discharges (RDs) closely associated in time and in spatial distribution to inter-ictal epileptiform discharges are not seen in scalp EEGs of patients with non-periodic focal epileptiform discharges (NPEDs) but they are unexpectedly common in patients with periodic lateralized epileptiform discharges (PLEDs). A classification of PLEDs into PLEDs Proper (PLEDs without RDs), and PLEDs Plus (PLEDs with RDs) is proposed. Such a classification is useful for an easier appreciation of PLEDs' pleomorphism. It underscores the changing periodicity of PLEDs and allows for a more inclusive definition of the phenomenon than the one reported by the literature. It also emphasizes the importance of recognizing RDs in scalp EEGs as transitional anomalies intercalated between inter-ictal PLEDs and ictal seizure discharges, analogous to those observed by Ralston in animal models. Indeed, the occurrence of recorded seizures is higher in patients with PLEDs Plus than in those with PLEDs Proper or NPEDs.

Correlates of suicide ideation in French-Canadian adults and adolescents: a comparison.

Five hundred fifty-eight French-Canadian adolescents and 150 adults served as subjects in a study that compared correlates of suicide ideation. Results of multivariate analyses indicated that suicide ideation in adolescents is related positively to depression and negative stress and negatively to self-esteem and satisfaction with social support. Adult ideation was found to be related negatively to self-esteem and positively to negative life experiences.