Imaging findings of iatrogenic pharyngeal and esophageal injuries in neonates.

Iatrogenic injuries to the upper gastrointestinal tract in neonates are rare but may lead to significant morbidity and mortality if undiagnosed. The clinical presentation of such injuries is usually nonspecific and symptoms may be overlooked, particularly in sick preterm neonates. Therefore, it is important to recognize the findings on plain chest radiographs obtained regularly in neonatal intensive care units (NICUs) on intubated patients. The purpose of this pictorial essay is to describe the imaging findings of various iatrogenic injuries to the pharynx and esophagus in the neonatal period in a cohort of seven cases.

Prevalence and impact of health-related internet and smartphone use among dermatology patients.

Health information is increasingly accessible via the Internet and smartphone applications (apps), and patients may perceive these resources as tools for self-education and/or self-diagnosis. The objective of this study was to assess the characteristics of dermatology patients who use the Internet and/or smartphone apps to access health information and to evaluate the impact that these resources have on patients' health care-seeking behavior and interactions with physicians. Online resources offer both opportunities and challenges for dermatologists. Because patients often consult online resources for information about dermatologic conditions and may rely on these resources instead of seeking the care of a dermatologist, it is important for dermatologists to be involved in the development of high-quality online content that educates the public while also emphasizing the need to seek in-person medical care.

Diagnostic inaccuracy of smartphone applications for melanoma detection.

OBJECTIVE: To measure the performance of smartphone applications that evaluate photographs of skin lesions and provide the user with feedback about the likelihood of malignancy. DESIGN: Case-control diagnostic accuracy study. SETTING: Academic dermatology department. PARTICIPANTS AND MATERIALS: Digital clinical images of pigmented cutaneous lesions (60 melanoma and 128 benign control lesions) with a histologic diagnosis rendered by a board-certified dermatopathologist, obtained before biopsy from patients undergoing lesion removal as a part of routine care. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of 4 smartphone applications designed to aid nonclinician users in determining whether their skin lesion is benign or malignant. RESULTS: Sensitivity of the 4 tested applications ranged from 6.8% to 98.1%; specificity, 30.4% to 93.7%; positive predictive value, 33.3% to 42.1%; and negative predictive value, 65.4% to 97.0%. The highest sensitivity for melanoma diagnosis was observed for an application that sends the image directly to a board-certified dermatologist for analysis; the lowest, for applications that use automated algorithms to analyze images. CONCLUSIONS: The performance of smartphone applications in assessing melanoma risk is highly variable, and 3 of 4 smartphone applications incorrectly classified 30% or more of melanomas as unconcerning. Reliance on these applications, which are not subject to regulatory oversight, in lieu of medical consultation can delay the diagnosis of melanoma and harm users.