Pulmonary embolism in patients with intermediate probability lung scans: diagnosis with Doppler venous US and D-dimer measurement.

PURPOSE: To test the usefulness of lower limb Doppler venous compression ultrasound (US) and serum D-dimer measurements in diagnosis of pulmonary embolism in patients in whom ventilation-perfusion (V-P) scans indicate intermediate probability of pulmonary embolism. MATERIALS AND METHODS: V-P scanning, pulmonary angiography, US, and D-dimer measurements were performed in 36 patients without known deep venous thrombosis but with intermediate probability of having a pulmonary embolism. RESULTS: Pulmonary angiography demonstrated pulmonary embolism in 15 (41%) of 36 patients. US demonstrated deep venous thrombosis in only two patients, both with pulmonary embolism. Sensitivity of US was only 13%, but specificity was 100%. Five (14%) of the 36 patients had normal (< 220 micrograms/L) D-dimer levels; none of the five had pulmonary embolism. Sensitivity and specificity of D-dimer values were 100% and 16%, respectively, with a negative predictive value of 100%. CONCLUSION: Combined D-dimer measurement and US were helpful in correctly diagnosing pulmonary embolism in only seven (20%) of 36 patients. Pulmonary angiography is still required to diagnose pulmonary embolism in the majority of patients.

Phlebotomine sandflies (Diptera: Psychodidae) from caves in Australia.

All three genera of phlebotomine sandflies recorded from the mainland of Australia are represented in collections from caves in Queensland. Phlebotomus (Australophlebotomus) mackerrasi Lewis and Dyce, Idiophlebotomus wellingsae (L. and D.) and Sergentomyia (Parrotomyia) trezkinni L. and D. achieve their biggest known populations in caves. Each has, however, been collected from outside environs. S. (P.) queenslandi (Hill) is most widespread and abundant across the continent and occurs less frequently in caves than in open situations where it is often associated with ground burrowing reptiles. Its occurrence in warmer caves may be linked with larger reptile predators of bats. S. (P.) curvata L. and D. is known as a single specimen from a cave. Hosts for the cave dominants are unknown but the regular concurrence with bats may be indicative. Immature stages of S. trezkinni and S. queenslandi have been recovered from isolated pellets of bat faeces and adults link reared. None of the species has been reared from mass accumulation of bat guano, and none of the species shows special adaptation for life in caves.

The significance of discrepant Farr and Crithidia luciliae tests.

The most specific serological test for systemic lupus erythematosus (SLE) is the detection of anti-dsDNA antibodies by the Farr or Crithidia luciliae (CL) assay. Serological interpretation is difficult when these assays give discrepant results (i.e., one is positive and the other negative). In the present study 34 patients with discrepant results (18 CL positive Farr negative; 16 CL negative Farr positive) were reviewed to determine whether they fulfilled ARA criteria for SLE at presentation or at follow up 1-50 months (mean 15.8 months) later. Only 2 patients had SLE, both of whom fulfilled ARA criteria at presentation. Discrepant CL and Farr assays are associated with SLE uncommonly and rarely precede the development of clinical lupus.