顺逆旋转及顺逆旋转延伸加压超声扫查法结合Alvarado评分对急性阑尾炎的诊断价值

目的探讨顺逆旋转及顺逆旋转延伸加压超声扫查法结合Alvarado评分对急性阑尾炎的辅助诊断价值。方法参照Alvarado评分（简称“评分”）,对我院超声科在2011年1～5月由急诊科医师拟诊为“急性阑尾炎”采用顺逆旋转及顺逆旋转延伸加压超声检查法的205例患者进行前瞻性分析。结果在本次研究拟诊为“急性阑尾炎”的205例中,有67例通过术后病理诊断确诊为阑尾炎,超声检查结合评分的准确率约为95．6％,灵敏度约为93．1％,特异性约为97．O％,阳性预测值94．4％,阴性预测值96．3％,关联系数为0．67,阴性阑尾切除率为5．97％。超声结合评分对急性阑尾炎的诊断结果如下：0～4分准确率为99．O％,灵敏度为91．7％,特异性为100％;5-6分准确率为88．6％,灵敏度为85．7％,特异性91.7％;7-8分准确率约为94．1％,灵敏度为97．1％,特异性为88．2％;9～10占准确率为100．O％,灵敏度为100．0％,特异性为100．0％。使用Pearsonx。检验,对顺逆旋转及顺逆旋转延伸加压超声扫查法结合Alvarado评分与临床最终诊断的关联性进行分析,其与临床最终诊断相关联,差异有统计学意义（x^2=167．31,P〈0．05）。结论顺逆旋转及顺逆旋转延伸加压超声扫查法结合Alvarado评分对急性阑尾炎的辅助诊断有一定的价值。     

改良头位分娩评分法在头位难产中应用研究

目的:探讨改良头位分娩评分法用于识别初产妇头位难产的可行性和临床价值。方法:对420例足月分娩初产妇应用改良头位分娩评分法进行适时评分,采取相应措施,选择正确分娩方式进行分娩。结果:420例孕妇中经阴道分娩为313例(74.5%),剖宫产的为107例(25.5%);新生儿窒息的发生率为5.2%(22/420);其中改良评分在80分以上的产妇经阴道分娩率为95.7%(267/279),剖宫产率为4.3%(12/279),评分在80分以下的产妇经阴道分娩率为67.4%(95/141),剖宫产率为32.6%(46/141),两者间比较,差异具统计学意义(P<0.05)。结论:改良头位分娩评分可及时地、准确地判断头位难产,便于医生作出正确选择,减少新生儿窒息的发生。     

M-POSSUM评分预测老年胃肠道肿瘤患者手术风险的临床意义

目的:应用M-POSSUM评分对老年胃肠道肿瘤患者手术风险进行评估,以评价该评分的临床有效性,同时对多个手术风险的单因素进行分析,为临床治疗决策提供参考。方法:对250例手术的老年胃肠道肿瘤手术患者进行M-POSSUM评分,同时统计术后实际并发症和死亡率,并与评分预测值进行比较,就有可能产生并发症和死亡的多个单因素进行比较分析。结果:M-POSSUM评分预测并发症和死亡率分别为36.7%和7.8%,与实际并发症(32.4%)和死亡率(5.6%)较为接近;单因素分析比较显示6个单因素与并发症的产生有关联,2个单因素与患者死亡有关联。结论:M-POSSUM评分系统可以较好地预测老年胃肠道肿瘤患者术后并发症和死亡率;6个手术风险的单因素应引起临床医师的高度重视。     

Programming InterStim™ for faecal incontinence

Objective  Sacral nerve stimulation (SNS) for faecal incontinence (FI) is achieved by implanting a pulse generator attached to a tined lead with individually programmable electrodes. Our aim was to establish whether the 'ideal' programme for the treatment of FI has been used most commonly. We also wished to determine whether re-programming changed the symptom severity scores.
Method  The following data were extracted from our SNS patient database: the frequency with which each programme was used, the length of time it was effective for, the number of months from implantation that the programme was started and the symptom severity scores prior to a change or no change in programme.
Results  Thirty-eight patients have had implanted pulse generators inserted since 2004. One hundred and two programme changes were documented in the database. The 'ideal' programme was not most commonly programmed. The common programmes were effective for longest. The electrode furthest from the tip was used in the initial programme only once and the median duration from implantation to the start of a programme including it is 13 months. Symptom severity scores were significantly higher in patients who required re-programming than in those whose programme remained unchanged.
Conclusions  In our patients the 'ideal' programme was not the programme used most frequently, nor for the longest duration. The theoretical migration of the tined lead inwards with time is upheld by our results. Patients who feel the sensation of SNS perianally have lower symptom scores than those who do not and who require re-programming.     

The accuracy of 1- and 3-mm slices in coronary calcium scoring using multi-slice CT in vitro and in vivo

The accuracy of coronary calcium scoring using 16-row MSCT comparing 1- and 3-mm slices was assessed. A thorax phantom with calcium cylinder inserts was scanned applying a non-enhanced retrospectively ECG-gated examination protocol: collimation 12×0.75 mm; 120 kV; 133 mAs_eff. Thirty-eight patients were examined using the same scan protocol. Image reconstruction was performed with an effective slice thickness of 3 and 1 mm. The volume score, calcium mass and Agatston score were determined. Image noise was measured in both studies. The volume score and calcium mass varied less than the Agatston score. The overall measured calcium mass compared to the actual calcium mass revealed a relative difference of +2.0% for 1-mm slices and −1.2% for 3-mm slices. Due to increased image noise in thinner slices in the patient study (26.1 HU), overall calcium scoring with a scoring threshold of 130 HU was not feasible. Interlesion comparison showed significantly higher scoring results for thinner slices (all P<0.001). A similar accuracy comparing calcium scoring results of 1- and 3-mm slices was shown in the phantom study; therefore, the potentially necessary increase of the patient's dose in order to achieve assessable 1-mm slices with an acceptable image-to-noise-ratio appears not to be justified. The study was supported by a “START” grant from the University Hospital of Aachen, Germany.     

Evaluation of the influence of acquisition and reconstruction parameters for 16-row multidetector CT on coronary calcium scoring using a stationary and dynamic cardiac phantom

A calcium-scoring phantom with hydroxyapatite-filled cylindrical holes (0.5 to 4 mm) was used. High-resolution scans were performed for an accuracy baseline. The phantom was mounted to a moving heart phantom. Non-moving data with the implementation of an ECG-signal were acquired for different pitches (0.2/0.3), heart rates (60/80/95 bpm) and collimations (16 × 0.75/16 × 1.5 mm). Images were reconstructed with a cone-beam multi-cycle algorithm at a standard thickness/increment of 3 mm/1.5 mm and the thinnest possible thickness (0.8/0.4 and 2/1). Subsequently, ECG-gated moving calcium-scoring phantom data were acquired. The calcium volume and Agatston score were measured. The temporal resolution and reconstruction cycles were calculated. High-resolution scans determine the calcium volume with a high accuracy (mean overestimation, 0.8%). In the non-moving measurements, the volume underestimation ranged from about 6% (16 × 0.75 mm; 0.8/0.4 mm) to nearly 25% (16 × 1.5 mm; 3/1.5 mm). Moving scans showed increased measurement errors depending on the reconstructed RR interval, collimation, pitch, heart rate and gantry rotation time. Also, a correlation with the temporal resolution could be found. The reliability of calcium-scoring results can be improved with the use of a narrower collimation, a lower pitch and the reconstruction of thinner images, resulting in higher patient doses. The choice of the correct cardiac phase within the RR interval is essential to minimize measurement errors.     

Trauma patients in the intensive care unit: short- and long-term survival and predictors of 30-day mortality

BACKGROUND: The aims of this cohort study were to assess the survival of trauma patients treated in a general intensive care unit (ICU) and to evaluate the simplified acute physiology score (SAPS) II, maximum sequential organ failure assessment (SOFA) score, injury severity score (ISS), age, sex and severe head injury as predictors of 30-day mortality. METHODS: Three hundred and twenty-five adult patients admitted during 1998-2003 were evaluated retrospectively with update of survival data in January 2005. Kaplan-Meier statistics and Cox proportional hazards regression were used to study survival and to assess predictors of mortality, respectively. RESULTS: The 30-day mortality was 16.9%, ICU mortality 13.8% and hospital mortality 17.8%. Long-term survival (observation time, 1-7 years) was 77.8%. After 3.5 years, mortality was the same as for the background population. Severe head injury was the main cause of death and increased the risk of 30-day mortality 2.4-fold. In addition, SAPS II and an age above 50 years proved to be significant predictors of mortality in a multivariate analysis. Sex was not associated with mortality, and ISS and the maximum SOFA score were significant predictors in univariate analyses only. CONCLUSION: Reduced long-term survival was observed up to 3.5 years after acute injury. The 30-day mortality was strongly related to severe head injury, SAPS II and an age above 50 years. These variables may be useful as predictors of mortality, and may contribute to risk adjustment of this subset of trauma patients when treatment results from different centres are compared.     

APACHE-II scoring system in perforative peritonitis

BACKGROUND: Prospective assessment of the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scoring system of stratification of disease severity has been shown to provide objective discrimination between low-risk and high-risk groups of patients with intra-abdominal sepsis. The current study was undertaken to evaluate the performance of APACHE-II score in prediction of mortality risk in patients with peritonitis due to hollow viscus perforation. STUDY DESIGN: Fifty patients admitted to a teaching hospital with peritonitis due to hollow viscus perforation were prospectively studied over a 2-year period. APACHE-II points were assigned to all patients in order to calculate their individual risk of mortality before undergoing emergency surgery. The accuracy in outcome prediction of the APACHE-II system was assessed by means of receiver operating characteristic (ROC) curve and the Pearson correlation coefficient and its significance test. RESULTS: Of the 50 patients admitted during the study period, there were 42 (84%) survivors and 8 (16%) nonsurvivors. Mean APACHE-II score of the study population was 11.38 with a range of 1 to 23. The predicted death rate was 23% and the observed death rate was 16%. Mean APACHE-II score in survivors was 9.88, whereas in nonsurvivors it was 19.25. Using ROC analysis, the area under the curve was found to be .984. Correlation of APACHE-II score and predicted death rate showed perfect correlation, with r = .99 and P <.001 [R2 = .9993]. APACHE-II score between 11 and 15 showed a sensitivity and specificity of 100% and 73.8%, respectively, and APACHE-II score of 16 to 20 had a sensitivity and specificity of 87.5% and 100%, respectively. CONCLUSION: APACHE-II score between 11 and 20 was shown to be a better predictor of risk of mortality in patients with peritonitis due to hollow viscus perforation. Predicted mortality did not correlate with observed mortality in patients with APACHE-II scores of 1 to 10 and greater than 20. The APACHE-II scoring system can be used to assess group outcomes in patients with peritonitis due to hollow viscus perforation. However, it does not provide sufficient confidence for outcome prediction in individual patients.     

Prognostic scoring in patients with melanoma after adjuvant isolated limb perfusion

BACKGROUND: The clinical course in melanoma is variable. The aim of the present study was to assess adjuvant isolated limb perfusion (ILP) efficacy using a surrogate comparison of observed survival versus Cochran-predicted survival. MATERIALS AND METHODS: All patients in a single university hospital with primary, non-ulcerated limb melanoma who had undergone adjuvant ILP over 10 years (1986-1995) were studied. Clinical and pathological details including follow-up and survival were prospectively recorded in a national database. All patients were risk scored, as described by Cochran et al., to yield individual survival probability at the end of 3, 5 and 10 years and this was compared with observed survival at corresponding intervals. RESULTS: There were 85 patients who had adjuvant ILP for primary non-ulcerated limb melanoma. Of these, 14 deaths were observed (O) within the 10-year follow-up period. The Cochran score predicted (E) 20 deaths within 10 years (O/E ratio 0.7). The O/E ratios for deaths in the 0 to 3, 3 to 5, and 5 to 10 year intervals were 8/7.4, 5/6.0, and 1/6.5, respectively; prediction of late deaths tended to be overestimated. When patients were grouped by predicted 10-year mortality (<20%, 20-40%, >40%) the overestimation was found to occur mainly in the highest risk group: O/E ratios were 6/5.9, 6/8.4, and 2/5.6, respectively (P = 0.10, Hosmer-Lemeshow test). CONCLUSION: The observed and expected survival in patients receiving adjuvant ILP at the end of 3 and 5 years are comparable. The Cochran scoring system overestimated deaths during the 5 to 10 year interval. It is not clear whether this observation is a consequence of ILP efficacy or inaccuracy of the Cochran score.