Surgeon-performed ultrasound as a diagnostic tool in appendicitis

Purpose

Diagnosing appendicitis may require adjunct studies such as computed tomography or ultrasound (US). Combining a clinical examination with surgeon-performed US (SPUS) may increase diagnostic accuracy and decrease radiation exposure and costs.

Methods

A prospective study was conducted including children with a potential diagnosis of appendicitis. A surgery resident performed a clinical examination and US to make a diagnosis. Final diagnosis of appendicitis was confirmed by operative findings and pathology. Results were compared with radiology department US (RDUS) and a large randomized trial. Analysis was performed using Fisher exact test.

Results

Fifty-four patients were evaluated and underwent SPUS. Twenty-nine patients (54%) had appendicitis. Overall accuracy was 89%, with accuracy increasing from 85% to 93% between the 2 halves of the study. Radiology department US was performed on 21 patients before surgical evaluation, yielding an accuracy of 81%. Surgeon-performed US on those 21 patients yielded an accuracy of 90%. No statistical differences were found between any groups (P > .05).

Conclusion

Accuracy of SPUS was similar to RDUS and that of a large prospective randomized trial performed by radiologists. Furthermore, when the same clinician performs the clinical examination and US, a high level of accuracy can be achieved. With this degree of accuracy, SPUS may be used as a primary diagnostic tool and computed tomography reserved for challenging cases, limiting costs, and radiation exposure.     

Musculoskeletal ultrasound as a diagnostic and prognostic tool in rheumatoid arthritis

The use of musculoskeletal ultrasound (MSKUS) has increased in a variety of rheumatic conditions, particularly rheumatoid arthritis (RA). MSKUS complements the physical examination by allowing for superior visualization of synovitis and erosive changes compared to conventional radiography and provides detail comparable or supplementary to magnetic resonance imaging (MRI). This modality is also less expensive than MRI and CT scans, without claustrophobia or other contraindications, while uniquely providing dynamic, rather than static imaging. A growing body of literature for MSKUS in RA is contributing significantly to the understanding of diagnostic and prognostic utility, longitudinal assessment, and disease remission. Furthermore, scoring systems focusing on the patient level rather than individual joints have been developed, allowing for simplification of exams while still retaining accuracy and utility. The combination of these advances has led to increased use of MSKUS in RA in the realm of research as well as at the bedside and in the clinic.     

Utility and accuracy of endobronchial ultrasound as a diagnostic and staging tool for the evaluation of mediastinal adenopathy

Background

Endobronchial ultrasound (EBUS) is an emerging technology for mediastinal evaluation which is less invasive than cervical mediastinoscopy, the traditional gold standard. The purpose of our study is to evaluate the utility and accuracy of EBUS as a diagnostic and staging tool at our regional teaching institution.

Methods

We retrospectively reviewed the institutional thoracic surgery database for all patients undergoing EBUS between August, 2008 and March, 2011.

Results

190 patients underwent EBUS. 87 (46 %) patients underwent EBUS for diagnosis only; 73 (38 %) for staging only; and 30 (16 %) for both diagnosis and staging. Diagnoses obtained by diagnostic EBUS included non-small cell lung cancer—n = 36 (31 %); other cancer—n = 22 (19 %); sarcoid/granulomatous—n = 8 (7 %); benign lymphoid tissue—n = 50 (43 %); and was nondiagnostic in one case (1 %). For staging EBUS 53 (51 %) patients had benign lymph node tissue. 103 patients had a benign result at the time of EBUS. Fifty-six (54 %) of these patients underwent subsequent mediastinal lymph node dissection or mediastinoscopy for tissue confirmation with the remainder undergoing follow up surveillance chest CT scans. Two patients had a false negative EBUS. Both false negative studies sampled levels 4L, 4R, and 7. The overall false negative rate was 2 % for all benign results, and 4 % for those benign results confirmed with lymph node dissection or mediastinoscopy. The sensitivity and specificity of diagnostic EBUS was 97 and 100 %. The sensitivity and specificity for staging EBUS was 98 and 100 %. In those patients (n = 103) undergoing a staging EBUS, a mean of 2.6 nodal stations were sampled, with 59 % (n = 61) of these patients having three lymph node stations sampled and 33 % (n = 30) had two lymph node stations sampled.

Conclusion

We found that EBUS is a highly accurate and minimally invasive manner in which to both diagnose mediastinal masses and stage the mediastinum.     

《妇产科护理学》教学改革初探

目的对《妇产科护理学》的教学工作进行改革,提高学生的学习兴趣,提高教学质量。方法将58名2001级学生作为对照组,81名2002级学生作为观察组。对照组采用传统方法教学,观察组从《妇产科护理学》教材内容的分工、理论教学模式、见习课的安排方面进行改革。结果观察组学生的学习成绩明显高于对照组(P<0.05),且观察组学生对教学内容中的医疗护理知识融合程度、教学方法的应变性、见习课的安排及集中见习效果的评价,优良率分别为96.3%、85.2%、88.9%、92.6%。结论《妇产科护理学》是一门实践性很强的学科,对其教学工作进行改革可提高教学质量。     

Electron microscopy as a diagnostic tool in pathology.

As pathologists begin to examine increasing numbers of tumors under the electron microscope and the biochemistry begins to characterize molecular change associated with disease states, electron microscopy will gain wider acceptance in clinical practice. The clinician is admonished not to rely on electron microscopy as a sole diagnostic tool, but to use it as an integral part of the available diagnostic armamentarium.     

《妇产科护理学》教学改革初探

目的对《妇产科护理学》的教学工作进行改革，提高学生的学习兴趣，提高教学质量。方法将58名2001级学生作为对照组，81名2002级学生作为观察组。对照组采用传统方法教学，观察组从《妇产科护理学》教材内容的分工、理论教学模式、见习课的安排方面进行改革。结果观察组学生的学习成绩明显高于对照组（P〈0．05），且观察组学生对教学内容中的医疗护理知识融合程度、教学方法的应变性、见习课的安排及集中见习效果的评价，优良率分别为96．3％、85．2％、88．9％、92．6％。结论《妇产科护理学》是一门实践性很强的学科，对其教学工作进行改革可提高教学质量。     

Using LIBS as a diagnostic tool in pediatrics beta-thalassemia

Lasers in Medical Science - Beta-thalassemia major is a common inherited single-gene disorder. Thalassemic patients are at risk of changes in some important trace elements. To detect alteration of...     

高职《妇产科护理》翻转课堂的实施与效果评价

目的探讨翻转课堂教学在高职《妇产科护理》教学中的应用效果。方法将102名学生按照班级分为翻转班与对照班,翻转班实施翻转课堂教学,对照班实行传统授课模式。结果翻转班的理论成绩和实践成绩显著高于对照班(均P0.01),教学后自我导向学习能力显著高于对照班(P0.01)。结论实施翻转课堂教学有利于提高学生的学习成效和自我导向学习能力,为学生的终身学习打下基础。     

The ambulatory electro-encephalogram as a diagnostic tool in a children's hospital

The neurophysiology laboratory at the Red Cross War Memorial Children's Hospital provides a diagnostic electro-encephalogram (EEG) service for the hospital and surrounding community. In selected cases ambulatory EEG monitoring is undertaken. The present study is a review of the findings in 55 children thus investigated using the Oxford monitor. Indications included unexplained aberrant behaviour outbursts, erratic school performance, atypical absence episodes and the need to distinguish between real and simulated seizures in children with epilepsy. During reporting, correlations were noted between EEG appearances and the child's behaviour. Abnormalities were noted in 35 of the records. These included paroxysmal spike and wave discharge, focal cortical abnormalities and unequivocal seizure episodes. It is felt that the investigation made a significant contribution to correct diagnosis in 32 cases, and that ambulatory monitoring should be available in all laboratories which offer a diagnostic EEG service for children.     

Saliva as a non-invasive diagnostic tool for inflammation and insulin-resistance

Saliva has been progressively studied as a non-invasive and relatively stress-free diagnostic alternative to blood. Currently, saliva testing is used for clinical assessment of hormonal perturbations, detection of HIV antibodies, DNA analysis, alcohol screening, and drug testing. Recently, there has been increasing interest in evaluating the diagnostic potential of saliva in obesity, inflammation, and insulin-resistance. Current literature has demonstrated elevated levels of inflammatory biomarkers including C-reactive protein, tumor necrosis factor-α, interleukin-6, and interferon-γ in saliva of obese/overweight children and adults. Salivary antioxidant status has also been studied as a measure of oxidative stress in individuals with type 2 diabetes. Further, several studies have demonstrated correlations of salivary markers of stress and insulin resistance including cortisol, insulin, adiponectin, and resistin with serum concentrations. These findings suggest the potential diagnostic value of saliva in health screening and risk stratification studies, particularly in the pediatric population, with implications for inflammatory, metabolic and cardiovascular conditions. However, additionalstudies are required to standardize saliva collection and storage procedures, validate analytical techniques for biomarker detection, and establish reference ranges for routine clinical use. The purpose of this review is to summarize and evaluate recent advancements in using saliva as a diagnostic tool for inflammation and insulinresistance.