Comparison of asymptomatic and symptomatic childhood glomerulonephritis progressing to renal failure: a report of Kyushu Pediatric Nephrology Study Group

We evaluated the clinicopathological features and the outcome of 33 children with primary glomerulonephritis (GN) as the cause of renal failure; 17 had asymptomatic (ASP) haematuria and/or proteinuria and the remaining 16 had symptoms suggestive of GN. The renal histology in the ASP group indicated IgA GN in 6 children, focal segmental glomerular sclerosis (FSGS) in 4, diffuse proliferative GN (DPGN) in 3, membranous GN (MGN) in 1, membranoproliferative GN (MPGN) in 1 and diffuse sclerosing GN in 2. In the symptomatic (SYP) group, FSGS was evident in 9 children, DPGN in 3, MGN in 2, IgA GN in 1 and MPGN in 1. There was no difference in the histological severity between the two groups. Fourteen children in the SYP group had nephrotic syndrome (NS) and/or hypertension at their initial visits. Only 4 children in the ASP group showed NS or hypertension during the period of follow-up. Eleven children in the ASP group and all in the SYP group were treated with immunosuppressive and/or antihypertensive drugs, but these did not improve the prognosis of the ASP children compared with those in the SYP group. There was no significant difference in the mean duration between the onset of the disease and the start of dialysis in these two groups. In conclusion, it is questionable whether the urinary mass screening programme in Japan will alter the outcome of children with GN.Further participating centres: Oita Medical School, Oita, Japan (Makoto Uchiyama); Okinawa Prefectural Chubu Hospital, Naha, Japan (Koichiroh Tamanaha); Kagoshima University, Kagoshima, Japan (Makoto Ninomiya); Nishibeppu National Hospital, Beppu, Japan (Akio Furuse); School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (Minoru Yamagishi); Saga Medical School, Saga, Japan (Tadashi Satoh); Nagasaki University, Nagasaki, Japan (Kiyoaki Nagano); Miyazaki Medical School, Miyazaki, Japan (Kanehide Hashiguchi); Fukuoka Red Cross Hospital, Fukuoka, Japan (Tetsuro Yanase); Yahata Saiseikai Hospital, Kitakyushu, Japan (Keizo Ohbu); Kokura National Hospital, Kitakyushu, Japan (Kumiko Mukuno)     

Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives

Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.     

Efficacy of urine screening at school: experience in Shanghai,China

To explore the prevalence of hematuria or proteinuria in school children in Shanghai and to evaluate the screening methods, we conducted urine screening in more than 40,000 school children between 2003 and 2005. Children were tested with dipsticks read manually (method A) or dipsticks read by machines (method B) combined with a sulfosalicylic acid test or microscopy. Some children were tested once, and others who had abnormal results in the first screening were tested again 2 weeks later. The prevalence of urine abnormalities in the first screening was more than 5.00% and of the second screening about 1.00%. Either method B or testing two urine samples for each child had higher specificity. As to the direct cost, that of screening twice with method A was lower than just screening once with method B. So using method A to screen twice for each child was not only convenient and economical, but also could reduce the false positive rate effectively. More than 10 months of follow-up diagnosed two cases of IgA nephropathy. Asymptomatic chronic renal diseases in school children could be detected through school urine screening. For Shanghai, China, screening twice using method A might be the best choice.     

Circadian Rhythm of Proteinuria: Consequences of the Use of Urinary Protein:Creatinine Ratios

Proteinuria in patients with glomerular disease has a circadianrhythm, but for creatinine such a rhythm is either absent orof low amplitude. We found in 18 of 23 admitted patients (groupI) and in seven outpatients (group II) a marked circadian rhythmof the protein: creatinine ratio. Estimates of 24-h proteinuriawere obtained by multiplying the protein:creatinine ratio of3-h urine samples with 24-h creatinine excretion, calculatedfrom age, sex and bodyweight. Estimated proteinuria could beas low as 19% or as high as 349% of actually measured 24-h proteinuria;the mean SD was 23%. The best estimate was obtained with the06.00–09.00 hours urine samples. The estimates correlatedbetter with actually measured 24-h proteinuria than the protein:creatinine ratio per se correlated with the 24-h proteinuria.Day-to-day variation of proteinuria estimates from samples takenat the same time of the day was of similar magnitude as day-to-dayvariation of actual 24-h proteinuria. We conclude that the usefulnessof the protein:creatinine ratio of a random urine sample forestimation of proteinuria is limited, because of the circadianrhythm of proteinuria. However, samples collected at a fixedtime of the day are an acceptable alternative for 24-h urinecollections in the clinical follow-up of individual patients.     

Measurement of urinary concentration: a critical appraisal of methodologies

The measurement of urine concentration provides information concerning the kidney’s ability to appropriately respond to variations in fluid homeostasis. It also assists in the interpretation of other tests performed on the same urine specimen. The gold standard of estimating urinary concentration is the measurement of its osmolality; however, this procedure is not readily available to the practicing physician. Therefore, urine concentration is usually determined by measurement of its specific gravity (SG), which provides a fair estimate of urine osmolality. Over the years numerous tests have been developed to measure urine SG in a simple, quick, reliable and easily available method. These tests measure SG either directly (e.g., gravimetry) or by indirect methods (e.g., refractometry and reagent strip). All these tests have certain limitations based on their underlying physical principles. Specific gravity as measured by refractometry is influenced by proteinuria, such that for each 10 g/l protein the SG increases by 0.003. SG is also influenced by glucosuria such that it increases by approximately 0.002 per 10 g/l glucose when compared with urinary osmolality. Unlike osmolality, which is only affected by the number of particles, refractometry is affected by number, mass and chemical structure of the dissolved particles; hence large molecules like radiographic contrast or mannitol will increase SG relative to osmolality. The reagent strip is minimally affected by glucose, mannitol or radiographic contrast. However, it is affected by urinary pH such that only urine in the pH range of 7.0–7.5 can be correctly interpreted. The measurement of SG by reagent strip is based on the ionic strength of the urine and thus is significantly affected by the ionic composition of the urine and by proteins which have an electric charge in solution. In our experience, SG measured by the refractometer is consistently more accurate than the reagent strip. For the clinician who is interpreting urine SG results, it is important to be aware of these limitations and understand the reasons for possible potential errors of each particular method. Received: 14 August 2000 / Revised: 24 November 2000 / Accepted: 27 November 2000     

Attentional and visual demands for sprint performance in non-fatigued and fatigued conditions: reliability of a repeated sprint test

Background  

Physical performance measures are widely used to assess physical function, providing information about physiological and biomechanical aspects of motor performance. However they do not provide insight into the attentional and visual demands for motor performance. A figure-of-eight sprint test was therefore developed to measure the attentional and visual demands for repeated-sprint performance. The aims of the study were: 1) to assess test-retest reliability of the figure-of-eight sprint test, and 2) to study the attentional and visual demands for sprint performance in a non-fatigued and fatigued condition.     

Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization

STUDY DESIGN: One group pretest-posttest exploratory design. OBJECTIVES: Primary purposes of this study were to examine the short-term effect of hip mobilizations on pain and range of motion (ROM) measurements in patients with knee osteoarthritis (OA) and to determine the prevalence of painful hip and squat test findings in both patients with knee OA and asymptomatic subjects. The secondary purposes were to assess intrarater reliability and to determine whether fewer subjects experienced painful test findings following hip mobilization. BACKGROUND: Conservative intervention, including manual physical therapy applied to the lower extremity, has been shown to reduce impairments associated with knee OA. METHODS AND MEASURES: One rater pair administered 4 clinical hip tests to 22 patients with knee OA (mean age, 61.2 years; SD, 6.1 years) and 17 subjects without lower extremity symptoms or known pathology (mean age, 64.0 years; SD, 7.9 years). Intrarater reliability was examined for each clinical test. Patients with knee OA and painful-hip and squat test findings received hip mobilizations. Pain and ROM responses for each test were dependent variables. RESULTS: Intraclass correlation coefficients for all tests were greater than 0.87. Composite and individual test pain scores and ROM scores improved significantly following hip mobilization. All clinical test findings were more frequent in the group with knee OA, except for those of the FABER test, and the number of subjects with painful test findings following hip mobilization was reduced for all tests except the hip flexion test. CONCLUSIONS: Patients experienced increases in ROM, decreased pain, and fewer subjects had painful test findings immediately following a single session of hip mobilizations. Examination and intervention of the hip may be indicated in patients with knee OA.     

Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study

Background

Despite the increasing importance of cardiopulmonary exercise testing (CPET) for preoperative risk assessment, the reliability of CPET interpretation is unclear. We aimed to assess inter-observer reliability of preoperative CPET.

Urine is a saturated equilibrium and not a metastable supersaturated solution: evidence from crystalluria and the general composition of calcium salt and uric acid calculi

A computer algorithm is described which allows urine to be modelled as a saturated equilibrium solution with respect to any combination of the solids calcium oxalate, calcium hydrogen phosphate (brushite), amorphous calcium phosphate, uric acid, sodium hydrogen urate and ammonium hydrogen urate. It is demonstrated that this model of urine, unlike the widely accepted metastable supersaturated solution model, explains the long-known calcium salt crystalluria versus pH curves of both non-stone-forming and stone-forming urine. Further, the saturation model accounts for why most “infection” stones do not contain calcium oxalate and why most “urate” stones are composed solely of uric acid and not admixed with alkali metal hydrogen urate salts. The supersaturation model of urine cannot explain satisfactorily these well-known phenomena. For example, the supersaturation model predicts that virtually all“infection” stones should contain calcium oxalate along with calcium phosphate and, perhaps, struvite. Received: 18 November 1998 / Accepted: 25 March 1999     

The distal urethral electrical conductance test: Standardisation of method and clinical reliability

Urethral electrical conductance was recorded throughout standard exercise test in a group of 40 women with known urinary incontinence. Analysis of the results has shown it to be of little diagnostic value (sensitivity = 33%). It is, however, a sensitive means of detecting leakage (sensitivity = 97%), and a comparison of the total change in conductance during the exercise test with weighed perineal pads shows this parameter to be a reasonable index of the severity of leakage.     

Nurses under stress: A reliability and validity study of the NSI

The Nurse Stress Index (NSI) and other measures were instrumented with 117 nurses in seven hospitals and four hospices who were dealing with high-risk aspects of the profession. The NSI would seem to be a reliable and reasonably construct-valid measure for this purpose, but the findings of factor analysis suggested that for different groups of nurses, slightly different factor structures or subscales would be more appropriate.     

Precancerous conditions of gallbladder carcinoma: overview of histopathologic characteristics and molecular genetic findings

Two distinct epithelial lesions (dysplasia and adenoma) and one high-risk condition (anomalous pancreatico-biliary ductal junction; APBDJ) are currently recognized as premalignant stages of gallbladder carcinogenesis. In addition to clinicopathologic observations, recent molecular genetic studies have provided further insight into the pathogenesis and biological behavior of these precursor lesions. In this review, we concentrate on describing the histopathologic and clinicopathologic background and recent molecular genetic findings for each of these putative precursor lesions. Received: June 3, 2000 / Accepted: August 8, 2000     

Diagnostic, staging, and grading of urothelial carcinomas from urine: performance of BCA-1, a mini-array comparative genomic hybridisation-based test

Background

Cytogenetic abnormalities occur at an early stage of bladder urothelial carcinomas (BUC), and their frequency increases as the cancer becomes more advanced.

Objective

To assess the diagnostic performance of a test based on cytogenetic abnormalities to diagnose, stage, and grade BUC from the urine.

Design, setting, and participants

We used a 341 bacterial artificial chromosome (BAC) comparative genomic hybridisation (CGH)–array chip (BCA-1) designed to include loci affected in BUC. The chip was first used on 32 frozen BUC biopsies to design staging (BN0) and grading (BN1 and BN2) prediction models based on Bayesian networks analysis. The models were then validated on external data obtained from 98 tumour samples using a 2464 BAC CGH-array chip. The performance of the test was finally assessed on 44 urine pellets collected, including 22 patients who had BUC and 22 controls.

Measurements

We measured sensitivity and specificity to diagnose BUC stage and grade from urine pellets.

Results and limitations

In the urine, BCA-1 test sensitivity was 95%, specificity was 86%, and accuracy was 91%. The BN0 staging model identified T1–4 tumours in the urine with a sensitivity of 90%, a specificity of 83%, and an accuracy of 87%. The BN1 and BN2 grading models detected high-grade disease with a sensitivity, specificity, and accuracy of 86%, 88%, and 87%, respectively, using BN1 and 100%, 63%, and 82%, respectively, using BN2. BN models performed with similar sensitivity but reduced specificity using the external data. BCA-1 failed to produce results for eight additional samples (failure rate: 9%). The test needed high quantities and quality of DNA, and external validation in larger, prospective, and better-designed studies is necessary to confirm feasibility and performance.

Conclusions

The BCA-1 mini–CGH-array chip detected BUC in urine with a high diagnostic performance. It could also accurately discriminate low-grade from high-grade tumours and, to a lesser extent, lamina propria–invasive tumours from pTa tumours.     

A comparison of fifteen pulse oximeters. Part I: A clinical comparison; Part II: A test of performance under conditions of poor perfusion

Fifteen pulse oximeters were compared. Their physical characteristics, price, warranty, information handling and displays were catalogued. Times for changes in data display and susceptibility to interference were assessed. A model for comparison of oximeters under conditions of poor perfusion was developed using a tourniquet to progressively diminish limb perfusion pressure (systolic minus tourniquet pressure). The oximeters evidenced a wide variety of features and performance in poor perfusion states. Instruments lacking a beep varying in pitch with saturation or a waveform/pulse bar display of plethysmograph signal were considered less satisfactory. The majority of instruments, with some notable exceptions, performed remarkably well in a state of diminished perfusion. The study demonstrates that purchasers of pulse oximeters need to exercise care in assessing the suitability of particular instruments to their specific requirements.     

The importance of diagnostic test parameters in the interpretation of clinical test findings: The Prone Hip Extension Test as an example

The use of diagnostic tests is a crucial aspect of clinical practice since they assist clinicians in establishing whether a patient has or does not have a particular condition. In order for any clinical test to be used most appropriately, it is essential that several parameters be established regarding the test and that these are made known to clinicians to inform their clinical decision making. These include the test's sensitivity, specificity, predictive values, and likelihood ratios. This article reviews their importance as well as provides an illustrative example that highlights how knowledge of the parameters for a given test allows clinicians to better interpret their test findings in practice.     

Nerve injuries to the volar aspect of the hand: A comparison of the reliability of the Weber static test versus the gauze test

When examining lacerations to the volar aspect of the hand a gauze test may usually be performed to detect nerve injuries. However, published literature suggests that its sensitivity and specificity are lower than 100%. The aim of this study was to determine whether a Weber static (main hypothesis) and dynamic test or a Semmes-Weinstein test (secondary hypotheses) could be a more reliable test than the gauze test to rule out any nerve injury and avoid unnecessary wound explorations.Our case series included a total of 102 patients presenting with 123 palmar lacerations and 158 nerve injuries. On arrival at the emergency department, every patient was tested for epicritic sensation at the pulp of the injured and contralateral fingers with the Weber static and dynamic tests and the Semmes-Weinstein monofilament test. All lacerations underwent exploration under anesthetic to rule out nerve injury.The sensitivities of the gauze test, the Weber static test, the Weber dynamic test and the Semmes Weinstein monofilament test were proven to be 82.5%, 98.6%, 97.9% and 86.7% respectively. The specificities of the gauze test, the Weber static test, the Weber dynamic test and the Semmes Weinstein monofilament test were 79%, 79%, 79% and 78.9% respectively.Examination of lacerations to the volar aspect of the hand to rule out any nerve injuries should include a Weber static test instead of a gauze test. A negative Weber static test should not however discourage a surgical exploration of the laceration to rule out tendinous or vascular injury.     

Milch's classification of paediatric lateral condylar mass fractures: Analysis of inter- and intraobserver reliability and comparison with operative findings

This study aimed to test the usefulness and validity of two versions commonly quoted in the literature of the Milch classification of paediatric supracondylar mass fractures. Anteroposterior and lateral elbow radiographs of 10 consecutive acute paediatric lateral condylar mass fractures requiring open surgical reconstruction were presented to six observers in order to assess inter- and intraobserver reliability of both versions. Accuracy of classification was compared with intraoperative findings.Observers agreed with the operative findings in only 50% of cases. There was poor interobserver (κ < 0.2) and moderate intraobserver agreement (κ < 0.6) for both versions. Thus Milch's classification was not found to be a useful tool.