Relation between fibrositic and control site tenderness; effects of dolorimeter scale length and footplate size.

Recent data have suggested a correlation between the tenderness measured at tender and control sites, differing from earlier studies indicating site specific tenderness. In our study, the "constant control" model is tested against the "correlated control" model, in which control site tenderness varies with fibrositic site tenderness. Our study also addresses relevant technical issues in dolorimetry. We measured threshold of tenderness at 4 sites (2 fibrositic and 2 control) on 21 subjects, using dolorimeters with a 17 kg scale limit, and 3 different footplates, 0.7, 1.4 and 2.0 cm in diameter. To measure observer variation, we used multiple replications by multiple observers, obtaining in all 1,416 observations. There was a strong relationship between control and fibrositic site tenderness with control thresholds twice as high (half as tender). Scale length and dolorimeter footplate size each had important effects. The site specific approach is valuable diagnostically, but more broadly operative mechanisms should be the focus of research and therapy.     

Measuring disease activity: comparison of joint tenderness, swelling, and ultrasonography in rheumatoid arthritis

In a prospective study of 6 patients with classic rheumatoid arthritis, we evaluated 3 measures of disease activity: comprehensive joint swelling and joint tenderness counts, and ultrasonography of joints. After baseline data were obtained on these 6 patients, therapy with fenbufen, a new nonsteroidal antiinflammatory drug, was begun. Followup examinations were performed at 4 weeks and 24 weeks after baseline. There were statistically significant differences between joint tenderness and joint swelling findings and between joint tenderness and joint ultrasonography findings (P less than 0.05 by kappa test statistic). In comparisons of joint swelling and ultrasonography, no difference was found (P greater than 0.05). When measures of changes over 6 months were compared, there was a high concordance between improvement in joint swelling and improvement in joint ultrasonography (P less than 0.01). Our results demonstrate that clinical assessment of joint swelling provides an accurate measure of synovial effusion, as confirmed by the more objective ultrasound measurements.     

"Attitudes" toward the elderly: a comparison of measures.

College students were presented five questionnaires traditionally used to assess attitudes toward old people. The intercorrelations among the measures were low, accounting for no more than 24% of the variance between any two measures. The results suggest that the measures are not equivalent; it was argued that the practice of utilizing a single instrument to measure attitudes toward the elderly may contribute to inconsistencies reported in the literature.     

A comparison of two single-headed and two multi-headed allergen skin test devices.

Given the potential differences in performance of skin test devices, the purpose of this study was to prospectively assess the performance of two single-headed and two multiheaded devices for allergy skin testing in terms of wheal size, sensitivity, specificity, intradevice variability, and pain level. Two single-headed devices (Greer Pick, Duotip-Test) and two multiheaded devices (Multi-Test II, OMNI) were tested in 15 subjects in a prospective partially blind fashion looking at wheal reactions and pain using histamine and glycerol-saline on the arms and back. Differences among devices in wheal size and pain were noted. Sensitivity, specificity, and intradevice variability were calculated. Differences between corner and interior heads in multiheaded devices were analyzed. No significant differences were observed in wheal size between Greer Pick (7.1+/-1.4 mm) and Duotip-Test (7.2+/-1.6 mm). Multiheaded devices were significantly different in wheal size compared with each other and to the single-headed devices (Multi-Test II, 5.4+/-1.7 mm; OMNI, 3.3+/-1.2 mm). Single-headed devices were more sensitive (100% each, 95% CI of 92-100%) than the multiheaded devices. Multi-Test II was significantly more sensitive (83%, 95% CI of 78-87%) than OMNI (57%, 95% CI of 51-62%). There was significant intradevice variability for the multiheaded devices with corner heads being significantly more sensitive than interior heads. Specificities for all devices were equally good (-97%). Pain was greater for multiheaded devices than single-headed devices but was generally mild. In conclusion, this study supports the idea that single-headed devices may be more sensitive and consistent than multiheaded devices. Multi-Test II is more sensitive than OMNI. In multiheaded devices, corner heads are more sensitive than interior heads.     

Sleep desaturation: comparison of two oximeters

Oxygen saturation is measured by pulse oximetry during sleep studies. Body movements and peripheral vasoconstriction related to respiratory events may interfere with measurements by conventional oximeters. Our objective was to compare the detection rate of sleep desaturations by two oximeters, one of which used new motion-resistant technology. We studied 34 children (median age, 13 years; range, 3-18) with suspected sleep-disordered breathing. During polysomnography, oxygen saturation was measured by two oximeters set on fast mode: the motion-resistant Radical oximeter (2-sec averaging), and the conventional Nellcor N-200 oximeter (2-3-sec averaging). Respiratory events were identified based on airflow signal. The numbers of respiratory event-related desaturations > or =3% or > or =5% detected by each oximeter were determined. Valid desaturations were defined using the Nellcor plethysmographic waveform and the Radical signal-quality data. Hypoxemic respiratory events were those with associated valid desaturation. In total, 1,278 respiratory events were identified and pooled. Basal oxygen saturation measured just before event onset was not different between oximeters (Radical: 98%; range, 84-100; Nellcor: 97%; range, 86-100; P = ns). However, the Radical detected a greater number of valid desaturations than did the Nellcor for any level of desaturation (respectively, N = 651 and 476 desaturations > or =3%, P < 0.001; and N = 232 and 146 desaturations > or =5%, P = 0.01). Consequently, for each patient, the number of hypoxemic respiratory events per hour of sleep was greater using the Radical than using the Nellcor (P = 0.002, and P = 0.021, for desaturation > or =3% and > or =5%, respectively). In conclusion, standardized oximeter settings are required to achieve more accurate assessments of hypoxemia in children with sleep-disordered breathing.     

Methacholine challenge: comparison of two methods

BACKGROUND: Guidelines for the 2-min tidal-breathing and the five-breath dosimeter methods for methacholine challenge have recently been published by the American Thoracic Society (ATS). Although subjects are exposed to twice as much aerosol at any given concentration during the tidal-breathing method compared to the dosimeter method, they were thought to give equivalent results. OBJECTIVE: To compare the 2-min tidal-breathing and the five-breath dosimeter methacholine challenges. SETTING: Tertiary care university-based bronchoprovocation laboratory. PATIENTS: Forty subjects with currently symptomatic asthma. INTERVENTIONS: The two methacholine tests were done in random order on separate days at the same time of day at 1- to 7-day intervals. RESULTS: The dosimeter provocation concentration of methacholine causing a 20% fall in FEV(1) (PC(20)) was almost twice that of the tidal-breathing PC(20): 2.4 mg/mL vs 1.3 mg/mL (paired t test, p < 0.00005). The difference was greater in those with mild airway hyperresponsiveness (AHR) [PC(20) > 1.0 mg/mL; 3.2-fold] compared to those with moderate AHR (PC(20) < 1.0 mg/mL; 1.6-fold) [p = 0.04]. Three subjects with mild asthma and mild AHR (tidal-breathing PC(20), 1.9 to 4.3 mg/mL) had a nonmeasurable PC(20) (> 32 mg/mL) with the dosimeter. CONCLUSIONS: The tidal-breathing method, which exposes the subject to twice as much aerosol at each concentration, produced approximately twice the response. The total lung capacity maneuvers with breathhold during the dosimeter method may inhibit the response in some patients with asthma.     

Occult gastrointestinal bleeding due to aspirin: comparison of two compounds.

Occult gastrointestinal bleeding as measured by the faecal 51Cr-labelled red-cell loss was compared in eight healthy volunteers while on therapeutic doses of soluble aspirin and a new slow-release formulation of aspirin (Deskoval). While both preparations led to increased faecal blood loss, this was significantly less during administration of Deskoval than when soluble aspirin was taken.     

Epidemiology of tuberculosis in Sardinia: a comparison of two data-gathering methods.

SETTING: A complete surveillance system for tuberculosis should be able to guarantee constant updating of incidence and provide useful data on a variety of problems related to tuberculosis such as drug resistance, co-infection with the human immunodeficiency virus (HIV), the geographic origin of patients, and mycobacterial species. OBJECTIVE AND DESIGN: To assess the completeness of the surveillance system currently operating in Sardinia, cases seen by all medical centres between 1987 and 1995 were compared with those notified to Sardinian Public Health Services for the same period. RESULTS: Each year, on average 39% of cases seen in Sardinia are notified; 646 (40%) of the 1591 patients notified during the study period were never seen by regional medical centres. An analysis of the results shows that from 1992 the decline recorded in incidence rates in previous years ceased: 1992 (26/100,000), 1993 (25/100,000), 1994 (28/100,000), and 1995 (24/100,000). CONCLUSIONS: The current surveillance system in Sardinia is inadequate for performing an accurate epidemiological survey of the disease. Epidemiological analysis based solely on notification can provide neither reliable incidence rates nor useful information concerning many aspects of tuberculosis.     

Cefuroxime in severe respiratory infections: a double-blind comparison of two doses.

Cefuroxime, a new cephalosporin, was given in doses of 750 mg and 1000 mg three times daily for 10 days to 99 patients in a double-blind comparison. Patients were moderately or severely ill with exacerbations of chronic bronchitis, often accompanied by pneumonia. Both doses were equally efficacious in improving the clinical state and sputum purulence and in maintaining the improvement.     

Alcohol and injury: a comparison of emergency room populations in two Canadian provinces.

The few comparative emergency room (ER) studies reported have found alcohol's role in injury occurrence to vary and suggest that regional and cultural differences in drinking patterns may account, in part, for this variation. To further this research, a probability sample of 1708 ER patients was interviewed regarding the role of alcohol in the event, usual drinking patterns, and alcohol-related problems and a urine sample was obtained to estimate blood alcohol concentration (BAC). The sample was from ERs in two Canadian provinces with distinctly different cultures: primarily English-speaking Alberta and French-speaking Quebec. While differences in demographic and drinking characteristics between injured and noninjured in both the Alberta and Quebec ERs were similar to those in other ER studies, the injured in the Alberta ER were more likely to be positive for estimated BAC; to have higher BAC levels; to report drinking prior to the event; and, among those reporting drinking, to have consumed a larger number of drinks and to report feeling drunk at the time of injury compared to those in Quebec. These differences may be associated with cultural differences in typical drinking patterns, with higher rates of abstinence reported in the Alberta ER, but also with higher rates of heavy drinking and alcohol-related problems, while those in the Quebec ER were more likely to report consuming smaller quantities with greater frequency (typical of wine-drinking cultures). Additional research is needed to explicate further alcohol's role in injury occurrence for planning effective prevention strategies that are both culturally relevant and specific.     

Assessing progression of patellofemoral osteoarthritis: a comparison between two radiographic methods.

OBJECTIVE: To compare two plain radiographic methods for sensitivity to detect progression of patellofemoral osteoarthritis. METHODS: Two sets of paired skyline and lateral knee radiographs from 54 hospital referred patients (108 knees) with knee osteoarthritis were taken an average of 31 months apart (range 12-40). Films were examined separately in random order by a single observer blind to patient identity and time order. Minimum joint space was measured by metered caliper; individual features of osteoarthritis were graded 0-3 using an atlas. RESULTS: Intraobserver reproducibility assessed on 40 knees was to within +/- 0.5 mm for skyline lateral facet and +/- 0.7 mm for medial facet and lateral views. On the lateral view measured joint space decreased in 51% of knees but increased in 43%, with overall no significant mean group change with time (-0.2 mm, 95% confidence interval, 0.1 to -0.5). By contrast on the skyline view joint space decreased in at least one facet in 71% of knees, with significant decrease in mean joint space for both lateral facets (-0.4 mm, 95% CI, -0.2 to -0.6) and medial facets (-0.5 mm, 95% CI, -0.1 to -0.8). CONCLUSIONS: It is possible to detect significant joint space loss with time on the skyline view that is not apparent on the lateral view. The skyline view should be the method of choice to detect progression of patellofemoral osteoarthritis.     

Caregiver activity on respite and nonrespite days: a comparison of two service approaches.

Use of time was examined among female caregivers of dementia patients who used home care (n = 20) and day care (n = 20) respite services. Assessment of caregiver activity during respite and nonrespite days revealed significant program differences in the amount of caregiving time and overall differences in the amount of noncaregiving time. Use of respite time was also examined. Significant predictors of willingness to continue care were identified. Ratings of program satisfaction were very high.     

Simultaneous two level oesophageal pH monitoring in healthy controls and patients with oesophagitis: comparison between two positions.

For oesophageal pH monitoring, the pH probe is usually positioned 5 cm above the lower oesophageal sphincter (LOS). This is by convention, and has not been compared with other positions in its ability to discriminate between physiological and abnormal acid reflux. Using simultaneous two level 24 hour pH monitoring (5 and 10 cm above manometrically determined LOS) in 31 controls and 51 patients with reflux oesophagitis, the significance of the precise position of the probe in the oesophagus was examined. Secondly, this study compared the discrimination between the two groups achieved at the two levels. Patients had greater acid exposure than controls at both levels. In controls, acid exposure was greater at distal than at the proximal level except the supine acid exposure, which was similar at both levels. In patients, acid exposure was greater at the distal level for all variables (median % of total time pH < 4 = 11.7 v 7.6; p = 0.001). There was excellent correlation between the two levels for all variables in controls (r = 0.883, 0.935, 0.813, and p < 0.001 for percentage of time pH < 4 for total, supine, and upright times) as well as in patients (r = 0.848, 0.848, 0.779, and p < 0.001). On discriminant and receiver operating characteristic analysis, pH threshold 4 seemed as good as or better than other pH thresholds in discriminating between controls and patients. The percentage of total time pH below 4 seemed to discriminate as well or better than other variables at both levels. The distal level (5 cm above LOS) provided slightly better discrimination than proximal level (10 cm) (percentage of subjects correctly classified=81.7 v 75.6). The critical factor for the reliability of the test is not the precise position of the pH probe relative to the LOS, but that the same position is consistently used in patients and controls.     

Preclinical Cushing's syndrome in adrenal "incidentalomas": comparison with adrenal Cushing's syndrome.

Adrenal tumors are usually diagnosed by clinical symptoms of hormone excess. The increasing use of ultrasound and computed tomography results in the detection of a substantial number of incidentally discovered adrenal tumors. Most of these tumors are nonfunctional adrenocortical adenomas, but a few cases of subclinical cortisol production in "incidentalomas" have been reported. We investigated prospectively the prevalence of autonomous cortisol production in 68 patients (44 females and 24 males, aged 25-90 yr) with adrenal incidentalomas at our institution. As a screening procedure all patients with incidentalomas underwent an overnight dexamethasone suppression test (1 mg). Patients who failed to suppress serum cortisol below 140 nmol/L (5 micrograms/dL) underwent more comprehensive studies (prolonged dexamethasone suppression test, determination of the diurnal rhythm of cortisol secretion in saliva, and CRH stimulation test). Eight patients (12% of all patients with incidentalomas; 5 females and 3 males, aged 25-71 yr) were finally identified as having cortisol-producing tumors, and the findings in these patients were compared with those of overt Cushing's syndrome in 8 patients (8 females, aged 26-50 yr) suffering from cortisol-producing adrenal adenomas. The tumor size of patients with cortisol-producing incidentalomas ranged from 2-5 cm. No specific signs and symptoms of hypercortisolism were present, but arterial hypertension (seven of eight subjects), diffuse obesity (four of eight subjects), and noninsulin-dependent diabetes mellitus (NIDDM; two of eight subjects) were frequently observed. Baseline cortisol levels were in the normal to upper normal range, whereas baseline ACTH levels were suppressed in five of the eight patients. In none of the patients was serum cortisol suppressible by low dose or high dose dexamethasone. The ACTH and cortisol responses to CRH were normal in two, blunted in one, and suppressed in four patients. Unilateral adrenalectomy was performed in seven patients and resulted in temporary adrenal insufficiency in four of them. After surgery, improvement of arterial hypertension, a permanent weight loss in obese subjects, and a better metabolic control of NIDDM were noted in the majority of patients. The following conclusions were reached. Incidentally diagnosed adrenal tumors with pathological cortisol secretion in otherwise clinically asymptomatic patients are more frequently observed than previously assumed. Adrenocortical insufficiency is a major risk in these patients after adrenalectomy. After surgery, hypertension, obesity, and NIDDM may improve. Patients with asymptomatic adrenal incidentalomas, therefore, should be screened for cortisol production by means of an overnight dexamethasone suppression test.     

Control of tuberculosis in Uganda: a tale of two districts.

SETTING: Rakai and Mbarara districts, south-western Uganda. OBJECTIVE: To compare compliance and other treatment outcomes with tuberculosis (TB) treatment for Rakai and Mbarara districts, and to elucidate factors associated with the disparity. DESIGN: A retrospective cohort analysis of tuberculosis treatment outcomes for the period 1992-1996. Predictors for compliance were examined for 1995 using univariate and multivariate methods. RESULTS: Of the surviving patients, 57% finished treatment in Mbarara compared to 92% in Rakai. Enhanced compliance on univariate analysis was associated with being smear positive; previous TB treatment; use of short-course chemotherapy; return for repeat smear; no change of health unit; no change of district; registration in Rakai; and not being hospitalised. On multivariate analysis, being smear positive, previous TB treatment, hospitalisation and registration site were not significant. The highest risk for default was unit change after the intensive phase of treatment, with an adjusted odds ratio of 17.53. The highest differences in the two districts were for the hospitalisation and unit change rates, with corresponding odds ratios of 52 and 0.06. CONCLUSIONS: Initial hospitalisation of TB patients is not necessary for subsequent completion of treatment. Use of one health unit for both the intensive and continuation phase of treatment may improve compliance.     

Acute reflux pancreatitis in rats: a comparison between two experimental models.

This study was undertaken in order to compare the reliability of two acute reflux pancreatitis models in rats, one performed by positioning a silicon tube in the duodenum and the other by creating a gastro-jejunal anastomosis. In two groups (A = 10 and B = 10 rats) a silicon tube was positioned in the duodenum; in the remaining two groups (C = 12 and D = 6 rats) a latero-lateral antecolic anisoperistaltic gastro-jejunal anastomosis was performed 30 days before surgery. A closed duodenal loop was created for 12 hours in groups A and C but not in B and D. Rats in both groups A and C developed acute pancreatic inflammation of a mild degree. Sham operated rats with silicon tube placement had higher histological damage scores than those with gastro-jejunal anastomosis. The difference found between the two groups of rats which underwent gastro-jejunal anastomosis was more marked than that between the two groups which had silicon tube placement. It was concluded that the creation of a gastro-jejunal anastomosis is probably the safer procedure to allow gastro-intestinal flow in acute reflux pancreatitis in rats.