Arthrography of the knee: a comparative study of the accuracy of single and double contrast techniques

Single and double contrast arthrographic techniques were compared in 951 patinets with suspected meniscal injuries. Exploratory surgery of the knee was performed in 384 of these patients and good clinical follow-up was obtained in 135 patients. In the latter two groups of patients, the single contrast technique was 97% accurate in assessing the medial meniscus and 96% accurate in assessing the lateral meniscus. Double contrast arthrography was 97% accurate in assessing the medial meniscus and 93% accurate in assessing the lateral meniscus. Numerical differences in the results from the two techniques were not statistically significant. Therefore both techniques can be considered equally effective diagnostically.     

Detailed per-oral small bowel examination vs. enteroclysis. Part II: Radiographic accuracy

Accuracy of the detailed per-oral small bowel series and enteroclysis was compared in 134 patients known to have (or not have) disease of the small bowel. Overall sensitivity of the per-oral examination was 92% and specificity 94%, compared to 94% and 89%, respectively, for enteroclysis. There was no difference between the two in Crohn disease, adhesions, and metastatic disease; however, enteroclysis was thought to be more effective in delineating peritoneal adhesions in patients with obstruction. The authors conclude that while the per-oral study and enteroclysis are equally valid methods of examining the small bowel, the per-oral study is preferable as a screening examination because it requires less time, has fewer side effects, and involves a lower radiation exposure.     

Evaluation of the role of location and distance in recruitment in respondent-driven sampling

Background

The purpose of the project was to delineate a series of contiguous neighbourhood-based "Data Zones" within the Region of Peel (Ontario) for the purpose of health data analysis and dissemination. Zones were to be built on Census Tracts (N = 205) and obey a series of requirements defined by the Region of Peel. This paper explores a method that combines statistical analysis with ground-truthing, consultation, and the use of a decision tree.

Data

Census Tract data for Peel were derived from the 2006 Canadian Census Master file.

Methods

Following correlation analysis to reduce the data set, Principal Component Analysis was applied to the data set to reduce the complexity and derive an index. The Getis-Ord Gi*statistic was then applied to look for statistically significant clusters of like Census Tracts. A detailed decision tree for the amalgamation of remaining zones and ground-truthing with Peel staff verified the resulting zones.

Results

A total of 15 Data Zones that are similar with respect to socioeconomic and sociodemographic attributes and that met criteria defined by Peel were derived for the region.

Conclusion

The approach used in this analysis, which was bolstered by a series of checks and balances throughout the process, gives statistical validity to the defined zones and resulted in a robust series of Data Zones for use by Peel Public Health. We conclude by offering insight into alternative uses of the methodology, and limitations.     

Clinical and economic outcomes of thyroid and parathyroid surgery in children

CONTEXT: Clinical and economic outcomes after thyroidectomy/parathyroidectomy in adults have demonstrated disparities based on patient age and race/ethnicity; there is a paucity of literature on pediatric endocrine outcomes. OBJECTIVE: The objective was to examine the clinical and demographic predictors of outcomes after pediatric thyroidectomy/parathyroidectomy. DESIGN: This study is a cross-sectional analysis of Healthcare Cost and Utilization Project-National Inpatient Sample hospital discharge information from 1999-2005. All patients who underwent thyroidectomy/parathyroidectomy were included. Bivariate and multivariate analyses were performed to identify independent predictors of patient outcomes. SUBJECTS: Subjects included 1199 patients 17 yr old or younger undergoing thyroidectomy/parathyroidectomy. MAIN OUTCOME MEASURES: Outcome measures included in-hospital patient complications, length of stay (LOS), and inpatient hospital costs. RESULTS: The majority of patients were female (76%), aged 13-17 yr (71%), and White (69%). Whites were more often in the highest income group (80% vs. 8% for Hispanic and 6% for Black; P < 0.01) and had private/HMO insurance (76% vs. 10% for Hispanic and 5% for Black; P < 0.001) rather than Medicaid (13% vs. 32% for Hispanic and 41% for Black; P < 0.001). Ninety-one percent of procedures were thyroidectomies and 9% parathyroidectomies. Children aged 0-6 yr had higher complication rates (22% vs. 15% for 7-12 yr and 11% for 13-17 yr; P < 0.01), LOS (3.3 d vs. 2.3 for 7-12 yr and 1.8 for 13-17 yr; P < 0.01), and higher costs. Compared with children from higher-income families, those from lower-income families had higher complication rates (11.5 vs. 7.7%; P < 0.05), longer LOS (2.7 vs. 1.7 d; P < 0.01), and higher costs. Children had higher endocrine-specific complication rates than adults after parathyroidectomy (15.2 vs. 6.2%; P < 0.01) and thyroidectomy (9.1 vs. 6.3%; P < 0.01). CONCLUSIONS: Children undergoing thyroidectomy/parathyroidectomy have higher complication rates than adult patients. Outcomes were optimized when surgeries were performed by high-volume surgeons. There appears to be disparity in access to high-volume surgeons for children from low-income families, Blacks, and Hispanics.     

Survival of human cadaver skin on severe combined immune deficiency pigs: Proof of concept

Transplantation of human xenografts onto immunocompromised mice is a powerful research tool for studying wound healing. However, differences in healing between humans and mice and their small size limit this model. We determined whether human cadaver skin xenografts transplanted onto pigs with severe combined immune deficiency (SCID) would survive and not be rejected. Meshed (1:1.5), cryopreserved human cadaver skin was transplanted onto 10 partial thickness dermatome wounds in each of two normal domestic pigs and two SCID pigs. Autografts (n = 2/animal) from the four animals were used as controls. In normal pigs, all autografts were engrafted and healed with a minimal, if any, inflammation and scarring. All human xenografts were rejected by the normal pigs within 5–11 days and associated with an intense T‐cell inflammatory response. In contrast, both autografts and xenografts were engrafted and survived the 28‐day study in the SCID pigs with a minimal inflammation and no gross scarring.