Chest radiography in general practice: indications, diagnostic yield and consequences for patient management

BACKGROUND: Chest radiography (CXR) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care. AIM: To assess the influence of CXR on patient management in general practice. DESIGN OF STUDY: Prospective cohort study. SETTING: Seventy-eight GPs and three general hospitals in the Netherlands. METHOD: Patients (n = 792) aged > or =18 years referred by their GPs for CXR were included. The main outcome was change in patient management assessed by means of questionnaires filled in by GPs before and after CXR. RESULTS: Mean age of the patients was 57.3+/-16.2 years and 53% were male. Clinically relevant abnormalities were found in 24% of the CXRs. Patient management changed in 60% of the patients following CXR. Main changes included: fewer referrals to a medical specialist (from 26 to 12%); reduction in initiation or change in therapy (from 24 to 15%); and more frequent reassurance (from 25 to 46%). However, this reassurance was not perceived as such in a quarter of these patients. A change in patient management occurred significantly more frequently in patients with complaints of cough (67%), those who exhibited abnormalities during physical examination (69%), or those with a suspected diagnosis of pneumonia (68%). CONCLUSION: Patient management by the GP changed in 60% of patients following CXR. CXR substantially reduced the number of referrals and initiation or change in therapy, and more patients were reassured by their GP. Thus, CXR is an important diagnostic tool for GPs and seems a cost-effective diagnostic test.     

IL‐25 exhibits disparate roles during Th2‐cell differentiation versus effector function

A keenly sought therapeutic approach for the treatment of allergic disease is the identification and neutralization of the cytokine that regulates the differentiation of T helper 2 (Th2) cells. Th2 cells are exciting targets for asthma therapies. Recently, the cytokine IL‐25 has been shown to enhance Th2‐type immune activity and play important roles in mediating allergic inflammatory responses. To investigate this further, we crossed IL‐25^?/? C57BL/6 mice with G4 IL‐4 C57BL/6 reporter mice and developed an assay for in vitro and in vivo IL‐4‐independent Th2‐cell differentiation. These assays were used to determine whether IL‐25 was critical for the formation of Th2 cells. We found there was no physiological role for IL‐25 in either the differentiation of Th2 cells or their development to effector or memory Th2‐cell subsets. Importantly, this data challenges the newly found and growing status of the cytokine IL‐25 and its proposed role in promoting Th2‐cell responses.     

Quantitative diffusion weighted imaging for differentiation of benign and malignant breast lesions: The influence of the choice of b‐values

Purpose:

To evaluate the influence of the choice of different combinations of b‐values on the ADC and on the diagnostic performance of quantitative diffusion weighted imaging (DWI) in breast lesions.

Materials and Methods:

Seventy‐three patients (90 lesions) underwent 3 Tesla (T) breast MRI including a DWI‐scan using b‐values 0, 150, 499, and 1500 s/mm² and histological analysis. Five combinations of b‐values were used to calculate the ADC, each with different sensitivities to perfusion and diffusion effects. The median ADC of benign lesions, noninvasive carcinomas and invasive carcinomas and the diagnostic performance of the five methods were compared.

Results:

Eighty‐eight lesions were analyzed (37 benign, 13 noninvasive carcinomas, 38 invasive carcinomas). The median ADC was highest in benign lesions, intermediate in noninvasive carcinomas and lowest in invasive carcinomas for all methods. Calculating the ADC with the lowest 2 b‐values yielded the highest ADC for all lesions types; the highest 2 b‐values yielded the lowest ADC. The area under the receiver operating characteristic curve was approximately equal for all methods.

Conclusion:

The ADC of breast lesions varied substantially with the choice of different b‐values, indicating that absolute ADC threshold values to differentiate benign and malignant lesions should be interpreted with caution. However, the diagnostic performance of quantitative DWI was not affected by the choice of different b‐values. J. Magn. Reson. Imaging 2010;31:1100–1105. © 2010 Wiley‐Liss, Inc.     

Mild to Moderate Intrapulmonary Shunting in Pediatric Liver Transplantation: Is Screening Necessary?

Background

Despite reported associations between intrapulmonary vascular shunting (IPVS) and morbidity and mortality in pediatric liver transplantation (LT), there are no guidelines for screening.

Extensive Infection of Face by Mycobacterium chelonae: An Unusual Presentation

Mycobacterium chelonae is a rapidly growing mycobacteria, causes cutaneous, soft tissue, and rarely lung infections. Here we present a rare case of extensive infection of face at multiple sites by Mycobacterium chelonae, with an unusual presentation, diagnosed by using conventional methods.     

Value of papanicolaou smear in detection of Chlamydia trachomatis infection

This study was undertaken to assess the value of Papanicolaou smear for the diagnosis of Chlamydia trachomatis infection. The study was both retrospective (groups I and II) and prospective (group III). Group I consisted of 41 smears with cytomorphological changes proposed by Gupta, Kiviat, or Shiina. Group II was a control group, consisting of 30 cytologically normal smears. All these smears were subjected to specific immunofluorescent (IF) staining under identical conditions to confirm the diagnosis. In group III, 40 consecutive duplicate cervical smears were collected from patients attending the Sexually Transmitted Disease Clinic. One smear was routinely examined, and the specific IF staining was done on the other smear. The results in all the three groups were analysed. It was concluded that Papanicolaou smear is not useful in the detection of Chlamydia trachomatis infection.     

Therapeutic Consequences of Variation in Intraarterial Pressure Measurements After Iliac Angioplasty

Purpose: To assess the accuracy of intraarterial measurement of transstenotic pressure gradients for the detection of hemodynamically suboptimal iliac angioplasty. Methods: In 14 patients, referred for diagnostic angiography, mean pressure gradients in the aorta and iliac artery were obtained twice, using a double-sensor pressure catheter. Additional iliac measurements were performed during pharmacologically induced flow augmentation. Repeatability was assessed by calculation of the mean difference plus standard deviation (MD ± SD) and repeatability coefficient (2 × SD). These results were extrapolated to 137 iliac angioplasty procedures with secondary stenting where there was a residual pressure gradient > 10 mmHg. Results: MD ± SD for repeated measurements at rest and during flow augmentation were 0 ± 2 mmHg and 1 ± 3 mmHg, respectively. Repeatability coefficients were 3 and 6 mmHg. Mean pressure gradients after hemodynamically insufficient angioplasty were 8 ± 7 mmHg at rest and 17 ± 5 mmHg following vasodilatation. Inaccurate pressure recordings may have led to inappropriate stent placement in less than 2.5%, and inappropriate denial of stent placement in less than 5% of the lesions. Conclusion: Variability of intraarterial pressure measurements has little consequence in the detection of hemodynamically significant stenosis after angioplasty. Received: 0/00/00/Accepted: 0/00/00     

Perforating arteries originating from the posterior communicating artery: a 7.0-Tesla MRI study

The aim of this study was to investigate the ability of time-of-flight (TOF) magnetic resonance (MR) angiography at 7.0 Tesla to show the perforating branches of the posterior communicating artery (PCoA), and to investigate the presence of such visible perforating branches in relation to the size of the feeding PCoA. The secondary aim was to visualise and describe the anterior choroidal artery and the perforating branches of the P1-segment of posterior cerebral artery (P1). Forty-six healthy volunteers underwent TOF MR angiography at 7.0 Tesla. With 7.0-Tesla imaging, we visualised for the first time perforating arteries originating from the PCoA in vivo without the use of contrast agents. A perforating artery from the PCoA was found in a large proportion of the PCoAs (64%). The presence was associated with a larger diameter of the underlying PCoA (1.23 versus 1.06 mm, P = 0.03). The anterior choroidal artery was visible bilaterally in all participants. In 83% of all P1s, one or two perforating branches were visible. Non-invasive assessment of the perforating arteries of the PCoA together with the anterior choroidal artery and the perforating arteries of the P1 may increase our understanding of infarcts in the deep brain structures supplied by these arteries.