Reliability testing of tendon disease using two different scanning methods in patients with rheumatoid arthritis

Objective. To assess the intra- and interobserver reliability of musculoskeletal ultrasonography (US) in detecting inflammatory and destructive tendon abnormalities in patients with RA using two different scanning methods. Methods. Thirteen observers examined nine patients with RA and one healthy individual in two rounds independently and blindly of each other. Each round consisted of two consecutive examinations, an anatomy-based examination and a free examination according to personal preferences. The following tendons were evaluated: wrist extensor compartments 2, 4 and 6, finger flexor tendons 3 and 4 at MCP level, tibialis posterior tendon and both peronei tendons. Overall, positive and negative agreements and κ-values for greyscale (GS) tenosynovitis, peritendinous power Doppler (PPD) signal, intratendinous power Doppler (IPD) signal and GS tendon damage were calculated. Results. Intraobserver κ-value ranges were 0.53-0.55 (P?相似文献   

Lymphokine-induced phagocytosis in angiocentric immunoproliferative lesions (AIL) and malignant lymphoma arising in AIL

A factor that augmented the phagocytosis of IgG-coated ox red blood cells by the human monocyte/macrophage line U937 was identified in cell culture supernatants from two of two patients with angiocentric peripheral T cell lymphomas, three of three patients with angiocentric immunoproliferative lesions that were not frankly malignant, and one of two patients with T lymphoblastic malignancies. The factor was not present in supernatants derived from 14 nonangiocentric peripheral T cell lymphomas of other histologic types nor in ten cases of B cell lymphoma and two cases of Hodgkin's disease. A similar factor was present in the supernatants of concanavalin A (Con A)-stimulated normal peripheral blood mononuclear cells and in the supernatants of IL-2- dependent T cell lines derived from normal peripheral blood. The factor had an apparent mol wt of greater than 50,000 daltons, was heat labile (100 degrees C for two minutes), and stable at pH 2.0. Its stimulation of phagocytosis was independent of any increase in number of Fc receptors. Thus, this factor is probably not gamma-interferon. This factor may play a pathogenetic role in the hemophagocytic syndromes associated with certain T cell malignancies and immunodeficient states.     

Pneumothorax and other lung diseases: effect of altered resolution and edge enhancement on diagnosis with digitized radiographs

Prior studies have shown that pneumothorax is one of the more difficult entities to diagnose with digitized radiography. This study was designed to test whether increasing resolution from 1.25 to 2.5 line pairs per millimeter (lp/mm) and image processing (edge enhancement from unsharp masking) would increase accuracy and confidence in the diagnosis of pneumothorax, as well as normal cases and other forms of lung disease. Conventional radiographs were digitized with use of a laser reader and then reformatted as film hard copy. Eleven observers read 35 cases reformatted in three different ways (1.25 lp/mm, 2.5 lp/mm, 1.25 lp/mm unsharp mask). The images with finer resolution (2.5 lp/mm) and unsharp mask images were superior to those with coarser resolution (1.25 lp/mm) for the diagnosis of pneumothorax. There was no difference in diagnostic accuracy for normal patients. For abnormalities other than pneumothorax, the unsharp mask images were significantly worse. Confidence in the diagnosis of pneumothorax and other abnormalities was highest with the finest resolution (2.5 lp/mm).     

Digital and conventional chest images: observer performance with Film Digital Radiography System

The Film Digital Radiography System (FilmDRS) is a device with a laser optical film digitizer, 2,000 X 2,000 X 12-bit memory, and a 1,000-line video display. To evaluate the adequacy of this device for general radiography of the chest, four readers independently analyzed both radiographs and the corresponding video display of the digitized chest images of 150 patients, consisting of 100 images of abnormalities and 50 normal images. The overall results indicate equal sensitivity for the two systems. The FilmDRS, with interactive windowing, proved superior in the detection of hilar and mediastinal disease. X-ray film was superior in allowing detection of hyperlucent states. There was equivalent sensitivity for other disease categories. Superior specificity was achieved with conventional radiographs.     

Focal liver masses: differential diagnosis with pulsed Doppler US

Duplex Doppler ultrasound (US) was used in 68 consecutive patients with focal liver lesions, including 12 hepatocellular carcinomas, one cholangiocarcinoma, 37 metastases, 15 hemangiomas, one hemangioendothelioma, and two focal nodular hyperplasias. Of the hepatocellular carcinomas, six were diffusely hyperechoic, two were hypoechoic, two were single hyperechoic lesions, and two were multifocal and hyperechoic. All ten tumors with Doppler shifts of 5 kHz or above proved to be hepatocellular carcinomas. The other two hepatocellular carcinomas showed Doppler shifts of 3 kHz. In contrast, no hemangioma showed shifts above 0.7 kHz, and ten of the 15 gave no detectable signal. Of the metastases, 20 gave no signal and 17 had signals of up to 4 kHz. Three-kilohertz signals were also obtained from a cholangiocarcinoma, a hemangioendothelioma, and focal nodular hyperplasia. Correlation with angiographic findings suggested that the high-velocity Doppler signals were associated with large pressure gradients due to arteriovenous shunting. Duplex Doppler US can therefore aid in the differential diagnosis of diffuse and focal liver lesions.     

The effect of cigarette smoke on gastroduodenal mucosal endogenous prostacyclin level (experimental and clinical observations)

In our opinion the endogenous prostacyclin (PGI2) is one of the most important natural protective substances in the gastric mucosa. We have, therefore checked in experimental circumstances in rats, as well as in clinical observations in humans, the possible effect of smoking on endogenous gastroduodenal mucosal PGI2 level. The animal experiments seem to verify that cigarette smoke really has an unwanted effect on the gastric mucosa. The target of this action is the endogenous PGI2 content of the mucosa. According to our observations in humans there is a definite tendency toward decreased endogenous PGI2 production in the gastroduodenal mucosa of smokers too.     

Investigation of Gastrointestinal Bleeding in Patients with End Stage Renal Disease

In order to evaluate the source and course of gastrointestinal bleeding in patients with established renal insufficiency, we reviewed data on 40 patients with renal failure and gastrointestinal bleeding seen over 2 yr. A randomly selected control group of 39 patients without renal failure was used for comparison. Medical records of our University Hospital were reviewed, and patients with a documented gastrointestinal bleed and renal insufficiency (creatinine greater than 1.7 mg/dl) were included in this study. Panendoscopy was the most valuable procedure in terms of establishing a diagnosis as to the cause of bleeding. Colonoscopy was of questionable value unless the bleed was clearly of lower intestinal origin. Recurrent bleeding during the index admission occurred with the same frequency in both groups of patients. Both groups used nonsteroidal anti-inflammatory agents frequently. The findings and outcome for this group of patients with renal failure was comparable to the control patients with gastrointestinal bleeding.     

Are women who have abortions different from those who do not? A secondary analysis of the 1990 national survey of sexual attitudes and lifestyles

Studies of women undergoing termination of a pregnancy are often used to make recommendations about family planning and health education policy. However, it is not clear how similar the women in these studies are to the general population of women of childbearing age. Our secondary analysis of the National Sexual Attitudes and Lifestyles Survey allowed us to test the hypothesis that women who have undergone an abortion are the same as those who have not (in terms of socio-demographic characteristics, lifestyles, and attitudes). Our findings show significant differences between these two groups of women, particularly regarding ethnicity, marital status, number of natural children, lifetime number of sexual partners, and attitudes to abortion. We conclude that family planning/reproductive health services and health education policies need to take these differences into account and that further research is required to explain why these differences arise.