Initial evaluation of a continuous speech recognition program for radiology

The aims of this work were to measure the accuracy of one continuous speech recognition product and dependence on the speaker's gender and status as a native or nonnative English speaker, and evaluate the product's potential for routine use in transcribing radiology reports. IBM MedSpeak/Radiology software, version 1.1 was evaluated by 6 speakers. Two were nonnative English speakers, and 3 were men. Each speaker dictated a set of 12 reports. The reports included neurologic and body imaging examinations performed with 6 different modalities. The dictated and original report texts were compared, and error rates for overall, significant, and subtle significant errors were computed. Error rate dependence on modality, native English speaker status, and gender were evaluated by performing ttests. The overall error rate was 10.3 +/- 3.3%. No difference in accuracy between men and women was found; however, significant differences were seen for overall and significant errors when comparing native and nonnative English speakers (P = .009 and P = .008, respectively). The speech recognition software is approximately 90% accurate, and while practical implementation issues (rather than accuracy) currently limit routine use of this product throughout a radiology practice, application in niche areas such as the emergency room currently is being pursued. This methodology provides a convenient way to compare the initial accuracy of different speech recognition products, and changes in accuracy over time, in a detailed and sensitive manner.     

Value of an implantable EKG monitor for the diagnosis of arrhythmic syncope in children]

The value of an implantable ECG monitor (Reveal TM Plus) is reported in a 12 year old child with unexplained syncopal episodes despite extensive investigations. Twenty-seven days after the implantation, ventricular tachycardia at 450/min was recorded at the first recurrence. This case shows that this type of monitoring can be particularly useful when an arrhythmia is thought to be the cause of syncope in a child and the initial investigation is negative.     

Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO)

In order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for the treatment of breast cancer when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy (ELIOT) is proposed. One thousand and one nipple sparing mastectomies (NSM) were performed from March 2002 to November 2007 at the European institute of oncology (EIO), for invasive carcinoma in 82% of the patients and in situ carcinoma in 18%. Clinical complications, aesthetic results, oncological and psychological results were recorded. A comparison was performed between the 800 patients who received ELIOT and the 201 who underwent delayed one-shot radiotherapy on the days following the operation. The median follow up time was 20 months (range 1–69) for a follow up performed in 83% of the patients. The NAC necrosed totally in 35 cases (3.5%) and partially in 55 (5.5%) and was removed in 50 (5%). Twenty infections (2%) were observed and 43 (4.3%) prostheses removed. The median rate of the patients for global cosmetic result on a scale ranging from 0 (worst) to 10 (excellent) was 8. Evaluation by the surgeon in charge of the follow-up gave a similar result. Only 15% of the patients reported a partial sensitivity of the NAC. Of the fourteen (1.4%) local recurrences, ten occurred close to the tumour site, all far from the NAC corresponding to the field of radiation. No recurrences were observed in the NAC. In a group of patients characterized by a very close free margin under the areola, no local recurrence was observed. Overall, 36 cases of metastases and 4 deaths were observed. No significant outcome difference was observed between the 800 patients receiving intraoperative radiotherapy (ELIOT) and the 201 patients receiving delayed irradiation.     

Revisiting the role of doxorubicin in the treatment of rhabdomyosarcoma: an up-front window study in newly diagnosed children with high-risk metastatic disease

PurposeMany cooperative groups have reported on the chemo-sensitivity of rhabdomyosarcoma (RMS). Doxorubicin has been tested but remains a controversial treatment option. We report here the results of the up-front evaluation of the efficacy of doxorubicin in children and adolescents with high-risk metastatic RMS.Patients and methodsPatients younger than 18 years of age (>6 months) with newly diagnosed, histologically confirmed high-risk metastatic RMS were required to have measurable disease, to have undergone no prior chemotherapy or radiation therapy and to have normal liver, renal and cardiac function before treatment. Doxorubicin was administered intravenously over 48 h to a total dose of 60 mg/m². Two courses were given separated by a 21 day interval. Response to therapy was assessed by diagnostic imaging after the second course. The study was designed as a two-stage procedure according to the multistep plan described by Fleming.ResultsTwenty patients were eligible for analysis. Median age at diagnosis was 9.8 years (range from 2 to 16). Thirteen of the 20 patients treated in the first step responded to treatment, corresponding to an overall response to doxorubicin of 65% [95% confidence interval (CI), 44–85%]. The rates of CR and PR were 5% [95% CI, 0–14%] and 60% [95% CI, 39–81%], respectively. Four (20%) patients had progressive disease, corresponding to a progression rate of 20% [95% CI, 2–38%].ConclusionThis window study provides the definitive demonstration of the efficacy of doxorubicin in untreated RMS. Given the inconclusive results obtained from previous studies using differing schedules chemotherapy incorporating doxorubicin, the next step should be a randomised study testing dose intensity in high-risk localised RMS. This issue is being addressed in a current European study (EpSSG RMS 2005).     

Causal agents of photoallergic contact dermatitis diagnosed in the national institute of dermatology of Colombia

OBJECTIVE: To describe and identify the photoallergens causing photoallergic contact dermatitis in the population attending the outpatient clinic of the Centro Dermatologico Federico Lleras Acosta (CDFLLA), the National Institute of Dermatology of Colombia. MATERIALS AND METHODS: Eighty-two patients with clinical diagnosis of photoallergic contact dermatitis enter the study. These patients attended the CDFLLA between August 2001 and May 2003. Photopatch tests were performed using the standard series of sunscreens (Chemotechnique Diagnostics) and 6-methylcoumarin. Cetyl alcohol, phenoxyethanol, methylparabene, propylene glycol, triethanolamine, propylparabene, trichlorocarbanilide and dichromate were also included. The allergens were applied in duplicate on the healthy skin of the back and covered with opaque tape withdrawn 24 h later, the panel on the right was irradiated with an ultraviolet A dose of 5 J/cm(2). The tests were read 24 h after the application of the allergens, 24 and 72 h post-irradiation. The readings were assessed according to the visual scoring system recommended by the International Contact Dermatitis Research Group. RESULTS: Twenty-six patients (31.7%) showed positive photopatch test responses to one or several allergens. Four of them showed positive results to three components of the series and four patients to two components. Thirty-eight photoallergic and 18 allergic reactions were observed. Ultraviolet filters were the substances which more frequently produced positive photopatch test responses (30.5%). The most common ultraviolet filter photoallergen was benzophenone-3 with 22/82 positive results (26.8%), followed by octyl methoxycinnamate (8/82), benzophenone-4 and mexenone (2/82), phenylbenzimidazole sulphonic acid, methylbenziliden camphor and octyl dimethyl PABA (1/82). One patient showed a photoallergic response to 6-methylcoumarin. There was a concordance between the allergen which elicited the positive response and the use of different substances which contained that molecule among its compounds in 17 patients (65.3%). 19.5% of the patients (16/82) showed positive results to one or several allergens in the irradiated panel as well as in the unirradiated control site. These cases were diagnosed as contact allergy, probably caused by aeroallergens, presenting a natural history and a clinical picture similar to photocontact allergy. The most common allergen was dichromate with 10 positive results. CONCLUSIONS: The results of this study confirm that sunscreens are the more frequently involved substances in photoallergic contact dermatitis in our population. Identification of the photoallergen is the key element for adequate disease control and patient education.     

Treatment of orbital rhabdomyosarcoma: survival and late effects of treatment--results of an international workshop.

PURPOSE: Orbital rhabdomyosarcoma (RMS) historically has been associated with an excellent survival rate. The majority of patients are cured with the use of both chemotherapy and radiation therapy, but a significant number experience important late sequelae of treatment. In an attempt to determine optimal therapy in relation both to cure and to sequelae, the experience of the four international collaborative groups (Intergroup Rhabdomyosarcoma Study Group [IRSG], International Society of Paediatric Oncology [SIOP] Sarcoma Committee, German Collaborative Soft Tissue Sarcoma Group [CWS], and Italian Cooperative Soft Tissue Sarcoma Group [ICG] studies) was shared at an international workshop. PATIENTS AND METHODS: A total of 306 eligible patients were identified from group records (186 from IRS, 43 from SIOP MMT, 40 from CWS, and 37 from ICG). Median age was 6.8 years, and median follow-up was 6.5 years. Eighty percent of patients received radiation therapy (RT) as part of primary therapy, but there were significant differences in the use of RT between the individual groups (93% in IRSG, 76% in ICG, and 70% in CWS, but only 37% in the SIOP MMT group). RESULTS: At 10 years, event-free and overall survival for the whole cohort were 77% (range, 71% to 81%) and 87% (range, 82% to 92%), respectively. There was no difference in overall survival between the collaborative groups regardless of differences in the use of initial RT. In total, 34 (12%) of 273 survivors had not received RT, although this varied between the different groups (41% in the SIOP MMT group, 20% in CWS, 7% in ICG, and 6% in IRSG). There was no difference in overall survival for the whole cohort regardless of whether radiotherapy was used as part of initial therapy (86% at 10 years for both). CONCLUSION: These data suggest that a subset of patients with orbital RMS can be cured without systematic local therapy, although the total burden of treatment (primary therapy and treatment for relapse) must be taken into account when assessing the implications for late sequelae.