A comparison between digital images viewed on a Picture Archiving and Communication System diagnostic workstation and on a PC-based remote viewing system by emergency physicians

Picture Archiving and Communication Systems (PACS) make possible the viewing of radiographic images on computer workstations located where clinical care is delivered. By the nature of their work this feature is particularly useful for emergency physicians who view radiographic studies for information and use them to explain results to patients and their families. However, the high cost of PACS diagnostic workstations with fuller functionality places limits on the number of and therefore the accessibility to workstations in the emergency department. This study was undertaken to establish how well less expensive personal computer-based workstations would work to support these needs of emergency physicians. The study compared the outcome of observations by 5 emergency physicians on a series of radiographic studies containing subtle abnormalities displayed on both a PACS diagnostic workstation and on a PC-based workstation. The 73 digitized radiographic studies were randomly arranged on both types of workstation over four separate viewing sessions for each emergency physician. There was no statistical difference between a PACS diagnostic workstation and a PC-based workstation in this trial. The mean correct ratings were 59% on the PACS diagnostic workstations and 61% on the PC-based workstations. These findings also emphasize the need for prompt reporting by a radiologist.     

The Effects of Danazol After Endometrial Resection: Results of a randomized, placebo-controlled, double-blind study

Summary: We report the results of a controlled, randomized, prospective, 'double blind' evaluation of the effect of danazol treatment in 120 patients after hysteroscopic endometrial resection. After endometrial resection, the women were allocated to 1 of 3 groups: Group A—placebo; Group B—high-dose danazol (600 mg daily); Group C—low-dose danazol (200 mg daily) plus placebo tablets. Tablets were specifically manufactured for the study, were identical in appearance, and were supplied in individual prepackaged boxes. The duration of treatment was 3 months and patients' compliance was noted. Amenorrhoea, dysmenorrhoea and premenstrual tension symptoms were assessed for each group by 1 or 2 independent gynaecologists at follow-up intervals of 6 weeks, 3, 6 and 12 months. A statistically-significant increased rate of amenorrhoea was found in patients who received treatment with the higher-dose danazol (600 mg day) following endometrial resection. While not statistically significant, the same trend was noted with the low-dose danazol. This result should influence our clinical management of women with menorrhagia, and the long-term results on the same cohort of patients are awaited with interest.     

Seizure outcome for surgery of extratemporal epilepsy

Over a 10-year period, 64 surgical operations were carried out on 55 patients suffering from refractory extratemporal epilepsy. Patient class outcome 3 years after the final surgical procedure showed that 9 patients (16%) were completely seizure free and 21 patients (38%) had less than a 50% reduction in seizure outcome. Corpus callosal section as a surgical procedure had the highest percentage (57%) of patients with a class 4 outcome. Corpus callosotomy as a final operation resulted in reduction in frequency and severity of ‘drop attacks’ in all patients. Gliosis without atrophy was the most common histopathology. There were no deaths as a result of surgery, although 4 patients died postsurgery; 2 died in status epilepticus. Multiple lobectomy was the most successful surgical procedure, with a Prognostic Index of 2.0, followed by 2.5 for extratemporal tumour resection. Corpus callosotomy and cystectomy had a Prognostic Index of 3.3 and 3.1, respectively.