Low-dose CT coronary angiography for assessment of coronary artery disease in patients with type 2 diabetes - A cross-sectional study

Background Silent coronary artery disease (CAD) is prevalent in type 2 diabetes mellitus (T2DM). Although coronary computed tomography angiography (CCTA) over recent years has emerged a useful tool for assessing and diagnosing CAD it’s role and applicability for patients with T2DM is still unclarified, in particular in asymptomatic patients. We aimed to assess the role of CCTA in detecting and characterizing CAD in patients with T2DM without cardiac symptoms when compared to gold standard invasive coronary angiography (ICA). Methods This was a cross-sectional analysis of patients with T2DM without symptomatic CAD enrolled in the Asker and Baerum Cardiovascular Diabetes Study who, following clinical examination and laboratory assessment, underwent subsequently CCTA and ICA. Results In total 48 Caucasian patients with T2DM (36 men, age 64.0 ± 7.3 years, diabetes duration 14.6 ± 6.4 years, HbA1c 7.4 ± 1.1 %, BMI 29.6 ± 4.3 kg/m2) consented to, and underwent, both procedures (CCTA and ICA). The population was at intermediate cardiovascular risk (mean coronary artery calcium score 269, 75 % treated with antihypertensive therapy). ICA identified a prevalence of silent CAD at 17 % whereas CCTA 35 %. CCTA had a high sensitivity (100 %) and a high negative predictive value (100 %) for detection of patients with CAD when compared to ICA, but the positive predictive value was low (47 %). Conclusions Low-dose CCTA is a reliable method for detection and exclusion of significant CAD in T2DM and thus may be a useful tool for the clinicians. However, a low positive predictive value may limit its usefulness as a screening tool for all CAD asymptomatic patients with T2DM. Further studies should assess the applicability for risk assessment beyond the evaluation of the vascular bed

Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study

<p>Abstract</p> <p>Background</p> <p>One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS).</p> <p>Methods</p> <p>Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups.</p> <p>Results</p> <p>There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence.</p> <p>Conclusion</p> <p>Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction.</p

The impact of PACS on radiographic interpretations in an orthopedic outpatient clinic

We found no significant change in the accuracy of clinicians' reading of skeletal radiographs before and after PACS- introduction. The level of inter-rater agreement between clinicians and radiologists was high in both periods, but they disagreed in significantly more cases after PACS

Cross-Table Lateral Radiographs Accurately Predict Displacement in Valgus-Impacted Femoral Neck Fractures

Background: Femoral neck fractures are classified as nondisplaced (Garden types I and II) or displaced (Garden types III and IV) on the basis of anteroposterior radiographs. Cross-table lateral radiographs are important in the assessment of Garden type-I and II fractures as posterior tilt of the femoral head may influence treatment results. A posterior tilt of >20° has been associated with an increased risk of treatment failure after internal fixation, although the precision of these measurements has not been validated. Therefore, the purpose of the present study was to compare cross-table lateral radiographs with 3-dimensional computed tomographic (3D-CT) reconstructions of Garden type-I and II femoral neck fractures. Methods: Twenty-three patients presenting with Garden type-I and II femoral neck fractures that were verified on anteroposterior radiographs underwent CT scanning immediately after radiographic examination. 3D models of the fractured and uninjured femora were reconstructed from the CT images, and displacement of the 3D models was determined by superimposing the fractured and uninjured femora. We defined a coordinate system with its origin at the center of the uninjured femoral head with the x axis oriented medially; the y axis, posteriorly; and the z axis, cranially. Correlations between lateral radiographs and 3D models were assessed with the Spearman rank coefficient, mean difference, and limits of agreement. Results: Posterior tilt of the femoral head on lateral radiographs was strongly correlated with displacement of the femoral head along the y axis of the 3D models, with a correlation coefficient of 0.86 (p < 0.001). Correlations between the findings on lateral radiographs and displacements along the x or z axis were weak, with coefficients of −0.30 (p = 0.18) and 0.21 (p = 0.34), respectively. The mean difference between displacement on lateral radiographs and displacement along the y axis of the 3D models was smaller, and demonstrated a smaller limits-of-agreement interval, compared with the x or z axis. Conclusions: Our results demonstrated a strong correlation between posterior displacement of the femoral head on lateral radiographs and displacement along the y axis in 3D models of Garden type-I and II femoral neck fractures. This finding indicates that lateral radiographs provide an accurate assessment of posterior tilt

Placental volume in gestational week 27 measured by three dimensional ultrasound and magnetic resonance imaging

Introduction Ultrasound is the diagnostic tool of choice in pregnancy. We lack valid ultrasound methods for placental size measurements. Our aim was therefore to compare three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for measurements of placental volume. Material and methods We measured placental volume by 3D ultrasound and MRI in 100 unselected pregnancies at 27 weeks of gestation (25+4–28+4 weeks). The 3D ultrasound acquisitions were analyzed offline, and the placental outline was manually traced using the virtual organ computer-aided analysis (VOCAL) 30° rotational technique. The MRI examinations included a T2-weighted gradient echo sequence in the sagittal plane, with 5-mm slices through the entire uterus. The placental outline was manually traced in each slice. The correlation between 3D ultrasound and MRI placental volumes was estimated by intraclass correlation coefficients. Bland-Altman analysis was applied to visualize systematic bias and limits of agreement, in which the ratio MRI placental volume/3D ultrasound placental volume was plotted against the average of the two methods. Results The intraclass correlation coefficient between 3D ultrasound and MRI measurements was 0.49 (95% confidence interval 0.33-0.63). In general, 3D ultrasound measured smaller placental volumes (median 373 cm3, interquartile range 309-434 cm3) than MRI (median 507 cm3, interquartile range 429-595 cm3) and the systematic bias was 1.44. The 95% limits of agreement between the two methods were wide (0.68-2.21). Conclusions We found poor to moderate correlation between 3D ultrasound and MRI placental volume measurements. Generally, 3D ultrasound measured smaller placental volumes than MRI, suggesting that 3D ultrasound failed to visualize the entire placenta. Our findings may hopefully contribute to the improvement of ultrasound methods for placental measurements

Improved Survival after Implementation of Multidisciplinary Team Meetings, Perioperative Chemotherapy, Extended Lymphnode Dissection and Laparoscopic Surgery in the Treatment of Advances Gastric Cancer

Aims: The treatment of gastric cancer has changed in the western countries during the last decade. This includes multidisciplinary team (MDT) meetings, perioperative chemotherapy, extended lymph node dissection, and laparoscopic surgery, all of which were gradually implemented at our department from 2008. The aim of the present study was to determine the effect of these changes on morbidity and survival. Material and Methods: 185 patients with gastric cancer were operated with curative intent from 2000 until 2016 in this retrospective, observational, follow-up study; 83 before implementation of modern principles in 2008 (period 1) and 102 were treated after 2008 (period 2). Results: The resection rate (94% vs 92.8%) and mortality rates (4.8% vs 2.9%) did not differ between the two periods. In period 2, 48 patients (47.1%), received neoadjuvant chemotherapy. In 36 patients (35.3%), laparoscopic surgery with D2 lymphadenectomy was performed. There was a significantly higher yield in the number of lymph nodes in period 2 compared to period 1 (14 vs 8, p < 0.001). This is also apparent between laparoscopic and open surgery in the second period (32 vs 10, p < 0.001). The five-year survival rate was significantly improved after the change in treatment principles with an estimated improvement from 30% to 40% between the periods (p = 0.033). Conclusion: The combined effect of MDT meetings, neoadjuvant chemotherapy, extended lymphnode dissection and laparoscopy has improved the prognosis of gastric cancer patients. KEYWORDS Gastric Cancer, Chemotherapy, Laparoscopy, Survival, D2 Lymphadenectom

Sudden infant death syndrome (SIDS) - Standardised investigations and classification: Recommendations

Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variety of heritable and idiosyncratic endogenous factors interacting with exogenous factors. This has been elegantly summarised in the "three hit" or "triple risk" model. Contradictions and lack of consistencies in the literature have arisen from diverse autopsy approaches, variable applications of diagnostic criteria and inconsistent use of definitions. An approach to Sudden infant death is outlined with discussion of appropriate tissue sampling, ancillary investigations and the use of controls in research projects. Standardisation of infant death investigations with the application of uniform definitions and protocols will ensure optimal investigation of individual cases and enable international comparisons of trends