How can patient registries facilitate guideline-based healthcare? A retrospective analysis of the CEDATA-GPGE registry for pediatric inflammatory bowel disease

Background: Early diagnosis is mandatory for the medical care of children and adolescents with pediatric-onset inflammatory bowel disease (PIBD). International guidelines ('Porto criteria') of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommend medical diagnostic procedures in PIBD. Since 2004, German and Austrian pediatric gastroenterologists document diagnostic and treatment data in the patient registry CEDATA-GPGE on a voluntary basis. The aim of this retrospective study was to analyze whether the registry CEDATA-GPGE reflects the Porto criteria and to what extent diagnostic measures of PIBD according to the Porto criteria are documented. Methods: Data of CEDATA-GPGE were analyzed for the period January 2014 to December 2018. Variables representing the Porto criteria for initial diagnostic were identified and categorized. The average of the number of measures documented in each category was calculated for the diagnoses CD, UC, and IBD-U. Differences between the diagnoses were tested by Chi-square test. Data on possible differences between data documented in the registry and diagnostic procedures that were actually performed were obtained via a sample survey. Results: There were 547 patients included in the analysis. The median age of patients with incident CD (n = 289) was 13.6 years (IQR: 11.2-15.2), of patients with UC (n = 212) 13.1 years (IQR: 10.4-14.8) and of patients with IBD-U (n = 46) 12.2 years (IQR: 8.6-14.7). The variables identified in the registry fully reflect the recommendations by the Porto criteria. Only the disease activity indices PUCAI and PCDAI were not directly provided by participants but calculated from obtained data. The category 'Case history' were documented for the largest part (78.0%), the category 'Imaging of the small bowel' were documented least frequently (39.1%). In patients with CD, the categories 'Imaging of the small bowel' (χ2 = 20.7, Cramer-V = 0.2, p < 0.001) and 'Puberty stage' (χ2 = 9.8, Cramer-V = 0.1, p < 0.05) were documented more often than in patients with UC and IBD-U. Conclusion: The registry fully reproduces the guideline's recommendations for the initial diagnosis of PIBD. The proportion of documented diagnostic examinations varied within the diagnostic categories and between the diagnoses. Despite technological innovations, time and personnel capacities at participating centers and study center are necessary to ensure reliable data entry and to enable researchers to derive important insights into guideline-based care

POOR-QUALITY RED-BLOOD-CELL LABELING WITH TC-99M - CASE-REPORT AND REVIEW OF THE LITERATURE

Technetium-99m red blood cell (RBC) venography is a simple and sensitive technique for the diagnosis of deep vein thrombosis of the lower limb, but optimal labelling of the blood pool is essential for a diagnostic study. Here we report the case of a 44-year-old male with deep vein thrombosis of the right leg. RBC venography of the lower extremities showed poor labelling. In addition we review the literature on the subject

Comparison of Tc-99m methylene diphosphonate, Tc-99m human immune globulin, and Tc-99m-labeled white blood cell scintigraphy in the diabetic foot

Purpose: The aims of this prospective study were to evaluate the contribution of Tc-99m methylene diphosphonate (MDP), Tc-99m human immune globulin (HIG), and Tc-99m white blood cell (WBC) to the diagnosis of osteomyelitis in the diabetic foot and to evaluate the surgical or medical therapy with Tc-99m HIG and Tc-99m WBC scans

Comparison of Tc-99m MIBI and TI-201 uptake in musculoskeletal lesions

The aim of this study was to make a comparison between the uptake of Tc-99m MIBI and Tl-201 in evaluation of musculoskeletal lesions, Fourteen cases were studied, Each study consisted of a Tl-201 study followed by a Tc-99m MIBI scan, In addition, a whole-body bone scan was performed in each patient to visualize bone metastases, Tl-201 and Tc-99m MIBI uptakes were evaluated by visual assessment and by using lesion-to-background (L/B) ratio, The authors found increased Tl-201 uptake with a mean L/B ratio of 2.81 and less Tc-99m MIBI uptake with a mean L/B ratio of 2.18 in malignant lesions, Both agents showed lower uptake with mean L/B ratios of 1,6 and 1.2 in benign lesions, but there was no statistical difference between the uptakes of either Tl-201 or Tc-99m MIBI in those with malignant and those with benign lesions, In addition, false-positive imaging was observed with both Tl-201 and Tc-99m MIBI. The results demonstrated that Tl-201 and Tc-99m MIBI accumulations in musculoskeletal lesions are not specific for malignancy

VISUALIZATION OF A PERFORATED SMALL-BOWEL DUPLICATION DURING MECKEL SCINTIGRAPHY

A case of a small bowel tubular duplication is described. It was lined with ectopic gastric mucosa which showed a perforation. The diagnosis was made preoperatively by Tc-99m pertechnetate scintigraphy

TC-99M NANOCOLLOID AND TC-99M MDP 3-PHASE BONE IMAGING IN OSTEOMYELITIS AND SEPTIC ARTHRITIS - A COMPARATIVE-STUDY

The aim of this study was to compare Tc-99m nanocolloid scintigraphy with Tc-99m MDP bone imaging in the diagnosis of osteomyelitis and septic arthritis. Overall, 31 Tc-99m MDP bone scans and 39 Tc-99m nanocolloid studies were performed in 34 patients (15 female, 19 male; mean age, 14.88 years +/- 19.00 years) who were suspected of osteomyelitis and/or septic arthritis. The final diagnoses were established by needle aspiration, cultures, radiography, clinical course, and, in some patients, with CT, ultrasonography, and biopsy. The sensitivity, specificity, and accuracy were 100%, 75%, and 92%, respectively for both Tc-99m MDP and Tc-99m nanocolloid scans in detecting osteomyelitis. For septic arthritis, Tc-99m MDP bone imaging showed 100%, 85%, and 94%, and Tc-99m nanocolloid scans showed 90%, 59%, and 76%, sensitivity, specificity, and accuracy, respectively. These results show that, although both scans are in good agreement for osteomyelitis, for septic arthritis nanocolloid is not specific enough to recommend it to be a complementary method to MDP bone scans

Tc-99(m)-polyclonal IgG scintigraphy in the detection of infected hip and knee prostheses

We investigated the usefulness of Tc-99(m)-polyclonal human IgG (Tc-99(m)-HIG) scintigraphy in the diagnosis of infected hip and knee prostheses. Twenty-nine scintigraphic studies were performed in 27 patients (17 females, 10 males) with a suspected prosthetic infection. As some patients had bilateral prostheses, a total of 35 prostheses were evaluated. There were 25 hip replacements and 10 knee prostheses. The images were analysed both visually and quantitatively. The scintigraphic results were compared with the culture results of surgical specimens and also with clinical follow-up after 3 months. Increased uptake was observed in 22 prostheses, of which 12 were true-positive and 10 were false-positive results. Staphylococci were the agents most commonly isolated. In all false-positive patients, aseptic inflammation was diagnosed. Based on quantitative analysis, no statistically significant difference was found between the true-positive and false-positive cases. For the prostheses as a whole, the sensitivity, specificity, positive predictive value and negative predictive value were 100%, 41%, 54% and 100% respectively. For the hip prostheses alone, these values were 100%, 53%, 57% and 100% respectively. Taking its high sensitivity and predictive value into consideration, Tc-99(m)-HIG scintigraphy can be used as a screening test to help eliminate prosthetic infection