[Use of an expert system as a tool to carry out urinary cyto-bacteriologic tests].

International audienceAn expert system for urine examinations was developed. Its validation was performed in a routine work, by comparison of expert decisions with software conclusions. Results of finished examinations or in progress were taken into account. The agreement was satisfactory. In addition to reliability, advantages constituted by availability, flexibility and adaptability were notified. Repeatability and reproducibility were also emphasized

[Use of an expert system as a tool to carry out urinary cyto-bacteriologic tests].

International audienceAn expert system for urine examinations was developed. Its validation was performed in a routine work, by comparison of expert decisions with software conclusions. Results of finished examinations or in progress were taken into account. The agreement was satisfactory. In addition to reliability, advantages constituted by availability, flexibility and adaptability were notified. Repeatability and reproducibility were also emphasized

Value of preoperative echocardiography for the diagnosis of coronary artery patterns in neonates with transposition of the great arteries

International audienceBACKGROUND: Abnormal coronary pattern may complicate coronary transfer during arterial switch operation. OBJECTIVE: To evaluate the accuracy of echocardiography in assessing the anatomy of coronary arteries in neonates with transposition of the great arteries, and determine impact on outcomes. METHODS: We conducted a retrospective analysis of data in neonates with transposition of the great arteries. Preoperative echocardiographic coronary artery pattern and surgical intraoperative reports were compared. Mismatch between transthoracic echocardiography and surgical intraoperative reports and the impact on perioperative outcome were assessed. Coronary patterns were classified into four groups: type 1 (normal); type 2 (risk of coronary with intramural course); type 3 (coronary loop); and type 2+3. RESULTS: Overall, 108 neonates who underwent an arterial switch operation were included: 68 were classified as type 1; seven as type 2; 32 as type 3; and one as type 2+3. Overall, 10 adverse events occurred. Five patients died, three from coronary causes. Survival was 96% at 1 month. Transthoracic echocardiography and surgical intraoperative reports differed in 17.6% of cases. Mortality was 15.8% in case of inappropriate diagnosis and 2.2% for appropriate diagnosis (P=0.01). Mortality in type 2 was 66.7% in case of discordance versus 0% when concordant. Multivariable analysis found that inappropriate preoperative transthoracic echocardiography diagnosis of coronary pattern was the only significant risk factor for mortality (P=0.04). CONCLUSIONS: Echocardiography can assess coronary artery anatomy in neonates with transposition of the great arteries. Intramural coronary course is often misdiagnosed. Preoperative misdiagnosis of coronary artery anomaly may impact perioperative mortality. However, this assessment will have to be confirmed by further larger studies