Success Rate with Ultrasound-Guided Transabdominal Manually Reduction of Pediatric Intussusception

Background: Intussusception is the most common abdominal emergency and the second most common cause of intestinal obstruction in children under 2 years old. Delays in diagnosis and treatment can be dangerous and even deadly. This study aimed to investigate the success rate of ultrasound-guided transabdominal manually reduction of intussusceptions in children. Methods: In this cross-sectional study, after applying exclusion criteria in children with definite intussusceptions, 20 patients were selected. Field variables and the final result of treatment were examined. All the patients were treated similarly to each other. In the case of successful elimination of intussusceptions, each patient was followed for one week after treatment. Then, the data were analyzed using chi-square test via SPSS software. Results: Girl to boy ratio was 11.9 and patients' mean age was 20.5 months. Considering the place of intussusceptions, 7 were ascending colon, 4 were transverse colon, 7 were hepatic flexure, and 2 were splenic flexure. The amount of success was 65%. Considering the sex, 6 girls and 7 boys, and the place, 6 intussusceptions in ascending colon, 6 in hepatic flexure, and 1 in transverse colon had successful placement. Conclusion: Transabdominal manually reduction of intussusception using sonography guide is an appropriate method of treatment. But, further researches with more sample volumes are needed to examine possible complications and recurrence rate. Keywords Intussusception; Manual reduction; Ultrasonograph

Comparison of the Prevalence of Hypertension between the Children with Hematuria and Healthy Children

Background: Abnormal disposal level of red blood cells in the urine is called hematuria and can be a sign of a serious or benign renal pathology in children. Hematuria, hypertension, and kidney diseases have closely relationship. Given the high prevalence of hypertension in children, the aim of this study was to compare it between children with hematuria and healthy children. Methods: This was a case-control study on 50 children with hematuria and 50 healthy children. Detection of hematuria was performed with urinary analysis and confirmation of diagnosis by microscopic observation. Child's blood pressure and body mass index, and parental pressure were measured accurately by one person. Then, statistical analysis was performed via SPSS software. Results: The frequency of sex (20 men and 30 women, and 21 men and 29 women in case control groups, respectively) was not significantly different between the two groups (P = 0.839), as well as other demographic variables. Children's maximum and minimum blood pressure in the case group (and mmHg) was significantly higher than the control group (88.90 vs. 81.20 and 63.93 vs. 55.86 mmHg, respectively). Significant correlations were seen between maximum blood pressure in children with hematuria with parents' minimum and maximum blood pressure, and children's age. Conclusion: Due to the elevated blood pressure in children with hematuria, child's blood pressure can be named as a risk factor in incidence of hematuria. Keywords Hematuria; blood pressure; body mass inde

Supplementary Material for: Multiple Silent Lacunes Are Associated with Recurrent Ischemic Stroke

Background: Silent lacunes are a common finding on brain imaging in ischemic stroke patients, but the prognostic significance of these lesions is uncertain. We aimed at investigating the association of silent lacunes and the risk of ischemic stroke recurrence, death, and cardiovascular events in a cohort of patients with incident ischemic stroke and no atrial fibrillation (AF). Methods: We included 786 patients (mean age 59.5 (SD 14.0); 42.9% females) in a registry-based, observational cohort study on patients with first-ever ischemic stroke. On brain MRI we assessed the number of silent lacunes as none, single, or multiple and we calculated stratified incidence rates of the outcomes. Cox proportional hazard ratios (HRs) adjusted for age, gender, congestive heart failure, hypertension, diabetes, and vascular disease were calculated with no silent lacunes as reference. In additional analyses, we further adjusted for white matter hyperintensities. Patients were followed up until death or recurrence of ischemic stroke. Results: In 81 (10.3%) patients, a single silent lacune was present, and in 87 (11.1%) patients, multiple silent lacunes were present. Patients with at least one silent lacune were older (mean age 66.1 vs. 57.7, p < 0.001) and were more often hypertensive (60.1 vs. 43.4%, p < 0.001) compared to patients with no silent lacunes. During a median follow-up time of 2.9 (interquartile range 3.1) years, we observed 53 recurrent ischemic strokes, 76 deaths, and 96 cardiovascular events. Incidence rates per 100 person-years of ischemic stroke recurrence were 1.6, 2.5, and 5.0 for none, single, and multiple silent lacunes respectively. Corresponding incidence rates were 2.6, 2.4, and 4.4 for death, and 3.4, 4.0, and 6.6 for cardiovascular events respectively. Adjusted HRs of ischemic stroke recurrence were 1.53 (0.67-3.49) and 2.52 (1.25-5.09) for a single and multiple silent lacunes, respectively. Further adjustment for white matter hyperintensities maintained positive association although not significant. Corresponding adjusted HRs were 0.56 (0.25-1.25) and 0.65 (0.33-1.25) for death and 1.16 (0.61-2.22) and 1.51 (0.86-2.66) for cardiovascular events. Conclusions: In this large cohort of patients with incident ischemic stroke and no AF, an increasing number of silent lacunes was associated with increasing incidence rates of ischemic stroke recurrence. In the adjusted Cox proportional hazard analyses, the presence of multiple silent lacunes was significantly associated with an increased risk of ischemic stroke recurrence. The risk of death or cardiovascular events was not significantly influenced by the presence of silent lacunes

Supplementary Material for: Multiple Silent Lacunes Are Associated with Recurrent Ischemic Stroke

Background: Silent lacunes are a common finding on brain imaging in ischemic stroke patients, but the prognostic significance of these lesions is uncertain. We aimed at investigating the association of silent lacunes and the risk of ischemic stroke recurrence, death, and cardiovascular events in a cohort of patients with incident ischemic stroke and no atrial fibrillation (AF). Methods: We included 786 patients (mean age 59.5 (SD 14.0); 42.9% females) in a registry-based, observational cohort study on patients with first-ever ischemic stroke. On brain MRI we assessed the number of silent lacunes as none, single, or multiple and we calculated stratified incidence rates of the outcomes. Cox proportional hazard ratios (HRs) adjusted for age, gender, congestive heart failure, hypertension, diabetes, and vascular disease were calculated with no silent lacunes as reference. In additional analyses, we further adjusted for white matter hyperintensities. Patients were followed up until death or recurrence of ischemic stroke. Results: In 81 (10.3%) patients, a single silent lacune was present, and in 87 (11.1%) patients, multiple silent lacunes were present. Patients with at least one silent lacune were older (mean age 66.1 vs. 57.7, p < 0.001) and were more often hypertensive (60.1 vs. 43.4%, p < 0.001) compared to patients with no silent lacunes. During a median follow-up time of 2.9 (interquartile range 3.1) years, we observed 53 recurrent ischemic strokes, 76 deaths, and 96 cardiovascular events. Incidence rates per 100 person-years of ischemic stroke recurrence were 1.6, 2.5, and 5.0 for none, single, and multiple silent lacunes respectively. Corresponding incidence rates were 2.6, 2.4, and 4.4 for death, and 3.4, 4.0, and 6.6 for cardiovascular events respectively. Adjusted HRs of ischemic stroke recurrence were 1.53 (0.67-3.49) and 2.52 (1.25-5.09) for a single and multiple silent lacunes, respectively. Further adjustment for white matter hyperintensities maintained positive association although not significant. Corresponding adjusted HRs were 0.56 (0.25-1.25) and 0.65 (0.33-1.25) for death and 1.16 (0.61-2.22) and 1.51 (0.86-2.66) for cardiovascular events. Conclusions: In this large cohort of patients with incident ischemic stroke and no AF, an increasing number of silent lacunes was associated with increasing incidence rates of ischemic stroke recurrence. In the adjusted Cox proportional hazard analyses, the presence of multiple silent lacunes was significantly associated with an increased risk of ischemic stroke recurrence. The risk of death or cardiovascular events was not significantly influenced by the presence of silent lacunes

Reporting and handling of equivocal imaging findings in diagnostic studies of bone metastasis in prostate cancer

BackgroundEquivocal scanning results occur. It remains unclear how these results are presented and their management influence diagnostic characteristics.PurposeTo investigate the reporting and handling of equivocal imaging findings in diagnostic studies of bone metastases, and to assess the impact on diagnostic performance of the methods used to analyze equivocal findings. The conceptual issue was reified based on two actual observations.Material and MethodsA recent meta-analysis of bone metastases in prostate cancer was conducted and data were obtained from a large clinical trial with a true reference of bone metastasis, where diagnostic characteristics were calculated with equivocal scans handled by: removal; considered malignant; considered benign; and intention-to-diagnose.ResultsThe meta-analysis included 18 trials where the median proportion of reported equivocal results was 27%. Eleven (61%) studies reported an equivocal option for the index test, 42% reported equivocal results and described how these were analyzed. The clinical trial included 583 prostate cancer patients with 20% equivocal results. The different methods of managing equivocal findings resulted in highly variable outcomes: sensitivity = 85%–100%; specificity = 78%–99%; and positive and negative predictive values = 44%–94% and 97%–100%, respectively. The diagnostic performances obtained using the four methods were differentially susceptible to the proportion of equivocal imaging findings and the prevalence of bone metastases.ConclusionReporting of equivocal results was inadequate in bone imaging trials. The handling of equivocal findings strongly influenced diagnostic accuracy

ACR890087 Supplemental Material1 - Supplemental material for Reporting and handling of equivocal imaging findings in diagnostic studies of bone metastasis in prostate cancer

Supplemental material, ACR890087 Supplemental Material1 for Reporting and handling of equivocal imaging findings in diagnostic studies of bone metastasis in prostate cancer by Lars J Petersen, Martin N Johansen, Jesper Strandberg, Louise Stenholt and Helle D Zacho in Acta Radiologic

Regression models for interval censored data using parametric pseudo-observations

Abstract Background Time-to-event data that is subject to interval censoring is common in the practice of medical research and versatile statistical methods for estimating associations in such settings have been limited. For right censored data, non-parametric pseudo-observations have been proposed as a basis for regression modeling with the possibility to use different association measures. In this article, we propose a method for calculating pseudo-observations for interval censored data. Methods We develop an extension of a recently developed set of parametric pseudo-observations based on a spline-based flexible parametric estimator. The inherent competing risk issue with an interval censored event of interest necessitates the use of an illness-death model, and we formulate our method within this framework. To evaluate the empirical properties of the proposed method, we perform a simulation study and calculate pseudo-observations based on our method as well as alternative approaches. We also present an analysis of a real dataset on patients with implantable cardioverter-defibrillators who are monitored for the occurrence of a particular type of device failures by routine follow-up examinations. In this dataset, we have information on exact event times as well as the interval censored data, so we can compare analyses of pseudo-observations based on the interval censored data to those obtained using the non-parametric pseudo-observations for right censored data. Results Our simulations show that the proposed method for calculating pseudo-observations provides unbiased estimates of the cumulative incidence function as well as associations with exposure variables with appropriate coverage probabilities. The analysis of the real dataset also suggests that our method provides estimates which are in agreement with estimates obtained from the right censored data. Conclusions The proposed method for calculating pseudo-observations based on the flexible parametric approach provides a versatile solution to the specific challenges that arise with interval censored data. This solution allows regression modeling using a range of different association measures

ACR890087 Supplemental Material2 - Supplemental material for Reporting and handling of equivocal imaging findings in diagnostic studies of bone metastasis in prostate cancer

Supplemental material, ACR890087 Supplemental Material2 for Reporting and handling of equivocal imaging findings in diagnostic studies of bone metastasis in prostate cancer by Lars J Petersen, Martin N Johansen, Jesper Strandberg, Louise Stenholt and Helle D Zacho in Acta Radiologic

Regression models for interval censored data using parametric pseudo-observations

Abstract Background Time-to-event data that is subject to interval censoring is common in the practice of medical research and versatile statistical methods for estimating associations in such settings have been limited. For right censored data, non-parametric pseudo-observations have been proposed as a basis for regression modeling with the possibility to use different association measures. In this article, we propose a method for calculating pseudo-observations for interval censored data. Methods We develop an extension of a recently developed set of parametric pseudo-observations based on a spline-based flexible parametric estimator. The inherent competing risk issue with an interval censored event of interest necessitates the use of an illness-death model, and we formulate our method within this framework. To evaluate the empirical properties of the proposed method, we perform a simulation study and calculate pseudo-observations based on our method as well as alternative approaches. We also present an analysis of a real dataset on patients with implantable cardioverter-defibrillators who are monitored for the occurrence of a particular type of device failures by routine follow-up examinations. In this dataset, we have information on exact event times as well as the interval censored data, so we can compare analyses of pseudo-observations based on the interval censored data to those obtained using the non-parametric pseudo-observations for right censored data. Results Our simulations show that the proposed method for calculating pseudo-observations provides unbiased estimates of the cumulative incidence function as well as associations with exposure variables with appropriate coverage probabilities. The analysis of the real dataset also suggests that our method provides estimates which are in agreement with estimates obtained from the right censored data. Conclusions The proposed method for calculating pseudo-observations based on the flexible parametric approach provides a versatile solution to the specific challenges that arise with interval censored data. This solution allows regression modeling using a range of different association measures

ACR890087 Supplemental Material3 - Supplemental material for Reporting and handling of equivocal imaging findings in diagnostic studies of bone metastasis in prostate cancer

Supplemental material, ACR890087 Supplemental Material3 for Reporting and handling of equivocal imaging findings in diagnostic studies of bone metastasis in prostate cancer by Lars J Petersen, Martin N Johansen, Jesper Strandberg, Louise Stenholt and Helle D Zacho in Acta Radiologic