56 research outputs found
Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis
Background
Ultrasound (US) has largely replaced contrast venography as the definitive diagnostic test for deep vein thrombosis (DVT). We aimed to derive a definitive estimate of the diagnostic accuracy of US for clinically suspected DVT and identify study-level factors that might predict accuracy.
Methods
We undertook a systematic review, meta-analysis and meta-regression of diagnostic cohort studies that compared US to contrast venography in patients with suspected DVT. We searched Medline, EMBASE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Reviews of Effectiveness, the ACP Journal Club, and citation lists (1966 to April 2004). Random effects meta-analysis was used to derive pooled estimates of sensitivity and specificity. Random effects meta-regression was used to identify study-level covariates that predicted diagnostic performance.
Results
We identified 100 cohorts comparing US to venography in patients with suspected DVT. Overall sensitivity for proximal DVT (95% confidence interval) was 94.2% (93.2 to 95.0), for distal DVT was 63.5% (59.8 to 67.0), and specificity was 93.8% (93.1 to 94.4). Duplex US had pooled sensitivity of 96.5% (95.1 to 97.6) for proximal DVT, 71.2% (64.6 to 77.2) for distal DVT and specificity of 94.0% (92.8 to 95.1). Triplex US had pooled sensitivity of 96.4% (94.4 to 97.1%) for proximal DVT, 75.2% (67.7 to 81.6) for distal DVT and specificity of 94.3% (92.5 to 95.8). Compression US alone had pooled sensitivity of 93.8 % (92.0 to 95.3%) for proximal DVT, 56.8% (49.0 to 66.4) for distal DVT and specificity of 97.8% (97.0 to 98.4). Sensitivity was higher in more recently published studies and in cohorts with higher prevalence of DVT and more proximal DVT, and was lower in cohorts that reported interpretation by a radiologist. Specificity was higher in cohorts that excluded patients with previous DVT. No studies were identified that compared repeat US to venography in all patients. Repeat US appears to have a positive yield of 1.3%, with 89% of these being confirmed by venography.
Conclusion
Combined colour-doppler US techniques have optimal sensitivity, while compression US has optimal specificity for DVT. However, all estimates are subject to substantial unexplained heterogeneity. The role of repeat scanning is very uncertain and based upon limited data
Comparison of Devices Used for Stent-Assisted Coiling of Intracranial Aneurysms
INTRODUCTION: Two self-expandable stents, the Neuroform and the Enterprise stent, are widely used for stent-assisted coiling (SAC) of complex shaped intracranial aneurysms. However, comparative knowledge about technical feasibility, peri- and post-procedural morbidity and mortality, packing densities as well as follow-up data is limited. MATERIAL AND METHODS: We conducted a retrospective study to investigate differences in aneurysms stented with the Enterprise or Neuroform stents. Angiographic follow-up (mean 19.42 months) was available in 72.6% (61/84) of aneurysms treated with stent-assisted coiling. We further sought to compare stent-assisted coiling to a matched patient population with aneurysms treated by conventional coil embolization. RESULTS: The stenting success rate of the Enterprise was higher compared to the Neuroform stent (46/48 and 42/51, respectively). In 5 of 9 cases in which the Neuroform stent was not navigable to the landing zone, we successfully deployed an Enterprise stent instead. Eventually, 42 aneurysms were coiled after stenting in each group. We observed no significant differences in peri-procedural complication rate, post-procedural hospital stay, packing density, recurrence rate or number of in-stent stenosis. Strikingly, 36.1% of followed aneurysms in the SAC group showed progressive occlusion on angiographic follow-up imaging. The packing density was significantly higher in aneurysms treated by SAC as compared to conventionally coiled aneurysms, while recanalization rate was significantly lower in the SAC group. CONCLUSION: The procedural success rate is higher using the Enterprise, but otherwise both stents exhibited similar characteristics. Lower recurrence frequency and complication rates comparable to conventional coil embolization emphasize the importance of stent-assisted coiling in the treatment of complex aneurysms. Progressive occlusion on angiographic follow-up was a distinct and frequent observation in the SAC group and may in part be due to flow diversion
Parent artery reconstruction for large or giant cerebral aneurysms using a Tubridge flow diverter (PARAT): study protocol for a multicenter, randomized, controlled clinical trial
Treatment of ruptured complex and large/giant ruptured cerebral aneurysms by acute coiling followed by staged flow diversion
Antiviral treatment with interferon alpha and ribavirin influences serum markers of liver fibrosis in children with chronic hepatitis C
Central neurocytoma
Background: A 40-year-old man presented with short-term memory loss and behavioral changes.There was no previous medical history and neurological examination was normal
The influence of age on a clinical presentation of Toxocara spp. infection in children
Toxocariasis is a helminthozoonosis due to the infestation of humans by roundworms, Toxocara spp. Actual informations
indicate it the most common worm infection in many countries, typically connected with rural areas. The authors analyzed
the documentation of 84 children with positive serology to this worm. An individual record was made and following data
were restricted: anamnesis data, clinical symptoms, epidemiological data, eosinophils number, level of immunoglobulins
G and E. The highest Toxocara spp. seropositivity frequency was found in the schoolchildren aged 7-10. The most frequent
clinical findings in children infected Toxocara spp. were lymphadenopathy, hepatomegaly, arthralgia and arthritis. 15.5%
of seropositive patients presented non-specific symptoms originating from the central nervous system: headaches, sleep
and behavioural disorders, and hyperactivity. The mean eosinophilia in the peripheral blood was detected in the youngest
children: 4,023 cell/μl, which is 15.55 times more than the limit value. Hyperimmunoglobulinemia E was detected in all age
groups, and the youngest children presented a serum concentration of IgE that was 16.47 times higher than the limit value.
Conclusions: 1. Toxocara spp. infection is detected in children at every age, but the most specific age group are schoolchildren,
representing 38% of positive individuals. 2. The clinical spectrum of toxocariasis reflects various manifestations depending
on the internal organs infected by the migrating worms and the intensity of infection. 3. Eosinophilia seems to be a good
marker of infection in young children who have a more symptomatic course of the disease. 4. Hyperimmunoglobulinemia
IgE can be the important element which distinguishes between current and past Toxocara infection, but its meaning is not
connected with the age of infected childre
Antiviral treatment with interferon alpha and ribavirin influences serum markers of liver fibrosis in children with chronic hepatitis C
- …