To examine general practitioners' attitudes to plain lumbar spine radiographic examinations.
A postal questionnaire consisting of questions on background data and doctors' opinions about plain lumbar spine radiographic examinations, as well as eight vignettes (imaginary patient cases) presenting indications for lumbar radiography, and five vignettes focusing on the doctors' willingness to request lumbar radiography on the basis of patients' age and duration of symptoms. The data were analysed according to the doctor's age, sex, workplace and the medical school of graduation.
Six hundred and fifteen randomly selected physicians working in primary health care (64% of original target group).
The vignettes revealed that the use of plain lumbar radiographic examination varied between 26 and 88%. Patient's age and radiation protection were the most prominent factors influencing doctors' decisions to request lumbar radiographies. Only slight differences were observed between the attitudes of male and female doctors, as well as between young and older doctors. Doctors' willingness to request lumbar radiographies increased with the patient's age in most vignettes. The duration of patients' symptoms had a dramatic effect on the doctor's decision: in all vignettes, doctors were more likely to request lumbar radiography when patient's symptoms had exceeded 4 weeks.
General practitioners commonly use plain lumbar spine radiographic examinations, despite its limited value in the diagnosis of low back pain. Further consensus and medical education is needed to clarify the indications for plain lumbar radiographic examination.
Between September 1, 1981, and August 31, 1982, all patients with suspected or confirmed pneumonia among the 46,979 inhabitants of four municipalities in the province of Kuopio, Finland, were reported to a pneumonia register by their attending physicians. In addition, two study pathologists reported all cases of pneumonia found at autopsy, and two permanent registers were checked for retrospective identification of patients. Chest radiographs were obtained from 97% of all patients. The final diagnosis was based on radiologic or autopsy criteria. A total 546 patients (323 males and 223 females) had community-acquired pneumonia; of these, 37% were less than 15 years of age, and 31% were 60 years of age or older. Nineteen percent of the patients had defined chronic conditions, and 42% were admitted to hospital. The case fatality rate was 4%. The overall incidence of community-acquired pneumonia per 1,000 inhabitants per year was 11.6 (13.9 in males, 9.4 in females). The age-specific incidence per 1,000 inhabitants per year was as follows: age or = 75 years, 34.2.
In the current climate of budget constraints and personnel shortages, hospitals are required to demonstrate ever-greater cost effectiveness. In the diagnosis of breast lesions, it is useful to compare the costs and benefits of fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB).
To determine the total costs of FNAB and CNB of breast lesions, and to compare the costs and diagnostic value of these methods.
The material consisted of 688 breast lesion cases from a Finnish breast-imaging unit. All cases underwent FNAB and/or CNB. Based on the primary biopsy method used, the cases were allocated to the FNAB (n=590) or CNB (n=98) group. Data on costs, sensitivity, and specificity were used to compare the cost effectiveness of the two methods.
590 FNABs were performed in the FNAB group and 98 CNBs in the CNB group. In addition, we needed 78 CNBs in the FNAB group and 11 FNABs in the CNB group for further assessment. The false-negative rate for FNAB was 19% and for CNB 11%; the false-positive rates were 9% and 1%, respectively. The average cost of biopsies per case in the FNAB group was euro 66 and in the CNB group euro 221. FNAB was most expensive when performed under ultrasound guidance (euro 44.65) and CNB when performed under stereotactic guidance (euro 246.37).
FNAB is a less reliable and less informative diagnostic method than CNB. Although a negative or indeterminate FNAB result requires follow-up or a re-biopsy with core needle, it is still a cost-effective procedure. Stereotactic guidance considerably increases the costs of CNB, and therefore US guidance should be used whenever possible.
Treatment with percutaneous nephrostomy (PN) without co-existing stents was attempted in 18 patients with urinary fistulas and leakages. Seven patients were cured by PN alone. Two of these developed a ureteral stricture at the site of the lesion: one showed no impairment of urinary flow on the follow-up, the other needed continuous urological surveillance. In the remaining 6 cases PN provided temporary relief of the associated urinary stasis. Percutaneous nephrostomy could not be applied in 5 cases because of the lack of renal pelvic dilatation. Only catheter related complications occurred. Because of its easy and little traumatic technique, simple PN could be used as the primary therapeutic approach in such lesions.
We present here a combination of time-domain signal analysis procedures for quantification of human brain in vivo 1H NMR spectroscopy (MRS) data. The method is based on a separate removal of a residual water resonance followed by a frequency-selective time-domain line-shape fitting analysis of metabolite signals. Calculation of absolute metabolite concentrations was based on the internal water concentration as a reference. The estimated average metabolite concentrations acquired from six regions of normal human brain with a single-voxel spin-echo technique for the N-acetylaspartate, creatine, and choline-containing compounds were 11.4 +/- 1.0, 6.5 +/- 0.5, and 1.7 +/- 0.2 mumol kg-1 wet weight, respectively. The time-domain analyses of in vivo 1H MRS data from different brain regions with their specific characteristics demonstrate a case in which the use of frequency-domain methods pose serious difficulties.
During 12 months in 1981-82, 201 children were hospitalized due to radiologically verified definite or probable pneumonia. In 1985, 194 chest radiographs (anteroposterior views) were re-evaluated jointly by two radiologists, and classified into three categories: alveolar, interstitial and probable pneumonia. In 127 cases definite pneumonia was diagnosed on both occasions, alveolar in 48 cases and interstitial in 79 cases. Variation between the two evaluations 3 years apart was observed in 46 (24%) of the 194 cases; the adjusted kappa (0.47) was in the modest region. Factors contributing to this variation were young age, less than 12 months, and the presence of interstitial infiltration, bronchial obstruction and low C-reactive protein. Factors associated with less marked variation were the presence of alveolar infiltration, auscultatory fine rates and elevated C-reactive protein. The microbial aetiology of infection, assessed by viral and bacterial antigen and antibody assays, showed no association with diagnostic variation. A lateral view of the chest radiograph was obtained from 158 patients; it was positive in 99 (91%) of the 109 cases with definite pneumonia. In only three cases the diagnosis was based on the lateral view alone. Our results show that the radiological diagnosis of pneumonia is difficult in children, especially in young children with interstitial pneumonia.
AIMS: The accident at the Chernobyl nuclear power station occurred in April 1986. We report on a comparative epidemiological study on thyroid abnormalities in the contaminated and uncontaminated populations of the Bryansk region, South-West Russia, in 1993, 7 years after the accident. MATERIAL AND METHODS: The study material consisted of all inhabitants aged 3-34 years in the contaminated village of Mirnyi and in the uncontaminated village of Krasnyi Rog, excluding those who had moved to the villages after the accident. The total material comprised 302 inhabitants in Mirnyi and 200 in Krasnyi Rog. RESULTS: No pathological US findings in either village were found in children born after the accident. In the age group 0-9 years old at the time of the accident, the prevalence of thyroid abnormalities was 8.1% in the contaminated village compared to 1.6% in the uncontaminated village. In the age group 10-27 years the corresponding figures were 18.8% and 17.7%. Only 55% of the pathological US findings were detected by physical palpation. CONCLUSION: The total prevalence of thyroid abnormalities was higher among children in the contaminated village. We recommend an active screening of young contaminated subjects with US, supplemented with fine needle biopsy.