TThe Syva MicroTrak Chlamydia enzyme immunoassay (EIA; Syva Company, San Jose, Calif.) with cytospin and direct fluorescent-antibody assay (DFA) confirmation was evaluated on 43,630 urogenital specimens over a 1-year period in the Provincial Laboratory in Regina, Saskatchewan, Canada. This was a two-phase study intended to define a testing algorithm for Chlamydia trachomatis that would be both highly accurate and cost-effective in our high-volume (> 3,000 tests per month) laboratory. The prevalence of C. trachomatis infection in our population is moderate (8 to 9%). In phase 1, we tested 6,022 male and female urogenital specimens by EIA. All specimens with optical densities above the cutoff value and those within 30% below the cutoff value were retested by DFA. This was 648 specimens (10.8% of the total). A total of 100% (211 of 211) of the specimens with optical densities equal to or greater than 1.00 absorbance unit (AU) above the cutoff value, 98.2% (175 of 178) of the specimens with optical densities of between 0.500 and 0.999 AU above the cutoff value, and 83% (167 of 201) of the specimens with optical densities within 0.499 AU above the cutoff value were confirmed to be positive. A total of 12% (7 of 58) of the specimens with optical densities within 30% below the cutoff value were positive by DFA. In phase 2, we tested 37,608 specimens (32,495 from females; 5,113 from males) by EIA. Only those specimens with optical densities of between 0.499 AU above and 30% below the cutoff value required confirmation on the basis of data from phase 1 of the study. This was 4.5% of all specimens tested. This decrease in the proportion of specimens requiring confirmation provides a significant cost savings to the laboratory. The testing algorithm gives us a 1-day turnaround time to the final confirmed test results. The MicroTrak EIA performed very well in both phases of the study, with a sensitivity, specificity, positive predictive value, and negative predictive value of 96.1, 99.1, 90.3, and 99.7%, respectively, in phase 2. We suggest that for laboratories that use EIA for Chlamydia testing, a study such as this one will identify an appropriate optical density range for confirmatory testing for samples from that particular population.
A total of 73 patients with acute pneumonia received two-stage treatment: etiotropic treatment based on early etiological diagnosis (at hospital) and subsequent early rehabilitation at sanatorium with the use of peloid therapy. It made it possible to attain the best short-term results in the treatment of pneumonias (as compared with control group patients), to shorten 2-4-fold the times of the patients' stay at hospital and to raise bed capacity, to reduce the total doses and duration of antibacterial therapy, to decrease the possibility of the allergic reactions and side effects, and to reduce 2-fold the cost of antibacterial therapy.
Karbase, a Danish register for vascular surgery is presented with data from four years experience. The register consists of 65 variables centered on risk factors, the perioperative course as well as follow-up information. During the four-year period 1989-1992 a total of 4902 admissions were registered in 3810 patients. Surgery was performed during 4005 admissions. Output data from Karbase is presented with results on survival and postoperative complications, related to preoperative risk factors. The incidence of surgical wound infections was 3.9%, with a significant reduction during the years (p = 0.004). Karbase is now used by all vascular surgical units in Denmark. We conclude that the establishment of a continuous registration has been beneficial to the department. We have achieved valid data on treatment, outcome and complications in relation to individual risk factors. In the future the use of Karbase will be extended with the aim of further quality development, locally as well as nation wide.
An out-patient service for patients suffering from amyotrophic lateral sclerosis (ALS), the ALS-clinic, was established at the Department of Neurology, Haukeland Hospital, in 1990. The number of ALS patients who were hospitalised during the period 1990-1995 was 59, with a mean stay in hospital of 14.8 days. Eleven of the patients died in hospital. The ALS-clinic had 127 consultations during the same period, with a mean of 2.2 consultations per patient. Speech difficulties were the dominating problem at 26 of the consultations. 32 patients experienced feeding difficulties, and a percutaneous endoscopic gastrostomy was performed in nine cases. Respiratory problems dominated in ten patients, but only two of these patients wanted a home ventilator. Various assistive devices were adapted for 16 patients.
The management of lymphangioma in children is challenging because complete resection is difficult to achieve in some cases, and recurrences are common. The authors reviewed their experience to assess the risk factors for recurrence and the role of nonoperative treatment.
A retrospective study over a period of 25 years was carried out. One hundred eighty-six patients with 191 lesions (five patients with de novo lesions in different sites) were treated. There were 98 boys and 88 girls. The average age at diagnosis was 3.3 years (range, fetal life to 17 years) and the average size 8 cm in diameter. Histocytological confirmation was obtained in all patients. The involved sites were head and neck, 89 patients (48%); trunk and extremities, 78 patients (42%); internal or visceral locations (eg, abdominal and thorax), 19 patients (10%). The treatment consisted of macroscopically complete excision in 145 patients (150 lesions, of which five were recurrences in different sites), partial excision in 10 patients, aspiration in five patients, laser excision in 10 patients, biopsy only in four patients, drainage and biopsy in two patients, and injection of sclerosing agents in 10 patients.
There were 54 recurrences; 44 underwent excision (five of them more than once), and five regressed spontaneously on follow-up. Five other recurrences were stable and not progressing. Recurrences, (defined as clinically obvious disease), were found to be 100% after aspiration, 100% after injection, 40% after incomplete excision, 40% after laser excision, and 17% after macroscopically complete excision. The recurrence rate in the last group was the highest in the head (33%), the least in the internal locations (0%), and intermediate for the cervical location (13%). There were no significant differences, in terms of outcome, between those who had their surgery immediately at the time of diagnosis (n = 101) and those who had delayed surgery (n = 85).
There were fewer recurrences after macroscopically complete excision. Aspiration and injection had the highest recurrence rate. Risk factors for recurrence included location, size, and complexity of lesions. A period of observation may be useful for infants to facilitate complete excision. In the present series, spontaneous regression was infrequent and was seen more often with recurrent lesions.
The academic organization of residency programs: the evaluation of the effect of "service" responsibilities upon the residency program; the influence of personal responsibility of a "chief" for the resident compared with the "system" approach to resident education.
This study investigated the accuracy and inter-rater reliability of 'specialized' physical therapists in the auscultation of tape-recorded lung sounds. In addition, a correlation was investigated between accuracy of interpretation and the number of years of specialization in the field of cardiorespiratory physical therapy. This research follows an earlier study which investigated the accuracy and inter-rater reliability of auscultating tape-recorded lung sounds in a 'non-specialized' cohort of physical therapists. The subjects were 26 'specialized' cardiorespiratory physical therapists working in acute urban teaching hospitals. These individuals were required to have been practising currently and exclusively for at least one year in the area of cardiorespiratory physical therapy. Participants listened with a stethoscope to five different sounds and identified them from a standardized list of terms. One of three tapes with the same lung sounds in different order was randomly selected for each physical therapist. The percentage of correct answers for all subjects was calculated. An accurate response in the detection of lung sounds was arbitrarily defined as a percentage of correct answers of 70% or greater. The difference between the pooled correct response rate of 50% and the arbitrarily set value of 70% was statistically significant (z = 2.23, p
In forensic odontology, registration of dental characteristics is crucial in the identification procedure. It has been found that the most common errors made are incorrect registration of restorations and confusion about premolars and molars in both jaws. In an earlier study, dental students were observers and the charting was made without radiographs. However, in practical forensic work dentists make the registrations and radiographs are usually available. In this investigation eight dental students and eight dentists made registrations on ten excised macerated jaws with the aid of radiographs. The mean number of errors for each jaw for the students and the dentist was 4 and 3 respectively. The most common error among the dentists was incorrect registration of restorations, while errors on registrations of missing teeth were most common among the students. Even though the material in this study was limited, the results indicate the importance of re-examining of postmortem findings before the comparison with the antemortem data is done. Additionally, the forensic work should be performed by specialists.
The Conseal plug was evaluated in a four week period among 30 consecutive colostomy patients. The clinical trial, a multicenter study covering 11 Danish Hospitals, was started five to 12 days postoperatively among motivated patients in good physical condition. Twenty patients (67%) completed the trial. Ten patients (33%) gave up because of wound infection, leakage, extrusion of the foam part or fault in the test procedure. At the end of the trial all 20 patients wanted to continue using the plug and 84% were still using the Conseal system six months later. We conclude that the plug is well tolerated among motivated patients less than a week postoperatively and that the Conseal plug is a good alternative to the colostomy bag early in the postoperative course.