RESUMEN
PURPOSE: Elastography is a promising method for the identification and differentiation of malignant tissue in several organ systems. The primary aim was to evaluate the inter- and intraobserver reproducibility of endorectal strain elastography differentiation of adenomas and adenocarcinomas. The secondary aim was to compare the performance of strain elastography to endorectal ultrasonography (ERUS) examinations. MATERIALS AND METHODS: Consecutive inclusion of 95 ERUS examinations and 110 elastography video loops with ERUS overlay mode. Videoâloops were randomized and evaluated by eight observers on two separate occasions. Observers were blinded to all clinical information except the circumferential location of the tumor. A continuous visual analog scale (VAS) and a categorical scale (W-score) were used for elastography evaluation. ERUS loops were T-staged according to the TNM classification system. Histopathological evaluation of surgical resection specimen was used as the reference standard. RESULTS: Strain elastography visual evaluation yielded intraobserver variability from 0.86 to 0.97 and interobserver variability of 0.99. VAS strain elastography differentiation of adenomas (pT0) and adenocarcinomas (pT1â-â4) yielded sensitivity, specificity, accuracy, positive and negative predictive values of 0.94, 0.71, 0.89, 0.92 and 0.78, respectively. The corresponding ERUS values were 0.83, 0.64, 0.79, 0.88 and 0.54, respectively. CONCLUSION: Visual evaluation of elastography loops is highly reproducible in an offline setting with blinded observers, and correlates significantly with pT-stages. Strain elastography performs better than ERUS and might consequently improve staging.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad/métodos , Endosonografía/métodos , Variaciones Dependientes del Observador , Neoplasias del Recto/diagnóstico por imagen , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Neoplasias del Recto/patología , Recto/diagnóstico por imagen , Recto/patología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Método Simple CiegoRESUMEN
BACKGROUND: Several epidemiological studies on the association between primary headaches and insomnia have been published in recent years. Both disorders are frequent, and our purpose was to review results from population-based studies exploring this association. METHODS: We performed a literature search in PubMed for "insomnia" (or sleep disturbance) and "headache" (or migraine) linked with "epidemiology." Two hundred and eight records were identified. Three longitudinal and 10 cross-sectional studies met our inclusion criteria: population-based design with at least 200 participants including a numerical estimate of the association between headache and insomnia. RESULTS AND CONCLUSIONS: In nearly all studies, primary headaches, including migraine and tension-type headache, were significantly related to insomnia symptoms with OR estimates ranging from 1.4 to 1.7. The odds were even greater, from 2.0 to 2.6, for frequent, comorbid or severe headache. Recent large longitudinal studies from Norway found a bidirectional, possibly causal, association between headache and insomnia. However, not all studies used standardized diagnostic criteria for either headache or insomnia. Further research should use well defined and validated diagnostic criteria both for insomnia and headache types in order to improve the comparability between studies, investigate causality and clarify the relevance of the findings for clinical practice.
Asunto(s)
Cefalea/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , HumanosRESUMEN
A prospective, randomized, double-blind trial concerning prophylaxis of thrombosis in 82 patients undergoing hip fracture surgery was conducted to compare a new low-molecular-weight heparin (Fragmin) with a placebo. Deep venous thrombosis (DVT) was detected by I125-fibrinogen uptake test followed by ascending phlebography when positive. Sixty-eight patients completed the study and a 50% reduction in the incidence of DVT was demonstrated: 9/30 (30%) patients in the treatment group and 22/38 (50DVT. This significant difference was achieved by one daily dose of 5.000 IU Fragmin subcutaneously, commencing preoperatively and continuing for six days. No differences in bleeding nor other complications in the two groups were observed. Fragmin administered once daily offers an effective and safe prophylaxis of thrombosis in hip fracture surgery.