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Color doppler ultrasound in deep venous thrombosis: A comparison with venography
289
Abstracts
? ?COLOR DOPPLER ULTRASOUND IN DEEP VENOUS THROMBOSIS: A COMPARISON WITH VENOGRAPHY. Baxter GM, McKechnie S, Duffy P. Clin Radiol. 1990;42:32-6. The diagnosis of deep venous thrombosis by physical examination is notoriously unreliable. Currently, contrast venography is the gold standard; however, it is invasive, has limitations, and may be associated with complications. Many alternative procedures have been evaluated. Color Doppler ultrasound is a new technical development that combines real time imaging and a dynamic color flow vascular image. This double-blind prospective study compared color Doppler ultrasound with contrast venography in the diagnosis of lower limb thrombosis. Color Doppler scans and contrast venography were carried out on 40 patients suspected of having deep venous thrombosis. Both examinations were performed by different radiologists without prior knowledge of the result of the other test. Of the study group, 26 venograms and 27 color Doppler scans were negative. The one false negative color Doppler scan missed a calf and lower popliteal thrombosis. Of the 14 patients with positive venograms, 13 had a positive color Doppler scan. Overall, the sensitivity and specificity for detecting lower limb thrombosis were 93% and lOO%, respectively. Despite missing one calf vein thrombosis, two cases of isolated calf vein thrombosis were detected by color Doppler scan. The authors conclude that color Doppler ultrasound is accurate in the diagnosis of femoral and popliteal thrombosis and gives additional information about flow and nonocclusive clot. They also suggest that color Doppler ultrasound may be useful in the diagnosis of calf vein thrombosis, although [Mark E. Copeland, MD] further clinical trials are necessary.
COMPARISON OF TEMPERATURE PROFILES (DEVETHERM) AND CONVENTIONAL VENOGRAPI-IY IN SUSPECTED LOWER LIMB THROMBOSIS. Stevenson AJM, Moss JG, Kirkpatrick AE. Clin Radiol.
0
1990;42:37-9. The technique of measuring leg temperature profiles (thermography) has been described as a screening test for deep venous thrombosis (DVT). This prospective study evaluated a new thermographic scanner (DeVeTherm) in the detection of DVT in the lower limb. Venography was used as a reference. Bilateral lower limb temperature profiles and subsequentvenography were performed on 124 consecutive patients suspected of having a lower limb DVT. Of the 53 patients with positive venograms, 49 had positive and 4 had negative temperature profiles (sensitivity = 92%). Of the 71 patients with negative venograms, 53 had positive and 18 had negative temperature profiles (specificity = 25%). The predictive value of positive temperature profiles was 0.48, and that of negative temperature profiles was 0.82. The authors conclude that these results do not justify using the DeVeTherm as a screening test [Mark E. Copeland, MD] for DVT of the lower limb.
and are caused by the human papillomavirus (HPV). This article reviewed the English literature for documented cases of pediatric condylomata acuminata. The survey included 74 children who ranged in age from birth to 17 years, average 5.5 years. The female-to-male ratio was roughly 3 to 2. Trends noted male children were much more likely to have condylomata of the perianal area, 77% in children compared to 8% of men, although only 29% of the cases in male children were from known or suspected sexual abuse. Female children were less likely to have labial involvement compared to women, 16% versus 30%, respectively. The presence of anogenital warts in children must raise the question of possible sexual abuse but is not conclusive evidence, since transmission of the virus is believed to occur by one of three mechanisms: 1) from infected birth canal at time of delivery; 2) by routine nonsexual familial contact; and 3) as a result of sexual contact. Depending upon location of the condylomata, podophyllin is the initial therapy of choice, although other therapeutic options are available. Eradication of the viral agent and long-term follow-up are recommended because of the association of HPV with development of carcinoma. [Lefayne A. Hodde, MD]
0
PRACTICAL MANAGEMENT OF BELL’S PALSY.
Hughes GB. Otolaryngol Head Neck Surg. 1990;102:658-63. Diagnosis and management of Bell’s palsy is no easy task for the emergency physician. Controversy remains regarding diagnostic and treatment decisions in the emergency department setting. For this retrospective study, an otolaryngologist reviewed the charts of 63 Bell’s palsy patients whom he had cared for over an 8-year period. Forty-six patients presented with palsy while 17 had progressed to paralysis. This physician also reviewed a large study involving over 1000 Bell’s palsy patients and compared their results with his experiences. His conclusions are that optimum management occurs then these patients are divided into different subgroups. Presentation before or after 21 days and the presence or absence of paralysis defines the differences. His survey of cases leads him to recommend steroids for those patients presenting before 21 days and electroneurography for facial paralysis. He believes audiograms, photo documentation, and eye care are necessary for all patients. Computed tomography or magnetic resonance imaging (MRI) is indicated for patients with paralysis to rule out a central etiology; otherwise, radiographic studies are without utility. The author’s final caveat is that most patients in his experience will see some improvement within 6 months, even without therapy, and controlled studies comparing treatment modalities are not available as of yet. The author admits that his data, due to small sample size and lack of variable control, are not statistically sound. [Steven William Kamm, MD]
EFFECT OF HELIUM CONCENTRATION ON EXPERIMENTAL UPPER AIRWAY OBSTRUCTION.
0
CONDYLOMATA ACUMINATA IN THE PEDIATRIC POPULATION. Boyd AS. Am J Dis Child. 1990;144:
0
817-24. Condylomata acuminata, or venereal warts, are papillomatous growths predominantly confined to the anogenital region,
Houck JR, Keamy MF III, McDonough JM. Ann Otol Rhino1 Laryngol. 1990;99:556-61. This study investigated the effects of different helium concentrations in gas flow and resistance in both nontidal (unidirectional) and bidirectional (tidal) flow situations in
Abstracts
? ?COLOR DOPPLER ULTRASOUND IN DEEP VENOUS THROMBOSIS: A COMPARISON WITH VENOGRAPHY. Baxter GM, McKechnie S, Duffy P. Clin Radiol. 1990;42:32-6. The diagnosis of deep venous thrombosis by physical examination is notoriously unreliable. Currently, contrast venography is the gold standard; however, it is invasive, has limitations, and may be associated with complications. Many alternative procedures have been evaluated. Color Doppler ultrasound is a new technical development that combines real time imaging and a dynamic color flow vascular image. This double-blind prospective study compared color Doppler ultrasound with contrast venography in the diagnosis of lower limb thrombosis. Color Doppler scans and contrast venography were carried out on 40 patients suspected of having deep venous thrombosis. Both examinations were performed by different radiologists without prior knowledge of the result of the other test. Of the study group, 26 venograms and 27 color Doppler scans were negative. The one false negative color Doppler scan missed a calf and lower popliteal thrombosis. Of the 14 patients with positive venograms, 13 had a positive color Doppler scan. Overall, the sensitivity and specificity for detecting lower limb thrombosis were 93% and lOO%, respectively. Despite missing one calf vein thrombosis, two cases of isolated calf vein thrombosis were detected by color Doppler scan. The authors conclude that color Doppler ultrasound is accurate in the diagnosis of femoral and popliteal thrombosis and gives additional information about flow and nonocclusive clot. They also suggest that color Doppler ultrasound may be useful in the diagnosis of calf vein thrombosis, although [Mark E. Copeland, MD] further clinical trials are necessary.
COMPARISON OF TEMPERATURE PROFILES (DEVETHERM) AND CONVENTIONAL VENOGRAPI-IY IN SUSPECTED LOWER LIMB THROMBOSIS. Stevenson AJM, Moss JG, Kirkpatrick AE. Clin Radiol.
0
1990;42:37-9. The technique of measuring leg temperature profiles (thermography) has been described as a screening test for deep venous thrombosis (DVT). This prospective study evaluated a new thermographic scanner (DeVeTherm) in the detection of DVT in the lower limb. Venography was used as a reference. Bilateral lower limb temperature profiles and subsequentvenography were performed on 124 consecutive patients suspected of having a lower limb DVT. Of the 53 patients with positive venograms, 49 had positive and 4 had negative temperature profiles (sensitivity = 92%). Of the 71 patients with negative venograms, 53 had positive and 18 had negative temperature profiles (specificity = 25%). The predictive value of positive temperature profiles was 0.48, and that of negative temperature profiles was 0.82. The authors conclude that these results do not justify using the DeVeTherm as a screening test [Mark E. Copeland, MD] for DVT of the lower limb.
and are caused by the human papillomavirus (HPV). This article reviewed the English literature for documented cases of pediatric condylomata acuminata. The survey included 74 children who ranged in age from birth to 17 years, average 5.5 years. The female-to-male ratio was roughly 3 to 2. Trends noted male children were much more likely to have condylomata of the perianal area, 77% in children compared to 8% of men, although only 29% of the cases in male children were from known or suspected sexual abuse. Female children were less likely to have labial involvement compared to women, 16% versus 30%, respectively. The presence of anogenital warts in children must raise the question of possible sexual abuse but is not conclusive evidence, since transmission of the virus is believed to occur by one of three mechanisms: 1) from infected birth canal at time of delivery; 2) by routine nonsexual familial contact; and 3) as a result of sexual contact. Depending upon location of the condylomata, podophyllin is the initial therapy of choice, although other therapeutic options are available. Eradication of the viral agent and long-term follow-up are recommended because of the association of HPV with development of carcinoma. [Lefayne A. Hodde, MD]
0
PRACTICAL MANAGEMENT OF BELL’S PALSY.
Hughes GB. Otolaryngol Head Neck Surg. 1990;102:658-63. Diagnosis and management of Bell’s palsy is no easy task for the emergency physician. Controversy remains regarding diagnostic and treatment decisions in the emergency department setting. For this retrospective study, an otolaryngologist reviewed the charts of 63 Bell’s palsy patients whom he had cared for over an 8-year period. Forty-six patients presented with palsy while 17 had progressed to paralysis. This physician also reviewed a large study involving over 1000 Bell’s palsy patients and compared their results with his experiences. His conclusions are that optimum management occurs then these patients are divided into different subgroups. Presentation before or after 21 days and the presence or absence of paralysis defines the differences. His survey of cases leads him to recommend steroids for those patients presenting before 21 days and electroneurography for facial paralysis. He believes audiograms, photo documentation, and eye care are necessary for all patients. Computed tomography or magnetic resonance imaging (MRI) is indicated for patients with paralysis to rule out a central etiology; otherwise, radiographic studies are without utility. The author’s final caveat is that most patients in his experience will see some improvement within 6 months, even without therapy, and controlled studies comparing treatment modalities are not available as of yet. The author admits that his data, due to small sample size and lack of variable control, are not statistically sound. [Steven William Kamm, MD]
EFFECT OF HELIUM CONCENTRATION ON EXPERIMENTAL UPPER AIRWAY OBSTRUCTION.
0
CONDYLOMATA ACUMINATA IN THE PEDIATRIC POPULATION. Boyd AS. Am J Dis Child. 1990;144:
0
817-24. Condylomata acuminata, or venereal warts, are papillomatous growths predominantly confined to the anogenital region,
Houck JR, Keamy MF III, McDonough JM. Ann Otol Rhino1 Laryngol. 1990;99:556-61. This study investigated the effects of different helium concentrations in gas flow and resistance in both nontidal (unidirectional) and bidirectional (tidal) flow situations in