ABSTRACT
Background: Conventional tests are not always helpful in making a diagnosis of tuberculous pleurisy. Many studies have investigated the usefulness of adenosine deaminase (ADA) in pleural fluid for the early diagnosis of tuberculous pleuresy. We conducted a metaanalysis to determine the accuracy of ADA measurements in the diagnosis of tuberculous pleurisy. Methods: After a systematic review of English language studies, sensitivity, specificity, and other measures of accuracy of ADA concentration in the diagnosis of pleural effusion were pooled using random effects models. Summary receiver operating characteristic curves were used to summarize overall test performance. Results: Sixty-three studies met our inclusion criteria. The summary estimates for ADA in the diagnosis of tuberculous pleurisy in the studies included were sensitivity 0.92 (95% confidence interval 0.90-0.93), specificity 0.90 (95% confidence interval 0.89-0.91), positive likelihood ratio 9.03 (95% confidence interval 7.19-11.35), negative likelihood ratio 0.10 (95% confidence interval 0.07-0.14), and diagnostic odds ratio 110.08 (95% confidence interval 69.96- 173.20). Conclusions: ADA determination is a relative sensitive and specific test for the diagnosis of tuberculous pleurisy. Measurement of ADA in pleural effusion is thus likely to be a useful diagnostic tool for tuberculous plerisy. The results of ADA assays should be interpreted in parallel with clinical findings and the results of conventional tests.
ABSTRACT
Study objective: Current clinical practice assumes a negative computed tomography (CT) head sean result and a negative lumbar puncture result together are adequate to rule out subarachnoid hemorrhage in patients with acute headache. Our objective is to determine the sensitivity of a negative CT result combined with a negative lumbar puncture result to exelude subarachnoid hemorrhage. Methods: This prospective cohort study was conducted at 2 tertiary care emergency departments (EDs) during 3 years. We enrolled all patients who were older than 15 years, had a nontraumatic acute headache and normal neurologic examination result, and who had a CT head sean and a lumbar puncture ifthe CT result was negative (ie, no blood in the subarachnoid space). Patients were followed up with a structured telephone questionnaire 6 to 36 months añer their ED visit and electronic hospital records review to ensure no missed subarachnoid hemorrhage. We calculated sensitivity, specificity, and likelihood ratios of the strategy of CT and then lumbar puncture for subarachnoid hemorrhage. Results: Five hundred ninety-two patients were enrolled, including 61 with subarachnoid hemorrhage. The mean patient age was 43.6 years, with 59.1 percent female patients. Aneases of subarachnoid hemorrhage were identified on initial CT or lumbar puncture. One patient without subarachnoid hemorrhage was subsequently diagnosed with cerebral aneurysm, requiring surgery. The strategy classified patients with subarachnoid hemorrhage with sensitivity, specifícity, and positive and negative likelihood ratios (with 95 percent confidence intervals fCIsJ) of 100 percent (95 percent CI94 percent to 100 percent), 67 percent (95 percent CI 63 percent to 71 percent), 3.03 (95 percent CI 2.69 to 3.53), and 0. For diagnosis of subarachnoid hemorrhage or aneurysm, these were 98 percent (95 percent CI91 percent to 100 percent), 67 percent (95 percent CI63 percent to 71 percent), 2.98...
ABSTRACT
El objetivo de esta comunicación es analizar los resultados del tratamiento quirúrgico y pronóstico en los pacientes mayores de 70 años con cáncer del recto (CR). Método: este estudio retrospectivo incluye 211 pacientes operados con intención curativa en el período enero de 1975 a diciembre 1997. De éstos 81 pacientes son de 70 o más años (grupo A) y 130 menores de 70 años (grupo B). La información fue obtenida de la base de datos computarizada y la sobrevida certificada a través de registros clínicos, entrevista telefónica y certificados de defunción. Las curvas de sobrevida fueron estimadas por el método de Kaplan-Meier, y comparadas con el test log-rank. Resultados: la localización del cáncer en el tercio inferior del recto (0-7 cm del margen anal) fue de 43 por ciento (35) para el grupo A y 54 por ciento (70) para el grupo B (p=n.s). Resección abdominoperineal se practicó en el 36 por ciento del grupo A y en el 44 por ciento del grupo B. Hubo un mayor porcentaje de pacientes ASA II y III en el grupo A (p<0,05). Se observó una mayor morbilidad en grupo A (40 por ciento v/s 22 por ciento), p<0,05). Sin embargo, al comparar sólo los pacientes ASA I de ambos grupos no se encontró diferncia en la morbilidad (p=n.s). No hubo mortalidad operatoria (30 días) en el grupo B, en tanto que en el grupo A se observó en dos pacientes (2,4 por ciento). El tiempo de seguimiento medio fue de 39 y 56 meses para el grupo A y para el grupo B, respectivamente. La sobrevida libre de enfermedad a 5 años fue de 54 por ciento sin observarse diferencias significativas entre ambos grupos (p=n.s). Conclusión. En pacientes seleccionados mayores de 70 años con CR, la cirugía resectiva con intención curativa se puede realizar con cifras de morbimortalidad y pronóstico comparables al grupo de menores de 70 años