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<p><b>OBJECTIVE</b>To assess the diagnostic accuracy of 64-slice computed tomography coronary angiography (64-SCTCA) in individuals with suspected coronary artery disease (CAD).</p><p><b>METHODS</b>The study enrolled 285 individuals undergoing 64-SCTCA with calcium scoring and thereafter invasive coronary angiography (CAG) within 4 weeks for suspected CAD. Pretest probability of having obstructive CAD was determined using the Duke clinical score, which was estimated by type of chest discomfort, age, gender, and traditional risk factors and stratified into 3 levels of probability: low (≤ 30%, n = 80), intermediate (31% to 70%, n = 92), and high (≥ 71%, n = 113). CAD was defined as the presence of at least one vessel of ≥ 50% coronary stenosis on CAG.</p><p><b>RESULTS</b>The patient-based diagnostic accuracy of 64-SCTCA for detecting CAD according to CAG revealed a sensitivity of 81.2%, a specificity of 93.3%, a positive predictive value of 68.0% and negative predictive value of 96.6%. The CAD prevalence in the low, intermediate and high risk groups according to Duke probability was 46.3%, 72.8% and 82.3%, respectively. The sensitivity and positive predictive value were lower in the low probability group than those in the intermediate and high probability groups. For those with coronary artery Agatston calcium score > 400, the diagnostic accuracy was linked with a higher sensitivity but lower specificity. The diagnostic value of 64-SCTCA for proximal and mid-segment of coronary artery was superior to that for distal segment.</p><p><b>CONCLUSIONS</b>64-SCTCA is mainly indicated in individuals with an intermediate probability of having CAD. The diagnostic value of 64-SCTCA could be affected by coronary artery calcium, lesion location and vessel diameter.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Angiography , Methods , Coronary Artery Disease , Diagnostic Imaging , Predictive Value of Tests , Sensitivity and Specificity , Tomography, Spiral Computed , MethodsABSTRACT
<p><b>OBJECTIVE</b>To analyze the risk factors of heterotopic (HO) ossification after total lumbar disc replacement and probe the preventive strategies for it.</p><p><b>METHODS</b>The radiographs and clinical data of 78 discs in 65 patients who received artificial lumbar disc replacement (ADR) from April 1998 to December 2003 were analyzed retrospectively by two radiologists and one orthopaedic surgeon and then postoperative HO were graded according to McAfee system. The bony formations in disc spaces, time of HO were found, and range of motion (ROM) of the operated levels were measured on radiographic films. In addition, the risk factors such as preoperative peri-annulus ossification, bony endplates injuries, and subsided or mal-position of the prostheses were also analyzed by Logistic regression analysis.</p><p><b>RESULTS</b>Postoperative HO was found in 10 spaces of 9 cases. Class I of HO were occurred in 7 patients at means 2.1 years postoperatively with normal range of motion preserved. Three of them turned into class II or III with 10 degrees of mean ROM in the following 2.5 years. Another 2 (2/9) cases with preoperative peri-annulus ossification had bridging trabecular bone (class III) between the endplates and 9 degrees of ROM 2 years after surgery, then turned into class IV at 6 years with 0 degrees and 4 degrees of motion in the operated levels. As the risk factors of HO, preoperative annulus ossification (2 cases), bony endplates injuries (5 cases), mal-positioned prostheses (2 cases) and subsided prostheses (2 cases) were found simultaneity with significant positive relation to HO occurred (P < 0.05).</p><p><b>CONCLUSIONS</b>Factors such as preoperative ossification of annulus, endplate injuries, prosthesis subsided and mal-position would have higher risks to have HO occurred after ADR, but ROM of most affected levels are preserved. Strict control indication and avoid all above risk factors can prevent HO occurring effectively.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Diskectomy , Follow-Up Studies , Lumbar Vertebrae , General Surgery , Ossification, Heterotopic , Prosthesis Implantation , Retrospective Studies , Risk FactorsABSTRACT
Objective To evaluate the clinical efficacy of percutaneous ultra-fine needle CO_2 splenoportography (CO_2-SP).Methods CO_2-SP and 3D-CE-MRA were performed in 36 patients.The imaging quality of the methods was compared by a scoring criterion setup based on the visualization of the trunk,intrahepatic branches of the portal vein and collateral vessels.Results Transient mild abdominal discomfort was presented in 19 patients(52.8% )receiving CO_2-SP.One patient developed snbcapsular splenic hematoma and was discharged with clinical stability several days later after conservative treatment. The imaging quality of the intrahepatic branches of the portal vein with CO_2-SP was much more superior to 3D-CE-MRA (the score was 232 and 198 respectively,t=4.52,P0.05 ).Conclusion Ultrafine needle CO_2-SP is a minimally invasive and safe procedure,able to provide dynamic and clearer imaging of the intrahepatic branches of the portal vein.
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0.05). Dysphasia resolved significantly after stent placement in both groups.The improvement of dysphasia was more significant in Group A than in Group B after 2 months of stent placement(1.37?0.56 in group A, 1.82?0.50 in group B,P=0.004).The median survival period was longer in Group A than in Group B (7 months vs 4 months).The mean survival period was also longer in Group A than in Group B (8.3 months vs 3.5 months).There was a statistically significant difference in the survival period between the two groups(P