Effect of clinician's experience and expertise on the inter- and intra-observer reliability of hip migration index in children with cerebral palsy: A STROBE-compliant retrospective study.

ABSTRACT: Few studies have investigated the reliability of Reimers' hip migration percentage (RMP) in children with cerebral palsy (CP). Most studies on the topic reflected rating results of physician with a similar level of experience from the same expertise. This study aimed to determine the effect of clinician's experience and expertise on the intra-and inter-observer reliability of RMP.In this retrospective observational study, hip radiographs of children with CP were identified. 5 observers with different degrees of working experience from 3 different clinical fields, including orthopedics, radiology, and physical medicine and rehabilitation, performed all RMP measurements. All measurements were repeated 6 weeks later by the same observers. Inter- and intra-observer reliability for RMP measurements were assessed using Intraclass Correlation Coeficient (ICC), calculated from 2 sets of repeated measurements on a subset of 50 hips, with a 6 week apart for each observer.Fifty hip radiographs of 25 children with CP (10 females and 15 males; mean age: 6 years; age range: 2-8 years) were examined in the current study. No significant differences existed in intra-and inter-observer measurements. Excellent intra-observer reliability was observed between the 2 separate measurements for each observer, with a mean ICC of 0.976 (range: 0.956-0.989; P < .001). Among 5 observers, inter-observer reliability was excellent for the 2 separate RMP measurements, with the mean ICC minimally increasing between the 2 measurement periods (mean ICC: 0.928, range: 0.838-0.979 and mean ICC: 0.936, range: 0.861-0.983, respectively) (P < .001).Clinician's experience and expertise may not affect inter-and intra-observer reliability of RMP measurements.

Current role of laser angioplasty of restenotic coronary stents.

Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1+/-9.9 vs 13.6+/-9.1 mm; p = 0.034), more complex (36.5% type C stenoses vs 14.3%; p = 0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p = 0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered.

Femoral pseudoaneurysm due to diagnostic or interventional angiographic procedures.

The authors investigated the incidence of, diagnostic methods for, and treatment strategies for iatrogenic femoral pseudoaneurysms in their hospital and compared the results with those in the literature. The hospital records of 25,273 patients who had coronary or peripheral angiography and angioplasty in Sani Konukoglu Medical Center from September 1997 to December 2002 were collected retrospectively. All the complications were detected and femoral pseudoaneurysm cases were selected. Diagnostic criteria and treatment strategy were documented. All results were compared with the literature. Femoral pseudoaneurysm was the second in number of complications and bleeding the first. Twenty-eight patients with pseudoaneurysm were diagnosed with color Doppler ultrasound (US) imaging (0.11%). Eleven of these closed spontaneously within 3-7 days. Image-guided compression therapy was applied to the remaining 17 and was effective in 10. The remaining 7 patients were operated on successfully. In this series the incidence of iatrogenic femoral pseudoaneurysm was comparable with the literature (0.02%-2%). Color Doppler US is the best diagnostic tool for this complication, and no other method was necessary. Eleven cases of spontaneous closure may show a rather benign prognosis, but close follow-up is advised. Image-guided compression is also an effective and noninvasive method of therapy for this complication. In late cases with a thick neck, surgery should be done immediately. It is easy to prevent rather than treat this complication. The similar incidence in the literature and in this series shows that a number of complications are to be expected, and so prompt and early diagnosis and effective treatment are very important. Application of good external compression after catheterization, selecting the thinnest introducer, use of B-mode and color Doppler US imaging for suspected cases, and image-guided compression therapy are also effective in early cases with a thin neck of the aneurysm.

Management of 28 consecutive iatrogenic femoral pseudoaneurysms with ultrasound-guided compression.

We attempted to evaluate nonsurgical methods of treating postcatheterization iatrogenic femoral pseudoaneurysms at our hospital and compared the results with those in the literature. The hospital records of 25 273 patients who underwent femoral catheterization at our institution from September 1997 to December 2002 were collected retrospectively. All complications were detected and femoral pseudoaneurysm cases were selected. Diagnostic criteria and treatment strategy were documented. All results were compared with those in the literature. Twenty-eight patients were diagnosed as having a pseudoaneurysm (0.11%). In 11 patients the pseudoaneurysms closed by themselves within 3-7 days. Ultrasound-guided compression therapy was applied to the remaining 17 and was effective in 10 of them. The last 7 patients were operated on with success. Ultrasound-guided compression is also an effective and noninvasive method of therapy for femoral pseudoaneurysms. Surgical therapy can be reserved for progressive and complicated lesions.