Cochlear ossification in patients with profound hearing loss following bacterial meningitis.

CONCLUSION: Cochlear ossification following bacterial meningitis is related to causative pathogen, but not age at disease or time point of evaluation. However, progression may occur over time, especially in case of primary signs of ossification. OBJECTIVE: To investigate the occurrence and degree of cochlear ossification on CT and MRI in patients with bilateral profound hearing loss following bacterial meningitis, in relation to causative pathogen, age at disease, and time point of evaluation. Progression of ossification in cases that underwent more than one scan was evaluated. METHODS: In the period 1982-2008, 47 cochlear implantations were performed in 34 consecutive candidates suffering from bilateral profound hearing loss following bacterial meningitis. A retrospective review of patient files and preoperative CT and MR images was performed. RESULTS: Cochlear ossification was observed in 35% of patients and 26% of ears on CT. The corresponding values for MRI were 44 and 30% (difference not significant). Streptococcus pneumoniae infection caused ossification more frequently than Neisseria meningitidis. No difference was found between pediatric and adult cases, and the occurrence of ossification was not related to the time point of evaluation. Signs of progressive ossification were found in cases with two CT scans, especially if ossification was present at the first scan.

[Diagnostic strategy in patients with clinically suspected deep vein thrombosis]. / Diagnostisk strategi hos patienter, der er henvist til skadestuen på mistanke om dyb venøs trombose.

INTRODUCTION: The standard method for diagnosing deep vein thrombosis (DVT) involves determination of D-dimer and ultrasound scanning. In an attempt to reduce the number of ultrasound examinations we have supplemented this with a clinical probability estimate for DVT (DVT-score) over one year. MATERIALS AND METHODS: A total of 508 consecutive patients presenting in the emergency room with suspected DVT had D-dimer and DVT-score performed. Patients with non-elevated D-dimer and a low or moderate DVT score received no treatment. The remainder had ultrasound scanning from the groin to the popliteal fossa. If no DVT was revealed, the patient was contacted by telephone 7-10 days later, and was offered a repeat examination if symptoms persisted. RESULTS: Three patients with chronic DVT were excluded. Normal D-dimer and low or moderate DVT-score was found in 103 patients, none had DVT. Only five patients with normal D-dimer had high DVT-scores, none had DVT, so that the benefit from determining DVT-scores was modest. Ultrasound scanning revealed DVT in 85 out of 397 patients with elevated D-dimer. A repeat examination was performed in 91 patients with persisting symptoms, and disclosed DVT in two. CONCLUSION: We recommend that ambulatory patients with clinically suspected DVT have a D-dimer test. If D-dimer is elevated, compression ultrasound should be performed in the groin and the popliteal fossa.

[Waste of resources as a result of cancelled or delayed diagnostic imaging of hospitalized patients]. / Resursespild ved manglende aflysning eller forsinkelse af billeddiagnostiske undersøgelser hos indlagte patienter.

INTRODUCTION: When diagnostic imaging is cancelled on short notice or an examination is delayed, the Imaging Department suffers a loss. Based on voluntary reporting of such events, we have estimated the total expenditure involved. MATERIALS AND METHODS: For one year an orderly reported cases in which, when he arrived to fetch an inpatient, the latter was no longer in the ward or was not ready. From this study material we estimated the waste of time for the staff and the total price of cancelled or delayed examinations, spread over various categories. This sum is related to the estimated cost of one preventive measure: letting the orderly check in the hospital's electronic administrative system whether the patient is still in the ward indicated. RESULTS: A total of 436 cancelled or delayed examinations were reported in 2004. In 249 cases the examination was cancelled, and since the recorded total number of cancellations was 1,435, we estimate the total number of cancelled or delayed exams to be approximately 2,500 (1,435 x 436/249). The estimated total waste of time is 66 weeks (1(1/2) years' work). The estimated price of the cancelled or delayed examinations is 2.4 million Danish kroner. When we relate the savings if the problem is solved to the cost of prevention, we find that it would be clearly profitable to address fluoroscopy and CT scanning. Conversely, addressing bone X-rays would generate a loss. CONCLUSION: We conclude that there is a very large waste of resources caused by cancelled or delayed imaging examinations.

[Etiology and diagnostic methods in vocal cord paralysis]. / Aetiologi og diagnostiske metoder ved stemmebåndsparese.

INTRODUCTION: The etiology of vocal cord paralysis (VCP) is varied. There is lack of consensus regarding the choice of investigations to be used in the evaluation of VCP. The aim of this study was to establish the etiology, assess the diagnostic methods used in the evaluation, and outline an algorithm for future evaluation of unilateral vocal cord paralysis (UVCP). MATERIAL AND METHODS: Charts of all patients (n = 94) with the diagnostic code of VCP were reviewed, and reexaminations were performed of patients in whom no etiology was found after the initial symptoms. RESULTS: The etiology of UVCP was neoplasm in 34%, surgical trauma in 12%, and miscellaneous causes in 54%. The etiology of bilateral vocal cord paralysis (BVCP) was neoplasm in 24%, surgical trauma in 24%, and miscellaneous causes in 52%. The reexaminations did not reveal any cancer diseases in the patients concerned. The most effective diagnostic method was CT-scanning while the least effective was thyroid scanning. DISCUSSION: Because cancer is a common cause of VCP a thorough evaluation is necessary. For UVCP we recommend history and physical examination, X-ray of the chest, ultrasonography of the neck, and CT-scanning of the superior mediastinum. If these prove negative, panendoscopy should be performed. Workup of patients with idiopathic VCP should include examination, X-ray of the chest at 6-month intervals, and annual CT-scanning for two years.