Diagnostic utility of unenhanced computed tomography for acute aortic syndrome.

BACKGROUND: The diagnostic value of unenhanced computed tomography (CT) for diagnosing acute aortic dissection (AAD) and ruptured thoracic aortic aneurysm (TAA) remains unclear. METHODS AND RESULTS: We examined 219 consecutive patients who visited the emergency room with suspected acute aortic syndrome (AAS) because of chest or back pain and who underwent both unenhanced and contrast-enhanced 64-row multi-detector CT. The unenhanced CT findings were evaluated by the cardiologist on duty who was blind to the findings of contrast-enhanced CT. Diagnosis of AAS was confirmed in 103 patients (47%, 95 AAD and 8 ruptured TAA patients) based on evaluation of both unenhanced and contrast-enhanced CT images, which was used as the reference standard for validating the diagnostic value of the unenhanced CT findings. Sensitivity and specificity of the findings of a high-attenuation crescent, which represents hematoma in the aortic wall, were 61.2% and 99.1%, respectively. Sensitivity and specificity of linear high density in the aorta, which represents an intimal flap, were 59.2% and 96.6%, respectively. If unenhanced CT showed none of high-attenuation crescent, linear high density, internal displacement of intimal calcification, or TAA, the negative predictive value was 93.3%. CONCLUSIONS: Unenhanced CT is a good tool for ruling AAS in, but the false-negative rate of 6.7% is high for ruling AAS out because it has to be the minimum possible.

[Usefulness of a manual on physician behavior at the time of death confirmation].

The behavior of a physician when confirming the death of a patient is thought to greatly affect the bereaved family. The required aspects of a physician's behavior after a patient's death are rarely included in physician education. Therefore, the few physicians who confirm the death of a patient should be conscious of the grief of the family members. A questionnaire survey was administered to nurses of a palliative care unit, and the findings showed that the behavior of an attending physician was different from that of other physicians when confirming death. We have prepared a manual that specifies the expected behavior of physicians confirming the death of patients to ensure that physicians other than the attending physician are also conscious of subsequent grief care for the bereaved family.

Measurement of HRQL using EQ-5D in patients with type 2 diabetes mellitus in Japan.

OBJECTIVES: We measured the health-related quality of life (HRQL) of diabetes mellitus patients using the Japanese version of EQ-5D, and examined the relationship between clinical condition and health status. METHODS: A study was conducted on 220 patients with type 2 diabetes mellitus at a hospital in Saitama Prefecture on the day of their visit from November 17 to December 24, 1998. Patients evaluated their health status using five dimensions (5D) and a visual analog scale (VAS). The EQ-5D score was calculated based on the 5D responses using the Japanese version of the value set. RESULTS: There were no responses of "extreme problem." The frequency of "some problem" was significantly higher in patients with complications than in those without for mobility (27.4% and 14.4%) and anxiety/depression (25.7% and 13.5%). The mean EQ-5D score was 0.846 (95% confidence interval [CI] 0.817-0.874) in patients with complications versus 0.884 (95% CI 0.855-0.914) in those without complications. There was no statistically significant difference between VAS scores according to the presence or absence of diabetic complications, but a significant difference in VAS scores was seen according to the presence or absence of retinopathy. CONCLUSION: These findings suggest the value of measuring health status in diabetes mellitus patients, because it is able to comprehensively evaluate the patient's health condition, and add another dimension to the subjective symptoms and laboratory data.