Lung ultrasound could reduce X-ray after major lung resection.

OBJECTIVES: This study evaluated the role of ultrasound in postoperative care after major lung resection. BACKGROUND: High accuracy of lung ultrasound imaging was proved in various medical fields. The experience with ultrasound after thoracic surgery is limited. METHODS: Patients scheduled for major lung resection were consecutively included in a prospective study comparing two modalities of imaging examinations, namely those employing ultrasound and X-ray in the diagnoses of pneumothorax and pleural effusion. Two examinations were performed. One after recovery from anaesthesia, the second before chest tube removal. RESULTS: Forty-eight patients underwent 87 examinations. X-ray and ultrasound examinations showed substantial and fair agreements for pneumothorax (Cohen's kappa coefficients 0.775 and 0.397) and slight and substantial agreements for pleural effusion (Cohen's kappa coefficients 0.036 and 0.611). The sensitivity bounds for pneumothorax were 45.5-58.5 % at the first and 29.7-59.4 % at the second examination. Sensitivity bounds for pleural effusion were 0-86.2 % at the first and 32.6-36.9 % at the second examination. Except for two cases of pneumothorax being missed by X-ray imaging, the rest of mismatches were clinically irrelevant conditions with no impact on clinical decision and patient's outcome. CONCLUSION: The use of ultrasound can reduce the number of X-ray examinations and thus lower the radiation exposure after major lung resections (Tab. 4, Ref. 30).

[Single-photon emission-computed tomography in the diagnosis of cerebrovascular diseases]. / Príspevok jednofotónovej emisnej pocítacovej tomografie k diagnostike cievnych ochorení mozgu.

BACKGROUND: SPECT-HM-PAO allows to detect the regional cerebral blood flow and total diminution of the brain perfusion still before morphological substrate evolution in CT scan, without invasive technologies. SEARCH GOAL: The authors have analyzed data obtained by SPECT-99mTc HM-PAO in the group of 46 patients suffering from cerebrovascular disorders and they have compared them with results aimed by CT scans. Both, the SPECT-99mTc HM-PAO and CT scan were performed within 48 hours or later after the onset of the stroke; some of CT scans were repeatedly performed. RESULTS: They discovered 40 positive and 6 negative SPECT-HM-PAO findings, 26 positive and 20 negative CT scans. SPECT investigation more frequently discovers circulatory failures in the clinically altered hemisphere than the CT scan does in a substrate; SPECT discloses hypoperfusion of the clinically unaltered hemisphere if silent hypoperfusion is present. The ipsilateral foci of CT substrates were significantly less frequently observed (p < 0.001) than some ipsilateral regional hypoperfusions. Not only the number, but also size and extent of hypoperfusional foci searched by SPECT are significantly higher and wider than the numbers and dimensions of substrates observed by CT (p < 0.001). CONCLUSION: CT scan diagnostic possibilities are restricted by the time factor (CT examinations performed within 48 hours since the onset of the stroke are significantly less frequently positive than those performed later-p < 0.001). SPECT examination has not such a limiting time factor (p > 0.05). MEANING: Hence SPECT-HM-PAO renders early, long lasting and wide information on the restriction of the overall and regional perfusion, independently of the fact as to whether the reduction of cerebral perfusion is, or is not going to result in ischemic necrosis and/or ischemic sclerosis. SPECT renders correlation of the perfusion disorder earlier, wider in space, and more frequently than the CT scan, and therefore it is a prerequisite to the disclosure of the mentioned silent focal blood flow reductions. (Graph 12, Fig. 3, Ref. 4.)

[Lyme disease in internal medicine]. / Lymeská choroba vo vnútornom lekárstve.

The authors present a review on the aetiology, clinical aspects, diagnosis and treatment of Lyme disease. They describe three patients who were treated in their department for Lyme disease. Although this disease has been followed up in Bohemia and Slovakia only for nine years, it is probable that it is more frequent than diagnosed. Lyme disease is a disease which affects different organs. Therefore it is important that specialists in internal medicine should more frequently consider the possible presence of this disease when making differential diagnoses.

[Radionuclide scintigraphy in the diagnosis of Meckel's diverticulum]. / Vyuzitie rádionuklidovej scintigrafie pri diagnostike Meckelovho divertiklu.

In the submitted case-history the authors draw attention to the advantage of radionuclide diagnosis of ectopic gastric mucosae located in Meckel's diverticula. Diagnosis with 99mTc is according to the authors the treatment of choice in acute haemorrhage into the GIT with an obscure aetiology.