Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment.

OBJECTIVE: The purpose of our study was to assess the clinical usefulness of helical CT findings that are interpreted as negative for pulmonary embolism. MATERIALS AND METHODS: One hundred twenty-six patients underwent 132 helical CT examinations and 352 patients underwent ventilation-perfusion scanning for suspected acute pulmonary embolism over a 17-month period at a single institution. Findings from clinical follow-up at a minimum of 6 months were assessed, with a special focus on the presence of recurrent thromboembolism and mortality in 78 consecutive patients in whom helical CT findings were interpreted as negative for pulmonary embolism and anticoagulant therapy was not administered (group I). During the same 17-month period, 46 patients underwent ventilation-perfusion scanning that was interpreted as normal (group II), and 132 patients underwent ventilation-perfusion scanning that was interpreted as showing a very low to low probability for pulmonary embolism (group III). Patients in groups II and III did not undergo helical CT or pulmonary angiography and did not receive anticoagulant therapy. However, clinical follow-up was solicited. Patients from groups II and III were used as control subjects. RESULTS: Nine patients in group I died, one of whom was found to have a microscopic pulmonary embolism at autopsy. In group II, four patients died, none of whom were shown to have a missed or recurrent pulmonary embolism. Of the 18 patients in group III who died, three had a recurrent or missed pulmonary embolism (mean interval, 9 days), and two were found to have deep vein thrombosis on sonography of the leg (mean interval, 12 weeks). Negative predictive values for helical CT, normal lung scanning, and low-probability ventilation-perfusion scanning were 99%, 100%, and 96%, respectively (p = .299). CT provided either additional findings or an alternate diagnosis in 42 (53.8%) of the 78 patients in whom helical CT findings had been interpreted as negative for pulmonary embolism. CONCLUSION: A helical CT scan can be effectively used to rule out clinically significant pulmonary emboli and may prevent further investigation or unnecessary treatment of most patients.

[Infections with penicillinase-producing Neisseria gonorrhoeae in females. Report on 24 cases]. / Infektionen mit Penicillinase produzierenden Neisseria gonorrhoeae bei Frauen. Bericht über 24 Fälle.

Between the last few weeks of 1980 and March 1985 the susceptibilities of 881 strains of Neisseria gonorrhoeae to penicillin were tested by a simple screening method (disc diffusion test). 76.6% of the isolates were good susceptible, 17.7% moderately susceptible and 5.7% resistant to 3 units of penicillin G. Penicillinase-producing Neisseria gonorrhoeae (PPNG) could be detected in 24 cases (2.7%), most of them between July 1983 and January 1984 (n = 18). 23 patients have been treated successfully with oxytetracycline. All infections had been acquired in the GDR, however, the sources of infection could be firmly traced in 6 cases only. On the basis of the results some clinical and microbiological aspects of infections with penicillin resistant gonococci are discussed.

Prenatal stress as possible aetiogenetic factor of homosexuality in human males.

Out of 865 homosexual males who were registered by venerologists in 6 districts of the GDR highly significantly more homosexuals were born during the stressful war and early postwar period of the Second World War, i.e. between 1941 and 1947 (with a maximum of relative frequency in 1944-1945), than in the years before or after this critical period. This finding suggests that stressful prenatal (or perinatal) events may represent an aetiogenetic factor for homosexuality in human males.