Interobserver variation in the detection of pulmonary venous hypertension in chest radiographs.

A total of 171 sets of chest radiographs chosen randomly were reviewed independently by two residents in their second year of training, and two experienced radiologists. The degree of interobserver agreement in an overall assessment of pulmonary venous hypertension and in the assessment of five signs, indicative of pulmonary venous hypertension was determined by kappa statistics. The average level of agreement was moderate (0.51-0.56) for the overall assessment and the signs of perivascular clouding, perihilar haze and pleural effusion, and poorer (0.31-0.38) for flow shift and Kerley lines. In the overall assessment agreement between experienced radiologists was slightly better (0.63) than average. Multiple reader interpretation is recommended for the assessment of low-grade pulmonary venous hypertension.

Computed tomography of the lungs in acquired immunodeficiency syndrome. An early indicator of interstitial pneumonia.

Computed tomography of the chest was performed on 42 occasions as part of the diagnostic work-up in 26 homosexual men with, or suspected of the acquired immunodeficiency syndrome (AIDS). In 17 cases both the chest radiographs and the lung scans were abnormal, and bronchoscopy and/or lung biopsy established an etiologic diagnosis in the majority of these cases. In 9 cases CT of the lungs revealed unequivocal interstitial infiltration in the presence of a normal chest radiograph, and subsequently an etiologic agent was demonstrated in all these cases. In 9 cases, patients with symptoms indicative of pulmonary infection had both a normal chest radiograph and a normal lung scan, and in none of these cases did the clinical course or additional diagnostic procedures indicate the presence of current opportunistic lung infection. CT of the lungs seems to identify accurately those patients with severe HIV-related diseases in whom invasive diagnostic procedures such as bronchoalveolar lavage and/or lung biopsy should be done.

Computed tomography in opportunistic lung infections.

Chest radiography in two teenage boys, one with Wiscott-Aldrich's syndrome and one with acute lymphatic leucemia in remission showed increased interstitial pattern. In both computed tomography (CT) of the lungs showed heavy interstitial pneumonia, rather different in appearance but in both cases equal to the CT findings in opportunistic lung infections known from immunoincompetent patients with for instance pneumocystis carinii and/or cytomegalo virus infections. In both patients the CT findings led to lung biopsy establishing the etiologic agent.

Reaction time and brain disease: relations to location, etiology and progression of cerebral dysfunction.

Using the results from 485 patients with various forms of cerebral dysfunctions and from 60 hospitalized controls, it was shown that measurement of continuous reaction times (CRT) is sensitive to cerebral lesions. Reaction times were more impaired by progressive than by non-progressive brain diseases. The test did not distinguish between patients with right- or left-hemisphere lesions and was not influenced either by etiology, chronicity, age or sex. Our conclusion is that CRT is useful as a "screening" test for the presence of cerebral dysfunction and is especially sensitive to progressive diseases. Its discrimination power is equivalent to more sophisticated and complex psychological tests.

Excretory urography with glucagon: a randomized trial.

The authors compared the effect of glucagon (1 mg I.V.) and a placebo on visualization of the collecting systems and ureters in 185 adults undergoing routine excretory urography. Either glucagon or the placebo was given 10 minutes after contrast injection in the first 95 patients and 5 minutes after contrast injection in the remaining 90 patients. Ampules were randomized. Objective and subjective analysis showed no improvement in visualization of either the collecting systems or the ureters in either group: in fact, glucagon caused the quality of the urograms to decrease significantly. Possible reasons for this are discussed. No side effects attributable to the glucagon were observed.

Reliability of the abdominal plain film diagnosis in pediatric patients with suspected intussusception.

In order to reassess the diagnostic reliability of the abdominal plain film examination in suspected intussusception, the findings in 100 consecutive cases of this disorder were analysed. Then, these were compared with the same number of cases in which the diagnosis had been rejected by means of barium enema. It was found that a positive plain film diagnosis of intussusception was possible in 89 patients. In 11 cases inconclusive plain film findings called for supplementary barium enemas to establish the diagnosis. In the reference group intussusception was excluded on the basis of plain film findings alone in 74% of cases. In the remaining 26% of patients a barium enema proved necessary to reject the diagnosis of suspected intussusception.

A controlled long-term study of flunitrazepam, nitrazepam and placebo, with special regard to withdrawal effects.

The hypnotic effect of flunitrazepam (Ro 5-4200), nitrazepam and a placebo was studied in 117 outpatients using hypnotics for at least 3 months prior to the study. They obtained various neurotropic drugs and this and other treatments were unchanged throughout the trial period of 13 weeks. This consisted of 3 weeks on the previously used hypnotic, 3 weeks on a test drug (during the first of these a doubling of the dose was permitted if the initial dose of 1 mg flunitrazepam, 5 mg nitrazepam or one tablet of placebo was not satisfactory) and 4 weeks' observation after a request to stop medication with the test drug. The effects were evaluated every week by self-ratings. Also noted were: the frequency of dose increase after 1 week of the test period, number of drop-outs in the test period, and failure in the attempt to stop taking the test drug. A "psychological concentration test" was done, as was a follow-up interview. The self-ratings had a good reliability and showed that more patients experienced shorter sleep induction, longer sleep time, better sleep quality and a subjective feeling of having had a better rest with flunitrazepam than with either nitrazepam or placebo. There were no differences between the nitrazepam and the placebo groups. Tiredness was the most common side effect and appeared in the same frequency in all groups. The number of patients who increased the dose after 1 week's medication, as well as the number of drop-outs, was significantly higher in the nitrazepam and placebo groups than in the flunitrazepam group. There was no difference in the ability to discontinue the medication between the test groups or between groups having previously used different hypnotics. The "psychological concentration test" did not reveal any differences between groups. It was concluded that withdrawal of a hypnotic in chronic users was not facilitated by the use of a placebo. This was interpreted as due to a strong psychological dependence upon the hypnotics and their lack of pharmacological effects during long-term treatment.