Can training improve the results with infrared tympanic thermometers?

BACKGROUND: Infrared tympanic thermometry (ITT) is a method for body temperature measurement. Correct measuring technique is said to be important to achieve good results with this method. The objective of this study was to investigate the accuracy and effect of training in the use of infrared tympanic thermometry (ITT) on the measurement results. METHOD: Nurses trained in the use of ITT, and nurses not trained performed measurement sequences on 65 patients: one rectal and two ITT measurements in each sequence. RESULTS: Mean rectal temperatures were significantly (P < 0.01) higher than with ITT (0.44 +/- 0.42 (SD) degree C for trained, 0.56 +/- 0.4 (SD) degree C for untrained). Coefficient of repeatability for ITT measurements was +/- 0.54 degree C for trained nurses, and +/- 0.48 degree C for untrained. With ITT temperatures adjusted upwards of 0.5 degree C, the sensitivity of ITT for detecting fever as defined by rectal measurements would be 70% for trained, and 54% for untrained nurses. Repeatability and sensitivity for trained and untrained nurses were not significantly (P > 0.05) different. CONCLUSION: Training had little effect on the accuracy of the measurements. According to our results, ITT is often unreliable and should be used with caution.

[Infrared tympanic thermometry. Experience and training does not improve the quality of measurement results]. / Infrarød tympanisk termometri. Erfaring og opplaering i bruken av metoden bedrer ikke kvaliteten på målingene.

Nurses, with and without training in the use of infrared tympanic thermometry, performed measurement sequences on patients. One rectal and two repeated measurements with each of two types of equipment for infrared tympanic thermometry (Genius, Core Check) were used in each sequence. Rectal measurements showed temperatures significantly higher than infrared tympanic thermometry, but there were variations (Genius 0.3 +/- 0.58 (SD) degree C, Core Check 0.5 +/- 0.42 (SD) degree C). The sensitivity of infrared tympanic thermometry for fever, as defined by rectal measurements, was 36% for Genius and 21% for Core Check. The quality of the measurements was not improved by training. Our results indicate that infrared tympanic thermometry should be used with caution when screening for fever in hospitals.

Radiotherapy in the treatment of symptomatic vertebral hemangiomas: technical case report.

OBJECTIVE AND IMPORTANCE: In contrast to the frequent finding of vertebral hemangiomas at autopsy and during radiographical examinations, symptomatic lesions are rare. In the literature, a variety of therapies and combinations of therapies have been reported. There is, however, significant inconsistency regarding which therapy is considered appropriate. CLINICAL PRESENTATION: We report a young man with multiple vertebral hemangiomas, epidural extension, and secondary spastic paraparesis. INTERVENTION: Rapid neurological deterioration and the clinical suspicion of malignant disease led to an initial decompressive laminectomy and biopsy of the intraspinal soft tissue lesion. Postoperative radiotherapy produced, however, substantial effects, with complete regression of the epidural hemangioma. CONCLUSION: Based on the literature, we focus on diagnostic problems and choice of therapy for vertebral hemangiomas. Further, we discuss in particular the beneficial role of radiotherapy in the treatment of these nonmalignant lesions.

Enhancement of iron-catalyzed free radical formation by acidosis in brain homogenates: differences in effect by lactic acid and CO2.

The influence of lactic acidosis and of extreme hypercapnia on free radical generation and lipid peroxidation in brain tissues was studied. Cortical homogenates were prepared from the rat brain in a bicarbonate buffer and incubated for 60 min. Lipid peroxidation was evaluated by measurements of thiobarbituric acid reactive (TBAR) material and alpha-tocopherol analysis. The pH during incubations were decreased to 6.10-6.20 by either lactic acid administration or equilibration with 60% CO2 gas in paired experiments. In homogenates treated with lactic acid there was a 20-fold increase in TBAR material and the alpha-tocopherol concentration decreased to approximately 60% of control. There was only a 10-fold increase in TBAR material and no change in alpha-tocopherol concentration if acidosis was induced by CO2. These differences between lactic acidosis and hypercapnic acidosis were statistically highly significant. The results indicate that lactic acidosis has a more pronounced effect in augmenting free radical generation in brain tissues than acidosis due to an increase in CO2 tension. It is suggested that this effect of lactic acid is mediated by increased dissociation of catalytic iron from proteins of the transferrin type.

Cerebral panangiography in spontaneous subarachnoid hemorrhage from intracranial aneurysms.

Cerebral panangiography was performed in 594 patients with subarachnoid hemorrhage from intracranial aneurysms. Aneurysm of the middle cerebral arteries was the most frequent location of aneurysms in this material. Multiple aneurysms of the middle cerebral arteries are far more frequent than the combination of other locations. Judged from this material there is a 7 per cent possibility of finding a contralateral aneurysm of the middle cerebral arteries if one is found. Multiple aneurysms were found in 51 (8.6%) of the 594 patients. We conclude that the results of this study are typical for Norwegians, although some selection exists since the patients were first admitted to other hospitals. The frequency of complications with cerebral panangiography in subarachnoid hemorrhage was less than that of cerebral angiography in patients with other diseases.

Neurological outcome after surgery for thoracic and lumbar spine injuries.

New techniques for internal fixation, employed by neurosurgeons and orthopaedic surgeons, provide reduction and stabilization with early mobilization of patients after injuries of the thoracolumbar spine. It has, however, appeared difficult to prove that the neurological outcome after surgery may be superior to conservative treatment. In this study the neurological results after surgery are evaluated in 30 patients with injuries of the spinal cord and/or cauda equina. Canal encroachment was found on tomograms or CT in all patients. The unstable fractures, dislocations or fracture-dislocations were all reduced and stabilized by the Harrington distraction device. However, peroperative inspection revealed that the Harrington instrumentation alone may be inadequate in achieving intraspinal decompression. Additional anterior decompression by posterolateral approach was necessary in 13 of the 30 patients (43%). In this series there was an unexpectedly high rate of dural tears. These were found in 8 patients (27%) and nerve roots (cauda equina) appeared to have herniated through the tear in 6 of the 8 patients. Significant improvement of the neurological deficit was obtained in 22 of the 30 patients (73%), and the improvement rate in patients with incomplete lesions of the spinal cord was 83% (25 of 30 patients). In this series there was a definite trend toward greater neurological recovery when compared to the results obtained in patients treated conservatively. The importance of a neurosurgical approach in diagnosis and treatment of these patients is stressed.

Traumatic aneurysms of the pericallosal arteries.

Of a total of 912 operated intracranial aneurysms only three were classified as traumatic (0.3%). They were found in children after severe head trauma and were all located on the pericallosal artery or its branches and not at bifurcations. Shearing forces between the falx, the arteries and the brain at the time of injury are held responsible for the development of these aneurysms. Unlike these traumatic aneurysms, 29 "spontaneous" pericallosal aneurysms (3.2%) in adults were located at the bifurcations of the artery. As significantly fewer reports of traumatic aneurysms have been published during the last decade than before 1976, it is suggested that some might have been overlooked as a consequence of CT replacing cerebral angiography in the neuroradiological evaluation of severe head injury. This possibility should be kept in mind, especially when dealing with children after head injury and when CT scans indicate brain damage around the falx. The possibility of overlooking traumatic pericallosal aneurysms is described by other authors and discussed further in this paper.