[Stimulation with 0,3 mg recombinant human thyrotropin (rhTSH) increases the effect of 131I therapy in patients with nontoxic nodular goiter. A prospective, randomized, double-blind trial--secondary publication]. / Stimulation med 0,3 mg rekombinant human thyrotropin øger effekten af 131 I-behandling hos patienter med atoksisk nodulaer struma. En prospektiv, randomiseret, dobbeltblindet undersøgelse--sekundaerpublikation.

In a randomized, double-blind, placebo-controlled trial, 57 patients with nontoxic nodular goiter were stimulated with either 0.3 mg recombinant human thyrotropin (rhTSH) or placebo before radioactive iodine 131I therapy. After one year the goiter reduction had improved by 35% compared to conventional 131I therapy. The difference was most pronounced in patients with a large goiter. Adverse effects, including development of permanent hypothyroidism, were significantly more frequent in the rhTSH group. Patient satisfaction was high and uninfluenced by the use of rhTSH.

[Quality control of whole-body bone scintigraphy. Patient surveys]. / Kvalitetsudvikling af helkropsknogleskintigrafi. Patientundersøgelser.

INTRODUCTION: The quality of health care is but sparsely elucidated; surveys of complete patient courses hardly exist. We established and used benchmarks for a major nuclear medicine examination: whole-body bone scintigraphy. MATERIALS AND METHODS: The study material included 458 out of 512 consecutive examinations. Patients were referred by general practitioners (12%), practising specialists (16%) and hospital departments (72%). The survey dealt with waiting times and information provided, as judged by the patient, the referring physician and the Department of Nuclear Medicine (DNM) in relation to referrals, reporting and the passing on of the results to the patient. The DNM judged the quality of the examinations, and the referring physician assessed the implications for diagnosis and treatment. RESULTS: In 10% of the cases, the patient felt that the waiting time was unsatisfactory, as the referring physician might take up to 150 days to send the referral and because 11% had, after two months, still not been informed of the examination result. Supplementary tomography was used in 38 examinations (8%); of these, only one (3%) provided new evidence. Based on the examination results, the referring physician could make a diagnosis and/or wanted to change management for 61% of patients. CONCLUSION: Referrals were delayed mainly by the referring physicians, who often forgot to inform their patients of the examination results. Special admissions seldom yielded extra information. The examination result had important clinical implications in almost two thirds of patients.

[Diagnostic imaging in acute pulmonary embolism. The use of spiral computed tomography, lung scintigraphy and echocardiography]. / Billeddiagnostik ved akut lungeemboli. Om brug af spiralcomputertomografi, lungeskintigrafi og ekkokardiografi.

Acute pulmonary embolism is an underdiagnosed and potentially lethal condition. Treatment may be lifesaving but is associated with severe side effects. Thus, reliable diagnostic imaging is essential. We conducted a literature review on the use of spiral computed tomography, lung scintigraphy and echocardiography in acute pulmonary embolism and identified 562 articles, of which 16 original papers met our inclusion criteria. From these, we concluded that none of the modalities is applicable in every situation. Spiral computed tomography can confirm the diagnosis but cannot rule out subsegmental embolism. With lung scintigraphy, perfusion imaging alone is probably sufficient and suited to both confirming and ruling out the diagnosis. Echocardiography should be reserved for patients with an emergent need for treatment and cannot rule out the diagnosis.

[Diagnostic imaging in acute pulmonary embolism in Denmark. A survey]. / Billeddiagnostisk håndtering af akut lungeemboli i Danmark. A rundsporge.

INTRODUCTION: Acute pulmonary embolism is a frequently occurring disease that is associated with a high mortality rate. Accurate diagnosis is essential, but the condition is often misdiagnosed. National and international guidelines do not agree on which imaging modality is preferable for making the diagnosis. Our objective was to determine what the diagnostic method of choice in Denmark is. MATERIALS AND METHODS: We conducted a survey in 30 hospital departments in Denmark regarding the primary imaging procedure for patients with suspected pulmonary embolism. These departments represented various types of hospitals in all parts of Denmark but were otherwise randomly selected. RESULTS: Twenty-seven departments responded. Approximately half of the departments used lung scintigraphy as the primary diagnostic test, one third used echocardiography and the rest used spiral computed tomography. This distribution was largely independent of the type of hospital and which modalities were available in a given hospital. DISCUSSION: We found no coherence between the primary diagnostic modality of choice and other factors including hospital size, type and availability of diagnostic methods.

Diagnostic accuracy of myocardial perfusion imaging in a study population without post-test referral bias.

BACKGROUND: Most previous studies on the accuracy of myocardial perfusion imaging (MPI) are hampered by post-test referral bias, in that referral for coronary angiography was influenced by the MPI result. In this way, patients with a normal MPI result less frequently underwent catheterization, a tendency supposed to cause an underestimation of test specificity and an overestimation of test sensitivity. METHODS AND RESULTS: MPI by use of a gated dual-isotope protocol was undertaken before angiography in 357 patients referred for angiography for suspected stable angina pectoris. The MPI reports were kept secret to prevent post-test referral bias. The MPI study was normal in 215 patients (60%) and showed reversible perfusion abnormalities in 118 (33%) and fixed defects in 24 (7%). Angiography was normal in 231 patients (65%) and revealed 1 or more significant stenoses in 126 (35%). With angiography as the reference, the sensitivity and specificity of MPI for detecting significant coronary artery stenosis were 75% and 79%, respectively. CONCLUSIONS: In this prospective study without post-test referral bias, we found a lower sensitivity and slightly higher specificity than in studies with post-test referral bias. The imperfect accuracy may reflect differences between anatomic and physiologic imaging.