Increased diagnosis of pulmonary embolism without a corresponding decline in mortality during the CT era.

AIM: To determine the association between the increasing computed tomography (CT) use for suspected pulmonary embolism (PE) on the annual rates of PE diagnosis and mortality, using time as a surrogate for CT use. MATERIALS AND METHODS: New York State's (NYS) Statewide Planning and Research Cooperative System (SPARCS) database was used to determine the rate of PE diagnosis and mortality between 1 January 1994 and 31 December 2004. Risk factors for PE were investigated. Bivariate and multivariate analyses were performed to determine the relationships between variables. RESULTS: The study population consisted of 24,871,131 NYS patients. The number of patients with a primary diagnosis of PE nearly doubled over the study period, from 2590 in 1994 to 4920 in 2004, while total admissions remained stable. PE deaths did not vary significantly over time, from 157 in 1994 to 159 in 2004 and did not vary with the diagnoses of PE. Age-adjusted multivariate analysis did not reveal a significant association between the rates of PE diagnosis or mortality and corresponding risk factors. CONCLUSION: This study suggests that the increased use of CT in patients with suspected PE has led to an increase in the diagnosis of PE without a corresponding decline in mortality. Further evidence, using data on individual patients, is needed to determine the appropriate role of CT in evaluating patients with suspected PE.

Gallstone empyema complicating laparoscopic cholecystectomy.

Empyema may rarely present as a delayed complication after laparoscopic cholecystectomy. Patients with this complication invariably have associated dropped gallstones in the peritoneal cavity. The gallstones may erode through the diaphragm or migrate through preexisting defects in the diaphragm. The latter are seen in over 50% of the elderly population and may predispose them to this rare complication.

Drug-resistant tuberculosis in an urban population including patients at risk for human immunodeficiency virus infection.

In the past 5 yr, an increased incidence of tuberculosis has been noted in the United States. Simultaneously, the population infected with human immunodeficiency virus-type I (HIV-I) and the number of cases of acquired immunodeficiency syndrome (AIDS) have increased. Selected areas of the United States have also reported increases in the frequency of drug-resistant isolates of Mycobacterium tuberculosis. Because our institution serves a population in which tuberculosis, AIDS, and drug resistant isolates of M. tuberculosis are frequently encountered, we sought to better define interrelationships among these factors by retrospectively reviewing the demographic, clinical, bacteriologic, and radiologic data for all adult patients in whom M. tuberculosis was isolated from a culture of respiratory-tract secretions during a 1-year period (June 1, 1988 to May 31, 1989). Two hundred forty-six patients were thus identified; 66.5% were U.S. born blacks, and 62.6% were 17 to 40 yr of age. Risk factors for HIV infection were present in 106 patients. The overall resistance rate (one or more drugs) = 30.9%, with primary resistance = 22.6% (35 of 155) and secondary resistance = 49.2% (29 of 59). In addition, 12 resistant isolates were found in 32 patients whose prior treatment status was indeterminate. Of the resistant isolates, 56.6% (43 of 76) were multiply resistant. Isoniazid resistance was noted in 90.7% (69 of 76) and rifampin resistance was noted in 50% (38 of 76) of the resistant isolates. No significant differences in the overall frequency of resistance were noted in patients at risk for HIV infection compared with those without these risks.(ABSTRACT TRUNCATED AT 250 WORDS)