Carney's triad.

The purpose of this study is to provide an overview of cases of Carney's triad and to discuss the clinical implications of this diagnosis. A search was made of the English-language literature for original articles, reviews and abstracts addressing Carney's triad. A new patient was described and added to the number of known patients. In literature 40 patients were found with a complete or incomplete triad. There exists no agreement on the pathology and possible common origin of these tumours. Directions are given for diagnostics and therapy. The diagnosis of Carney's triad has specific clinical implications that make a good knowledge of this syndrome mandatory.

Diagnosing scaphoid fractures: radiographs cannot be used as a gold standard!

To evaluate the reproducibility of the interpretation of radiographs for the diagnosis of scaphoid fractures, 134 radiographs (60 consecutive patients) were blindly observed by a resident radiologist, consultant radiologist, resident trauma surgeon and consultant trauma surgeon. The results of radiographs were analysed using kappa (kappa) statistics and stratified according to the results of the corresponding bone scan. In 23 patients the bone scan was positive for fracture of the scaphoid. Irrespective of training and experience, the kappa of the comparison of the scores of the radiographs between any two observers did not exceed 40 per cent. After stratification of the outcome of the bone scan, the kappa did not increase significantly. A panel of three experienced observers gave their opinion of all radiographs. The results were compared with the bone scan results. We conclude that radiographs in suspected scaphoid fracture cannot be used as a reliable diagnostic approach because of the low inter-observer agreement in the interpretation, irrespective of the experience and training of the observer.