Soft-copy versus hard-copy cranial sonography: intraobserver agreement and workstation efficiency.

OBJECTIVE: The objective of the study was to determine the intraobserver agreement, confidence level, and efficiency in interpretation of soft-copy (workstation) versus hard-copy (laser-printed film) sonograms of the cranium. MATERIALS AND METHODS: Cranial sonograms of 100 premature infants were randomly reviewed twice on both soft-copy and hard-copy images by three observers and were graded for hemorrhage using a five-level scale. The kappa statistic was calculated to measure intraobserver agreement. Differences in agreement were tested for statistical significance with a test for marginal homogeneity. Observers rated their confidence in interpretation using a six-point ordinal scale. Total viewing time was recorded, and videotaped sessions were analyzed for image handling time (opening each case, closing each case, and selecting the next case) and interpretation time. RESULTS: For soft copy versus hard copy, the mean kappa value was .73; for hard-copy 1 versus hard-copy 2, .71; and for soft-copy 1 versus soft-copy 2, .65. None of these differences was statistically significant (p > .05). The mean confidence score was the same for soft copy (5.3) and hard copy (5.3). On average, the observers needed 24 min longer to review 100 studies on soft copy than on hard copy. Opening and closing times for soft copy were significantly faster than for hard copy (p = .0001); however, case selection for soft copy, which was not needed for hard copy, took 4.69-9.09 sec per case. Extrapolated to 100 cases, case selection accounted for 8-15 min of viewing time. CONCLUSION: Radiologist agreement and confidence in the interpretation of cranial sonograms for hemorrhage was the same for soft copy and hard copy. However, viewing times were longer for soft copy. Elimination of inefficiency in case selection could improve image-handling time.

Perforation of the small bowel following a suction biopsy: diagnosis on upper GI series.

A number of complications following small bowel biopsy have been reported. We wish to report an uncommon complication, in which there was a perforation of the small bowel discovered during an upper GI series.

Duodenocolostomy: a surgical complication of duodenal atresia repair.

A variety of complications after repair of congenital duodenal obstruction have been reported. The authors describe a case in which the duodenum was mistakenly anastomosed to the transverse colon, which resulted in intractable diarrhea.

Occult posttraumatic avascular necrosis of hip revealed by MRI.

Three hips with avascular necrosis in two patients had associated traumatic lesions noted on magnetic resonance imaging. Location of stress fracture in two femoral necks and acetabular contusion development prior to avascular necrosis favors these processes as being etiologic. These cases are particularly noteworthy in that nondisplaced fractures or other musculoskeletal trauma not visible on plain films has rarely been associated with subsequent development of avascular necrosis.

L-homocysteic acid: an endogenous excitotoxic ligand of the NMDA receptor.

L-Homocysteic acid (L-HCA) has been proposed as a natural transmitter at the N-methyl-D-aspartate (NMDA) subtype of excitatory amino acid receptor based on recent evidence that L-HCA occurs L-HCA occurs naturally in the mammalian CNS, is released from K+ stimulated brain slices in a calcium-dependent manner and may be contained in nerve terminals located in certain brain regions that have a high density of NMDA receptors. Here we report that L-HCA potently induces a pattern of cytopathology in the ex vivo chick retina which mimics the pattern of NMDA but not kainic acid (KA) neurotoxicity. We also show that known NMDA antagonists, including Mg++, D-aminophosphonopentanoate and certain anesthetics, analgesics, and sedative hypnotics block the neurotoxic actions of L-HCA in direct proportion to their efficacy in blocking NMDA neurotoxicity. While there is a perfect correspondence between agents that block NMDA and L-HCA neurotoxicity, only a few such agents are active against KA neurotoxicity. We find that 3H-Glu binding is inhibited more potently by L-HCA (Ki = 67 microM). Moreover the patterns with which L-HCA and NMDA displace 3H-Glu binding in autoradiograms appear essentially identical. These findings are consistent with the proposal that L-HCA is an endogenous ligand at NMDA receptors.

A retractable, multi-view gas delivery apparatus.

The author described a radioxenon gas delivery apparatus which permits ventilation imaging of the lung in multiple positions during the rebreathing (equilbrium) phase following the administration of a single dose of tracer. A single, rapid check for gas leakage is outlined. This can be done before xenon is introduced into the system thus minimizing the chance of xenon escaping. The unit is suspended from the ceiling and retracts out of the way when not in use. A parts list is included.