Solución del caso 33. Interrupción proximal unilateral de la arteria pulmonar izquierda / Solution to case 33. Unilateral proximal interruption of the left pulmonary artery

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Utilidad diagnóstica y variabilidad interobservador del sistema BI-RADS-ecografía / Diagnostic accuracy and interobserver variability in the BI-RADS ultrasound system

Objetivos: Conocer los valores predictivos y la variabilidad interobservador de los descriptores y de las categorías diagnósticas del sistema BI-RADS- ecografía y su utilidad para predecir la malignidad de los nódulos sólidos mamarios. Material y métodos: Se seleccionaron consecutivamente 601 nódulos sólidos de 554 pacientes evaluados mediante ecografía. Todas las ecografías fueron realizadas por alguno de los 3 radiólogos participantes en el estudio y las imágenes estáticas revisadas independientemente por los 3, sin conocimiento de la historia clínica, de la mamografía ni de la anatomía patológica. Resultados: Los descriptores que mejor predijeron la benignidad fueron el margen circunscrito y la formal oval (valor predictivo negativo [VPN] > 96%), la orientación paralela (VPN, 84–91%) y la interfase abrupta (VPN, 81–90%). Los que mejor predijeron la malignidad fueron el margen espiculado (valor predictivo positivo [VPP], 77–85%), el halo ecogénico (VPP, 61–71%) y la orientación antiparalela (VPP, 53–54%). Resultados: La concordancia interobservador fue buena para la morfología (k=0,61), el margen circunscrito (k=0,65) y las calcificaciones (k=0,63). Resultados: Los descriptores que presentaron los valores pronósticos más altos para la malignidad fueron el margen espiculado (odds ratio [OR] =14,68–10,45) y la orientación antiparalela (OR=3,95–6,17). Resultados: La categoría 3 mostró un excelente VPN para los 3 radiólogos (99–100%). La concordancia interobservador fue buena para las categorías 5 (k=0,77) y 3 (k=0,68) y moderada para la 4 (k=0,59). Conclusiones: El sistema BI-RADS-ecografía ayuda a diferenciar las lesiones mamarias benignas de las malignas con una concordancia interobservador buena o moderada. La categoría 3 mostró un excelente VPN, lo que permitiría evitar las biopsias de las lesiones incluidas en ésta (AU)

Objectives: To determine the predictive values and the interobserver variability of the descriptors and diagnostic categories of the BI-RADS- Ultrasound system and its usefulness for predicting malignancy in solid breast nodules. Material and methods: We evaluated 601 consecutive solid nodules in 554 patients studied with ultrasound. All ultrasound examinations were performed by one of the three radiologists that participated in the study and the static images were reviewed by all three radiologists independently; radiologists were blind to the clinical history and to the findings at mammography and at histological study. Material and methods: The descriptors that best predicted benignity were circumscribed margins and oval shape (NPV, > 96%), parallel orientation (NPV, 84%-91%), and abrupt interface (NPV, 81%-90%). The descriptors that best predicted malignancy were spiculated margins (PPV, 77%-85%), echogenic halo (PPV, 61%-71%), and nonparallel orientation (PPV, 53%-54%).Material and methods: Interobserver concordance was good for lesion shape (k=0.61), circumscribed margins (k=0.65), and calcifications (k=0.63).Material and methods The descriptors that presented the highest prognostic values for malignancy were spiculated margins (OR=14.68–10.45) and nonparallel orientation (OR=3.95–6.17) (AU)

[Diagnostic accuracy and interobserver variability in the BI-RADS ultrasound system]. / Utilidad diagnóstica y variabilidad interobservador del sistema BI-RADS-ecografía.

OBJECTIVES: To determine the predictive values and the interobserver variability of the descriptors and diagnostic categories of the BI-RADS- Ultrasound system and its usefulness for predicting malignancy in solid breast nodules. MATERIAL AND METHODS: We evaluated 601 consecutive solid nodules in 554 patients studied with ultrasound. All ultrasound examinations were performed by one of the three radiologists that participated in the study and the static images were reviewed by all three radiologists independently; radiologists were blind to the clinical history and to the findings at mammography and at histological study. RESULTS: The descriptors that best predicted benignity were circumscribed margins and oval shape (NPV, > 96%), parallel orientation (NPV, 84%-91%), and abrupt interface (NPV, 81%-90%). The descriptors that best predicted malignancy were spiculated margins (PPV, 77%-85%), echogenic halo (PPV, 61%-71%), and nonparallel orientation (PPV, 53%-54%). Interobserver concordance was good for lesion shape (kappa=0.61), circumscribed margins (kappa=0.65), and calcifications (kappa=0.63). The descriptors that presented the highest prognostic values for malignancy were spiculated margins (OR=14.68-10.45) and nonparallel orientation (OR=3.95-6.17). Final assessment category 3 yielded an excellent NPV for all three radiologists (99%-100%). The interobserver concordance was good for category 5 (kappa=0.77) and for category 3 (kappa=0.68); it was moderate for category 4 (kappa=0.59). CONCLUSIONS: The BI-RADS- Ultrasound system helps differentiate benign breast lesions from malignant ones and has a good or moderate interobserver concordance. Final assessment category 3 yielded an excellent negative predictive value, making it possible to avoid biopsies in lesions in this category.

Dracunculiasis / Dracunculiasis

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Utilidad diagnóstica de la exploración física para detectar hepatomegalia / Diagnostic usefulness of the physical examination in detecting hepatomegalia

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Deliberate, repeated self-administration of metallic mercury injection: case report and review of the literature.

Self-administration of metallic mercury through the intravenous route is rare. This event has been reported in psychiatric patients and in suicide attempts. We report a case of successive intravenous self-injections of mercury demonstrated by plain film radiographs and CT scans of the thorax and abdomen.

Utilidad diagnóstica del cuestionario "Alcohol Use Disorders Identification Test" (AUDIT) para detectar trastornos relacionados con el alcohol en pacientes hospitalizados / Diagnostic usefulness of "alcohol use discorders identifications tets" (audit) for detecting alcohol-related problems in hospitalized patients

Fundamento: Evaluar la utilidad diagnóstica del cuestionario AUDIT (Alcohol Use Disorders Identification Test) para detectar trastornos relacionados con el alcohol (TRA) en pacientes hospitalizados valorar las posibles diferencias en función del sexo o la edad y compararla con la de otros métodos utilizados habitualmente (CAGE y marcadores biológicos). Resultados: La sensibilidad del AUDIT para detectar TRA fue del 98 porciento, la especificidad del 94 porciento y el área bajo la curva ROC de 0,99 (IC 95 porciento: 0,98-1). Su sensibilidad fue menor en las mujeres (94 porciento frente a 99 porciento) y en los pacientes menores de 60 años (97 porciento frente a 100 porciento). El CAGE mostró una sensibilidad del 78 porciento y una especificidad del 99 porciento. Entre los marcadores biológicos destacaron la GGT y el VCM con sensibilidades del 83 y 74 porciento y especificidades del 53 y 74 porciento respectivamente. Conclusiones: El AUDIT es un cuestionario muy Efectivo y claramente superior a otros métodos utilizados habitualmente para detectar TRA en pacientes hospitalizados. Su utilidad diagnóstica es menor en mujeres, similar en los dos grupos de edad considerados y claramente superior a la de otros métodos utilizados habitualmente (AU)

[Diagnostic usefulness of the questionnaire "Alcohol Use Disorders Identification Test" (AUDIT) to detect conditions associated with alcohol in hospitalized patients]. / Utilidad diagnóstica del cuestionario "Alcohol Use Disorders Identification Test" (AUDIT) para detectar trastornos relacionados con el alcohol en pacientes hospitalizados.

OBJECTIVE: To evaluate the diagnostic usefulness of AUDIT (Alcohol Use Disorders Identification Test) for detection of alcohol-related problems (ARP) among hospitalized patients, to assess the potential differences according to age or sex and to compare its diagnostic value with that of some other conventionally used measures (CAGE questionnaire and biological markers). MATERIAL AND METHODS: This is a cross-sectional study for evaluation of diagnostic tests including 179 hospitalized patients in a Medicine Unit. Data about weekly alcohol intake were collected through a semistructured interview. AUDIT and CAGE questionnaires were administered and blood levels of GGT, MCV, AST, ALT, alkaline phosphatase, platelet count, trylicerides and uric acid were determined. RESULTS: AUDIT sensitivity in detecting ARP was of 98%, specificity was of 94% and area under ROC was 0.99 (95% CI: 0.98-1). Its sensitivity was shown to be lower both in the female group (94% vs. 99%) and in age group under 60 years (97% vs. 100%). CAGE showed a sensitivity of 78% and a specificity of 99%. Among biological markers GGT and MCV should be highlighted with sensitivities of 83% and 74% and specificities of 53% and 74% respectively. CONCLUSIONS: AUDIT is an effective tool for detection of ARP among hospitalized patients. Its diagnostic usefulness being lower for females, similar for both age groups considered and clearly higher than that of other commonly used measures.