[Diagnosis--therapy and documentation]. / Diagnose--Therapie und Dokumentation.

The procedures of documentation of diagnostic findings are well established--but different in their graphical and structural appearance of patients histories. Out of multiple findings a retrieval with valid informations is very clumsy. In order to increase quality a complete and reliable registration of clinical data base is necessary. For this purpose the use of electronic media is profitable if the requirements of the data-base are well defined. A nationwide agreement on one key-system--including the transformation of textual structures--is proposed. Only this way leads to comparable results in therapeutic procedures.

[The reliability and sources of error in basic clinical documentation--a critical report of experiences]. / Zuverlässigkeit und Fehlerquellen in einer klinischen Basisdokumentation--ein kritischer Erfahrungsbericht.

Since 1. 1. 1985, computer-aided basic medical documentation has been routine at the University Orthopedic Clinic in Friedrichsheim, near Frankfurt. In addition to data on patient's histories, all data needed to satisfy the criteria of the Federal Directive on Operating Cost Rates are gathered. The diagnoses are stored in clear text, in a modified Eichler code, and according to ICD 9. Conversion from the Eichler code to ICD 9 is almost fully automated. In a study covering 100 hospitalized cases the following findings were obtained relating to sources of error and reliability: Without any additional in-house plausibility checks, the rate of error in the ID code, created by coding family name, date of birth, and sex, was 7%. In clear text all diagnoses except one and all forms of therapy were correctly reproduced as contained in the medical report. On the other hand, 7% of the conversions into the Eichler code contained errors. The reason for the difference in the quality of data is pointed out. In some of the other surveys, e.g., of infection rates, the rates of error were very high; most errors had been caused by the ward physicians. Data quality is enhanced by exploitation of routine process data when these control administrative procedures or are used for communication between physicians, since they then become relevant to actions and decisions and hence have to be reliable, regardless of documentation purposes.

[Clinical value of gastrointestinal bleeding scintigraphy in vivo using 99mTc-labeled erythrocytes]. / Klinische Wertigkeit der gastrointestinalen Blutungsszintigraphie mittels in vivo mit 99mTc markierter Erythrozyten.

99mTc labeled red blood cell imaging was performed in 13 patients with clinical evidence of gastrointestinal bleeding from an unknown source. In all these patients the bleeding sites had remained unclear after the standard diagnostic evaluation, including upper gastrointestinal endoscopy (13 patients), colonoscopy (12 patients) and angiography (4 patients). Nine of 13 patients (70%) had a scan indicating active bleeding. In the 10 patients in whom the bleeding site was definitely identified by endoscopy, arteriography, or surgery, scintigraphy correctly localized the bleeding site in 6 (60%). One false positive localization was noted. Bleeding was detected in 7 of 9 patients with melena and in 2 of 4 patients with occult bleeding and chronic anemia. In all but 1 patient, additional diagnostic investigations were needed to finally establish the bleeding site. In patients in whom a potential bleeding site has been identified by standard diagnostic tests, 99mTc red blood cell imaging may provide a reliable noninvasive test by which to document active bleeding from the suspected source.

[Radiological and scintigraphic evaluation of hip prostheses (author's transl)]. / Röntgenologische und szintigraphische Beurteilung von Hüftgelenkstotalprothesen.

The radiological findings following the introduction of hip prostheses are often equivocal. Additional bone scintigrams often provide important information for the evaluation of the prostheses. 1. An unstable hip prosthesis is characterised by abnormal uptake in bone, due to static and mechanical stress. 2. A positive scintigram does not necessarily indicate instability of the prosthesis. Increased uptake may also be due to inflammatory bone changes, healing, bone replacement, abnormal local stresses or soft tissue calcification. 3. In evaluating the scintigram one must take account not only of the intensity of isotope uptake, but also its distribution and exact localisation. 4. It is essential to compare the scintigram with the radiograph. Radiological features of possible instability become diagnostic if they correspond to appropriate increased radioactivity. If the latter is absent, the of instability remains doubtful. 5. In some cases early loosening of the stem of the prosthesis can be diagnosed while the radiograph is still negative. Increased radioactivity in the acetabulum is frequently seen in the presence of a stable acetabular prosthesis and must be interpreted with caution as a sign of loosening of the prosthesis.

[Radio-isotope investigations in bone and joint disease (author's transl)]. / Radioisotopenuntersuchung bei Knochen- und Gelenkerkrankungen.

Scintigraphy of the skeleton has a definite place. It is indispensable in examinations of clinically or radiologically doubtful lesions and should be routinely used for the classification of malignant tumors. Scintigrams may often provide additional information to radiographs and make possible more precise diagnosis or assessment of results of treatment.

[Radioiodine studies with 1231]. / Radiojodstudium mit 123J

The use of 123I (half-life of 13,3 h, no beta emission) results in a marked diminution of thyroid and total body exposure in comparison to 131I. 99mTc-pertechnetate would give the lowest radiation dose, but is not an ideal thyroid agent because it only reflects the iodine trapping mechanism. Several studies show discrepancies between pertechnetate and iodine scans, i.e. Usher and Arzoumanian (2), Turner and Spencer (3). 123I is cyclotron produced, in Switzerland by the 127I (p, 5n) leads to 123Xe leads to 123I reaction. The short half-life needs a modification of the usual testing with 131I. In the present study, thyroid uptakes after 6 h and 24 h, blood sampling after 24 h for 123PBJ and scanning after 6 h give the best results for a complete 123I tracer study of the thyroid. If only morphology of the thyroid is needed, a 6 h scan is done. The normal ranges for uptake values and the 123PBJ are similar to those with 131I. The scans with 123I are definitely faster and of better quality, either by scanner or by camera. The administered doses are 100 muCi for scanning and 300 muCi 123I orally for a complete tracer study. 100 muCi 123I result in a thyroid radiation dose of about 1,5 rads and a total body dose of about 3 mrads [James, Wagner, Cook (1)].