RESUMO
Our objective was to study agreement between the compression ultrasound images taken in our respiratory medicine department and the duplex ultrasound images obtained by radiologists at our hospital for patients admitted to our ward with suspected diagnoses of venous thromboembolism.Seventy-eight consecutive patients admitted to our respiratory medicine ward suspected of venous thromboembolism were enrolled. Both types of images were available for all patients studied. Agreement was 90% with a Kappa coefficient of 0.81. Agreement between the two techniques was good. Therefore, compression ultrasonography is a technique that can be handled by respiratory medicine specialists for the diagnosis of venous thromboembolism.
Assuntos
Pneumologia , Tromboembolia/diagnóstico por imagem , Ultrassonografia/métodos , Trombose Venosa/diagnóstico por imagem , Humanos , Ultrassonografia Doppler Dupla/normasRESUMO
El propósito de este trabajo es estudiar la concordancia de la ecografía que realizamos en nuestro servicio de neumología (ecografía compresiva), comparada con la que realizaban los radiólogos en nuestro hospital (ecografía dúplex), en el diagnóstico de pacientes con sospecha de enfermedad tromboembólica venosa que ingresaron en nuestra planta. Se incluyó a 78 pacientes consecutivos ingresados en nuestra planta de neumología por sospecha de enfermedad tromboembólica venosa, a los cuales se les practicaron ambas técnicas. El acuerdo observado fue del 90 por ciento con un índice de concordancia kappa de 0,81. Se produjo una buena concordancia entre el resultado de ambas técnicas y, por tanto, la ecografía compresiva es una técnica que pueden utilizar perfectamente los neumólogos en el diagnóstico de la enfermedad tromboembólica venosa (AU)
Assuntos
Humanos , Pneumologia , Tromboembolia , Ultrassonografia , Ultrassonografia Doppler Dupla , Trombose VenosaRESUMO
We proposed developing two symptom-based systems for assessing the presence of pulmonary thromboembolism (TEP) in our practice, using a standardized questionnaire and multivariate models. Data were collected from September 1993 through November 1994 (case reports, physical examination findings and complementary test results) of patients admitted to our ward with a suspicion of TEP. The calculated odds ratio for each of the variables recorded were used as weights to determine their relevance or not for the group at risk for TEP. The yield of the two systems developed (a weights system and a logistical model) were studied by plotting ROC curves. Eighty-two patients (40 women and 42 men, mean age 60.94 +/- 14.39 years) were admitted. The questionnaire had a sensitivity of 88% and a specificity of 75%, a positive predictive value of 94% and a negative predictive value of 60%. The logistical regression model had a sensitivity of 96.3% for a diagnosis of TEP with inclusion of the following variables: female sex, disease-related immobility, presence of deep venous thrombosis (DVT) in the lower extremities and the appearance of unexplained dyspnea. Neither system was clearly superior to the other for arriving at a clinical diagnosis of TEP.
Assuntos
Embolia Pulmonar/diagnóstico , Inquéritos e Questionários , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: To determine the frequency of pneumonia in patients with primary lung cancer requiring hospital admission, the etiologic diagnosis, probable production mechanisms, and the factors which may condition the evolution. METHODS: A prospective study was carried out in patients with primary lung cancer requiring hospital admission between 1986-1990. The diagnosis of pneumonia was performed by clinical and radiologic criteria and the etiology, in all cases, by hemocultures, pulmonary aspiration puncture, transtracheal aspiration and bronchoscopic techniques. RESULTS: The frequency of pneumonia was 12%. Etiologic diagnosis of the pulmonary infection was achieved in 16 patients and the most frequent etiologic agents were Gram negative (56%), anaerobic (31%) and Pneumocystis carinii (31%). Mortality was 16%. Community or nosocomial infection was not related with the evolution of the lung infection. Neither did diagnosis of the etiologic agent condition mortality attributable to the pneumonia but facilitated treatment. CONCLUSIONS: Pulmonary infection is a frequent and severe disease in patients with primary lung cancer. Bronchial obstruction may be the related pathogenic mechanism in the greatest number of cases with pneumonia. Due to the etiologic spectrum of these infections the practice of reliable diagnostic techniques is recommended to obtain etiologic diagnosis in addition to the administration of initial wide spectrum empiric antibiotherapy against the mentioned germs.
