Poul Stage

Late Ventricular Dilatation in Survivors of Acute Myocardial Infarction

The purpose of this study was to assess the natural course of left ventricular (LV) volumes in the convalescent phase of acute myocardial infarction (AMI). Fifty-seven patients were examined 2 weeks and approximately 1 year after AMI by a radionuclide method allowing determination of absolute LV volumes. After 1 year the patients had fewer clinical and radiologic signs of heart failure, but median end-diastolic volume index had increased from 92 to 112 ml/m2 (p less than 0.001), median end-systolic volume index from 51 to 65 ml/m2 (p less than 0.001) and median stroke volume index from 39 to 47 ml/m2 (p less than 0.001). Patients with first anterior infarcts had significantly greater increases in end-diastolic volume index, end-systolic volume index and stroke volume index than patients with first inferoposterior infarcts. The increase in LV volumes was significantly greater in patients with clinical manifestations of heart failure than in those without these signs. Notably, changes in LV size had an unpredictable effect on LV ejection fraction.

Predictive Values of Diagnostic Tests in the Evaluation of Female Urinary Stress Incontinence

Preoperatively a collaboration between gynecologists, urologists and radiologists is essential for the diagnostic accuracy of urinary incontinence especially to isolate stress incontinence for surgical treatment. the aim of this study was to estimate the value of these combined efforts.

Interobserver Agreement and Accuracy of Bedside Estimation of Right and Left Ventricular Ejection Fraction in Acute Myocardial Infarction

Ninety-eight patients with acute myocardial infarction were examined by 3 clinicians who, independently of each other, gave an estimate of left ventricular (LV) and right ventricular (RV) ejection fraction (EF) in each patient. Their estimates were based on physical examination, chest x-ray, electrocardiogram, patient history and clinical course during admission. Ejection fractions were estimated as belonging to 1 of 4 categories: normal (LVEF greater than or equal to 0.53, RVEF greater than or equal to 0.57), mildly reduced (LVEF 0.40 to 0.52, RVEF 0.45 to 0.56), moderately reduced (LVEF 0.30 to 0.39, RVEF 0.35 to 0.44) or severely reduced (LVEF less than 0.30, RVEF less than 0.35). Radionuclide ventriculography was carried out immediately after the physical examination. LVEF was correctly estimated in 43% of all examinations, deviated from radionuclide LVEF by 1 LVEF category in 45% and by 2 LVEF categories in 12%. The 3 clinicians agreed on estimated LVEF in only 32% of the patients. RVEF was correctly estimated in 67% of the examinations, but none of the clinicians identified greater than 43% of the relatively few patients with reduced radionuclide RVEF and they greatly disagreed as to who among the patients had a reduced RVEF. Previous myocardial infarction, electrocardiographic infarct location, Killip class, physical signs of left- and right-sided heart failure, radiographic pulmonary congestion and cardiomegaly were analyzed to determine which were the most helpful in predicting LVEF and RVEF. The results disclosed that several variables, traditionally believed to be reliable indexes of reduced ventricular function, were surprisingly poor predictors of LVEF and RVEF.

Clinical Synovitis and Radiological Lesions in Rheumatoid Arthritis: A Prospective Study of 25 Patients during Treatment with Remission-inducing Drugs

The joints of hands and feet of 25 patients (1150 joints) with rheumatoid arthritis were compared, joint by joint, clinically and radiologically, over 2 years of treatment with remission-inducing drugs. Joints with clinical signs of synovitis decreased from 47% to 17% (p less than 0.001), while the number of joints with radiological lesions increased from 23% to 27% (p less than 0.01). Definite radiological progression of bone lesions was seen in 7% of the joints. Joints with clinical synovitis had a higher risk of progressive bone damage than joints without clinical synovitis (p less than 0.001) and joints in which the clinical signs of synovitis persisted during the study had a higher risk of progressing bone lesions than joints in which the clinical synovitis subsided (p less than 0.001). Progressive bone damage was seen more often in swollen joints than in tender joints without swelling or joints without clinical signs of synovitis (p less than 0.001), the difference in radiological progression between the latter two groups being non-significant. Twenty-one per cent of the joints with progressive bone lesions had no clinical signs of synovitis during the period.

Stricture prophylaxis in transurethral prostatectomy.

In a prospective study 317 patients with prostatic hypertrophy, admitted for transurethral prostatectomy (TUR P), were randomized into three different groups: (1) urethral dilation and TUR P; (2) urethrotomy according to Otis and TUR P, and (3) TUR P alone. The number of postoperative urethral strictures significantly decreased in the Otis group and significantly increased in the dilatation group as compared with the control group.

Endoscopic retrograde cholangiopancreatography and transhepatic cholangiography in patients with suspected obstructive jaundice. A randomized study.

To establish principles for choosing between endoscopic retrograde and percutaneous transhepatic cholangiography, we randomized 52 consecutive jaundiced patients with clinically suspected obstructive jaundice. The bile ducts were visualized in 85% by the endoscopic and in 84% by the transhepatic route. A conclusive diagnosis was reached in 89% and 68% of the patients, respectively, but the difference is not significant (0.10 less than P less than 0.20). If the planned type of cholangiography failed, the other method was tried. By comparing the total numbers of investigations, a conclusive diagnosis was achieved in 91% by endoscopic and 69% by transhepatic route, which is significantly different (P less than 0.05). We therefore prefer to do endoscopic cholangiography initially with transhepatic cholangiography as the complementary method.

High-dose urography in advanced renal failure. I. Evaluation of diagnostic value.

Following the introduction of the less toxic triiodinated contrast media for urography in 1953 (the diatrizoates) more than 10 years elapsed before the higher doses were employed in renal failure (SCHWARTZ et colI. 1963, SCHENCKER 1964). This reluctance was due to experiences with the earlier diiodinated contrast media, which frequently caused deterioration of renal function, even in low doses, and furthermore, produced poor diagnostic results (OLSSON 1954). High...dose urography has been applied to patients with marked renal failure, even in a state of anuria, in recent years (FRY & CATTELL 1971, BROWN et colI. 1970). The diagnostic results were encouraging and the examinations were apparently not followed by further depression of renal function; its systematic recording before and after urography was however not performed. The value of high-dose urography in advanced renal failure is however not generally accepted, and the present investigation was therefore undertaken, first to assess the diagnostic information in extremely uremic patients, all having endogenous creatinine clearances less than 12 ml per minute with several already in dialysis, and secondly to determine the effect of the contrast medium on renal and hepatic functions. A number of patients were examined both before

Washout Urography: Its Value in the Diagnosis of Renovascular Hypertension

Washout urography was used as a screening test in 805 hypertensive patients. Its value in the diagnosis of renovascular hypertension was evaluated from 124, of these patients who had renal aortography in close time relation to the urographic examination. In 22 cases the diagnosis of renovascular hypertension was verified by operation and postoperative follow-up. Sixty five patients had normal renal arteries. The washout test was positive in 95% of cases with proven renovascular hypertension and in 9% of the cases with normal renal arteries. Blood pressure was unchanged after operation in 5 patients. Four of these had normal washout tests preoperatively. These results were more favourable than those obtained from other urographic features such as differences in kidney length and early excretion rate (one minute sequence filming), and isotope renography. If difference in early excretion rate is used as a single diagnostic criterion, the intervals between exposures should be shorter than one minute. As a rad...

Ultrasonic Diagnosis and Transurethral Incision of Ureterocele with Hydronephrosis

In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography is advantageous in diagnosing acute urinary-tract obstruction, and transurethral incision is useful in the acute treatment of ureterocele.

Urethrography and Urethroscopy in Males

In the diagnosis of urethral stenosis before prostatectomy, urethrography and urethroscopy were independently compared in a prospective series of 100 cases. Total agreement was found in 94%. In 6% ure