Thesis(M. Med (Anaesthesiology)--University of Limpopo(Medunsa Campus), 2010. / The purpose of this study was to interrogate the clinical relevance and cost effectiveness of the routine preoperative chest X-rays at DGMH. It was conducted as a descriptive cross-sectional prospective study of radiographic films in the Radiology department. A review of patients’ files and chest X-rays performed during a 6-month period from January to June 2008. Data from 100 patients’ files were included in the analysis. The age of patients ranged from 45 to 84years, the median age was 57years. The majority of patients younger than 50years were female, while the majority of male patients were over 50years. From a total of 100 patients only 8%(8 patients) were deemed unfit and consequently postponed or cancelled for further investigation and optimization. The cost for performing one routine chest X-ray was estimated to be R393 manpower, time and film inclusive, the total costs for the 100 patients included in this study being R39300. This study has provided some evidence that the routine preoperative chest X-rays can help in uncovering some abnormalities that were not apparent on clinical examination, it has pointed out that the impact of these uncovered abnormalities is very minimal on the planned surgery and that the costs associated with doing routine pre-operative chest X-rays can be substantial.

As computer technologies are developed rapidly in recent years, the ways to diagnose diseases also alter in clinical practice. Picture Archiving and Communication System (PACS) is an example that makes the diagnostic way for medical images change from view box to monitor. All types of medical images tend to be digitized and this makes it practical for helping doctor diagnose medical images via computer technologies. In this thesis, we propose a systemic approach to screen abnormalities in chest radiographs. First, a preprocess step identifying the view of chest radiographs is introduced. Second, a method is proposed for automated detection of gross abnormal opacity in chest radiographs. Third, computation time reduction is performed by subsampling. Finally, a computer-aided diagnosis system is implemented and evaluated in a clinical environment. Major technique used in this thesis is to analyze the projection profile obtained by projecting a chest image on to the mediolateral axis. The discriminant performance for each method is evaluated by using receiver operating characteristic (ROC) analysis. The results indicate that the proposed methods are potentially useful for screening abnormalities in chest radiographs.

Made available in DSpace on 2014-06-11T19:28:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-11Bitstream added on 2014-06-13T18:57:56Z : No. of bitstreams: 1 bertoletti_m_me_guara.pdf: 1431070 bytes, checksum: 5b8e46801dd377e4d6599b68338d5083 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A vibração torácica é uma técnica de fisioterapia respiratória utilizada para higienização brônquica, que facilita a remoção da secreção, evitando sua retenção e danos na função pulmonar, como na troca gasosa. Existe um grande número de pacientes com problemas respiratórios que se beneficiam desta técnica. O propósito deste trabalho é justamente analisar e mensurar a freqüência de oscilação da técnica de vibração torácica, realizada por diversos fisioterapeutas, que atuam em fisioterapia respiratória ou em outra área da fisioterapia, para que, por meio desses estudos possam verificar qual a freqüência da técnica de vibração torácica predominante, e se a freqüência obtida está próxima da freqüência da literatura técnica, uma vez que existem poucos trabalhos científicos em questão. A freqüência de vibração é medida em hertz (Hz). / The chest vibration is a technique of respiratory physiotherapy used in order to promote a bronquial cleaning, to facilitate the sputum removal of the secretion, preventing its retention and damages in the pulmonary function as in the gaseous exchange. A great number of patients with respiratory problems exists that are benefit of this technique. The intention of this work is exactly to analyze and to measure the frequency of oscillation of the technique of chest vibration, carried through by diverse physiotherapists, who act with in respiratory physiotherapy and that they act in another area of the physiotherapy, so that through these studies can verify which the frequency of the technique of predominant chest vibration between them, and if the gotten frequency is next to the frequency of literature, technique exists few scientific works in question. The vibration frequency is measured in hertz (Hz).

Resumo: O trauma torácico (TT) é uma situação bastante comum no politraumatizado nos dias de hoje. Uma das injúrias provocadas pelo TT é a perda da estabilidade torácica consequente a fraturas múltiplas do gradil costal (tórax instável). O paciente com tórax instável pode ser tratado clinicamente com intubação oro-traqueal e ventilação mecânica, como também pode ser submetido à cirurgia para fixação das fraturas costais. Na busca da melhor evidência para decisão do tratamento justifica-se a procura da resposta através de uma revisão sistemática. Avaliar a eficácia e segurança do tratamento cirúrgico quando comparado ao tratamento clínico em pacientes com trauma torácico fechado com tórax instável. Revisão sistemática de ensaios clínicos aleatorizados avaliando a eficácia e segurança do tratamento cirúrgico quando comparado ao tratamento clínico. Estudos relevantes foram identificados eletronicamente por meio de bases de dados MEDLINE, EMBASE, LILACS, Cochrane Controlled Trials register (CENTRAL). Referências bibliográficas também foram pesquisadas para encontrar estudos não indexados. A qualidade metodológica foi avaliada com formulários retirados do HANDBOOK (Higgins & Green 2009), e as análises estatísticas foram executadas através do REVNAN 5.0.2 fornecido pela Colaboração Cochrane. Nas bases eletrônicas de dados foram selecionados seis estudos, desses apenas dois estudos cumpriam os critérios de inclusão para se fazer uma metanálise. Nestes estudos foram analisados 77 pacientes, dos quais 38 foram tratados cirurgicamente e 39 tratados conservadoramente. Apenas quatro desfechos avaliados eram comuns aos dois estudos, mortalidade, incidência de pneumonia, tempo de ventilação mecânica (tVM) e tempo de internação em UTI (tUTI). Apenas para a mortalidade não houve diferença estatística após a metanálise. Já o tVM, tUTI e incidência... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The thoracic trauma (TT) is a common situation in polytraumatized today. One of the injuries caused by the TT is the loss of stability resulting in multiple fractures of thoracic rib cage (flail chest). The patient with flail chest can be treated medically with orotracheal intubation and mechanical ventilation, but also may undergo surgery to fix the costal fractures. In search of the best evidence for treatment decision justifies the search for an answer through a systematic review. To evaluate the efficacy and safety of surgical treatment compared to medical treatment in patients with blunt chest trauma with flail chest. A systematic review of randomized controlled trials evaluating the efficacy and safety of surgical treatment compared to medical treatment. Relevant studies were identified through electronic databases MEDLINE, EMBASE, LILACS, Cochrane Controlled Trials register (CENTRAL). References were also searched to find studies not indexed. Methodological quality was assessed with forms taken from the HANDBOOK (Higgins & Green 2009), and the statistical analyzes were performed by REVNAN 5.0 provided by the Cochrane Collaboration. The electronic databases were selected six studies, only two of these studies met the inclusion criteria for doing a meta-analysis. These studies analyzed 77 patients in whom 38 were treated surgically and 39 treated conservatively. Only four outcomes evaluated were common to both studies, mortality, incidence of pneumonia, mechanical ventilation time (MVt) and length of stay in ICU (ICUt). Just for mortality showed no statistical difference after the meta-analysis. Already MVt, ICUt and incidence of pneumonia showed a statistical difference favoring the surgical group. Based on the results of this systematic review and meta-analysis we can conclude that there is scientific evidence currently available providing surgical treatment for unstable chest... (Complete abstract click electronic access below) / Orientador: Paulo Eduardo de Oliveira Carvalho / Coorientador: Antonio José Maria Cataneo / Banca: Regina P. El Dib / Banca: Samuel Marek Reibscheid / Banca: Olavo Ribeiro Rodrigues / Banca: João Alessio Juliano Perfeito / Doutor

Abstract The prevalence of coronary heart disease (CHD) and associated manifestations with ischaemic resting electrocardiogram (ECG) changes, clinical findings and sociodemographic factors were studied in 1990–1991 among an elderly population in southwestern Finland. One of the specific aims was to describe the health-related quality of life of elderly coronary heart disease patients, i.e. the associations between CHD and physical, psychological, cognitive and social functioning. 488 men and 708 women aged 64 years and over (93% of those eligible) participated in this cross-sectional epidemiological survey in the rural district of Lieto. The participants were examined and interviewed during two visits to the local health centre. An ECG and a chest x-ray were taken and a clinical examination was made by a doctor. The Rose questionnaire was used to determine the prevalence of angina pectoris (AP). The Minnesota codes were used in the analyses of ECG findings. The medical records were reviewed. The prevalence of AP was 9.1% (95% Confidence Interval 6.7–12.0) among men and 4.9% (3.5–6.8) among women. The respective figures for past myocardial infarction (MI) (based on the medical records or a major or moderate Q/QS item on ECG, codes 1.1–1.2) were 13.9% (10.9–17.0) and 6.5% (4.8–8.6). Ischaemic ECG findings (codes 1.1–1.3, 4.1–4.4, 5.1–5.3, 7.1) were common: 32.9% (28.7–37.1) of men and 39.3% (35.7–43.0) of women had such changes. The total prevalence of CHD, including AP, MI, past coronary bypass surgery or angioplasty or ischaemic ECG findings, was 37.7% (33.4–42.0) in men and 42.0% (38.3–45.6) in women. The patients and controls were mainly aged, non-institutionalized, community-living persons. The patients with CHD (AP and/or a past MI) had more difficulties in physical functioning than their age- and sex-matched controls. According to logistic regression analyses, CHD was not independently associated with difficulties in physical functioning. However, physical disability was associated with the use of cardiovascular drugs and also with old age, the use of psychotropic drugs, depression and cancer. More male patients than controls had depression measured on the Zung Self-Rating Depression Scale. The depression had often gone undiagnosed, especially among men. Among men, the most important factors associated with depression were difficulties in physical functioning and widowhood or divorce, while among women, previous depression and the use of ACE inhibitors emerged as significant. There were no differences between the patients and controls in cognitive functioning. The male patients had a higher frequency in visiting activity than the controls. Old age, difficulties in physical functioning, CHD and chronic obstructive pulmonary disease were associated with impaired social functioning. In conclusion, CHD is common in the Finnish elderly. The clinical picture of CHD in elderly people is varying. It seems that CHD has no independent impact on functional disability in the elderly. Old age, sociodemographic factors, medication and other chronic diseases are also contributors.

No description available.

Cardiac-specific troponins (Tns) are sensitive and specific markers of myocardial injury that have been shown to be predictive of outcomes in many cardiac and noncardiac conditions. We sought to determine whether normal cardiac Tn concentrations obtained during the first 24 hours following blunt chest trauma would predict good cardiac outcomes. A PubMed/MEDLINE search was performed to identify prospective studies in patients with blunt chest trauma in which serial cardiac TnT or TnI values were measured within 24 hours of admission and clinical outcomes assessed. Ten studies qualified for review. Studies that used the lower reference limit of Tn as the cutoff for cardiac injury showed 100% negative predictive value (NPV) for developing cardiac complications, whereas studies using higher Tn cutoffs showed wider variation in NPV (50%-98%). Cardiac Tn measured within 24 hours using the lower reference limit (LRL) as the cutoff appears to have excellent NPV for clinically significant adverse cardiac events. This could allow for early discharge after a 24-hour observation period in otherwise uncomplicated blunt chest trauma patients and avoid the need for more expensive cardiac imaging and additional resource utilization.

Precise sexing–97% to 99% accuracy–of adult chest plates is possible when highly predictive costal cartilage ossification patterns are combined with four simple metric determinations. More than 1100 chest plate roentgenograms were evaluated for ossification pattern, fourth rib width, corpus width, sternal length and sternal area in an adult decedent population. An elementary, empirically obtained algorithm using the patternings and measurements, along with simple derivations (sternal length and area indices) was developed and then applied in chest plate sexing. This technique is not only easy, rapid and inexpensive, but it also results in a permanent and easily stored record.

Myocardial infarction is the primary diagnosis to rule out in emergency department chest pain patients. In this retrospective, multi-site study, we compared logistic regression (LR) with machine learning (ML) in predicting which patients were at risk of major adverse cardiac events (MACE) and abnormal troponin. Of the 1,538 patients identified over 43 days, 1,014 were retained of whom 70 suffered a MACE. LR and ML models for MACE were internally validated and achieved similar area under curve (AUC): 0.89 (95% CI: 0.87, 0.93) and 0.92 (95% CI: 0.89, 0.94) respectively. Abnormal troponin models had overlapping AUCs. Two novel clinical decision scores were derived: the Preliminary Chest Pain Risk Score with a sensitivity of 100.00% (95% CI: 94.87%, 100.00%) for identifying low risk chest pain patients and the Ultra-Low Risk Troponin Score which could be used in lieu of troponin. Future prospective studies will be required to externally validate these scores.

No description available.