Biomedical subjects
Publications and source records attributed to C L Foot.
Visual inspection of a patient's urine has long been used by physicians, with colour recognised as having important clinical implications. In this review the authors will revisit this ancient pastime with relevance to contemporary medical practice.
OBJECTIVE: To examine the utility of four criteria for distinguishing aortic from mitral valve prostheses on supine anteroposterior (AP) chest x rays in critically ill patients. MATERIALS AND METHODS: Two reviewers independently examined the post operative chest X-rays (CXR) of all patients undergoing either an aortic or mitral valve replacement over a 32 month period, in a blinded fashion. They applied four criteria to each film. For each criterion a sensitivity and specificity of differentiating the valve positions correctly was calculated for each reviewer, as well as a kappa statistic for inter-observer agreement between the two reviewers. RESULTS: Two hundred and twenty seven CXR's were evaluated by each of the reviewers. There were 174 aortic and 53 mitral valve replacements. There was a high level of inter-observer agreement for all four criteria applied (kappa values 0.785 to 0.966). Criterion one (imaginary line method) could be applied by both reviewers to less than 50% of CXR's, and when applied was specific but not sensitive. The other three criteria could be applied by both reviewers to approximately 80% of films. Criterion 2 (orientation method) was sensitive but not specific. Criteria 3 (valve orifice method) and 4 (perceived direction of blood flow method) were both highly sensitive and specific and are therefore the best methods. CONCLUSIONS: The well known imaginary line method is of limited value when identifying prosthetic valve positions on supine AP CXR's. We advocate the use of the "valve orifice" method or the "perceived direction of blood flow" method to gain valuable information regarding the presence and position of prosthetic heart valves.
Ventricular rupture occurs in 10% of acute myocardial infarctions and is associated with significant mortality. We describe two cases of ventricular rupture post myocardial infarction who survived. We highlight salient points in their diagnosis and management and review the existing literature to determine what constitutes optimal management in these difficult cases.
OBJECTIVE: To utilise an evidence-based strategy to answer two clinical questions regarding myocardial contusion - How is the diagnosis made and how long does a patient require cardiac monitoring? METHODS: Pubmed search using appropriate MeSH terminology then selection of abstracts using a predetermined criteria. RESULTS: One meta-analysis, five descriptive reviews and thirty-two other articles were selected for detailed review. CONCLUSION: Myocardial contusion is an ill-defined term for traumatic cardiac injury. "Significant blunt chest trauma" appears to be a more useful term. Normal serially performed electrocardiograms and troponin I assays over 8 hours appear to exclude this condition. When complications occur, the onset is usually within 48 hours of injury. Monitoring of patients with abnormal ECG's or troponins for at least 48 hours post injury would therefore be prudent.
Explore the source record for details and available documents.
In the case of a patient with an impalement injury, the object should be removed in a controlled operating theatre environment. We report an 18-year-old man for whom this rule could not be followed. He was removed from a metal pipe transfixing his chest at the roadside.