Clinical radiology
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Comparative Study
The cost effectiveness of metal oesophageal stenting in malignant disease compared with conventional therapy.
Expanding metal oesophageal stents are being used more commonly to palliate patients with inoperable oesophageal carcinoma. Many reports have so far documented their clinical effectiveness, however, their high acquisition cost has caused on-going concern when compared with the cost of conventional therapies. We reviewed 64 consecutive patients with inoperable oesophageal carcinoma, half of whom had received our conventional method of palliation using a variety of techniques including, BICAP diathermy, alcohol injection and Atkinson tube insertion. ⋯ However, once this was corrected for survival the difference in the cost of palliation on a per diem basis was reduced (metal stents = pound sterling 60 per day, conventional group = pound sterling 72 per day). The results of our study indicate that the initial high cost of metal stents is more than outweighed by resource savings elsewhere in the hospital by virtue of reduced need for re-intervention and shorter length of hospital in patient stay. Such cost savings taken in combination with the improved clinical effectiveness and low mortality related to metal stents provide significant support for introducing their use into clinical practice.
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The chest radiograph is widely used for the diagnosis and follow-up of patients with pulmonary venous hypertension (PVH) caused by rheumatic heart disease. Observer accuracy and interobserver agreement on the radiographic diagnosis of PVH is rarely assessed. We have studied this accuracy and agreement in 120 consecutive patients. ⋯ The chest radiograph is useful in detecting the presence of PVH and in distinguishing significant elevations in PCWP (> 20 mmHg) from mildly elevated PCWP. There is poor correlation between haemodynamic and radiographic findings when more precise grading of the severity of PVH is attempted.
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Clinical Trial Controlled Clinical Trial
The therapeutic impact of lumbar spine MRI on patients with low back and leg pain.
The influence of lumbar spine magnetic resonance imaging (MRI) on the management of patients with low back and leg pain, with a clinical diagnosis of neural compression, has been investigated by a controlled prospective observational study. The clinical features of the patients at the time of request for MRI have been compared with the subsequent management in order to define the clinical indications for lumbar spine MRI. ⋯ The major impact of MRI was to move patients towards conservative treatment. A variety of features in the history and physical examination as well as MRI findings are predictors for surgical treatment. The variety of diagnoses and surgical options available make it difficult to define clear clinical guidelines for the use of MRI.