The New England journal of medicine
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To evaluate the efficacy of transbronchial lung biopsy in the diagnosis of sarcoidosis, 26 consecutive patients with clinical features of sarcoidosis underwent this procedure during fiberoptic bronchoscopy. In 21, the biopsy revealed noncaseating granuloma and, in the remaining five, normal lung parenchyma. ⋯ The only complication was one 20 per cent pneumothorax, which resolved spontaneously. Because of its low morbidity rate, high diagnostic yield and specificity transbronchial lung biopsy is recommended as one of the initial procedures for obtaining histologic confirmation in patients with suspected sarcoidosis.
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Clinical Trial Controlled Clinical Trial
Editorial: Low-dose heparin prophylaxis for postoperative venous thromboembolism.
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The sensitivity and specificity of the hypertensive intravenous pyelogram and the iodohippuran renogram have been determined for the diagnosis of renovascular disease, and cost-effectiveness calculations have been made for the diagnosis and surgical treatment of patients with renovascular hypertension. When the intravenous pyelogram alone is used to screen representative hypertensive population, 78 per cent of patients with renovascular disease are located, but at the same time an equal number of patients without renovascular diasease have abnormal pyelograms. The renogram, on the other hand, is associated with varying true-positive and false-positive ratios. ⋯ The cost of finding a patient with renovascular disease is about $2,000, and that of a surgical cure is about $20,000. The number of deaths for 100 surgical cures is approximately 15. The dollar cost of screening and treating the total American renovascular hypertensive population is of the order of 10 to 13 billion dollars.
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The value of a diagnostic test lies in its ability to detect patients with disease (its sensitivity) and to exclude patients without disease (its specificity). For tests with binary outcomes, these measures are fixed. For tests with a continuous scale of values, various cutoff points can be selected to adjust the sensitivity and specificity of the test to conform with the physician's goals. Principles of statistical decision theory and information theory suggest technics for objectively determining these cutoff points, depending upon whether the physician is concerned with health costs, with financial costs, or with the information content of the test.