The accuracy of limited computed tomography with rectal contrast (CTRC)
for the diagnosis of acute appendicitis in adults has been shown to be 98%,
but its diagnostic value in children, in whom the diagnosis of acute appendicitis
is particularly difficult, is not known. In a prospective study of 139 children
aged 3 to 21 years who presented to an emergency department with equivocal
clinical findings of acute appendicitis, Peña and colleagues found
that a protocol using CTRC after negative or inconclusive results on pelvic
ultrasonography was 94% accurate for the diagnosis of acute appendicitis.
CTRC correctly changed patient management in 79 (73.1%) of 108 children.
Treadmill exercise testing for the diagnosis of coronary artery disease
is less accurate when nonspecific ST-T abnormalities are present on resting
ECG. Kwok and colleagues assessed the prognostic accuracy of the Duke treadmill
score in 939 patients with symptoms of chest pain or dyspnea who had nonspecific
ST-T abnormalities on resting ECG (study group) and 1466 patients who had
normal resting ECG results (control group). Seven-year cardiac and overall
survival rates among patients classified as high-risk according to the Duke
treadmill score were worse than in the intermediate- and low-risk groups in
both study and control populations. Within each risk category, rates of cardiac
death and overall mortality were generally worse among study patients than
among control patients.
Using each of 25 different scales developed to identify high-quality
trials, Jüni and colleagues reanalyzed a previously published meta-analysis
of 17 trials that compared low-molecular-weight heparin with standard heparin
for prevention of postoperative thrombosis. Results of the repeated meta-analyses
varied depending on which quality scale was used, and, in some instances,
reached opposite conclusions about treatment effect. In regression analyses,
effect estimates did not differ significantly between high-quality and low-quality
trials for any of the scales, and trial quality scores were not correlated
with treatment effect. In a second article, Lijmer and colleagues examined
184 studies that evaluated 218 diagnostic tests and identified specific methodological
problems and reporting deficiencies associated with overestimation of reported
diagnostic accuracy. In an editorial, Berlin and Rennie discuss how quality
of studies should be taken into account in the clinical interpretation of
See Article and Article and editorial Article
Medicaid patients with chronic illnesses may disproportionately select
Medicaid managed care organizations sponsored by academic medical centers
(AMCs) over other health plans, putting AMCs at increased financial risk.
In an analysis using Medicaid claims data from January 1994 through August
1995 for TennCare, the statewide Tennessee Medicaid managed care program,
Bailey and colleagues found that the prevalence per 100,000 enrollees of 5
of 6 state-specified high-cost chronic medical conditions was higher for AMC
managed care organizations compared with statewide and regional health plans.
Both biological plausibility and results from observational studies
suggest that the antioxidant β-carotene may reduce the risk of developing
type 2 diabetes mellitus (DM). In this analysis of data from the Physicians'
Health Study, however, Liu and coworkers found that the risk of developing
type 2 DM among 10,765 healthy men randomly assigned to receive dietary supplementation
with β-carotene for an average of 12 years was similar to that among
a group of 10,712 men who received placebo.
"I'd never seen a case of polio, measles, or diphtheria, but I had seen
children shot, drowned, shaken, and hit by cars." From "Mikey."
Activation of apoptosis-inducing caspase-3 protein by HIV protease selectively
kills HIV-infected cells in vitro, suggesting a novel strategy for the treatment
of persons infected with HIV.
Advances in osteoarthritis research are leading toward improved treatment
and prevention strategies that will help alleviate suffering and delay onset
of this disabling disease.
At the Clinical Center of the National Institutes
of Health New therapies that modify T-cell costimulatory pathways may
prevent chronic allograft rejection without global immunosuppression.
Original research on editorial peer review is invited for the fourth
International Congress on Peer Review in Biomedical Publications to be held
in September 2001 in Barcelona, Spain.
In a district hospital in Hlabisa, South Africa, the demand for specific
health services increased markedly between 1991 and 1998, coincident with
rising HIV seroprevalence.
For your patients: Appendicitis in children.
This Week in JAMA. JAMA. 1999;282(11):1015. doi:10.1001/jama.282.11.1015