The ability of computed tomography (CT) to detect mediastinal lymph node metastases from nonsmall cell bronchogenic lung cancer is highly controversial, as evidenced by reported accuracies ranging from 0.35 to 0.95 over the past eight years. We examined all studies on this matter published between January 1980 and April 1988, both to describe the overall experience and to identify characteristics (study design and methodology and CT scan techniques) that influenced reported accuracy. Of 79 relevant publications, 37 were excluded because they were review reports, assessed small cell lung cancer, or contained insufficient evidence to construct a contingency table (CT result versus node histology). The pooled, unweighted (weighted) results based on the remaining 42 studies were as follows: sensitivity, 0.79 (0.83); specificity, 0.78 (0.81); accuracy, 0.79 (0.81). Using a node size greater than 1.0 cm to define a "positive" CT result, as compared to a smaller diameter, was associated with significantly higher specificity, 0.89 versus 0.76, and accuracy, 0.86 versus 0.75 (p less than or equal to 0.005), but not sensitivity, 0.79 versus 0.75. The observed differences in accuracy between a fourth generation CT (0.83) and either a third or a second generation CT, (0.77 and 0.78, respectively) were not significant at p less than 0.05. No characteristics, either singly or in combination, resulted in accuracies exceeding 0.86. There exists random variation of individual study results around an overall mean accuracy of only 0.79, which is marginally improved by advances in CT technology and methods. Significant advances in the noninvasive detection of lymph node metastases must await an approach fundamentally different from CT-determined node size.
Combined general and epidural anaesthesia and postoperative epidural analgesia do not reduce the incidence of myocardial ischaemia or morbidity compared with general anaesthesia and postoperative intravenous analgesia.
The lack of agreement on definition of terms and consistent reporting strategies in sports epidemiology complicates the determination of injury rates in any sport. This study describes Canadian Intercollegiate ice hockey injuries over a 6-year period by following a standardized reporting strategy and clearly defined terminology. Overall, the data show that the knee is most susceptible to injury, that the forwards recorded the highest number of injuries, and that body contact caused the majority of injuries. Compared to other studies the results indicate a decreasing per game injury rate over the last 15 years and provide evidence that helmets and visors reduce the risk of head and facial injuries. Recommendations are propagated toward the adherence of standardized reporting strategies and uniform definitions to be used in future sports injury epidemiologic research.
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