|
#16
10.04.2010, 17:31
|
|||
|
|||
|
Цитата:
 
|
|
#17
10.04.2010, 17:57
|
||||
|
||||
|
"УЗИ - не является "золотым стандартом" диагностики венозных тромбозов, так же как и венография с МРВ."
Вы очень ошибаетесь. Венография считается "золотым стандартом" в диагностике ТГВ конечностей. НЕКОТОРЫЕ протоколы МРВ равны венографии.
|
|
#18
10.04.2010, 19:04
|
|||
|
|||
|
Цитата:
Предоставьте доказательства, что венография - "золотой стандарт" диагностики. Если посмотреть протоколы, в частности АССP, то там тоже нет однозначного мнения о самом точном методе диагностики венозного тромбоза = "золотой стандарт". Если с проксимальным тромбозом, есть хоть какая то определенность, то по дистальному к сожалению нет 
|
|
#19
11.04.2010, 13:22
|
||||
|
||||
|
Есле лень (или что там ешё!) мешает в находке азов для профессионалов, интересуюшихся флебологией, пожалуйста:
1. "The gold standard for establishing the diagnosis of deep vein thrombosis has been contrast venography." Diagnosis, investigation, and management of deep vein thrombosis BMJ 2003;326:1180-1184 2. "...the diagnosis of DVT was largely dependent on venography. Although being replaced by ultrasonography, it is still regarded as the `gold standard' for diagnosing DVT". [Ссылки доступны только зарегистрированным пользователям ] 3. "Venography Considered “gold standard”. Used when othertest results are not conclusive". [Ссылки доступны только зарегистрированным пользователям ] Ishite dal'she sami!
|
|
#20
11.04.2010, 14:52
|
||||
|
||||
|
Слайд от Андрея Середы доставляет (к вопросу о дистальных тромбозах вообще и асимптомных дистальных - в часности)
 :http://forums.rusmedserv.com/showpos...1&postcount=44
|
|
#21
11.04.2010, 15:00
|
||||
|
||||
|
Там, действительно, много и интересного и смешного
 . Признание ортопедов - "мы счастливые люди, которые не имеют дело с отдалёнными последствиями плохо пролеченного или недодиагностированного ТГВ"  .
|
|
#22
11.04.2010, 15:46
|
||||
|
||||
|
Цитата:
Цитата:
Цитата:
Цитата:
Вот Вам тоже совет пользуйтесь [Ссылки доступны только зарегистрированным пользователям ]!
|
|
|
.|
#24
11.04.2010, 19:34
|
||||
|
||||
|
Вот краткий исторический экскурс становления контрастной венографии и как этот метод превратился в "золотой стандарт" визуализации венозного тромбоза нижних конечностей. Наверное, он все-таки уступает по точности "платиновому стандарту" морфологической диагностики, осуществляемой патанатомом "post mortem", но многие методы прижизненной визуализации этим грешат...
Radiology. 1988 Jul;168(1):277-8. Deep venous thrombosis: is contrast venography still the diagnostic "gold standard"? Contrast venognaphy (CV) has been performed for over half a century. Though early attempts at CV were fraught with technical problems related to the radiographic equipment of the time, the available contrast agents, and an incomplete understanding of venous hemodynamics, the procedure has been the premier diagnostic test for DVT for at least the past 20 years. A seminal article on CV technique was published in 1972 by Rabinov and Paulin (7), and most current techniques are modifications of their approach. Venograms are considered positive for acute DVT when one or more well-defined filling defects are seen in fully opacified veins. Nonfilling of veins in a technically satisfactory examination is generally considered strong presumptive evidence of acute DVT. Venognaphy has been accepted as the diagnostic “gold standard,” primarily because of its long history and the general accuracy of positive and, more important, negative findings (8). Certainly intraluminal filling defects in the deep venous system seen at CV are virtually always clots. CV provides direct pictorial evidence of these abnormalities. In reality, CV has become the “gold standard” by default. There are several problems with CV that make alternate approaches to the diagnosis of DVT welcome. It is not always possible to cannulate an appropriate pedal vein because of edema on other problems; these patients must be studied with other techniques. Incomplete venous filling and other technical problems during CV bead to inadequate studies in as many as 5% of cases (9-12). Filling of the venae profunda femoris (deep femoral veins) occurs in about one-half of examinations, and muscular branches of the calf also cannot be reliably opacified. There is difficulty incorrectly and consistently interpreting venognams. In one study, disagreement about the presence or absence of clot was found in 10% of cases (13). CV causes some patient discomfort, though this is lessened by the use of nonionic contrast media (14). Reactions to contrast medium occur. Extravasation of contrast medium into the subcutaneous tissue of the foot can cause enough skin necrosis to necessitate skin grafting. Contrast medium is irritating to the venous endothelium and has been implicated as a cause of postvenography DVT (15-17). Finally, performance of CV requires a minimum staff of a technologist and a radiologist and may be difficult to perform on an urgent basis in some hospitals. It also requires that the patient be able to be moved to the radiology department. [Ссылки доступны только зарегистрированным пользователям ]
|
|
#25
11.04.2010, 20:00
|
||||
|
||||
|
Вадим, спасибо. Радиологам всегда приятно, когда коллеги других специальностей высказывают интерес и понимание радиологических нюансов.
В данном случае я не полностью согласен с позицией уважаемой коллеги из Техаса . В южный штат не перколировалась блестяшая лондонская монография -M. Lea Thomas, Phlebography of the Lower Limb. Churchill Livingstone; 1St Edition edition (December 1982). Hardcover: 220 pages. Hикто из учеников Ли Томаса не имел проблем с техникой  .
|
|
#26
11.04.2010, 20:14
|
||||
|
||||
|
Уж случаем не эти спецы, что предложили королевскую модификацию, были учениками Ли Томаса?
Lower limb contrast venography: a modified technique for use in thromboprophylaxis clinical trials for the accurate evaluation of deep vein thrombosis. Department of Radiology, King's College Hospital, Department of Haematology, John Radcliffe Hospital, Oxford, UK [Ссылки доступны только зарегистрированным пользователям ]
|
|
#28
11.04.2010, 20:31
|
||||
|
||||
|
Вот любопытное проспективное исследование с прямым сравнением:
J Arthroplasty. 1994 Oct;9(5):543-8. Color duplex Doppler ultrasound scanning for detection of deep venous thrombosis in total knee and hip arthroplasty patients. Incidence, location, and diagnostic accuracy compared with ascending venography. Leutz DW, Stauffer ES. Southern Illinois University, School of Medicine, Department of Surgery, Springfield 62794-9230. Abstract Цитата:
Кстати, как-то не нашел свежих исследований по сравнению каких-либо диагностических методов с венографией как с эталонным методом. А вот исследование, в котором "золотым стандартом" называют ультразвуковое сканирование (правда, венография, или по нашему - флебография, тут уже ни при чем). [Ссылки доступны только зарегистрированным пользователям ] А что мы все-таки вкладываем в понятие "золотой стандарт"?
|
|
#29
11.04.2010, 20:58
|
||||
|
||||
|
А что мы все-таки вкладываем в понятие "золотой стандарт"?
gold standard, 1 an accepted test that is assumed to be able to determine the true disease state of a patient regardless of positive or negative test findings or sensitivities or specificities of other diagnostic tests used. 2 an acknowledged measure of comparison of the superior effectiveness or value of a particular medication or other therapy as compared with that of other drugs or treatments.
|
|
#30
11.04.2010, 21:02
|
||||
|
||||
|
--------------------------------------------------------------------------------
BMJ 2005;330:1121 (14 May), doi:10.1136/bmj.330.7500.1121 The gold standard: not a golden standard Studies that evaluate a new diagnostic test, procedure, or method should do so by comparing it with a time honoured alternative that is considered to be the current standard in the field. In this context the meaning of the word standard is "authoritative or recognised exemplar of quality or correctness." "Gold standard" is the popular term to describe this test; but "golden standard" is sometimes used as well. In fact, almost all medical publications in Dutch use the term "gouden standaard" which is a translation of "golden standard." Apparently, medical scientists have become confused about the true meaning of the term gold standard. Inspired by the Olympic Games, where the best athlete wins the gold medal, people who use "golden standard" think the term denotes the best standard in the world. Not bronze, not silver, but gold. Of course, this is incorrect. Gold standard is a historical term borrowed from economists. It signifies a monetary standard, under which the basic unit of currency was defined by a stated quantity of gold. The analogy should be clear: the value of each country's method of payment (currency) was weighed against the gold standard, which made it possible to compare these different currencies for international trading. In a Medline search from 1955 onwards, the first emergence of the term—albeit in a different meaning—was in 1962, in an anonymous commentary in the Lancet. Entitled "Towards a gold standard," it pleaded to set a standard for the use of gold salts in patients with rheumatoid arthritis. It may well have been Rudd who first introduced the "gold standard" in medicine in its current sense in 1979.1 In the following years, the number of publications that employed the term grew rapidly. This was much to the dismay of one biochemist, who thought the term was "presumptuous" for a biological test, since "the subject is in perpetual evolution [and] gold standards are by definition never reached."2 He proposed abolishing the term "because the phrase smacks of dogma... After all, the financiers gave up on the idea of a gold standard decades ago." He failed in his mission, however: since 1995, over 10 000 publications mentioned "gold standard." So why is there also a "golden standard," a term used in over 600 publications since 1995 in English and in many more in foreign languages? I think this is because it is tempting to interpret the word "gold" in gold standard as an adjective, as in gold medal, and then to replace it with "golden," which simply sounds better if English is not your first language. In addition, "golden standard" is a persuasive term that makes sense: if a standard is the one test by which all others are judged, then the golden standard must be perfect. Herein lies, I think, the importance of this discussion. The concept of a "golden standard" implies a level of perfection that can never be attained by any biological test, and will provoke criticism like that ventilated by Duggan.2 In contrast, a gold standard in its true meaning, derived from the monetary gold standard, merely denotes the best tool available at that time to compare different measures. Even in its glory days, the monetary gold standard was never considered perfect. It was subject to endless debate, and in the end it was abandoned for a better system. Similarly, today's gold standard tests will be replaced by better ones. As was eloquently stated by Versi: "It is the absolute truth that is never reached; gold standards are constantly challenged and superseded when appropriate."
|
Линейный вид
