key: cord-0007716-bws1mtq3
authors: Ahuja, A
title: Radiological Findings in Severe Acute Respiratory Syndrome
date: 2003-05-10
journal: Clin Radiol
DOI: 10.1016/s0009-9260(03)00179-x
sha: 5b427a4f85508c07859716ef7008cfc87bd02b82
doc_id: 7716
cord_uid: bws1mtq3

nan

and symptomatic patients is unclear. Army recruits may not always be representative of the general population, perhaps those rejected by the army have a lower prevalence of TM! Byrne et al. add further evidence for a cross-sectional association between TM and testicular malignancy. However neither the Peterson study nor the evidence of Byrne et al. address the clinically important question of whether TM predicts future malignancy.

King and Hanbury note the discrepancy between the high prevalence of TM and the low incidence of testicular cancer. They also point out the lack of consensus regarding screening even for patients with a proven increased risk of testicular cancer. However in the light of the cross-sectional association between TM and testicular cancer, it remains important to base policy on knowledge of the incidence of testicular cancer in patients with pre-existing TM.

We have updated our summary of the limited prospective data on the incidence of testicular cancer in symptomatic patients with pre-existing TM. Two new cases have been reported [2] in a revised total of 8646 person-months of follow-up. This gives a new estimate of 2.8 (CI 0.3-10)

per 1000 per annum. The incidence of testicular cancer is 0.07 per 1000 per annum in the general population.

Only a large multi-centre prospective study can give a precise estimate of this incidence. In the meantime we would encourage all centres that follow-up patients with TM to publish their data. 

Sir -The survey of out of hours nephrostomy practice [1] raises the question of whether percutaneous nephrostomies (PCNs) can be safely inserted by inexperienced operators?

We have just completed a prospective audit of PCNs in our department over a 1-year period (1 January 2002 -31 December 2002 ). An analysis of outcomes over the first 6 months of our study has been presented [2] , and readers of Clinical Radiology may be interested in the data in the following The two specialist consultants (H.C.I. and M.J.W.), with 23 and 9 years experience of interventional uroradiology consultant practice, respectively, had the highest primary success rates and the lowest incidence of complications. However, the trainee radiologists (Junior Specialist Registrars (SpRs) in years 2 and 3, Senior SpRs in years 4, 5 and 6) had success and complication rates approaching the target ranges suggested by the Royal College of Radiologists Standards Committee (unpublished). These ranges were derived from a literature review, and used by us as our audit standards (primary success rates 88 -99%, major complications 4-8%, and minor complications 3-15%).

The apparently high complication rates of the non-specialist consultants must be interpreted with caution. The small number of cases included two very sick patients with minimally dilated collecting systems. These procedures had already been judged too difficult by the SpRs! Riddell and Charig have documented that 24% of the consultant radiologists who perform PCNs out of hours are not performing such procedures as part of their routine clinical practice [1] . Our data indicate that relatively inexperienced operators can achieve acceptable success and complication rates. Many of the non-specialist radiologists who cover the out of hours service will have been trained to perform ultrasound-guided puncture procedures, and may indeed be performing them as part of their routine clinical practice. They should therefore be competent to perform PCNs (to an acceptable level) out of hours. 

A survey of current practice in out of hours percutaneous nephrostomy insertion in the United Kingdom

Ultrasound-guided percutaneous nephrostomy insertion: a prospective study at a UK teaching hospital