From this prospective study a model based on preoperative symptoms was developed to predict postcholecystectomy pain. Since intrastudy reclassification may give too optimistic results, the model should be validated in future studies.

102 patients with myocardial infarction (MI) were examined by three clinicians, who independently recorded the following symptoms and signs: dyspnoea, a displaced apex beat, S3-gallop, rales, neck vein distension, hepatomegaly, and dependent oedema. Chest X-ray, radionuclide ventriculography, and (in 40 patients) right heart catheterization were carried out immediately after the physical examination. The clinicians frequently disagreed as to the presence of physical signs of heart failure in individuals. Moreover, these signs were of limited value in identifying patients with pulmonary vascular congestion on chest X-ray, reduced left or right radionuclide ventricular ejection fractions, enlarged ventricular volumes or haemodynamic evidence of ventricular dysfunction. We conclude that clinicians frequently disagree in the recognition of physical signs of heart failure, and that these signs have an unpredictable relationship to radiographic, radionuclide and haemodynamic measures of ventricular performance in patients with MI. Nevertheless, physical signs are useful in identifying patients with high risk of cardiac death.

Preoperatively a collaboration between gynecologists, urologists and radiologists is essential for the diagnostic accuracy of urinary incontinence especially to isolate stress incontinence for surgical treatment. The aim of this study was to estimate the value of these combined efforts. 212 women referred for urinary incontinence were assessed by history of micturition, pelvic examination, cystoscopy, cystometry, stress test for urine loss, uroflowmetry and colpo-cysto-urethrography. A final diagnosis obtained on this basis classified the patients in stress incontinence (130), urge incontinence (47), neuromuscular dysfunction (6), uncertain type (10), other disease (8) and no incontinence (11). According to calculations of predictive values of positive and negative tests, respectively, each single test in the preoperative investigation programme was evaluated regarding the final diagnosis stress incontinence. It was assumed that the symptom stress incontinence, the pelvic examination and the colpo-cysto-urethrography were of minor or no importance for the diagnosis stress incontinence but might have been for the choice of surgical treatment. Cystoscopy and uroflowmetry had no place in daily routine. In contrast normal cystometry and especially the sign stress incontinence deserved consideration of refinements.

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