Biomedical subjects

K Partanen

Publications and source records attributed to K Partanen.

115 records · Page 7Linked to original sources

PubMedDate not supplied

The value of clinical assessment in the diagnosis of icterus and cholestasis.

We studied the reliability of the clinical assessment and the discriminatory value of different symptoms and signs in diagnosing obstructive and non-obstructive diseases causing icterus and/or cholestasis. During a period of two-and-a-half years, clinical assessment done by both physicians-in-training and by senior physicians was completed for 266 patients, and the usefulness of different symptoms and signs was tested in 220 of these. Clinical assessment was found to be a reliable method in distinguishing between obstructive and non-obstructive conditions causing icterus, with the sensitivity of 92% and specificity of 86%. In cases of anicteric cholestasis, the sensitivity and specificity of clinical assessment were 74% and 80%, respectively. Abdominal pain and abdominal tenderness were significantly (p less than 0.01) associated with obstructive diseases, whereas an enlarged liver, fever and excessive consumption of alcohol were associated with non-obstructive diseases (p less than 0.01, p less than 0.05, p less than 0.05, respectively). Itching, vomiting, intolerance to fatty foods, previous cholecystectomy, abdominal tumour and clinical icterus had no discriminatory value. Clinical evaluation is a reliable method in the diagnostic workup of a patient with icterus or anicteric cholestasis, and it is still of crucial importance in directing further investigations.

Cholestasis↗

PubMedDate not supplied

Preoperative electroneuromyography and myelography in cervical root compression.

The preoperative diagnostic accuracy of electroneuromyography and myelography was evaluated in 77 patients with cervical radiculopathy and/or myelopathy. In 57% of the patients, the affected root level could be determined with ENMG (accuracy 1-2 segments), 10% had a non-specific finding, and in 33% of the patients, ENMG was normal. If the symptoms had lasted less than three months, 67% of the patients had a localizing finding in ENMG. Among the 97 operated root levels, there were distinct findings in myelography in 79, minor root sheath deformities in 13, and the finding was negative in five. In addition, in myelography there were clearly pathological root sheath deformities at 20 and minor changes at 20 root levels which were not operated. ENMG and myelography have a complementary role in the diagnosis of cervical root compression. By combining the information of ENMG and myelography, the functional significance of the morphological root sheath deformities can be assessed.

Adult↗

PubMedDate not supplied

Large-image intensifier photofluorography and conventional radiography in pulmonary emphysema. Correlation with computed tomography.

Large-screen image intensifier (II) photofluorography was compared with full-size screen-film chest radiography in the diagnosis of pulmonary emphysema in 84 patients. Photospot films and conventional radiographs were interpreted independently by three radiologists. Computed tomography (CT) was used as an independent reference technique, and diagnostic performance of chest radiography in various CT patterns of emphysema was evaluated. The difference in diagnostic sensitivity for emphysema in favor of conventional chest radiography over photofluorography (0.65 versus 0.56) was statistically significant (p less than 0.05). Specificity of the imaging modalities was equal: 0.78 in full-size films and 0.77 in photospot films. All CT patterns of emphysema had great false negative response rates in chest radiography, which is an inaccurate technique for the diagnosis of emphysema. CT is required for reliable radiologic evaluation of emphysema.

Emphysema↗

PubMedDate not supplied

A prospective study on the value of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the diagnosis of unjaundiced cholestasis.

The purpose of this study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of unjaundiced cholestasis. Moreover, attention was paid to the ability of these methods to distinguish between benign and malignant causes of obstruction. The inclusion criteria of laboratory values suggesting cholestasis were serum alkaline phosphatase 350 U/l and gammaglutamyl transpeptidase 100 U/l or liver-specific alkaline phosphatase elevated. The diagnostic value of the imaging methods was tested in 33 patients. The most common cause of unjaundiced obstruction was choledochal stone disease. The diagnostic sensitivities of US, CT and ERCP for the detection of extrahepatic cholestasis were 53%, 53% and 79%, respectively. In patients on whom all three imaging studies were done (n = 20), the difference between US and ERCP was statistically significant (p > 0.05). The specificities of US, CT and ERCP were 100%, 86% and 90%, respectively. CT was better than US in defining the benign nature of obstruction, but ERCP was superior in this respect. In malignant obstructions CT was comparable to ERCP. In conclusion, ERCP seems to be considerably sensitive for the detection of extrahepatic obstruction in cases of unjaundiced cholestasis, whereas US and CT are rather insensitive. The specificity of all these imaging methods is high. The results are in favour of CT as the best noninvasive investigation method, and also indicate the important role of ERCP. However, in many cases all three imaging methods are needed, and a flexible and complementary use of them is recommended.

Carcinoma, Papillary↗

PubMedDate not supplied

Clinical evaluation of tissue polypeptide antigen (TPA) in the diagnosis of pancreatic carcinoma.

The serum values of tissue polypeptide antigen (TPA) were measured in a prospective series of 100 patients with jaundice, 54 patients with suspicion of chronic pancreatitis or a pancreatic tumour, and 19 patients with unjaundiced cholestasis to assess its value in diagnosing pancreatic cancer. There were altogether 25 patients with a cancer of the pancreas including 2 patients with a cancer of the papilla of Vater. The highest serum TPA values were noticed in patients with pancreatic cancer, but raised values were also seen in patients with malignant or benign liver diseases, and with cholangiocarcinoma. The sensitivity of TPA was 52% with a specificity of 85% and an efficiency of 80%. In comparison to CEA, CA 50 and CA 242, TPA showed lower sensitivity but higher specificity. When TPA was combined with the other markers, the specificity and efficiency improved clearly in all combinations, being highest in that of TPA and CA 242 (specificity 94.5%, efficiency 87.2%). The results suggest that the TPA test has a useful complementary role in the clinical use of the current serum tumour markers in the diagnosis of pancreatic cancer.

Alkaline Phosphatase↗

PubMedDate not supplied

The value of combined use of serum tumour markers and nuclear magnetic spectroscopy of plasma in the detection of pancreatic cancer among patients with jaundice or cholestasis: results from a prospective study.

We studied a combined utilization of serum tumour markers and proton nuclear magnetic resonance 1H NMR spectroscopy of plasma in the detection of pancreatic cancer. Serum concentrations of carcinoembryonic antigen (CEA), carboanhydrate antigens CA 50 and CA 242, and 1H NMR spectra of plasma were determined in a series of 51 patients, of whom 25 had malignant and 26 benign hepatopancreatobiliary disorder. The measurements in 1H NMR spectra were performed both manually and by computed technique, and both methylene (CH2) and methyl (CH3) peaks were evaluated. In the patients with pancreatic cancer (n = 17, including two cases of cancer of the papilla of Vater), the mean serum values of all tumour markers were significantly (p = 0.001) higher than in the patients with benign disease. The diagnostic sensitivity of the tumour markers alone reached 82-100% with a specificity of 35-82%. In the 1H NMR spectra of sera, the mean linewidth of the CH3-peak both in the manual and computed measurement was significantly narrower in the patients with pancreatic cancer than in the benign disease group. Using the cut-off level of 33 Hz, the sensitivity and specificity of 1H NMR alone was in the manual measurement 53% and 76%, respectively, while in the computed measurement the corresponding figures were 94% and 20%. When the serum tumour markers and 1H NMR spectroscopy were evaluated as combinations, both in the manual and computed measurements the specificities and positive likelihood ratios were clearly better than those of the tumour markers alone, but efficiencies improved only slightly. The results suggest that the combined use of tumour marker tests and 1H NMR of plasma gives only slightly improved accuracy in the diagnosis of pancreatic cancer.

Adolescent↗

PubMedDate not supplied

Multivariate analysis of six serum tumor markers (CEA, CA 50, CA 242, TPA, TPS, TATI) and conventional laboratory tests in the diagnosis of hepatopancreatobiliary malignancy.

A prospective study of 277 patients with benign (n = 212) and malignant (n = 65) hepatopancreatobiliary disease was carried out to evaluate the value of six serum tumour markers (CEA, CA 50, CA 242, TPA, TPS, TATI) and 16 conventional laboratory tests in the distinction between benign and malignant diseases. In univariate analysis, all tumour marker tests except TATI showed significantly (p < 0.001) higher serum values in the patients with malignant disease than in the patients with benign disease. Among the conventional laboratory tests serum bilirubin, alkaline phosphatase and leucine aminopeptidase showed significantly. (p < 0.001) higher values in the patients with malignant disease, whereas serum protein and amylase levels were significantly (p < 0.01) higher in the patients with benign disease. In a multivariate analysis, serum bilirubin (p < 0.001), antithrombin III (p < 0.01) and blood hemoglobin (p < 0.05) were the most significant independent predictors of hepatopancreatobiliary malignancy. To sum up the contributions of the best tests a diagnostic score (DS) was developed. The sensitivity of DS in detecting malignancy was 73% with a specificity of 82% and an efficiency of 79%. In conclusion, our results speak against the use of multiple tumour marker tests, and rather suggest the use of a relatively limited amount of conventional laboratory tests in the distinction between benign and malignant hepatopancreatobiliary disease.

Alkaline Phosphatase↗