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At least 1,801 records · Page 100Linked to original sources
PubMed2007

[Diagnostic imaging of liver tumours. Current status].

Nowadays, contrast enhanced ultrasound (CEUS) is an imaging technique equivalent to multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the detection and characterization of focal liver lesions. These methods have comparable sensitivity and specificity in differentiating a liver lesion as "benign" or "malignant". For benign lesions, CEUS is the recommended method of the choice. In unclear cases, or if CEUS is not available, MRI or CT are the methods of the second choice. If a benign tumor remains unclear, then a needle biopsy is recommended. In the case of a malignant tumor, it is necessary to use a second imaging technique besides CEUS. In addition to the detection and characterization of a liver tumor, CT and MRI provide information on the extrahepatic spread of a tumor, particularly into the lung or retroperitoneum. The rapid development of surgical and interventional approaches requires accurate information on the character and number of malignant liver lesions. Therefore, the combined use of CEUS and MDCT or MRI currently represents the most modern and optimal standard of imaging. The standardization of CT and MRI protocols has increased the general diagnostic level of these images. Adequate training and a certificate for the use of CEUS is recommended in order to maintain the high diagnostic level of this method (EFSUMB guide lines). An optimal interdisciplinary imaging strategy for focal liver lesions minimises unnecessary invasive or potentially harmful imaging and reduces health costs.

Contrast Media↗
PubMed2005

Management of heart failure after cardiac resynchronization therapy: integrating advanced heart failure treatment with optimal device function.

Cardiac resynchronization therapy (CRT) is an established adjunctive treatment for patients with systolic heart failure (HF) and ventricular dyssynchrony. The majority of recipients respond to CRT with improvements in quality of life, New York Heart Association functional class, 6-min walk test, and ventricular function. Management of HF after CRT may include up-titration of neurohormonal blockade and an exercise prescription through cardiac rehabilitation to further improve and sustain clinical outcomes. Diagnostic data provided by the CRT device may help to facilitate and optimize treatment. Initial nonresponder rates remain problematic. We suggest a simple step-by-step management and troubleshooting strategy that integrates device function with advanced HF therapy in patients who do not initially respond to CRT. This algorithm represents a new, comprehensive, collaborative approach between the HF and electrophysiology specialists to further improve and sustain outcomes in the field of CRT.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Pre-operative evaluation of cervical adenopathies in tumours of the upper aerodigestive tract.

BACKGROUND: Carcinomas of the upper aerodigestive tract are characterized by a high incidence of local metastasis in the neck. The presence of lymph node metastasis represents the most unfavorable prognostic factor for these tumors. A diagnostic routine is needed in order to identify the highest number of neck metastasis, thereby optimizing the selection of patients eligible for surgical neck treatment and reduce costs and length of hospital stay. MATERIALS AND METHODS: Our study analyzes the sensibility, specificity, and diagnostic accuracy of clinical examination, echography (US), computed tomography (CT) in cervical metastasis detection by comparing them with the histopathological examination of the neck dissection specimens (pN) in 53 patients suffering from carcinoma of the upper aerodigestive tract. RESULTS: Clinical examination: sensibility 82.1%; specificity 80%; diagnostic accuracy 81.1%; US with a cut off point for minimal adenopathy diameter of 0.5 cm 92.8% sensibility, 60% specificity, 77.3% diagnostic accuracy; US with cut off point 1 cm 82.1% sensibility, 80% specificity, 81.1% diagnostic accuracy; US with cut off point 1 cm, also considering round shape or multiplicity of the adenopathy: 82.1 sensibility, 80% specificity, 81.1% diagnostic accuracy; CT with cut off point 0.5 cm: 92.8% sensibility, 32% specificity, 64.1% diagnostic accuracy; CT with cut off point 1 cm: 85.7% sensibility, 64% specificity, 75.4% diagnostic accuracy; CT with cut off point 1 cm, also considering central necrosis, extracapsular spread, multiplicity of the adenopathy 89.2 sensibility, 60% specificity, 75.5% diagnostic accuracy. CONCLUSIONS: By relating the results obtained from preoperative methods to the anatomopathological analysis of the surgical specimens we can draw the following conclusions: a) a neck positive to palpation in a subject with carcinoma of the upper aero digestive tract must be submitted to neck dissection. Such patients have an 81.1% likelihood of having a metastasis. In these patients the use of radiologic studies of the neck must be restricted to cases with uncertain involvement of retropharingeal, mediastinic, paratracheal lymph nodes or in the follow-up after treatment; b) a neck negative to palpation in a subject with carcinoma of the upper aero digestive tract, must be further investigated. The US and the CT must use a cut-off point of 1 cm to consider a neck positive. Radiologic criteria for malignancy, i.e., multiplicity, roundish shape, central necrosis and capsular invasion do not significantly increase the diagnostic accuracy of the radiographic methods; c) the combined use of US and CT does not offer significant advantages in the detection of metastasis, in any case CT is preferable when primary tumor has to be evaluated; d) the assessment of patients that are negative to palpation and to US and to CT must consider the parameters linked with primary tumor, such as site and size, Broder's grading, Invasive Cell Grading, and thickness.

Head and Neck Neoplasms↗
PubMed2004

[The "Würzburg T". A concept for optimization of early multiple trauma care in the emergency department].

INTRODUCTION: Anaesthesia management, radiological diagnostic and the concept of damage control surgery should be combined in the resuscitation room. Defined clinical targets and their realisation are a CT-scan and complete damage control surgery in the shock room. Furthermore minimised patient transfer and positioning with continuous access to the head, upper parts of the body and anaesthesia machine should be realised during diagnostic procedures. METHODS: Based on a carbon-slide fixed on a turntable and innovative alignment of diagnostic devices, a three phase treatment algorithm has been established. RESULTS: Phase A includes primary survey, anaesthetic management and ultrasound examination. Following a turn of the table conventional x-ray diagnostic is assessed in phase B. Tracks for the slide enable immediate transfer to a spiral CT-scan without additional patient positioning (phase C). Following complete CT-scan rearrangement of the table to phase A facilitates immediate damage control surgery. To accelerate device operation and treatment the integrated anaesthesia workstation is ceiling-mounted and manoeuvres close to the patient. CONCLUSIONS: This concept realizes complete diagnostic procedures and damage control surgery without time consuming patient transfer or rearrangement.

Algorithms↗
PubMed2002

On-table cecoscopy : a novel diagnostic method in acute diverticulitis of the right colon.

PURPOSE: Controversies abound regarding the optimal surgical management in noncomplicated diverticulitis of the right colon, ranging from a conservative approach to diverticulectomy to right hemicolectomy. One of the arguments for resection is to exclude carcinoma. However, there is significant morbidity associated with resection. We aim to introduce on-table cecoscopy as a tool to improve the diagnosis of acute diverticulitis of the right colon, exclude carcinoma, and reduce the rate of resection. METHODS: From October 1999 to June 2000, five patients presented to our unit with suspected acute appendicitis. Intraoperatively, we found a colonic inflammatory mass at either the cecum or the ascending colon. The cecum and ascending colon were mobilized, and bowel clamps were applied to the ascending colon and ileum. A bronchoscope (Olympus(R) BF-P200) was introduced through the appendix stump. To achieve a good endoscopic view, a limited volume of air was introduced through the working channel. RESULTS: After on-table cecoscopy, all the patients were diagnosed as having acute nonperforated diverticulitis of the right colon. They received appendicectomy, and the diverticulitis was managed conservatively. They were treated with a course of cephalosporin and metronidazole. We performed colonoscopy four weeks later and confirmed that none of them had carcinoma of the colon. CONCLUSIONS: On-table cecoscopy is a new, safe, and effective means of diagnosing acute diverticulitis of the right colon. We can confidently exclude carcinoma and reduce the amount of colonic resection in patients with noncomplicated diverticulitis of the right colon.

Acute Disease↗
PubMedDate not supplied

[Optimization of a method for purifying antibodies for immunofluorescent diagnosis of influenza].

Efficiency and diagnostic adequacy of immunoglobulin isolation from rabbit immune serum by reiterated salting out with ammonium sulfate and subsequent separation of DEAE sephadex A-50 was evaluated. Electrophoresis and immunoelectrophoresis in agar gel demonstrated that the resultant immunoglobulin fraction is much more pure than after one salting out. It contains nothing more than antibodies to influenza virus taken for immunization, and after binding to the stain shows high fluorescent activity and induces but a moderate background nonspecific fluorescence in the subsequent preparations. In clinical trials of conjugates based on the new combined method of purification, influenza A or B could be correctly diagnosed in 97-98% cases.

Animals↗
PubMed1995

[The optimization of the heparin prophylaxis of postoperative thromboembolic complications].

Using the methods of early diagnostics of phlebothromboses and thromboembolisms of pulmonary arteries allowed the author to establish that the optimum method of prophylactics of thromboembolic complications is considered to be the individual doses and schemes of administration of heparin which do not cause hypocoagulation shifts in the hemostasis system and greater bleeding of the wound at the early postoperative period.

Drug Evaluation↗
PubMed2001

The use of USG spatial reconstructions in diagnosing cholelithiasis and cholecystitis.

The aim of the paper is to determine diagnostic value of Spatial USG reconstructions in the diagnostics of cholelithiasis and inflammatory changes in the gallbladder. There was discussed the optimal way of examining the gallbladder in 3D USG presentation and advantages resulting from the use of the spatial option in diagnosing biliary deposits in selected inflammatory changes. USG spatial reconstructions which supplement the standard 2D USG examination in the diagnostics of difficult and doubtful cases of gallbladder pathology were found useful.

Cholecystitis↗
PubMedDate not supplied

Methods to estimate the optimal threshold for normally or log-normally distributed biological tests.

Putting a screening or a diagnostic test into everyday use requires the determination of its threshold. The authors present methods that yield a point and an interval estimation of the threshold that maximize the population utility whenever the test results are normally or log-normally distributed among healthy and among diseased subjects, with equal variances. These methods were assessed for bias, coverage probability, coverage symmetry, and confidence-interval width using simulation. They proved to be asymptotically nonbiased and to have a satisfactory coverage probability whenever the sample sizes of the healthy and the diseased subjects are equal to or greater than 50. The methods were next applied to determine an optimal threshold for the antibody load used to diagnose congenital toxoplasmosis at birth. The methods are easy to implement and impose few constraints; however, the sample sizes should be carefully determined according to the required accuracy.

Antibodies, Protozoan↗
PubMed2001

Laboratory diagnostics in vasculitis patients.

Anti-neutrophil cytoplasm antibodies are important markers of certain small vessel necrotizing vasculitides, but the optimal use of laboratory results in daily clinical practice necessitates collaboration between clinicians and laboratory specialists. Physicians must familiarize themselves with ANCA tests in ANCA-related vasculitides as well as in differential diagnostic patient populations in order to define cutoff values. Indirect immunofluorescence with a consensus-agreed technique combined with standardized enzyme immunoassays is the modality for detecting the main SSV-associated ANCA specificities using cutoff values that can sufficiently distinguish SVV from non-SVV patients. The combined use of IIF and direct EIA to demonstrate proteinase 3-ANCA and myeloperoxidase-ANCA at significant levels leads to a very high diagnostic specificity towards SVV conditions such as Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, and limited forms of these such as renal-limited focal necrotizing glomerulonephritis. A strong reactivity of ANCA against several azurophil granule components indicates a drug-induced syndrome. ANCA-related SVV and drug-induced vasculitis or lupus syndromes have characteristic ANCA profiles that can help distinguish these conditions from other inflammatory diseases.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2000

Guidelines on the management of H.pylori in primary care: development of an implementation strategy.

BACKGROUND: Clinical guideline programmes as being developed in many European countries contribute to quality of care in general practice. The applicability of multicountry guidelines will depend on country-specific circumstances. Implementation programmes are required for optimal compliance with guidelines. OBJECTIVE: In order to achieve optimal follow-up of the European Society for Primary Care Gastroenterology (ESPCG) Helicobacter pylori guidelines in general practice, we analysed factors that might obstruct compliance at national level, and integrated this in implementation programmes. METHOD: Discussion groups in eight participating countries reviewed epidemiological characteristics and diagnostic and therapeutic resources that would hinder applicability. The groups also indicated potential constraints to optimal compliance and developed a national implementation programme. RESULTS: Helicobacter pylori infection rates and peptic ulcer incidence vary widely across Europe, as do the availability, access and reimbursement of diagnostic test facilities for H.pylori Minor adaptation of the ESPCG guidelines is required in some countries. Implementation programmes have been developed and partially carried out in all countries. CONCLUSION: A pan-European approach to H.pylori guideline development should result in a framework of best practice into which nationally specific details can be incorporated, thus guaranteeing optimal follow-up of the guidelines and true improvement of dyspepsia management in primary care.

Benchmarking↗
PubMed2002

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

The incidence of differentiated thyroid cancer (DTC) has increased in many places around the world over the past three decades, yet this has been associated with a significant decrease in DTC mortality rates in some countries. While the best 10-year DTC survival rates are about 90%, long-term relapse rates remain high, in the order of 20-40%, depending upon the patient's age and tumor stage at the time of initial treatment. About 80% of patients appear to be rendered disease-free by initial treatment, but the others have persistent tumor, sometimes found decades later. Optimal treatment for tumors that are likely to relapse or cause death is total thyroidectomy and ablation by iodine-131 ((131)I), followed by long-term levothyroxine suppression of thyrotropin (TSH). On the basis of regression modeling of 1510 patients without distant metastases at the time of initial treatment and including surgical and (131)I treatment, the likelihood of death from DTC is increased by several factors, including age >45 years, tumor size >1.0 cm, local tumor invasion or regional lymph-node metastases, follicular histology, and delay of treatment >12 months. Cancer mortality is favorably and independently affected by female sex, total or near-total thyroidectomy, (131)I treatment and levothyroxine suppression of TSH. Treatments with (131)I to ablate thyroid remnants and residual disease are independent prognostic variables favorably influencing distant tumor relapse and cancer death rates. Delay in treatment of persistent disease has a profound impact on outcome. Optimal long-term follow-up using serum thyroglobulin (Tg) measurements and diagnostic whole-body scans (DxWBS) require high concentrations of TSH, which until recently were possible to achieve only by withdrawing levothyroxine treatment, producing symptomatic hypothyroidism. New paradigms, however, provide alternative pathways to prepare patients for (131)I treatment and to optimize follow-up. Patients with undetectable or low Tg concentrations and persistent occult disease can now be identified within the first year after initial treatment by recombinant human (rh)TSH-stimulated serum Tg concentrations greater than 2 microg/l, without performing DxWBS. These new follow-up paradigms promptly identify patients with lung metastases that are not evident on routine imaging, but which respond to (131)I treatment. In addition, rhTSH can be given to prepare patients for (131)I remnant ablation or (131)I treatment for metastases, especially those who are unable to withstand hypothyroidism because of concurrent illness or advanced age, or whose hypothyroid TSH fails to increase.

Adenocarcinoma, Follicular↗
PubMed2004

Methods for multi-category cancer diagnosis from gene expression data: a comprehensive evaluation to inform decision support system development.

Cancer diagnosis is a major clinical applications area of gene expression microarray technology. We are seeking to develop a system for cancer diagnostic model creation based on microarray data. In order to equip the system with the optimal combination of data modeling methods, we performed a comprehensive evaluation of several major classification algorithms, gene selection methods, and cross-validation designs using 11 datasets spanning 74 diagnostic categories (41 cancer types and 12 normal tissue types). The Multi-Category Support Vector Machine techniques by Crammer and Singer, Weston and Watkins, and one-versus-rest were found to be the best methods and they outperform other learning algorithms such as K-Nearest Neighbors and Neural Networks often to a remarkable degree. Gene selection techniques are shown to significantly improve classification performance. These results guided the development of a software system that fully automates cancer diagnostic model construction with quality on par with or better than previously published results derived by expert human analysts.

Algorithms↗
PubMed1964

INVESTIGATIONS INTO THE EUGLENA METHOD FOR THE ASSAY OF THE VITAMIN B12 IN SERUM.

Details are given of a modified Euglena method for the assay of B(12) in serum. Serum in very small quantities is usually inhibitory to the growth of the Euglena. In general, this inhibition is most marked when the organism is growing prolifically. For estimating serum B(12) values, a standard curve is used from B(12) standards containing 0.01 ml. of serum of low B(12) content, so that growth in test serum solutions is compared with growth in serum-containing standards. The recovery of B(12) added to serum, incomplete when estimated from aqueous standards, is now complete and the variation in results from batch to batch is markedly reduced. Various factors-such as medium, light, and inoculum-can affect growth in aqueous and serum solutions differently and are an important cause of variations between batches and laboratories. Optimal conditions were studied and they are essential for the most sensitive and accurate assay, but if the results are estimated from serum-containing standards accurate values can be obtained even under less than optimal conditions. Subnormal serum B(12) concentrations can be detected visually as early as 24 hours after the start of assay. For diagnostic purposes the assay can be read at three days, provided that appropriate dilutions are used, conditions are optimal, and growth is measured in a 1 cm. cell.

Biological Assay↗
PubMed1990

[Stabilization surgery of the spine].

New diagnostic tools and alternatives such as CAT-scan, NMRI, discography, functional X-rays, infiltrations and immobilization tests have made spinal instability a more rational diagnosis than it was only a few years ago. Neurological deficit, radicular pain and pseudo-radicular pain may only be an expression of instability and are best treated by stabilizing operations. Laminectomy has few indications and is not a logical procedure, especially if used as decompression of the dural sac in tumor involvement of the spine, which usually comes from the front (vertebral body). Therefore, anterior surgery is indicated rather than so-called posterior decompression. In accordance with osteosynthesis techniques of limb disorders, high stability can be achieved through special implants, on the basis of a better understanding of the biomechanics of implants and the healthy and impaired spine. Short fusion and fixation have therefore become a principle which is the standard of reference for present and future spinal surgery. The spectrum of indications for spinal surgery has vastly increased in the last few years, though exact diagnosis is mandatory for optimal treatment.

Adolescent↗
PubMed2006

Optimized detection of circulating anti-nuclear envelope autoantibodies by immunofluorescence.

BACKGROUND: Antinuclear antibodies are useful diagnostic tools in several autoimmune diseases. However, the routine detection of nuclear envelope autoantibodies using immunofluorescence (IF) is not always easy to perform in patients' sera because of the presence of autoantibodies to other nuclear and cytoplasmic components which could mask the characteristic rim-like pattern of nuclear envelope autoantibodies. This is particularly common in sera from patients with primary biliary cirrhosis (PBC), which generaly have high titres of anti-mitochondrial antibodies. Therefore, we have assayed a number of commercial slides and alternative fixation conditions to optimize the detection of anti-nuclear envelope antibodies (ANEA) in PBC sera. METHODS: We have explored the presence of ANEA in 33 sera from patients with established PBC using three different Hep2 commercial slides and home-made slides with HeLa and Hep2 cells fixed with methanol, ethanol, 1% or 4% formaldehyde. RESULTS: We observed that the IF pattern was related to the cell type used (Hep2 or HeLa), the manufacturer and the cell fixation scheme. When both cell lines were fixed with 1% formaldehyde, the intensity of the cytoplasmic staining was considerably decreased regardless to the serum sample, whereas the prevalence of cytoplasmic autoantibodies was significantly lowered, as compared to any of the Hep2 commercial slide and fixation used. In addition, the prevalence of ANEA was importantly increased in formaldehyde-fixed cells. CONCLUSION: Immunofluorescence using appropriately fixed cells represent an easy, no time-consuming and low cost technique for the routine screening of sera for ANEA. Detection of ANEA is shown to be more efficient using formaldehyde-fixed cells instead of commercially available Hep2 cells.

Adult↗
PubMed2006

Accuracy of clinical decision rule, D-dimer and spiral computed tomography in patients with malignancy, previous venous thromboembolism, COPD or heart failure and in older patients with suspected pulmonary embolism.

BACKGROUND: The diagnostic work-up of patients with suspected pulmonary embolism (PE) has been optimized and simplified by the use of clinical decision rules (CDR), D-dimer (DD) testing and spiral computed tomography (s-CT). Whether this strategy is equally safe and efficient in specific subgroups of patients is evaluated in this study. METHODS: A diagnostic strategy including a CDR, DD test and s-CT was evaluated in patients with malignancy, previous venous thromboembolism (VTE), chronic obstructive pulmonary disease or heart failure and in older patients. PE was ruled out by either an unlikely CDR and a normal DD or a s-CT negative for PE. The safety of these tests was assessed by the 3-month incidence rate of symptomatic VTE in those without PE at baseline. The efficiency was evaluated by calculating the numbers needed to test for the different subgroups. RESULTS: The venous thromboembolic incidence rate after the combination of an unlikely CDR and a normal DD varied from 0% (95% CI: 0-7.9%) in the 482 patients older than 75 years of age to 2% (95% CI: 0.05-10.9%) in the 474 patients with a malignancy. For s-CT these incidences varied from 0.3% to 1.8%. The number needed to test in order to rule out one patient from PE with the studied strategy was highest in cancer patients and in the elderly patients (approximately 10). CONCLUSION: It appears to be safe to rule out PE by either the combination of an unlikely CDR and a normal DD or by a negative s-CT in various subgroups of patients with suspected PE. However, the clinical usefulness of the CDR in combination with the DD as the initial step in the diagnostic process varied among these patient groups.

Adult↗

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