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PubMed2005

Diagnostic assessment of nonpalpable breast cancer--the difference in diagnostic approach for the clinical treatment of breast cancer between the Japanese Guidelines and the National Comprehensive Cancer Network(USA)Guidelines.

The detection of non-palpating breast cancer might improve the survival of patients with whole breast cancer because it can be diagnosed at an early stage. Therefore, to standardize the quality of patient care, a published assessment guideline is necessary in a clinical setting. For this purpose, Japan and USA have independent guidelines with different approaches. ''The evidence-based guideline for clinical treatment of breast cancer'' that was published in June 2005 by the Japanese breast cancer society, is the first set of integrated guidelines pertaining to breast cancer in Japan. These guidelines are presented in the research questions (RQ)format. This paper explains 7 RQs(out of 31 RQs)and also discusses the recommendations pertaining to the diagnosis of nonpalpable breast cancer. The National Comprehensive Cancer Network (NCCN; USA)guidelines, which are widely recognized as one of the most reliable guidelines based on published evidences, also contain the diagnostic assessment of asymptomatic patients with a negative physical examination. This paper discusses pros and cons of each of the above mentioned guidelines as well as their clinical application. It is necessary to use both the Japanese and NCCN guidelines while understanding the differences between the two.

Breast Neoplasms↗
PubMed2000

Prevalence of undiagnosed diabetes in three American Indian populations. A comparison of the 1997 American Diabetes Association diagnostic criteria and the 1985 World Health Organization diagnostic criteria: the Strong Heart Study.

OBJECTIVE: In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus of the American Diabetes Association (ADA) recommended three new sets of criteria for the diagnosis of diabetes that were different from those established by the World Health Organization (WHO) in 1985. One of these three methods was based on a fasting plasma glucose value only. This article compares ADA criteria with WHO criteria by applying them to three subgroups of American Indians in the Strong Heart Study who had no known diabetes. RESEARCH DESIGN AND METHODS: The Strong Heart Study is a prospective epidemiological study of vascular disease in three American Indian populations aged 45-74 years. During the baseline examination from 1988 to 1991, participants without diagnosed diabetes underwent a fasting glucose test and a 2-h oral glucose tolerance test. These values were used to compare the ADA and WHO diagnostic criteria. RESULTS: By using fasting and 2-h glucose values, prevalence rates of undiagnosed diabetes were 15.9% according to WHO criteria and 14.4% according to ADA criteria. The overall agreement rate was 65%, and the weighted kappa statistic was 0.474, which indicates moderate agreement. The age-specific analysis showed that, among participants between 45 and 54 years of age, the prevalence rates of undiagnosed diabetes were 13.4% according to WHO criteria and 12.7% according to ADA criteria. Among those aged 55-74 years, the rates were 18.7% according to WHO criteria and 16.3% according to ADA criteria. Thus, the difference in the prevalence rates when using WHO and ADA criteria, although generally small in this population, was three times higher in the older group (2.4%) than the difference in the younger group (0.7%). CONCLUSIONS: The Strong Heart Study found that prevalence rates of undiagnosed diabetes determined by ADA criteria and WHO criteria were similar in its American Indian population. The data suggest that the difference between the two criteria may increase as age increases. Longitudinal data will be needed to evaluate further the utility of the two criteria.

Aged↗
PubMed1985

Diagnostic tests in breast cancer. Clinical strategies based on diagnostic probabilities.

Optimal diagnostic strategies used in screening for breast cancer and evaluating breast masses depend on the likelihood of malignancy, findings at physical examination, and the accuracy of tests and procedures. Results from published series, in conjunction with calculations of the probability of malignancy based on test results, indicate that only mammography is needed for screening. A clinical sequence for evaluating palpable breast masses should include a combination of mammography, ultrasound examination, and needle aspiration. In patients with negative findings, the probability of cancer will be sufficiently low to obviate the need for immediate surgical biopsy. However, if there are positive findings, or the initial clinical likelihood of malignancy is high, excision of the mass is indicated.

Adult↗
PubMed1999

[Impact of the new diagnostic criteria proposed by the American Diabetes Association (ADA-97) on the diagnostic prevalence of type 2 diabetes mellitus].

OBJECTIVE: To compare the diagnostic prevalence of type-2 Diabetes Mellitus (DM2) according to the criteria of the American Diabetes Association (ADA-97) and the WHO. DESIGN: Crossover descriptive study. SETTING: Urban Health Centre, with a total of 34,234 clinical histories (CH). PATIENTS: 782 patients, selected through simple random sampling from medical records, aged 45 or over, with a minimum of 5 attendances recorded in their CH and at least 3 attendances in the previous 2 years, were studied. MEASUREMENTS AND MAIN RESULTS: Through review of the CH, the variables age, sex and presence of obesity (BMI3 30) were collected. DM2 patients were classified according to WHO criteria, in the three ADA-97 categories: DM2, basal glucaemia altered (BGA) and normal glucaemia (NG) and other situations with altered glucaemia. Mean age was 62.6 (SD 10.8), with 56.4% women. 95 patients (12.1%) had no glucaemia recorded. 15.6% of the patients with WHO criteria (10.7% through oral overload) were diagnosed with DM2, proportion that went up to 18.3% (CI 95% of difference: -1 to 6.4%) on application of the ADA-97 criteria. 12.8% had BGA, 54.1% NG and 2.7% other situations. Additional DM2 cases diagnosed with ADA-97 criteria had a greater proportion of obese people (p = 0.03), with no differences for age and sex found. CONCLUSIONS: We found a 2.7% increase in the prevalence of DM2 diagnosis in the 45 or over population on applying the ADA-97 criteria. These criteria simplify the diagnosis and will enable an appreciable number of patients not diagnosed under WHO criteria (since oral overload is little used) to be diagnosed. This will foment early action to retard micro and macrovascular complications caused by the disease.

Aged↗
PubMed1999

Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe.

BACKGROUND: The American Diabetes Association (ADA) recommend that fasting glucose alone with the oral glucose tolerance test should be used to diagnose diabetes mellitus. We assessed mortality associated with the ADA fasting-glucose criteria compared with the WHO 2 h post-challenge glucose criteria. METHODS: We assessed baseline data on glucose concentrations at fasting and 2 h after the 75 g oral glucose tolerance test from 13 prospective European cohort studies, which included 18,048 men and 7316 women aged 30 years or older. Mean follow-up was 7.3 years. We assessed the risk of death according to the different diagnostic glucose categories. FINDINGS: Compared with men who had normal fasting glucose (< 6.1 mmol/L), men with newly diagnosed diabetes mellitus by the ADA fasting criteria (> or = 7.0 mmol/L) had a hazard ratio for death of 1.81 (95% CI 1.49-2.20); for women the hazard ratio was 1.79 (1.18-2.69). For impaired fasting glucose (6.1-6.9 mmol/L), the hazard ratios were 1.21 (1.05-1.41) and 1.08 (0.70-1.66). For the WHO criteria (> or = 11.1 mmol/L), the ratios for newly diagnosed diabetes were 2.02 (1.66-2.46) in men and 2.77 (1.96-3.92) in women, and for impaired glucose tolerance (7.8-11.1 mmol/L) were 1.51 (1.32-1.72) and 1.60 (1.22-2.10). Within each fasting-glucose classification, mortality increased with increasing 2 h glucose. However, for 2 h glucose classifications of impaired glucose tolerance, and diabetes, there was no trend for increasing fasting glucose concentrations. INTERPRETATION: Fasting-glucose concentrations alone do not identify individuals at increased risk of death associated with hyperglycaemia. The oral glucose tolerance test provides additional prognostic information and enables detection of individuals with impaired glucose tolerance, who have the greatest attributable risk of death.

Adult↗
PubMedDate not supplied

Diagnostic accuracy and predictive value of the tumor-associated antigen S100 in malignant melanomas: validation by whole body FDG-PET and conventional diagnostics.

UNLABELLED: We investigated the predictive value of the protein S100 as a tumor-marker in the post-surgical follow-up staging of patients with High Risk melanomas (Clark Levels IV/V, Thickness > 0.75 mm). METHODS: In 51 follow-up studies, performed in 50 patients, serum concentrations of the protein S100 were measured and evaluated with respect to their diagnostic value based on the findings of whole body F-18-FDG-PET studies. The findings of FDG-PET were correlated with the findings of CT, MRI, lymph node sonography, bone scintigraphy, and with histological findings, or a follow-up staging after at least 6 months, respectively. Thus, FDG-PET exhibited a sensitivity of 100% and a specificity of 95%. S100 concentrations were measured by an established RIA (Ria-mat Sangtec 100) and by a novel LIA (Lia-mat Sangtec 100 beta). Subsequently, S100 was compared with thymidine kinase for the predictive values of both tumor-markers in the follow-up of malignant melanoma. RESULTS: Intraindividual comparison of S100 concentrations measured by LIA with those obtained by RIA showed a calculated correlation coefficient of 0.97 (Cutoff-levels were 0.1 microgram/l [RIA] and 0.2 microgram/l [LIA]). The arrangement of these cutoff-levels leads to a sensitivity of 85% at a specificity of 55% for Protein S100 when measured by RIA, and to a sensitivity of 77% at a specificity of 61% when measured by LIA. The negative predictive values are 91% (RIA) and 88% (LIA), in association with positive predictive values of 39% (RIA) and 40% (LIA). At a cutoff-level of 4.0 micrograms/l, thymidine kinase showed a sensitivity of 70% and a specificity of 41%. CONCLUSIONS: a) The results obtained by LIA are in a very good correlation with the results measured by the well-established RIA. Thus, the LIA is a suitable method for the clinical routine. b) The protein S100 as a tumor-marker of malignant High Risk melanomas has no clinically important sensitivity and specificity as could be proved by a comparison with the predictive value of FDG-PET. c) Whether or not during therapy information concerning progression/remission of the disease can be received out of repetitive measurements of the S100, has to be shown by the results of validated long term follow-up studies.

Adult↗
PubMed1976

[Diagnostic and differential diagnostic considerations in osteopmyelitis].

A report is drawn up of the available diagnostic procedures in the detection of the different forms of osteomyelitis. Special reference is made to the problems involved in the clinical diagnosis of the mitigated and non-typical forms of haematogenous osteomyelitis which occur more frequently in the present antibiotics era. Early diagnosis of haematogenous osteomyelitis is of the greatest importance, since, in our experience, a cure can only be expected with very early initiation of antibiotic therapy. In regard to the differential diagnosis, abortive manifestations of haematogenous osteomyelitis must be differentiated from rheumatoid arthritic diseases and soft-part inflammations of all kinds, whilst caution must be taken to avoid a mistaken diagnosis of osteosarcoma.

Anti-Bacterial Agents↗
PubMed2001

[Diagnostic and differential diagnostic potential of mitochondrial DNA assessment in patients with Leber's hereditary optic neuropathy].

OBJECTIVE: To study the primary mutations of mitochondrial DNA (mtDNA) associated with Leber's hereditary optic neuropathy (LHON) in patients with optic neuropathy. METHODS: Seventy-nine patients with a variety of bilateral optic neuropathy were examined. Mutations at np 3,460, np 11,778 and np 14,484 of mtDNA were tested by PCR-restriction fragment length polymorphism technique to detect DNA in peripheral blood. The samples were taken from 16 cases of clinically diagnosed LHON, 44 cases of suspected LHON, two cases of alcohol amblyopia, four cases of multiple sclerosis, five cases of autosomal dominant hereditary optic atrophy, 4 cases with primary open-angle glaucoma, three cases of spinocerebellar degeneration, and one case of ethambutol-induced optic neuropathy. RESULTS: The mutation at np 11,778 was identified in 31 cases (39.2%), consisting of all the 16 clinically diagnosed LHON cases, thirteen cases (29.5%) of the suspected LHON, and the two cases of alcohol amblyopia. The remaining 48 cases were negative for mtDNA mutations at np 3,460, np 11,778, or np 14,484. CONCLUSION: Assessment of mtDNA provides a useful diagnostic aid in confirming and excluding the diagnosis of LHON, particularly useful in cases without a family hereditary history and cases with cause unknown bilateral optic neuritis.

Adult↗
PubMed1975

[Problems in the diagnostic of primary gastric stump cancer and recurrences of gastric cancer. A comparison of X-ray diagnostic and endoscopy (author's transl)].

X-ray findings and gastroscopic findings of patients with primary gastric stump cancer and recurrences of gastric cancer are compared. These findings are compared with the observations of operations. The reasons of false diagnoses and doubtful tentative diagnoses were analyzed. In the analysis of X-ray pictures especially the benign operative caused and the postoperative alterations of the wall and mucosa of the stomach must delimit from infiltrative and polypous increasing tumors. The postoperative control examination may be valuable for the diagnosis, because it gives the possibilities for comparison. Roentgenography in double contrast relieves the diagnosis. Stenosing processes of the cardia and anastomose causes difficulties in differential diagnosis in gastroscopy opposite to scared alterations. The aimed biopsy improves the tumor protection. Both examination techniques shows difficulties in recognition of recurrences, which develop from the duodenal stump. Only a special examination technique leads to an improvement of the results. The instruction and experience of the examiner, the knowledge of tumor diagnostics and of the methods of operations and of the postoperative alterations are for the diagnosis of these processes of decisive importance. X-ray examination and endoscopy are two supplementing examination methods.

Endoscopy↗
PubMed1992

[A comparative study of the diagnostic value of polyclonal and monoclonal antibodies to human IgM in immunoenzyme diagnostic agents].

Monoclonal antibodies (McAb) to human IgM, capable of recognizing antigenic determinants of different character, have been obtained. Three type-specific McAb have been used in diagnostic systems for the determination of specific IgM antibodies in the sera of patients with hepatitides A and B. The affinity constant and high specificity of McAb have made it possible to change affinity-purified polyclonal antibodies to heavy chains of IgM for the gamma fraction of hybridoma-induced ascitic fluids without decreasing the sensitivity and specificity of test systems. The main advantages of McAb are the standard character of the reagent and reproducibility of its properties.

Animals↗
PubMed2004

[Diagnostics and differential diagnostics of the chronic obstructive pulmonary disease].

The author builds upon present definition of chronic obstructive pulmonary disease (COPD) and states that diagnosis of COPD is based on history of risk factors and on presence of bronchial obstruction which is not entirely reversible. The main examination method for diagnosing and confirmation of COPD is spirometry. Differential diagnostics is necessary for identifying other diseases with similar symptoms: bronchial asthma, congestive heart failure, lung carcinoma, bronchiectasia, pulmonary tuberculosis, bronchitis obliterans, interstitial pulmonary processes. The author presents a list of symptoms and findings which help to distinguish these diseases from COPD.

Diagnosis, Differential↗
PubMedDate not supplied

[Diagnostic value of myocardial biopsy in the diagnostic algorithm in cardiomyopathies in children].

The purpose of this work was to show the importance of myocardial bioptate analysis using different methods in the diagram of diagnostic flow in primary cardiomyopathies in children. According to the guidelines of the Task Force on Cardiomyopathies of the WHO/ISFC, we identified 121 children (50 f and 71 m) as having cardiomyopathy, giving an average occurrence for all cardiomyopathies of 38.81 for each 10,000 pts examined in our outpatient clinics for paediatric cardiology. The dilated cardiomyopathy (DCM) was identified in 52 pts (42.9%), hypertrophic cardiomyopathy (HCM) in 43 pts (35.5%) and restrictive cardiomyopathy (RCM) in 6 pts (4.8%). We placed 11 pts (9.0%) in the group of specific cardiomyopathies. In nine pts (7.4%), it was impossible to classify the cardiomyopathy. Most of those with DCM had been diagnosed prior to the age of 3 years (RR 1.9, 95% CI 1.4-2.47). There were no statistically significant differences in the incidences of DCM as compared to HCM (Z 0.923, p < 0.1779), but we encountered a significantly lower occurrence of RCM (Z 6.044, p < 0.001). The biopsy of endocardium and myocardium was done to confirm the etiology of primary cardiomyopathy in 22 pts, 12 m and 10 f, age 1 to 17 (average age 9.5y). The bioptates were analysed by light microscope (Dallas criteria) in all pts, 13 bioptates by direct immunofluorescence, 8 by immunohystochemical method (two hystochemically by the method of coloring with Kongo red, one by the microscopy in polarised light), 7 by electron microscope, and 5 by PCR method where DNA and RNA of cardiotrophic viruses was used. Out of 10 pts with DCM, in 4 myonecrosis as a consequence of acute myocarditis and in 6 signs of late inflammatory processes, as a consequence of chronic immunologic myocarditis, were found. In 4 of them rebiopsy proved complete healing. In 5 pts with HCM the diagnosis was confirmed hystologically. One bioptate was analysed by electron microscope to rule out mitochondriopathy. Out of 4 pts with RCM due to inflammation, in 3 pathohistological findings proved diagnosis and in one showed primary amyloidosis. In one patient pathohystological finding showed fibroelastosis. In one patient heart tumor (fibroma) has been found.

Adolescent↗
PubMed2006

[Diagnostical values of antibody on A60 antigen in diagnostic of tuberculosis].

Aim of this research was to investigate diagnostic value of discovering of antibody on A60 antigen in patients who were tested for presents of Mycobacterium tuberculosis in there biological samples. We tested a samples of sputum, gastric juice, urine, cerebrospinal fluid and punctate from group of 353 patients who were suspected for tuberculosis. In all patients we were looking for antibodies classes A60 antigen. We used immune chromatographic "Hexagon TB" test, Germane company "Human Geselschaft fur Biochemica und Diagnostica". From 353 patients we found 58 (16.43%) patients with positive BK, 79/22,38%) patients with positive Lowenstein culture and 122 (34,55%) patients with antibody in sera on A60 antigen. Patients who were BK and Lowenstein positive, have had antibody in 94,23% cases, Patients who were BK negative and Lowenstein positive have had antibodies in 70,37% cases and patients who were BK negative and Lowenstein negative have had antibody in 19,03% cases. Patients with BK positive and Lowenstein negative results have had antibody in 50,00% cases. Difference between results is significant (p<0,01). From 122 patients with positive antibodies, 52 were BK positive and 68 have had positive Lowenstein cultures. From 231 patients with no antibody, just 6 were BK positive and 11 Lowenstein positive. In 62 patients with positive antibodies, were BK and Lowenstein negative. We confirmed that antibody on A60 antigen in microbiological positive patients are more often then in microbiological negative patients (p<0,001).

Antibodies, Bacterial↗
PubMed1991

[Assessment of diagnostic lung function and diagnostic laboratory parameters in workers exposed to diesel exhaust below ground in comparison with non-exposed workers].

Toxic gases caused by the use of large Diesel-driven devices in underground mines may lead to impairment of health, especially in the respiratory system. By means of occupational hygiene supervision it may be checked if the effectiveness of accomplished occupational hygiene measures are sufficient. By an enlarged examination programme of the respiratory function and laboratory diagnostic investigation miners exposed to Diesel-exhaust-gas were compared within the above mentioned supervision with a non-exposed population. In this study was not found any difference between the respiratory results attributed to influence of Diesel-exhaust-gas. Among the laboratory parameters the exposition to Diesel-exhaust-gas will only affect the mercapturic acid, however, which also may be influenced by other factors. Under the conditions of the measured low degree of exposition was not found any correlation between the level of mercapturic acids and the duration of exposure as well as to the actual degree of exhaust-gas exposition.

Adult↗
PubMed1978

The diagnostic laboratory and its relationship to practitioners. Diagnostic laboratory professional staff.

Diagnostic services provided to practitioners include necropsy, histopathology, bacteriology, virology, parasitology, immunopathology, clinical pathology and toxicology. Services are also available at the college in avian and aquatic diseases. The laboratory expects to continually upgrade its services through the addition of appropriate tests, re-evaluation of existing tests, development of methods for more convenient specimen collection and shipment, increased responsiveness to veterinarians' needs, epidemiological investigations, and continuing education.

Animals↗
PubMed1990

[Methodology and diagnostic possibilities of macro-EMG. II. Diagnostic possibilities].

The macro-EMG can be recorded with a modified single fiber or concentric needle. The two needles attain different results with smaller potentials values for the concentric needle type. For the single fiber type normal data are given for the EDC and tibialis anterior muscle. These data are compared with previously published results and their statistical evaluation. The concentric needle type can be used for scanning EMG. In addition potential stability can be examined in different parts of the MU using the unblanketing principle. A further novel use for macro-EMG is simultaneous single motor unit twitch recording to compare mechanical and electrical MU activity. In normal muscle the electrical signal is positively correlated with twitch force. In diseased muscle like ALS twitch is dissociated from electrical potential size. Macro-EMG allows to quantify MU size, a prerequisite to follow up dynamic changes in muscle. Improved computer programs in commercially available EMG-machines will help to introduce this method into clinical EMG laboratories as a useful addition to increase the diagnostic yield of EMG.

Electromyography↗
PubMed1990

[Bilateral radial nerve paralysis. Diagnostic and differential diagnostic aspects].

Bilateral radial nerve palsies are rare, and hence in this situation an underlying generalized peripheral neuropathy must always be considered. Among 103 patients with radial nerve palsies seen at our department during the last five years, there were three cases presenting with bilateral non-traumatic radial nerve palsies. These patients are presented in detail. One had a bilateral nerve entrapment in the supinator channel associated with a neuropathy of unclear origin, the second had bilateral sleep palsy, and the third had mononeuropathy multiplex associated with HIV infection. Following a summary of the cases reported in the literature, diagnostic considerations and additional investigations are discussed.

Adult↗
PubMed1989

[Diagnostic imaging of gallbladder carcinomas with special reference to ultrasonographic findings. Retrospective review with emphasis on diagnostic problems in preoperatively undiagnosed gallbladder carcinomas].

The diagnostic images of twenty surgically-resected gallbladder carcinomas were retrospectively reviewed for correlations with macroscopic findings. Among them, nine cases were correctly diagnosed preoperatively; 11 were not. Macroscopically, all correctly diagnosed lesions were elevated type carcinomas. Preoperatively undiagnosed lesions were comprised by 9 superficial and 2 elevated types of carcinomas. None of these 11 undiagnosed carcinomas could be identified on retrospective review of the ultrasonographic findings. Thorough evaluation of the gallbladder wall was prevented by gallstones and/or emphysema in 6 cases, and by contraction of the gallbladder in 4 cases. There was no definite evidence of wall thickening in one case of diffuse superficial carcinoma involving the muscle layer. As for lesion detectability, computed tomography was inferior to ultrasonography, though the former demonstrated localized wall thickening of the gallbladder in the majority of cases of elevated type carcinomas. Intravenous cholangiographic findings were non-specific.

Adenocarcinoma↗