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At least 253 records · Page 14Linked to original sources
PubMed1995

Identification of mycobacteria to the species level by automated restriction enzyme fragment length polymorphism analysis.

An automated method for the restriction fragment length polymorphism (RFLP) analysis for the differentiation of mycobacteria to the species level is described. After polymerase chain reaction (PCR) amplification of a sequence of the gene encoding the 65-kDa surface antigen common to all mycobacteria the product was investigated by RFLP analysis. For accurate determination of fragment sizes the asymmetrically fluorescein-labelled PCR product was partially digested with restriction site enzymes BstEII and HaeIII. The fragments obtained were analysed electrophoretically using an automated laser fluorescence DNA sequencer. Determination of fragment sizes revealed a deviation of +/- 1 base pair (bp; 0.6%) when compared to expected sizes. The validity of this approach was confirmed by analysing mycobacterial DNA obtained from pure cultures of Mycobacterium (M.) tuberculosis and alcohol-fixed smears as well as paraffin-embedded sputa of patients with culture-proven tuberculosis. Additionally a diagnostic algorithm was established by investigation of cultured M. bovis, M. bovis bacille Calmette-Guérin, M. avium, M. intracellulare and M. fortuitum. The method allows the identification of restriction enzyme sites which are only 40 bp apart. Partial restriction enzyme digestion of asymmetrically fluorescence-labelled PCR products will presumably lead to the discovery of new restriction enzyme sites.

Algorithms↗
PubMed1995

Updated management strategy for patients with cervical osteophytic dysphagia.

Anterior cervical osteophytes impinging upon the pharynx or esophagus constitute a rare cause of dysphagia. In severe cases, surgical removal of these osteophytes can provide symptomatic relief. We describe a patient of this type who failed to improve postoperatively, only to be found subsequently to have a carcinoma of the base of the tongue. To assist other clinicians in evaluating similar patients, and also to emphasize the great utility of modern radiologic techniques in these cases, we propose a diagnostic algorithm that incorporates magnetic resonance or computerized tomographic imaging.

Aged↗
PubMed1988

The impact of magnetic resonance on the diagnostic evaluation of acute cervicothoracic spinal trauma.

From 1984 to 1987 magnetic resonance (MR) imaging was performed on 100 patients suffering acute spinal trauma. MR demonstrated one or more injuries to the cervicothoracic region in 31 patients. It displayed a spectrum of spinal cord injury ranging from mild compression and swelling to complete transection. MR was also useful in evaluating alignment at the cervicothoracic junction, in depicting ligamentous injury, in establishing the presence of disc herniation, and in identifying unsuspected levels of injury. We present a diagnostic algorithm that incorporates the role of MR in evaluating acute cervicothoracic spinal trauma and emphasizes the replacement of myelography by MR in the initial assessment of neurologic deficit.

Acute Disease↗
PubMed1997

Prenatal diagnosis of the fetus with cystic fibrosis and meconium ileus.

The sonographic finding of hyperechoic or dilated fetal bowel raises suspicion of a number of prenatal disorders including meconium ileus (MI), meconium peritonitis, congenital infection, neoplasm, or chromosomal trisomy. These findings may also represent transient normal variants. The following case report details the evaluation of one pregnancy with abnormal intestinal echogenic findings on serial sonograms (US), to demonstrate inherent diagnostic difficulties in such a case. A diagnostic algorithm is presented to aid in the proper use of US and DNA mutation analysis for cystic fibrosis (CF), so that the cause of an abnormal abdominal US can be established earlier and more accurately than suggested by previous management schemes. Earlier fetal diagnosis may help to anticipate postnatal problems associated with CF/MI, and therefore provide more optimal clinical management of the affected fetus.

Adult↗
PubMed1984

Detection of intraperitoneal bile accumulations: significance of ultrasonography, CT, and cholescintigraphy.

Free or loculate intraperitoneal fluid can easily be detected by ultrasonography or computerized tomography. The differentiation of bile fluid from other liquid collections and the documentation of the presence and extent of a bile leak can be difficult diagnostic problems. In representative case studies the use and the diagnostic limits of ultrasonography and CT in the diagnosis of intraperitoneal bile accumulations are discussed. A diagnostic algorithm including cholescintigraphy for the evaluation of biliary leakage is proposed.

Adult↗
PubMedDate not supplied

Prevention of deep vein thrombosis in patients with hip fractures: low molecular weight heparin versus dextran.

A randomized open trial was undertaken to compare the antithrombotic efficacy of a low molecular weight heparin (LMWH; Sandoparin) with that of dextran 70 in patients undergoing surgery for hip fracture. One hundred thirteen patients received LMWH once daily subcutaneously at a fixed dosage while 103 patients received intravenous dextran 70. Postoperative deep vein thrombosis (DVT) was assessed by a diagnostic algorithm using the 125Iodine fibrinogen uptake test as screening and Duplex ultrasonography and/or ascending venography as confirming techniques for suspected DVT. The frequency of DVT was significantly lower in the LMWH group than in the dextran group (15.5 versus 32.6%, p less than 0.005). Proximal DVT was rare in both groups (LMWH: 2%, Dextran: 1%). Only one case of fatal fat pulmonary embolism was observed during the 10 day prophylaxis period in a patient receiving Dextran. Three cases of pulmonary embolism occurred later; one fatal event in the dextran group on day 14, and two cases in the LMWH group (one fatal and one non-fatal event) on day 14 and 17, respectively. There was no major bleeding complication in either group. We conclude that the LMWH we used is safe, was well tolerated, and has a significantly better thromboprophylactic effect than dextran 70.

Adult↗
PubMed1989

Autism diagnostic interview: a standardized investigator-based instrument.

The development of a new standardized investigator-based interview for use in the differential diagnosis of pervasive developmental disorders is described, together with a diagnostic algorithm (using ICD-10 criteria) based on its use. Good interrater reliability for algorithm items was shown between four raters, two in Canada and two in the UK, who rated 32 videotaped interviews. The items also significantly discriminated between 16 autistic and 16 nonautistic mentally handicapped subjects. The algorithm based on ICD-10 identified all 16 autistic individuals and none of the 16 nonautistic subjects.

Adolescent↗
PubMed1977

Progress toward a second generation Laboratory Information System (LIS).

A Laboratory Information System (LIS) is a convenient organization of programs and hardware designed to meet the health care delivery needs of a department of pathology. A full service LIS is now a commercially viable product and after 2 years of experience, certain desirable design features are evident for a second generation system. Such variables as hardware configuration, physical plant, libraries, diagnostic algorithms, system usage and surveillance, and manpower and human engineering are now significant operational features and essential for LIS acceptance by a department of pathology as well as the practicing medical staff.

Data Display↗
PubMed1997

[Widening mediastinum after blunt thoracic trauma: an unexpected differential diagnosis].

We report our experience concerning a young, white, healthy woman who had a typical blunt chest injury caused by a severe car accident. We had to evaluate and differentiate the initial roentgenographic post-traumatic mediastinal enlargement in order definitely to exclude a suspected covered rupture of the thoracic aorta or the heart caused by this high-velocity deceleration trauma. The difficulties encountered are critically discussed with regard to the unexpected primary thymoma that was diagnosed postoperatively. The diagnostic algorithm in blunt chest injury is also discussed. The controversy about the classification and management options of primary thymic tumors is also presented.

Adult↗
PubMed1996

Practice guideline development task force of the College of American Pathologists. Hereditary hemochromatosis.

Hereditary hemochromatosis is an autosomal recessive disorder, the gene for which occurs in approximately 10% of Americans, most of whom are unaffected heterozygotes. Approximately 5/1000 white Americans are homozygous and at risk of developing severe and potentially lethal hemochromatosis. The disorder affects numerous organ systems, but the most common symptoms are fatigue, palpitations, joint pains, and impotence; the most common signs are those that relate to hypothalamic, cardiac, hepatic or pancreatic dysfunction, including poor cold tolerance, impotence in males, amenorrhea in females, cardiac arrhythmias, dyspnea, edema, hepatosplenomegaly, spider telangiectases, ascites, deformity, swelling or limitation of motion of joints, weight loss, hyperpigmentation. Characteristic abnormalities of laboratory tests include elevated serum iron concentration, high transferrin saturation, elevated serum ferritin concentration, elevated serum transaminases, hyperglycemia and low values for thyroid-stimulating hormone (TSH) and gonadotropins. Death may be the result of cardiac arrhythmia, congestive heart failure, liver failure or liver cancer. Since many of these complications cannot be reversed once they have developed, early diagnosis and treatment are essential. In view of the high prevalence in the American population (prevalence varies with ethnic background), the low cost of diagnosis and treatment, the efficacy of treatment if begun early, and, on the other hand, high costs and low success rate of late diagnosis and treatment, systematic screening for hemochromatosis is warranted for all persons over the age of 20 years. The initial screening should be by measurement of serum iron concentration and transferrin saturation. The practice guideline provides a diagnostic algorithm for cases in which the serum transferrin saturation is 60% or greater. It also provides guidelines for clinical management.

Female↗
PubMed1994

Laboratory medicine in ulcer disease.

The role of laboratory medicine in ulcer disease is poorly defined. However there is increasing evidence of the clinical usefulness of some laboratory tests that investigate secretory functions and defensive properties of the stomach, gastrointestinal hormones and Helicobacter pylori infection. These tests may modify the clinical management of patients with peptic ulcer by identifying H. pylori positive subjects, patients with high acid output, patients who do not respond to antisecretory therapy, and patients with high gastrin levels in whom Zollinger-Ellison syndrome may be suspected. Here we review the clinical value of laboratory tests in ulcer disease, particularly as concerns the cost/benefit ratio. The relative merits of these tests are described giving an indication of their possible role in the diagnostic algorithm.

Chemistry, Clinical↗
PubMedDate not supplied

Patterns of malaria morbidity and mortality in children in northern Ghana.

A malaria prevalence survey was carried out in young children in northern Ghana between October 1990 and September 1991, in an area with continuous mortality and morbidity surveillance. There was marked seasonal variation in malaria deaths, reported fevers, parasite rates and mean parasite densities, with parasite rates reaching 85-94% in the wet season. The monthly numbers of malaria deaths were highly correlated with rainfall in the previous 2 months (r = 0.90, P < 0.001). Parasite rates were highest in the oldest children (5-7 years), but parasite densities and rates of febrile illness were highest in those 6-11 months old. Haemoglobin levels were also at their lowest in this age group. The predominant species, Plasmodium falciparum, was present in 71% of all blood films. Febrile illness was well recognized by mothers, but it was not possible to construct a simple clinical diagnostic algorithm which would identify even 50% of children with high levels of malaria parasitaemia (> or = 4000 parasites/microL). Malariometric indicators appear to have changed little in this area since a previous survey in 1955.

Age Factors↗
PubMedDate not supplied

Visual disturbances of migraine.

Migraine, a clinical syndrome of unknown etiology, is a common cause of a variety of visual disturbances. This review describes the visual alterations associated with migraine syndromes of particular interest to the ophthalmologist; acephalgic, ocular, and ophthalmoplegic. Several current theories of migraine pathophysiology are discussed. Migrainous episodes are common and must be differentiated from neurologic dysfunction due to ischemia, inflammation, seizure, and compression. The differentiating characteristics of these conditions as well as a diagnostic algorithm are presented.

Adolescent↗
PubMed1995

Semi-automatic external defibrillation and implanted cardiac pacemakers: understanding the interactions during resuscitation.

Many emergency medical service (EMS) systems are currently implementing semi-automatic external defibrillation (AED) by emergency medical technicians. Surprisingly little information is available on the possible interactions between AEDs and implanted cardiac pacemakers. Therefore, at present there are no clear guidelines for the use of AEDs on patients having a cardiac pacemaker. During resuscitation, multiple interactions between pacemakers and AEDs are possible. External defibrillation can cause damage to several functions of the pacemaker. On the other hand, the presence of pacemaker spikes during cardiac arrest might prohibit recognition of the ventricular fibrillation by the AED. We report on two resuscitation attempts in which the interaction between the ventricular fibrillation, an implanted dual chamber pacemaker and the AED was decisive for the defibrillation success. A clear understanding of these possible interactions is necessary for the further refining of diagnostic algorithms and clinical strategies of prehospital defibrillation.

Adult↗
PubMedDate not supplied

Radiologic diagnosis of renal colic: the role of plain films, excretory urography and sonography.

The accuracy of plain films, excretory urography and ultrasound for the clinical work-up of renal colic for detecting urinary calculi was evaluated prospectively in 49 patients. Excretory urography was the most sensitive and specific test. Plain films and sonography each had a sensitivity of approximately 60%, but combined yielded a sensitivity of 80%; specificity did not improve. A diagnostic algorithm where sonography was performed first followed by an excretory urography in case of a negative sonography was highly sensitive (93%) and rather specific (79%). This algorithm appears also to have a good cost-benefit rate.

Acute Disease↗
PubMed1995

Unusually located osteoid osteomas.

The files of 12 patients (aged 12-33 years) with an equal number of surgically proven osteoid osteomas (OOs) were reviewed in attempt to find a diagnostic algorithm in cases of unusually located OOs. Plain radiography (PR) and thin collimation computed tomography (CT) had been performed in all patients, while bone scintigraphy (BS) had been performed in eight and magnetic resonance imaging (MRI) in two. The OOs were located at juxta- or intra-articular sites, except for one located at the left neck of the L4 vertebra. The diagnosis based on the MRI examinations was synovitis. BS showed increased accumulation of the radioisotope at the site of the lesions, without the 'double density' sign. PR showed the nidus of OO in only six patients, whereas CT located the nidus in all patients. In conclusion, we believe that when an OO is clinically suspected at an unusual location, CT should be performed in all cases, even when a lesion is depicted by PR and BS, because CT will not only locate the nidus but will also provide a precise anatomy of the area around the nidus and help in therapeutic decision making and surgical planning. MRI can be misleading and must not be used in the initial assessment of a possible osteoid osteoma.

Acetabulum↗
PubMedDate not supplied

CT evaluation of the equivocal pulmonary nodule.

In the setting of a questionable pulmonary nodule demonstrated by conventional radiographs, the place of CT in the diagnostic algorithm is not well established. We reviewed our experience in 50 consecutive patients referred to CT for a "possible pulmonary nodule." From the chest radiographs we noted nodule location, maximum dimension, presence on one or both views, and presence on a previous radiograph (greater than 1 year old), and nodules were categorized as "likely" or "unlikely" to be real parenchymal lesions based on radiographic appearance. Of a total of 56 questionable nodules, CT demonstrated no abnormality in 21 cases, parenchymal nodules in 16, scarring, atelectasis, or infiltrate in 11, and normal structural variants in 8. True pulmonary nodules were statistically significantly more frequently categorized as "likely" lesions than normal variants or no disease, but this was not of a magnitude to be clinically useful. Based on analysis of various radiographic features of equivocal nodules and their subsequent outcomes, we suggest a radiologic approach to the equivocal pulmonary nodule.

Humans↗