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Results for “diagnostic optimization”

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At least 253 records · Page 14Linked to original sources
PubMed2004

Role of lamellar body count for the prediction of neonatal respiratory distress syndrome in non-diabetic pregnant women.

OBJECTIVE: Lamellar body count is a new and fast technique to establish the presence of fetal lung maturity. We have assessed the predictive ability of lamellar body count for neonatal respiratory distress syndrome (RDS) in a non-diabetic population. STUDY DESIGN: We accessed a cohort of amniocenteses in non-diabetic women from 1998 to 2002 (n=102). Neonatal RDS was defined as need for surfactant, intubation, or continuous positive airway pressure (CPAP) in the setting of chest X-ray findings consistent with RDS. The predictive ability of lamellar body count was compared with those of lecithin/sphingomyelin (L/S) ratio and presence of phosphatidylglycerol (PG) using logistic regression analysis. The optimal threshold value of lamellar body count for prediction of neonatal RDS was established with receiver operating characteristic (ROC) curve analysis. RESULTS: Lamellar body count ROC curve analysis identified a lamellar body count >37,000 microl(-1) as optimal diagnostic threshold for diagnosis of lung maturity, having a negative predictive value of 98%. Lamellar body count and PG, but not L/S ratio, added significantly to the prediction of RDS. CONCLUSIONS: Lamellar body count is a reliable predictor of fetal lung maturity in non-diabetic women and it can replace the L/S ratio.

Amniocentesis↗
PubMed2005

A case of mistaken identity: intraoperative discovery of an extracranial internal carotid artery aneurysm.

The optimal diagnostic modality for extracranial carotid artery aneurysm is not firmly established because of the emerging trend of replacing traditional carotid angiography with magnetic resonance imaging and angiography. An extracranial carotid artery aneurysm can have profound neurologic sequelae, and an elective resection is often suggested. Imaging studies should firmly establish the diagnosis and differentiate the aneurysm from other lesions of the carotid, especially carotid body tumor, prior to surgical planning. Magnetic resonance studies may not properly distinguish between different lesions of the carotid arteries. This case of an unexpected carotid aneurysm found intraoperatively demonstrates that while traditional angiography is costly and invasive, it is still the diagnostic study of choice when an aneurysm is a possible diagnosis.

Aged↗
PubMed2006

Clinical insights into the diagnosis and management of atherosclerotic renal artery disease.

Atherosclerotic renovascular disease (ARVD) is an increasingly common contributor to hypertension and renal failure. However, not all patients with an identified obstructive atherosclerotic renal artery stenosis will have clinical improvement, even after successful percutaneous intervention. As such, there remains extensive controversy regarding optimal diagnostic and treatment strategies. Part of this controversy is the result of a paucity of well-designed prospective, randomized clinical trials, but the complex nature of the disorder and the heterogeneity of patients presenting with possible ARVD make simple diagnostic and treatment paradigms difficult to develop. This narrative review describes the latest observations concerning the prevalence, pathogenesis, natural history, diagnostic studies, and treatment options for suspected ARVD. Hopefully, this knowledge will improve the ability of clinicians to weigh risks and benefits and determine the best strategy in individual patients.

Angiography↗
PubMed2000

Imaging of soft-tissue sarcomas.

A multidisciplinary approach that includes active participation by a radiologist is beneficial for optimal diagnostic evaluation and treatment of soft-tissue sarcomas. Recent advances in diagnostic imaging include a better understanding of the practical roles of ultrasonography, computed tomography, and magnetic resonance imaging in the evaluation of primary and recurrent soft-tissue sarcomas. The potential role of positron emission tomography scanning and dynamic magnetic resonance imaging in the evaluation of soft-tissue sarcomas has been preliminarily evaluated. The clinically practical utility of radiologic imaging in the evaluation of soft-tissue sarcomas is discussed, and ongoing research is briefly reviewed.

Diagnosis, Differential↗
PubMed1999

Facet Joint Pain and the Role of Neural Blockade in Its Management.

Chronic spinal pain is a common medical problem with serious financial and social consequences. Among the various structures with potential for producing pain in the spine, facet joints as sources of chronic spinal pain have attracted considerable attention and controversy. Significant progress has been made in precision diagnosis of spinal pain with neural blockade, in the face of less than optimal diagnostic information offered by imaging and neurophysiologic studies. Research into the role of facet joints in spinal pain has shown that cervical facet joints are the cause of chronic neck pain in 54% to 60% of patients, whereas lumbar facet joints cause pain in 15% to 40% of patients with chronic low back pain. Local anesthetic blocks of medial branches have proven to be a reliable diagnostic test; they are target-specific when used appropriately with control blocks, either with two local anesthetics with different durations of action or with the addition of an inactive placebo injection. The literature is replete with reports on uncontrolled studies, case reports, and documentation from a few controlled studies, all of which offer supporting information on the rationale and effectiveness of facet blocks and neurotomy. Facet joint injections and medial branch blocks are considered to be of equal value. Lumbar intra-articular steroid injections have been proven effective to a certain extent, but evidence indicates that cervical intra-articular steroids are ineffective. The role of repeat medial branch blocks is not known. Radiofrequency neurotomy remains the only practical and validated treatment for cervical facet joint pain; however, its role in management of either lumbar or thoracic facet joint pain awaits validation.

Journal Article↗
PubMed1999

Crystal-induced inflammation and cartilage degradation.

In the past year, there have been advances in our understanding of the induction of cartilage damage by calcium-containing crystals. Mechanisms of deposition and the biologic effects of crystals have been further characterized, as has the interaction between crystals and leukocytes. Studies of the clinical diagnosis of crystal deposition diseases suggest that accuracy with microscopy needs to be enhanced. Normal values for serum NTPPPHase have been established and optimal diagnostic imaging strategies for calcium pyrophosphate deposition disease have been suggested. There are still no available drugs to inhibit deposition or effect reabsorption of calcium-containing crystals.

Calcinosis↗
PubMed1994

Dobutamine stress echocardiography: clinical utility and predictive value at various infusion rates.

Dobutamine stress echocardiography has increasingly been used to assess patients for coronary artery disease. Despite the popularity of this test, the optimal dose of dobutamine has not been established. The objective of this study was to assess the accuracy of dobutamine stress echocardiography at various infusion doses and its utility as a predictor of perioperative risk in patients undergoing a noncardiac surgical procedure. One hundred thirteen consecutive patients underwent dobutamine stress echocardiography, subsequent cardiac catheterization and/or a noncardiac surgical procedure. Three patient groups were analyzed on the basis of peak dobutamine infusion rates (17 +/- 4, 29 +/- 2, and 40 +/- 0 micrograms/kg/min, respectively). The three groups were comparable with regard to age, sex, ejection fraction, and severity of coronary artery disease. In group I, the sensitivity and specificity of dobutamine stress echocardiography were 74% and 33%, respectively, with a positive predictive value of 78%. In group II, the sensitivity and specificity improved to 84% and 78%, with a positive predictive value of 89%. In group III, the sensitivity and specificity were 86% and 80%, respectively, with a positive predictive value of 86%. In the noncardiac surgical group there was only one nonfatal cardiac complication among the 50 patients with a dobutamine echocardiogram, which was negative for evidence of inducible ischemia. In conclusion, this study demonstrates that dobutamine stress echocardiography should use an infusion rate of > or = 30 micrograms/kg/min to optimize diagnostic accuracy relative to angiographic coronary artery disease. A test that shows no evidence of new, inducible ischemia predicts a low risk of perioperative cardiac events in patients undergoing noncardiac surgery, even at an infusion rate as low as 20 microns/kg/min.

Aged↗
PubMed1993

Measurement of eosinophil cationic protein (ECP) and eosinophil protein X/eosinophil derived neurotoxin (EPX/EDN). Time and temperature dependent spontaneous release in vitro demands standardized sample processing.

The measurement of eosinophil derived proteins such as eosinophil cationic protein (ECP) and eosinophil protein X/eosinophil derived neurotoxin (EPX/EDN) in biological fluids may be a useful indicator of eosinophil activity in ongoing inflammatory processes. This study was performed on blood samples and illustrates that serum values of ECP in particular, but also of EPX, are mainly a result of spontaneous release during the processing of blood samples. In the presence of divalent cations (Ca2+ and Mg2+), the amount of released ECP and EPX is dependent upon the incubation temperature and the time before centrifugation and recovery of serum. Moreover, the utensils used for blood sampling may influence the serum levels of ECP and EPX. Thus, standardized sample processing is of paramount importance if the results are to have optimal diagnostic or clinical value.

Blood Proteins↗
PubMed1989

Compartment syndromes.

The compartment syndrome is defined as a condition in which high pressure within a closed fascial space (muscle compartment) reduces capillary blood perfusion below the level necessary for tissue viability'. This condition occurs in acute and chronic (exertional) forms, and may be secondary to a variety of causes. The end-result of an extended period of elevated intramuscular pressure may be the development of irreversible tissue injury and Volkmann's contracture. The goal of treatment of the compartment syndrome is the reduction of intracompartmental pressure thus facilitating reperfusion of ischaemic tissue and this goal may be achieved by decompressive fasciotomy. Controversy exists regarding the critical pressure-time thresholds for surgical decompression and the optimal diagnostic methods of measuring intracompartmental pressures. This paper will update and review some current knowledge regarding the pathophysiology, aetiology, diagnosis, and treatment of the acute compartment syndrome.

Capillaries↗
PubMed1989

Regional cerebral function and blood flow: complementary single photon emission computed tomography of the brain using xenon-133 and [123I]iodoamphetamine.

Regional cerebral function and blood flow can be imaged using isopropyl[123I]iodoamphetamine (IMP), or 133Xe (DSPECT), respectively. Both of these essentially non-invasive, quantitative, methods are suitable for many nuclear medicine laboratories. This study assessed the in vivo information about intracerebral disease provided by IMP and DSPECT techniques to determine the optimal diagnostic use of these modalities. Single photon emission computed tomograms of 53 subjects were acquired using similar displays for IMP and DSPECT data. Lobar tracer distributions were graded by three experienced observers and analyzed using a kappa statistic to eliminate chance agreements. Overall, both IMP and DSPECT had similar patterns. However, while similar, one or the other technique often displayed abnormalities not present on both. Although technical factors may account for some differences between the modalities, a case of arteriovenous malformation proves that discordant findings can result directly from tracer localization properties. Thus at least some discordances provide truly complementary diagnostic information lacking in either single study taken alone.

Adult↗
PubMed1994

Diagnosis of thyroid dysfunction: present and future.

Thyroid disorders represent the second most common endocrine disorder after diabetes mellitus. For this reason, investigation of thyroid function is frequently carried out, taking advantage of numerous tests currently available. It it the physicians's difficult task to select the most appropriate assay(s) in the different pathophysiological conditions from the bewildering array of thyroid function tests, in order to satisfy optimal diagnostic standards, but also to fulfill cost/benefit criteria. Aim of this paper is to provide a brief overview of advantages and disadvantages of main thyroid function tests, and to suggest a testing strategy for the diagnosis of suspected thyroid dysfunction.

Autoimmune Diseases↗
PubMed2006

Use of N-terminal prohormone brain natriuretic peptide assay for etiologic diagnosis of acute dyspnea in elderly patients.

BACKGROUND: B-type peptide assay (brain natriuretic peptide [BNP] and N-terminal prohormone brain natriuretic peptide [NT-proBNP]) is useful for the diagnosis of heart failure (HF), but few data are available on the use of these markers in elderly subjects. The aim of this study was to evaluate NT-proBNP assay for the diagnosis of acute left HF in patients older than 70 years hospitalized for acute dyspnea. METHODS: We prospectively enrolled 256 elderly patients with acute dyspnea. They were categorized by 2 cardiologists unaware of NT-proBNP values into a cardiac dyspnea subgroup (left HF) and a noncardiac dyspnea subgroup (all other causes). RESULTS: Mean age was 81 +/- 7 years, and 52% of the patients were women. The diagnoses made in the emergency setting were incorrect or uncertain in 45% of cases. The median NT-proBNP value was higher (P < .0001) in patients with cardiac dyspnea (n = 142; 7906 pg/mL) than in patients with noncardiac dyspnea (n = 112; 1066 pg/mL). The area under the receiver operating characteristic curve was 0.86 (95% CI 0.81-0.91). At a cutoff of 2000 pg/mL, NT-proBNP had a sensitivity of 86%, a specificity of 71%, and an overall accuracy of 80% for cardiac dyspnea. The use of 2 cutoffs (< 1200 and > 4500 pg/mL) resulted in an 8% error rate and a gray area englobing 32% of values. CONCLUSION: NT-proBNP appears to be a sensitive and specific means of distinguishing pulmonary from cardiac causes of dyspnea in elderly patients. An optimal diagnostic strategy requires the use of 2 cutoffs and further investigations of patients with values in the gray area.

Acute Disease↗
PubMed2005

Diagnosis and management of iron-deficiency anaemia.

Anaemia is typically the first clue to iron deficiency, but an isolated haemoglobin measurement has both low specificity and low sensitivity. The latter can be improved by including measures of iron-deficient erythropoiesis such as the transferrin iron saturation, mean corpuscular haemoglobin concentration, erythrocyte zinc protoporphyrin, percentage of hypochromic erythrocytes or reticulocyte haemoglobin concentration. However, the changes in these measurements with iron deficiency are indistinguishable from those seen in patients with the anaemia of chronic disease. The optimal diagnostic approach is to measure the serum ferritin as an index of iron stores and the serum transferrin receptor as a index of tissue iron deficiency. The treatment of iron deficiency should always be initiated with oral iron. When this fails because of large blood losses, iron malabsorption, or intolerance to oral iron, parenteral iron can be given using iron dextran, iron gluconate or iron sucrose.

Anemia, Iron-Deficiency↗
PubMed2004

Historical prospective of human cytogenetics: from microscope to microarray.

After the fundamental discovery in 1956 that normal human cells contain 46 chromosomes, clinical cytogenetics was born and studies into the relation of chromosomal defects and disease could begin. Although many technical advances have been made over this long period, including the introduction of molecular techniques, until now, all cytogenetic studies have been performed through regular microscopes, which was throughout the years the most important equipment of a cytogenetic laboratory. However, recently a new technique has been introduced based on comparative genomic hybridization on an array of thousands of different probes (array-CGH). This technique enables an increase in the sensitivity of detecting chromosomal aberrations far beyond the detection limit of regular banding techniques. Furthermore, it gives us the possibility to detect genomic changes in malignant cells in cases where aberrations are too complex to study or when chromosomes are not available at all. Cytogenetic laboratories are now challenged to introduce and incorporate this new application next to the various well-established microscopical techniques to provide optimal diagnostic services.

Chromosome Banding↗
PubMed2005

Bicycle ergometer test to obtain adequate skin temperature when measuring nerve conduction velocity.

OBJECTIVE: To achieve optimal diagnostic accuracy, measurements of nerve conduction velocity require standardised tissue temperatures. To warm an extremity to a desired temperature that remains constant during the measurement may be difficult, especially in subjects with low finger temperatures. The aim of this study was to investigate if a submaximal bicycle ergometer test before the examination would be a useful method of obtaining high and stable finger temperatures during nerve conduction studies in the hand. METHODS: 114 women aged 25-65 (median 44) performed a bicycle ergometer test on an electrically braked bicycle ergometer (Siemens-Elema) before they underwent a nerve conduction test. RESULTS: Before cycling, the mean finger temperature was 28.1 degrees C (range 20.5-35.4 degrees C) and 15 min after the test 35.1 degrees C (range 30.3-36.9 degrees C). The levels remained almost constant throughout the nerve conduction examination, which had a duration of approximately 25 min. CONCLUSIONS: A bicycle ergometer test proved to be a simple and effective method of raising hand temperature.

Adult↗
PubMedDate not supplied

PET scan-CT correlation: what the chest radiologist needs to know.

The purpose of this article is to familiarize the chest radiologist with the basics of PET scanning in the chest and to correlate PET findings with thoracic CT findings. After completing this article, the reader should know the following: (a) how PET scanning is performed; (b) the indications for PET scanning in the chest; (c) the significance of SUV and a positive test; (c) the causes of false-positive and false-negative PET scans; and (d) the importance of correlating PET findings with Chest CT findings. The authors conclude that PET and chest CT studies should be read in conjunction to optimize diagnostic accuracy. Interpreting either study alone is fraught with errors, while combined interpretations yield information on both functional activity and anatomic localization. PET-CT hybrid devices that fuse PET and CT data simplify this task and fusion imaging is rapidly becoming the test of choice for evaluating thoracic malignancies.

Carcinoma, Non-Small-Cell Lung↗
PubMed2005

Superior vena cava (SVC) thrombosis: diagnosis and follow up by transesophageal echocardiography (TEE).

Hemodialysis catheters (HC) were developed as a vascular access, intended to be a bridging device until a permanent access is placed. Although many reports exist of indwelling catheter-related thrombosis, optimal diagnostic study and therapeutic options are yet to be established. We are presenting a case with HC thrombosis diagnosed by TEE managed conservatively with excellent long-term outcome.

Adult↗
PubMed2004

EAU Guidelines on Penile Cancer.

OBJECTIVES: The European Association of Urology (EAU) consensus group on penile cancer has prepared these guidelines to help urologists assess the scientific evidence for the management of penile cancer and to incorporate recommendations into their clinical practice. METHOD: References used in the text have been assessed according to the level of scientific evidence involved and guideline recommendations have also been evaluated according to the Agency for Health Care Policy and Research [Clinical Practice Guidelines Development: Methodological Perspectives. Washington DC: US Department of Health and Human Services, Public Health Service; 1992, pp. 115-127]. RESULTS: The diagnosis, treatment and follow-up of patients suspected of, or diagnosed with, penile cancer is listed as an easy reference text. CONCLUSION: A guidelines text is presented which aims at aiding medical specialists in determining the most optimal diagnostic and treatment options for this pathology.

Follow-Up Studies↗