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PubMed1984

CPK and CPK-MB in the early diagnosis of acute myocardial infarction and prediction of infarcted area.

This study was carried out on patients of a coronary unit to evaluate the diagnostic efficiency of total CPK and CPK-MB by using different analytical techniques: catalytic, immunoassisted, cellulose acetate electrophoresis, radioimmunoassay and immunoradiometric assay. The behaviour of the enzyme was studied in all patients with reference to the localization and extent of the infarct. In all cases a diagnostic algorithm was followed based on the combined use of CPK and its MB isoenzyme; the activity was measured twice, at three-hour intervals after admission. In this way the utilization of total CPK and MB isoenzyme allows almost complete diagnostic efficiency within the first 9 hours from onset of chest pain, together with the possibility of calculating the slope of the curve of MB isoenzyme release useful for calculating infarct size. Maximum diagnostic efficiency is also obtained in cases of small infarcts, with silent ECG, and those difficult to classify clinically.

Creatine Kinase↗
PubMed1994

Diagnosis of pulmonary embolism at a large teaching hospital.

Pulmonary embolism (PE) is a common clinical entity, although the signs and symptoms that accompany it are nonspecific. This has led to the development of several diagnostic algorithms for diagnosis of PE. These approaches combine noninvasive tests such as ventilation/perfusion (V/Q) lung scanning, impedance plethysmography, and ultrasound, with invasive techniques such as venography and pulmonary angiography. To investigate the manner in which clinicians select and use these various diagnostic strategies, we retrospectively reviewed 316 consecutive cases of suspected PE to determine the sequence and type of diagnostic strategy employed by clinicians. We found that in the majority of cases, physicians chose not to further pursue a diagnosis of PE if the V/Q scan was nondiagnostic. These results suggest that physician behavior is often at variance with published clinical recommendations and that the implementation of clinical practice guidelines needs to be further examined.

Angiography↗
PubMed1990

Immunohistochemistry of solid tumors. Brief review of selected problems.

The immunohistochemical approach to tumor typing has dramatically improved our possibilities in the objective diagnosis of neoplasms. Use of optimal material and careful techniques will help to maintain good sensitivity, specificity, and reproducibility of immunohistochemistry. However, the complexity of antigen patterns in tumors, and lack of comprehensive knowledge about them requires caution in the interpretation of results, and may prohibit the simple use of diagnostic algorithms. Especially it is not certain whether the results obtained from typical representatives of various tumor entities will pertain to borderline cases and to undifferentiated variants of the same entities. Use of panels of antibodies rather than the use of single "diagnostic" tests will help to avoid these diagnostic pitfalls. However, all tumor types do not have immunohistochemically distinctive features. This emphasizes the need to use other techniques in such cases, and also suggests that some entities, such as malignant fibrous histiocytoma, are from the point of view of immunohistochemistry diagnoses only made by exclusion rather than being specifically diagnosable entities. All diagnostic immunohistochemistry has to be interpreted in the context of standard histological examination.

Antigens, Neoplasm↗
PubMed1993

Reliability and usefulness of a new immunochemical assay for Alzheimer's disease.

OBJECTIVE: To assess the reliability and usefulness of a new sandwich enzyme-linked immunoassay (ALZ-EIA) that detects Alzheimer's disease-associated proteins in the diagnosis of Alzheimer's disease. DESIGN: The reliability of the assay was assessed between two laboratories. Sensitivity and specificity of a diagnostic algorithm based on the results of the ALZ-EIA were determined using the Consortium to Establish a Registry for Alzheimer's Disease neuropathological diagnoses as the "gold standard." SETTING: Autopsy cases were obtained from a teaching hospital with a specialized Alzheimer Disease Diagnostic and Treatment Center. CASES: Brain tissue was selected from 24 cases with dementia and 10 normal controls. MAIN OUTCOME MEASURES: Optical density measurements from the ALZ-EIA in the hippocampus and three neocortical regions. RESULTS: A 95% concordance in ALZ-EIA activity was found between the two laboratories, and an 85% concordance was found between ALZ-EIA and the Consortium to Establish a Registry for Alzheimer's Disease diagnoses. Perfect agreement was obtained for "typical" Alzheimer's disease cases (those with plaques and tangles), while discrepancies occurred for "atypical" cases (those with predominantly plaques or tangles). CONCLUSIONS: The ALZ-EIA provides a highly reliable method of assessing neurofibrillary degeneration. Its clinical usefulness as a diagnostic test would be enhanced by the availability of a complementary assay for beta-amyloid.

Aged↗
PubMed1997

An evaluation of teaching methods utilized during an HIV miniresidency course for Thai physicians.

This study examines the efficacy of medical education methods in improving the knowledge base and clinical skills of participants attending a 2-day miniresidency course in HIV infection. Instructional methods included: a didactic lecture format, diagnostic algorithm presentation, color slide photographic demonstration, bedside teaching rounds, and "meet-the-professor" sessions. Questions to assess the various instructional formats were administered and teaching methods were evaluated. Fifty-seven Thai physicians, highly exposed to HIV patient care duties, completed both precourse and postcourse tests. Overall, significant improvement was noted in participant's final global test score. However, discrepancies existed among the efficacy of instructional methods. Recognizing physical signs of HIV infection, as taught by slide photographs, revealed a high baseline level of expertise. Statistically significant postcourse gains were made in physician's diagnostic decision-making ability and basic knowledge of HIV and AIDS taught respectively by the methods of a teaching algorithm and didactic lecture. Despite the latter, participation performed poorly regarding HIV case management. This observation may be related to test design and cultural differences but likely underscores the difficulty in imparting clinical HIV management skills to course participants over a short period of time. Future continuing medical education (CME) courses intended to enhance physician care for the HIV infected must strive to refine evaluation methods for assessing case management skills while exploring innovative instructional techniques when current methods are ineffective.

Adult↗
PubMed1996

Detection of iron-deficiency anemia in hospitalized patients by zinc protoporphyrin.

The diagnostic value of zinc protoporphyrin (ZPP) as an indicator of iron-deficient anemia (IDA) in hospitalized patients is assessed in this study. ZPP was measured using an AVIV hematofluorometer with a coefficient of variation (CV) less than 5% and a recovery of greater than 97%. A reference range of 53-70 mu mol/mol heme was determined for ZPP in non-anemic patients in a hospital population. Hospitalized patients (221) with low hemoglobin (< 120 g/l) were evaluated for their iron status. ZPP and other anemia tests were performed. Macrocytic patients with mean corpuscular volume (MCV) greater than 98 fl) were excluded from the study. Seventy-four microcytic patients (MCV < 80 fl) were determined as having IDA according to a diagnostic algorithm. A distribution study of these microcytic patients showed that there was a significant overlap of values between the IDA and non-IDA patients for all serum anemia tests. A receiver-operator curve analysis revealed that ZPP has a relatively high degree of diagnostic efficiency better than iron and ferritin for this patient population. At a cutoff value > 170 mu mol/mol heme, ZPP has a sensitivity of 93% and a specificity of 90%. In addition, ZPP is also elevated in normocytic patients (MCV = 80-98 fl) with low ferritin values, who may have iron depletion. From these data, it is proposed that ZPP may be used as a screening tool for IDA in hospitalized patients.

Adult↗
PubMed1992

[Diagnosis, clinical course and prognosis of parenchymatous- ventricular hemorrhages].

As many as 61 patients with hemorrhagic brain stroke and blood penetration in the ventricular system were subjected to a clinical analysis. Based on the data available, attempts were made to predict an outcome of brain stroke. The authors describe the results of studying different aspects of the diagnostic algorithm of parenchymatous ventricular hemorrhages. In accordance with the clinical and computer-aided tomography data, consciousness disturbances, occlusion hydrocephalus, secondary stem syndrome as well as the localization, volume of hematomas and the degree of the blood filling of the ventricular system may serve as diagnostic predictors of brain hemorrhages. The authors' observations correspond with the conclusions made by foreign scientists that ventricular hemorrhages are not always fatal. Parenchymatous ventricular hemorrhages are likely to eventuate in a favourable outcome owing to the drug treatment.

Adult↗
PubMed1991

[Methods of assessing the state of the digestive system in mass examinations of rural population].

On the basis of physician's logic a questionnaire has been elaborated for identifying the most common diseases of digestive system during mass medical check-ups of rural population. 98 combinations of signs were considered in the diagnostic algorithm for making conclusions regarding 11 diseases. The programme elaborated envisages recommendations on the volume of examinations necessary for verification of diagnoses. The questionnaire and rules governing it were verified for 152 patients. By means of mathematical statistics methods the informativeness of the signs used have been assessed. The analysis showed a great diagnostic value of choosing signs on the basis of physician's logic taking into account their pathogenetic correlation. The efficiency of questionnaires have been demonstrated and sufficient under conditions of automated examinations sensitivity (on the average for diseases 78.1%) and specificity (on the average for diseases 70.0%).

Algorithms↗
PubMed2000

Imaging of blunt aortic and great vessel trauma.

The thoracic aorta and great vessels are at risk of injury by both blunt and penetrating trauma. High-speed deceleration injury, predominately caused by motor vehicle accidents, is the primary cause of blunt traumatic aortic injury (TAI). Though largely fatal if untreated, these injuries are amenable to surgical repair if appropriately diagnosed. Algorithms for both diagnosis and treatment of TAI have undergone changes in recent years. Radiologic imaging plays a key role in the evaluation of TAI, and this review focuses on the relative roles of chest radiography, computed tomography (CT) (particularly helical CT), and aortography in the diagnostic algorithm for TAI. Other aortic imaging methods have been used in the setting of TAI, such as transesophageal echocardiography, magnetic resonance imaging, and intravascular ultrasound; although these techniques may play a complementary role in TAI evaluation, they are unlikely to have as significant an impact on routine radiologic practice as will CT.

Aorta, Thoracic↗
PubMed1998

Improving the utility of urine flow rate to exclude outlet obstruction in men with voiding symptoms.

OBJECTIVES: Many older men with voiding symptoms do not have bladder outlet obstruction (BOO) but have conditions amenable to medical treatment. If primary care providers could reliably exclude men who have BOO, then they could initiate appropriate evaluation and treatment in a substantial proportion of the remainder. Urine flow rate, although widely used, is insufficiently sensitive to exclude BOO reliably. We investigated whether the decline in flow rate with age could be utilized to improve the utility of flow rate for excluding BOO in symptomatic men, especially when combined with knowledge of the patient's postvoiding residual volume (PVR). DESIGN: Prospective study using two patient cohorts. SETTINGS: A Veterans Affairs urology clinic serving community-dwelling and institutionalized healthy older men. PARTICIPANTS: 111 men with voiding symptoms (mean age 72.4 +/- 9.2 years). MEASUREMENTS: Maximum urine flow rate, measured with standard flowmeter, and PVR, measured by catheterization. BOO was determined by multichannel videourodynamic testing. RESULTS: The sensitivity of flowrate for BOO increased significantly with age (P = .0001) and did not appear to be confounded by comorbid conditions. An algorithm incorporating age, flow rate, and PVR had a sensitivity of 90%, specificity of 43%, and accuracy of 74% in screening for BOO. The algorithm's sensitivity was better than that of flow rate alone (55%); its sensitivity was also similar to a "refer all" strategy (100%) but had improved specificity (41% vs 0%). CONCLUSIONS: Flow rate alone is insufficiently sensitive as a screening test to exclude BOO, but a simple diagnostic algorithm using age, flowrate, and PVR was more sensitive and accurate. This algorithm allows primary care evaluation and initial management of men with voiding symptoms while potentially reducing unnecessary referrals and costs.

Aged↗
PubMed1987

The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey.

During the 2-yr period 1981-83, demographic, clinical, and laboratory information was collected for 5,469 patients from whom nontuberculous mycobacteria (NTM) had been isolated. Among the potential NTM pathogens, isolates of Mycobacterium avium complex were most frequent, followed by M. kansasii, M. fortuitum, M. scrofulaceum, and M. chelonae. Almost 90% of the isolates were obtained from respiratory specimens. Prevalence rates for NTM disease, as calculated by a diagnostic algorithm, were highest for M. avium complex (1.3/10(5)), M. fortuitum-M. chelonae (0.2/10(5)). The data suggest a changing epidemiologic picture of NTM disease due perhaps to the decreasing incidence of tuberculosis, the increasing prevalence of chronic lung disease, and increased culturing of diagnostic specimens, as well as possibly a change in the ecology of these organisms.

Adolescent↗
PubMed2001

Diagnosing ectopic pregnancy: decision analysis comparing six strategies.

OBJECTIVE: To compare six published methods of diagnosing ectopic pregnancy. METHODS: Decision analysis compared six diagnostic algorithms involving combinations of clinical examination, transvaginal ultrasound, serum progesterone, serum hCG, and D&C. The population was composed of hemodynamically stable women who presented to a tertiary care university emergency department with abdominal pain or bleeding in their first trimesters. Outcome measures included number of missed ectopic pregnancies, potentially interrupted intrauterine pregnancies, surgical and diagnostic procedures, time until diagnosis, and cost. RESULTS: Ultrasound followed by serum hCG in women with nondiagnostic scans yielded the most favorable outcomes; no ectopic pregnancy was missed, only 1% of all potential intrauterine pregnancies were interrupted, and time to diagnosis averaged 1.46 days. Quantitative hCG measurement followed by ultrasound only in women with hCG levels above the discriminatory zone was optimal if sensitivity of ultrasound to diagnose intrauterine pregnancy was less than 93%. Serum progesterone measurement was not favored because it was associated with missed ectopic pregnancies (2.6%). CONCLUSION: Given the current accuracy of tests for diagnosing ectopic pregnancy, algorithms using a combination of ultrasound and hCG resulted in the best outcomes. Ultrasound as the first step was the most efficient and accurate method of diagnosing ectopic pregnancies.

Chorionic Gonadotropin↗
PubMed1989

[A program of prevention of dysplastic arthrosis (general principles)].

The authors put forward a program of prevention of dysplastic arthrosis which is presented in graphic form with textual description. It has been worked out on the basis of the formerly elaborated conceptual model "Dysplasia of the joint-dysplastic arthrosis" and it is a complex of general medical prophylactic measures oriented towards the elimination of mutagenous environmental factors, i.e. towards prevention of morbidity and towards the treatment-and-rehabilitation orthopaedic measures directed at reduction of the risk of development of dysplastic arthrosis in the conditions of dysplastic lesion of the joint (prevention of the disease). The conditions necessary for carrying out this program are supposed to be: a diagnostic algorithm providing for revealing dysplastic lesions already at the preclinical stage; thorough quantitative and qualitative characteristics of the dysplastic process providing for planning of correct surgical interventions; prognostic evaluations presuming a probability of evolution of the dysplastic process and its outcome; and a system of stage-by-stage diagnostic and treatment-and-rehabilitation measures providing for achievement of the effect expected in each particular case. Three groups of surgical interventions have been pointed out: prophylactic, which are performed on the dysplastic joint in case of absence of dystrophic changes; therapeutic, which are performed in case of presence of reversible dystrophic changes (e.g. chondromalation at stages I and II); and palliative, which only result in temporary stabilization of the arthrosis process, i.e. leading to improvement.

Adolescent↗
PubMed1997

Vaginal ultrasonography versus endometrial biopsy in women with postmenopausal bleeding.

OBJECTIVE: Our goal was to compare the predicted outcomes and costs of two diagnostic algorithms for postmenopausal bleeding. STUDY DESIGN: Two algorithms for postmenopausal bleeding were developed, one with vaginal ultrasonography and the other with office endometrial biopsy as the first test. Literature review was performed to estimate the probability of either an abnormal result of ultrasonography or a nondiagnostic biopsy, or both. Cost and sensitivity analyses were performed. RESULTS: Estimated probability of a nondiagnostic endometrial biopsy was 28%, and estimated probability of an abnormal result of vaginal ultrasonography (either inconclusive or endometrial thickness > 4 mm) was 55%. Cost analysis showed that vaginal ultrasonography as the first diagnostic test cost $230 per patient on average compared with $244 for endometrial biopsy, with savings ranging from $14 to $20 per patient over a wide range of possible values for estimated parameters. CONCLUSION: Vaginal ultrasonography costs slightly less than office endometrial biopsy as the first test in the diagnostic evaluation of women with postmenopausal bleeding.

Algorithms↗
PubMed1991

[Filling defects in the upper urinary tract: update on the etiologic diagnosis and review of the specific value of urinary cytology].

We present 3 cases with upper tract filling defect and exfoliative cytology positive for malignant cells in 2 of these cases (micturition and via ureteral catheter, respectively). The initial suspicion of urinary tract tumor was discarded by subsequent work up in 2 patients who were managed conservatively and followed closely. The third patient was submitted to nephroureterectomy. The histopathological examination disclosed chronic pyelonephritis and a deposit of amorphous mucoid material but no evidence of tumor. We review the etiologies of upper tract filling defects and present a useful diagnostic algorithm for the study of these conditions and the etiopathogenic and physiopathologic evaluation of the false positives in urinary cytology.

Adult↗
PubMedDate not supplied

Pitfalls in diagnosis of aortic dissection by angiography: algorithmic approach utilizing CT and MRI.

Dissection of the thoracic aorta is a life-threatening event requiring imaging studies to define the level of the tear and the intimal flap. The "gold standard" has been angiography. This method may fail to demonstrate the dissection, however, due to overlap of the true and false lumens or a very thin flap that is imaged en face rather than tangentially. Computed tomography has a diagnostic accuracy of 95%, but can fail to image the dissection due to technical factors or a thrombosed false lumen. Magnetic resonance imaging requires a hemodynamically stable and cooperative patient. A diagnostic algorithm is proposed for diagnosis of aortic dissection based on renal function and the surgeon's imaging modality preference.

Aged↗
PubMed2001

[Preoperative assessment of thyroid nodules in an endemic goiter region--possibilities and limitations].

In iodine-sufficient areas any thyroid nodule has to be regarded as potentially malignant, whereas in iodine-deficient areas (endemic goiter areas) thyroid nodules, even multinodular goiter, are frequent. The majority of thyroid nodules in an endemic goiter area can be regarded as being most likely benign and thus not all patients with multinodular goiter have to undergo surgery. The major diagnostic aim and challenge is the selection for surgery of only those patients who suffer from mechanical obstruction due to large goiter and those who present with nodules suspicious of malignancy. Thus, for these cases the question of accurately excluding or verifying malignancy is essential for the patient and the specialist of nuclear medicine or endocrinology. A variety of investigations may be used for the preoperative evaluation of thyroid nodules, although currently sonography and fine-needle biopsy have to be regarded as the key investigations to clarify preoperatively the dignity of thyroid nodules. The article presents the indications and limitations of the different methods in use for the evaluation of thyroid malignancy. The authors present a diagnostic algorithm for the preoperative evaluation of thyroid malignancy with special respect to problems occurring in a(n) (former) endemic goiter area.

Biopsy, Needle↗
PubMed1995

Diagnostic procedures for catheter malfunction in programmable implantable intraperitoneal insulin infusion devices.

OBJECTIVE: To evaluate the roles of 1) abdominal radiography, 2) a pressure diagnostic procedure (PDP) using a standardized diluent infusion into the catheter sideport, and 3) radiocontrast imaging of the catheter lumen as procedures for diagnosing catheter malfunction in diabetic patients implanted with a programmable intraperitoneal infusion device. RESEARCH DESIGN AND METHODS: Sixteen type I diabetic patients implanted with Infusaid programmable intraperitoneal insulin pumps were studied. The ability of the above three procedures to assist diagnosis of catheter malfunction and distinguish between occlusion and catheter breakage was retrospectively analyzed. Glycated hemoglobin was measured to determine the clinical importance of catheter malfunctions and decreases in pump flow due to insulin aggregation in the pump chamber. RESULTS: Mean glycated hemoglobin levels increased significantly from 8.0 +/- 0.3 to 9.0 +/- 0.4% (P < 0.05) before and after catheter malfunction, but not during pump flow slowdowns. Mean peak pressure during PDP was 1.96 +/- 0.14 psi (P < 0.01 vs. normal) in reversibly occluded catheters and 1.86 +/- 0.35 psi (P < 0.05 vs. normal) in broken catheters, compared with 1.32 +/- 0.23 psi in normal catheters. Decay times during PDP were > 50 s for both reversibly occluded and broken catheters (P < 0.001 vs. normal of 3.6 +/- 0.82 s). Abdominal radiographs and sideport injections of contrast material were used to distinguish the types of broken catheters. CONCLUSIONS: Catheter breakage and occlusion are complications in implantable insulin infusion systems and result in metabolic deterioration. The presence of a sideport allows pressure data and radiographic procedures to assist in determining the cause of catheter malfunction. A diagnostic algorithm was generated to improve efficiency in investigating catheter problems.

Adult↗