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At least 325 records · Page 18Linked to original sources
PubMed2005

Diagnostic performance of venous lactate on arrival at the emergency department for myocardial infarction.

OBJECTIVES: To determine the sensitivity of the venous lactate level at presentation for acute myocardial infarction (AMI) in emergency department (ED) patients with chest pain. METHODS: A prospective, double-blind observational study was done in a tertiary care ED. From January to April 2000, all consecutive patients presenting with chest pain were eligible. Lactate level was obtained on arrival and compared with two criterion standards for the diagnosis of AMI: the World Health Organization (WHO) and the Joint European Society of Cardiology/American College of Cardiology Committee (ESC/ACC) classifications. A lactate level greater than 1.50 mmol/L was considered positive. RESULTS: Between January and April 2000, 718 patients were enrolled. By the WHO criteria, 64 patients suffered an AMI, of whom 59 had an elevated lactate level, yielding a sensitivity of 92% (95% CI = 86% to 99%), a specificity of 44% (95% CI = 40% to 48%), and a negative predictive value (NPV) of 98% (95% CI = 97% to 99%). For all patients presenting with more than two hours of chest pain (n=34), the lactate level was elevated. When using the ESC/ACC criteria, 100 patients sustained an AMI, of whom 88 had an elevated lactate level, yielding a sensitivity of 88% (95% CI = 82% to 94%), a specificity of 46% (95% CI = 42% to 50%), and an NPV of 96% (95% CI = 94% to 98%). CONCLUSIONS: Venous lactate level at presentation is highly sensitive for the diagnosis of AMI, particularly in patients with more than two hours of chest pain. Given its limitations in specificity and ability to detect creatine kinase-MB-negative/troponin-positive microinfarcts, further research is needed to determine how lactate can complement other cardiac enzymes in risk-stratifying all acute coronary syndromes.

Adult↗
PubMed2004

Diagnostic performance of a new highly sensitive thyroglobulin immunoassay.

The determination of serum thyroglobulin (Tg) is commonly used for detecting the presence of residual thyroid tissue or cancer recurrence in patients treated for differentiated thyroid cancer (DTC). The aim of the study was to evaluate the performance characteristics of a recently introduced fully automated chemiluminescent immunoassay, based on four monoclonal antibodies and which produces results in 40 min. Analytical sensitivity (0.01 micro g/l) was computed from 20 replicates of the zero calibrator and of the 'Tg-free' sample pool. Functional sensitivity (0.1 micro g/l at 20 coefficients of variation percent) was determined from the imprecision profile obtained by assaying ten serum pools. The reliability of the measurements in the low concentration range (Tg<1 micro g/l) has been checked by progressive dilution with the 'Tg-free' serum of a sample pool at 5.27 micro g/l; measured values were very close to the expected values (recovery 100-133%).Cut-off at the 99th percentile in DTC stage I 'disease-free' treated patients (n=53) was 0.16 micro g/l. Tg measurement in basal conditions during L-thyroxine suppression therapy and 5 days after recombinant human TSH stimulation was performed in 22 patients with DTC. In 80% of patients with basal Tg<0.1 micro g/l (12/15), Tg remained<0.1 micro g/l after stimulation, and in all of these Tg was<1 micro g/l. Our results have indicated the optimal analytical and clinical performance of this Tg immunoassay and encourage further studies on larger populations of patients with DTC.

Adult↗
PubMed1997

CT of cystic renal masses: analysis of diagnostic performance and interobserver variation.

OBJECTIVE: Our objective was to assess the clinical usefulness and interobserver variability of the Bosniak classification scheme for characterizing a series of pathologically proven cystic renal lesions imaged with CT. MATERIALS AND METHODS: Seventy pathologically proven cystic renal masses (38 benign, 32 malignant) in 46 patients were reviewed independently by three radiologists. The cystic masses were categorized by each reviewer according to both the Bosniak classification and the receiver operating characteristic (ROC) analysis. Both the individual results for each reader and the pooled results for all three readers were analyzed. Interobserver agreement and discordance in classifying lesions as Bosniak categories I-II or III-IV were assessed. RESULTS: The distribution of the 70 lesions (based on the average of the three readers) was 22 Bosniak I (0% malignant), eight Bosniak II (13% malignant), 11 Bosniak III (45% malignant), and 29 Bosniak IV (90% malignant). All readers agreed on the Bosniak classification in 59%, or 41 of the 70 lesions (I, 17; II, one: III, four: and IV, 19). Eleven (16%) of the 70 lesions were classified as Bosniak I or II by one reader and as Bosniak III or IV by at least one other reader. The area under the curve for the pooled ROC analysis was calculated to be 0.957. Individual reader values ranged from 0.914 to 0.981. The sensitivities, specificities, and accuracies for the three readers ranged from 94% to 100%, 71% to 92%, and 84% to 93%. Assessment of interobserver variability by kappa analysis yielded scores of .571 and .477 for the Bosniak and ROC analyses, respectively. CONCLUSION: Overall, the Bosniak classification scheme is useful for evaluating renal masses: however, interobserver variation in distinguishing. Bosniak II and Bosniak III lesions may present difficulties in recommending surgical versus conservative management.

Adult↗
PubMed1992

Improved diagnostic performance of the circulating antigen assay in human schistosomiasis by parallel testing for circulating anodic and cathodic antigens in serum and urine.

Serum and urine levels of two Schistosoma circulating antigens, the circulating anodic antigen (CAA) and the circulating cathodic antigen (CCA), were determined by monoclonal antibody-based enzyme-linked immunosorbent assays in 56 Egyptian patients infected with S. mansoni and in 12 patients infected with both S. mansoni and S. haematobium. Both CAA and CCA could be specifically demonstrated in 82% and 88% of the serum samples and in 88% and 87% of the urine samples, respectively. While complete specificity was maintained, sensitivity was increased to a range of 91-98% by parallel use of the two circulating antigen assays, i.e., an individual with a positive titer for at least one of the assays was considered to be infected. A combination of CAA and CCA determinations in urine samples only resulted in a sensitivity of 94%. However, the highest sensitivity was achieved when the serum-CCA assay was combined with the urine-CCA assay (98%) or with the urine-CAA assay (97%). Sensitivity could not be increased further by combining more than two tests. A significant correlation was demonstrated between the level of circulating antigen and the number of parasite eggs in feces in each of the four assays. In addition, the levels of CAA and CCA in serum and urine were significantly correlated with each other. Our results indicate that diagnosis of schistosome infections by detection of circulating antigens can be significantly improved by parallel testing for multiple antigens.

Adolescent↗
PubMed2007

Diagnostic performance of a random versus lesion-directed biopsy of the prostate from transrectal ultrasound: results of a 5-year consecutive clinical study in 1 institution in South Taiwan.

OBJECTIVE: The purpose of this study was to compare cancer detection rates of sonographically suspicious lesion-directed biopsies and random biopsies through transverse examination of prostate halves in 518 patients over 5 years. METHODS: From 1998 to 2002, 518 patients were referred for prostate biopsies because of either elevated prostate-specific antigen (PSA) levels or abnormal digital rectal examination findings. On the basis of transverse examination of prostate halves by transrectal ultrasound, we performed lesion-directed biopsy of 3 to 5 cores if morphologically suspicious lesions existed on sonography or random biopsy of 3 cores if no obvious suspicious lesions existed. Biopsy specimens were put into 2 labeled containers. Pathologic results were correlated with random and lesion-directed guided locations. RESULTS: Nine-hundred fifty-nine results were obtained from 439 random and 520 lesion-directed biopsies in 518 patients. Cancer was detected in 207 patients (40.7%). Patients with cancer who had PSA levels of 10.0 ng/mL or greater had higher proportions of bilateral cancer lesions than those with PSA levels of less than 10 ng/mL (P = 0.03). One hundred ten (25.1%) of 439 normal-appearing halves taken by random biopsy were tumor-positive compared with 200 (38.5 %) of 520 biopsies from halves with sonographically suspicious lesions. Regardless of having random or lesion-directed biopsies, patients with PSA levels of 10 ng/mL or greater had higher positive malignancy rates than those with PSA levels of less than 10.0 ng/mL (P < .001). In about 40 patients, a diagnosis was made by random biopsy from halves that were morphologically normal on sonography, not by lesion-directed biopsy from tumor-suspicious contralateral halves. CONCLUSIONS: Cancer detection rates of lesion-directed biopsies are superior to those of random biopsies regardless of PSA level.

Adult↗
PubMed1998

[The indications for performing diagnostic and therapeutic laparoscopy in emergency surgery on the abdominal organs].

In 1352 patients with urgent diseases and traumatic injuries of the abdominal cavity organs laparoscopy was conducted. Diagnostic authenticity of method is 96.5%. Indications to remedial laparoscopy, conducted in 47.4% of patients, were rendered concrete and broadened. An acute inflammation was eliminated in 95.3% of patients, which were operated on according to the indications in a "cool period", 104 (7.5%) of patients died.

Abdomen, Acute↗
PubMed1999

New electrochemiluminescent immunoassay for the determination of CYFRA 21-1: analytical evaluation and clinical diagnostic performance in urine samples of patients with bladder cancer.

BACKGROUND: A new electrochemiluminescent immunoassay (ECLIA) has been developed for the determination of cytokeratin 19 (CYFRA 21-1) in the Elecsys 2010 immunoassay system. Urinary CYFRA 21-1 might have a role in the diagnosis of bladder cancer. METHODS: We performed an analytical evaluation of the CYFRA 21-1 ECLIA for serum and urine samples. The clinical value of urinary CYFRA 21-1 for the detection of bladder cancer was evaluated through its measurement in 226 urine samples from symptomatic and asymptomatic controls. RESULTS: At concentrations of 2-30 microg/L, within-assay imprecision (CV) was below 2.1% for sera and 3.3% for urines, with interassay CVs below 3.3% for sera and 4.9% for urines. The day-to-day CV was <20% at concentrations >0.2 microg/L (functional sensitivity). Measurement of diluted samples showed that the assay estimated CYFRA 21-1 between 98% and 103% for sera and 98% and 105% for urines. Recovery of added CYFRA 21-1 was 99-105% for sera and 96-115% for urines. We separately compared serum and urine CYFRA 21-1 ECLIA results with those obtained with an IRMA (CIS bio international). Regression analysis for sera was: CYFRA 21-1 (ECLIA) = 0.520 + 1.018 CYFRA 21-1 (IRMA); [95% confidence interval (CI) (y-intercept), -0.260 to 1.309]; 95% CI (slope), 0.978-1.060; n = 100; S(y|x) = 3.242; r(2) = 0.987. For urine samples it was: CYFRA 21-1 (ECLIA) = 0.716 + 0.966 CYFRA 21-1 (IRMA); 95% CI (y-intercept), 0.009-1.422; 95% CI (slope), 0.956-0.976; n = 100; S(y|x) = 4.136; r(2) = 0.986. In urine samples voided by patients with and without bladder cancer, the best ROC analysis discrimination provided 81.0% (95% CI, 72.7-87.7%) sensitivity and 97.2% (95% CI, 90.2-99.6%) specificity at a threshold value of 5.7 microg/L. CONCLUSIONS: Our initial evaluation showed reliable analytical performance for urinary CYFRA 21-1, which might assist urologists in the detection of bladder cancer as a noninvasive adjunct to cystoscopy.

Adult↗
PubMed2000

[Profile comparison systems and performance diagnostic, electronic data processing-supported technology--their use in improving responses to social medicine questions and expert assessments and planning of rehabilitation measures].

Systems for comparing ability and requirement profiles as well as instruments for evaluating functional capacity are current topics in rehabilitation. Only few of them however are related to vocational rehab. This article describes the present state of affairs in the development in procedures, instruments and methods to measure work-related human functional capacity with the aim of vocational rehabilitation and integration, helping to obtain objective results to decide about further steps. They are an addition to sociomedical advice in assessment and vocational centres, and serve to expand the common basis of the WHO International Classification of impairments, disabilities and handicaps (ICIDH). The purpose is intervention. Abilities are contrasted with requirements, as the basis for defining a need for intervention and realizing appropriate action. This is the thinking integrated in the German profiling assessment and documentation system IMBA--Integration von Menschen mit Behinderungen in die Arbeitswelt (Integration of people with disabilities into worklife). Diagnostic, computer based technology and work simulation and measurement to evaluate functional capacity as developed and used in the U.S. is complementary to IMBA. Work simulation is based on databases, such as the D.O.T., and includes standardized work requirement profiles. Such systems have been imported from the United States of America to Switzerland and the Netherlands and now to Germany. There are numerous connections with German assessment systems, and the fundamentals of ICIDH are included. Common application in the field of rehabilitation is dealt with, also in view of pensioning issues. The need for user training and quality management are reported in this article as well.

Chronic Disease↗
PubMed2002

Two easy-to-perform diagnostic tests for Gilbert's syndrome.

Gilbert's syndrome is a benign, often familial condition characterized by asymptomatic jaundice. A patient suffering from Gilbert's syndrome may have hepatic activity of bilirubin-UDP-glucuronosyltransferase decreasing to levels around 30% of the normal. A clinical diagnosis of Gilbert's syndrome is usually followed in case of mild hyperbilirubinemia with a high fraction of unconjugated bilirubin, normal values of liver enzymes, and no overt signs of hemolysis. This article reported a 17-year-old male with only partial indication of indirect hyperbilirubinemia. Rifampicin test and caloric restriction test were applied to assure the patient had Gilbert's syndrome. These two non-invasive diagnostic means, with the benefit of avoiding hazardous liver biopsy, are gaining popularity in our routine Gilbert's syndrome examination.

Adolescent↗
PubMed1975

[70. Performance diagnostic studies for the determination of the condition and health risks of managers in comparison with other exposed and inexposed professional workers].

By screening examinations of 1,287 persons fit to work from 9 professions altogether 208 persons of risk were selected who were classified into a group of managers and into a group of workers who were professionally increasedly exposed or demanded and who were-in comparison to a control group-comprehensively after-examined, including complex ergometry. The managers have an increased risk of health by hypertension and cardial ischaemia and at the same time an unfavourable condition. The increasedly exposed or demanded workers have an increased risk by hypertension and bronchitis despite favourable condition. The results confirm the necessity of a prevention of persons from professional and dispositional risk of health according to a graduated health control programme.

Acidosis↗
PubMed2002

Improved diagnostic performance of thallium-201 myocardial perfusion scintigraphy in coronary artery disease: from planar to single photon emission computed tomography imaging.

BACKGROUND: This study was performed to compare Tl-201 myocardial perfusion single photon emission computed tomography (SPECT) with planar scintigraphy in the diagnosis of coronary artery disease (CAD). METHODS: Retrospectively, 240 of 3262 patients, with exercise-redistribution Tl-201 myocardial perfusion scintigraphy performed between January 1990 and October 1997, were analyzed to compare Tl-201 scintigraphy and coronary arteriography. Within 30 days, all 240 patients underwent both coronary arteriography and exercise-redistribution Tl-201 myocardial perfusion scintigraphy with 86 SPECT and 154 planar images acquired. RESULTS: The sensitivities of Tl-201 myocardial perfusion scintigraphy in individual coronary arteries including left anterior descending (LAD) artery, left circumflex (LCX) artery, and right coronary artery (RCA), were 77%/72%, 31%/30%, and 77%/50% in the SPECT/planar study groups, respectively. The sensitivities of CAD detection in patients with single-vessel, double-vessel, and triple-vessel diseases were 96%/82%, 91%/85%, and 96%/90% in the SPECT/planar study groups, respectively. CONCLUSION: SPECT images provide greater advantages over planar images for better detection of the number, location, and extent of CAD. Cardiac SPECT does improve the accurate interpretation in abnormal Tl-201 distributions due to the higher contrast resolution and better separation of overlapping myocardial regions.

Adult↗