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At least 343 records · Page 19Linked to original sources
PubMed2003

Similar diagnostic performance for neurocysticercosis of three glycoprotein preparations from Taenia solium metacestodes.

The detection of antibodies to Taenia solium metacestodes is very important in the differential diagnosis of neurocysticercosis (NCC). In this study, an electroimmunotransfer blot (EITB) assay that uses an elaborate protocol with metacestode glycoproteins as antigens was compared with two other Western blots that use glycoproteins obtained using simpler methods, including an eluate from a lectin column, or the vesicular fluid (VF) of the parasite. The concordance between the three assays was 91% in patients with active NCC and 100% in patients with suspected NCC and previous documentation of negative serology. The specificities for the Western blots and the EITB assay were 98% and 100%, respectively (98% concordance). These data suggest that the simplest of these immunoassays, the one that uses the VF of T. solium metacestodes in a Western blot format, can be reliably used for the serologic diagnosis of NCC in developing countries where access to the EITB assay is difficult.

Blotting, Western↗
PubMed1992

[Unconscious self control of diagnostic performance].

Assessment of quality of general practitioners' performances and assessment of maintaining quality requires appropriate parameters. Such are the specific protocols developed by general practice basic research. They are guiding the doctor in more than 80 difficult first consultations. When assessing the quality of a colleagues performance, we cannot give him a good mark, if he does not utilize these new tools. His eventual contendedness with a mere consulting by experience and intuition does not count. If a general practitioner on the other hand conscientiously and broadly makes use of the protocols, we can attest him: As far as possible he is offering medical care with a minimal risk of overlook rare, hidden avoidably dangerous outcomes. That is a symptom of good general practice.

Clinical Competence↗
PubMed1991

Probabilistic diagnosis using a reformulation of the INTERNIST-1/QMR knowledge base. II. Evaluation of diagnostic performance.

We have developed a probabilistic reformulation of the Quick Medical Reference (QMR) system. In Part I of this two-part series, we described a two-level, multiply connected belief-network representation of the QMR knowledge base and a simulation algorithm to perform probabilistic inference on the reformulated knowledge base. In Part II of this series, we report on an evaluation of the probabilistic QMR, in which we compare the performance of QMR to that of our probabilistic system on cases abstracted from continuing medical education materials from Scientific American Medicine. In addition, we analyze empirically several components of the probabilistic model and simulation algorithm.

Algorithms↗
PubMed1991

[Vesico-sigmoidal fistulas. Evaluation of the diagnostic performance of the complementary tests in our series].

We analyzed 14 cases of colovesical fistula that had been diagnosed and treated at the urology and gastroenterology and general surgery services of our hospital from 1986-1990. In 85.7% of the cases, the fistula had been caused by a tumor (adenocarcinoma of the colon) and in 14.3% by inflammatory disease (diverticulitis of the colon). All patients presented a varying degree of micturition syndrome; 30% had pneumaturia and 40% fecaluria. Cystoscopy proved to be the most effective in diagnosing colovesical fistula. It permitted visualization of the fistula or passage of fecal material to the bladder in 33% of the cases, while indirect endoscopic signs could be observed in 100%. Furthermore, it permitted the anatomopathological diagnosis of adenocarcinoma of the colon in 5 cases. We performed one-stage en bloc radical surgery in 57% of the cases, shotgun barrel discharge colostomy in 2 cases, exploration laparotomy in 3 and treatment was withheld in 1 case. The overall survival for the group submitted to radical surgery was 19.5 +/- 8.0 months. There were 4 deaths from metastasis, 2 from sepsis originating in the abdomen and the remaining deaths were due to iliofemoral venous thrombosis, cardiovascular disease and pneumopathy.

Adenocarcinoma↗
PubMed1991

Diagnostic performance characteristics of the standard Phadebas RAST, modified RAST, and pharmacia CAP system versus skin testing.

Results from three in vitro assays for allergen-specific IgE, the standard Phadebas radioallergosorbent test (PhRAST), modified RAST (mRAST), and the new Pharmacia CAP System (CAP) were compared with skin prick testing (SPT) results in 104 patients with allergic rhinitis and/or asthma and 24 nonatopic controls. Five allergens were evaluated: cat, Dermatophagoides pteronyssinus, Alternaria, June grass, and short ragweed. Using SPT results as the reference standard, the PhRAST had the lowest sensitivity (62%) and highest specificity (99%). The CAP achieved higher sensitivity (74%) with comparable specificity (96%) while the mRAST had even higher sensitivity (90%) but lower specificity (87%). The overall frequency of positive results in controls was 0% for PhRAST, 1.7% for CAP, and 3.3% for mRAST. If the threshold for a positive mRAST was raised to greater than or equal to class 2, this assay achieved performance characteristics similar to the CAP. If the results of these in vitro tests are used as the sole guide to the prescription of environmental control and immunotherapy in unselected patients with rhinitis and asthma, the performance characteristics of the CAP make it the preferred test.

Adolescent↗
PubMed1987

Diagnostic performance of sensitive measurements of serum thyrotropin during severe nonthyroidal illness: their role in the diagnosis of hyperthyroidism.

Serum thyrotropin (TSH) concentrations were measured serially in 14 heart-transplant recipients (group 1) and 21 patients undergoing coronary artery bypass surgery (group 2), all without thyroid disease, and randomly in 158 patients hospitalized for various other nonthyroidal illnesses, including 144 judged euthyroid (group 3), six with increased FT4 and (or) T3 (group 4), and eight classified hypothyroid by conventional tests. The serial measurements indicated profound fluctuations. In group 1, TSH was subnormal in 21% of studies and increased in 10%. In group 2, corresponding abnormalities were found in 7% and 13%, respectively. Transiently low or high TSH tended to be associated with normal free thyroxin (FT4), prolonged subnormal TSH (greater than 1 week) with subnormal FT4. By contrast, subnormal TSH plus elevated FT4, or high TSH plus low FT4, were not encountered, making it unlikely that they occur by chance in severely ill patients who are not also hyper- or hypothyroid. In group 3, a suppressed TSH (plus borderline high FT4, T3/FT3) identified four cases of subclinical hyperthyroidism; however, another 11% of patients had subnormal and 10% had above-normal TSH, paired with normal FT4 and no evidence of thyroid disease. In group 4, suppressed TSH confirmed hyperthyroidism in five of six patients, and all in group 5 had increased TSH. We conclude that, in the hospital setting, sensitive TSH measurement can help to detect or confirm mild hyperthyroidism, but the positive predictive value of TSH alone may be as low as 35%.

Adult↗
PubMedDate not supplied

The diagnostic performance of the L-tryptophan/competing amino acids ratio in major depression.

L-tryptophan (L-TRP), the competing amino acids (CAA) valine and leucine and the cortisol levels taken at 8 a.m. after administration of dexamethasone on the previous day, were determined in 160 patients suffering from depression. The ratio between the L-TRP values and the sum of the competing amino acids was calculated. The clinical relevance of the L-TRP/CAA ratio in the case of major depression (DSM-III) versus minor depression (dysthymic disorder, atypical depression and adaptation disorder with depressive mood) was studied in comparison with the DST. Patients suffering from major depression showed a significantly decreased (p = 0.0006) L-TRP/CAA ratio. The combination of a decreased L-TRP/CAA ratio (cut off point less than or equal to 0.130) or an abnormal DST (cut off point greater than or equal to 3.5 micrograms/dl) is the best criterion which allows 59.0% of the patients suffering from major depression to be identified correctly with a specificity of 90.9%; the above-mentioned criterion permits 70.0% of the patients to be classified correctly into their actual group.

Adjustment Disorders↗
PubMed1995

[Compared diagnostic performances of CKMB measurements by immuno-inhibition and three immunoenzyme methods for the early diagnosis of myocardial infarction].

In 98 patients consecutively admitted in a medical intensive care unit, an aliquot taken from the blood sample withdrawn for the cardiac enzyme admission request has been frozen. After thawing of these 98 aliquots total CK and the creatine kinase MB isoenzyme were measured on the same day. For this last determination, four methods were used and compared: an immunoinhibition method (Merck) and three immunoenzymatic assays (Abbott on IMX; Baxter on Stratus II; Hybritech on single use Icon cylinder). In 19 out of the 98 patients studied the diagnosis of myocardial infarction was made retrospectively by a cardiologist. This diagnosis was established according to the criteria defined by the WHO. The clinical performances (sensitivity, specificity, positive predictive value, negative predictive value) have been calculated for each test according to the following criteria: on the one hand, a cut-off of 8% (reference range of our laboratory) for the immunoinhibition technique; on the other hand, a cut-off defined by the manufacturer together with a cut-off obtained from the ROC curves for the three immunoenzymatic assays. Our results clearly demonstrate that the clinical performances of the three immunoenzymatic CKMB assays are very comparable and appear to be much better than the immunoinhibition method which should be abandoned.

Adult↗