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At least 379 records · Page 21Linked to original sources
PubMed2002

Serious consequences of the wrong diagnosis of meniscal lesion in a case of stress fracture of the distal femur.

We report on a 42-year-old runner who developed pain on weight bearing during his training in his right femur that radiated to the knee. A pulled muscle was suspected and treatment with nonsteroidal anti-inflammatory drugs initiated. Because of persisting pain, radiological diagnosis was started and a lesion of the meniscus suspected. The radiograph of the knee was negative and magnetic resonance imaging (MRI) showed a mild degeneration of the meniscus. Six weeks after the symptoms started, the patient underwent arthroscopy based on the MRI findings. Intraoperatively, while his leg was being fixed in the leg-holder, a supracondylar fracture of the left femur occurred. A pathologic fracture was suspected and the patient was admitted to our hospital. Another MRI and a biopsy examination were performed. Histopathologic findings were normal concerning malignancy, and osteosynthesis was performed. The subsequent analysis of the first MRI showed intramedullary and periosteal edema with high signal intensity, which led to the suspicion of a pre-existing stress fracture. After 6 months, the patient returned to sports. Because of insufficient initial anamnesis and clinical examination, a diagnostic algorithm of the stress fracture had not been kept. Additionally, in these cases, biopsy must be performed to obtain a reliable diagnosis. This mistake led to a fracture of the femur and a long rehabilitation for this patient.

Adult↗
PubMed2001

Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score.

OBJECTIVE: To develop a simple standardized clinical score to stratify emergency ward patients with clinically suspected pulmonary embolism (PE) into groups with a high, intermediate, or low probability of PE to improve and simplify the diagnostic approach. METHODS: Analysis of a database of 1090 consecutive patients admitted to the emergency ward for suspected PE in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS: A total of 296 (27%) of 1090 patients were found to have PE. The optimal estimate of clinical probability was based on 8 variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis, or elevation of a hemidiaphragm on chest x-ray film. A probability score was calculated by adding points assigned to these variables. A cutoff score of 4 best identified patients with low probability of PE. A total of 486 patients (49%) had a low clinical probability of PE (score </=4), of which 50 (10.3%) had a proven PE. The prevalence of PE was 38% in the 437 patients with an intermediate probability (score of 5-8; n = 437) and 81% in the 63 patients with a high probability (score >/=9). CONCLUSIONS: This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to emergency ward patients suspected of having PE could allow a more effective diagnostic process.

Adolescent↗
PubMed1998

A new electrocardiographic approach to identify the coronary artery responsible for acute inferior myocardial infarction: a study in 100 patients.

OBJECTIVE: The objective of this study is to analyze the value of the electrocardiogram in the identification of the coronary artery responsible for acute inferior myocardial infarction. MATERIAL AND METHODS: One hundred consecutive patients with acute inferior myocardial infarction were studied, 67 with a lesion in the right coronary artery and 33 in the circumflex artery. The ST segment changes in the inferior, lateral, precordial and right-chest leads were analyzed, as well as the arithmetic sum of the ST segment in the inferior and V2 leads (II + V2, III + V-2 and aVF + V2). We also developed a diagnostic process based on a stepwise approach of three electrocardiographic criteria: a) elevation of the ST segment in DI; b) arithmetic sum of the ST magnitude in DIII + V2 < 0; c) depression of the ST segment in V4R. RESULTS: This study shows that the most useful parameters to predict (with a specificity of 100%) the lesioned coronary artery in acute inferior myocardial infarction are: a) the arithmetic sum of the ST segment: aVF + V2 > 0, for the right coronary artery; b) the arithmetic sum of the ST segment: III + V2 < 0, for the circumflex artery; c) the arithmetic sum of the ST segment: aVF + V2 > 1 mm, for the proximal right coronary artery. CONCLUSIONS: The incorporation of these three criteria in an algorithm diagnostic system allows us to locate the coronary artery responsible for acute myocardial infarction with 100% sensitivity and specificity.

Algorithms↗
PubMed2001

Exclusion of pulmonary embolism using quantitative plasma D-dimer assays.

Recent quantitative studies using pulmonary angiography as reference method have indicated that the overall accuracy of quantitative D-dimer assays for the exclusion of pulmonary embolism (PE) in patients suspected of PE is poorer than was reported in earlier studies in which the same D-dimer assays were used (90-94% vs 98-100%). An explanation can be found in the fact that the earlier studies are hampered by the fact that the reference method was a compilation of clinical data and non-invasive diagnostic tests rather than a true gold standard. Furthermore, in those studies no discrimination was made between the milder cases of subsegmental PE and the more severe cases of segmental and larger PE. The lack of a true gold standard and preselection leading to reduced proportions of cases of subsegmental PE in the earlier studies rather than differences in the storage conditions of plasma samples or treatment with heparin, appear to have caused the discrepancies in the reported accuracy of D-dimer assays. It is concluded that the sensitivity and negative predictive values obtained with different quantitative D-dimer assays are in close agreement with each other, that is poor for subsegmental PE and excellent for segmental and larger PE. In diagnostic algorithms D-dimer can reliably exclude acute segmental and/or massive PE. Further work-up within 48 hours is still necessary in negative D-dimer outcomes to exclude subsegmental PE.

Antifibrinolytic Agents↗
PubMed2003

Comparison of six D-dimer methods in patients suspected of deep vein thrombosis.

We evaluated six D-dimer methods to determine their sensitivity, specificity, and negative predictive values (NPV) in symptomatic patients suspected of deep vein thrombosis (DVT). In patients suspected of DVT a whole blood D-dimer test (SimpliRED, Agen) was performed, and then tested using enzyme-linked immunosorbent assay (VIDAS D-Dimer, BioMerieux; Asserachrome D-Di, Stago International; Dimertest Gold, Agen) and automated immunoturbidometric methods (Advanced D-Dimer, Dade Behring; MiniQuant, Biopool). Each D-dimer method was independently compared with radiographic results to determine sensitivity and NPV. There were 151 patients enrolled in the study. Thirty-five (23.2%) patients had a positive Doppler ultrasound, with 26 proximal, eight distal, and one patient with both proximal and distal thrombus. Two patients (1.3%) had inconclusive studies and were excluded from the analyses. For all patients, the sensitivities for the rapid D-dimer methods were: SimpliRED, 82.3% [95% confidence interval (CI), 80.3-84.3%]; VIDAS D-Dimer, 91.4% (95% CI, 89.9-92.9%); MiniQuant D-Dimer, 96.3% (95% CI, 95.1-97.5%); and Advanced D-Dimer, 97.1% (95% CI, 96.3-97.9%). The sensitivity improved for SimpliRED (86.4%; 95% CI, 83.3-89.4%), VIDAS D-Dimer (95.5%; 95% CI, 85.0-100%), MiniQuant D-Dimer (100%; 95% CI, 96.9-100%) and Advanced D-Dimer (100%; 95% CI, 98.9-100%) in the inpatient population. The automated immunoturbidometric methods, the MiniQuant D-Dimer and Advanced D-Dimer, demonstrated comparable sensitivities and NPV with the VIDAS D-Dimer method in symptomatic patients suspected of DVT, which would suggest that these newer D-dimer methods could be used as part of the diagnostic algorithm for patients suspected of DVT.

Enzyme-Linked Immunosorbent Assay↗
PubMed2026

Cost-Effectiveness and the Economics of Genomic Testing and Molecularly Matched Therapies.

Cost-effectiveness analysis of precision oncology can help guide value-driven care. Next-generation sequencing is increasingly cost-efficient over single gene testing because diagnostic algorithms require multiple individual gene tests to determine biomarker status. Matched targeted therapy is often not cost-effective due to the high cost associated with drug treatment. However, genomic profiling can promote cost-effective care by identifying patients who are unlikely to benefit from therapy. Additional applications of genomic profiling such as universal testing for hereditary cancer syndromes and germline testing in patients with cancer may represent cost-effective approaches compared with traditional history-based diagnostic methods.

Humans↗
PubMed1996

Is venous duplex imaging an appropriate initial screening test for patients with suspected pulmonary embolism?

Noninvasive tests for deep venous thrombosis (DVT) are helpful in evaluating patients with suspected pulmonary embolism (PE) who have non-high-probability ventilation/perfusion (V/Q) lung scans. Based on the enthusiasm for these noninvasive tests, venous duplex imaging (VDI) has evolved as the initial screening test for patients with clinically suspected PE in some centers. This study evaluates the utility of VDI as the initial test in a diagnostic algorithm for patients with suspected PE. A total of 306 consecutive patients who underwent VDI as the initial screening test for clinically suspected PE during the past 24 months were reviewed; 121 patients were subsequently evaluated with V/Q scans and 20 underwent pulmonary arteriography. VDI demonstrated DVT in 10% (23/216), with 7% (22/306) having proximal DVT and 3% (9/306) having isolated calf DVT. In 25 patients with unilateral leg symptoms, DVT was found in 40% (10/25); however, among the 281 without unilateral leg symptoms, results of VDI were abnormal in only 5% (15/281). V/Q scans were obtained in 40% (121/306), with only 16% (19/121) of scans showing a high probability of PE. DVT was found in 25% (5/19) of patients with high-probability V/Q scans and in 25% (26/102) with non-high-probability scans. In patients with clinically suspected PE the incidence of detectable infrainguinal DVT is low. VDI appears to be a reasonable initial screening test in patients with clinically suspected PE and unilateral leg symptoms. However, in patients without unilateral leg symptoms, the diagnostic yield is low and an alternative diagnostic approach appears justified.

Adult↗
PubMed1997

Unilateral sinonasal disease without bone destruction. Differential diagnosis using diagnostic imaging and endonasal endoscopic biopsy.

OBJECTIVE: To evaluate the diagnostic algorithms leading to minimal-access surgery in unilateral sinonasal disease without evidence of bone destruction. DESIGN: In selected patients, we assigned qualitative preoperative diagnoses by performing computed tomography (CT), magnetic resonance imaging (MRI), and endonasal endoscopic biopsy and prospectively analyzed the results for 3 years, from 1992 to 1995. PATIENTS: Of 278 untreated patients who complained of nasal and sinus-related symptoms and underwent CT examinations, 130 were found to have unilateral sinonasal abnormalities without detectable changes in the bone structure. RESULTS: Accurate preoperative diagnoses were made using CT in 75% of the patients with chronic sinusitis with or without nasal polyps and 85% of the patients with mucoceles. In the remaining patients, preoperative diagnoses for both diseases were made using MRI. All fungal and vascular diseases were accurately diagnosed using MRI alone. Although neither CT nor MRI were useful in the qualitative diagnosis of neoplasm, the presence of neoplastic conditions, except papilloma, was indicated by MRI. Using endonasal endoscopy, biopsy was an accurate diagnostic tool, with minimal tissue damage, in 88% of the neoplasms. CONCLUSIONS: In differentiating untreated unilateral sinonasal disease without evidence of bone destruction, we conclude that CT is the first modality of diagnostic imaging and MRI is more sensitive than CT in identifying fungal disease and angiofibroma. Furthermore, MRI is helpful when neoplasm is indicated, but it is not an accurate diagnostic tool. The endonasal endoscopic approach for obtaining pathologic specimens is a qualitative diagnostic tool in the diagnosis of sinonasal neoplasm.

Adult↗
PubMed1999

Spiral CT angiography of the pulmonary circulation.

Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. As a minimally invasive examination, this technique is becoming widely available and has progressively replaced conventional and digital pulmonary angiography as the standard diagnostic imaging modality of the pulmonary circulation. The purpose of this review is to capture the current state of the art of the technical aspects of spiral CT angiography, with special emphasis on the post-processing techniques currently available. As CT is responsible for a considerable part of the medical radiation dose applied to the population, the current trends for dose saving will also be emphasized. With regard to the clinical applications of spiral CT angiography, its introduction into the diagnostic work-up of pulmonary embolism has considerably modified the diagnostic algorithms. Our 8-year review of the literature presented herein is expected to provide the readers with a basis for formulating an informed opinion on this topic. In addition, a large number of congenital and acquired disorders of the pulmonary circulation are also relevant to this technique, and these indications are discussed in the context of the corresponding therapeutic options. Owing to the multiple possibilities inherent to this technique, spiral CT has the potential for cost savings without reduction in image quality or diagnostic accuracy.

Aneurysm↗
PubMed2001

Palpable asymmetrical thickening of the breast: a clinical, radiological and pathological study.

While management protocols for a discrete palpable breast lump are standardized in most centres, the approach to an area of palpable asymmetrical thickening in the breast has seldom been addressed. A diagnostic algorithm for palpable asymmetrical thickening of the breast was prospectively evaluated in 116 Oriental women, followed by a retrospective review of their mammograms and histology specimens. Most women (86%) were pre-menopausal and 82% complained of a lump. The thickening eventually resolved spontaneously in 93 (80%) women. None of these 93 women developed cancer at a median follow-up of 41 months. A total of 9 (7.8%) cancers were found in the series of 116 women, including two with a lobular component. The occurrence of cancer was more likely when the woman was older than 43 years or when the thickening was marked (p<0.04). Mammographic review showed correlation of the palpable thickening with localized increase in breast tissue density and/or microcalcifications in 18% of cases. Histology review suggested fibrosis as an explanation for the clinical presentation. Although most cases of thickening tend to resolve with time, a significant number of cancers present in this way. A diagnostic approach with early and liberal imaging and biopsy for high risk women is required.

Adult↗
PubMed1995

Deep venous valve reconstruction.

The place of deep venous valve reconstruction in the surgical management of the patient with chronic venous insufficiency has become clearer with collected experience over the past 25 years. The reasons to perform surgery in chronic venous disease and the specific rationale for deep venous repair are contrasted with the management of the same patient by medical means. A new classification of chronic venous disease has been developed and provides the basis for a more objective understanding of specific entities in the entire field of chronic venous symptoms. The requirements for diagnosis before reconstructive surgery are stringent and a diagnostic algorithm is discussed in the selection of candidates for deep venous reconstruction. The multiple surgical techniques for deep venous reconstruction include internal intravenous direct valve repair and extravenous tightening of the vein wall around the valve cusp. The results of valve repair for primary valve incompetence are discussed in terms of long-term clinical results, long-term imaging results and long-term physiologic results as reflected by venous pressure examinations. It is becoming increasingly clear with the passage of time and the sharpening of our diagnostic skills that reflux is the dominant cause of chronic venous insufficiency. The ability of surgical procedures to decrease reflux in a diseased extremity can be used to restore patients to their normal way of life free of pain, swelling and ulceration and, in the ideal case, free of the need for elastic support.

Chronic Disease↗
PubMedDate not supplied

Clinical evaluation of hepatic lesions: guidelines for diagnostic protocols and injury severity scores.

The standardisation of diagnostic procedures according to an adequate sequence is a mandatory in determining the therapeutic strategy in liver traumas. In a series of 26 consecutive cases of trauma of the liver, 3 of them penetrating, we adopted a diagnostic algorithm based on the extensive use of sonography and "Injury Severity Scores" in addition to the standard clinical procedures. The treatment of the lesions was surgical in 21 cases (81%) and conservative in 5 (19%); post operative mortality was 14% and overall mortality 11.5%. None of the cases treated by conservative approach had to be submitted to surgery during the follow-up period. Sonography, carried out by surgical staff within 30' from observation and at definitive intervals, allowed a correct surgical approach in all cases; a similar sensitivity was obtained by sonography also in the cases treated conservatively and submitted to C.T. evaluation. The absolute correlation between Revised Trauma Score, Injury Severity Scale, classes of severity of the lesions and subsequent surgical survey suggest that this scoring system could be adopted in the first triage of traumatic lesions of the liver. Sonography could be preferred to diagnostic peritoneal lavage in the screening of cases with circulatory instability; furthermore, it could be a valid alternative to C.T. in hemodynamically stable patients.

Adolescent↗
PubMed2002

Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy.

Our objective was to evaluate, in a routine clinical setting, the role of spiral CT as a second procedure in patients with clinically suspected pulmonary embolism (PE) and abnormal perfusion scan. We prospectively studied the role of spiral CT in 279 patients suspected of PE. All patients started their diagnostic algorithm with chest radiographs and perfusion scintigraphy. Depending on the results of perfusion scintigraphy, patients proceeded to subsequent levels in the algorithm: stop if perfusion scintigraphy was normal; CT and pulmonary angiography if subsegmental perfusion defects were seen; ventilation scintigraphy followed by CT when segmental perfusion defects were seen; and pulmonary angiography in this last group when results of ventilation/perfusion scintigraphy and CT were incongruent. Reference diagnosis was based on normal perfusion scintigraphy, high probability perfusion/ventilation scintigraphy in combination with abnormal CT, or pulmonary angiography. If PE was present, the largest involved branch was noted on pulmonary angiography, or on spiral CT scan in case of a high-probability ventilation/perfusion scan and a positive CT scan. A distinction was made between embolism in a segmental branch or larger, or subsegmental embolism. Two hundred seventy-nine patients had abnormal scintigraphy. In 27 patients spiral CT and/or pulmonary angiography were non-diagnostic and these were excluded for image analysis. Using spiral CT we correctly identified 117 of 135 patients with PE, and 106 of 117 patients without PE. Sensitivity and specificity was therefore 87 and 91%, respectively. Prevalence of PE was 53%. Positive and negative predictive values were, respectively, 91 and 86%. In the high-probability group, sensitivity and specificity increased to 97 and 100%, respectively, with a prevalence of 90%. In the non-high probability-group sensitivity and specificity decreased to 61 and 89%, respectively, with a prevalence of 25%. In a routine clinical setting single-detector spiral CT technology has limited value as a second diagnostic test because of low added value in patients with a high-probability lung scan and low sensitivity in patients with non-high-probability lung scan result.

Algorithms↗
PubMed2003

Optimal excitation-emission wavelengths for autofluorescence diagnosis of bladder tumors.

Tissue autofluorescence depends on endogenous fluorophores in the tissue, which undergo a change associated with malignant transformation. This change can be detected as an alteration in the spectral profile and intensity of autofluorescence. Our purpose was to determine the optimal excitation and emission wavelengths for autofluorescence diagnosis of bladder cancer. A total of 52 bladder tissue specimens were obtained from 25 patients undergoing mucosal biopsies or surgical resections of bladder tumors. Light-induced autofluorescence measurements were performed to study the spectroscopic differences between normal and malignant bladder tissue. Fluorescence excitation wavelengths varying from 220 to 500 nm were used to induce tissue autofluorescence, and emission spectra were measured in the 280-700 nm range. These spectra were then combined to construct 2-dimensional fluorescence excitation-emission matrices (EEMs). Significant changes in fluorescence intensity of EEMs were observed between normal and tumor bladder tissues, the most marked differences being at the excitation wavelengths of 280 and 330 nm. The diagnostic algorithm based on the combination of the fluorescence peak intensity ratios of I(350)/I(470) at 280 nm excitation and I(390)/I(470) at 330 nm excitation yielded a sensitivity of 100% [95% confidence interval (CI) 0.95-1.0] and specificity of 100% (95% CI 0.90-1.0). The results of the present fluorescence EEM study demonstrate that autofluorescence spectroscopy can distinguish malignant from normal bladder tissue and that excitation wavelengths of 280 and 330 nm are the most significant for differentiation between normal and malignant bladder mucosae with a high degree of diagnostic accuracy.

Aged↗
PubMed2000

Application of an algorithm for the diagnosis of asthma in Chinese families: limitations and alternatives for the phenotypic assessment of asthma in family-based genetic studies.

Phenotype assessment is a crucial issue in gene mapping studies of asthma. Recently, Panhuysen and coworkers proposed an algorithm to define the asthma phenotype in gene mapping family-based studies. We classified members of 2,756 Chinese families ascertained on the basis of the presence of two or more siblings and no more than one parent with asthma using a slightly modified version of the aforementioned algorithm. Among 4,097 Chinese parents, 404 (9.9%) were classified as having "definite asthma," 284 (6.9%) as "probable asthma," 1,193 (29.1%) as "unclassifiable obstructive airway disease, " 626 (15.3%) as "COPD," and 1,590 (38.8%) as "unaffected" (no obstructive airway disease). Among 6,424 Chinese offspring, 1,065 (16.6%) were classified as having "definite asthma," 820 (12.8%) as "probable asthma," 1,996 (31.1%) as "unclassifiable obstructive airway disease," 228 (3.5%) as "COPD," and 2,315 (36%) as "unaffected." The use of the algorithm proposed by Panhuysen and coworkers in a Chinese population with a high prevalence of smoking would result in the exclusion of subjects with asthma who smoke or who have severe airflow obstruction from linkage analysis, as well as in an inability to explore any potential interactions between genetic factors and cigarette smoking in the pathogenesis of asthma. In the absence of a "gold standard," definitions of asthma that incorporate a combination of respiratory symptoms, increased airway responsiveness or bronchodilator response, and a physician's diagnosis of asthma are reasonable. The choice of a particular diagnostic algorithm for family-based genetic studies of asthma should be made according to factors such as the prevalence of smoking in the study population. Genetic studies of intermediate phenotypes related to asthma, which are objectively defined and may be influenced by a smaller number of genes, continue to be of great importance.

Adolescent↗
PubMed1981

Computer-aided alcoholism diagnosis in obstetric-gynecologic medical settings.

A computer-aided Alcoholism Diagnostic ALGOrithm (ADALGO) based on the NCA criteria for the diagnosis of alcoholism is applied in 233 obstetric and gynecologic patients. Alcoholism symptoms in the patients were intensively investigated by means of a 10-page, self-administered questionnaire, a 45-minute interview, and a medical record review. Alcoholism diagnoses based on the resulting set of 43 NCA symptoms are compared with ADALGO diagnoses utilizing an average of 26 symptoms. Agreement was achieved in 95.7% of the cases for dichotomous, alcoholic-nonalcoholic diagnoses and in 91% of the cases using a five-category alcoholism diagnostic schema. The feasibility of routinely screening for and diagnosing alcohol-related problems in ambulatory care settings using ADALGO and the NCA criteria is discussed.

Alcoholism↗
PubMed2002

Complex pathological diagnosis of granulocytic sarcoma: apropos of a case.

The diagnosis of granulocytic sarcoma can be very difficult when there is no demonstrable abnormality in the peripheral blood or bone marrow. We present the diagnostic algorithm of granulocytic sarcoma by reporting on a case mimicking large cell lymphoma without previous manifestation of acute myeloid leukemia or a myeloproliferative disorder. After standard histoprocessing, we used immunohistochemical and molecular biological methods to analyze our case. The lymph node showed diffuse infiltration of immature blast cells resembling large cell lymphoma. However, immunohistochemistry did not support this diagnosis. The tumor cells showed LCA, bcl-2, CD43, CD34 and myeloperoxidase positivity. We also detected bcl-2 gene rearrangement. In case of a lack of a specific histological picture, particularly in poorly differentiated tumors, only some minor histological signs in combination with immunohistochemistry and molecular diagnostic methods can help to render the correct diagnosis.

Adult↗
PubMed1991

Case finding, data quality aspects and comparability of myocardial infarction registers: results of a south German register study.

The population-based Augsburg Coronary Event Register (330,000 residents, age 25-74 years) has registered a total of 1012 cases of acute myocardial infarction (AMI) in 1985 and 1021 AMI in 1986 and categorized them on the basis of the current WHO diagnostic algorithm for AMI. The register is designed for longitudinal comparisons of annual AMI risk (incidence, attack rate, death rate), and the risk to the AMI patients themselves (28-day case fatality). The methodology and specific issues encountered during registration and data evaluation are described. With an estimated 95% completeness of case finding, the quality control data review which the register conducts annually shows a consistency of specific data structures which indicate stable case finding and validation procedures. However, local conditions which affect case finding and data completeness per case are responsible for the creation of subsets of AMI which are in turn distinguished by differences in diagnostic category structures. With regard to the study objectives, the differences among subsets appear to have the least effect on rate calculations if DEFINITE and POSSIBLE AMI are combined. The implications of methodological variations and subset differences within and across registers on annual rate calculations and result comparisons are discussed.

Adult↗