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Results for “diagnostic optimization”

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At least 433 records · Page 24Linked to original sources
PubMed1980

[Study of the clinical features of psychopathy-like schizophrenia in childhood and adolescence].

As a result of comparing the clinical course in 230 cases with psychopathlike schizophrenia, followed up on an average for 10 years, with 600 cases of psychopathies which are formed in adolescents, basic clinical characteristics, differentiating the first group from the second were detected and described. Age-associated time-course of morbid disorders in psychopathlike schizophrenia with an early onset, depending upon age crisis and phases of pubertal period was demonstrated. With the aid of special programmes, designed to solve the question of classification by a computer, a combination of factors comprising an optimal diagnostic complex for psychopathlike schizophrenia in adolescence was demonstrated.

Adolescent↗
PubMed1980

[Reproducibility of sinus node recovery time in relation to the time of the day and the overdrive stimulation rate (author's transl)].

Corrected sinus node recovery time (CSRT) was tested in 9 patients with (CSRTI) and 6 patients without sick sinus syndrome = SSS (CSRTII) at 6 constant time intervals each, on 3 consecutive days using 5 rates of atrial overdrive stimulation (AST) via a stable loop mounted atrial electrode. From the results presented it can be concluded: CSRTI is reproducible with high rates when corresponding time periods and the same AST rate are used. A stepwise CRST increase by 60% is consistent up to AST 140 bpm only; up to AST 200 bpm the pattern varies within maximal pathological CSRT ranges for each of the 6 time periods measured, as an expression of influences unidentified in this study. The implication is: For an optimal diagnostic yield in CSRT testing several AST rates above 140 bpm are required and the time intervals of 17 and 8 hours represent a "high" and at 14 hours a "low" for CSRT testing; there are factors, other than the sinus node dysfunction, that added to the pathologic significance of the CSRT.

Adult↗
PubMed1981

Technetium-99m calcium phytate--optimization of calcium content for liver and spleen scintigraphy: concise communication.

The addition of ionic calcium to technetium-99m stannous phytate produced an agent with improved splenic uptake. In a series of patients, it was found that molar ratios of 2:1 and 3:1 produced scans of optimal diagnostic quality. Studies in mice showed dose-related changes in the biodistribution. Electron microscopy demonstrated that the addition of calcium produced progressive aggregation of the colloid as the molar ratio was increased. Chemical analysis of sodium phytate was essential to obtain accurate ratios.

Animals↗
PubMed1995

[Silent myocardial ischemia in outpatients being treated for hyperlipoproteinemia].

BACKGROUND: Hyperlipoproteinaemias, in particular those associated with hypercholesterolaemia, are in a causal relationship with the development and acceleration of atherogenesis. One of the serious forms of coronary heart disease is silent myocardial ischaemia--an asymptomatic objectively confirmed ischaemic episode. The objective of the present study was to 1. assess the prevalence of this disease in subjects with hyperlipoproteinaemia and 2. to assess the optimal diagnostic procedure to detect it. METHODS AND RESULTS: The group comprises 57 subjects selected at random (23 men and 34 women) from the out-patient department for genetics and treatment of hyperlipoproteinaemias. In all subjects an ergometric loading test was made and 24-hour ambulatory ECG monitoring. Suspected silent myocardial ischaemia (i.e. positive results of the two examinations) was confirmed by load scintigraphy of the heart muscle. Silent myocardial ischaemia was proved in 3 of 23 examined men (13%) and in 4 of 34 women (11.8%). CONCLUSIONS: Prevalence of silent myocardial ischaemia is significantly higher in high risk subjects--with hyperlipoproteinaemia than in the general asymptomatic population. The best screening test for its detection is a loading test and ambulatory ECG monitoring, supplemented by loading scintigraphy of the heart muscle.

Adult↗
PubMedDate not supplied

An MR protocol for presurgical evaluation of patients with complex partial seizures of temporal lobe origin.

PURPOSE: To find an optimal diagnostic protocol for the presurgical MR evaluation of patients with temporal lobe epilepsy. METHODS: MR imaging in 14 healthy subjects and 25 consecutive patients with temporal lobe epilepsy was performed in paracoronal sections perpendicular to the hippocampi with T1-weighted inversion recovery and T2 weighting. Volume measurements of the hippocampus/amygdala complex were performed and a multiecho sequence yielded T2-calculated images. RESULTS: Hippocampal disease was seen in 22 of 25 temporal lobe epilepsy patients on paracoronal T1-weighted inversion recovery images. Four had bilateral abnormalities. Characteristic for hippocampal disease were features such as volume loss, decreased signal, and loss of internal morphology. Only 17 of 25 patients demonstrated hippocampal pathology on T2-weighted images, and in one patient this was bilateral. Patients with only minimal structural loss on T1-weighted inversion recovery had normal T2-weighted images. T2 calculation was no more sensitive than visual assessment on the T2-weighted images. Volume measurements were normal in one patient and misleading in two patients. Lateralization, as compared with clinical and electroencephalographic findings, was most confidently done with paracoronal T1-weighted inversion recovery images and volume measurements. CONCLUSIONS: An optimum MR protocol for temporal lobe epilepsy patients is proposed. Its essential feature is that the hippocampus be evaluated by paracoronal T1-weighted inversion recovery images and volume measurements. T2-weighted imaging can be omitted.

Adolescent↗
PubMed1994

Cervical cancer complicated by pregnancy: episiotomy site recurrences following vaginal delivery.

OBJECTIVE: To determine the optimal diagnostic and therapeutic modalities relevant to episiotomy site recurrence of cervical cancer after vaginal delivery. METHODS: Records from the past 30 years were reviewed to identify patients treated at the Mayo Clinic with episiotomy site recurrence of cervical cancer complicated by pregnancy with vaginal delivery. RESULTS: Four patients with episiotomy site recurrence of squamous cell carcinoma of the cervix were treated primarily at the Mayo Clinic. These cervical cancers were originally diagnosed at delivery or in the immediate postpartum period and were treated by radical hysterectomy. Episiotomy site recurrences were detected less than 12 weeks after surgery in three patients and at 2 years in one patient. Three patients have died of recurrent cancer and one is disease-free at 1 year. CONCLUSIONS: Careful screening and examination of cervical abnormalities during pregnancy is required. The primary cancer was not diagnosed until delivery or postpartum in all patients who developed episiotomy site recurrences. If vaginal delivery is elected in a patient with cervical cancer, perineal inspection becomes critical. Including other cases reported in the literature, six of nine with stage IB disease were diagnosed with episiotomy site recurrence within 12 weeks of primary therapy. Consideration should be given to colposcopy of the episiotomy site or random biopsy in these women preoperatively to rule out occult implantation, and this site warrants careful postoperative surveillance.

Adult↗
PubMed1994

Can fetal biophysical observations anticipate outcome in preterm labor or preterm rupture of membranes?

OBJECTIVE: To evaluate fetal biophysical testing as a predictor of preterm delivery after preterm labor or preterm rupture of the membranes (PROM). METHODS: We studied 50 women with suspected preterm labor and intact membranes and 25 women with PROM but not in labor between 28 and 36 weeks' gestation. Before treatment, each subject had cervical Bishop scoring and 1-hour ultrasound observation of fetal heart rate, breathing, body movements, and flexion-extensions. Data were compared with t tests, chi 2 tests, or receiver operating curves. RESULTS: The mean gestational age at entry was similar in both groups. Twenty (80%) PROM and ten (18%) preterm labor patients delivered within 72 hours of admission; two (8%) PROM and 38 (76%) preterm labor patients delivered more than 7 days after admission. Absent breathing and body movements had high positive predictive values (100%) but moderate sensitivities (less than 55%) for predicting delivery within 72 hours or 7 days in the PROM and preterm labor groups. These sensitivities increased to nearly 70% with the addition of Bishop scores. The optimal diagnostic cutoffs for delivery within 72 hours or 7 days were a breathing incidence below 1% for the PROM group and a body movement incidence below 1% for the preterm labor group, and a breathing incidence of at most 5%. CONCLUSIONS: Complete absence of one biophysical variable confers limited sensitivity but high positive predictive value for early delivery in patients with preterm labor or PROM. The use of cutoff percentages for the incidence of individual variables improved sensitivity for both conditions. Cervical scoring added to biophysical monitoring by improving the sensitivity for early delivery of patients in preterm labor.

Chi-Square Distribution↗
PubMed1993

[Diurnal variation of active movements: an indication of fetal hypotrophy?].

In a prospective study of 36 pregnancies, the authors made use of the mother's counting of active movements in order to evaluate the correlation between daytime fluctuations in active movements and fetal hypotrophy. With a threshold peak mean evening motor activity no more than 20 p. cent greater than in the morning throughout the period counted, daytime variations were found to have optimal diagnostic capacity for hypotrophy. During the last week preceding delivery, a threshold mean peak evening active movements no more than 35 p. cent greater than in the morning yielded optimum diagnosis of fetal hypotrophy. Furthermore, there was a correlation between daytime fluctuations in active movements and the findings of fetal ultrasound biometry and utero-umbilical flow velocimetry.

Anthropometry↗
PubMed1993

[HIV antigen test of blood donors].

The importance of an optimal diagnostic standard for the prevention of transfusion-associated AIDS (TAA) was recently enforced by a decision of our Supreme Court. Although only 18 transfusion-associated HIV infections following transfusion of approximately 30 million blood units were officially reported since 1985, HIV-1 p24 antigen testing of blood donors was introduced in Hamburg and by the Bavarian Red Cross in summer 1992. So far, no p24 antigen-positive, HIV antibody-negative blood donor has been found (May 1993).

Blood Donors↗
PubMed1993

[Multiple endocrine neoplasia].

The authors review present knowledge on multiple endocrine neoplasias types 1 and 2. They discuss in the light of recent literature data, the natural history, diagnosis, differential diagnosis and the optimal diagnostic approaches of these disorders. A short review on the therapeutic modalities draws attention to important differences between sporadic and inherited endocrine tumors. Finally, the authors emphasize recent developments about the genetic background and the importance of molecular biologic techniques, including family screening in the diagnosis of these disorders.

Endocrine Gland Neoplasms↗
PubMed1993

[Consensus diagnosis pulmonary embolism].

Pulmonary embolism is a frequent occurrence and requires adequate diagnosis and treatment to avoid unnecessary mortality and complications. However, until recently, the optimal diagnostic management was not determined. This prompted the organisation of a consensus meeting. The advised diagnostic strategy was derived from available data in the literature, a cost-effectiveness analysis, and the discussions which took place at the meeting. The preferred diagnostic strategy consists of a combination of perfusion-ventilation lung scintigraphy, ultrasonography of the legs, and finally pulmonary angiography. Perfusion scintigraphy is performed first. If a normal perfusion is seen further anticoagulant therapy may be withheld. Ventilation scintigraphy is performed if a segmental or larger perfusion defect is found. If a normal ventilation scan is obtained (mismatch) the diagnosis of pulmonary embolism is sufficiently certain to warrant institution of long-term anticoagulant therapy. In all other lung scan findings (non-conclusive or non-diagnostic) the meeting advised to perform ultrasonography of the legs. If deep venous thrombosis is detected the patient requires long-term anticoagulant therapy. If a normal ultrasound result is found, pulmonary angiography is required as the final test in the diagnostic strategy.

Cost-Benefit Analysis↗
PubMed1995

[Death or uncertain cause].

The unclear case of death usually occurs suddenly and unexpectedly, but can mostly be attributed to a underlying disease which was unknown during the life-time of the patient. A reduction of mortality might be achieved by improved preventive measures and early treatment. During the last years, the sleeping apnea syndrome as an example turned out to be a considerable risk factor for cardiovascular diseases and accidents. Nevertheless, very many patients exist with an unrecognized sleeping apnea syndrome and are in urgent need of therapy. At first, unclear cases of death in the area of internal medicine can mostly be solved by an autopsy. Autopsy results are demonstrating that only one of three pulmonary embolism has been recognized clinically. The correct diagnosis for an unexpected death in the area of internal medicine could be almost ever found by a more careful differential diagnosis; only a few cases of death remain unclear after optimal diagnostics. At first, one has to think of a pulmonary embolism, cardiac arrhythmias or myocardial ischemia when a sudden death has occurred. Additionally, a pneumothorax, an alimentary bolus or an asthma attack may cause death unexpectedly. Metabolic dysfunctions, poisoning or a ruptured aortic aneurysm are often not recognized as the cause of death if it is not especially looked for.

Asthma↗
PubMed1996

[Therapy-oriented assessment of heart failure in the hospital and clinical practice].

Heart failure represents a complex of symptoms caused by heart disease. The understanding of the underlying pathophysiological changes due to myocardial damage are crucial for an optimal diagnostic evaluation and treatment. The use of vasodilators and ACE inhibitors has led us to realize that the modulation of the neurohumoral system plays an eminent role in the morbidity and for survival of heart failure patients; therefore, the goal must be to recognize as early as possible myocardial damage, preventing the devastating effects of neurohumoral activation. This paper illustrates this aspect and discusses the clinically available therapeutic approaches.

Cardiovascular Agents↗
PubMed1996

The interface of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.

The expanding use of laparoscopic cholecystectomy in conjunction with intraoperative cholangiography and laparoscopic common bile duct exploration has caused a reexamination of the indications of preoperative ERCP. Several studies have demonstrated the benefits of early preoperative ERCP in patients with severe gallstone pancreatitis and acute cholangitis. Those patients with only mild biochemical or radiographic abnormalities suggestive of choledocholithiasis present a clinical dilemma. The optimal diagnostic and therapeutic approach in these patients will depend on the level of expertise of both the biliary endoscopist and laparoscopist. The interface of laparoscopic cholecystectomy and ERCP will continue to evolve as surgeons become more facile with the techniques of laparoscopic common bile duct exploration. When these laparoscopic skills become widely disseminated, the use of ERCP will most likely be relegated to its well-established role in the open cholecystectomy era.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1977

Safe amounts of contrast medium for angiocardiography in neonates and infants.

The results were analysed of 485 (biplane) cineangiocardiograms performed in 200 consecutive cardiac investigations on neonates (under 4 wk) and infants (4 wk to 1 yr). 10 deaths occurred during or within 24 h of cardiac catheterization, all in patients who were profoundly acidemic because of their hemodynamic disturbance. A total dose of Cardio-Conray at any one investigation of 4-5 ml/kg body weight was satisfactory and without undue risk. Single injections of 1.5-2.0 ml/kg body weight were safe whilst providing optimal diagnostic information. The interval between multiple injections did not appear to affect the risk to the patients.

Angiocardiography↗
PubMed1996

Fever without source in infants and young children.

Febrile infants and young children pose a challenge to primary care physicians because the clinical appearance of children who present with fever without source that is related to a viral illness may be similar to the appearance of those with occult bacteremia. The evaluation of the febrile infant and child comprises a comprehensive history, a thorough physical examination and judicious use of laboratory studies. The information derived from this evaluation will help clinicians with the two key management decisions that face physicians caring for this vulnerable population: the initiation and use of antimicrobial therapy, and inpatient versus outpatient management. Although no optimal diagnostic and therapeutic schema exists, physicians should take a structured and rational approach to these patients, depending on their own clinical experience and interpretation of the literature on this topic.

Algorithms↗
PubMed1997

Diagnosing cytomegalovirus disease in CMV seropositive renal allograft recipients: a comparison between the detection of CMV DNAemia by polymerase chain reaction and antigenemia by CMV pp65 assay.

The optimal diagnostic test for CMV disease in renal allograft recipients in a locality with a high CMV seropositive rate has not been fully determined. We compared the usefulness of the CMV pp65 antigenemia (CMV-Ag) assay with the detection of DNAemia by a nested polymerase chain reaction (PCR) method in diagnosing CMV disease in 56 renal allograft recipients, of whom 50 (89.2%) were CMV seropositive prior to transplant (tx). Positive CMV-Ag assays were found in 126/281 samples (44.8%) of 27 patients (48.2%) of whom five had seven episodes of CMV disease. The remaining 22 patients were asymptomatic. The symptomatic patients had significantly higher median peak CMV-Ag levels than the asymptomatic patients [800 (160-1380) vs. 5 (1-604) per 2 x 10(5) peripheral blood leukocyte (PBL), p < 0.0001]. One hundred and eight samples were tested by both CMV-Ag and PCR methods. Out of the 108 samples, 89 showed concordant results (37 positive and 52 negative for both tests). Seventeen samples of 11 patients were CMV-Ag negative/PCR positive. Out of these 11 patients, two had CMV disease and the discrepancy in the results was due to blood samples taken after the start of ganciclovir therapy. Falsely negative PCR tests were found in two samples of two patients with positive CMV-Ag assays. With a outoff antigenemia level of 100 per 2 x 10(5) PBL, the sensitivity, specificity, positive and negative predictive values for diagnosing CMV disease were 100, 96, 71.4 and 100%, respectively. On the other hand, CMV DNAemia was detected in many asymptomatic patients, and the PCR test results correlated poorly with the clinical manifestations of the disease. In symptomatic patients undergoing ganciclovir therapy, the quantification of antigenemia level allowed the assessment of treatment efficacy. In addition, positive CMV-Ag assays at the end of therapy were associated with the subsequent relapse of CMV disease in two patients. The high specificity, together with the short processing time of 4 h, make the CMV-Ag assay the test-of-choice for diagnosing CMV disease in a renal transplant population with a predominance of CMV seropositive patients.

Adolescent↗
PubMed1998

Serological diagnosis of nasopharyngeal carcinoma by enzyme linked immunosorbent assay: optimization, standardization and diagnostic criteria.

OBJECTIVES: To produce an enzyme linked immunosorbent assay (ELISA) to detect antibodies against Epstein Barr virus (EBV) specified nuclear antigen 1 (EBNA 1) and the 18 kD EBV matrix protein, and to determine and optimize its sensitivity and specificity for the diagnosis of nasopharyngeal carcinoma (NPC). METHODS: We used a combination of highly purified glutathione transferase fusion proteins of the 40 kD carboxy domain of EBNA1 and the 18 kD EBV matrix protein for coating ELISA plates. In three separate studies, we tested for IgA antibodies in serum specimens from 28 EBV seronegative donors, 284 EBV seropositive donors and 160 newly diagnosed NPC patients. By comparing the sensitivity and specificity of diagnosis obtained for different cutoff values, we derived several quantitative parameters to evaluate assay performance, establish objective diagnostic criteria which optimize the intrinsic diagnostic capability of the assay and assess the significance of individual test results, respectively. Optimum cutoff optical density (OD) is defined as the cutoff OD where sensitivity of the assay equals its specificity, and resolution of the assay is indicated by the value of sensitivity (or specificity) determined at the optimum cutoff OD. Diagnosis of NPC was achieved by setting a cutoff zone at +/- 20% of this value. RESULTS: All the EBV seronegative donors tested were not reactive, and most of the EBV seropositive donors were weakly reactive, while the majority of NPC patients were moderately or strongly reactive. While the assay was thus shown to be specific for EBV, there was an overlap in the level of these serum antibodies between few individuals of the two latter groups. It was shown that the assay performed equally well in two separate studies conducted under different testing conditions and using different collections of sera in that assay resolution determined on these occasions were 86% and 87% respectively. Diagnosis of NPC can be achieved at the same expected sensitivity of 89% and 83% determined at the lower and upper limits of the cutoff zones, with the corresponding values of specificity being 78% and 91%. It was further shown in the third study that resolution of the assay can be increased to 90% using an assay produced with a higher concentration of the same antigens, and that diagnosis of NPC can be achieved at a higher sensitivity ranging between 86% and 95% at a corresponding specificity of 93% and 86%. CONCLUSIONS: After optimization and standardization, the ELISA can achieve a sensitivity ranging from 86% to 95%, with corresponding specificities of 93% and 86% respectively for the diagnosis of NPC.

Antibodies, Viral↗