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PubMed1995

Updated management strategy for patients with cervical osteophytic dysphagia.

Anterior cervical osteophytes impinging upon the pharynx or esophagus constitute a rare cause of dysphagia. In severe cases, surgical removal of these osteophytes can provide symptomatic relief. We describe a patient of this type who failed to improve postoperatively, only to be found subsequently to have a carcinoma of the base of the tongue. To assist other clinicians in evaluating similar patients, and also to emphasize the great utility of modern radiologic techniques in these cases, we propose a diagnostic algorithm that incorporates magnetic resonance or computerized tomographic imaging.

Aged↗

PubMed1988

The impact of magnetic resonance on the diagnostic evaluation of acute cervicothoracic spinal trauma.

From 1984 to 1987 magnetic resonance (MR) imaging was performed on 100 patients suffering acute spinal trauma. MR demonstrated one or more injuries to the cervicothoracic region in 31 patients. It displayed a spectrum of spinal cord injury ranging from mild compression and swelling to complete transection. MR was also useful in evaluating alignment at the cervicothoracic junction, in depicting ligamentous injury, in establishing the presence of disc herniation, and in identifying unsuspected levels of injury. We present a diagnostic algorithm that incorporates the role of MR in evaluating acute cervicothoracic spinal trauma and emphasizes the replacement of myelography by MR in the initial assessment of neurologic deficit.

Acute Disease↗

PubMed1997

Prenatal diagnosis of the fetus with cystic fibrosis and meconium ileus.

The sonographic finding of hyperechoic or dilated fetal bowel raises suspicion of a number of prenatal disorders including meconium ileus (MI), meconium peritonitis, congenital infection, neoplasm, or chromosomal trisomy. These findings may also represent transient normal variants. The following case report details the evaluation of one pregnancy with abnormal intestinal echogenic findings on serial sonograms (US), to demonstrate inherent diagnostic difficulties in such a case. A diagnostic algorithm is presented to aid in the proper use of US and DNA mutation analysis for cystic fibrosis (CF), so that the cause of an abnormal abdominal US can be established earlier and more accurately than suggested by previous management schemes. Earlier fetal diagnosis may help to anticipate postnatal problems associated with CF/MI, and therefore provide more optimal clinical management of the affected fetus.

Adult↗

PubMed1984

Detection of intraperitoneal bile accumulations: significance of ultrasonography, CT, and cholescintigraphy.

Free or loculate intraperitoneal fluid can easily be detected by ultrasonography or computerized tomography. The differentiation of bile fluid from other liquid collections and the documentation of the presence and extent of a bile leak can be difficult diagnostic problems. In representative case studies the use and the diagnostic limits of ultrasonography and CT in the diagnosis of intraperitoneal bile accumulations are discussed. A diagnostic algorithm including cholescintigraphy for the evaluation of biliary leakage is proposed.

Adult↗

PubMedDate not supplied

Prevention of deep vein thrombosis in patients with hip fractures: low molecular weight heparin versus dextran.

A randomized open trial was undertaken to compare the antithrombotic efficacy of a low molecular weight heparin (LMWH; Sandoparin) with that of dextran 70 in patients undergoing surgery for hip fracture. One hundred thirteen patients received LMWH once daily subcutaneously at a fixed dosage while 103 patients received intravenous dextran 70. Postoperative deep vein thrombosis (DVT) was assessed by a diagnostic algorithm using the 125Iodine fibrinogen uptake test as screening and Duplex ultrasonography and/or ascending venography as confirming techniques for suspected DVT. The frequency of DVT was significantly lower in the LMWH group than in the dextran group (15.5 versus 32.6%, p less than 0.005). Proximal DVT was rare in both groups (LMWH: 2%, Dextran: 1%). Only one case of fatal fat pulmonary embolism was observed during the 10 day prophylaxis period in a patient receiving Dextran. Three cases of pulmonary embolism occurred later; one fatal event in the dextran group on day 14, and two cases in the LMWH group (one fatal and one non-fatal event) on day 14 and 17, respectively. There was no major bleeding complication in either group. We conclude that the LMWH we used is safe, was well tolerated, and has a significantly better thromboprophylactic effect than dextran 70.

Adult↗

PubMed1989

Autism diagnostic interview: a standardized investigator-based instrument.

The development of a new standardized investigator-based interview for use in the differential diagnosis of pervasive developmental disorders is described, together with a diagnostic algorithm (using ICD-10 criteria) based on its use. Good interrater reliability for algorithm items was shown between four raters, two in Canada and two in the UK, who rated 32 videotaped interviews. The items also significantly discriminated between 16 autistic and 16 nonautistic mentally handicapped subjects. The algorithm based on ICD-10 identified all 16 autistic individuals and none of the 16 nonautistic subjects.

Adolescent↗

PubMed1977

Progress toward a second generation Laboratory Information System (LIS).

A Laboratory Information System (LIS) is a convenient organization of programs and hardware designed to meet the health care delivery needs of a department of pathology. A full service LIS is now a commercially viable product and after 2 years of experience, certain desirable design features are evident for a second generation system. Such variables as hardware configuration, physical plant, libraries, diagnostic algorithms, system usage and surveillance, and manpower and human engineering are now significant operational features and essential for LIS acceptance by a department of pathology as well as the practicing medical staff.

Data Display↗

PubMed2003

[Pregnancy and cardiomyopathies].

This overview on the topic of cardiomyopathy and gestation comprises the diagnostic and therapeutic options of patients with preexistent cardiomyopathies (dilated, hypertrophic, inflammatory, and others) and with cardiomyopathies which have been discovered during or in the 6 months following delivery. CARDIOMYOPATHIES PREEXISTENT BEFORE GESTATION: If cardiomyopathy is present before an intended gestation, the couple should be advised against pregnancy because of the high risk of deterioration both during gestation and peripartum. If pregnancy occurs, according to ESC (European Society of Cardiology) recommendations termination should be advised if the ejection fraction is < 50% and/or the LV dimensions are definitely above normal. If termination is refused, the patient must be checked regularly by both gynecologist and cardiologist, by the latter to perform regular echocardiograms. Termination is not recommended for the hypertrophic (nonobstructive) cardiomyopathies. If atrial fibrillation occurs, anticoagulation with low molecular weight heparin and digoxin and/or Betablockers are recommended for rhythm and rate control. PERIPARTUM CARDIOMYOPATHIES: In peripartum cardiomyopathies, which are discovered clinically postpartum, inflammation of the myocardium sometimes associated with pericarditis is frequently found. For those patients, we recommend heart catheterization with endomyocardial biopsy to allow for the exact diagnosis of the underlying cardiac process (inflammatory and/or viral vs autoreactive myocarditis or noninflammatory or nonviral [= idiopathic] forms). This diagnostic algorithm, which we recommend for any form of dilated cardiomyopathy, bears impact on treatment options beyond the mere heart failure therapy that should be instigated anyhow.

Abortion, Induced↗

PubMed2004

[Environment-related health disorders. Experience and perspectives in the care of patients with environment-related health disorders].

Environmental medicine outpatient clinics, counseling centers, and practicing physicians have observed environment-related health disorders in patient groups of mixed age as well as for groups consisting only of adults or children. Practicing physicians suspected correlations between environmental factors and health disorders in 36-45% of cases, environmental medicine outpatient clinics and counseling centers in 4-34% for mixed-age groups, 0-24% for adults, and 9-13% for children. A comparison of these data is difficult due to differences in data acquisition, evaluation methods, and descriptive statistics used. Furthermore, data on children are insufficient. Patient-oriented environmental medicine faces a number of problems regarding determination of exposure, effects, and susceptibility, including a lack of scientifically verified cause-and-effect models as well as incorrect diagnoses, attributions, and conclusions. In view of the scope and intensity of environment-related health disorders, the topic cannot be ignored. A functioning program of environmental medicine counseling and patient care is needed for practicing physicians, universities and/or the public sector to deliver effective primary medical care in this field. As always, the building blocks of environ-mental medicine counseling are medical history, physical examination, differential diagnosis, human biomonitoring, and on-site inspection with environmental monitoring while also taking gender differences into account. Uniform basic documentation procedures and health science analyses will help to optimize patient care in environ-mental medicine. The value of a diagnostic algorithm in the care of patients with environment-related health disorders is beyond dispute. Last but not least, quality assurance and control are a sine qua non of patient-oriented environmental medicine.

Adult↗

PubMed1997

[Widening mediastinum after blunt thoracic trauma: an unexpected differential diagnosis].

We report our experience concerning a young, white, healthy woman who had a typical blunt chest injury caused by a severe car accident. We had to evaluate and differentiate the initial roentgenographic post-traumatic mediastinal enlargement in order definitely to exclude a suspected covered rupture of the thoracic aorta or the heart caused by this high-velocity deceleration trauma. The difficulties encountered are critically discussed with regard to the unexpected primary thymoma that was diagnosed postoperatively. The diagnostic algorithm in blunt chest injury is also discussed. The controversy about the classification and management options of primary thymic tumors is also presented.

Adult↗

PubMed2001

[The role of diagnostic PET in treatment planning before tumor surgery].

Positron emission tomography (PET) can be used for the noninvasive biochemical analysis of lesions whose benign or malignant nature cannot be assessed by morphological methods alone. This information and the possibility of quantitation are the reasons for the successful application of PET in staging, diagnosis of tumor recurrence and therapy monitoring in different malignant tumors. Since malignant tumors show characteristic biochemical properties with an enhancement of glucose metabolism, 18fluorodeoxyglucose (FDG) has proven useful for oncologic studies. This paper deals with the influence of PET on the surgical and other therapeutic procedures in patients with cancer of the lung, thyroid, intestine, breast and soft tissue. PET is useful for the mediastinal staging of patients with lung cancer and the evaluation of persistent tissue or tumor recurrence after treatment of lung cancer and colorectal cancer. Furthermore, important information is obtained for the staging of colorectal cancer and mammary carcinoma. PET is also indicated in patients with colorectal cancer or mammary carcinoma and a rising tumor marker. An important future application is therapy monitoring. New treatment modalities will raise new problems in terms of functional diagnosis for the different imaging procedures. Therefore, future work has to concentrate on the establishment of diagnostic algorithms for the optimization of therapy.

Breast Neoplasms↗

PubMed2004

[Post-traumatic embitterment disorder (PTED). Differentiation of a specific form of adjustment disorders].

Adaptation disorders are a heterogeneous group of mental disorders. Although they play a major role in clinical practice, are difficult to treat, and often lead to chronicity and disability, diagnostic algorithms are vague and scientific research is rare. Clinical practice has shown a subtype of adaptation disorder that is characterized primarily by lasting embitterment after exceptional though normal life events which violate basic beliefs. This disorder can be called post-traumatic embitterment disorder (PTED). A case vignette and results of a pilot study are reported. Critical life events were found to be job loss in 38%, conflicts at work in 24%, death of a loved one in 14%, familial strain in 14%, and other events in 10%. When reminded of the critical event, patients report feelings of embitterment (85.7%), sadness (81.0%), anger (76.2%), or helplessness (75.0%). When standardized assessments are made, they fulfill criteria of various comorbid disorders such as GAD (38.1%), depression (33.3%) and dysthymia (33.3%), agoraphobia (28.6%), or panic (19.0%). Of the patients, 81% said they avoid places which remind them of the critical events. Impairments were suffered in work (70%), leisure (65%), and familial relations (57.1%).

Adjustment Disorders↗

PubMed1999

[Skull and brain injuries in children].

Our contribution reviews the diagnostic algorithm of head injuries in children. According to the Heidelberg consensus on head injury, patients should be divided into three risk groups. In low-risk patients clinical observation is the method of choice and radiological examinations are usually unnecessary. Patients at medium risk should be observed carefully. Sometimes neurosurgical consultation or CT is necessary. High risk patients in most instances need CT and neurosurgical consultation. Skull X-ray is helpful only in selected cases. A simple fracture as demonstrated by skull X-ray has no therapeutic consequence. However, normal findings in skull X-ray do not exclude intracranial injury. CT is the method of choice to detect intracranial hemorrhage, epi- or subdural hematoma and cerebral contusion. If patients present with severe clinical deficits, CT allows characterization of lesions and initiation of specific therapy.

Brain Injuries↗

PubMed1999

[The painful hip in childhood].

The etiology of the painful hip in children is widespread. In this paper, predominants cases without previous trauma are discussed in detail. Depending on age, history, clinical picture and laboratory results, an imaging diagnostic algorithm is presented, which should avoid unnecessary tests and lead to the necessary therapeutic measure. Several common as well as uncommon clinical entities are illustrated by representative examples.

Child↗

PubMed2001

[Bronchial carcinoma screening with low dosage CT. Current status].

Lung cancer is the most common cause of death from malignancy. It is characterized by a favourable prognosis when treated in early stages and a poor prognosis in advanced stages. Populations at risk are relatively well defined, i.e. heavy smokers and workers exposed to asbestos and radon. Therefore, early detection using diagnostic techniques promises reduction of mortality from this tumor. Previous studies using chest radiography and sputum cytology were, however, disappointing due to poor sensitivity of these tests for early tumor stages. The new technique of low-dose computed tomography provides both high sensitivity for small tumors and a comfortable examination. As small benign pulmonary nodules are common reliable non-invasive diagnostic algorithms are required for classification of nodules. Preliminary studies using low-dose CT screening in smokers have provided promising results. Prior to a wide application of the technique in clinical routine more data are required as to inclusion criteria, examination intervals and the effect of screening on mortality reduction.

Carcinoma, Bronchogenic↗

PubMed2001

[Rational radiologic after-care of endoluminal aortic bypass].

GOAL: To identify essential and relevant diagnostic algorithms in the follow-up of stent-grafts placed for aortic dissections and aneurysms based on our 7 years experience including the use of more than 10 different devices. MATERIAL AND METHODS: Evaluation of conventional biplane imaging, angiography, sonography, CT and MR in the efficacy of demonstrating endoleaks, sac shrinkage, changes of stent-graft integrity and, with special reference to MR-compatibility of various stent-graft devices. RESULTS: Endoleaks are found in 20-30% of patients after endovascular exclusion of abdominal aortic aneurysms. However, this rate neither necessarily reflects the clinical course nor the onset and course of sac shrinkage. Physical long-term integrity of the devices is seen best on conventional bi-plane radiographs. Sonography is helpful only in selected patients (non-obese, good compliance) otherwise not providing information precisely enough for sac control. As gold standard both CT (CTA) and MR (MRA) are equally effective in the follow-up of endovascular stent-grafts, allowing 3D control of sac geometry in aneurysmal disease or hemodynamic changes in stent-grafts for aortic dissection. MRI is considered to be more effective in the detection of small endoleaks. Angiography is inferior to CT and MRI in the diagnosis of endoleaks and thus is required only for intervention planning in patients with suspected endoleaks. Two of 8 evaluated stent-graft devices proved to be prohibitive for MRI because of their severe artifacts productions (Life-path, Zenith) as a result of their thick metallic meshwork. CONCLUSION: CT including CTA with 2D and 3D reformatting is the method of choice for the follow up of stent-graft treatment of aortic disease. Depending on availability, MRI may be used alternatively. In young patients and for those with contraindications to iodinated contrast media MRI is a perfectly equivalent alternative. Especially in patients with known contraindications to iodinated contrast media the MR-compatibility should be taken into consideration in the choice of the endovascular device.

Aged↗

PubMedDate not supplied

Fetal echocardiography in ectopia cordis.

Ectopia cordis is an extremely rare congenital abnormality occurring in 5.5 to 7.9 per 1 million live births with high lethality. Between January 1995 and October 1997 eight cases of ectopia cordis were diagnosed at our institute before birth. On the basis of echocardiography the fetal heart anatomy was categorized as either normal heart anatomy (NHA; n = 3) or congenital heart defect (CHD; n = 5). In the majority of cases (seven of eight) other abnormalities were present. Some reports have described ectopia cordis being diagnosed in the first trimester of pregnancy. In our study group the average gestational age at diagnosis was 26 weeks. The prenatal diagnosis of isolated ectopia cordis is easy; counseling the patient, the perinatal management including term, place, and method of delivery, and optimal care of the newborn are more difficult. Ectopia cordis is a malformation that pediatricians rarely encounter, even at pediatric cardiology centers. Much more frequently it is a problem for sonographers and obstetricians; however, pediatric cardiologists should be aware of diagnostic algorithm for such cases, especially when additional abnormalities are present.

Abnormalities, Multiple↗

PubMed1999

Economic evaluation studies in nuclear medicine: the need for standardization.

The guidelines for publishing economic evaluations require a statement of the economic importance of the analysis and the viewpoint from which it has been carried out, as well as specification of at least two alternative programmes or interventions, the form of economic evaluation, the outcome measure, the method of costing, the time horizon and adjustment for timing of costs and benefits (e.g. by a discount factor), and the allowance for uncertainties (e.g. by implementation of a sensitivity analysis). The decision analysis can be based on clinical trial data, on retrospective or administrative databases, or on modelling. The choice of outcome measures is the key issue in an economic evaluation. In cost-effectiveness analysis, benefits are usually measured in natural units. This is the form of economic evaluation most frequently used in nuclear medicine. Endpoints of effectiveness applied in studies in this field have been procedures avoided, procedures initiated, cardiac events, survival probability, morbidity, quality of life and protracted or failed surgical procedures. In other instances, surrogate endpoints have been used such as metastases detected, staging, viability or tumour response. This, however, limits comparability of cost-effectiveness considerably, as proof of a change in the health outcome cannot be obtained. Measures of utility such as QALYs (quality-adjusted life years) have so far only been applied for decision tree analysis. Useful examples of economic evaluation studies in nuclear medicine are presented here for fluorodeoxyglucose positron emission tomography (FDG-PET) in the preoperative staging of non-small cell lung cancer, for FDG-PET in differentiating indeterminate solitary pulmonary nodules, for somatostatin receptor scintigraphy in detecting metastases of carcinoid tumours, for routine preoperative scintigraphy with sestamibi in patients with parathyroid adenoma, for periodic measurement of thyroid-stimulating hormone in detecting mild thyroid failure, for diagnostic algorithms including a lung scan in patients with suspected pulmonary embolism, for myocardial perfusion imaging as an incremental prognostic factor in patients with coronary artery disease, and for the use of radioiodine as first-line therapy of Graves' hyperthyroidism and of toxic nodular goitres. Further evaluations of effectiveness or utility should be carried out within a multidisciplinary framework to ensure that nuclear medical procedures are included in the general management guidelines.

Cost-Benefit Analysis↗