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PubMed2006

Utility of biochemical screening in the context of evaluating patients with a presumptive diagnosis of osteoporosis.

The ageing population is expected to increase the burden of osteoporosis on the health care system. Secondary causes of osteoporosis are found in a proportion of patients. There is much controversy regarding the best work-up for patients who have been diagnosed as having osteoporosis based on bone mineral density. It is difficult to decide where interventions should be targeted both from a patient's perspective and for cost effectiveness. We evaluated the utility of a standard panel (full blood count, plasma viscosity, plasma protein, electrophoresis, urine Bence Jones protein, thyroid function test, bone profile, fasting lipids and liver function test) of biochemical investigations in 327 consecutive patients (287 females, 40 males) referred to the new patient osteoporosis clinic from April 1999 to March 2000. Patients were characterised after measurement of spinal/femoral neck bone mineral density after a dual energy X-ray absorptiometry (DEXA) scan. There were 88 patients with osteoporosis, 91 with osteopenia, 130 had normal bone mineral density and 20 who did not have a bone scan. No case of multiple myeloma was found in this cohort of patients. There was no difference in the mean plasma viscosity of patients with and without osteoporosis (P=0.182). There was no significant difference in the abnormal urine calcium/creatinine (Ca/Cr ratio) in patients with osteoporosis and those without osteoporosis (P=0.316). There was no significant difference in the prevalence of hypothyroidism (P=0.213) or thyrotoxicosis (P=0.138) in patients with and without osteoporosis. There was no strong correlation between cholesterol concentrations and osteoporosis (r=0.069). We found no utility in performing a myeloma screen. A small proportion of patients had abnormalities of calcium homeostasis or thyroid disease. We recommend that a screening biochemical evaluation should be restricted to calcium/bone profile and thyroid function tests in patients with a presumptive diagnosis of osteoporosis.

Bone Density↗
PubMed2000

[A simplified six-item checklist for screening of fragile X syndrome].

OBJECTIVE: To investigate whether a simplified six-item checklist could be developed to improve the screening fragile X syndrome test result. METHODS: Nine clinical characteristics were selected from patient records of 190 male and 18 female pediatrics for fragile X screening test were analyzed. The characteristics included mental retardation, family history of mental retardation, elongated face, large or prominent ears, attention deficit hyperactivity disorder, Autistic-like behavior, simian crease, macroorchidism, and hyperextensible joints. RESULTS: Seven cases were diagnosed with fragile X syndrome by Southern analysis on PCR product. Among the nine characteristics, simian crease, macroorchidism, and hyperextensible joints were eliminated, because of low frequency and statistical insignificance. Using remaining six-item clinical checklist, if a score of 6 or more was used as the criteria for screening fragile X test, about 60% of this test in our cases could have been eliminated clinically without missing any positive cases. Thereby the proportion of case with positive results improved 8.8%. CONCLUSIONS: With our simplified six-item clinical checklist, 60% of testing could have been eliminated clinically, thereby improving the effectiveness of fragile X screening test and promoting the proportion of cases with positive results in two groups.

Adolescent↗
PubMed2003

[Retrospective analysis of chief complaints of patients with urogenital malignancies over the past decade at the Jikei University Hospital].

We analyzed the chief complaints of patients with four major urogenital malignancies (renal cancer, renal pelvis and ureter cancer, bladder cancer and prostatic cancer) over the past decade (1990-1999) at the Jikei University Hospital. Over the last 10 years, a high percentage of renal cancers were detected incidentally. By contrast, prostatic cancers were more likely (10.5%) than other cancers to be detected on the basis of symptoms of metastasis. However, since 1995 more prostatic cancers are being detected with prostatic-specific antigen screening at the health checkups. Gross hematuria is the chief complaint of most patients with uroepithelial cancers (cancers of the renal pelvis, ureter and bladder cancer). Additionally, renal pelvis and ureter cancers were diagnosed with screening in a few patients in the past five years.

Carcinoma, Renal Cell↗
PubMed1995

[Natural history of HCV seropositive cases found in health screening].

In order to elucidate causative factors in HCV infection and natural history of HCV seropositive cases, examinees of adult health screening in two rural districts near Asahikawa (Groups A and B) were tested for HCV antibody and the clinical data of the HCV seropositive cases were retrospectively followed up. The examinees who showed cut-off index not less than 2.0 in C100-3 antibody test were taken as HCV seropositive cases. HCV seropositive rate was 5.1% for Group A, compared with 2.7% for Group B. HCV related factors were examined between HCV seropositive cases and age/sex-matched controls in the same group. As a result, blood transfusion and operation histories proved to be responsible for HCV seroreactivity in both Groups A and B. Although no significant difference was noted in blood transfusion and operation histories between Groups A and B, the rates with past history of liver disease, HBV exposure, and advanced age above 60 were significantly higher for Group A, suggesting HCV related factors other than blood transfusion and operation to be regionally different. Majority of HCV seropositive cases (79.2%) were ALT-normal, but 42.5% and 32.5% of this group showed ZTT- and ADA-abnormality, compared with 6.5 and 10.9% of the normal ALT group of HBV carriers respectively. HCV seropositive cases could be classified as ALT-abnormal (group I), ALT-transition from normal to abnormal (group II) and ALT-persistently normal (group III), depending on the change in ALT level during follow-up period. Of these, group III represented 38% of HCV seropositive cases. The rate in which the HCV seropositive cases of this group III showed ZTT abnormality at least once during follow-up period was 81% and significantly higher than 43.5% for HBV carriers with persistently normal ALT level. Significant correlations between ZTT and IgG values were noted for both HCV seropositive cases and HBV carriers with persistently normal ALT level. For HCV seropositive cases, ZTT and IgG showed broad distributions from low to high values, compared with distribution in normal area for HBV carriers. ZTT-abnormality in HCV seropositive cases may reflect some hepatic changes, because no other factors contribute to their ZTT abnormality. At least, some of group III HCV seropositive cases found in health screening may represent those who make no progress with chronic persistent hepatitis.

Adult↗
PubMed1992

[Utility of SCG (screening colonography) and combined sigmoidoscopy-SCG in thorough physical checkups].

Given the increasing incidence of colon cancer in recent years, it is important to establish a diagnostic system for early detection and introduce it into clinical practice. A double contrast examination that uses a disposable tip and tube with an enema reservoir filled with 200 ml of 60 w/v% barium sulfate, known as SCG (screening colonography) was used in this study. In order to assess its utility SCG was performed on 1,554 patients, and 2,004 patients were examined by a within 24 hours combination of sigmoidoscopy and SCG by way of screening for colon cancer. Given the brief duration of SCG, which ranged from 10 to 13 min in most patients in the study, the efficiency of the examinations was considered to be rather high. Furthermore, the barium reached the cecum in as many as 98.7% of the patients. Overall, SCG proved to have an excellent diagnostic capability. Sigmoidoscopy-SCG, on the other hand, detected colon cancer in 114 patients (5.7%) and colon polyps in 658 patients (32.8%). The rates of detection of colon cancers and polyps were higher in the patients who tested positive in immunological fecal examinations for occult blood. Judging from our results, it may be said that for many patients receiving thorough physical checkups to screen for colon cancer, our system will provide for efficient screening whereby patients are first examined for fecal occult blood and those who test positive undergo sigmoidoscopy and SCG within the same day.

Adult↗
PubMed1983

[Screening for colorectal carcinoma in AMHTS (automated multiphasic health testing and services)].

A mass survey program for the early detection of colorectal carcinoma was tested on asymptomatic persons who visited the AMHTS (Ningen-Dokku). During a 10-month period, 4574 of 8216 persons over the age of 45 years participated in this program. They were screened by the 3-day fecal occult blood test using guiac method. Barium enema examination was performed in 50 of 84 persons who were selected by the screening tests. Tow cases of advanced carcinoma and 10 adenomas were detected.

Adult↗
PubMed2006

Three-stage contingent screening for Down syndrome.

OBJECTIVE: To demonstrate the potential value of three-stage sequential screening for Down syndrome. METHODS: Protocols were considered in which maternal serum pregnancy associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (hCG) measurements were taken on all women in the first trimester. Those women with very low Down syndrome risks were screened negative at that stage and nuchal translucency (NT) was measured on the remainder and the risk reassessed. Those with very low risk were then screened negative and those with very high risk were offered early diagnostic testing. Those with intermediate risks received second-trimester maternal serum alpha-fetoprotein, free beta-hCG, unconjugated estriol and inhibin-A. Risk was then reassessed and those with high risk were offered diagnosis. Detection rates and false-positive rates were estimated by multivariate Gaussian modelling using Monte-Carlo simulation. RESULTS: The modelling suggests that, with full adherence to a three-stage policy, overall detection rates of nearly 90% and false-positive rates below 2.0% can be achieved. Approximately two-thirds of pregnancies are screened on the basis of first-trimester biochemistry alone, five out of six women complete their screening in the first trimester, and the first-trimester detection rate is over 60%. CONCLUSION: Three-stage contingent sequential screening is potentially highly effective for Down syndrome screening. The acceptability of this protocol and its performance in practice, should be tested in prospective studies.

Algorithms↗
PubMed1990

Results of a work-site educational and screening program for hypertension and cancer.

Cardiovascular disease and cancer account for 68% of deaths in the United States each year. Office-based screening efforts to detect early or asymptomatic disease have been modestly successful at best, as neither patients nor physicians routinely follow American Cancer Society guidelines. The work site, representing a captive group of patients, is an alternative screening site. Eight hundred eighty-eight employees at 10 work sites were screened for hypertension and six types of cancer (oral, breast, rectal, colon, prostate, and testicular). Fifty-one employees with new onset or poorly controlled hypertension were identified, along with two early cancers (rectal, breast) and four malignant precursors. Potential dollar savings to employee, employer, and society were three times the cost of the screening program. Screening at the work site represents an efficient, cost-effective approach for the early detection of hypertension and cancer.

Adult↗
PubMed2000

[Screening for prostatic diseases in one-day total health check-up by using prostate specific antigen, international prostate symptom score and QOL index].

We preliminarily studied screening for prostatic diseases in one-day total health check-up by employing prostate specific antigen (PSA), international prostate symptom score (IPSS) and quality of life (QOL) index. From January 6 to March 31, 1998, a total of 390 men were included in this study, whose age ranged from 50 to 78 years with the mean of 57.5 years. The questionnaires, IPSS and QOL index, were mailed to the participants in advance. PSA (IMx: Dainapack) was measured at the end of the health check-up and the results of tests were explained on the same day. Participants who showed more than 8 points in IPSS, more than 4 points in QOL index and/or more than 4.1 ng/ml in PSA were given a referral to urologists of corresponding hospitals for further examination. A total of 116 men (29.7%) were judged to need thorough examination. Among 106 men who were referred to urologists, only 34 (32.1%) had visited the urologists by the end of July 1998. Two men (0.51% in all participants) were diagnosed with prostate cancer, 10 received some pharmacotherapy, and 2 underwent transurethral resection of prostate. The results indicate that screening for prostatic diseases in total health check-up is useful, even in an institute without staff urologists, in close association with urologists.

Aged↗
PubMed1999

Possible advantages and drawbacks of adding flexible sigmoidoscopy to hemoccult-II in screening for colorectal cancer. A randomized study.

BACKGROUND: Flexible sigmoidoscopy (FS) has been recommended as a screening method to reduce mortality from colorectal cancer (CRC). The present study evaluates the effect of adding FS to the fecal occult blood test Hemoccult-II (H-II) on diagnostic yield of colorectal neoplasia. METHODS: A total of 10,978 normal persons aged 50-75 years were invited to participate, 5495 persons being allocated at random to H-II and FS and 5483 to H-II alone. RESULTS: In spite of a lower compliance (40% versus 56%) for the combined procedure, the diagnostic yield of colorectal neoplasia was higher than for H-II alone (12 CRC versus 4 CRC, and 72 large adenomas versus 14). Within 24-62 months after screening there were fewer CRCs detected after H-II + FS than after H-II alone. The stage distribution was less favorable than in screen-detected cases. CONCLUSION: One FS may not be an optimal way of screening, but FS deserves to be evaluated in randomized population studies including repeated H-II tests in the control arm.

Aged↗
PubMed1976

Serum gamma-glutamyl transpeptidase as a diagnostic aid in the periodic health examination.

Serum gamma-glutamyl transpeptidase is one of the enzymes in diagnosis of liver diseases, since a new colorimetric method was devised by Orlowski, M. et al. Forty mU/ml of serum gamma-glutamyl transpeptidase activity is said to be the upper limit at clinical level. When this value is set up as a screening level in the periodic health examination, about 35% of the subjects including daily drinkers can be evaluated as abnormal. In the present study, the upper limits of serum gamma-glutamyl transpeptidase activity were 102 mU/ml for 147 normal subjects including daily drinkers and 49 mU/ml in 70 non-drinkers selected from the subjects. Therefore, we propose that the standards for screening the abnormal from the normal in the periodic health examination should be 50 mU/ml for non-drinkers and 100 mU/ml for drinkers.

Adult↗
PubMed1998

[Check-up studies at an internal medicine polyclinic: reasons, diagnostic tests, results and therapeutic consequences].

Data of an investigation on initial motives for and outcome of so-called diagnostic check-ups are presented. Over a period of about one year a total of 82 persons applying for such a check-up have been investigated. Concrete reasons for this step were not given initially, however, elucidated in 87% of cases after special interrogation. Mostly fear of carcinoma or HIV-infection because of unspecific symptoms or diseases of family members or friends was reported. Clinical status and additionally arranged investigations (laboratory and others) revealed as a rule no further relevant pathological findings, thus, acting mainly to exclude rather than prove a disease. If motives for such check-ups could be elucidated in time, a more focussed, cost-effective investigation could be initiated, with more benefit for the patient and higher satisfaction for the physician. Such a screening consultation might represent furthermore a good opportunity to communicate preventive aspects to the patient.

Adult↗
PubMed1998

Effects of an assessment of needs for medical and social services on long-term mortality: a randomized controlled study.

BACKGROUND: The aim of this study was to investigate the long-term effects of one general health screening on mortality. METHOD: After stratification and randomization of a population of 450,000 inhabitants, two groups were formed, an intervention group of 3064 people and a control group of 29,122 people. From the National Cause of Death Register, data were collected as regards death and causes of deaths for 1970-1990. RESULTS: Multivariate analysis was used to correct for known confounders. We then found no differences between the groups regarding deaths from all causes, cardiovascular diseases, cancer or accidents and poisoning. CONCLUSIONS: One general health screening seems to have little, if any value in preventing fatal diseases.

Adolescent↗
PubMed2002

Objective screening methods for prior refractive surgery in donor tissue.

PURPOSE: Laser refractive surgery presents a growing contamination of the available corneal donor pool. There currently is no objective method for screening donor tissue for previous refractive surgery. We evaluated the usefulness of pachymetry and curvature maps in the screening of donor corneas. METHODS: Pachymetry and curvature maps were generated from the Orbscan for 40 normal donor eyes. The average central pachymetry measurement was subtracted from the thinnest average midperipheral pachymetry measurement for each map to generate a normal range of pachymetry measurements. For curvature, the average curvature at the 3-mm zone was subtracted from the average curvature at the 7-mm zone to generate a normal range of corneal curvature. The pachymetry and curvature results from 10 donor eyes that had undergone refractive surgery were then compared with the normal range for each technique. RESULTS: The average difference in pachymetry measurements between the midperipheral and central cornea for normal eyes was 0.040 +/- 0.026 mm. Four of 10 corneas that had undergone refractive surgery were outside two standard deviations of this normal range. The average difference in corneal curvature between the 7-mm zone and the 3-mm zone for the healthy eyes was -0.2 +/- 1.0 diopters. Four (40%) of 10 corneas that had undergone refractive surgery were identified with this method. When combined, the pachymetry and curvature methods detected seven (70%) of 10 corneas that had undergone refractive surgery. CONCLUSION: Regional differences in thickness and curvature in donor eyes may provide methods for screening for refractive surgery for myopia. Refinement in mathematical manipulations may further improve the sensitivity of these techniques.

Adult↗
PubMed1978

EPSDT in practice: what's happening in the field?

A study of five local program operations in different states around the country indicates that EPSDT is presently ineffective in identifying, referring, and treating children with developmental difficulties. It is suggested that problems in implementation are not merely administrative, and that developmental screening may best be carried out within the context of routine, comprehensive pediatric assessment.

Adolescent↗
PubMed2000

Coronary and major vascular disease: aggressive screening and priority-based therapy.

It is well know that atherosclerosis can simultaneously affect different vascular subsystems, and patients with diffuse atherosclerosis can be a major management problem both for preoperative evaluation and for intraoperative management. The authors have conducted a prospective study to evaluate the prevalence of coronary artery disease in arteriopathic patients, and vice versa, to assess the effectiveness of aggressive screening together with a priority-based approach. Study 1 consisted of 1,000 consecutive non-emergent patients who were affected by abdominal aortic or carotid disease and were screened for the presence of coronary artery disease before surgery with a newly developed clinical risk assessment. They were stratified into three risk categories with different preoperative evaluation strategies. When coronary artery disease was concomitantly demonstrated in these patients, the choice of surgical method was based on priorities, and the use of combined surgical procedures as required. In study 2, 1,000 consecutive patients that required coronary angiography for suspected coronary artery disease were screened for the presence of carotid or abdominal aortic pathology, directly in the cardiac catheter laboratory during coronary angiography, by obtaining views of the aortic arch and abdominal aorta. Surgical approaches paralleled those of study 1. The results for study 1 showed that 720 patients (72%) were affected by abdominal aortic disease, 238 (24%) by carotid disease and 42 (4%) by both pathologies. Significant coronary artery disease was found in 152 patients (15%), of these 123 (81.5%) were affected by abdominal aortic disease and 29 (18.5%) by carotid artery disease. Abdominal aortic surgery was performed directly or after myocardial revascularization, with an overall mortality rate of 4/718 (0.6%), and a perioperative myocardial infarction rate of 10/718 (1.4%). For patients with carotid artery disease, the completed screening and possible therapy for coronary artery disease resulted in an in-hospital mortality rate of 2/238 (0.8%), and a perioperative myocardial infarction rate of 2/238 (0.8%). There were no significant differences in these rates between patients with or without coronary artery disease. Results for study 2 showed that of the 1000 consecutive patients enrolled for suspicion of coronary artery disease, 767 (77%) were affected by significant coronary artery disease. Among these, 38 (4.9%) had a surgically correctable aortic disease and 31 (4%) a surgically correctable carotid disease, which was monolateral and bilateral in 22 (74%) and nine (26%) patients, respectively, and four (0.5%) were diagnosed with both pathologies. These arteriopathic patients were treated for their coronary and vascular disease with no in-hospital mortality nor perioperative myocardial infarction. In patients with multiple vascular involvement, both coronary and vascular surgery can be performed with low risk when aggressive screening and priority-based therapy are adopted.

Angioplasty, Balloon, Coronary↗
PubMed1991

Prevalence study of oral precancerous lesions within a complex screening system in Hungary.

Previous epidemiological studies, performed in conjunction with compulsory lung screening examinations, showed good results in detecting oral lesions in Hungary, where the mortality rate of oropharyngeal cancer has increased by more than 30% in the past decade. Oral examinations were performed on a district population sample in Budapest, called regularly for X-ray lung examinations. Precancerous lesions and conditions were diagnosed and grouped according to internationally accepted criteria. Oral examinations of 7820 individuals were performed: 42.9% in men and 57.1% in women; 42% of all examined subjects were over 60 yr of age. Oral leukoplakia was diagnosed in 104 cases (1.3%). Histologic examination revealed squamous cell carcinoma in one case. About 70% of oral leukoplakias occurred in men and 30% in women. Oral lichen was diagnosed in six cases (0.08%). The prevalence of smokers was 86.5% in the leukoplakia group as compared with with 29% in the non-lesion group. The new organizational screening model seems to function well in the "risk group" of elderly persons, especially in the early diagnosis of oral cancer and precancerous lesions.

Adolescent↗