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Results for “diagnostic optimization”

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At least 613 records · Page 34Linked to original sources
PubMed2002

[Diagnosis and surgical treatment of pathologic tortuosity of carotid and vertebral arteries].

The article summarizes an experience with 179 surgical interventions on patients with pathological tortuosity of brachiocephalic arteries. The optimal described diagnostic algorithm for this pathology included ultrasonic dopplerography, transcranial dopplerography, angiography or magnetic resonance tomography in the angiography regimen. Clinical and angiographic indications to surgical treatment of this pathology were determined. The operative treatment was carried on in patients with neurological symptoms having kinks of brachiocephalic arteries. The intraoperative strategy depending on the type and localization of the disease are analyzed. Stabile regression of manifestations of vascular cerebral insufficiency after surgical correction of the pathological tortuosity of the brachiocephalic arteries was achieved in 76% of the patients.

Adult↗
PubMedDate not supplied

[Algorithms of x-ray and ultrasonic diagnoses in urology].

Roentgenourologic methods and ultrasonic scanning (USS) should be combined in the radiologic diagnosis of urologic diseases. USS should be the first stage of examinations of urologic patients, and its results should be taken into account when planning and carrying out excretory urography. USS can be repeated before more sophisticated roentgenourologic examinations in order to single out the "zones of interest"; special programmes are possible for the purpose-pharmacoechography, dopplerography, etc. Development of tentative algorithms of x-ray and ultrasonic diagnosis of the major urologic diseases will help optimize the diagnostic process.

Algorithms↗
PubMed2003

[Primary hyperaldosteronism: report of two cases (normalization of hypertension after adrenalectomy)].

Two cases of Conn Syndrome with high hypertension, who were successful operated, have been prescribed. Retrospective evaluation of both cases suggests that severe and hypocalemic hypertension should motivate the researchers towards primary hyperaldosteronism. Etiology of the disease remains to be an important diagnostic challenge, optimal treatment will vary for each case of primary hyperaldosteronism. For individuals with aldosterone producing tumours the recommended type of treatment will be surgical as in most cases; it results in stabile normalization of RR level and abatement of metabolic dysfunction.

Adolescent↗
PubMedDate not supplied

[Genomic structure and DNA diagnosis of hereditary monogenic diseases in the Volga-Ural region].

The review considers the main results of molecular analysis of the genes responsible for cystic fibrosis, phenylketonuria, Wilson-Konovalov disease, Duchenne-Becker progressive muscular dystrophy, myotonic dystrophy, Huntington's disease, and nonsyndromic hereditary hypoacusis in populations of the Volga-Ural region. The results were obtained in the past ten years within the framework of the Russian program Human Genome. The mutation spectra and frequencies of these genes were characterized in the major ethnic groups (Bashkirs, Tatars, Russians) of Bashkortostan. Several diseases were associated with particular alleles or haplotypes of polymorphic loci of relevant genes. The results were used to develop DNA diagnostic procedures optimal for the region and to establish the origin of the mutations involved.

DNA↗
PubMed2004

Huge aneurysmal bone cyst of iliac bone in a mid-aged female.

Aneurysmal bone cyst is a rare nonneoplastic expansile osteolytic bone lesion of unknown etiology. It usually occurs in the first 2 decades of life. The most common sites are the metaphysio-epiphyseal areas of long bones or vertebrae with eccentric expansion. We present a 42-year-old female with a huge aneurysmal bone cyst of the pelvis with dumbbell-shaped expansion on the both side of the iliac bone, which grew rapidly in 6 months. We also review the literature and discuss its prevalence, clinicopathologic characteristics, differential diagnostic problems, optimal treatment, and the potential of recurrence.

Adult↗
PubMed2005

Optimized intravenous contrast administration for diagnostic whole-body 18F-FDG PET/CT.

UNLABELLED: Standard application of CT intravenous contrast agents in combined PET/CT may lead to high-density artifacts on CT and attenuation-corrected PET. To avoid associated diagnostic pitfalls, we designed and compared different intravenous contrast injection protocols for routine whole-body PET/CT. METHODS: Whole-body PET/CT included a topogram and a single spiral CT scan (2-row) with or without intravenous contrast, followed by an emission scan. The CT scan was used for attenuation correction of the emission data. Four groups of 10 whole-body PET/CT referrals each were investigated: (A) no intravenous contrast agent, (B) biphasic injection (90 and 50 mL at 3 and 1.5 mL/s, respectively) of intravenous contrast (300 mg/mL iodine) and CT in the craniocaudal direction with a 30-s delay, (C) triple-phase injection (90, 40, and 40 mL at 3, 2, and 1.5 mL/s, respectively) in the craniocaudal direction with a 50-s delay, and (D) dual-phase injection (80 and 60 mL at 3 and 1.5 mL/s, respectively) in the caudocranial direction with a 50-s delay. CT image quality was assessed on a scale from 1 to 3, and CT and attenuation-corrected PET images were reviewed separately for contrast-induced artifacts. RESULTS: Average CT image quality was poorest for protocol A (1.0) but improved to 2.8 when using intravenous contrast agents (protocols B-D). Only protocols B and C resulted in contrast-induced image artifacts that were limited to the thorax. The most homogeneous intravenous contrast enhancement without high-density image artifacts on either CT or PET after CT-based attenuation correction was achieved with protocol D. CONCLUSION: Dual-phase intravenous contrast injection and CT in the caudocranial direction with a 50-s delay yields reproducible high image quality and is now used routinely for combined diagnostic PET/CT at our hospital.

Contrast Media↗
PubMed2005

Malaria prevalence and associated risk factors in Eritrea.

A parasitological cross-sectional survey was undertaken from September 2000 through February 2001 to estimate the prevalence of malaria parasitemia in Eritrea. A total of 12,937 individuals from 176 villages were screened for both Plasmodium falciparum and Plasmodium vivax parasite species using the OptiMal Rapid Diagnostic Test. Malaria prevalence was generally low but highly focal and variable with the proportion of parasitemia at 2.2% (range: 0.4% to 6.5%). Despite no significant differences in age or sex-specific prevalence rates, 7% of households accounted for the positive cases and 90% of these were P. falciparum. Multivariate regression analyses revealed that mud walls were positively associated with malaria infection (OR [odds ratio] = 1.6 [95% CI: 1.2, 2.2], P < 0.008). For countries with low and seasonal malaria transmission, such information can help programs design improved strategic interventions.

Eritrea↗
PubMed2006

HIV-1 genetic diversity in Argentina and early diagnosis of perinatal infection.

HIV-1 diagnosis of perinatally exposed children is usually performed by molecular biology-based methods, allowing the direct detection of the virus. Thus, HIV-1 genomic variability within and across strains plays a major role in relation to the sensitivity of these tests, often leading to misdiagnosis. We describe the performance of an in-house multiplex nested PCR (nPCR) for early detection of HIV-1 infection in perinatally exposed children born in Argentina, where the percentage of diverse BF recombinants is as high as 80%. After evaluation of 1316 HIV-1 perinatally exposed children collected over a 7-year period, the specificity and sensitivity of the diagnostic nPCR was of 100% and 99.2% respectively, with only two false negative cases indicating a good performance of the diagnostic nPCR in the Argentine pediatric cohort. In search of unusual HIV-1 subtypes among 22 HIV-1 infected cases presenting partial or complete HIV-1 gene amplification failure, we performed phylogenetic and recombination analysis of a vpu-env fragment in addition to gag and env Heteroduplex Mobility Assay screening. The most unusual findings included two subtypes A and a novel BC recombinant, while the majority of the strains were a variety of different BF recombinants. These results indicate the presence of novel and heterogeneous genotypes in our country and the need of continuous viral surveillance not only for diagnostic test optimization but also for the eventual implementation of a successful vaccine.

Argentina↗
PubMed2007

Can PET/CT replace separate diagnostic CT for cancer imaging? Optimizing CT protocols for imaging cancers of the chest and abdomen.

Stage-adapted treatment in oncology relies on correct tumor staging for patients with malignant diseases. To ensure accurate assessment of the tumor stage in thoracic and abdominal diseases by PET/CT, both CT and PET need to be optimized. In this setting, different malignant diseases require customized imaging protocols. Although in the clinical setting of therapy assessment, PET/CT with integration of low-dose, nonenhanced CT may be sufficient, tumor staging may require a more sophisticated CT protocol. This review focuses on potential CT protocols for imaging cancers of the chest and abdomen. Examples of CT protocols are presented and discussed for non-small cell lung cancer, breast cancer, colorectal cancer, gastrointestinal stromal tumors, and interventional liver therapy.

Abdominal Neoplasms↗
PubMed1992

Application of neural networks to the interpretation of laboratory data in cancer diagnosis.

Neural networks are a relatively new method of multivariate analysis. The purpose of this study was to investigate the ability of neural networks to differentiate benign from malignant breast conditions on the basis of the pattern of nine variables: patient age, total cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein A-I, apolipoprotein B, albumin, the tumor marker CA15-3, and the Fossel index (measurement of methylene and methyl line-widths in proton NMR spectra). The laboratory analyses were made with blood plasma or serum specimens. The neural network was "trained" with 57 patients: 23 patients with breast malignancies and 34 patients with benign breast conditions. A neural network with nine input neurons, 15 hidden neurons, and two output neurons correctly classified all 57 patients. The ability of the network to predict the diagnoses of patients that it had no encountered in training was tested with a separate group (cross-validation group) of 20 patients. The network correctly predicted the diagnoses for 80% of these patients. For comparison we analyzed the same sets of 57 training patients and 20 cross-validation patients by quadratic discriminant function analysis. The quadratic discriminant function, calculated from the same 57 patients used to train the neural network, correctly classified 84% of the 57 patients, and correctly diagnosed 75% of the 20 cross-validation patients. The results suggest that neural networks are a potentially useful multivariate method for optimizing the diagnostic utility of laboratory data.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1989

Evaluation of allopurinol use in patients with gout.

The use of long-term allopurinol therapy in patients with gout was evaluated. A pharmacy computer printout was used to identify all outpatients for whom allopurinol had been prescribed during a six-month period in 1985 at a large Veterans Administration medical center. Medical records were reviewed to (1) classify patients as either having or not having definite indications for allopurinol treatment, (2) determine whether physicians had ordered roentgenographic and laboratory tests for presence of monosodium urate crystals, uric acid excretion, and renal function, and (3) identify gout-associated risk factors and disease entities that could cause hyperuricemia. A pharmacy record of all allopurinol and probenecid prescriptions for the six-month period was obtained, along with cost data. Of the 286 patients who received allopurinol, 32 received the drug for an indication that could not definitely be established as gout. Of the 254 remaining patients, only 45 (17.7%) had a definite indication for allopurinol use as defined by the pharmacy and therapeutics committee. Although pretreatment measurement of serum creatinine was common, only a few patients underwent joint aspiration, a 24-hour urine collection, or roentgenography of affected joints. Large proportions of the patients were found to have gout-associated risk factors. If the 209 patients without definite indications for allopurinol therapy had been treated with probenecid instead of allopurinol, the annual cost savings would have been about $3700. Most of the patients receiving allopurinol for gout could reasonably have been treated with a uricosuric agent such as probenecid at a lower cost. Generally, physicians did not use diagnostic tests optimally before prescribing allopurinol and did not attempt to modify risk factors for gout.

Allopurinol↗
PubMedDate not supplied

The treatment of lymphedema of the extremities with microsurgical lympho-venous anastomoses.

Personal 20-years clinical experience in diagnosis and treatment of various types of lymphedema of the lower limbs with microsurgical lymph node-vein and lymph vessel-vein anastomoses is presented. Optimizing of diagnostic method, improvements in operation technique and results of the follow-up have, during that period of time, modified indications for surgical therapy of lymphedema toward a more conservative approach and applying microsurgical methods to a carefully selected group. At present, lympho-venous shunts are performed in patients with local, segmental obstruction of proximal lymphatics. Peripheral lymph vessels should be patent and have their contractility at least partly preserved. Long-term penicillin therapy is indispensable prior to surgery in cases with a history of lymphangitis. The diagnostic procedures necessary for proper evaluation of the degree of lymph stasis, including the technique of lymph pressure and flow measurements are described. The details of operation of lymphovenous shunts based on personal experience are presented.

Anastomosis, Surgical↗
PubMed1987

Chronic pelvic pain.

Chronic pelvic pain is one of the most challenging gynecologic problems seen in primary care practice. Important causes of this problem include endometriosis, pelvic adhesions, chronic pelvic inflammatory disease, and the syndrome of chronic pelvic pain without obvious pathology. The diagnostic approach to chronic pelvic pain begins with a careful medical history and physical examination in conjunction with a comprehensive psychosocial assessment. Laboratory evaluation may include pelvic ultrasonography, psychometric testing, and diagnostic laparoscopy. Optimal management of these patients may require a multidisciplinary approach, integrating chronic pain management techniques with specific therapy.

Female↗
PubMed1988

Common artifacts encountered in magnetic resonance imaging.

Magnetic resonance imaging has rapidly become a widely accepted and clinically useful imaging modality primarily because of its excellent contrast resolution, ability to perform multiplanar acquisition, and the lack of ionizing radiation. However, the nuances of image acquisition are not trivial. Many technical factors must be considered and understood in order to knowledgeably choose sequence parameters that suppress artifacts and optimize the diagnostic quality of a particular MR examination. Even then, residual artifacts may persist. The presence of the artifacts and their technical basis must be understood before completely accurate MR interpretation can be rendered.

Brain↗
PubMed1985

Circadian and/or circahemidian rhythms in nine lymphocyte-related variables from peripheral blood of healthy subjects.

Circadian variations were investigated for nine lymphocyte-related variables in the peripheral blood of healthy subjects. Monoclonal antibodies targeted at membrane immunoglobulins (anti-Ig, anti-kappa, anti-lambda) or differentiation antigens (anti-IA and OKT3) were used to characterize respectively mature B cells (SIg+, kappa +, lambda +), cells expressing HLA-DR antigen (IA+), and T cells (OKT3+). Blood (33 ml) was drawn every 4 hr for 24 hr starting at 8.30 hr, on seven occasions in five apparently healthy male volunteers, recumbent from 23.00 hr to 07.00 hr. Leukocyte and differential counts were measured. Mononuclear cells were isolated on Ficoll-Hypaque before being incubated with monoclonal antibodies. The proportion of fluorescent cells per 100 microscopically determined cells was multiplied by the number of circulating lymphocytes per milliliter of venous blood. Temporal variations were validated by both paired t-test and cosinor. Rhythms with a period (tau) identical to 24 hr were validated with statistical significance (p less than 0.05) for total lymphocytes, OKT3+ cells and OKT3+:SIg+ ratio, and suggested (0.05 less than or equal to p less than or equal to 0.10) for lambda + and (kappa + + lambda +) cells. Rhythms with tau identical to 12 hr were also found (p less than 0.05) for OKT3+, SIg+, kappa +, and IA+ cells as well as for the OKT3+:SIg+ and the kappa +:lambda + ratios. Validated rhythms exhibited a large amplitude, e.g., peak-through differences were 40% of the 24-hr mean. This circadian and circahemidian temporal structure of immunologic variables constitutes a time-qualified reference system for investigating immune regulations and a tool for optimizing both diagnostic criteria and effectiveness of immunotherapeutic attempts.

Adult↗
PubMed1986

Benign biliary strictures: an analytic review (1970 to 1984).

This report concerns 105 patients with benign biliary stricture operated on at the Cleveland Clinic from 1970 through 1984; in 102 patients the stricture was iatrogenic. The mean follow-up was 5 years (3 months to 13 years). Fifty-eight patients (55%) had undergone one or more attempts at correction of the stricture before referral to us; in 47 patients (45%) we performed the first corrective repair. Percutaneous transhepatic cholangiography was the optimal preoperative diagnostic procedure to define the site of stricture. Most patients had undergone a biliary-intestinal anastomosis, either choledochoduodenostomy, choledochojejunostomy, or hepatojejunostomy. Morbidity and mortality rates were 13% and 4%, respectively. The results of operative repair were correlated with the number of previous operations, site of stricture, type of operation, presence of a fistula, presence of cirrhosis, and length of T or Y tube stenting. The overall recurrence rate after a first operation was 18% and after a second operation was 26%. With continued attempts at repair, eventual success was achieved in 93% of patients.

Adolescent↗