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Results for “diagnostic optimization”

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At least 649 records · Page 36Linked to original sources
PubMed2002

Performance of OptiMAL(R) in the diagnosis of Plasmodium vivax and Plasmodium falciparum infections in a malaria referral center in Colombia.

Alternative, non-microscopic methods for the diagnosis of malaria have recently become available. Among these, rapid dipstick methods stand out. One such test, OptiMAL(R), is based on the immunochromatographic detection of Plasmodium lactate dehydrogenase (pLDH) and has the capacity to detect and distinguish infections caused by P. falciparum and Plasmodium sp. This capacity is particularly important in countries where different species of Plasmodium co-exist. In this study we evaluated the performance of OptiMAL(R) in an urban referral center for malaria diagnosis. Two sets of patients were included: one (n = 112) having predetermined infections with P. falciparum or P. vivax and individuals with negative blood smears; and another consisting of all eligible consecutive patients (n = 80) consulting for diagnosis at the referral center during one month. The overall diagnostic efficiency of OptiMAL(R) for both sets of patients was 96.9%. Efficiency was higher for P. vivax (98.1%) than for P. falciparum (94.9%). These results corroborate the diagnostic utility of OptiMAL(R) in settings where P. vivax and P. falciparum co-exist and support its implementation where microscopic diagnosis is unavailable and in circumstances that exceed the capacity of the local microscopic diagnosis facility.

Animals↗
PubMed1986

Temporomandibular joint disorders: a diagnostic challenge.

During the past decade much interest has been focused on disorders of the TMJ. The etiology appears to be multifactorial, with signs and symptoms difficult to evaluate and radiologic investigations insufficient. This review attempted to analyze current diagnostic tools. The recent introduction of various techniques promises optimism for this diagnostic and therapeutic challenge.

Arthroscopy↗
PubMed1979

The roles of Gallium-67 scintigraphy, ultrasonography, and computed tomography in the detection of abdominal abscesses.

The evaluation of patients with suspected abdominal abscesses begins with a history and careful physical examination. Gallium-67 (67Ga) scintigraphy, ultrasonography (US), and computed tomography (CT) are utilized only after other routine investigations have failed to localize the abscess. All three modalities are reliable for the detection of abdominal abscesses. The decision regarding which of these three diagnostic tests to use in a particular patient rests upon clinical considerations. If the patient has acute localizing signs and symptoms, 67Ga should not be used initially. In this type of patient, rapid diagnosis is best provided by either US or CT. Further radiologic investigation may be terminated if the CT or US findings are characteristic of an abscess. A 67Ga scan should be performed in a patient with acute localizing signs and symptoms if the initial CT or US is negative. In a patient with nonlocalizing signs and symptoms, 67Ga imaging should be employed as the first procedure since the entire body is easily surveyed. If the 67Ga images are abnormal, then CT or US should be utilized for further lesion characterization. This diagnostic approach will optimize the rapidity of patient evaluation and will minimize diagnostic errors.

Abdomen↗
PubMed2003

Diagnostic and prognostic utility of rapid strip (OptiMal and Paracheck) versus conventional smear microscopy in adult patients of acute, uncomplicated P. falciparum malaria in Mumbai, India.

OBJECTIVES: The present study compared the diagnostic and prognostic utility of two rapid tests the (Paracheck and OptiMal) versus conventional smear microscopy. METHODS: Using two independent microscopists we carried out the three tests in 31 adult cases of smear positive, acute, uncomplicated Plasmodium falciparum malaria. All three tests were done pretreatment, and on Days 8, 15 and 29. RESULTS: Compared to microscopy, the Paracheck had a sensitivity of 100%, while the OptiMal had a sensitivity of 83.7%. The lower sensitivity of OptiMal resulted from misidentification by both microscopists of 6/31 cases as Plasmodium vivax. As a follow up tool, the OptiMal was better than Paracheck, due to the earlier disappearance of the parasite LDH. Also in the Paracheck, between microscopists, there was a significant difference in reading the tests, on Days 8 and 15. CONCLUSION: Our study reiterates, the continued utility of conventional smear microscopy.

Adolescent↗
PubMed2005

Optimization of MDCT of the wrist to achieve diagnostic image quality with minimum radiation exposure.

OBJECTIVE: This study tests various acquisition and reconstruction protocols for MDCT of the wrist to determine the optimal protocol for obtaining diagnostic image quality with minimal radiation exposure. MATERIALS AND METHODS: Thirty anatomic specimens were examined with an MDCT collimation of 4.0 x 1.0 mm and 2.0 x 0.5 mm (80, 120, and 140 kV; 80, 100, 130, 160, and 200 mA; rotation time, 0.5 0.75, 1.0 sec; pitch, 1.0, 1.3, 1.5, and 2.0). Coronal images were reconstructed using a slice thickness of 0.5, 1.0, and 2.0 mm with 60% overlap. Three observers evaluated all images independently for gross and fine anatomic detail. Diagnostic confidence was tested using Shrout-Fleiss intraclass correlation coefficients. Interobserver agreement was assessed by Kappa statistics and the Kruskal-Wallis test. RESULTS: Fine anatomic detail was best presented in 0.5-mm or 1.00-mm reconstructions based on a 2.0 x 0.5 mm acquisition. A rotation time of > or = 0.75 sec resulted in fewer artifacts; a significant dose reduction was achieved with 80 kV and 100 mA at the expense of somewhat increased noise, but without significant loss of anatomic detail in bone presentation. Artifacts were tolerable with a pitch of 1.5 or less. CONCLUSION: MDCT at the described optimal settings allows significant dosage reduction without sacrificing image quality. An acquisition and reconstruction thickness of 0.5 mm results in the best depiction of anatomic detail. A reconstruction thickness of 1.0 mm with a reconstruction interval of 0.5 mm represents a good trade-off between noise and resolution when using low-dose protocols.

Aged↗
PubMed2001

Tuberculous pericarditis: optimal diagnosis and management.

Pericarditis is a rare manifestation of tuberculous disease. The appropriate diagnostic workup and optimal therapeutic management are not well defined. We present 10 new cases of tuberculous pericarditis and review the relevant literature. The specific topics addressed are (1) the importance of tissue for diagnosis, (2) the optimal surgical management, (3) the role of corticosteroids, and (4) the impact of human immunodeficiency virus (HIV) on the management of this disease. The cases and the literature suggest that the optimal management includes an open pericardial window with biopsy, both for diagnosis and to prevent reaccumulation of fluid. Corticosteroids probably offer some benefit in preventing fluid reaccumulation as well. The data are inconclusive regarding whether open drainage or corticosteroid use prevents progression to constrictive pericarditis. No studies have addressed these issues specifically in HIV-positive patients, but the 3 HIV-positive patients in our series had an excellent response to drainage and antituberculous therapy.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Choledocholithiasis: semeiotic and diagnostic accuracy of cholangiography with magnetic resonance].

The authors report their experience in the optimization of the diagnostic accuracy of Magnetic Resonance Cholangiography (MRC) to detect choledochal stones; pre- and post-MIP post-processing images were compared. Thirty patients with dilated biliary ducts (mean age: 55.6 years) were examined with MRC; two of them had stones in the intrahepatic biliary ducts. The gold standard and the inclusion criterion was ERCP. MRC was carried out with a 1.5 T superconductive magnet (Signa) with T2-weighted FAST SE sequences (TR/TE; 10000/256, matrix: 256 x 128, slice thickness: 3 mm, TA: 6 min 28 s). Coronal MR images were blindly studied before and after MIP post-processing; Friedman's test was used for statistical analysis (p < .05). ERCP showed 92 cases of choledocholithiasis, with the stones ranging .2 to 3.4 cm; MRC before MIP post-processing had 97.1% diagnostic accuracy, 97.8% sensitivity and 95.8% specificity. These values are significantly different from those obtained after MIP (91.4%, 86.9% and 95.8% respectively). In our experience, pre- and post-MIP post-processing MRC can be considered a reliable and accurate noninvasive technique to detect choledochal stones.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2004

[Effects of extended clinical diagnostics on the diagnostic spectrum of an outpatient memory clinic].

OBJECTIVES: In an outpatient memory clinic, the methods of extended clinical diagnostics pertaining to imaging and neuropsychology were changed but the modus of assignment to the clinic remained unchanged at different times. Expected changes in the diagnostic spectrum can be attributed to the changed diagnostics. Consistent with reports from the literature regarding the consequences of such changes, the associated costs have to be taken into consideration as well. METHODS: The clinical final diagnoses of 174 patients referred in 2000/2001 for the diagnostics and differential diagnostics of dementia ("current population") were compared with those of 169 patients who visited the same outpatient clinic in 1998/1999 ("former population"). The diagnostic spectra of the two populations were compared. The diagnoses were differentiated in "no dementia" (XD), "neurodegenerative dementia" (ND), "vascular dementia" (VD), and "dementia of the mixed type" (MIXD). For all patients, the same clinical diagnostic criteria (ICD-10) and laboratory tests were implemented. Only the neuroradiological and neuropsychological methods changed from 1998/1999 to 2000/2001: The current population was examined with MRI instead of CT and underwent an expanded neuropsychological test battery with additional power and speed tests. RESULTS: The diagnoses of the two populations differed significantly in their frequency distribution. A dementia was excluded in 51.1% of the "current" patients vs 19.5% of the "former" patients. The frequencies of the dementia diagnoses were significantly different for the diagnoses ND (29.9 vs 47.9%) and MIXD (1.1 vs 7.7%), but not for VD (13.2 vs 12.4%). Beside other independent modalities, the improvement of imaging with MRI is discussed as recording atrophy size and vascular lesions better than CT. The improvement of the neuropsychological test battery containing additional speed tests is discussed as being able to differentiate even minimal cognitive disturbances. CONCLUSION: Using optimized imaging and neuropsychological methods, the diagnostic spectrum of an outpatient memory clinic changed. The clinical diagnosis was improved by the more sensitive, extended clinical diagnostics. Through optimized differential diagnostic allocation and the exclusion of dementia, expenses can be reduced by early and indication-related medication and by the resulting delay of institutionalized care.

Aged↗
PubMed1997

[How reliable are laboratory results? Many factors are to be considered].

Variation in medical laboratory results is predominantly due to biological factors in the patients and differences in sampling and sample handling procedures, factors which are unaffected by quality assurance procedures in the laboratory. Regarding medical diagnostics, physicians are often deficient in their knowledge of optimal analytical alternatives appropriate for different clinical requirements, and of biological and pre-analytical factors characterised by variation. This reduces the efficacy of laboratory diagnostics. Laboratory results are reliable when they are obtained by competent personnel, and reach their optimal diagnostic potential when they are interpreted by experienced and well informed diagnosticians.

Clinical Laboratory Techniques↗
PubMed1996

New Therapeutic Approaches to Peptic Ulcer Disease: The Role of Helicobacter Pylori.

One of the most common bacterial infections of human involves Helicobacter pylori, a spiral, gram-negative bacterium that is now thought to be a dominant factor in the development of peptic ulcer disease and may be significant in causing certain forms of gastric cancer. Almost 100% of patients with duodenal ulcer and 70 to 90% affected with gastric ulcer are infected with H. pylori. In order to achieve cure of H. pylori--induced ulcer disease, it is necesary to eradicate the bacterial infection. Mere suppression or clearance infection without eradication is associated with a >80% recurrence of the ulcer. The epidemiology, microbiology, and pathogenesis of H. pylori infections are reviewed. Diagnostic methods and optimal treatment strategies for H. pylori infections are examined. The most current diagnostic and treatment algorithms for peptic ulcer disease are discussed critically, and future directions for drug development aimed at eradication of H. pylori infection are considered.

Journal Article↗
PubMed2003

[Clinical and pathogenetic significance of the euphylline-calcium test for direct analysis of the exocrine secretory function of the pancreas in chronic relapsing pancreatitis].

The authors improved the probe assay of the pancreas: an original euphylline-calcium test was developed. The examination is informative and safe in the diagnostics of the chronic relapsing pancreatitis. A number of advantages of the optimized method of diagnostics before the traditional ones, including the secretin-pancreazimin test, were proven.

Aminophylline↗
PubMed2005

[Optimalization of methodical repertoire for laboratory diagnostic of autoimune diseases of the thyroid gland--aspiration cytology versus histology (cytodiagnostic accuracy)].

In this study was evaluated the rate of cytodiagnostic accuracy of Hashimoto's thyroiditis (HT) in smears prepared from thyroid fine-needle aspirates in 72 cases and of focal lymphocytic thyroiditis (FLT) in 101 cases. The cytodiagnostic accuracy of Hashimoto's thyroiditis (HT) was 75% and 20% in case of focal lymphocytic thyroiditis (FLT). In case of focal lymphocytic thyroiditis (FLT) the cytodiagnostics of autoimmune lymphocytic diseases of thyroid gland apears to have very low ability.

Biopsy, Needle↗
PubMed1995

Dosimetric optimization of postproduction neutron-activated erbium-170-oxide-enriched pancreatin.

UNLABELLED: The feasibility of postproduction neutron activation of an enteric-coated pancreatic enzyme preparation for in vivo gastric emptying studies has been investigated. METHODS: During production of this multicomponent preparation, small amounts of 170Er-enriched erbium oxide, suitable for neutron activation, were added. RESULTS: Postproduction neutron irradiation of the labeled preparation resulted in short-lived (7.5 hr) gamma-emitting 171Er. Various radiocontaminants, however, are produced also. Because of variations in activation yields, half-lives, decay schemes and radiotoxicities, both major and trace constituents were considered for optimization of both dosimetry and the diagnostic measurement. Conditions were optimized for the best ratio of the committed dose equivalent due to 171Er to the total committed dose equivalent. CONCLUSION: The results show that postproduction neutron activation of a 170Er-enriched multicomponent preparation can be performed safely within the guidelines set by the WHO for experiments in humans involving radioactive materials.

Erbium↗
PubMed2005

Diagnosis of tuberculous pericarditis and treatment without corticosteroids at a tertiary teaching hospital in Taiwan: a 14-year experience.

Tuberculous (TB) pericarditis is a rare but life-threatening form of extrapulmonary tuberculosis. The diagnostic strategy and optimal therapy for TB pericarditis are not well established. We retrospectively analyzed the diagnostic data, clinical characteristics, treatment and outcome in a total of 19 patients with TB pericarditis treated from January 1988 to July 2002. Based on the finding of echocardiography, 8 of these patients were classified as having early stage and 11 as having advanced-stage disease. There were 15 men and 4 women, with a mean age of 65 years (range, 34 to 80 years). All patients received antituberculosis chemotherapy, and all but 2 underwent at least 1 of the following procedures: pericardiocentesis and biopsy, pericardial window placement, and pericardiectomy. None of the patients received corticosteroids concurrently. Of the 8 patients with early-stage TB pericarditis, 3 (37.5%) developed constrictive pericarditis, while of the 7 patients with advanced-stage disease (excluding 4 who had already developed TB constrictive pericarditis at diagnosis), 6 (85.7%) subsequently developed constriction. These findings underscore the importance of pericardiectomy in patients with advanced-stage TB pericarditis. To avoid potentially lethal cardiac tamponade and constrictive cardiomyopathy, clinicians should have a high index of suspicion of TB pericarditis when encountering a patient with pericardial effusion. Histopathologic study of pericardial tissue sample is the key to timely diagnosis of TB pericarditis. The favorable outcomes of patients in this series suggest that a combination of antituberculosis chemotherapy and timely pericardiectomy may be the optimal therapy for patients with TB pericarditis.

Adrenal Cortex Hormones↗
PubMed2004

Surveillance of childhood influenza virus infection: what is the best diagnostic method to use for archival samples?

Despite the clinical importance of influenza virus in pediatric respiratory infections, the optimal set of diagnostic tests to use when conducting studies using archival samples is not clear. In this study, we compared diagnostic tests for influenza virus in 75 children younger than 5 years of age who presented with symptomatic respiratory infection during one of four influenza seasons, had negative viral cultures for other respiratory pathogens, and had both an archival nasal aspirate obtained at the time of illness and serology spanning that influenza season. For all eligible children, we compared the results of viral culture performed at the time of collection with serology and PCR of archival nasal aspirates. Using real-time viral culture as the "gold standard," the test characteristics of PCR of archival nasal aspirates (sensitivity, 82%; specificity, 100%) and serology (sensitivity, 82%; specificity, 87%) were similar. The relatively low sensitivity of PCR of archival nasal samples in this study compared to that of PCR of fresh samples in a previous study suggests that RNA degradation occurred despite storage of the specimens at -70 degrees C. RNA degradation would also explain why only 11 (52%) of 21 archival nasal samples that had positive influenza virus cultures at the time of collection had positive repeat cultures in the summer of 2000. Thus, in archival specimens stored at -70 degrees C, PCR was more sensitive than viral culture. However, testing of fresh specimens had the highest yield in this study. Studies of optimal methods for specimen storage are needed.

Child, Preschool↗
PubMedDate not supplied

Imaging assessment before surgical resection.

The improvement of preoperative imaging techniques gets hepatic surgery easier making it more safer and effective. The authors describe the most common hepatic pathologies, benign and malignant, pointing out for each one the principal diagnostic appearances achievable with, the several techniques and, collating these last between them, they optimize the diagnostic-curative pathways for several pathologies. Beyond allowing the diagnosis of the lesion's nature, an important role of the imaging modalities is also to evaluate the resectability of single lesion, weighing up its exact location and the impact on the vascular system esteeming, finally, the volume of remnant liver in case of larger resections. The intra- and extrahepatic, preoperative staging, of the varied hepatic lesions, primitive and secondary, performed comparing the most modern diagnostics techniques, results to be dramatically important arterial portography during, CT (CTAP), contrast-enhanced helical CT, MR imaging. For each patient it's possible to plan the most adequate treatment to his pathology.

Diagnosis, Differential↗