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PubMed2002

Effect of dose reduction in digital dental panoramic radiography on image quality.

OBJECTIVES: To investigate the effect of dose reduction in digital panoramic radiography on subjective image quality and diagnostic performance. METHODS: Two digital panoramic radiographs were obtained with the Orthophos DS(Sirona, Bensheim, Germany) of patients (n=100) receiving dental care. The first image was taken at the standard exposure setting. For the second image the tube current was reduced by between 48 and 53%, 63 and 69%, 75 and 80% and 80 and 81% respectively. Ten observers rated both images for 21 specific anatomical details and 30 pathological findings. RESULTS: All radiographs taken at reduced mA levels had a significantly inferior score (P<0.01) for anatomical details. There was no difference in the scores for pathological findings. CONCLUSION: Radiographs obtained at reduced mA had inferior subjective image quality, but there was no difference in diagnostic performance. Thus, a reduction in tube current of approximately 50% is recommended. In certain circumstances such as follow-up radiographic examinations, a reduction of up to 65% should be considered.

Analysis of Variance↗
PubMed2026

The role of circulating tumor DNA (ctDNA) to detect minimal residual disease in locally advanced gastroesophageal carcinoma: the BUTTERFLY study.

BACKGROUND: Despite advances in perioperative and neoadjuvant strategies, patients with locally advanced gastroesophageal cancers remain at high risk of recurrence after curative intent treatment. No validated biomarkers are available to detect minimal residual disease (MRD) or to guide post-operative risk-adapted management. Circulating tumor DNA (ctDNA) has emerged as a noninvasive tool for disease monitoring; single-parameter or tumor-informed assays, however, may lack sensitivity in low-tumor burden settings. Multimodal, tumor-agnostic approaches may overcome these limitations. METHODS: The BUTTERFLY study is a prospective, multicenter observational study enrolling patients with stage II-III gastric, gastroesophageal junction, or esophageal cancer treated with perioperative chemotherapy or neoadjuvant chemoradiotherapy followed by surgery. It evaluates the diagnostic performance and prognostic value of an academic, tumor-agnostic, multimodal ctDNA assay for MRD detection and prognostic stratification. Serial plasma samples are collected from baseline through post-operative follow-up and at relapse. Cell-free DNA is analyzed using the Agnostic Liquid Biopsy Multimodal Advancement (ALMA) platform, integrating tumor fraction estimation, somatic copy number alterations, fragmentomic features, single-nucleotide variants, and whole-genome methylation profiling. Multimodal features are combined with clinical variables using machine learning-based models to enhance MRD detection and relapse risk stratification. The primary endpoint includes sensitivity and specificity of ALMA-defined ctDNA/MRD status at the 4-8 weeks after surgery landmark, whereas secondary endpoints assess diagnostic performance at other time points and associations between ctDNA status and dynamics with disease-free survival, overall survival, treatment response, and lead time to recurrence. FUTURE PERSPECTIVES: If validated, this tumor-agnostic, multimodal ctDNA approach may enable earlier molecular relapse detection and support personalized post-operative management strategies.

circulating tumor DNA (ctDNA)↗
PubMed2003

Fat suppression gradient-echo magnetic resonance imaging of experimental articular cartilage lesions: comparison between phase-contrast method at 0.23T and chemical shift selective method at 1.5T.

PURPOSE: To evaluate the diagnostic performance of a newly developed single-scan phase-contrast water-fat imaging technique for fat suppression at 0.23T open magnet, compared to the conventional chemical shift selective fat suppression method at 1.5T, in the detection of experimental articular cartilage lesions. MATERIALS AND METHODS: Sixty regions of 20 knee joint specimens of pigs with artificially created articular cartilage lesions were examined with 0.23T and 1.5T MR scanners. Sagittal fat-suppressed three-dimensional gradient-echo (3D GRE) images, obtained with the phase-contrast method at 0.23T, and fat-suppressed three-dimensional spoiled gradient recalled echo (3D SPGR) images, obtained with a chemical shift selective method at 1.5T, were evaluated. Diagnostic performance was analyzed. The conspicuity of the lesions, the amount of artifacts, and the uniformity of fat suppression were evaluated. The contrast-to-noise (CNR) values of cartilage-to-bone marrow, and cartilage-to-infrapatellar fat were calculated. RESULTS: At 0.23T, sensitivity and specificity were 80% and 95% for partial cartilage lesions (grade 2), and 91% and 100% for full-thickness lesions (grade 3). At 1.5T, sensitivity and specificity were 85% and 95% for grade 2 lesions, and 96% and 97% for grade 3 lesions. No significant difference was detected in the conspicuity of lesions. The uniformity of fat suppression was more constant with 3D SPGR images compared to 3D GRE images. More susceptibility artifacts, derived from the procedure of creating lesions, were detected at 1.5T. The cartilage-to-fat CNRs were significantly higher with high-field images. CONCLUSION: Phase-contrast method for fat suppression at 0.23T is a useful technique in detecting articular cartilage lesions.

Animals↗
PubMed2006

Simultaneous arterial pressure recordings improve the detection of endofibrosis.

PURPOSE: Exercise improves the diagnostic performance of ankle-to-brachial index (ABI) in the detection of exercise-induced arterial endofibrosis (EIAE). Pressure values for all four limbs are required to calculate ABI, but rapid systemic pressure changes occur during the recovery period from exercise. We checked whether after exercise, ABI calculated from simultaneous measurements was better than from consecutive measurements for differentiating athletes with EIAE from normal athletes. METHODS: We studied 42 normal athletes and 42 athletes suffering from unilateral pain caused by histologically proven EIAE. Bilateral brachial and ankle (ASBP) systolic blood pressure levels were simultaneously measured in the supine position at rest and every minute during the first 4 min of the recovery from incremental maximal exercise. Using receiver operating characteristics curves (ROC), we compared the diagnostic performance of single-leg ASBP and ABI values and between-leg ASBP (DeltaASBP) and ABI (DeltaABI) differences, calculated from simultaneous (simu) versus consecutive (cons) measurements, to discriminate athletes with EIAE from normal athletes. RESULTS: For single-leg postexercise values, ROC curve area was significantly higher for ABIsimu compared with ASBPsimu (P < 0.05, r = 0.91) and ASBPrand (P < 0.05, r = 0.68). Areas (+/- SE of area) of the ROC curves for postexercise Delta ASBPsimu and Delta ABIsimu were 0.97 +/- 0.01 and 0.97 +/- 0.02, respectively, and were higher than areas for postexercise Delta ASBP and Delta ABI calculated from consecutive and random measurements (P < 0.01). Accuracy for postexercise Delta ASBPsimu and Delta ABIsimu in discriminating EIAE from normal athletes was 93% [95% CI; 85-97], with a cutoff point of 22 mm Hg and 0.10, respectively. CONCLUSION: Delta ASBP and/or Delta ABI calculated from simultaneous pressure measurements should be recommended when searching for unilateral EIAE. Whether this result is applicable in the detection of early atherosclerotic lesions in sedentary subjects requires future investigation.

Adult↗
PubMed2006

CT colonography in a Korean population with a high residue diet: comparison between wet and dry preparations.

AIM: To compare wet and dry preparation methods for computed tomography colonography (CTC) in terms of preparation quality, interpretation time, and diagnostic performance for polyp detection in a population with a high residue diet. MATERIALS AND METHODS: Eighty-six patients were divided into two groups. Group 1 (n=24) received a wet preparation of 4l polyethylene glycol (PEG) solution, and group 2 (n=62) received a dry preparation of phosphor-soda. Abnormal findings, including polyps, and the time required to interpret the CTC images in both groups were documented by a radiologist. CTC findings were compared to those of colonoscopy as a reference standard. Two radiologists evaluated the quality of CTC with regard to residual fluid, faeces, and colonic distension using a four-point scale in consensus. Statistical differences for residual fluid, faeces, distensibility on CTC, and interpretation time between the two groups were analysed. The diagnostic performance of CTC in both groups was also compared. RESULTS: One-hundred and ninety polyps in 70 patients were identified using colonoscopy. Regarding the quality of images produced the wet preparation was significantly better than the dry preparation (p<0.05). The average interpretation time was significantly shorter for the wet group (11.7 min) than the dry group (16.4 min) (p<0.05). For per-patient analysis, the positive predictive value (PPV) was significantly better for the wet (100%) than the dry group (79.6%; p=0.025). Sensitivities and PPV for >or=10 mm polyps were comparable between two groups (p>0.05). CONCLUSION: In a population with a high-residue diet, CTC with wet preparation can be interpreted in a time-efficient manner and is comparable with CTC with dry preparation.

Adenomatous Polyposis Coli↗
PubMed2005

Comparison of 2-dimensional and 3-dimensional power-Doppler imaging in complex adnexal masses for the prediction of ovarian cancer.

OBJECTIVE: The purpose of this study was to compare 2-dimensional and 3-dimensional power-Doppler imaging diagnostic performance for the prediction of ovarian cancer in complex adnexal masses. STUDY DESIGN: Sixty-nine complex adnexal masses in 60 women (mean age, 48.4 years [range, 17-82 years]) were evaluated by 2-dimensional and 3-dimensional power-Doppler imaging for differentiating benign from malignant masses. Complex adnexal mass was defined in the presence of at least 1 of the following features: solid areas, thick papillary projections, thick septa, or purely solid echogenicity. One examiner performed 2-dimensional power-Doppler imaging, and a second examiner performed 3-dimensional power-Doppler imaging. All masses were removed surgically, and definitive diagnosis was obtained. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for both techniques. RESULTS: Forty-five tumors (65.2%) were proved to be malignant, and 24 tumors (34.8%) were proved to be benign. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for 2-dimensional power-Doppler imaging were 97.8%, 87.5%, 93.6%, 95.5%, and 94.2%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for 3-dimensional power-Doppler imaging were 97.8%, 79.2%, 89.9%, 95%, and 91.3 % respectively. There were no statistical differences in sensitivity and specificity (McNemar test: P = .250) CONCLUSION: Three-dimensional power-Doppler imaging did not have a better diagnostic performance than 2-dimensional power-Doppler imaging for the discrimination of benign from malignant complex adnexal masses.

Adnexa Uteri↗
PubMed1999

Transvaginal color Doppler ultrasonography and CA-125 in suspicious adnexal masses.

OBJECTIVE: To compare diagnostic performance of color Doppler ultrasound and CA-125 in suspicious adnexal masses on B-mode sonography. MATERIALS AND METHODS: Data on 94 patients (mean age: 47.4 years, range: 17-79 years. Fifty-two (55.3%) premenopausal and 42 (44.7%) postmenopausal women) managed in our institution because of a suspicious adnexal mass were reviewed. All patients were evaluated by transvaginal color Doppler ultrasonography (CD) and serum CA-125 level determination prior to surgery. Definitive histopathological diagnosis was obtained in each case. Sonographic morphology evaluation was suspicious in all cases. CD was considered as suspicious when flow was detected and the lowest RI found was < or = 0.45. CA-125 cut-off was > or = 35 UI/ml. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each method and compared. ROC analysis was performed for RI and CA-125. Areas under curve (AUC) were calculated and compared. RESULTS: Fifty-six (59.6%) tumors were found to be malignant and 38 (40.4%) benign. Sensitivity, specificity, PPV and NPV for CD were 87.5% (95% CIs: 75.3-94.4), 84.2% (95% CIs: 68.7-94), 89.1% (95% CIs: 77.7-95.9) and 82.1% (95% CIs: 66.5-92.5), respectively. Sensitivity, specificity, PPV and NPV for CA-125 were 83.9% (95% CIs: 71.7-92.4), 68.4% (95% CIs: 51.3-82.5), 79.7% (95% CIs: 66.2-89) and 74.3% (95% CIs: 56.7-87.5), respectively. Sensitivity, PPV and NPV were not statistically different. CD had higher specificity (P = 0.01). AUC curve for Doppler (0.75) was significantly higher than for CA-125 (0.61) (P = 0.0002). CONCLUSIONS: Our results indicate that color Doppler ultrasound has a better diagnostic performance as compared with CA-125, being significantly more specific.

Adnexal Diseases↗
PubMed1994

A Monte Carlo study of grid performance in diagnostic radiology: task-dependent optimization for digital imaging.

A Monte Carlo computational model has been used to optimize grid design in digital radiography. The optimization strategy involved finding grid designs that, for a constant signal-to-noise ratio, resulted in the lowest mean absorbed dose in the patient. Different examinations were simulated to explore the dependence of the optimal scatter-rejection technique on the imaging situation. A large range of grid designs was studied, including grids with both aluminium and fibre interspaces and covers, and compared to a 20 cm air gap. The results show that the optimal tube potential in each examination does not depend strongly on the scatter-rejection technique. There is a significant dose reduction associated with the use of fibre-interspaced grids, particularly in paediatric radiography. The optimal grid ratio and strip width increase with increasing scattering volume. With increasing strip density, the optimal strip width decreases, and the optimal grid ratio increases. Optimal grid ratios are higher than those used today, particularly for grids with large strip density. It is, however, possible to identify grids of good performance for a range of strip densities and grid ratios provided the strip width is selected accordingly. The computational method has been validated by comparison with measurements with a caesium iodide image receptor.

Algorithms↗
PubMed2002

Oncological diagnosis using positron coincidence gamma camera with fluorodeoxyglucose in comparison with dedicated PET.

The purpose of this study was to compare the utility of a dual-head positron coincidence detection gamma camera (PCD) with that of dedicated positron emission tomography (PET) in the imaging of various malignancies using (18)F-fluorodeoxyglucose (FDG). 25 patients with known or suspected malignancies at various sites underwent imaging with both methods, and diagnostic performance on a lesion basis was compared. Tumour lesions were analyzed visually and semi-quantitatively using the ratio of tumour-to-background counts (T/B ratio). FDG PCD and FDG PET visually detected 34 (72.3%) lesions and 37 (78.7%) lesions, respectively. The mean T/B ratio and standard deviation (SD) of FDG PCD was 3.5+/-3.3, significantly lower than that of FDG PET (8.4+/-7.1, p<0.001). When tumour lesions were less than 2.0 cm in diameter, the sensitivity of FDG PCD was 37.5%, significantly inferior to that of FDG PET (50.0%, p<0.01). Sensitivity between FDG PCD and FDG PET in lesions of more than 2.0 cm diameter showed no statistically significant difference. This study indicates that FDG imaging with a dual-head coincidence detection gamma camera can provide suitable diagnostic performance for lesions greater than 2.0 cm diameter, but performed significantly worse than dedicated PET for lesions smaller than this.

Adult↗
PubMed2004

Confidence interval for rate ratio in a 2 x 2 table with structural zero: an application in assessing false-negative rate ratio when combining two diagnostic tests.

In this article, we consider problems with correlated data that can be summarized in a 2 x 2 table with structural zero in one of the off-diagonal cells. Data of this kind sometimes appear in infectious disease studies and two-step procedure studies. Lui (1998, Biometrics54, 706-711) considered confidence interval estimation of rate ratio based on Fieller-type, Wald-type, and logarithmic transformation statistics. We reexamine the same problem under the context of confidence interval construction on false-negative rate ratio in diagnostic performance when combining two diagnostic tests. We propose a score statistic for testing the null hypothesis of nonunity false-negative rate ratio. Score test-based confidence interval construction for false-negative rate ratio will also be discussed. Simulation studies are conducted to compare the performance of the new derived score test statistic and existing statistics for small to moderate sample sizes. In terms of confidence interval construction, our asymptotic score test-based confidence interval estimator possesses significantly shorter expected width with coverage probability being close to the anticipated confidence level. In terms of hypothesis testing, our asymptotic score test procedure has actual type I error rate close to the pre-assigned nominal level. We illustrate our methodologies with real examples from a clinical laboratory study and a cancer study.

Biometry↗
PubMed1998

Colour Doppler sonography in breast tumours: an update.

The aim of our study was to reassess the diagnostic performance of image-based, computer-assisted colour Doppler quantification under routine conditions. We used a computer-assisted protocol that quantitatively characterises a colour Doppler image by the relative amount of colour pixels (colour pixel density, CPD) and the colour hues (numerically expressed by the mean colour value, MCV) in 44 patients with breast carcinoma and 49 patients with benign breast lesions. Studies were carried out over two periods by two examiners, subsequently in charge of breast ultrasound. During the first period, the sensitivity of the MCV was 92 %, the specificity 75 %; the sensitivity of the CPD was 80 %, the specificity 81 %. During the second period, the sensitivity of the MCV was 58 %, the specificity 77 %; the sensitivity of the CPD was 68 %, the specificity 71 %. Despite measures to create uniform examination conditions, the diagnostic performance of this method may decline under routine conditions.

Adult↗
PubMed2001

Evaluation of recomWell Treponema, a novel recombinant antigen-based enzyme-linked immunosorbent assay for the diagnosis of syphilis.

OBJECTIVE: To evaluate the diagnostic performance of an enzyme immunosorbent assay (recomWell Treponema) for the diagnosis of syphilis. The novel recombinant antigens Tpn47, TpN17 and TpN15 were utilized. METHODS: A total of 782 human serum specimens, belonging to four different categories (blood donors, n = 200; routine laboratory screening for syphilis, n = 400; syphilis patients, n = 122; potential cross-reactors, n = 60), were evaluated to compare the sensitivity and specificity of the recomWell Treponema kit with a standard whole Treponema pallidum cell lysate antigen-based ELISA (Syphilis Screening) and with micro-haemagglutination (MHA-TP). RESULTS: The overall specificity and sensitivity of the recomWell Treponema IgG was 98.9% and 98.3%, respectively. The specificity and sensitivity of Syphilis Screening ELISA was 98.7% and 98.3%, respectively. The agreement between recomWell Treponema and Syphilis Screening was 100%, 97.8%, 95.9% and 95% among the blood donor specimens, screening samples, syphilis specimens and the potential cross-reactors, respectively. Values of concordance varying from 96.7% to 98.3% were found in the different groups of sera between recomWell Treponema and MHA-TP. In addition, recomWell Treponema demonstrated a good diagnostic performance when used to detect the IgM to T. pallidum. No false-positive sera were identified and, in 17/19 samples from primary infection, an IgM immune response was found. CONCLUSIONS: recomWell Treponema was shown to be a highly specific and sensitive method in all stages of syphilis screening and it can be considered as alternative to other ELISA tests based on native antigen preparations.

Antibodies, Bacterial↗
PubMed2004

Digital slot-scan charge-coupled device radiography versus AMBER and Bucky screen-film radiography for detection of simulated nodules and interstitial disease in a chest phantom.

PURPOSE: To evaluate the diagnostic performance of full-field slot-scan charge-coupled device (CCD)-based digital radiography in the detection of simulated chest diseases in clinical conditions versus that of two screen-film techniques: advanced multiple beam equalization radiography (AMBER) and Bucky radiography. MATERIALS AND METHODS: Simulated nodules and interstitial nodular and interstitial linear lesions were attached onto an anthropomorphic chest phantom. One hundred sixty-eight lesions were distributed over 25 configurations. A posteroanterior chest radiograph of each configuration was obtained with each technique. The images were presented to six observers. Each lesion was assigned one of two outcome scores: "detected" or "not detected." False-positive readings were evaluated. Differences between the imaging methods were analyzed by using a semiparametric logistic regression model. RESULTS: For simulated nodules and interstitial linear disease, no statistically significant difference was found in diagnostic performance between CCD digital radiography and AMBER. The detection of simulated interstitial nodular disease was better with CCD digital radiography than with AMBER: Sensitivity was 71% (77 of 108 interstitial nodular lesions) with CCD digital radiography but was 56% (60 of 108 lesions) with AMBER (P =.041). Better results for the detection of all lesion types in the mediastinum were observed with CCD digital radiography than with Bucky screen-film radiography: Sensitivity was 45% (227 of 504 total simulated lesions) with CCD digital radiography but was 24% (119 of 504 lesions) with Bucky radiography (P <.001). There were fewer false-positive observations with CCD digital radiography (35 [5.7%] of 609 observations) than with Bucky radiography (47 [9.5%] of 497 observations; P =.012). CONCLUSION: Differences were in favor of the full-field slot-scan CCD digital radiographic technique. This technique provides a digital alternative to AMBER and Bucky screen-film radiography.

Dose-Response Relationship, Radiation↗
PubMed2002

Validity of D-dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays.

OBJECTIVES: To assess the diagnostic reliability of a new quantitative D-dimer assay (VIDAS New) and an established quick test (Nycocard D-dimer assay) in the diagnosis of deep vein thrombosis (DVT) compared with ultrasonography. A third assay (Auto Dimer) became available during sample collection and has been included in the final assessment. The diagnostic performance of the Auto Dimer assay was evaluated on three different coagulation analysers. DESIGN: A clinical prospective study of patients admitted to hospital for evaluation of DVT. Setting. The admission ward at Aalborg Hospital. Subjects. A total of 113 outpatients with suspected DVT. Main outcome measures. Compression ultrasonography was used as the reference method for a diagnosis of DVT and compared with different D-dimer assays. The results were expressed as sensitivity, specificity, positive predictive value and negative predictive value (NPV). RESULTS: Deep vein thrombosis was established in 49 patients (43%). Two D-dimer assays (VIDAS New and Auto Dimer) showed sensitivities of 90 and 88%, specificities of 42 and 44%, and NPV's of 85 and 83%, respectively. The Nycocard D-dimer assay showed a sensitivity of 63%, specificity of 67% and NPV of 71%. CONCLUSIONS: The diagnostic performance of VIDAS New and the Auto Dimer D-dimer assays is almost identical, but this study suggests that neither of the D-dimer assays is suitable as the only screening method for DVT, in a situation with a high pretest probability of DVT. This call for a differential strategy that distinguishes between cases of low and high clinical probability using either a D-dimer test or ultrasonography. Abbreviations DVT, deep venous thrombosis, NPV, negative predictive value, PPV, positive predictive value

Adult↗
PubMed2006

Contribution of the MDRD equation and of cystatin C for renal function estimates in cancer patients.

BACKGROUND: Serum creatinine (SCr) and Cockcroft-Gault creatinine clearance (CG CrCL) are used to estimate glomerular filtration rate (GFR). Other markers have been proposed including serum cystatin C (cysC) and the Modification of Diet in Renal Disease (MDRD) study equation. PATIENTS AND METHODS: We have compared the diagnostic performances of SCr, cysC, CG CrCL, and the MDRD equation in 144 cancer patients. For reference we used either the measured or the predicted carboplatin clearance, which is around the GFR + 25 mL/min. RESULTS: CysC was more sensitive than SCr (70.1% vs 13.4%) but was not very specific (61% for a cut-off = 0.95 mL). CysC values were higher in 40 cancer patients vs 40 healthy controls with a similar and normal mean CG CrCL (1.08 vs 0.71 mg/L; p < 0.001). CG and the MDRD equations gave similar values for Pearson's coefficient, ROC-plot AUC, and precision, except for patients with poor general status, where the MDRD equation was better (MAPE: 12.4% vs 19.6%, p < 0.001; R: 0.908 vs 0.813). CONCLUSIONS: In cancer patients, cysC is a more sensitive indicator of the glomerular filtration rate than SCr, but its diagnostic performance is lower than for CG CrCL. There may be no advantage in replacing the CG equation by the MDRD equation except for patients with severe malnutrition and/or inflammation.

Adult↗
PubMed1996

Test of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) for prehospital use.

STUDY OBJECTIVES: To test diagnostic performance for acute cardiac ischemia (ACI) in a manually calculated and in a computerized, ECG-calculated ACI time-insensitive predictive instrument (ACI-TIPI) in prehospital chest pain patients. METHODS: We carried out prospective inclusion and data acquisition with retrospective analysis. Over a 6-month period, 439 adult emergency medical services patients with chest pain underwent prehospital electrocardiography. Because of incomplete data, 77 cases were excluded, leaving a study sample of 362 patients. Excluded patients did not differ significantly with respect to age, sex, final diagnosis, or history of myocardial infarction, heart surgery, diabetes, or stroke. ACI-TIPI probabilities of ACI were computed on the basis of the prehospital ECGs as interpreted retrospectively and independently by two study investigators blinded to patient outcome, with a specially programmed electrocardiograph, and with a computer algorithm further modified by logistic-regression analysis. RESULTS: Diagnostic performance on the basis of receiver operating characteristic (ROC) curve areas of the ACI-TIPI was scored, by the two physician readers, .73 and .74; and by ECG, .75. Patients with low ACI-TIPI probability (0% to 9%) had no acute myocardial infarctions, a 2.3% incidence of angina, and no prehospital life-threatening events. CONCLUSION: ACI-TIPI probabilities of ACI as generated by a specially programmed electrocardiograph are comparable to those based on physician ECG interpretations and may be useful in the prehospital evaluation of chest pain.

Acute Disease↗
PubMed2003

Is there really an increase in non-minimal change nephrotic syndrome in children?

BACKGROUND: Reports on the worldwide increase in focal segmental glomerulosclerosis (FSGS) in childhood may have been hampered by referral bias. A true increase in FSGS possibly could alter the current practice of withholding renal biopsy in childhood nephrotic syndrome (NS) unless the patient fails to respond to a 28-day course of corticosteroid therapy. METHODS: With these questions in mind, we analyzed a 17-year database covering a 275,000-child population with mandatory referral. The incidence of NS per 100,000 childhood population per year was calculated, charts of 159 patients with NS seen between 1985 and 2002 were reviewed, and a receiver operating characteristic (ROC) plot analysis was performed to analyze the diagnostic performance of remission time. RESULTS: Results show that 115 of 159 patients had minimal change NS, diagnosed either on the basis of corticosteroid response (n = 89), verified by renal biopsy (n = 14), or with minimal change plus mesangial immunoglobulin M on histological examination (n = 12). The remaining 44 patients underwent a renal biopsy showing FSGS (n = 29; 18.2%), diffuse mesangial hypercellularity (n = 8; 5%), membranoproliferative glomerulonephritis (n = 1; 0.6%), membranous nephropathy (n = 3; 1.9%), or other diagnoses (n = 3). The incidence of FSGS increased significantly (P = 0.0253) from 0.37 to 0.94/100,000-child population/y in the two 8(1/2)-year intervals of our study. ROC plot analysis confirmed diagnostic sensitivity and specificity greater than 80% for remission time between 21 and 28 days of therapy. CONCLUSION: We confirm the increasing incidence of FSGS in children with idiopathic NS in a well-defined catchment area and, at the same time, find no reason to change the initial therapy and current indications to perform renal biopsy in childhood NS.

Adolescent↗
PubMed2005

Cold stimulus-fingertip lacticemy: standardization of the test in normal volunteers and diagnostic application for systemic sclerosis.

OBJECTIVES: To standardize the cold stimulus-fingertip lacticemy test (CS-FTL) in normal individuals and to establish reference levels for discrimination of normal individuals and patients with systemic sclerosis (SSc). METHODS: FTL was determined before (pre-CS) and 3, 8, and 13 min after cold stimulus (post-CS) in 94 normal controls according to gender and age. Diagnostic performance of DeltaCS-FTL (percentage difference between post- and pre-CS-FTL) was tested comparing 25 SSc patients and the 94 normal individuals by ROC curve analysis. RESULTS: Successive FTL determinations in the same fingertip yielded consistent results and the whole CS-FTL test proved to be reproducible. Pre-CS-FTL in SSc patients was higher than in normal controls (P<0.001). FTL decreased after cold stimulus (negative DeltaCS-FTL) in normal controls while SSc patients presented positive DeltaCS-FTL. Gender did not influence pre-CS-FTL and post-CS-FTL in normal controls. The decrease in FTL after cold stimulus was more prominent for normal individuals between 25 and 34 years old in comparison to other age subgroups, with statistical significance for females at 3 min post-CS (P<0.05). ROC curve analysis showed better diagnostic performance with post-CS-FTL at 8 and 13 min. CONCLUSION: CS-FTL test provides a reproducible quantitative biochemical parameter that reflects fingertip microcirculation status and was able to discriminate patients with SSc and normal controls, with optimal performance with post-CS-FTL at 8 to 13 min.

Adolescent↗