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PubMed1998

The mobile hospital--an experimental telemedicine system for the early detection of disease.

To detect early disease, especially lung disease, we created a new telemedicine system, called the Mobile Hospital. It consists of a satellite or ground communication system using a large vehicle in which is installed a whole-body spiral computerized tomography scanner and a multimedia telecommunications system. The Mobile Hospital goes to small villages and carries out mass screening for early lung disease, especially lung cancer. It travelled over 8000 km from May 1996 to March 1997. In this period 6358 persons aged 50-85 years and younger heavy smokers were screened in the Matsumoto area. As a result, 37.7% of the subjects were suspected of having various latent lung diseases. The cost of medical treatment for the lung cancers detected by the Mobile Hospital was 44% of that for a conventional medical care group, and the length of hospital treatment with surgical operation was 30% of that of the conventional group.

Aged↗
PubMed1989

Evaluation of transrectal ultrasound in the early detection of prostate cancer.

To determine the ability of transrectal ultrasound to detect early localized prostate cancer, unsuspected (nonpalpable) cancer in the contralateral lobe of patients undergoing radical prostatectomy for clinically localized disease was evaluated. A total of 59 patients with palpable prostate cancer clinically confined to 1 lobe underwent transrectal ultrasound before radical prostatectomy and step-sectioning of the radical prostatectomy specimen. Transrectal ultrasound was performed with 5 or 7 MHz. real-time transrectal units. Pathological findings in these 59 cases revealed no tumor in the contralateral lobe in 34 (58%) and the presence of unsuspected tumor in 25 (42%). Transrectal ultrasound detected 13 of 25 unsuspected cancers for a sensitivity of 52%. Of 34 patients with no contralateral lobe lesion transrectal ultrasound was correct in 23 for a specificity of 68%. The positive and negative predictive values for transrectal ultrasound in this study group were 54 and 66%, respectively. There was no significant difference in the pathological size of the clinically suspected and clinically unsuspected cancers as measured by average largest dimension, and transrectal ultrasound sensitivity did not correlate with the size of the cancer. Based on careful sonopathological analysis, transrectal ultrasound may not be a good method to detect clinically unsuspected prostate cancer and the false positive rate would appear to be high.

Humans↗
PubMed1984

Early detection of pancreatic lesions in chronic alcoholism: diagnostic accuracy of ERP.

In order to detect early pancreatic changes in chronic alcoholism, we reviewed pancreatograms (ERP) in 35 patients with alcoholic chronic liver disease who had no clinical evidence of pancreatitis. The patients were grouped by the length of history of alcohol intake (group 1: 5-15 years; group 2: more than 15 years), and on the basis of daily alcohol intake (group 1: 100-150 g/day; group 2: 150-200 g/day; group 3: more than 200 g/day). Pancreatic changes were present at ERP in 48.6% of patients, suggesting mild pancreatitis in 15 patients and advanced pancreatitis in two. Pancreatic lesions were significantly more frequent (p less than 0.01) in those who took more than 200 g of alcohol each day. There was no correlation with the length of history of alcoholism or with hepatic lesions. Our data confirm that asymptomatic pancreatitis is frequent in chronic alcoholism and that ERP can detect pancreatic lesions not otherwise demonstrable.

Adult↗
PubMedDate not supplied

Early detection and treatment of screw loosening in triple pelvic osteotomy.

OBJECTIVE: To detect early screw loosening in triple pelvic osteotomy (TPO) and to evaluate the efficacy of retightening using fluoroscopic guidance and minimally invasive surgery to maintain acetabular alignment and achieve bone healing. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Sixteen dogs that had TPO. METHODS: Dogs (16) had TPO (21) by using pre-angled plates secured with 3.5 and 4.0 mm screws, with ischiatic or iliac cerclage, for osteosynthesis. In all but 1 TPO at least 1 screw was inserted into the sacral body (43 screws). The mean radiographic screw length inserted in the sacrum was 10.2 mm, and the mean percent sacral engagement was 22%. Dogs were examined clinically and radiographically immediately postoperatively, and at 10, 30, 60, and 90 days to evaluate screw position. Loose screws were retightened through stab incisions using fluoroscopy to locate the screw. RESULTS: TPO was performed without operative complications. At 10 days, 12 TPOs (57%; 11 dogs) had loose screws primarily located in the cranial aspect of the plate. This represented 20% (25) of the inserted screws. In 5 dogs, screw loosening resulted in medial rotation of the acetabular segment. All loose screws were retightened; 3 screws loosened again in 2 dogs and were detected at 60 days. However, the osteotomies healed with the planned acetabular rotation without further intervention. Screw tightening corrected the acetabular segment displacement. Screws correctly seated at 10 days did not subsequently loosen. Clinical and radiographic outcome was judged excellent in all dogs. CONCLUSION: Loose screws in TPO plates can be identified by 10 days postoperatively and retightened using fluoroscopic guidance to achieve acetabular realignment and healing without need for further surgery. CLINICAL RELEVANCE: Postoperative radiographic evaluation of screw position at 10 days after TPO is recommended to detect loose screws. Retightening loose screws should be considered as an alternative to TPO revision or confinement, especially in immature dogs.

Animals↗
PubMed2005

Can cystatin C be a better marker for the early detection of renal damage in primary hypertensive patients?

In this study, we aimed to compare Cystatin C (Cys C) with other traditional glomerular filtration rate (GFR) markers and to evaluate its superiority over them in detecting early renal involvement in patients with primary hypertension. Fifty-one primary hypertensive patients and 29 healthy control subjects, who were similar in terms of age and gender, were included in the study. In all subjects serum levels of Cys C, beta-2 microglobulin, serum creatinine (SCr), uric acid, BUN, albumin; 24 h urinary levels of protein (Upro), albumin (Ualb) and creatinine were measured. The GFR was calculated according to Creatinine Clearance (CrCl), Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas. The MDRD was used as the reference method. A GFR<80 mL/min/1.73 m2 was considered as the lower cut-off limit. Mean levels of the serum parameters were found to be significantly higher in the patient group than they were in the control group (p<0.05). Mean CrCl, CG, and MDRD levels were lower in patients than they were in controls but the difference was statistically significant for CG and MDRD. The serum parameter having the best correlation with MDRD was SCr (r = -0.760) in patients and Cys C (r = -0.622) in controls. However, in ROC analysis; the area under curve (AUC) for Cys C was found to be superior (AUC = 0.900) to the other markers. The CrCl was the parameter having the worst diagnostic efficiency (AUC = 0.598). As a conclusion, compared to other traditional markers, measurement of Cys C may be a better parameter to estimate GFR, especially to detect mild reductions of GFR in primary hypertensive patients.

Adult↗
PubMed1985

Early detection of myocardial infarction in conscious dogs by analysis of plasma MM creatine kinase isoforms.

To determine whether myocardial infarction could be detected early after onset by analysis of subforms of the MM isoenzyme (isoforms) of creatine kinase (MM CK) in plasma, we subjected eight conscious dogs to coronary occlusion and quantified isoforms in serial plasma samples by chromatofocusing. The fractions of MMA (isoelectric point [pI] = 7.91), MMB (pI = 7.74), and MMC (pI = 7.51) in plasma samples before coronary occlusion averaged 11.4 +/- 4.8% (SD), 22.3 +/- 5.5%, and 66.3 +/- 9.6% of total MM CK activity. The fraction of MMA, the isoform of MM CK found in myocardium, increased significantly in plasma 1 hr after coronary occlusion, reached a maximum of 49.7 +/- 8.0% in 4.1 +/- 1.3 hr, and returned to baseline in 12.0 +/- 2.3 hr. The fraction of plasma MM CK activity attributable to MMC, an isoform formed slowly in plasma from MMA via MMB as an intermediate, decreased significantly within 1 hr, reached a minimum of 14.0 +/- 4.1% in 4.8 +/- 1.1 hr, and returned to baseline in 13.0 +/- 2.9 hr after coronary occlusion. Total CK activity did not increase significantly until later, i.e., 5 hr after occlusion, and peaked at 1371 +/- 530 IU/liter in 10.9 +/- 1.9 hr. Within the first 4 hr after coronary occlusion, MMA consistently comprised more than 20% of plasma MM CK activity despite insignificant increase of total CK. Changes in isoform proportions were consistent and independent of peak total CK activity and of cumulative CK release over a 10-fold range. Thus initial CK release indicative of infarction is detectable within 1 hr after the onset of ischemia by quantification of plasma MM CK isoforms.

Animals↗
PubMed1993

Computed tomography in the early detection of asbestosis.

Computed tomography (CT; both conventional (CCT) and high resolution (HRCT)) scans of the thorax were evaluated to detect early asbestosis in 61 subjects exposed to asbestos dust in Québec for an average of 22(3) years and in five controls. The study was limited to consecutive cases with chest radiographs of the International Labour Organisation categories 0 or 1 determined independently. All subjects had a standard high kilovoltage posteroanterior and lateral chest radiograph, a set of 10-15 1 cm collimation CCT scans and a set of three to five 2 mm collimation HRCT scans in the upper, middle, and lower lung fields. Five experienced readers independently read each chest radiograph and sets of CT scans. On the basis of three to five readers agreeing for small opacities of the lung parenchyma, 12/46 (26%) negative chest radiographs were positive on CT scans, but 6/18 (33%) positive chest radiographs were negative on CT scan. On the basis of four to five readers agreeing on a chest radiograph, 36/66 (54%) subjects were normal (group A), 17/66 (26%) were indeterminate (group B), and 13/66 (20%) were abnormal (group C). By the combined readings of CCT and HRCT, 4/31 (13%) asbestos exposed subjects of group A were abnormal (p < 0.001), 6/17 (35%) of group B were abnormal, and in group C, 1/13 (8%) was normal, 2/13 were indeterminate, and 10/13 (77%) were abnormal. Separate readings of CCT and HRCT on distinct films in 14 subjects showed that all cases of asbestosis were abnormal on both CCT and HRCT. Inter-reader analyses by kappa statistics showed significantly better agreement for the readings of CT than the chest radiographs (p < 0.001), and for the reading of CCT than HRCT (p < 0.01). Thus CT scans of the thorax identifies significantly more irregular opacities consistent with the diagnosis of asbestosis than the chest radiograph (20 cases on CT scans v 13 on chest radiographs when four to five readers agreed, 13% of asbestos exposed subjects with normal chest radiographs or 21% of asbestos exposed subjects with normal or near normal chest radiographs. It decreased the number of indeterminate cases significantly from 17 on chest radiographs to 13 on CT scans. All cases of asbestosis detected only on CT scans were similarly seen on CCT and HRCT and did not have significant changes in lung function. The CT scans significantly reduced the inter-reader variability, despite the absence of ILO type reference films for these scans.

Adult↗
PubMed1995

Office laparoscopy as a screening tool for early detection of ovarian cancer.

Laparoscopy is a safe and effective surgical procedures used in evaluating the peritoneal cavity. Laparoscopy, under local anesthesia, has been well documented in the literature. These studies support the concept that laparoscopy can be performed under local anesthesia. Several small studies have addressed the respiratory, cardiac, and hemodynamic changes observed using local anesthesia and suggest that, with proper monitoring, these procedures can be safely performed in an outpatient setting. Optical catheter systems now have diameters ranging from 0.25 mm to 2.5 cm. Image fibers 6 microns in diameter are combined in bundles. The catheter system produces a brighter though grainier picture than views produced by a xenon light source and a 5 mm laparoscope. An Adair Verres needle (18 gauge) is inserted through a 3 mm plastic introducer. The Adair Verres needle is removed and a gas extension tube is used to create a pneumoperitoneum with carbon dioxide. The optical catheter is placed through the extension tube. If a second site is required for biopsy or washings, a 3 mm port can be inserted under direct visualization. Miniature ultrasound transducers have now been developed as a means of imaging the internal structures of the ovary. These transducers, housed in #3.5-6.2 French catheters, can be passed through a laparoscope, adding a new dimension to laparoscopy. Although the technology of office laparoscopy as a means of detecting early ovarian cancer exists, it has limited applicability for screening the population at large. It may be more useful as secondary or tertiary testing in the work-up of patients suspected of having ovarian cancer.

Ambulatory Care↗
PubMed1978

Early detection of human chorionic gonadotropin in urine by simple immunoassays.

Data are presented to show that human chorionic gonadotropin (hCG) in urine can be detected early in pregnancy by simple immunoassays performed prior to or around the time of the expected but missed menstrual period. Differences between the use of simple immunoassays with urine and radioimmunoassays and radioreceptor assays with serum are discussed.

Chorionic Gonadotropin↗
PubMedDate not supplied

Early detection of glaucomatous damage. I. Psychophysical disturbances.

In summary, automated perimetry and other psychophysical tests currently provide the most sensitive, reliable and reproducible means of clinically detecting early glaucomatous changes. Compared to optic disk and nerve fiber layer evaluation, such procedures provide a consistent, quantitative method of distinguishing between early abnormalities and normal variations.

Glaucoma↗
PubMed2000

Early detection of cardiovascular autonomic neuropathy in diabetic pigs using blood pressure and heart rate variability.

Cardiac autonomic neuropathy is a common complication in insulin dependent diabetes mellitus. Nevertheless, little is known about when this impairment occurs during the time course of the disease. Analysis of blood pressure (BP) and heart rate (HR) variability could be used to detect early signs of autonomic alteration. To test this proposal, twelve sexually mature male Yucatan miniature pigs were equipped with an arterial catheter for telemetric BP analysis, and with a venous access. BP and HR were recorded together with respiratory movements while the animals were resting in a sling. After the first recording session performed when the pigs were 5 months old, streptozotocin (STZ) was used to induce diabetes in seven pigs, while the five others were controls. BP and HR were measured 3 and 6 months after the onset of diabetes and at a similar age in the controls. BP and HR oscillated at the respiratory range (0.19 Hz). Spectral analysis showed this respiratory component was the main determinant of the short-term variability of BP and HR. Atropine increased HR and BP and markedly diminished the respiratory sinus arrhythmia. Propranolol diminished HR and the respiratory peak of HR. A reduced respiratory oscillation of BP paralleled the diminution of the respiratory peak of HR. Baroreceptor-HR reflex was estimated using injections of phenylephrine and nitroprusside, and by cross-spectral analysis between BP and HR. Atropine shifted the curve to higher HR values, while propranolol reduced the level of the upper plateau. Atropine decreased both the coherence and gain of the cross-spectral analysis. STZ injection resulted in a type 1 diabetes. At 3 months, diabetic pigs exhibited low levels of BP and a reduced overall variability of HR and BP. Spectral analysis indicated the respiratory sinus arrhythmia was markedly reduced. In addition, the sensitivity of the baroreceptor-HR reflex was reduced. At a latter stage of diabetes these alterations were marked and the level of the resting HR was increased. These data demonstrate the dual (vagal and sympathetic) control of HR in pigs and the dominant role of respiration in the genesis of HR and BP fluctuations. The spectral and cross-spectral analysis of BP and HR were altered after 3 months of diabetes and could be proposed as early detectors of cardiac autonomic neuropathy.

Adrenergic beta-Antagonists↗
PubMed1993

Early detection of myocardial infarction with magnetic resonance imaging in a canine model.

STUDY OBJECTIVE: To determine the effectiveness of magnetic resonance imaging in detecting early myocardial infarction in vivo after coronary artery occlusion. DESIGN: A prospective, controlled canine study using a left anterior descending coronary artery ligation model. INTERVENTIONS: After thiopental anesthesia, nine mongrel dogs underwent cardiac-gated magnetic resonance imaging with a 2.35-T magnet with a 40-cm bore before and four hours after ligation of the left anterior descending coronary artery. MEASUREMENTS AND MAIN RESULTS: Hemodynamic and left ventricular blood flow changes were determined. The mean image intensity ratio of the suspected infarct region to the normal myocardium was determined in the four-hour postocclusion images and compared with the ratio from the same anatomic region obtained at baseline. The area of necrotic and ischemic myocardium was determined using fluorescein and triphenyl tetrazolium chloride staining immediately after four-hour images. All animals were noted to have necrotic (range, 1.8% to 20.4% of ventricles) and ischemic (range, 9.2% to 36.6% of ventricles) myocardium with histochemical staining. The mean intensity ratio of infarcted myocardium four hours after left anterior descending coronary artery occlusion was significantly higher than baseline (four hours, 2.31 +/- 0.82; baseline, 1.02 +/- 0.09; P < .002). CONCLUSION: Magnetic resonance imaging can distinguish myocardial edema associated with acute infarcting myocardium in vivo as early as four hours after left anterior descending coronary artery occlusion. Magnetic resonance imaging may be clinically useful in identifying thrombolytic therapy candidates among acute myocardial infarction patients presenting with atypical symptoms.

Animals↗
PubMed2003

Semiology, proteomics, and the early detection of symptomatic cancer.

"Diagnostic delay," the duration of symptoms or the symptom to diagnosis interval (SDI), are highly complex variables that reflect the behavior of the patient and the attending physician, tumor biology and host-tumor interactions, the functioning of the health care system, and sociocultural norms. In addition to tumor stage, other variables mediate the relationship between duration of symptoms and survival; clinical and epidemiologic procedures to measure them must be improved. Largely at odds with clinical and common wisdom, decades of research have shown that often SDI is not associated with tumor stage and/or with survival from cancer. It would be relevant to increase evidence in support of the notion that, for each type of tumor, there is a positive relationship between the length of the presymptomatic and the symptomatic phases. SDI could then be used to classify tumors according to their likelihood of being detected early when still asymptomatic. Also, tumors could be classified according to the ratio of the median SDI to the median survival (SDI to survival ratio, SSR), which may estimate the relative likelihood for clinical lead-time bias. If adhering to rigorous methodologic standards, proteomic analyses of early-stage cancers might provide new insights into changes that occur in early phases of tumorigenesis. More real examples are needed of uses of pathologic and genomic data to study mechanisms through which SDI influences-or fails to influence-prognosis. The degree of correlation between proteomic patterns and classic semiology constitutes an area of interest in itself; their respective correlations with cancer prognosis should be assessed in properly designed epidemiologic studies.

Humans↗
PubMed2006

In vivo bioluminescence imaging of transplanted islets and early detection of graft rejection.

BACKGROUND: Bioluminescence imaging (BLI) modalities are being developed to monitor islet transplant mass and function in vivo. The aim of this study was to use the BLI system to determine how the change in functional islet mass correlated to metabolic abnormalities during the course of alloimmune rejection in a murine transplant model. METHODS: Islets obtained from a transgenic mouse strain (FVB/NJ-luc) that constitutively expressed firefly luciferase were transplanted to various implantation sites of syngeneic wild-type FVB/NJ or allogeneic Balb/C streptozotocin-induced diabetic recipients. In vivo graft luminescent signals were repeatedly measured after transplantation using the BLI system and related to blood glucose levels and graft site histologic findings. RESULTS: The BLI signals were detected in as few as 10 islets implanted in the renal subcapsular space, intrahepatic, intraabdominal, and subcutaneous locations. There was a linear relationship between the number of islets transplanted and luminescence intensity. In isografts, stable luminescence intensity signals occurred within 2 weeks of transplantation and remained consistent on a long-term basis (18 months) after transplantation. In allografts, after normoglycemia was achieved and stable luminescence intensity occurred, graft bioluminescent intensity progressively decreased several days before permanent recurrence of hyperglycemia as a result of histologically proven rejection ensued. CONCLUSIONS: Bioluminescence imaging is a sensitive method for tracking the fate of islets after transplantation and is a useful method to detect early loss of functional islet mass caused by host immune responses even before overt metabolic dysfunction is evident. Bioluminescence imaging holds promise for use in designing and testing interventions to prolong islet graft survival.

Animals↗
PubMed1995

Early detection of cutaneous microcirculatory change during hemorrhage using a laser Doppler flowmetry.

The purpose of the present study was to evaluate the usefulness of cutaneous microcirculatory monitoring during hemorrhage. We observed changes in cutaneous blood volume, velocity and flow of five adult rabbits during hemorrhage by using a laser Doppler flowmetry. Mean arterial blood pressure, heart rate and blood gas values were measured. Cutaneous blood volume, velocity and flow decreased significantly after drawing 10 mL/kg of blood, while heart rate, mean arterial blood pressure and blood gas did not change. The decrease of cutaneous blood velocity preceded that of blood volume and was associated more deeply with the reduction of blood flow. In conclusion, cutaneous microcirculatory monitoring using laser Doppler flowmetry is a sensitive technique for detecting early changes of circulatory failure caused by hemorrhage.

Animals↗
PubMed2006

Early detection of Richter's transformation: stable disease with dose-reduced gemcitabine and local radiation.

BACKGROUND: The occurrence of Hodgkin's lymphoma (HL) as a second aggressive lymphoid malignancy (known as Hodgkin's disease variant of Richter's transformation) is rarely observed. Response rates, even with highly aggressive therapy such as stem cell transplantation, are limited, ranging from 4 to 43%, and the medium survival time ranges from 5 to 8 months. CASE REPORT: A 72-year-old patient with a history of chronic lymphatic leukemia (CLL) was admitted with thoracic back pain and assumed progression of the CLL. The patient showed no fever, night sweats or weight loss. A computed tomography (CT) scan confirmed the progression of axillary and cervical lymph nodes. In addition, an intraspinal infiltration at the 8th thoracic vertebra (Th8) was detected. Surprisingly, histology of an extirpated lymph node demonstrated the existence of 2 tumors in the same lymph node. Infiltrates of small lymphocytes representing the pre-existing CLL (CD5-, CD20-, CD23-positive) coexisted with Reed-Sternberg Hodgkin's cells (CD30-, CD15-positive). Chemotherapy was started, combined with palliative radiation of vertebrae Th7-Th10. 12 months after diagnosis of Richter's transformation the patient is still alive without any progression of the underlying disease. CONCLUSION: We present a unique case of a Hodgkin's disease variant of Richter's transformation and CLL in the same lymph node, which was detected early because of spinal infiltration and was subsequently stabilized with reduced-dosage gemcitabine and local radiation. Additionally, we show unique pictures of 2 tumors coexisting in the same lymph node.

Aged↗
PubMed1991

Computed tomography scan in the early detection of silicosis.

We evaluated the ability of both the conventional and high resolution computed tomography (CCT and HRCT, respectively) scans of the thorax to detect early silicosis in subjects exposed to silica dust in the mines and foundries of Québec for an average of 29 +/- 2 yr. The study was limited to subjects with chest radiograph (CR) of the International Labor Organization (ILO) Categories 0 or 1 as determined independently a priori. All subjects had a standard high-kilovoltage posteroanterior and lateral CR, a set of 10 to 15 1 cm collimation CCT scans, and a set of three to five 2 mm collimation HRCT scans in the upper, middle, and lower lung fields. For each CR and sets of CT scans, readings were done independently by four experienced readers. For small opacities of the lung parenchyma on CR, 32 of the 51 subjects were normal (Group A), six were indeterminate (Group B), and 13 were abnormal (Group C). By the combined readings of HRCT and CCT, 13 of the subjects (40%) in Group A were abnormal (p less than 0.001); four of the subjects in Group B were abnormal, and in Group C, one subject was normal, one indeterminate, and 11 (84%) abnormal. For confluence of small opacities, 48 of the 51 subjects were negative (Group 0), and three were positive (Group 1) on the CR. By the CT scan, 42 of the 48 subjects in Group 0 were negative, and the three subjects in Group 1 were positive; thus the CT scan added six positive cases with confluence of small opacities (six of 48, 12.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Computerized delayed matching to sample and paired associate performance in the early detection of dementia.

This study examined the ability of two computerized neuropsychological tests, delayed matching to sample and paired associate learning, to detect early dementia. Three groups of subjects classified by NINCDS-ADRDA criteria and standard neuropsychological tests were studied: normal controls, patients believed to be in early stages of dementia of the Alzheimer type, and a group of questionable dementia subjects who reported memory loss but performed normally on standard measures of cognition. All subjects completed the two computerized tests. The early dementia group performed at a significantly lower level than the other two groups on all standard and computerized measures. A linear discriminant function analysis of the computerized tests classified 100% of the normal controls and 87.5% of the dementia patients into the same groups as standard testing. The majority of questionable dementia subjects were classified as nondemented. The concurrent validity and test-retest reliability of the computerised tests were also investigated. It is suggested that computerized tests are useful when screening for early dementia, and that longitudinal studies are required to evaluate the comparative reliability of the tests.

Journal Article↗