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At least 73 records · Page 4Linked to original sources
PubMed1991

Serum enzyme alterations in chronic muscle disease. A biopsy-based diagnostic assessment.

The results of interpretation of muscle biopsies were compared retrospectively to activities of serum enzymes and isoenzymes. A total of 137 patients seen at the Cleveland Clinic Foundation in 1986 and 1987 were included in this study. Serum enzymes evaluated were CK, AST, LD, and aldolase (ALS), as well as the percentage CK-MB isoenzyme. The units of CK-MB and the ratios of CK to AST, LD, and ALS were calculated. Descriptive statistics, Kruskal-Wallis one-way analysis of variance, and stepwise logistic regression were performed. A diagnostic algorithm was constructed using a computer-assisted rule generation program. Myopathic diseases yielded a greater mean increase in serum enzyme activity than atrophic diseases. By multivariate stepwise logistic regression, increases in serum AST and CK activity were independently associated with the presence of inflammation in a muscle biopsy specimen. The diagnostic algorithm allowed for the separation of myopathies from atrophies and could identify cases of Duchenne's muscular dystrophy and polymyositis.

Algorithms↗
PubMed1992

Avoiding laparotomy in nonsurgical pneumoperitoneum.

Patients with free intraperitoneal air collections usually undergo emergency surgery, and the majority will have a gastrointestinal tract perforation. However, there is a subset of patients in whom no identifiable perforation is found at surgery. This entity of noniatrogenic, nonsurgical spontaneous pneumoperitoneum is being diagnosed more frequently at present and is commonly associated with other disease processes that, together, may suggest a benign process. Therefore, a diagnostic algorithm that would preclude operative intervention in this cohort of patients would be of paramount clinical importance. In this report, we present representative cases of the most common types of nonsurgical pneumoperitoneum, review the pathogenesis of this disorder, and discuss its relationship with pneumatosis cystoides intestinalis, pulmonary disorders, scleroderma, and gynecologic processes. Finally, we outline a diagnostic algorithm that may identify patients who can safely be observed, thereby reducing the incidence of negative laparotomies and, secondarily, the aggregate cost of health care.

Algorithms↗
PubMed1991

Spectroscopic diagnosis of colonic dysplasia.

We have developed a method for defining diagnostic algorithms for pathologic conditions based on fluorescence spectroscopy. We apply this method to human colon tissue and show that fluorescence can be used to diagnose the presence or absence of colonic adenoma. This method uses fluorescence excitation-emission matrices (EEM) to identify optimal excitation regions for obtaining fluorescence emission spectra which can be used to differentiate normal and pathologic tissues. In the case of normal and adenomatous colon tissue, these were found to be: 330, 370, and 430 nm +/- 10 nm. At these excitation wavelengths, emission wavelengths for use in diagnostic algorithms are identified from average difference and ratio of the spectra from normal and pathologic tissues. In colon tissue, at 370 nm excitation, 404, 480, and 680 nm were found to be useful emission wavelengths for diagnosing the presence of adenoma in vitro. The basis of colon tissue autofluorescence was investigated using EEM of pure molecules and relevant excitation-emission maxima in the literature.

Adenoma↗
PubMed1991

[Cytomorphological criteria of atypical hyperplasia and cancer of the endometrium based on data from a multivariate statistical analysis].

Multifactorial statistical analysis was used to identify differential diagnostic cytological features of glandular hyperplasia, atypical hyperplasia and well-differentiated adenocarcinoma of the endometrium. Twelve cytological features were identified for calculating linear discriminant function. The effectiveness of the diagnostic algorithm depends upon the diagnostic value of the sample and proficiency of the cytologist.

Adenocarcinoma↗
PubMed1986

An algorithm for differential diagnosis in jaundice and its applications.

During the recent years a broad spectrum of diagnostic methods have appeared for the differentiation of obstructive and nonobstructive jaundice: ultrasound examination, CT-scan, direct cholangiography, etc. These investigations are costly and not without risks. It is therefore essential to devise an optimal diagnostic strategy for each patient. Extensive clinical and clinical chemical information was collected from 1,002 jaundiced patients. By application of Bayes' theorem and logistic discriminant analysis a diagnostic algorithm was developed based upon 21 variables of the 107 variables collected. This algorithm permitted a probabilistic classification of jaundiced patients into four diagnostic categories: acute non-obstructive, chronic non-obstructive, benign obstructive and malignant obstructive jaundice. Adopting a probability limit of 0.80, 683 patients (69 p. 100) were correctly classified, 34 patients (3.5 p. 100) were wrongly so, and 268 patients (27 p. 100) could not be classified with a probability above 0.80 (doubtful cases). The algorithm was also tested in a further series of 110 jaundiced patients and found to perform equally well: 88 patients classified, 22 patients remaining doubtful. Patients with doubtful diagnoses should be referred to a non-invasive test such as ultrasound examination, whereas patients with definite diagnoses can be referred to invasive tests (liver biopsy, direct cholangiography) as appropriate. The diagnostic algorithm seems to be a reliable tool for the primary differential diagnosis of the jaundiced patient and can be used in the planning of further diagnostic tests for the individual patient.

Algorithms↗
PubMed1987

Algorithmic diagnosis of jaundice.

Extensive clinical and clinical chemical information was collected from 1002 jaundiced patients. By applying Bayes' theorem and logistic discriminant analysis, a diagnostic algorithm was developed based upon 21 of the 107 variables collected. This algorithm permitted a probabilistic classification of jaundiced patients into four diagnostic categories: acute non-obstructive, chronic non-obstructive, benign obstructive and malignant obstructive jaundice. Of the 985 patients with a final diagnosis a correct probabilistic diagnosis (obstruction vs. non-obstruction) was suggested by the algorithm in 867 patients (88%). Adopting a probability limit of 0.80, 683 patients (69%) were correctly classified, 34 patients (3.5%) were wrongly so, and 268 patients (27%) could not be classified with a probability above 0.80 (doubtful cases). The algorithm was also tested in a further series of 110 jaundiced patients and found to perform equally well: 88 patients classified, 22 patients remaining doubtful. Patients with doubtful diagnoses should be referred to a non-invasive test such as ultrasound examination, whereas patients with definite diagnoses can be referred to invasive tests (liver biopsy, direct cholangiography) as appropriate. The diagnostic algorithm seems to be a valuable aid for the preliminary differential diagnosis of the jaundiced patient and can be used in the planning of a diagnostic strategy for the individual patient.

Algorithms↗
PubMed1992

[Priapism: review of current knowledge and presentation of a diagnostic and therapeutic algorithm].

In medicine, priapism is defined as pathological state: a prolonged, generally painful erection not accompanied by sexual desire not ending with an ejaculation. Rare before 1980, priapism became more frequent after introduction of erection-inducing drugs by intracavernosal injections for treatment of impotence. Therefore, the medical practitioner can be faced with this problem, and the authors present with an algorithm the current diagnostic and therapeutic steps based on knowledge of pathology, physiopathology and etiology of this disease.

Algorithms↗
PubMed1987

Radiology of acute spinal trauma.

Radiologic diagnostic modalities utilized to evaluate acute spine trauma include plain films, tomography, computerized tomography (CT), myelography and CT-myelography, and magnetic resonance imaging. The initial evaluation is aimed at delineating the nature and extent of both boney and soft tissue injuries, with particular attention directed toward differentiating intrinsic cord damage from extrinsic spinal cord or nerve root compression that may respond to surgical intervention. The selection of the optimal radiologic diagnostic algorithm requires familiarization with the techniques and limitations of each diagnostic procedure.

Algorithms↗
PubMed1988

Correlation of pathology observed in double contrast arthrotomography and arthroscopy of the shoulder.

Correlation of double contrast arthrotomography (DCAT) of the shoulder and arthroscopic surgery diagnostic results have been undertaken in 55 patients with persistent shoulder pain or involuntary shoulder instability. During the period March 1984 to December 1986, 55 patients underwent DCAT followed by videotaped diagnostic shoulder arthroscopy. The primary indication for DCAT was persistent pain in 36 patients and instability in 17 patients. DCAT was performed according to the method of El-Khoury and Albright, and all arthroscopies were performed in a similar fashion by the senior author (HJS). Both tests were reviewed separately, retrospectively, and their results were correlated. For combined (anterior and posterior) labral pathology, the sensitivity/specificity for the instability group was 0.91/0.91, respectively; sensitivity/specificity for the pain group was 0.63/0.94. DCAT accurately depicted the status of 76% of anterior labrums and 96% of posterior labrums. For complete rotator cuff tears, sensitivity/specificity was 1.0/0.94. The status of a complete rotator cuff tear was accurately depicted in 91% of patients. Partial rotator cuff tears were missed in 83% of patients by DCAT. The presence or absence of loose bodies was accurately represented by 96% of DCAT. Arthroscopy showed that 71% of the instability patients had a labral tear, compared with 44% of the pain patients. Rotator cuff pathology was present in 12% of instability patients and 42% of pain patients. These findings indicate that DCAT may be a conditionally reliable test in the diagnosis of shoulder instability. DCAT must be considered inconclusive, however, in the painful shoulder without instability. Its usefulness as a preoperative screening test is discussed, and a diagnostic algorithm is presented. DCAT does not equal the diagnostic accuracy of shoulder arthroscopy.

Adolescent↗
PubMedDate not supplied

[Ultrasound diagnosis of gallbladder and bile duct diseases].

The paper is concerned with analysis of the potentialities of ultrasound introscopy in the diagnosis of various diseases of the gall bladder and biliferous ducts in 174 patients aged 19 to 76. The accuracy of the detection of calcium containing concrements of the gall bladder was 98.8%, that of choledocholithiasis--75%, noncalculous cholecystitis--88.4%, choledochodilatation--71.4%. In the absence of pathological changes in the gall bladder and biliferous ducts the reliability of echography was 27.7 and 93.1%, respectively. Causes of diagnostic errors in ultrasound tomography of the biliary system were discussed, methods of their prevention were proposed. A diagnostic algorithm of the sequence of use of ultrasound introscopy and other diagnostic methods to be employed in clinical practice was devised.

Adult↗
PubMedDate not supplied

[Ultrasonic diagnosis of diseases of the gallbladder and bile ducts].

The paper is concerned with analysis of the potentialities of ultrasound introscopy in the diagnosis of various diseases of the gall bladder and biliferous ducts in 174 patients aged 19 to 76. The accuracy of the detection of calcium containing concrements of the gall bladder was 98.8%, that of choledocholithiasis--75%, noncalculous cholecystitis--88.4%, choledochodilatation--71.4%. In the absence of pathological changes in the gall bladder and biliferous ducts the reliability of echography was 27.7 and 93.1%, respectively. Causes of diagnostic errors in ultrasound tomography of the biliary system were discussed, methods of their prevention were proposed. A diagnostic algorithm of the sequence of use of ultrasound introscopy and other diagnostic methods to be employed in clinical practice was devised.

Adult↗
PubMed1985

Scintigraphic diagnosis of hepatic hemangioma: its role in the management of hepatic mass lesions.

Hepatic cavernous hemangiomas are benign tumors of the liver that are often an incidental finding. They are usually asymptomatic but may cause symptoms when traumatized, may bleed spontaneously, or may produce pain by virtue of their large size and mass effect. A retrospective analysis of the clinical presentation, liver function tests, and diagnostic imaging procedures in 20 patients with hepatic hemangiomas is presented and the literature is reviewed. The 20 patients had 27 mass lesions as seen on liver scintigraphy, computed tomography, or sonography. Technetium-99m-labeled red blood cell flow studies and blood pool scintigrams showed delayed filling of the mass lesions, diagnostic of hemangiomas. This finding was not encountered in any other type of lesion. A new diagnostic algorithm is proposed in which blood-flow and blood-pool scintigraphy play a more prominent role in the diagnostic workup. According to this algorithm, if liver function tests in a patient with hepatic mass are either normal or abnormal and suggestive of hepatocellular dysfunction, the patient should undergo hepatic blood-flow and blood-pool studies.

Adult↗
PubMed1984

[Neuroradiology of primary and secondary spinal tumors].

The recent availability of spinal CT has modified the classic diagnostic algorithm of spinal and spinal cord tumors. The most important diagnostic signs given by traditional radiologic study of the spine (postural defects, signs of dysraphism, alterations of peduncles and neural foramina , soft paraspinal tissue changes, intra- and extra-vertebral calcifications, etc.), by myelography with hydrosoluble non ionic contrast medium and by spinal angiography are described. Their complementary indications and their up-to-date role in the diagnosis of site, size and nature of spinal neoplasms are discussed. The neuroradiological pictures of the most frequent spinal and vertebral tumors are summarized.

Angiography↗
PubMed1989

[The simulation of histopathological diagnosis with the help of an automated image analysis system (VISIAC)].

Simulation of the diagnostic algorithm in histopathology at 2 different light microscopical magnifications (x4, x40) for separating 7 diagnostic groups in lung pathology (healthy lung, healthy bronchus, lymphocytic inflammation, epidermoid-, adeno-, small cell, and large cell carcinoma) is presented. 140 cases were tested as a teaching set, 105 cases as learning set. Gray value distribution discriminates between healthy parenchyma and the diseases in all cases tested; minimum spanning tree discriminates between inflammation and carcinoma in all cases, and in between the carcinoma with 70% to 80% accuracy. The measurements may be used as additional aid in difficult diagnostic cases.

Algorithms↗
PubMed1986

Applications of computerized interactive morphometry in pathology. II. A model for computer generated diagnosis.

We present a model for the analysis and tentative diagnosis of pathologic problems by a trained observer utilizing data generated by a video based computerized interactive morphometry system in conjunction with multivariate methods of discriminant classificatory analysis that separate classes based on unweighted numerical values and with adhoc algorithms based on hierarchical analysis. The model was tested with two diagnostic problems that could benefit from a morphometric approach: the classification of non-Hodgkin's lymphomas from routine histologic slides and the distinction of malignant mesotheliomas from benign effusions in smears prepared from pleural effusions. The touch-sensitive screen of the computerized interactive morphometry system enables trained observers to measure the real time image of profiles of interest either by using graphic standards or simply by touching the two extreme points of the diameter of interest. This procedure generates multiple data in the form of classes that can be effectively used toward the more objective discrimination of lesions of difficult classification by analysis with a combination of adhoc diagnostic algorithms and multivariate statistical methods.

Computers↗
PubMed1989

[Methods of evaluating the effectiveness of diagnostic procedures].

The informational efficacy is evaluated of diagnostic tests that are employed in both screening programs and clinical routine. The main data concerning with the decision making theory are summarized and may be successfully applied in order to obtain diagnoses in practical conditions. Various diagnostic algorithms are demonstrated on practical examples. The attention is focused on such diagnostic methods which are issued from binary input data, ROC curve, the use of information theory and Bayes formula. Also the problem related to the statistical induction in evaluating diagnostic tests is treated.

Decision Theory↗
PubMed1991

[Quantitative assessment of qualitative traits of radionuclide images of the bones].

The results of radionuclide visualization of 147 patients with primary bone pathology were analyzed using probability algorithms. This analysis resulted in the determination of several groups of signs of various degrees of reliability in the diagnosis of some types of bone pathology. Diagnostic algorithms allow summing up and classifying practical experience and to test hypotheses, put forward by some of the physicians as a result of their practical activities. The use of probability algorithms in radionuclide studies is necessitated by a great variety of radiopharmaceuticals and a multitude of radiodiagnostic approaches to the standardization of methods and unification of diagnostic decisions.

Algorithms↗