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At least 739 records · Page 41Linked to original sources
PubMed2002

Continuous 12-lead ST-segment monitoring improves identification of low-risk patients with chest pain and a worse in-hospital outcome.

BACKGROUND: Various strategies have been proposed to improve diagnosis and triage of patients with chest pain at low risk, but uncertainty still exists on the optimal combination of diagnostic tools that should be used in this subset of patients. HYPOTHESIS: The aim of this study was to evaluate the incremental benefit of continuous 12-lead ST-segment monitoring over that provided by conventional diagnostic tools in patients with chest pain. METHODS: Of 232 consecutive patients referred because of chest pain, 52 were classified as low-risk according to the Agency for Health Care Policy and Research unstable angina guidelines and observed for 12 h with serial cardiac enzymes and electrocardiograms (ECG) (every 3 h). All patients also underwent both echocardiography at entry and continuous 12-lead ST-segment monitoring during the observation period. RESULTS: During a mean hospital stay of 3.7 days (range 1-14 days), a benign outcome was observed in 37 patients (71%), whereas 15 patients (29%) had major cardiac events or recurrence of chest pain of ischemic origin. Addition of ST-segment monitoring findings to baseline clinical data as well as to serial enzymes and ECG features added significant incremental prognostic value (p < 0.001). Multivariate analysis showed reproduction of pain by chest pressure (p < 0.05) and presence of ST-segment changes (> or = 0.1 mV) during 12-lead ST-segment monitoring (p < 0.001) as independent predictors of a benign or unfavorable outcome. CONCLUSIONS: In low-risk patients with chest pain, continuous 12-lead ST-segment monitoring provides significant incremental diagnostic and prognostic information to currently used clinical, enzymatic, and ECG data, and is helpful in identifying the subset of patients with a worse in-hospital outcome.

Adult↗
PubMed1981

Report on international comparative evaluation of possible value of assays for immune complexes for diagnosis of human breast cancer.

There have been several reports on the possible value of measurements of circulating immune complexes for the diagnosis of human breast cancer. To begin to evaluate this possibility and the comparability of results among laboratories, a cooperative study was organized under the auspices of the International Agency for Research on Cancer and the National Cancer Institute (NCI) of the United States. Investigators from four laboratories performing assays for immune complexes were sent coded aliquots of serum specimens from the NCI-Mayo Clinic Serum Bank. The serum panel consisted of specimens from 30 patients with breast cancer (including 20 from untreated patients with resectable tumors), 30 preoperative patients with benign breast disease, and 30 normal women. Although some significant differences in levels of immune complexes between cancer patients and controls were seen, none of the assays had sufficient discriminatory capacity to support optimism about the diagnostic value of this approach. To relate the results with immune complexes to those with a widely used cancer marker, the same sera were also tested for levels of carcinoembryonic antigen (CEA). The CEA assay provided significant discrimination between cancer patients and normal donors but did not significantly discriminate between malignant and benign breast diseases.

Antigen-Antibody Complex↗
PubMed2003

Relevance of B19 markers in serum samples for a diagnosis of parvovirus B19-correlated diseases.

In order to evaluate the optimal and essential diagnostic test(s) for a correct diagnosis of B19 diseases, 344 consecutive serum samples were tested from 344 patients with clinical suspicion of B19 infection during an epidemic period (early Spring-Autumn 2000). Sera were tested for B19 DNA by a standardized competitive polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA) and dot-blot hybridization and for specific IgM and IgG by ELISA. Of 344 patients examined, 125 were positive for markers of B19-associated disease: 49 had both B19 DNA and IgM, 50 had B19 DNA without IgM, and 26 had IgM without B19 DNA. After examination of the different patterns of B19 markers as diagnostic tools for B19 infection, IgM determination detected only 60% of B19-documented infections. IgM tests were nevertheless fundamental, as they were the unique diagnostic marker in 20.8% of documented infections (26 of 125 patients), in the diagnosis of recent, but still symptomatic infections when B19 DNA was no longer detectable. The determination of B19 DNA with PCR permitted detection of 79.2% of infections and therefore represented an essential test. PCR was fundamental for the diagnosis of B19 disease, as the unique diagnostic marker in 32% of documented infections (50 of 125 patients), both in acute infections at the onset of symptoms before the appearance of immunological response, and during the course of persistent B19 infections in which IgM had cleared. The contemporaneous determination of B19 DNA by PCR and specific IgM appears to be the most appropriate diagnostic protocol for the correct laboratory diagnosis of B19 infection.

Antibodies, Viral↗
PubMed1993

Diagnostic and therapeutic management of atypical mycobacterial infections in children.

A series of 12 children (9 girls, 3 boys) with non-tuberculous mycobacterial lymphadenitis was reviewed to define the most frequent presenting features, helpful diagnostic measures and optimal management. The mean age at diagnosis was 42 months and cervical nodes in the submandibular region were most commonly affected. In most of the children the diagnosis was made on the basis of a positive intradermal skin test with specific antigens for atypical mycobacteria. The diagnosis was confirmed in all but one case by histopathologic examination. Total excision of the affected gland was recommended as the therapy of choice in the patients treated.

Child↗
PubMed1995

Intra-arterial digital subtraction angiography with isotonic dimeric (iodixanol) and monomeric (iohexol) nonionic contrast media: radiographic, clinical and neurophysiological evaluation.

Monomeric (iohexol 300 mg I/ml) and dimeric (iodixanol 270 mg I/ml) nonionic contrast media were compared in a double-blind, randomised, parallel group trial. Safety and efficacy of the media in intra-arterial cerebral digital subtraction angiography were evaluated by assessing adverse events, discomfort, EEG, heart rate and quality of radiodiagnostic information. Seventy-six patients underwent selective injection of the carotid and/or vertebral arteries. Both contrast media were well tolerated. No serious adverse events occurred. No effects on heart rate and EEG were evident. The arteriograms were of high quality and overall diagnostic information was optimal in 94% of the examinations. No clinically important differences between the two contrast media were found.

Adult↗
PubMed1995

Iodixanol in intra-arterial cerebral digital subtraction angiography: a comparison with iohexol.

We randomised 86 patients undergoing intra-arterial cerebral digital subtraction angiography (IADSA) to receive iodixanol (Visipaque; Nycomed, Oslo, Norway) 150 mgI/ml or iohexol (Omnipaque; Nycomed) 140 mgI/ml. The efficacy and safety of these two contrast media were compared: efficacy by evaluating the diagnostic information and radiographic density yielded by the angiograms, safety by recording all discomfort connected with the injections, and all adverse events up to 24 h after the investigation. Diagnostic information was optimal in all patients and the overall radiographic density optimal in all but one (iohexol) (P = 0.49). A feeling of warmth, the only discomfort reported, was experienced by 43% and 54% of patients receiving iodixanol and iohexol, respectively (P = 0.26). Two patients in the iodixanol group and five in the iohexol group reported one adverse event (nausea, dizziness, visual disturbance or paraesthesiae) (P = 0.30); all were of mild severity except for one moderate adverse event in each group. Iodixanol 150 mgI/ml and iohexol 140 mgI/ml were demonstrated to be suitable for IADSA, with no clinically or statistically significant differences in efficacy, discomfort or adverse events.

Adult↗
PubMed2004

[Acute cor pulmonale in pulmonary embolism. An important prognostic factor and a critical parameter for the choice of a therapeutic strategy].

Venous thromboembolism remains one of the most frequent and threatening acute cardiovascular syndromes. Its incidence has remained constant over the last several years, both in Europe and the United States, accounting for approximately 1.5 cases per 1000 inhabitants per year. Every year about 100 cases of venous thromboembolism per 100,000 inhabitants are admitted to the hospital, and 10% of these patients die during the hospital stay. Particularly alarming is the fact that in 50-70% of all patients who die from an acute pulmonary embolism the diagnosis is only made after death. These facts emphasize not only the relevance of the problem of "acute pulmonary embolism," but also the need for optimization of current diagnostic and therapeutic strategies. Rapid identification of acute cor pulmonale with echocardiography and cardiac biomarkers has recently proven to be especially helpful in this regard.

Algorithms↗
PubMed1998

Localization, malignant potential, and surgical management of gastrinomas.

Between 1987 and 1996 a total of 25 patients with proved Zollinger-Ellison syndrome (ZES) have been treated in our department. If preoperative imaging studies did not show diffuse metastatic disease, patients were scheduled for operation with a standardized surgical approach including thorough exploration and intraoperative ultrasonography (IOUS) of the pancreas and a longitudinal duodenotomy, with separate palpation of the anterior and posterior walls. Postoperatively, patients were followed up by physical examination, fasting gastrin levels, and the secretin stimulation test. Altogether 10 patients had duodenal wall gastrinoma, 14 patients pancreatic gastrinoma, and the tumor was not found in 1 patient. Only 15 tumors (60%) (2 duodenal wall and 13 pancreatic gastrinomas) could be visualized preoperatively. Intraoperatively, 24 of 25 primary gastrinomas were localized. The mean size of duodenal wall gastrinomas (9.6 mm) was significantly smaller than that of pancreatic gastrinomas (28.7 mm) (p < 0.05). At the time of surgical exploration, five duodenal and seven pancreatic gastrinomas had metastasized. The incidence of lymph node metastases was similar for both tumor sites, whereas patients with pancreatic gastrinomas more frequently had liver metastases. The presence of liver metastases was the most important determinant for survival. Four patients (40%) with duodenal and seven with pancreatic (50%) gastrinomas (mean follow-up 5.2 years) were biochemically cured by operation. Of the remaining patients, eight are still alive with recurrent disease. Our results suggest that preoperative localization of gastrinomas often fails despite all modern imaging methods. Therefore a standardized surgical exploration of the pancreas including IOUS and a duodenal exploration should be performed to achieve optimal results. Preoperative diagnostic imaging tests should include computed tomography, ultrasonography, and somatostatin receptor scintigraphy to exclude diffuse metastases. In contrast to liver metastases, lymph node metastases do not have a significant influence on survival.

Diagnostic Imaging↗
PubMedDate not supplied

Injection-associated pain in femoral arteriography: a European multicenter study comparing safety, tolerability, and efficacy of iodixanol and iopromide.

PURPOSE: To evaluate injection-associated pain, safety, and efficacy with the isotonic contrast medium iodixanol (Visipaque 270 mg I/ml) compared with iopromide (Ultravist 300 mg I/ml) in femoral arteriography. METHODS: A multicenter, double-blind, randomized, parallel-group clinical investigation was carried out in 54 hospitals in Europe. Of the patients evaluated, 1225 received iodixanol and 1227 iopromide in conventional and/or digital subtraction angiography. RESULTS: The iodixanol group reported statistically significantly less injection-associated pain (0.9%) than the iopromide group (9.5%) (p << 0.001). Further, 4.1% in the iodixanol group experienced pain and/or severe heat sensation vs 19. 8% in the iopromide group (p << 0.001). In the iodixanol group, 1.8% of the patients experienced contrast-related adverse events vs 2.4% in the iopromide group (p = NS). Overall diagnostic information was optimal for 94.1% in the iodixanol group and 95.3% in the iopromide group (p = NS). CONCLUSIONS: Iodixanol 270 mg I/ml causes significantly less injection-associated pain during femoral arteriography and is as safe and efficacious as iopromide 300 mg I/ml.

Aged↗
PubMed2005

The predictive value of additional late blood pool imaging to the three-phase bone scan in the diagnosis of reflex sympathetic dystrophy in hemiplegic patients.

Reflex sympathetic dystrophy (RSD) is a relative common sequel after hemiplegia. The diagnosis of RSD in hemiplegic patients presents difficult clinical problems, as the symptoms and signs of RSD are not specific and RSD may be due to reasons other than hemiplegia. Bone scintigraphy has been routinely used for the diagnosis of RSD; however, the optimal acquisition protocols, diagnostic patterns and the utility of quantitation are controversial. This prospective study was conducted to demonstrate the higher predictive value of an additional late blood pool image to the three-phase bone scan compared to the regular three-phase bone scans in RSD patients associated with hemiplegia. Thirty-four RSD patients were enrolled into the study. Bone scans according to the new protocol were obtained for all patients. Those patients with either negative or positive bone scans with no evidence of RSD were followed for 6 months. The patients had positive bone scan findings and were symptomatic at the time of the study. Of these, seven patients (58.3%) subsequently became symptomatic and five patients (41.7%) remained asymptomatic at 6 months. None of the patients with negative bone scans had symptoms of RSD on presentation except one case. We conclude that the addition of a late blood pool image increases the predictive value and has an impact on initiating early treatment in asymptomatic patients.

Aged↗
PubMed2005

Metastasis to nervous system: spinal epidural and intramedullary metastases.

Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer with an increasing incidence. Prostate, breast and lung cancer are the most common offenders. Metastasis usually arises in the posterior aspect of vertebral body with later invasion of epidural space. Pathophysiologically, vascular insufficiency is more important than direct spinal cord compression. The most common complaint is pain, and two thirds of patients with SEM have motor signs at initial diagnosis. Currently magnetic resonance imaging is the most sensitive diagnostic tool. The optimal management of SEM is still arguable, but recent advances in surgical management of SEM and higher complication rate of surgery following radiotherapy should persuade clinicians to consider de novo surgery where possible. Radiotherapy has an important role, particularly in treatment of radiosensitive tumors and in patients who are not candidates for surgery. Novel approaches such as stereotactic radiosurgery are promising; however, response to chemotherapy depends on inherent properties of primary tumor. Recurrent SEM is a substantial problem for which surgery or repeat radiotherapy may be options. Intramedullary metastasis is rare but should be considered in patients with systemic malignancy and asymmetrical presentation of myelopathic symptoms. The prognosis is usually poor and preferred modality of treatment is radiotherapy.

Epidural Neoplasms↗
PubMed1989

Mirror image of environmental deprivation: severe childhood obesity of psychosocial origin.

We report 12 children with severe obesity in very early childhood who had no evidence of organic causes for their obesity and whose families evidenced psychosocial dysfunction comparable to that often seen in growth failure of psychosocial origin. Features seen include family disorganization, separation of mother and child, displacement of child care to others, maternal depression, denial of the growth abnormality, hostility towards health care providers, and inconsistent medical follow-up. In all cases, parental limit setting was impaired. We suggest that this condition should be called "severe obesity of psychosocial origin." Very severe obesity of early childhood may be conceptualized as the mirror image of growth failure. Like growth failure, it requires evaluation and management focused on psychosocial issues. Research is needed to clarify the prevalence, diagnostic features, and optimal treatment of obesity of psychosocial origin.

Body Height↗
PubMed1985

Significance of anti-HBc IgM in the differential diagnosis of viral hepatitis.

IgM antibody to hepatitis B core antigen (anti-HBc IgM) as determined by IgM capture immunoassay is generally present in high titer during acute hepatitis B infection. A strong positive reaction for anti-HBc IgM during acute hepatitis is indicative of an acute HBV infection even in hepatitis B surface antigens (HBsAg)-negative patients. With the help of anti-HBc IgM otherwise unidentified HBV infection can be diagnosed in HBsAg-negative patients and an optimal combination of diagnostic tests for acute hepatitis B infection would therefore include assays for both HBsAg and anti-HBc IgM. In the HBsAg carrier with or without chronic liver disease the presence and meaning of anti-HBc IgM is still a matter for discussion. Detection of a weak positive result for anti-HBc IgM in HBsAg-positive patients without a recent history of acute hepatitis cannot always be regarded as a definite marker of recent hepatitis B infection. However, quantitation of the anti-HBc IgM results seems to improve the clinical value of the test. Comparison of the available anti-HBc IgM assays is needed and may well establish a reliable cut-off level that would differentiate acute from chronic hepatitis B and ongoing from resolving hepatitis B in HBsAg-positive patients.

Carrier State↗
PubMed1994

Current status of myocardial perfusion imaging after percutaneous transluminal coronary angioplasty.

Controversy exists with regard to the diagnostic accuracy and optimal technique of myocardial perfusion imaging after coronary angioplasty. Exercise treadmill testing is inexpensive, with adequate predictive value for restenosis and clinical events in patients with single-vessel coronary angioplasty with a normal rest electrocardiogram (ECG). Myocardial tomography has advantages for assessing patients with multivessel coronary angioplasty. Exercise stress imaging is generally preferable to pharmacologic stress in patients without physical limitations after angioplasty. Delayed thallium-201 imaging and reinjection protocols may be useful to reconcile whether residual ischemia exists in "fixed" perfusion defects. Appropriately timed stress myocardial perfusion imaging 2 to 4 weeks after procedurally successful coronary angioplasty can document improved cardiac functional capacity and reduced ECG and imaging evidence of myocardial ischemia. Although routine serial postangioplasty evaluations cannot be recommended, stress myocardial imaging may be valuable in subjects with defective anginal nociception or extensive myocardium at risk in the area subtended by the angioplasty vessel.

Angioplasty, Balloon, Coronary↗
PubMed2006

A low incidence of nontuberculous mycobacterial infections in pediatric hematopoietic stem cell transplantation recipients.

Hematopoietic stem cell transplantation (HSCT) is being used to treat a wide spectrum of clinical disorders but opportunistic infection remains an important factor determining outcomes for these patients. Nontuberculous mycobacterial (NTM) infections are being reported more frequently in HSCT recipients and the incidence of NTM infections in adult recipients is reported to be 0.4%-4.9%. However, the incidence and severity of NTM infections are less well described in pediatric HSCT recipients. Centers for Disease Control and Prevention guidelines were used to define definite and probable NTM infection among 132 children undergoing 169 HSCT between January 2000 and December 2004 at our institution. NTM infection was diagnosed in 5 of 132 pediatric recipients (3.8%). There were no NTM infections diagnosed in the autologous HSCT recipients and the incidence of NTM in allogeneic HSCT recipients was 6.4% (95% confidence interval, 0.8-11.9). The mean age of the HSCT recipients who developed NTM infections was 8 years (range, 2-19 years); 3 were male and 2 were female. Four conditioning regimens included alemtuzumab and 3 had antithymocyte globulin. Of the 5 patients with NTM infections, 2 met the criteria for definite infection and 3 for probable infection. Of the 2 patients with definite NTM infection, 1 had disseminated disease with Mycobacterium avium complex and the other had Mycobacterium chelonae catheter-related bloodstream infection. The probable NTM infections were 1 skin infection with Mycobacterium kansasii and 2 lower respiratory tract infections with M avium complex. Median time to NTM infection was 115 days (range, 14-269 days) after HSCT. Two patients had graft-versus-host disease at the time of NTM infection. All 5 patients received 3-4 antimycobacterial drugs and all NTM infections resolved. In summary, the incidence of NTM infection in pediatric HSCT recipients appears similar to that described in adult HSCT recipients and the outcome appears to be excellent with the proper antibiotic therapy. The increased use of anti-T cell antibodies appears to be associated with an increased risk of NTM infections in pediatric HSCT recipients. Multicenter studies are needed to identify the risk factors, early diagnostic criteria, and optimal therapy.

Adolescent↗
PubMed2006

The efficacy of St. John's Wort in patients with minor depressive symptoms or dysthymia--a double-blind placebo-controlled study.

INTRODUCTION: We studied the efficacy of St. John's Wort compared with placebo in patients with minor depressive symptoms or dysthymia, with the main focus on which diagnostic entities are optimally amenable to treatment with two different doses of Hypericum, and which are not. METHODS: One hundred and fifty patients, 25-70 years old, meeting ICD-10 criteria for mild or moderately severe depressed episodes or with dysthymia, and having a 17-item Hamilton Depression Scale for Depression (HAM-D) total score between 7 and 17, were randomly assigned to an extract. The extract, PM235, manufactured by Cederroth International AB, Sweden, was given t.i.d. in a lower (0.12% hypericine) or a higher (0.18% hypericine) formulation, based on 270mg extractions or identical placebo. Clinical response was defined by HAM-D as a 50% reduction and/or a score 7. The Beck Depression Inventory (BDI) and Visual Analog Scales (VAS) were used as secondary efficacy parameters. Measures were conducted at screening, baseline, and after 3 and 6 weeks of treatment. RESULTS: We found a large discrepancy in response between dysthymic and non-dysthymics, the latter seemingly more sensitive to Hypericum. HAM-D showed tendency but no significance toward a more frequent improvement of the non-dysthymics treated with Hypericum (p=0.057). BDI criteria showed significance (p=0.045) for both doses of Hypericum compared to placebo. Pooling high- and low-dose groups together, a significant reduction for HAM-D7 and BDI criteria was found among non-dysthymic patients (p=0.03). Significant improvement in response to Hypericum was found in symptoms reflected by VAS - again only in non-dysthymic patients (p=0.041). DISCUSSION: We observed, a tendency toward a more frequent significant improvement of the non-dysthymic patient treated with PM235, though this did not reach the level of statistical significance. In a secondary analysis, pooling both hypericine-treated groups concluded that Hypericum has a clinical significant effect in minor depressed patients with HAM-D up to 17. This finding was significant only in non-dysthymic patients.

Adult↗
PubMed1993

Comparison of 3- versus 6-minute infusions of adenosine in thallium-201 myocardial perfusion imaging.

Adenosine thallium stress testing has a demonstrated utility in the detection of coronary artery disease. The optimal dose for diagnostic efficacy with minimal side effects has not been critically evaluated. A randomized 3- and 6-minute infusion of adenosine (140 micrograms/kg/min) was performed in 11 subjects. Subjects reported more side effects during the 6-minute infusion protocol (p < 0.05). Hemodynamic changes were not different during either infusion duration. All dysrhythmias began within 2 minutes and therefore the duration of the infusion did not influence their occurrence. Segmental comparison of the stress images demonstrated an 89% agreement. Delayed scans demonstrated a 79% agreement. There was a higher incidence of redistribution following the 6-minute infusion (p = 0.014). We conclude that when side effects necessitate the discontinuation of a 6-minute adenosine infusion, a diagnostic test can still be achieved if 2 to 3 minutes of adenosine have been administered before the thallium injection; however, the amount of viable myocardium may be underestimated.

Adenosine↗
PubMed1998

Knowledge-based test result in interpretation in laboratory medicine.

The medical interpretation of laboratory test results aims for an optimization of the diagnostic decision process to improve the quality of medical care. It is of growing importance in Clinical Chemistry and Laboratory Medicine. Interpretation is an active process that depends on patient history, experience of the interpreter and local disease prevalences. For the field of Laboratory Medicine the tool Pro.M.D. was developed that enables the medical expert to formulate his knowledge and experience in a knowledge-based system. Nine Pro.M.D. systems are in routine use for knowledge-based test result interpretation at several hospital laboratories today. Our experience in providing clinicians with interpretive reports shows that a medical dialogue on individual findings can be established or improved. With the development of a new, highly differentiated and extensive knowledge base our group introduced a concept called NOTABENE as the basis for new maintenance tools.

Diagnosis, Computer-Assisted↗