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MR imaging of the symptomatic ankle and foot.

MR imaging can play a key role in the evaluation of soft tissues and marrow space of the symptomatic muscle and foot. Diagnostic efficacy is optimized by tailoring the examination to a given problem. Techniques for MR imaging of the foot and ankle are reviewed, the clinical use of MR imaging for examining the structures of the foot and ankle is discussed, and strategies for the integration of MR imaging into the work-up of selected clinical problems are presented.

Ankle Injuries↗

Sjögren's disease.

In summary, Sjögren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands, particularly the salivary and lacrimal glands. The sicca complex of xerophthalmia and xerostomia are the hallmark features of Sjögren's symptomatology. In addition to these hallmark symptoms of oral and ocular dryness, one third of patients with Sjögren's syndrome present with extraglandular manifestations. Many osf these extraglandular manifestations, as well as the sicca symptoms, have otolaryngologic relevance. Because patients with Sjögren's syndrome may present with vague or nonspecific head and neck complaints, ranging from oral dryness to hoarseness to hearing loss, an otolaryngologist's high index of suspicion for this disorder may prevent delay in diagnosis, allow appropriate diagnostic evaluation, and optimize therapeutic intervention.

Digestive System Diseases↗

Radiopacity of tantalum oxide nanoparticle filled resins.

OBJECTIVES: Radiopacity of composite resins allows radiographic distinction of existing restorations and recurrent caries. Current composites must be supplemented with heavy metal-containing glasses or minerals to achieve a desired radiopacity. The purpose of this study was to evaluate the radiopacity of Tantalum oxide (Ta2O5) filled resins at varying percentage loadings. METHODS: Methacrylate functionalized Ta2O5 nanoparticles (< 50 nm) in methanol-dissolved or powder forms were mixed into either glycerol dimethacrylate (GDMA) or a bisGMA, TEGDMA, bisEMA mixture (GTE). Specimens were made in a split brass mold (2 x 2 x 15 mm) and compared with an aluminum stepwedge (99.5% pure Al) and a dentin slice of the same thickness. Kodak Ultraspeed periapical X-ray film on a lead plate at a target distance of 45 cm was exposed at 70 kVp and 10 mA, for 0.5 s and processed automatically. Optical density was measured (n = 3) with an RMI Processor Control Densitometer. Radiopacity was calculated as percent relative linear attenuation coefficient (Alpha). ANOVA and Student-Newman-Keuls comparisons were used to determine significance at the 95% confidence level. RESULTS: Radiopacity increased significantly with Ta2O5 loading (p = 0.001). Ta2O5 nanoparticle filled resins enter the optimal range of diagnostic detectability (alpha = 150-250) at 50 wt.% and approach equivalence with enamel at approximately 70 wt.%. SIGNIFICANCE: The introduction of tantalum oxide nanoparticle filler has potential as a miscible component of a resin composite to provide radiopacity for microfiller-type restorative materials and to circumvent the need for hydrolysis-prone glass reinforcing fillers.

Analysis of Variance↗

Stochastic technology, production organization and costs.

Using a model including patients, physicians, insurers and uncertain diagnostic technology, the optimal cesarean rate is derived from preferences, technology and the incidence rate, when the choice of insured patients is constrained only by technology. Uncertain diagnosis produces unnecessary cesareans and unsafe vaginal births. Technical progress can lead to more cesareans and higher costs. Joint production of goods and bads and collective payments require incentive compatible pricing schemes, different from RBRVS. Equilibrium outcomes of HMOs and free-for-service organizations are identical. However, implementable incentive schemes involve additional costs. Efficiency requires insurers, and not providers, to be liable for malpractice claims.

Adult↗

Septic shock.

Septic shock is a life-threatening condition that results from the combined effects of bacteria and the host's chemical mediators of inflammation. Of particular detriment is the hyperdynamic and hypodynamic vasomotor instability that severely compromises the patient prior to the onset of overt bacteremia. The principles of therapy include (1) a prompt diagnosis, (2) removing the source of sepsis, (3) maintaining normal blood pressure through the use of parenteral fluids and inotropes, (4) selecting the appropriate antimicrobial agent, and (5) stringent patient monitoring. Sometimes, despite the optimal use of diagnostic tests and high-quality treatment, the prognosis remains guarded to grave.

Adrenal Cortex Hormones↗

Thromboembolic diseases of childhood.

Over the last decade, pediatric thrombophilia programs have emerged around the world as a new discipline in pediatric hematology. These programs specialize in the diagnosis, prevention and treatment of children with thromboembolic events (TEs) in both the venous and arterial systems. The need for separate pediatric programs has been discussed previously. (J Pediatr Hematol Oncol 1997; 19: 7-22.) The following article will update previous reviews (Hematol Oncol Clin North Am 1998; 12: 1283-1312; Thromb Haemost 1997; 78: 715-725) and will concentrate on three aspects: (1) The risk factors for acquiring TEs; (2) The confirmatory diagnostic tests used in children with TEs; and (3) The different antithrombotic agents used for prevention and treatment. The current knowledge in respect to the above points is only the "tip of the iceberg". Well-designed prospective trials are required to establish the contribution of congenital prothrombotic disorders, appropriate diagnostic strategies, and optimal therapy for children with TEs.

Child↗

Neonatal thrombosis and its treatment.

Thromboembolic disease (TE) has been described as the new epidemic of tertiary paediatrics, and no where is this more evident than in the neonatal population. As survival of premature and sick newborns has improved, the frequency of complications associated with intensive supportive therapy and monitoring has increased. Clinically significant thrombosis is emerging as one of the more common complications associated with improved neonatal outcome. The long-term implications of neonatal thrombosis are only just being realised. This systematic review will consider the epidemiology, diagnostic strategies, and outcome for both arterial and venous TE in neonates. The role of inherited thrombophilic abnormalities, and the evidence for anticoagulation therapy will also be considered. The lack of high level evidence in determining optimum therapy is obvious. Further research regarding diagnostic strategies, and optimal therapies is urgently needed.

Catheterization, Peripheral↗

[Neonatal hypoxemia due to misaligned pulmonary vessels with alveolar capillary dysplasia].

BACKGROUND: Refractory hypoxemia in the newborn requires a precise diagnostic investigation for optimal and fast management. CASE REPORT: A full term newborn presented with refractory hypoxemia associated with radiologically clear lung fields and extrapulmonary shunt. Echocardiography ruled out a cardiac malformation. The persistence of hypoxemia despite treatment of the extrapulmonary shunt and the absence of parenchymatous pulmonary disease led to suspect misaligned lung vessels with alveolar capillary dysplasia. This diagnosis was confirmed by post mortem microscopic examination of the lung. CONCLUSION: The diagnosis of misaligned lung vessels with alveolar capillary dysplasia can be suspected on clinical features. The disposition of pulmonary veins must be checked to recognize this disease in case of neonatal death with pulmonary hypertension.

Capillaries↗

Interventional radiology techniques in musculoskeletal disease.

It is likely that, over the next few years, the rapid technological advancements in ultrafast magnetic resonance imaging and ultrasound resolution improvements, coupled with a drive towards minimally invasive surgery, will further enlarge the scope of imaging guided interventional procedures. Such innovations should increase diagnostic accuracy for optimized treatment regimes as well as probably replace an increasing number of conventional 'open' operative procedures.

Humans↗

Multi-anode detection in electrospray ionization time-of-flight mass spectrometry.

An electrospray ionization ion source coupled to a time-of-flight mass analyzer incorporating a multi-anode time-to-digital converter is described. High-speed data acquisition (kHz mass spectral acquisition) rates are achieved. The four-anode detector produces a significant increase in detection/counting efficiency over that for a single-anode detector. In this work a 2.5 times increase in detection efficiency is demonstrated. The multi-anode detector is also used as a diagnostic tool to optimize transmission of the ion optics.

Cytochrome c Group↗

Identification and characterization of allergens in two species of tuna fish.

BACKGROUND: In countries where fish consumption is high, allergenic reactions to fish are common among patients diagnosed with food hypersensitivity. For tuna fish, allergenic proteins are not known. In addition, it is not known how the tuna fish extracts should be processed to obtain optimal in vitro diagnostic performance and to preserve labile antigens. OBJECTIVE: The aim of this study was to characterize IgE-binding components of Yellowfin and Albacore tuna fish. METHODS: Various tuna fish extract preparations were fractionated by sodium dodecylsulfate-polyacrylamide gel electrophoresis and transferred to nitrocellulose and analyzed by using tuna positive patients with different Western blot profiles. The functional activity of the extracts was evaluated by basophil histamine release. RESULTS: Immunoblot analysis showed the majority of patients responding to Yellowfin tuna extract. Inhibition studies using immunoblot analysis and histamine release testing showed a specific protein with a molecular weight of approximately 46 kD that is present in Yellowfin tuna, but absent in Albacore. Only defatted, lyophilized tuna fish extracts were able to induce histamine release from sensitized basophils although IgE-binding components were detected in fresh raw, fresh cooked, and canned tuna fish preparations. CONCLUSION: These studies indicate that patient sera may contain different tuna fish species IgE specific antibodies directed against unique species specific allergens present in Yellowfin and Albacore tuna fish. Possibly, extracts should contain specific allergenic components from both Albacore and Yellowfin to cover the epitope heterogeneity observed in sera from patients developing IgE antibodies against tuna fish.

Allergens↗

Diagnosis of leptospirosis: a reemerging disease of companion animals.

Canine leptospirosis has been known since 1899. Widespread use of canine leptospiral vaccines decreased the incidence of infection dramatically and reduced clinical attention to the disease. However, leptospirosis recently has reemerged as an important cause of febrile illness, and hepatic and renal disease in dogs. Feline leptospirosis is rare although the incidence of infection is higher than is recognized. Diagnosis of leptospirosis is difficult and no single diagnostic test provides optimal sensitivity or specificity. A combination of procedures, including serological assays and tests to detect the presence of leptospires in tissues or body fluids, is recommended.

Animals↗

Schistosoma: analysis of monoclonal antibodies reactive with the circulating antigens CAA and CCA.

Using spleen cells of mice infected or immunized respectively with cercariae or antigen preparations of Schistosoma mansoni, S. haematobium or S. japonicum monoclonal antibodies (mAbs) were produced against the schistosome gut-associated antigens CAA (circulating anodic antigen) and CCA (circulating cathodic antigen). Fusions nearly exclusively produced either anti-CAA (n = 25) or anti-CCA mAbs (n = 55) with a strong isotype restriction (IgM, IgG1 and IgG3) against both antigens, the majority of anti-CAA mAbs being IgG1 and the majority of anti-CCA mAbs being IgM. The mAbs, which on the basis of their selection were reactive with multiple carbohydrate epitopes of CAA or CCA, were applied in different immunological techniques including immunofluorescence, a dot immunobinding assay and immunoelectrophoresis to study the epitope repertoire. Anti-CAA mAbs were found to be reactive with 5 different epitopes, none of which occurred as multiple epitopes on eggs. Anti-CCA mAbs, on the other hand, recognized at least 10 different epitopes, while 44% of anti-CCA mAbs recognized epitopes common to the adult worm and the egg. Both CAA- and CCA-epitopes were found to be developmentally expressed at the level of the tegument in cercariae, schistosomula and 5-day-old lung worms, but in the adult worm were primarily found in the gut. Thus, the production of panels of mAbs has not only resulted in the selection of reagents optimally performing in diagnostic immunoassays, but also allowed a more detailed study of the epitope repertoire of these important schistosome antigens.

Animals↗

Sampling of periodontal pathogens by paper points: evaluation of basic parameters.

Paper points are widely established for the collection of subgingival plaque or other oral samples to analyze the microbiota, especially the presence of periodontal pathogenic bacteria such as Actinobacillus actinomycetemcomitans or Porphyromonas gingivalis. In contrast to the high frequency of usage of paper points in oral sampling, very few data are available about the parameters influencing the sampling process. Therefore, in four different in vitro experiments (6-9 repeats), we inoculated paper points with standardized suspensions (2 x 10(9) colony-forming units/ml) of A. actinomycetemcomitans and P. gingivalis to test the influence of the origin (kind) of paper point ("manufacturer"), size (according to the International Organization for Standardization ISO 25-80), sampling time (5 to 60 s), and elution time (5 to 60 s). Sampled bacteria were detected and (semi-) quantified using 16S rRNA/DNA-directed oligonucleotide probes. The bacterial load was categorized and calculations performed with index values ranging between 0 (below the detection limit of 10(2) to 10(3) colony-forming units) and 9 (> 10(6) colony-forming units). We found statistically significant differences in the efficiency of bacterial sampling between the 5 paper point manufacturers tested, expressed in a mean bacterial index between 4.4 and 7.8. ISO 45 Paper points were statistically proven to work most efficiently. According to our results, a sampling time of 60 s seems to be optimum. However, shorter times between 5 and 30 s did not significantly reduce the sampling efficiency. We found an interval of 20 s best to elute bacteria from the paper points by vortexing. The evaluation of basic parameters for subgingival plaque sampling by paper points might help to optimize microbiologically based diagnostics in periodontal diseases.

Aggregatibacter actinomycetemcomitans↗

Recurrence and survival after resection of adenocarcinoma of the gastric cardia. Rotterdam Esophageal Tumor Study Group.

In a retrospective study, the results after resection of carcinoma of the gastric cardia in the era without neoadjuvant therapy or extended lymph node dissection were evaluated. All 184 patients who underwent resection between January 1983 and December 1993 were included. Recurrence of disease, survival and prognostic factors were determined. The overall cumulative 5-year recurrence rate was 71% and the survival rate 23%. Multivariate analysis identified locoregional lymph node and distant metastases as the crucial prognosticators of recurrence of disease and survival. These results were similar to those from a previous study concerning our patients operated during the years 1983-88. The prognosis of a resected cardiacarcinoma has remained unchanged in our hands over the past 10 years. These results stress the importance of exploring new ways, such as the use of new diagnostic tools, to optimize preoperative patient selection and more aggressive treatment regimens to improve final outcome.

Adenocarcinoma↗

[Post-traumatic endophthalmitis after penetrating injury in Vietnam: risk factors, microbiological aspect and visual outcome].

BACKGROUND: Post-traumatic endophthalmitis associated with penetrating injury represents a distinct kind of intraocular infection and is still a severe problem for diagnosis and treatment in developing countries. We report the incidence, microbiological presentation and visual outcome of post-traumatic endophthalmitis in South Vietnam. PATIENTS AND METHOD: In a retrospective study medical reports of 515 patients with penetrating injury treated at Eye Hospital in Ho Chi Minh city, Vietnam, from 1/1999 to 5/2000 were reviewed and analysed. The treatment was standardised: 1. after vitreous-biopsy intravitreous injection of 0.1 mg/0.1 ml Gentamycine and 1 mg/0.1 ml Vancomycine; 2. subconjunctival injection of 25 mg/0.5 ml Vancomycine and 20 mg/0.5 ml Gentamycine; 3. topical and systemic antibiotic treatment due to microbiological presentation; 4. systemic steroids treatment. Clinical parameters were evaluated for association with an increased risk of endophthalmitis. RESULTS: Out of 515 patients with penetrating injury 61 patients (11.8 %) with endophthalmitis were treated and evaluated. Mean time interval from trauma to diagnosis of endophthalmitis was 16.8 +/- 5.6 days. Follow-up period was 15.6 +/- 23.4 days. Visual acuity at the diagnosis of endophthalmitis in 96 % of all patients was only finger counting or light perception. Enucleation was needed in 14 % of patients, 29 % of patients developed phthisis bulbi. A visual acuity better than finger counting was reached in only 10 % of all patients with endophthalmitis. Cultures of the vitreous aspirate were positive in only 50 % of cases available and showed Gram-positive (51 %), Gram-negative bacteria (33 %) and fungi (16 %). Risk factors found to be significant were: 1. a purely corneal wound; 2. wound length less than 5 mm; 3. surgical primary repair more than 24 hour after trauma; 4. inadequate antibiotic treatment and 5. a rural injury setting. CONCLUSION: Post-traumatic endophthalmitis is still a major problem in Vietnam. Delay in primary wound closure or inadequate antibiotic treatment worsen the prognosis profoundly. Comprehensive prophylactic antibiotic treatment at the time of injury repair is in dispensable. In risk eyes particular attention should be paid to prophylaxis and signs of infection. Further prospective studies are necessary to develop optimal and adequate diagnostic and treatment options in Vietnam.

Adolescent↗

Clinical infrastructures to support proteomic studies of tissue and fluids in breast cancer.

The Danish Breast Cancer Cooperative Group (DBCG) was established in 1977 with the aim to ensure optimal breast cancer diagnostics and therapeutic modalities on a nationwide basis. DBCG was organized in such a way so it represents a broad interdisciplinary collaboration with established clinical databases and biobanks. This review summarizes the infrastructures, such as those of the DBCG, that are required to facilitate translational research studies aiming at further diagnostic and therapeutic improvements through interactions directed at prevention, early diagnosis, and treatment of primary breast cancer.

Body Fluids↗

HPV prevalence in anal warts tested with the MY09/MY11 SHARP Signal system.

Anal warts are, from an aetiological point of view, a diverse category of lesions including condylomata acuminata, fibroepithelial polyps and seborrhoeic keratosis. Human papillomavirus induced anal warts, in contrast to other types of warts, are contagious and not infrequently sexually transmitted, they therefore need to be accurately identified. A total of 24 anal warts were randomly collected and the histopathological diagnoses based on microscopy, alone or in combination with a sensitive PCR-based human papillomavirus test, were compared using the SHARP Signal system for detection. Three lesions were identified as condyloma acuminatum by morphology alone due to the obvious presence of koiloytotic atypia; 11 warts without koilocytes were identified only after a positive test for anogenital human papillomavirus. One additional lesion contained human papillomavirus DNA of cutaneous type and 9 papillomas were human papillomavirus-negative and tentatively diagnosed as fibroepithelial polyps or seborrhoeic keratosis. All 14 condylomas contained human papillomavirus of low-risk type. Of these, 12 warts showed a positive human papillomavirus reaction with in situ hybridization. Morphology alone cannot reveal the true nature of most anal papillomas, even when koilocytotic atypia is considered as a diagnostic hallmark. An optimal diagnosis of anal warts requires a sensitive PCR-based human papillomavirus DNA test. A test for identification of cutaneous human papillomavirus DNA is also worthwhile.

Adult↗