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PubMed2001

[Nerve affection in connection with bloodletting I. A rare, but potentially serious complication].

Based on clinical experiences and a review of the literature we describe venepuncture of blood donors complicated by an affection of the peripheral nerves secondary to an arterial or venous lesion. Such complications are rare but potentially disabling and should be known in blood banks and clinical departments to which these patients are referred. Blood donors should be offered optimal and early diagnostics, which appear to be a prerequisite for treatment of donors complaining of pain of neuropathic character extending beyond the puncture site. Recognition of the complication opens options for prevention.

Blood Donors↗

PubMed2001

[Differential diagnosis of hemorrhagic fever with renal syndrome and acute surgical diseases of abdominal organs].

The results of differential diagnosis of hemorrhage fever with renal syndrome and acute surgical diseases of abdominal organs in 1250 patients were analyzed. It was revealed that the course of the disease was similar to acute abdomen in 13.2% of them. The combination of fibrogastroduodenoscopy and diagnostic laparoscopy is optimal for differential diagnosis and permits to reveal typical symptoms of hemorrhage fever with renal syndrome.

Abdomen, Acute↗

PubMed2001

Intermethod discordance for alpha-fetoprotein measurements in Fanconi anemia.

BACKGROUND: The significantly higher serum alpha-fetoprotein (AFP) in patients with Fanconi anemia (FA) than in non-FA aplastic patients has potential diagnostic utility, but the increase is method-dependent. The aim of this study was to compare five AFP assays on FA and non-FA samples and to investigate possible explanations for FA-specific discrepancies. METHODS: Two methods available in our laboratory (Kryptor and IMx) were compared on 59 FA and 27 non-FA patient samples. Kryptor, Immulite, Elecsys, Immuno-I, and Elsa-2 methods were then compared on 14 FA and 14 non-FA patient samples. The AFP glycosylation profile was analyzed by electrophoretic separation in a lectin-containing gel. RESULTS: With all six methods, AFP values were significantly higher in FA than in non-FA patients, but the diagnostic precision and optimal cutoff values varied. Indeed, two methods reached 100% sensitivity and specificity, but in other methods, one or both of these parameters were significantly <100%. Neither heterophilic antibodies nor a specific glycosylation profile was detected in FA samples. CONCLUSIONS: AFP results are method-dependent in FA. New methods must be evaluated before use in differential diagnosis of aplastic patients.

Adolescent↗

PubMed2001

Deletions on chromosome 8p22 may predict disease progression as well as pathological staging in prostate cancer.

PURPOSE: A recent report demonstrated that the deletion of chromosome 8p22 could predict disease progression in stage III (capsular penetrating) prostate cancer. We studied if the status of chromosomal deletions of 8p22 could reflect pathological stage as well as patient prognosis, thereby serving as a diagnostic tool to optimize the treatment strategy in prostate cancer. EXPERIMENTAL DESIGN: A total of 97 patients (41 Japanese and 56 Swedish) were studied by the fluorescence in situ hybridization technique. Seventy-seven patients (23 pT2, 18 pT3, and 36 pN+ tumors) underwent surgery (radical prostatectomy or lymph node dissection). The specimens were prepared by touch biopsy. From another 20 cases, fine-needle aspiration biopsies were obtained. RESULTS: 8p22 deletions were detected in 47 (61%) and 11 (55%) specimens of 77 touch biopsies and 20 fine-needle aspiration biopsies, respectively. No significant difference was found in the frequency of 8p22 deletion between different preparations of specimens, as well as between different races (Japanese versus Swedish). The frequency of 8p22 deletion was statistically higher in patients with pT3 or more than in those with pT2 (P < 0.01). Disease progression was evaluated in 57 patients. The Cox proportional hazards model revealed 8p22 deletion to be the strongest parameter to predict disease progression (hazards ratio = 5.75; P = 0.0001). CONCLUSIONS: Studies on chromosomal deletions of 8p22 by fluorescence in situ hybridization technique may serve as a genetic marker to optimize the treatment strategy in patients with prostate cancer to the optimal treatment.

Aged↗

PubMed1975

[Selective kidney angiography. Indispensable diagnostic method in urogenital tuberculosis].

Selective angiography of the kidneys was performed in 119 patients with urogenital tuberculosis. The diagnosis was confirmed by bacteriological and/or histological examinations. Diagnostic value. Under optimal technical conditions changes of the small renal arteries even in the parenchymal stage I of renal tuberculosis can be seen. These cannot be diagnosed with other methods. In stage II and III the degree of destruction and the localisation of the specific process can be demonstrated more efficiently by angiography than by urogram. In stage III/3 (kidney without function) the differential diagnosis between tuberculosis and the late form of polycystic renal disease is possible. Therefore the selective renal angiography ought to be performed more frequently for intensive diagnosis and also to reach a definite diagnosis before surgical procedures. Special surgical planning is more precise and knowledge of vascular anatomy reduces the operative risk.

Diagnosis, Differential↗

PubMed2002

Interpretation of computed tomography imaging of the eye and orbit. A systematic approach.

Computed tomography (CT) has revolutionised the diagnosis and management of ocular and orbital diseases. The use of thin sections with multiplanar scanning (axial, coronal and sagittal planes) and the possibility of three-dimensional reconstruction permits thorough evaluation. To make the most of this technique, users must familiarize themselves with the pertinent CT principles and terminology. The diagnostic yield is optimal when the ophthalmologist and radiologist collaborate in the radiodiagnostic workup. In this article we describe a systematic approach to the interpretation of ocular and orbital CT scans.

Eye↗

PubMed2005

Coeliac disease.

BACKGROUND: Coeliac disease (CD) probably affects one in 100 Australians, but is greatly underdiagnosed. Heightened media interest in the negative effects of dietary gluten has led many patients to request testing for CD or follow inappropriate diets. Doctors have had little education in CD because of its perceived rarity. OBJECTIVE: This article summarises current knowledge of clinical presentations, optimal screening and diagnostic tests, and how the general practitioner can best assist patients in adopting a successful gluten free diet. DISCUSSION: Coeliac disease is associated with a range of conditions including type 1 diabetes, thyroid disease, osteoporosis, and iron deficiency with or without anaemia. Gastrointestinal symptoms may not be present. The GP therefore has an important role in considering CD in the differential diagnosis in a variety of clinical presentations. Antitransglutaminase IgA and total serum IgA are the preferred screening tests but may miss occasional patients with CD. Endoscopic duodenal biopsy while eating gluten is needed for definitive diagnosis. A gluten free diet is complex, and may fail without the involvement of a skilled dietician.

Biomarkers↗

PubMed2004

Caries detection and quantification with DIAGNOdent: prospects for occlusal and root caries?

A possible consequence of light absorption as the interaction of electromagnetic radiation with molecules of the tooth's hard substances is, apart from the emission of heat, fluorescence. It was demonstrated that the emission spectra of enamel, dentin, and caries look alike upon excitation with red light; however, fluorescence increases with the process of carious destruction. Based on that, the DIAGNOdent System was developed, which simultaneously injects red light into the tooth surface and detects the resulting fluorescence. Due to this design, clinical application is currently limited to accessible occlusal and smooth surfaces. For occlusal caries detection, it was shown that validity and reproducibility could be optimized over classical diagnostic tests for deep dentin lesions with seemingly intact surfaces. The detection of root caries does not play a relevant role in the directly accessible areas, but estimation of the lesion's activity and progression rate is a prerequisite for differentiated lesion management Excellent reproducibility of the laser fluorescence measurements was confirmed for this scenario. Lesions with a soft surface texture show significantly higher fluorescence values than leathery or hard lesions, and values also increase with increasing cavity depth. DIAGNOdent offers the potential to improve follow-ups and estimation of the prognosis and to support clinical management of primary carious lesions.

Dental Caries↗

PubMed2006

Role of whole body positron emission tomography/computed tomography scan with 18F-fluorodeoxyglucose in patients with biopsy proven tumor metastases from unknown primary site.

AIM: The aim of this study was to evaluate the role of whole body PET/CT scan with (18)F-fluorodeoxyglucose (FDG) in the detection of the primary tumor in patients with metastatic cancer from unknown primary origin (CUP syndrome). METHODS: Sixty-eight consecutive patients, with CUP syndrome (39 lymph nodes, 29 visceral biopsy proven tumor metastases), underwent a whole-body FDG-PET/CT study. All enrolled patients were unsuccessfully studied, within the previous month, with physical examination, laboratory tests and conventional diagnostic procedures. All the pathological findings identified at PET/CT scan and suspected for primaries, were further investigated. After PET study, the minimum follow-up period for the inclusion in the studied population was 3 months. RESULTS: The primary tumor site was correctly identified by FDG-PET/CT in 24 patients (24/68, 35.3%): lung (n=9), rino/oro-pharynx (n=6), pancreas (n=5), colon (n=2), uterus (n=2). In 5 cases, FDG-PET scan did not identify a primary pathological focus, which was subsequently detected by other diagnostic methods within 3 months. In 39 patients (39/68, 57.4%), the primary tumor site was not localized. However, in 9 of them, FDG-PET/CT scan identified further unexpected metastases, modifying the stage of disease. Overall, the following oncological treatment was influenced by the PET scan, in a total of 33 patients (33/68, 48.5%). CONCLUSIONS: Our data strongly support the diagnostic contribution of whole body FDG-PET/CT scan in the evaluation of patients with CUP syndrome and suggest its use in an early phase of the diagnostic iter to optimize patient management.

Adult↗

PubMed2006

[Quality of care in chronic obstructive pulmonary disease].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has been a public health priority for many years and many recommendations have been published on its detection and management. STATE OF THE ART: Many studies have shown that practice remains sub-optimal, at both diagnostic and therapeutic levels, in the stable state and during exacerbations. There are multiple factors responsible including the recommendations themselves (method of development, format, distribution and implementation) and persisting grey areas in the literature upon which they are based. PERSPECTIVE: To improve this situation it will be necessary to clarify the place of various treatment options during the evolution of the disease, to define the best organisational care pathways and to produce precise and didactic guidelines that will be widely distributed and implemented. CONCLUSIONS: Real progress can be anticipated in view of the increasing quality of the guidelines and the clinical trials upon which they are based.

Critical Pathways↗

PubMed1991

[The use of the serum reference sample containing the antinuclear factor (homogeneous) to determine the working dilution of diagnostic fluorescing immunoglobulins against human IgG(H)].

A previously developed serum reference sample containing the antinuclear factor (homogeneous) in a standard dilution 1:40 was used to estimate the working dilution of commercial lots of diagnostic fluorescing immunoglobulins against human IgG (H) (IGF). Use of a working dilution of IGF in the diagnostic titer helps optimize the immunofluorescence test and save IGF.

Antibodies, Antinuclear↗

PubMed1990

[Medical informatics systems exemplified by the diagnosis of equilibrium disorders].

An interdisciplinary field, namely the differential diagnosis of balance disorders and vertigo, is used to describe how a medical expert system can be developed using modern computer analysis, medical expertise, and human pattern recognition techniques. The advantages, results, and unresolved issues of close cooperation between biomedical engineers and physicians are described. The aim of this cooperation was to ensure that complicated data were presented in simple graphic form and that large amounts of diagnostic data were optimally linked together for the generation of a recommended diagnosis. Similar techniques may usefully be employed in other areas of medicine.

Caloric Tests↗

PubMed1990

[TMJ reconstruction of the intracapsular condylar vertical fracture].

According to literature, it is difficult to make an early correct diagnosis and treatment of the intracapsular condylar vertical fracture. The author recently suggested a new method to diagnose and treat this kind of fracture with an optimal result. The diagnostic and treatment procedures are: 1. To take a condylo-pterygo-maxillo-oblique tomography which can clearly demonstrate the position of the bone fragment. 2. To remove the bone fragment by submandibular incision with an oblique osteotomy of the posterior part of the ramus. Therefore the secondary injury to the disk and the superior cavity could be avoided that is essential for TMJ reconstruction. 3. To reconstruct the TMJ after condyloplasty under the centric relation. Eight cases were successfully treated by this method. In this paper the details of the operation are described and discussed.

Adult↗

PubMed1990

[Some problems in organization and optimal work flow of an ophthalmologic clinic for children].

The paper presents data characterizing the reconstruction of work in a children ophthalmological hospital concerning perfection and optimization of medical diagnostic process. Questions on principles of organization of work medical institutions on economic-calculation basis are submitted to discussion. The authors consider that a system of averaged assessment of a hospital-bed cost doesn't provide favourable conditions for work in associations where new progressive methods of examination and treatment of patients are assimilated. It is proposed by means of joined efforts of different associations to work out and submit to discussion an operative mechanism of material security for progressive development of Soviet ophthalmology.

Algorithms↗

PubMed1988

Computed tomography of rheumatologic disorders. Part I.

The advent of computed tomographic (CT) scanning has initiated a revolutionary approach to the evaluation of articular disease. CT affords the opportunity to noninvasively evaluate both osseous and soft tissue structures during a single diagnostic examination. An optimal CT study demands proper technique, including a localization image, appropriate slice thickness and spacing, and window/level manipulation. The examination must be tailored to the specific indication for the study, which may include degenerative processes, inflammatory disease, or unexplained clinical symptomatology.

Humans↗

PubMed1988

Computed tomography of rheumatologic disorders. Part II.

Hip Joint↗

PubMed1988

[Reconstructive venous surgery. Principles and technical prerequisites].

The main prerequisites for successful reconstructive venous surgery include (1) critical selection of patients according to morphological and functional diagnostic aspects; (2) optimal surgical techniques; (3) the routine use of intraoperative lumen control in all disobliterative procedures (vascular endoscopy, phlebography); and (4) selective use of protective measures (temporary a.v. fistula, anticoagulans). Expanded PTFE-prostheses with increased microporosity and external ring support are the most suitable substitutes for big veins. Antireflux surgery, such as valvuloplasty, transposition technique and free valvular transfer, is a new approach for the repair of deep venous insufficiency.

Abdominal Neoplasms↗

PubMed1979

[Possibilities and limitations of gastrointestinal radiography].

The picture intensifier television radioscopy, picture intensifier initial level photography, double contrast method and pharmacoradiography together with endoscopy further the optimation of the diagnostics of the diseases of oesophagus, stomach and intestine. The value of the X-ray diagnostics for the recognition of the biliary diseases and of the incleared jaundice is high. In diseases of liver and pancreas the X-ray diagnostics may further the finding of decision. Ways for a better interdisciplinary cooperation are demonstrated.

Cholangiography↗