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PubMed1985

Computer diagnosis of depression and anxiety: the Stirling County Study.

A computer programme (DPAX) was constructed for a longitudinal study of psychiatric epidemiology in Stirling County (Canada). It identifies disorders involving the syndromes of depression and anxiety based on responses given in structured questionnaire interviews. The programme follows a diagnostic algorithm that uses criteria for: (1) essential features; (2) number, frequency, and pattern of associated symptoms; (3) impairment; and (4) duration. The programme reproduces case evaluations provided by psychiatrists, as conveyed by a sensitivity of 92% and a specificity of 98%.

Anxiety Disorders↗
PubMed2000

Incidence of depression in the Stirling County Study: historical and comparative perspectives.

BACKGROUND: The Stirling County Study provides a 40-year perspective on the epidemiology of psychiatric disorders in an adult population in Atlantic Canada. Across samples selected in 1952, 1970 and 1992 current prevalence of depression was stable. This paper concerns time trends in annual incidence as assessed through cohorts selected from the first two samples. METHODS: Consistent interview data were analysed by a computerized diagnostic algorithm. The cohorts consisted of subjects at risk for a first depression: Cohort-1 (N = 575) was followed 1952-1970; Cohort-2 (N = 639) was followed 1970-1992. Life-table methods were used to calculate incidence rates and proportional hazards procedures were used for statistical assessment. RESULTS: Average annual incidence of depression was 4.5 per 1000 for Cohort-1 and 3.7 for Cohort-2. Differences by gender, age and time were not statistically significant. The stability of incidence and the similarity of distribution by gender and age in these two cohorts corresponds to findings about the two early samples. In contrast, current prevalence in the recent sample was distributed differently and showed an increase among women under 45 years. CONCLUSIONS: The stability of the incidence of depression emphasizes the distinctive characteristics of current prevalence in the recent sample and suggests that the dominance of women in rates of depression may have occurred among those born after the Second World War. The results offer partial support for the interpretation of an increase in depression based on retrospective data in other recent studies but they indicate that the increase is specific to women.

Adolescent↗
PubMed2002

Sudden death in young athletes: HCM or ARVC?

Sudden non-traumatic death in young athletes is due to underlying congenital/inherited cardiac diseases in over 80% of cases. The two commonest conditions leading to sudden cardiac death in athletes below the age of 25 years are hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Hypertrophic cardiomyopathy is caused by mutations in genes, which code for sarcomeric contractile proteins. It can present with symptoms such as palpitation, presyncope or syncope. In a small number of cases, sudden death is the first clinical manifestation of the condition. It is well established that HCM accounts for over half of all cases sudden cardiac death in young individuals below 25 years of age. The management of HCM broadly encompasses symptom control, familial evaluation and the prevention of sudden death. Arrhythmogenic right ventricular cardiomyopathy, similarly, is a genetic disorder of the heart muscle and leads to symptoms such as palpitation and syncope and more rarely sudden death. The diagnosis of ARVC is most likely underestimated due to the lack of a single diagnostic test and subtle morphological changes in some cases. The diagnosis is based on clinical and family history and non-invasive investigations. The physiological adaptations seen in some athletes, as a response to physical training, may resemble phenotypically mild forms HCM and ARVC. Therefore, a diagnostic algorithm enabling this differentiation would be of importance especially bearing in mind the consequences of a misdiagnosis.

Adolescent↗
PubMed2006

[Hemoglobinopathies--clinical symptoms and diagnosis of thalassemia and abnormal hemoglobins].

Haemoglobinopathies constitute entities that are generated by either an abnormal haemoglobin or thalassaemias. While abnormal haemoglobins are caused by a qualitative structural abnormality of the haemoglobin molecule, thalassaemias result by diminished synthesis of the globin chain. Due to increased immigration from Asia, Africa and the Mediterranean to Northern Europe, haemoglobin S, haemoglobin C, haemoglobin E are also encountered commonly in Switzerland, while other abnormal haemoglobins are rare, yet can cause clinically relevant symptoms. This include haemolysis, polyglobulia, cyanosis or a combination thereof Thalassaemia-syndroms constitute with two million affected individuals to the most prelevant monogenetic diseases worldwide. Due to migration into Switzerland, they are also found quite commonly among our patients with 10-15 per cent of all hypochromic, microcytic, anemia second only to iron deficiency. Importantly, thalassaemias and haemoglobinopathies can occur concomitantly sometimes even with a normal haemoglobin variant. This results in wide-spread presentations, making diagnosis and clinical judgement difficult. We describe in this article not only physiological mechanisms and clinical presentation but also propose a step-wise diagnostic algorithm including selective use of molecular biology methods.

Hematologic Tests↗
PubMed2001

Danish Anaesthesia Allergy Centre - preliminary results.

BACKGROUND: Anaphylactoid reactions in anaesthesia are rare and should ideally be investigated in specialist centres. At Gentofte University Hospital, we established such a centre in 1998 as a joint venture between the Departments of Anaesthesiology and Dermatology. We present the methodology, diagnostic algorithm and preliminary results from our centre. METHODS: We are open for referral of patients from all of Denmark. Reactions are classified using a three-grade severity scale and all reactions ranging from mild to severe are investigated. Investigations follow a standard step-by-step protocol of in vitro testing and skin testing. Blood samples for tryptase analysis are taken at the time of reaction and a control sample is taken together with samples for specific IgE analysis 2-4 weeks after the reaction. Subsequent skin testing comprises both prick tests and intradermal tests in most cases. Patients are tested with all substances they were exposed to, including antibiotics, colloids, latex and chlorhexidine. RESULTS: A total of 68 patients have been referred to date (July 2001) and 36 have completed investigations. Positive test results were mainly seen in patients with more severe reactions, and there were more men than women in the group with the most severe reactions. Six patients had positive specific IgE, three for penicillin, two for latex and one for thiopental. In all, 21 patients had positive skin tests to various substances, of whom four men with anaphylactic shock tested positive for chlorhexidine. Only one patient has tested positive to a neuromuscular blocking drug (NMBD) so far. DISCUSSION: Our preliminary results appear to differ in two ways from results usually found in this field. Firstly, only one patient has tested positive for a NMBD and secondly, we have had four patients with anaphylactic shock who have tested positive for chlorhexidine. Possible reasons for these differences are discussed.

Adolescent↗
PubMed1991

Microbial keratitis--the false negative.

The investigation of presumed microbial keratitis includes microscopy and culture of corneal specimens obtained by scraping the infiltrated cornea. Routine microscopy fails to identify the infecting organism in about 15% of cases. We discuss the problems presented by 20 such eyes which required further investigation. We present a diagnostic algorithm aimed at reducing the delay in identifying the pathogen and increasing the rate of positive culture. This is important since unusual pathogens may require treatment with drugs other than the 'first line' broad spectrum combination of an aminoglycoside and a cephalosporin. The algorithm allows sequential restaining and reculturing of specimens for more thorough investigation. In addition to the use of special stains and culture conditions, it presents indications for further corneal scrapes and biopsies. Uncontrolled infection resulted in five perforations and penetrating keratoplasty was indicated in 11 cases. The visual outcome for these patients was poor with fewer than 30% achieving 6/12 acuity. The delay in diagnosis increases morbidity and this should be significantly reduced by adopting the algorithm we propose.

Adult↗
PubMed2003

The use of Raman spectroscopy to identify and grade prostatic adenocarcinoma in vitro.

Raman spectroscopy is an optical technique, which provides a measure of the molecular composition of tissue. Raman spectra were recorded in vitro from both benign and malignant prostate biopsies, and used to construct a diagnostic algorithm. The algorithm was able to correctly identify each pathological group studied with an overall accuracy of 89%. The technique shows promise as a method for objectively grading prostate cancer.

Adenocarcinoma↗
PubMed2005

The use of Raman spectroscopy to differentiate between different prostatic adenocarcinoma cell lines.

Raman spectroscopy (RS) is an optical technique that provides an objective method of pathological diagnosis based on the molecular composition of tissue. Studies have shown that the technique can accurately identify and grade prostatic adenocarcinoma (CaP) in vitro. This study aimed to determine whether RS was able to differentiate between CaP cell lines of varying degrees of biological aggressiveness. Raman spectra were measured from two well-differentiated, androgen-sensitive cell lines (LNCaP and PCa 2b) and two poorly differentiated, androgen-insensitive cell lines (DU145 and PC 3). Principal component analysis was used to study the molecular differences that exist between cell lines and, in conjunction with linear discriminant analysis, was applied to 200 spectra to construct a diagnostic algorithm capable of differentiating between the different cell lines. The algorithm was able to identify the cell line of each individual cell with an overall sensitivity of 98% and a specificity of 99%. The results further demonstrate the ability of RS to differentiate between CaP samples of varying biological aggressiveness. RS shows promise for application in the diagnosis and grading of CaP in clinical practise as well as providing molecular information on CaP samples in a research setting.

Adenocarcinoma↗
PubMed1998

Engineering analysis of penile hemodynamic and structural-dynamic relationships: Part III--Clinical considerations of penile hemodynamic and rigidity erectile responses.

PURPOSE: The extent to which hemodynamic erectile responses predict penile buckling forces has not previously been analytically investigated. An engineering study was performed to compare hemodynamic data with penile buckling force values. METHODS: Dynamic infusion pharmacocavernosometry studies in 21 impotent patients (age 43, range 24-62 y) were accomplished to obtain information during penile erection concerning hemodynamic values, penile buckling forces and their determinants: intracavernosal pressure, erectile tissue mechanical properties and penile geometry. RESULTS: In the 21 patients, discrepancies existed in several patients who demonstrated normal hemodynamic values (low flow-to-maintain and high equilibrium intracavernosal pressures) but elevated cavernosal compliance values and diminished penile buckling forces. There was poor correlation between cavernosal compliance and equilibrium intracavernosal pressure (r = -0.36); better correlation between compliance and expandability (r = -0.72) and best correlation between dimensionless compliance and the dimensionless product of expandability with equilibrium pressure (r = -0.88). These data implied that cavernosal compliance was dependent on multiple factors, not only equilibrium intracavernosal pressure. CONCLUSIONS: Hemodynamic indices which correlate with intracavernosal pressure alone do not predict penile buckling forces since the latter are dependent not only on intracavernosal pressure but also on penile geometry and erectile tissue properties. The most relevant tissue property in predicting adequate penile buckling forces is cavernosal expandability. A new impotence classification system and diagnostic algorithm based on the determinants of penile rigidity and not exclusively on hemodynamic responses in proposed.

Adult↗
PubMed2001

Clinical aspects of obesity in childhood and adolescence--diagnosis, treatment and prevention.

The level of fatness at which morbidity increases is determined on an acturial basis. Direct measurements of body fat content, eg hydrodensitometry, bioimpedance or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is frequently used to define obesity clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (MC4R). Environmental/exogenous factors contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc) and genetic syndromes (Prader-Labhard-Willi syndrome, Bardet-Biedl syndrome etc) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behavior modification and nutrition education. The role of regular exercise and exercise programs is emphasized. Surgical procedures and drugs used as treatments for adult obesity are still not recommended for children and adolescents with obesity. As obesity is the most common chronic disorder in the industrialized societies, its impact on individual lives as well as on health economics has to be recognized more widely. This review is aimed towards defining the clinical problem of childhood obesity on the basis of current knowledge and towards outlining future research areas in the field of energy homoeostasis and food intake control.

Adolescent↗
PubMed2002

Extra-intestinal manifestations associated with irritable bowel syndrome: a twin study.

BACKGROUND: Little is known about the role of genetic and environmental factors in irritable bowel syndrome. Various extra-intestinal manifestations are more prevalent in cases than in controls. Genetic effects may be important in the liability to develop functional bowel disorders. AIMS: To evaluate the associations of irritable bowel syndrome with several disorders co-morbid with the condition, using both a case-control design and a co-twin control design. METHODS: A sample of 850 Swedish twin pairs, aged 18-85 years, was contacted for a telephone interview. Through a diagnostic algorithm, 72 unrelated cases of irritable bowel syndrome and 216 age- and gender-matched controls were identified. Fifty-eight twin pairs discordant for irritable bowel syndrome were evaluated in co-twin analyses. RESULTS: Renal problems (odds ratio (OR)=3.3; confidence interval (CI), 1.3-8.2), obesity (OR=2.6; CI, 1.0-6.4), underweight in the past (OR=2.4; CI, 1.1-6.4), gluten intolerance (OR=9.0; CI, 1.4-60.1), rheumatoid arthritis (OR=3.2; CI, 1.1-9.4) and poor self-rated health (OR=1.8; CI, 1.0-3.2) were significantly associated with irritable bowel syndrome. In the co-twin analyses, the only factors maintaining significance were renal and recurrent urinary tract problems. CONCLUSIONS: The association between irritable bowel syndrome and renal and urinary tract problems does not reflect a genetic or familial mediation. Eating disorders in childhood represent a familial-environmental influence on irritable bowel syndrome, whereas the association with rheumatoid arthritis and perhaps gluten intolerance probably reflects genetic mediation.

Adult↗
PubMed2000

The search of latex sensitization in spina bifida: diagnostic approach.

BACKGROUND: Sensitization to latex has become a major problem in children with spina bifida. Life-threatening reactions may occur in these patients, therefore the search of latex sensitization must be an active task in all of these children. OBJECTIVE: To design an approach for the diagnosis of latex sensitization in children with spina bifida. METHODS: We studied 100 consecutive unselected patients. Skin prick tests with a commercial latex extract were performed, latex-specific serum immunoglobulin (Ig) E was determined by CAP test, and risk factors were studied. Originally, patients with an area of latex skin test > 50% of the area of histamine and/or CAP class > or = 3 were considered sensitized to latex. Diagnostic tests were also performed in a control group of 51 atopic and nonatopic children. RESULTS: After performing a receiver-operating characteristics curve for both tests we recommend skin tests > 25% of the area of histamine (sensitivity - SEN = 79%, specificity - SPE = 100%, positive predictive value - PPV = 100%, negative predictive value - NPV = 90%), or CAP class > or = 2 (SEN = 88%, SPE = 100%, PPV = 100%, NPV = 94%) as diagnostic cut-off points. The anamnesis had a SEN of 44% for diagnosis, and a SPE of 100%. Latex sensitization was associated with more than 5 operations (OR = 8, 95% CI = 3-21.3), a personal history of atopy (OR = 11.5, 95% CI = 2.3-57.1), and serum total IgE > or = 2 z-units (OR = 4, 95% CI = 1. 6-10). CONCLUSION: For the routine evaluation of children with spina bifida, we propose a diagnostic algorithm with skin prick tests as a first step and CAP second.

Child↗
PubMed2001

Idiopathic environmental intolerances (formerly multiple chemical sensitivity) psychiatric perspectives.

Idiopathic environmental intolerances (IEI)/multiple chemical sensitivity (MCS) is characterized by various somatic symptoms which cannot be explained organically, but are attributed to the influences of toxic environmental chemicals in low, usually harmless doses. In the absence of a widely accepted definition of IEI, contradictory aetiological hypotheses and therapeutic suggestions are discussed. Some authors doubt the existence of IEI/MCS as a disease entity of its own. The label IEI does not implicate neither a diagnosis of somatic disease nor that it is caused by an avoidable exposure. Many IEI patients suffer from psychiatric diseases. A majority of them can be diagnosed as somatoform disorders. Consequently, psychiatric therapies could be effective. This review describes the current knowledge about IEI/MCS, outlines a diagnostic algorithm and a psychotherapeutic concept for variants of IEI understood as a somatoform disorder.

Comorbidity↗
PubMed2001

The utility of serology in diagnosing candidosis in non-neutropenic critically ill patients.

This study was carried out to evaluate the utility of serological tests in the diagnosis of candidal infections in non-neutropenic critically ill patients. A prospective study was carried out in a 10-bed general intensive care unit; all patients with at least one organic sample with Candida spp. were included. A therapeutic-diagnostic algorithm was designed, and patients were treated or not, according to a classification. Blood samples were taken, and serological tests included: antigenaemia detection using two different commercial latex kits (Cand-Tec and Pastorex) and antibody detection by indirect haemagglutination (IHA) and indirect germ tube immunofluorescence (IFA). A total of 56% of antibody tests (IHA 45% and IFA 64%) and 26% of antigen tests (Cand-Tec 36% and Pastorex 17%) were positive. The sensitivity and specificity of these tests with respect to systemic candidosis were 37% and 78%, respectively, for antibodies, and 0% and 90% for antigens. There was statistical significance for mortality and low levels of antibodies; Candida glabrata was detected by IFA and Candida tropicalis by Cand-Tec. Serological tests may help to define the prognosis of these patients and to support the detection of specific Candida species.

Antibodies, Fungal↗
PubMed2002

The reliable electrocardiographic diagnosis of regular broad complex tachycardia: a holy grail that will forever elude the clinician's grasp?

The reliable and accurate diagnosis of regular broad complex tachycardia (BCT) by the ECG is a goal that has eluded clinicians and electrophysiologists alike for years. This article explores the reason for this by first giving an historical account on the development of the subject. Next, the electrophysiological mechanisms of ventricular tachycardia, supraventricular tachycardia with aberrant conduction, and preexcited tachycardia, the three main differential diagnoses for regular BCT, according to the latest knowledge from cellular and clinical electrophysiology study will be reviewed, together with considerations on how such understanding may help account for the manifestations of these tachycardias on the ECG and the difficulty in distinguishing between them. Finally, the use of electrophysiological study as the criterion standard for diagnosing regular BCT, as has been the case in most studies on the subject, will be critiqued in terms of the potential for misdiagnosis by the method and the use of any ECG diagnostic algorithms developed with its aid in the acute medical care setting.

Algorithms↗
PubMed2001

Clinical aspects of obesity in childhood and adolescence.

The level of fatness of a child at which morbidity acutely and/or later in life increases is determined on an acturial basis. Direct measurements of body fat content, e.g. hydrodensitometry, bioimpedance, or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is generally accepted now to be used to define obesity in children and adolescents clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (for example, MC4R). Environmental/exogenous factors largely contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc.) and genetic syndromes (Prader-Labhard-Willi syndrome, Bardet Biedl syndrome, etc.) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia, back pain and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasized. Surgical procedures and drugs used in adult obesity are still not generally recommended in children and adolescents with obesity. As obesity is the most common chronic disorder in industrialized societies, its impact on individual lives as well as on health economics has to be recognized more widely. This review is aimed towards defining the clinical problem of childhood obesity on the basis of current knowledge and towards outlining future research areas in the field of energy homoesostasis and food intake in relation to child health. Finally, one should aim to increase public awareness of the ever increasing health burden and economic dimension of the childhood obesity epidemic that is present around the globe.

Adolescent↗
PubMed1992

A nationwide survey of migraine in France: prevalence and clinical features in adults. GRIM.

In November 1990 a nationwide survey of migraine was conducted in France on a representative sample of residents aged 15 years and older. The diagnosis of migraine was based on the International Headache Society (IHS) classification. In a previous study, we validated a diagnostic algorithm which classifies headache sufferers as IHS migraine, "borderline" migraine, possible migraine and non-migrainous headache. The overall prevalence of migraine patients with the IHS criteria in the present study was 8.1%; another 4% were classified as "borderline" migraine, which we in fact considered as definite migraine. Age, gender and occupation were found to be risk factors for migraine. Neither frequency and duration of attacks nor length of time of disease differed with gender. Expressed intensity of attacks, however, was greater in females.

Adolescent↗