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PubMed2000

[The pharynx. The imaging of its normal anatomy].

BACKGROUND: The pharynx, being part of the digestive as well as the respiratory system, is embedded in the complex spatial anatomy of the neck and, due to its function and location, represents a very sophisticated region. DIAGNOSIS: Cross-sectional imaging with CT and MR imaging plays an indispensable complementary role to clinical work-up, as far as submucosal and deep cervical spaces are concerned. However, as dysphagia is a common symptom in clinical practice, interpretation of double contrast studies and videofluoroscopic investigations are also on frequent demand in the daily routine. CONCLUSION: Close interdisciplinary co-operation and the radiologist's familiarity with the anatomy of the region are required in order to use the diagnostic tools in an optimal fashion.

Cineradiography↗
PubMed1998

Intradural extramedullary spinal canal secondary neoplasms: MR findings in 30 patients.

The purpose of this study was to describe magnetic resonance findings of intradural spinal canal secondaries and to select the best way of investigating this condition. Thirty patients with a known malignancy [breast carcinoma (n = 14), lung carcinoma (n = 10), other sites (n = 6)] and unexplained neurologic signs were studied with pre- and post-contrast T1-weighted images and T2-weighted images. Cerebrospinal fluid cytology was available in 16 patients and positive in 11 patients. In all the patients, post-contrast T1-weighted images demonstrated abnormal enhanced lesions. Most of them were nodular, located on the conus medullaris and the cauda equina. Few lesions appeared at the thoracic or cervical levels, as nodular or thin areas of enhancement. Pre-contrast T1-weighted sequences failed or were equivocal to detect the lesions. Eighteen of 30 patients had cerebral metastases. Fourteen had osseous metastases. In conclusion, post-contrast T1-weighted sequence is the optimal modality for the diagnostic of intradural spinal canal metastases. Axial and coronal images may be a useful adjunct to precise anatomic changes. T1-weighted and T2-weighted sequences remain necessary when further information is expected on vertebra or soft tissue.

Breast Neoplasms↗
PubMed2001

"Early" vocal cord laterofixation for the treatment of bilateral vocal cord immobility.

OBJECTIVES: Vocal cord immobility (VCI) is commonly caused by a nonlaryngeal malignancy, thyroid surgery, or a presumed viral insult etc. The paralysis is often transient or temporary, thus the care of the patient should be optimized to avoid unnecessary diagnostic and therapeutic endeavours. This article reports on the result of the concept of early vocal cord laterofixation, which provides a minimally invasive solution to dyspnea in the critical early, potentially reversible, period of bilateral VCI. STUDY DESIGN: A prospective study of 25 consecutive patients (ages 33 to 81 years) who were diagnosed with a bilateral VCI. This condition had developed after thyroid surgery in 22 of the patients and after a blunt trauma of the neck in one case. In another case, a cricoarytenoid joint fixation was revealed, and aetiology remained unknown in one further patient. METHODS: The surgical procedure was performed endoscopically with a modification of Lichtenberger's endo-extralaryngeal suture lateralization technique. The abducted vocal cord position was achieved by inserting a non-resorbable thread around the vocal process and tying on to the prelaryngeal muscles. Regular spirometric measurements and radiological aspiration tests were conducted on the patients. RESULTS: Adequate postoperative airway was achieved in all patients except one. Significant spontaneous vocal cord medialization was observed in two cases within a year and in three patients in the second and the third year. Partial or complete vocal cord recovery was observed in 17 cases. Further voice improvement followed in 9 patients when the threads were removed, due to vocal cord medialization or recovery. The mild postoperative aspirations ceased in the first postoperative days in all cases except one. CONCLUSIONS: The concept of "early" laterofixation satisfies the important criteria: it can provide an immediate and long-lasting adequate airway, and it can be considered potentially reversible from the point of view of laryngeal functions. Thus the procedure is a reliable primary treatment for bilateral VCI.

Adult↗
PubMed2005

[Critical odontogenic infection involving the mediastinum. Case report].

BACKGROUND: Occasionally, trivial odontogenic infections may develop into complex diseases. This may even result in an unrestrained phlegmonous spread causing life-threatening complications. These problems have decreased since the introduction of antibiotics and also due to improved oral hygiene and improved diagnostic measures resulting in optimized medical treatment. However, life-threatening forms are still seen, in particular if infections spread along the cervical fascial sheaths down towards to the mediastinum. Over the past decade the number of critical infections has increased in other medical specialties. This is usually explained by the development of multiresistant pathogens in the context of nosocomial infections. PATIENTS AND METHODS: We reviewed the patients' records of the past 15 years at the Department of Oral and Maxillofacial Surgery of the University Hospital Kiel to assess a possible increase of odontogenic infections with life-threatening complications. From 1990 to 2004, four patients with odontogenic infections exhibiting critical phlegmonous spread were treated in the intensive care unit. Two patients developed bacterial mediastinitis which could be controlled by intravenous antibiotics only. One patient progressed to general septic mediastinitis and eventually died of cardiorespiratory arrest. The last patient also had septic mediastinitis and developed right pleural empyema. Several operations were necessary before the disease could be controlled. This patient's case report is presented in detail. CONCLUSION: The prognosis of patients with mediastinitis crucially depends on (a) early diagnosis including computed tomography of the neck and thorax, (b) early radical surgical intervention, and (c) optimized pathogen-oriented antibiotic treatment.

Abscess↗
PubMed1988

The value and limitations of the Gram stain examination in the diagnosis of intraamniotic infection.

Gram stain examination of amniotic fluid is a method used for the rapid diagnosis of intraamniotic infection in patients with preterm premature rupture of membranes and preterm labor. The management of these patients relies heavily on the Gram stain results. Therefore, it is critical that the diagnostic value and limitations, optimal technique, and outcome correlates be precisely established. Most studies have focused on culture results rather than on Gram stain results to describe neonatal and maternal outcome. However, management is based on the Gram stain because culture results are not immediately available. One hundred eighty-seven amniocenteses were performed in 131 patients with preterm premature rupture of the membranes (n = 90) and preterm labor (n = 41). Spun and unspun Gram stains were performed. Centrifugation of the sample did not improve the sensitivity of the technique significantly. The agreement between the two methods was substantial (kappa index 0.89, p less than 0.001). The sensitivity of the Gram stain was 44.8% and the specificity was 97.6%. The sensitivity of the Gram stain was directly proportional to the number of bacteria present in amniotic fluid. In the presence of greater than 10(5) colony forming units per milliliter, 80% of the Gram stains were positive. The absence of both bacteria and white blood cells in a smear was associated with a negative culture of amniotic fluid in 95% of the cases. Clinical chorioamnionitis was associated with a positive Gram stain of amniotic fluid (p less than 0.001). There was a trend toward a higher incidence of endometritis in patients with a positive Gram stain compared with those with a negative Gram stain (p = 0.07). There was no neonatal infectious morbidity in patients with a true negative Gram stain. Patients with a false negative Gram stain had a 25% incidence of neonatal infectious complications (proved and suspected sepsis).

Adult↗
PubMed1983

Detection of herpes simplex virus in clinical specimens by DNA hybridization.

An assay to detect herpes simplex virus (HSV) DNA in clinical specimens has been developed. It utilizes nucleic acid hybridization with a 32P-labeled DNA probe prepared from a fragment of HSV DNA cloned in a plasmid vector. This assay can detect 5 X 10(4) plaque-forming units of cell-free HSV and as few as four virus-infected cells. The assay has a sensitivity of 78% and a specificity of 100% compared to virus culture for the detection of HSV in swab specimens from genital lesions. No hybridization is observed with uninfected, varicella-zoster virus infected, or cytomegalovirus infected cells, and specimens from herpes zoster lesions are uniformly negative. While hybridization with a 32P-labeled probe is not optimally suited for routine diagnostic use, this report establishes the feasibility of using nucleic acid hybridization to detect HSV in clinical specimens.

DNA, Viral↗
PubMed2005

Executive neurocognition, memory systems, and borderline personality disorder.

Borderline Personality Disorder (BPD) is a common, disabling, and burdensome psychiatric condition. It is characterized by turbulent fluctuations of negative emotions and moods, unstable and conflictual interpersonal relationships, an incoherent and often contradictory sense of self, and impulsive, potentially lethal self-injurious behaviors. The neurobehavioral facets of BPD have not been extensively studied. However, clinical theoreticians and researchers have proposed that the symptoms and behaviors of BPD are, in part, associated with disruptions in basic neurocognitive processes. This review summarizes and evaluates research that has investigated the relationship between executive neurocognition, memory systems, and BPD. Three historical phases of research are delineated and reviewed, and the methodological and conceptual challenges this body of investigation highlights are discussed. Laboratory-based assessment of executive neurocognition and memory systems is integral to an interdisciplinary approach to research in BPD. Such an approach holds promise in elucidating the neurobehavioral facets, development, diagnostic boundaries, prevention, and optimal interventions for this debilitating and enigmatic disorder.

Borderline Personality Disorder↗
PubMed2005

Neuropsychiatric assessment.

Neuropsychiatric examination is an interdisciplinary approach to diagnostic assessment of mental and brain diseases. When performed in a skillful way, with a conceptually grounded structure, neuropsychiatric assessment offers the potential for comprehensive diagnostic insight, thereby facilitating optimally informed treatment planning.

Aphasia↗
PubMed2004

The benefit of video-assisted thoracoscopic surgery before planned abdominal exploration in patients with suspected advanced ovarian cancer and moderate to large pleural effusions.

OBJECTIVE: To analyze the findings and impact on the management of video-assisted thoracoscopic surgery (VATS) before planned abdominal exploration in patients with suspected advanced ovarian cancer and moderate to large pleural effusions. METHODS: We reviewed the charts of all patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent VATS from 10/01 to 7/03. VATS was performed under double lumen endotracheal anesthesia. A 2-cm chest wall incision was made in the fifth intercostal space on the side of the effusion. The thoracoscope was introduced and biopsies of suspicious lesions were performed through the single incision. After VATS, all patients had a chest tube placed through the incision, and those with malignant effusions underwent talc pleurodesis either intraoperatively or postoperatively. RESULTS: Twelve patients underwent VATS during the study period. Median operative time for VATS was 31 min (range: 20-49 min) with no complications attributable to the procedure. The median amount of pleural fluid drained was 1000 ml (range: 500-2000 ml). Solid, pleural-based tumor was found in six cases (50%), with nodules >1 cm noted in four patients (33%) and nodules <1 cm noted in two patients (17%). Of the six cases with no grossly visible pleural tumor, the pleural fluid was positive for malignant cells in two patients (17%) and negative in four patients (33%). Further initial patient management included the following: laparotomy with optimal cytoreduction, 6 (50%); diagnostic laparoscopy, 3 (25%); and no abdominal exploration, 3 (25%). Final diagnosis of primary disease site was as follows: ovary, 9 (75%); fallopian tube, 1 (8%); endometrium, 1 (8%); and lymphoma, 1 (8%). Based on the findings during VATS, laparotomy and attempted cytoreduction were avoided in four patients (33%), and the cytoreductive procedure was modified in one patient (8%). CONCLUSION: Fifty percent of patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent VATS had solid pleural-based tumor identified, and in 33% of cases the tumor nodules were >1 cm in diameter. VATS should be considered in these cases to delineate the extent of disease, treat the effusion, and to potentially select patients for either intrathoracic cytoreduction or a neoadjuvant chemotherapy approach.

Abdomen↗
PubMed1985

Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases.

Most babies born with congenital diaphragmatic hernia (CDH) die after birth. The natural course of CDH in the human fetus is not known. We found 94 cases of fetal CDH in the records of surgeons and obstetricians surveyed in the United States and Canada. We found the following: (1) prenatal diagnosis of CDH is accurate and current techniques can detect lethal nonpulmonary anomalies and prevent diagnostic errors; (2) despite optimal conventional therapy, most fetuses with detectable CDH will die in the neonatal period (80% mortality); (3) polyhydramnios is both a common prenatal marker for CDH (present in 76% of fetuses) and a predictor for poor clinical outcome (only 11% survived); (4) fetal CDH is a dynamic process--nonsurvivors have larger defects and may have more viscera displaced into the chest at an earlier stage of development. Surgical intervention before birth may be necessary to improve survival of the fetus with CDH and polyhydramnios.

Congenital Abnormalities↗
PubMed2003

Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force.

OBJECTIVE: To systematically review the evidence for screening for gestational diabetes mellitus (GDM). DATA SOURCES: We established eligibility criteria for relevant studies. We systematically searched MEDLINE and the Cochrane Collaboration Library for studies meeting eligibility criteria. We supplemented this search with further studies identified from reference lists of reviews. METHODS OF STUDY SELECTION: Two reviewers examined each article for eligibility. A single reviewer abstracted relevant data from the included articles; a second reviewer checked the abstractions. We graded the quality of the articles according to criteria developed by the U.S. Preventive Services Task Force. TABULATION, INTEGRATION, AND RESULTS: No well-conducted, randomized, controlled trial provides direct evidence for the health benefits of screening for GDM. The evidence is unclear regarding the optimal screening and reference diagnostic test for GDM. The impact of hyperglycemia on adverse maternal and neonatal health outcomes is probably continuous. Although insulin therapy decreases the incidence of fetal macrosomia for those women with more severe degrees of hyperglycemia, the magnitude of any effect on maternal and neonatal health outcomes is not clear. The evidence is insufficient to determine the magnitude of health benefit for any treatment among the large number of women with GDM at milder degrees of hyperglycemia. We found limited evidence regarding the potential adverse effects of screening for GDM. CONCLUSION: Because of the lack of high-quality evidence concerning critical issues, we are unable to determine the extent to which screening has an important impact on maternal and neonatal health outcomes. A randomized, controlled trial of screening is necessary to answer the many remaining questions.

Adolescent↗
PubMed1998

Larynx and hypopharynx.

Cross-sectional imaging with CT and MR imaging plays an indispensable complementary role to endoscopy in the pretherapeutic work-up of laryngeal and hypopharyngeal cancer and is very valuable for the detection of tumor recurrence after surgery or radiation treatment as well. Close interdisciplinary co-operation and the radiologist's familiarity with therapeutic options and challenges are required in order to use these powerful diagnostic tools in an optimal fashion. Other indications for cross-sectional imaging of the larynx and hypopharynx include uncommon neoplasms, benign masses, inflammatory disorders, and trauma.

Anatomy, Cross-Sectional↗
PubMedDate not supplied

Evaluation of a new Plasmodium lactate dehydrogenase assay (OptiMAL-IT) for the detection of malaria.

The new OptiMAL-IT(R) rapid diagnostic test for malaria was evaluated in 271 patients in Thailand with uncomplicated malaria between June and July 2002. The sensitivity and specificity for the diagnosis of Plasmodium falciparum parasites were 88% and 92%, respectively. For species other than P. falciparum, the sensitivity was 65% and specificity was 99%. The performance of the new test decreased markedly at low levels of parasitaemia.

Adolescent↗
PubMed2003

Odours from pulp mill effluent treatment ponds: the origin of significant levels of geosmin and 2-methylisoborneol (MIB).

Pulp and paper mills are well known for their sharp, sulphurous stack emissions, but the secondary treatment units also can be significant contributors to local odour. This study investigated the source(s) of earthy/musty emissions from a mixed hardwood pulp mill in response to a high local odour. Samples from five sites in the mill over five months were analyzed for earthy/musty volatile organic compounds (VOCs), examined microscopically, and plated for bacteria and moulds. In all cases, activated sludge showed substantial geosmin levels and to a lesser extent 2-methylisoborneol (MIB) at 2000-9000 times their odour threshold concentrations (OTCs). These VOCs were lower or absent upstream and downstream, suggesting that they were produced within the bioreactor. Geosmin and MIB were highest in late summer and declined over winter, and correlated with different operating parameters. Geosmin was most closely coupled with temperature and MIB with nitrogen uptake. Cyanobacteria were present in all sludge samples, but actinomycetes were not found. Gram-negative bacteria and one fungal species isolated from the bioreactor and secondary outfall tested negative for geosmin or MIB. We conclude: (i) geosmin and MIB contribute significantly to airborne odours from this mill, but are diluted below OTC levels at the river; (ii) these VOCs are generated by biota in the activated sludge; and (iii) cyanobacteria are likely primary source(s). The growth of cyanobacteria in activated sludge represents a loss of energy to the heterotrophic population; thus earthy/musty odours may represent a diagnostic for less than optimal conditions.

Actinobacteria↗
PubMed1999

The Women's Ischemia Syndrome Evaluation (WISE) study: protocol design, methodology and feasibility report.

OBJECTIVES: The Women's Ischemia Syndrome Evaluation (WISE) is a National Heart, Lung and Blood Institute-sponsored, four-center study designed to: 1) optimize symptom evaluation and diagnostic testing for ischemic heart disease; 2) explore mechanisms for symptoms and myocardial ischemia in the absence of epicardial coronary artery stenoses, and 3) evaluate the influence of reproductive hormones on symptoms and diagnostic test response. BACKGROUND: Accurate diagnosis of ischemic heart disease in women is a major challenge to physicians, and the role reproductive hormones play in this diagnostic uncertainty is unexplored. Moreover, the significance and pathophysiology of ischemia in the absence of significant epicardial coronary stenoses is unknown. METHODS: The WISE common core data include demographic and clinical data, symptom and psychosocial variables, coronary angiographic and ventriculographic data, brachial artery reactivity testing, resting/ambulatory electrocardiographic monitoring and a variety of blood determinations. Site-specific complementary methods include physiologic and functional cardiovascular assessments of myocardial perfusion and metabolism, ventriculography, endothelial vascular function and coronary angiography. Women are followed for at least 1 year to assess clinical events and symptom status. RESULTS: In Phase I (1996-1997), a pilot phase, 256 women were studied. These data indicate that the WISE protocol is safe and feasible for identifying symptomatic women with and without significant epicardial coronary artery stenoses. CONCLUSIONS: The WISE study will define contemporary diagnostic testing to evaluate women with suspected ischemic heart disease. Phase II (1997-1999) is ongoing and will study an additional 680 women, for a total WISE enrollment of 936 women. Phase III (2000) will include patient follow-up, data analysis and a National Institutes of Health WISE workshop.

Adult↗
PubMed2003

Vulvovaginal candidiasis.

VVC represents a spectrum of disease. Although there is a clear need for better use of diagnostic modalities and development of better treatment alternatives, most patients with VVC, even the complicated cases, at least have the perspective of achieving adequate control of their symptoms. Future advances, particularly in the area of home diagnostics, may help to optimize use of currently available medicines.

Anti-Bacterial Agents↗
PubMed2002

[Transient left myocardial dysfunction: a cause of neonatal hypoxemia].

UNLABELLED: Refractory hypoxemia in the newborn requires an accurate diagnostic investigation for an optimal and prompt management. CASE REPORT: After a short delivery, a post-term newborn developed a severe hypoxemia with patchy pulmonary alveolar opacities and systolic right-to-left extrapulmonary shunting through the ductus arteriosus. Echocardiography ruled out a cardiac malformation and showed dilated left atrium with left-to-right shunting by the ovale foramen due to left ventricular dysfunction. Inotropic support associated with mechanical ventilation allowed a rapid improvement. CONCLUSION: A pathophysiological analysis is needed in case of severe neonatal hypoxemia. Doppler ultrasound is a non invasive and rapid method allowing the adjustment of the therapeutic strategy.

Cardiotonic Agents↗
PubMed2001

Paramedian access to the epidural space: the optimum window for ultrasound imaging.

STUDY OBJECTIVE: To establish a useful ultrasonic approach to the epidural space so as to optimize pre-puncture diagnostics. DESIGN: Prospective study. SETTING: University clinic. PATIENTS: 60 participants (19 to 34 years of age), 40 healthy volunteers (20 male, 20 female) and 20 parturients. INTERVENTIONS: Ultrasound scanning of the lumbar spine was performed at the L(3)-L(4) vertebral interspace. Three ultrasound planes were employed: the transverse, median, and paramedian longitudinal approaches. MEASUREMENTS: We compared the width of the ultrasound-permeable area in the median and paramedian planes and assessed the visibility of the epidural space and its surrounding structures. MAIN RESULTS: In the paramedian plane, the permeable window was larger (p < 0.001) than in the median approach. The visibility of the ligamentum flavum (p < 0.0001), dura mater (p < 0.0001), and cauda equina (p < 0.0001) was significantly higher. Pulsation of epidural vessels could be observed more frequently (p < 0.0001) in the paramedian plane. CONCLUSIONS: The longitudinal paramedian plane provided information about the epidural space depth in excellent imaging quality. The additional information might be beneficial in epidural anesthesia and in other clinical specialties (e.g., neurosurgery, trauma care).

Adult↗