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At least 1,009 records · Page 56Linked to original sources
PubMed1997

[Brief interdisciplinary oncology: a model for ambulatory, multimodal treatment of tumor patients].

Since 10/1994 the Interdisziplinäre Kurzzeit-Onkologie (IKO) is an outpatient department for the treatment of patients with cancer used by the departments of hematology/oncology and surgery. Between 09/1995 and 02/1997, 818 patients received 2024 cytotoxic therapies with neoadjuvant (15%), adjuvant (65%) or palliative (20%) intention-mostly within multicenter clinical studies. Ambulatory operations like removal of lymph nodes for diagnosis or the implantation of venous catheter systems prepared the way for specialized modalities of cancer therapy. The high compliance and consent of patients, combined with better understanding of cancer therapy, resulted in an enhanced quality of life and optimized therapy. Standardization in diagnostics and fast realisation of interdisciplinary treatment schedules lead to reduction of costs and to enhancement of quality and security in cancer therapy.

Ambulatory Care↗
PubMed1998

[Vienna standard in diagnosis of nicotine dependence: Vienna Standard Smoking Inventory].

The Standard Vienna Smokers' Inventory (VSSI) ("Wiener Standard Raucher-Inventar" [WSR]) is based on the authors' experience and was designed to optimize primary and additional diagnostic procedures associated with smoking cessation treatment. The aim of this inventory is to enable therapists interested in smoking cessation interventions to initiate diagnostic procedures as well as to use efficient therapeutic modalities. The study also highlights those areas of the patient's history which should be given special attention and the theoretical background of these areas. The various comprehensive sections of the WSR include general data pertaining to the patient's life, the basic situation (basic rate), especially with regard to nicotine dependence, pre-abstinence syndrome and "tar" exposition values, follow-up of smoking habits, earlier attempts to give up smoking, and possible barriers to cessation of smoking--such as insufficient motivation, "nocturnal sleep disturbing nicotine craving" or carbohydrate dependence. Furthermore, previous illnesses, pre-existing risk factors and regular intake of drugs are also discussed. Finally, the study emphasizes that the WSR should be used by the therapist according to his/her level of training and experience, thus providing the possibility to use specific, individual approaches to deal with specific individuals and situations.

Adult↗
PubMed1998

[Low-level laser therapy in osteoarticular diseases in geriatric patients].

INTRODUCTION: Laser light absorption through the skin causes tissue changes, targeting the nervous, the lymphatic, the circulatory and the immune systems with an antalgic, anti-inflammatory, anti-edemic effect and stimulating tissue repair. Therefore low level laser therapy is now commonly used in numerous rehabilitation centers, including the "Istituto Gerontologico Pio Albergo Trivulzio", Milan, Italy. However, to activate the treatment program, the basic medical research results must always be considered to choose the best optical wavelength spectrum, technique and dose, for rehabilitative laser therapy. We analyzed the therapeutic effects of different wavelengths and powers in various treatment schedules. In particular, a protocol was designed to test such physical parameters as laser type, doses and individual schedule in different pathologic conditions. We report the results obtained with low level laser therapy in the rehabilitation of geriatric patients, considering the various physical and technical parameters used in our protocol. MATERIAL AND METHODS: We used the following laser equipment: an HeNe laser with 632.8 nm wavelength (Mectronic), a GaAs Laser with 904 nm wavelength (Mectronic) and a CO2 Laser with 10,600 nm wavelength (Etoile). To evaluate the patient clinical status, we use a different form for each involved joint; the laser beam is targeted on the region of interest and irradiation is carried out with the sweeping method or the points technique. Irradiation technique, doses and physical parameters (laser type, wavelength, session dose and number) are indicated on the form. The complete treatment cycle consists of 5 sessions per week--20 sessions in all. At the end of the treatment cycle, the results were scored on a 5-grade semiquantitative scale--excellent, good, fair, poor and no results. We examined 3 groups of patients affected with gonarthrosis (149 patients), lumbar arthrosis (117 patients), and algodystrophy (140 patients) respectively. RESULTS: In gonarthrosis patients, the statistical analysis of the results showed no significant differences between CO2 laser and GaAs laser treatments (p = .975), but significant differences between CO2 laser and HeNe laser treatments (p = .02) and between GaAs laser and HeNe laser treatments (p = .003). In lumbar arthrosis patients treated with GaAs or HeNe laser, significant differences were found between the two laser treatments and the combined sweeping-points techniques appeared to have a positive trend relative to the sweeping method alone, especially in sciatic suffering. In the algodystrophy syndrome, in hemiplegic patients, significant differences were found between CO2 and HeNe laser treatments (p = .026), between high and low CO2 laser doses (p = .024), and between low CO2 laser dose and high HeNe laser dose (p = .006). CONCLUSIONS: Low level laser therapy can be used to treat osteoarticular pain in geriatric patients. To optimize the results, the diagnostic picture must be correct and a treatment program defining the physical parameters used (wavelength, dose and irradiation technique) must also be designed.

Age Factors↗
PubMed1997

Magnetic resonance imaging of response to chemotherapy in orthotopic xenografts of human bladder cancer.

Although orthotopic xenografts offer the potential for improved modeling of tumor development and response to therapy, noninvasive methods are not readily available to serially monitor tumors growing at internal sites in small rodents. In this study, magnetic resonance (MR) imaging techniques were developed using a clinical 1. 5 T whole body scanner to routinely monitor tumor growth kinetics of orthotopic UCRU-BL13 human bladder cancer xenografts after systemic chemotherapy. As a vehicle to test the system, comparisons were made between a standard agent, doxorubicin (DOX), and a novel formulation of liposome-encapsulated doxorubicin (DOXIL) to determine whether liposome encapsulation would alter chemosensitivity of BL13 in an orthotopic model. High resolution MR images acquired using direct three-dimensional data acquisitions yielded accurate volumetric measurements and detected tumors calculated to be </=10 mm3. MR volume measurements were comparable with tumor volumes calculated from direct caliper measurements. Both DOX and DOXIL demonstrated statistically significant therapeutic effect against orthotopic tumors; DOXIL reduced tumor volumes by approximately 33% (P < 0.005), whereas treatment with free DOX resulted in 70% reduction in tumor volume at termination (P < 0.002). We show that noninvasive MR assessments can be performed longitudinally to construct classical tumor growth curves, which can be used to evaluate therapeutic response in animal models. Translation of the MR techniques used in this study into clinical diagnostic evaluation would allow optimization of individual treatment schedules and facilitate assessment of therapeutic response.

Animals↗
PubMed1989

Some indicative parameters on diagnostic radiology in Spain: first dose estimations.

The Medical Physics Group at the Complutense University of Madrid has been co-ordinating, for approximately 1 year, a project on optimization of radiation protection in diagnostic radiology, in co-operation with the other states of the European Community. Exhaustive data on the subject, which offer accurate results on patient dosimetry for the different types of examination, are the final aim of the project. So far, it has been possible to analyse in detail the data from the National Institute of Health (NIH), which manages the care of about 96% of the Spanish population, plus the findings from several hospitals, outpatient centres and private clinics of the community of Madrid, which allowed us to perform the first dose estimations and to extrapolate them to the rest of Spain. The following estimations are presented: annual frequency of different examinations, their variation from 1985 to 1986, number of diagnostic rooms used for a given minimum of annual examinations, organ doses for different examinations, effective dose-equivalent, genetically significant dose for some examinations, as well as the collective dose.

Humans↗
PubMed2001

Installation and experience of an automatic scheduling system for multiple diagnostic examinations: in search of maximum utilization of regional health care resources.

We installed a scheduling system that optimally schedules multiple appointments for various diagnostic examinations for a patient based on patient characteristics, disease characteristics and conditions, characteristics of diagnostic examinations, possible interactions between two successive examinations, and features and availability of diagnostic equipment. The system consists of four client terminals, 12 laboratory terminals, and one server. After the run-in period, the system started operation in July 2000. A total of 14353 examinations involving 11447 patients were managed over 7 months. On average, approximately 82 patients per day underwent approximately 103 examinations. On average, 16.1 patients a day requested 2 or more examinations in a scheduling session (approx. 2.3 examinations/patient; maximum 5 examinations for a single patient). After reading the request sheet(s) (OCR sheet(s)), suggested time/date slots of examination(s) were displayed on the client terminal within 10 seconds. The average time required for a patient to establish his or her schedule was approximately 2 minutes. Thus, the system greatly mitigated the load on health care professionals in scheduling appointments for examinations. In general, patients had a positive impression of the system. Furthermore, networking through these health care facilities and implementing this automatic scheduling system as a centralized appointment system can easily establish a "virtual diagnostic examination center" that fully utilizes the diagnostic equipment and staff available at community health care facilities. We estimate that approximately 30% of the diagnostic examinations in a health care facility can be referred to another facility in this cooperative system.

Algorithms↗
PubMed2006

Optimization of capillary array electrophoresis single-strand conformation polymorphism analysis for routine molecular diagnostics.

Mutation screening is widely used for molecular diagnostics of inherited disorders. Furthermore, it is anticipated that the present and future identification of genetic risk factors for complex disorders will increase the need for high-throughput mutation screening technologies. Capillary array electrophoresis (CAE) SSCP analysis is a low-cost, automated method with a high throughput and high reproducibility. Thus, the method fulfills many of the demands to be met for application in routine molecular diagnostics. However, the need for performing the electrophoresis at three temperatures between 18 degrees C and 35 degrees C for achievement of high sensitivity is a disadvantage of the method. Using a panel of 185 mutant samples, we have analyzed the effect of sample purification, sample medium and separation matrix on the sensitivity of CAE-SSCP analysis to optimize the method for molecular diagnostic use. We observed different effects from sample purification and sample medium at different electrophoresis temperatures, probably reflecting the complex interplay between sequence composition, electrophoresis conditions and sensitivity in SSCP analysis. The effect on assay sensitivity from three different polymers was tested using a single electrophoresis temperature of 27 degrees C. The data suggest that a sensitivity of 98-99% can be obtained using a 10% long chain poly-N,N-dimethylacrylamide polymer.

Acrylamides↗
PubMed2002

Use of recombinant proteins in antibody tests for bovine tuberculosis.

Tuberculosis (TB) in cattle remains a major zoonotic and economic problem in many countries. Since the standard diagnostic assay, the intradermal test (IDT) with bovine PPD tuberculin, has less than optimal accuracy in all situations, other diagnostic methods such as serological assays have been investigated. Because of fundamental concerns for the low sensitivity and specificity of previous ELISA protocols, a profiling ELISA with nine purified, recombinant proteins of TB complex mycobacteria, was employed on samples from four groups of cattle: (a) naturally Mycobacterium avium-exposed and experimentally Mycobacterium bovis-infected, (b) officially-certified TB-free herds, (c) exposed to M. bovis in two field TB outbreaks and scored as bovine reactors in the gamma-IFN assay for bovine TB, (d) paratuberculosis (para TB)-infected. The described ELISA proved to be highly specific. In fact, the antibody (Ab) response could be consistently detected in 3 out of 3 endotracheally-infected calves and in 1 out of 3 contact-infected calves. There was also a very low prevalence of low-titered, non-specific Ab responses in paraTB-infected animals. As for the animals exposed to field TB outbreaks, 16 out of 28 gamma-IFN positive cattle were also Ab-positive; importantly, 7 out of 12 gamma-IFN positive, IDT-negative cattle showed Ab responses to TB proteins. In general, the profile of the Ab response varied among animals; the reaction to single recombinant antigens was sometimes transient and fluctuating, whereas the panel of antigens on the whole was indeed more effective in Ab detection.

Animals↗
PubMed2001

The ischaemic lactate-ammonia test.

The ischaemic lactate-ammonia test is widely used for investigating patients with muscle pain and fatigue. It involves measuring plasma lactate and ammonia produced as a result of forearm exercise under ischaemic conditions in a fasted subject. Its clinical use is to screen patients with muscle complaints for disorders of carbohydrate metabolism, in particular to identify those in whom further investigation may provide useful diagnostic information. There is a wide variety of methods described, reflecting attempts to optimize the response and hence the diagnostic value of the test. Although it is often considered a general screening test for metabolic muscle disease, the situations in which it is useful are specific. Here we review the use of the test and present the results of an audit of its use in our departments.

Ammonia↗
PubMed2003

Diagnostic test with omeprazole in patients with posterior laryngitis.

The aim of the study was to evaluate the merit of empiric omeprazole therapy in patients with suspected laryngopharyngeal reflux (LPR), to determine the optimal dose and duration of diagnostic test, to compare the diagnostic value of upper gastrointestinal (GI) endoscopy and omeprazole test (OT). One hundred out-patients with posterior laryngitis and more than one atypical symptom of LPR, aged 14-68 years were treated with omeprazole for 4 weeks (clinical group). According to received omeprazole dose (20 mg, 40 mg, > 40 mg), three clinical subgroups were selected. Twenty patients treated only with life style modifications and diet composed dietary group. At the entry to the study, a symptom questionnaire (5 laryngeal and 3 esophageal scored from 0 to 3 points), well being in general (W-B(VAS) on 100-mm VAS scale), videolaryngoscopy, upper endoscopy, and voice assessment (4 voice range profile parameters and overall vocal dysfunction degree (VDD)) were completed. Total symptom index (TSI) was calculated multiplying sum of symptoms severity score by number of presented symptoms. Normal values of efficacy parameters were obtained from 113 healthy voice subjects (control group). Patients were evaluated twice during the treatment: after 1-2 weeks and after 4-5 weeks. Patients were confirmed as responders, if TSI improved at least 50%, and patients were satisfied with results. According to our data, the 1st control assessment showed significant improvement on symptoms, laryngoscopy scores, VDD, and W-B(VAS) only for clinical group patients (p<0.05). Responders rate also was advantageous for the clinical group patients in comparison to the dietary group (36.0% vs. 15%). The second control assessment showed significantly better results for the clinical group patients in comparison to the 1st (p<0.05 2nd vs. the 1st). Sixty five percent of them (65/100) were classified as responders (p<0.05). The better results were in patients receiving omeprazole more than 20 mg daily. Erosive esophagitis during upper GI endoscopy was found for 21.0% (21/100) clinical group patients, 18 of them were responders to omeprazole 4-week test (accuracy of OT with regard to confirmed diagnosis with upper endoscopy was 85.7%). At week 4, efficacy parameters were not in normal range. We concluded that short-term treatment with omeprazole might be useful in confirming the clinically based diagnosis of laryngopharyngeal reflux.

Adolescent↗
PubMed2004

Current diagnostic guidelines for biochemical diagnosis of acromegaly.

Acromegaly is a rare and chronic disease that, in the majority of cases, is due to the presence of a benign growth hormone (GH)-producing tumor of the pituitary. In the past, the diagnosis of acromegaly was established basically on physical changes, and only the patients with a severe clinical picture were brought to medical attention. The development of a radioimmunoassay for detecting GH allowed for the first time to confirm the diagnosis biochemically. Subsequently, methods for measuring insulin-like growth factor 1 (IGF-I) became available and added another important biochemical marker for the diagnosis and follow-up of these patients. Progressive improvements in assay methods have allowed for progressively better definitions of normality and, as a result, have permitted the diagnosis to be biochemically established in patients with only mild forms of the disease. Moreover, new potential markers of disease activity, such as other GH-dependent IGF system parameters, have been investigated and proposed in the diagnostic work-up and for monitoring the therapeutic outcome. Optimal assessment of disease activity, for both diagnostic and follow-up purposes, is mandatory. This subject has been strongly debated regarding proper cut-off values using highly sensitive GH assays as well as the problems linked to IGF system components measurement. Consequently, several consensus reports, as well as original studies, have been issued giving special attention to diagnostic procedures, cut-off revisions and definition of disease activity. The present review discuss principally the biochemical diagnosis of acromegaly based on these articles and on the experience collected in an endocrinological unit considered as reference center for pituitary diseases.

Acromegaly↗
PubMed1994

[The effect of preoperative diagnostic methods on the correct selection of operative procedure on the thyroid gland].

The study compares three diagnostic procedures, the analysis of which is aimed at a choosing the optimal extent of resection on the thyroid. Diagnostic procedures, when based on clinical examination (palpation, scintigraphy, laryngoscopy, X-ray), lead to the optimal extent of resection in 74.2% of patients. Procedures selection performed on the basis of fine-needle aspiration cytology (FNAC) results lead to the correct extent of resection in 93.1% of patients. The procedures of frozen section lead to the correct resection extent in 81.3% of patients. (Tab. 1, Fig. 1, Ref. 25.)

Adult↗
PubMed2004

Diagnostic efficiency of different amphetamine screening tests--the search for an optimal cutoff.

Increased use of designer drugs (amphetamines and amphetamine-like substances) raises the need for fast screening tests in urine in clinical settings, workplace and drug rehabilitation. Immunological assays currently used are subject to unwanted crossreactivities, partly depending on the cutoff concentrations used. The values recommended in Europe and the USA are 500 and 1000 ng/ml, respectively. In Switzerland, the recommended concentration of 300 ng/ml results in a high rate of false-positive urine samples and expensive, time-consuming confirmation testing. Using the Abbott Axsym analyzer, we found numerous false positives from patients in rehabilitation centers due to concomitant medication. Therefore, the diagnostic sensitivity and specificity of the Abbott test at different cutoff concentrations and the sensitivity of the Roche Cobas Integra, Beckman Synchron and Biosite Triage point-of-care test were examined. HPLC BioRad Remedi was chosen as the method of higher hierarchical order. The specificity of the Axsym analyzer (300 ng/ml) was 86%. At 500 ng/ml or 1000 ng/ml the specificity was increased to 99 or 100%, respectively, while the sensitivity only decreased from 97 to 91 or 81%, respectively. In summary, the cutoff concentration for amphetamine screening tests should not be below 500 ng/ml to avoid a high rate of false-positive results.

Amphetamine-Related Disorders↗
PubMed1978

[The choice of optimal sensitizing dose of the antigen in the preparation of cholera erythrocytic diagnostic agent, with consideration to the avidity of antibodies under study].

The authors studied the comparative antigenic activity in the indirect hemagglutination test (IHAT) of erythrocytic diagnostic agents sensitized with various doses of cholera O-antigen. A definite dependence of the IHAT results on the avidity degree of the antibodies determined in the serum was demonstrated. To ascertain the maximal levels of highly avid antibodies (in the hyperimmune cholera sera) it is possible to use antigen doses exceeding the optimal sensitizing ones. In examination of less avid antibodies (for example in the blood sera of cholera patients) the diagnostic agent in such doses displayed decreased IHAT titres. To increase the reliability of the IHAT results it is recommended to choose the sensitizing antigen doses for the preparation of the diagnostic agent to be used in the IHAT with consideration to the avidity of antibodies examined in the blood sera.

Antibodies, Bacterial↗
PubMed1995

Current status of three-dimensional spiral CT scanning for imaging the vasculature.

Three-dimensional CT angiography is a new modality for minimally invasive vascular imaging. Meticulous attention to technique is critical to optimizing image quality and achieving diagnostic images. In this article, the properties of spiral CT acquisitions, intravenous contrast delivery, and three-dimensional rendering techniques, as they pertain to the optimization of CT angiograms, are discussed. Next, a review of initial investigations into the clinical applicability of CT angiography in the cranium, neck, chest, abdomen, and pelvis is provided. Finally, CT angiography is compared with MR angiography and conventional angiography.

Angiography↗
PubMed2001

Influence of vitamin-optimized plasma homocysteine cutoff values on the prevalence of hyperhomocysteinemia in healthy adults.

BACKGROUND: Hyperhomocysteinemia is a cardiovascular disease (CVD) risk factor. We determined plasma homocysteine (Hcy) reference values at optimized vitamin status and investigated their influence on the prevalence of hyperhomocysteinemia in healthy adults. Results were compared with those obtained using European Concerted Action Project (ECAP) cutoff values. METHODS: Healthy adults (n = 101) received folic acid (5 mg/day) and vitamin B(12) (1 mg/day) for 2 weeks and the same dosages of folic acid and vitamin B(12) plus vitamin B(6) (1 mg. kg(-1). day(-1)) during the following 2 weeks. Hcy concentrations, both fasting and 6-h post-methionine load, were determined at baseline and after 4 weeks. RESULTS: Baseline (4 weeks) fasting and 6-h postload Hcy reference values were 4.7-14.6 (4.1-9.3) and 18.8-49.7 (12.9-35.1) micromol/L, respectively. Mean fasting and 6-h postload Hcy decreased after 4 weeks of vitamin supplementation by 3.5 micromol/L (33.5%) and 8.5 micromol/L (26.3%), respectively. The percentages of subjects exhibiting significant decreases in fasting Hcy following vitamin supplementation were 88% (all subjects), 92% (non-vitamin users), and 72% (vitamin users). The prevalences of hyperhomocysteinemia with use of ECAP cutoff values were 29% for all groups, 29% for men, 27% for premenopausal women, and 53% for postmenopausal women. With vitamin-optimized cutoff values, prevalences were 58%, 58%, 76%, and 89%, respectively. Use of vitamin-optimized cutoff values increased the diagnostic value of fasting Hcy and decreased that of a 6-h postload Hcy compared with use of ECAP cutoff values. CONCLUSIONS: Use of vitamin-optimized cutoff values gives rise to high hyperhomocysteinemia pretest probabilities in the general population and, therefore, precludes any meaningful role for Hcy testing. Future demonstration of a beneficial effect of decreasing Hcy on CVD risk would justify use of vitamin-optimized cutoff values for assessment of CVD risk.

Adolescent↗
PubMed2003

[Sonographic diagnosis of ectopic pregnancy: optimal strategy?].

AIM AND METHODS: The diagnostic algorithms of ectopic pregnancy (EP) include sonographic procedures. Diagnostic sensitivity is low because the procedure is operator-dependent and each clinical aspect of EP is variable. We analyzed results of standardized ultrasound procedures performed within the framework of a detailed analysis of clinical findings. RESULTS: The sonographic procedure must be performed within the framework of an overall analysis including laboratory results (hCG level), examination of the decidua, localization of the corpus luteum, and careful detailed examination of adnexa. Hematosalpinx is pathognomonic of EP and is observed in 80% of cases. When diagnosis is doubtful, a second ultrasound procedure should be performed 48 hours later before undertaking laparoscopic diagnosis. CONCLUSION: The diagnostic sensitivity of ultrasonography has been consistently high in published series, undoubtedly because the studies were performed in referral centers highly experienced in diagnostic ultrasound.

Adnexa Uteri↗
PubMed1986

[Means for optimizing the diagnosis of diabetic angiopathies].

Diagnostic algorithms for the recognition of diabetic angiopathies have been developed: an algorithm for the recognition of the most important syndromes of vascular involvement in patients with diabetes mellitus; an algorithm for the recognition of stages of diabetic retinopathy, and an algorithm for the recognition of stages of nephropathy. The algorithms are intended for a wide clinical use and mainly based on simple methods of research. More sophisticated methods extend the probability of the recognition of angiopathies. The use of the algorithms raise the efficacy of the recognition of angiopathies in demonstration experiments for teaching purposes.

Diabetic Angiopathies↗