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PubMed2000

[Morphologic classification of hypertrophic cardiomyopathy with myocardial single photon emission tomography. Comparison with echocardiographic classification].

INTRODUCTION AND OBJECTIVES: The aim of this study was to compare different morphologic types of hypertrophic cardiomyopathy obtained by single photon emission tomography to those obtained by echocardiogram. MATERIALS AND METHODS: In 76 (64%) out of 119 patients with hypertrophic cardiomyopathy the echocardiogram permitted an optimal visualization of all left ventricular segments in the short axis view and consequent classification to one of the six morphological types: type I (septal anterior hypertrophy), type II (septal anterior and septal posterior hypertrophy), type III (septal and antero-lateral hypertrophy), type IV (antero-lateral and/or septal posterior hypertrophy), type V (concentric hypertrophy) and type VI (apical hypertrophy). Without knowledge of echo data, two experienced observers included the short axis of single photon emission tomography images at rest (99mTc-tetrofosmin) to one of those types. RESULTS: Global concordance between echocardiogram and single photon emission tomography was 75%. Type III was the most frequent both in echo (76%) and in single photon emission tomography (74%) and type III produced the majority of discrepancies. SPET identified 4 patients with a predominant septal and inferior hypertrophy, that did not correspond to any of the 6 types of echocardiographic classification and had been previously classified as type III by echo in 3 cases and as type V in 1 case. CONCLUSIONS: There was agreement between echo and single photon emission tomography in the morphological classification of most of the patients (75%) with hypertrophic cardiomyopathy. Nevertheless, some discrepancies were observed for the type III echocardiogram.

Cardiomyopathy, Hypertrophic↗

PubMed1992

Revision of classification of laryngeal cancer, is it long overdue? (Proposals for an improved TN-classification).

The TNM-classification of laryngeal carcinomas of the UICC contains a number of weaknesses which diminish their prognostic relevance. Based on clinical observations and microscopic investigations of surgical specimens, several changes are proposed to improve the existing TN-classification. The larynx is subdivided by the UICC into the supraglottic, the glottic and the subglottic main area and their tumours. There are embryological, anatomical, functional and oncological reasons to divide the larynx into two main areas only--the supraglottis and the glottis (vocal folds) without any further subsites and to abandon a separate group of subglottic tumours. The T size of a tumour should not be assessed according to the extent of an ill-defined anatomical region, but measured in millimetres of greatest surface extent only. The T2 category of vocal fold tumours should not contain those which lead to an inhibited mobility of the fold. All tumours with reduced vocal fold mobility or fixation should be classified as T3 or T4 according to the dimension of invasion. Post-operative pathological examinations (pT/pN) allow an assessment of the true extent of a tumour in three dimensions. A validation study using a 'metric' TpT-classification shows very distinct groups of tumours with a significantly different prognosis from Tis 1 to T4. Studies of lymph node metastases in the neck have shown that, number, size, site of metastasis and the presence of extracapsular tumour spread have a significant influence on the prognosis. An improved N/pN-classification taking these factors in consideration is proposed.

Carcinoma in Situ↗

PubMed2000

New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study.

We believe that the pattern of blood pressure response to tilt during the time preceding the development of the vasovagal reaction may provide adjunctive diagnostic information. A group of 101 consecutive patients affected by syncope of uncertain origin underwent passive tilt testing for 45 min at 60 degrees followed, if negative, by oral (sublingual) trinitroglycerin (TNG) 0.4 microg with continuation of the test for 20 min. Three main patterns were observed: the classic (vasovagal) syncope pattern was observed in 36 patients who, during the preparatory phase, had a rapid and full compensatory reflex adaptation to upright position, resulting in stabilization of their blood pressure values until abrupt onset of the vasovagal reaction; the dysautonomic (vasovagal) syncope pattern was observed in 47 patients in whom steady-state adaptation to upright position was not possible. There was thus a progressive fall in their blood pressure until the occurrence of a typical vasovagal reaction; the orthostatic intolerance pattern was observed in 18 patients in whom there was a progressive fall in blood pressure, similar to that of the dysautonomic group, but this was not followed by a clear vasovagal reaction. Compared with the classic, the dysautonomic patients were older, had a higher prevalence of co-morbidities, a very much shorter history of syncopal episodes, and a prevalence of mixed and vasodepressor forms of the VASIS classification. The patients with orthostatic intolerance had clinical characteristics similar to the dysautonmic group but they could not be classified according to the VASIS classification. In conclusion, in patients with syncope, a variety of abnormal responses is observed during tilt testing, suggesting that different syndromes can be diagnosed by the test. A more detailed, although still arbitrary, classification may form the basis of a number of future drug and pacemaker trials, as well as help towards a greater understanding of the different mechanisms of tilt-induced syncope.

Autonomic Nervous System↗

PubMed1999

A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens.

This study was designed to assess intraobserver and interobserver agreement in the diagnosis of 56 endometrial specimens by five European expert gynecologic pathologists using the WHO classification and to establish which histologic features are significantly associated with each classification category. The seven categories were simple hyperplasia, complex hyperplasia, atypical hyperplasia, well-differentiated adenocarcinoma, proliferative endometria, secretory endometria, and other. Slides were reviewed twice for diagnosis, with accompanying evaluation of a checklist of histologic features. These seven categories were eventually reduced to four and three for the purposes of data analysis. The four modified diagnostic categories consisted of hyperplasia (previously simple hyperplasia and complex hyperplasia), atypical hyperplasia, well-differentiated adenocarcinoma, and cyclical endometrium (previously proliferative, secretory, and other). The three diagnostic categories consisted of hyperplasia, endometrioid neoplasia (previously atypical hyperplasia and well-differentiated adenocarcinoma), and cyclical endometrium. Intraobserver and interobserver agreement was assessed using the percentage agreement and kappa statistics. The associations among the various histologic features and diagnoses was analyzed using multiple logistic regression to identify those features that were useful for distinguishing diagnostic categories. When using seven categories, kappa values ranged from 0.53 to 0.74 (percentage agreement, 61-79%) and from 0.33 to 0.59 (percentage agreement, 43-63%) for intraobserver and interobserver agreement, respectively. When using four categories, kappa values ranged from 0.68 to 0.73 (percentage agreement, 77-80%) and from 0.39 to 0.64 (percentage agreement, 54-73%) for intraobserver and interobserver agreement, respectively. When using three categories, kappa values ranged from 0.70 to 0.83 (percentage agreement, 80-89%) and from 0.55 to 0.73 (percentage agreement, 70-82%) for intraobserver and interobserver agreement, respectively. Data were analyzed in each diagnostic category. When using four or three diagnostic categories, the mean intraobserver and interobserver agreements varied less between categories and achieved higher values, with smaller 95% confidence intervals. The mean percentage agreement was lowest for complex hyperplasia and for atypical hyperplasia. For distinguishing cyclical endometrium versus hyperplasia, the useful histologic feature was glandular crowding. For hyperplasia versus atypical hyperplasia and for hyperplasia versus endometrioid neoplasia, the useful features were nuclear enlargement, nuclear pleomorphism, vesicular chromatin, and nucleoli, but of these, only nuclear pleomorphism achieved substantial mean intraobserver and interobserver agreements. For discriminating atypical hyperplasia from well-differentiated adenocarcinoma, the only useful feature was stromal alterations, which achieved only fair mean intraobserver and interobserver agreements. In summary, in endometrial biopsy or curettage specimens, the lack of agreement in the diagnoses of complex hyperplasia and atypical hyperplasia and the lack of reproducibility in the recognition of the histologic feature of stromal alterations to differentiate atypical hyperplasia from well-differentiated adenocarcinoma suggest that the histologic classification should be simplified by including a combined category for simple and complex hyperplasia, called hyperplasia, and a combined category for atypical hyperplasia and well-differentiated adenocarcinoma, called endometrioid neoplasia. Diagnoses of hyperplasia and endometrioid neoplasia are highly reproducible between observers from different institutions. Glandular crowding is the best histologic feature to differentiate cyclical endometrium from hyperplasia, whereas nuclear pleomorphism is the reproducible cytologic feature to differentiate hyperplasia from endometrioid neoplasia.

Biopsy↗

PubMed1978

The classification of primary cutaneous malignant melanoma. A prospective study of 60 cases using Clark's classification.

A series of 60 primary cutaneous malignant melanomas has been studied by serial block technique. The resulting 492 sections have been classified as junctional naevus with or without atypia and preinvasive or invasive malignant melanoma according to Clark (1967). No sections showed lentigo maligna (melanoma). The overall classification resultedin 49 superficial spreading malignant melanomas, 6 nodular malignant melanomas and 5 unclassifiable malignant melanomas. In 3 cases (5%) there was inconsistency between the classification of the central section and the overall classification of the tumour. Five theoretical growth patterns have been postulated ranging from thatof the pure superficial spreading malignant melanoma completely surrounded by a preinvasive area to the pure nodular malignant melanoma which completely lacks any such area. Borderline cases between these two types certainly seem to exist. Features such as intraepidermal Pagetoid growth of tumour cells, co-existence of a benign melanocytic component and histological changes indicating tumour regression have been discussed. It is recommended that at least 3 tissue blocks should be taken from all malignant melanomas up to 25 mm in diameter and more if the tumour is larger.

Adolescent↗

PubMed1980

Multi-aspects classification of mental disorders (MACM). A solution to the present confusion in the international classification mental disorders.

The international classification of mental disorders (ICD-8) presented by the WHO has not been accepted in all countries and where it is used, local adjustments are made and sometimes parallel classification models are used. The diagnostic system has also been criticized as lacking in exactness and consistency and the reliability between diagnosticians has been shown to be low. As a consequence, international communication is made difficult and research is hampered. This problem is particularly relevant in the field of biological research. In fact, it can be suspected that most inconsistencies as regards results obtained in different places might depend upon an inconsistent use of the current diagnostic labels. A possible solution of this problem can be the use of a multiaspect classification model. Such a multiaspect model (MACM) including four variables - symptomatology, severity, course and supposed etiopathogenesis - has been tested for several years at Umeå. MACM is shown to be easly to communicate both in undergraduate training and in ternational communication. The reliability between diagnosticians is found to range from 56 to 82% as compared to 22-36% as concerns ICD-8. It is also shown that fairly homogeneous groups, both regarding course, supposed etiopathogenesis and biological basis, can be formed and that MACM seems to bear temporal stability. Computer programming of MACM diagnoses is as possible as with ICD-8 diagnoses. Furthermore, when Macm is used in clinical routine work, much more information valid in administrative routines is stored than what is possible when ICD-8 is used.

Humans↗

PubMedDate not supplied

[Nursing Intervention Classification (N.I.C.) and Nursing Outcome Classification (N.O.C,) of Iowa University: a description of methods, tools and contents].

This article is meant to introduce NIC and NOC classification by briefly describing the methodological pathway that was used to realize the two classifications and the underpinning philosophy that has enforced its implementation. The taxonomic structures of both classifications will be described too and the involvements on its use in the clinical field.

Education, Nursing↗

PubMed1985

[Reevaluation of the histological classification of breast cancer--a presentation of a new histological classification considering the relationship between scirrhous tendency and postoperative prognosis].

The present study was designed to evaluate the correlation between the histology and the prognosis of the patients with breast cancer. In this study, 1271 cases with breast cancer were retrospectively studied and an attempt of a new histological classification was presented, which was intended to reflect the prognosis more exactly than the ordinarily used classification by Japan Mammary Cancer Society. Japan Mammary Cancer Society classifies infiltrating carcinoma into 3 types; papillotubular, medullary tubular and scirrhous carcinoma. In this study, when scirrhous interstitial infiltration was observed in papillotubular or medullary tubular carcinoma, even if scirrhous tendency was observed only in small part, the patients' prognosis was as poor as scirrhous carcinoma. The prognosis of common type of infiltrating carcinoma with scirrhous tendency corresponded to that of one grade advanced stage without scirrhous tendency. Considering these results and clinical usefulness, common type of infiltrating carcinoma should be classified to 2 types, namely with or without scirrhous tendency in order to reflect the prognosis and to correspond to WHO classification.

Adenocarcinoma, Scirrhous↗

PubMed1987

[The fate of patients with diabetes in pregnancy--classification of gestational diabetes following the completion of pregnancy (p.g. classification)].

In 69 patients with a gestational diabetes-diagnosed by reproducible pathological results of two oral glucose loads (50 g) or by fasting blood glucose values of greater than or equal to 6.7 mmol/l in pregnancy the carbohydrate metabolism was checked postgestationally again with a glucose tolerance test (75 g) in a period of 6 weeks up to 2 years post partum. The postgestational classification showed the following results: manifested diabetes n = 15 (21.7%), impaired glucose tolerance n = 15 (21.7%), non-classificable disturbed carbohydrate tolerance n = 10 (14.5%), normal test results n = 29 (42%). The high rate of diabetic manifestations underlines the necessity of a postgestational classification of the so-called gestational diabetes controlled by the delivering center. The high risk of manifestation is calculable in the whole group, but not predictable for the single case. The risk is the higher the earlier a glucosuria in pregnancy can be found (before the 24th week), the earlier an insulinisation is necessary to guarantee a normoglycemia and the higher individual deviations of the individual blood glucose values during the daily course are observed (measurable with the glycemic index acc. Michaelis et al.). Additional risk factors are: obesity, an age over 30 years at the beginning of pregnancy, and heredity of first degree. From the retrospective point of view of a postgestational classification new therapeutic aspects could not be verified to avoid diabetes manifestation. Nevertheless an exact normoglycemic control and a very early start of treatment, a correct screening of risk factors and an immediate diagnosis of a gestational diabetes are a supposition to avert hyperglycemic dangers from the child.

Adult↗

PubMed1980

The Rappaport classification of non-Hodgkin's lymphomas: a closer look using other proposed classifications.

An essential purpose of a pathologic classification of non-Hodgkin's lymphomas is to supply guidance in the clinical management of patients. Ideally, an optimal subclassification should also be scientifically accurate, highly reproducible, and readily teachable. Such a system, when used in conjunction with uniform staging, should enable relatively homogeneous groups of patients to be defined. In the present study, we have evaluated four new systems for possible additions to the traditional Rappaport classifcation. In response to specific questions the following tentative conclusions could be drawn: (1) Within the Rappaport nodular lymphomas, there are no differences in survival between lymphomas that are totally nodular verusus those that are nodular and diffuse. (2) In lymphomas composed of small cleaved follicular center cells of the Lukes-Collins system, survival appears to be independent of pattern (follicular, follicular and diffuse, or diffuse). In contrast, in tumors classified as centroblastic-centrocytic in the Kiel classification or those classified as large cleaved or large noncleaved in the Lukes-Collins system, a totally or partially follicular pattern confers a better prognosis than its diffuse counterpart. (3) The numbers are small but there is no apparent difference in survival between cases of Rappaport's difuse well differentiated lymphocytic lymphomas with or without plasmacytoid differentiation. (4) Within the original Rappaport DPDL there were at least two distinct types of lymphomas: (1) a convoluted lymphoblastic that occurs in younger patients has a high frequency of B symptoms and carries a poor prognosis; and (2) a diffuse lymphoma that is cytologically identical to nodular PDL, occurs in older patients, and has a relatively good prognosis. In August of 1976 Rappaport modified his classification to recognize these lymphoblastic lymphomas as a distinct clinicopathologic entity. (5) In this 22-yr retrospective review, neither the Kiel nor the Lukes-Collins system could identify any relatively favorable subsets within Rappaport's category of diffuse histiocytic lymphoma. Prospective studies applying the same approach to large numbers of patients subjected to modern uniform staging and aggressive combination chemotherapy may provide data upon which to base an optimal subclassification of DHL.

Adolescent↗

PubMed1976

[New classification of tumor lesions of the hematopoietic and lymphatic tissues and use of these classifications in prosector practice].

The author presents a review of the world medical literature reports on the latest classifications of tumours of the hemopoietic and lymphatic tissues, based on new concepts of the hemopoiesis system. Changes in the interpretation of the meaning of such terms as "reticular cell", "reticulosis", reticulosarcoma", "hemocytoblastosis", and others are discussed. A contraversial nature of many new concepts and incompleatness of the discussion concerning the problem are emphasized. The author is one of the opinion that it would be better to abstain from the use of new classifications and from alterations in terms in practical work of pathologists before the appearance of a unified international classification of the tumours in question. Further studies of new theoretical aspects of the problem and continuation of detailed morphological, including histochemical, immunomorphological and other investigations of the substrate of tumour lesions of the hemopoietic and lymphatic tissues are recommended.

Autopsy↗

PubMed1993

Nursing interventions classification. A comparison with the Omaha System and the Home Healthcare Classification.

Standardized languages for nursing practice are required to meet the needs of the profession and the patients we serve. The authors review and compare three classifications of nursing interventions: Nursing Interventions Classification (NIC), the Omaha System, and the Home Healthcare Classification (HHC). The information will help users make the best selection for their agency and client population.

Community Health Nursing↗

PubMed1997

The alpha and omega of G-protein coupled receptors: a novel method for classification. Part 2. Bin classification.

A novel way of classification of G-protein coupled receptors is presented that is only based on receptor sequence information by counting of amino acid residues. It involves the number of amino acid residues between the Asn residue in TM1 and the residue Cys in the loop between TM4 and TM5, the number of residues between the latter Cys residue and Pro residue in TM6, and the number of residues between the latter Pro and the last amino acid residue (called omega) in the sequence. The classification of 131 sequences, covering biogenic amine, opioid and somatostatin receptors, is visualized by means of a diagram which is referred to as a bin map. Each bin in the diagram encloses all the sequences that belong to one and only one receptor type or subtype. This so-called bin classification was obtained by means of the genetic algorithm methodology, which offers new opportunities for classifying proteins.

Animals↗

PubMed1998

Outpatient costing and classification: are we any closer toa national standard for ambulatory classification systems?

The Outpatient Costing and Classification Study was commissioned by the Department of Health and Family Services to evaluate the suitability of the Developmental Ambulatory Classification System (DACS). Data on the full range of ambulatory services (outpatient clinics, emergency departments and allied health services) were collected prospectively from a stratified sample of 28 public hospitals. Patient encounters captured in the study represent 1% of the total ambulatory encounters in Australia in one year. Costing per encounter included time spent with the patient, cost of procedures, indirect costs (salaries and consumables), overhead costs and diagnostic costs. The most significant variable explaining cost variation was hospital type, followed by outpatient clinic type. Visit type and presence or absence of a procedure--major splits for the proposed DACS--did not produce splits that were consistent across all hospital strata. The study found that DACS is not an appropriate classification for hospital ambulatory services. A clinic-based structure for outpatients and allied health departments is recommended for classifying and funding ambulatory services in Australia.

Ambulatory Care↗

PubMedDate not supplied

Chinese classification of mental disorders (CCMD-3): towards integration in international classification.

The CCMD-3 Task Force has prepared and completed field trials for the Chinese Classification of Mental Disorders Version 3 (CCMD-3). It has also worked on the Treatment and Nursing of Mental Disorders Relevant to CCMD-3, and the Rating Test for Health Problems and Diseases as a set of relevant diagnostic scales and software. From 1996 to 2000, the CCMD-3 Task Force has been actively engaged in prospective follow-up field trials aimed at improving the classification and diagnostic criteria of mental disorders in China. A total of 114 psychiatrists from 41 mental health centers and psychiatric hospitals carried out the trials, considering for the 17 adult mental disorders, and 7 mental disorders with onset usually occurring in childhood and adolescence. Based on the results of the field trials, the Task Force has finalized the CCMD-3. Throughout the phase of initial drafting, each item in CCMD-3 was compared with the corresponding item in the CCMD-2R, and the descriptive definitions were based on the Clinical descriptions and diagnostic guidelines of ICD-10. The diagnostic criteria also refer to the Research Criteria of ICD-10, and the DSM-IV. Following the decision made by the Chinese Psychiatric Association, CCMD-3 has been published as diagnostic guidelines to be used by all psychiatrists across the country.

Adolescent↗

PubMed1995

From image processing to classification: II. Classification of electrophoretic patterns using self-organizing feature maps and feed-forward neural networks.

In a recent study, isoelectric focusing patterns were classified with a neural network using the back-propagation algorithm [1]. In order to further study the classification process and to generalize the presentation of electrophoretic patterns, Kohonen's self-organizing feature maps [2] were applied in this study. Although these feature maps are very efficient in many pattern recognition tasks, our data proved to be too complex for classification with an unsupervised system. Therefore, a second supervised network on top of the feature map was necessary. As in [3], a feed-forward network trained by the back-propagation algorithm was used. The final system allows us to correctly classify 90% of all wheat varieties. Moreover, the system proved to be reliable, reasonable in training time and shows the same accuracy in different experimental setups.

Algorithms↗

PubMed1996

From image processing to classification: IV. Classification of electrophoretic patterns by neural networks and statistical methods enable quality assessment of wheat varieties for breadmaking.

The end-use quality of products made from doughs consisting of wheat flour and water is often dependent upon the storage (gluten) proteins of the grain endosperm. Today the electrophoretic patterns of the high molecular weight (HMW) glutenin subunits are used for quality selections in wheat breeding programs in several countries. In this study, we used two multivariate techniques to classify digitized patterns from isoelectric focusing of gliadins and glutenins: a two-layered neural network architecture consisting of a self-organizing feature map and a feed-forward classifier [1], and discriminant analysis [2,3]. Three groups of seven wheat varieties (Triticum aestivum L.), associated with poor, medium or good properties in relation to bread-making quality, were used. The best classification results were obtained by the neural network model, based on data from the gliadin fraction: it was possible to classify varieties associated with poor or good quality, with recognition rates of 70 and 69%, respectively. The statistical method was better suited to solve the classification problem when the data was based on the glutenin fraction: if a specific variety was already known to be non-poor, this method enabled us to classify the medium- and good-quality classes with recognition rates of 90 and 88%, respectively. The results obtained were confirmed by correlation coefficients.

Discriminant Analysis↗

PubMed1996

Cytogenetic findings in 175 patients indicate that items of the Kiel classification should not be disregarded in the REAL classification of lymphoid neoplasms.

Cytogenetics have proved to be a valuable tool for classifying systemic lymphatic neoplasms, as this technique allows different stem line aberrations and clonal developments to be distinguished. This study was designed to analyze how far groups defined according to common cytogenetic features correlated with their position in either the Kiel (KC) or the REAL classification. Cytogenetic analyses were performed on material from 175 patients with lymphoid neoplasms (LN). Samples were prepared from peripheral blood and bone marrow in acute lymphoblastic leukemia (ALL), from bone marrow in multiple myeloma (MM), and from lymph node biopsies in lymphomas. The results of this study support the inclusion of ALL, MM, and extranodal lymphomas into a comprehensive classification, because their chromosomal aberrations were always characteristic for LN. From the cytogenetic point of view, a subgroup of ALL appears as a leukemic manifestation of lymphoblastic lymphoma. MM have structural aberrations of chromosomes 1, 11, and 14 and secondary aberrations of chromosomes 3, 6, 7, 12, 13, and 18, all of which are characteristic for lymphatic disease. The groups with follicle center cell lymphoma and mantle cell lymphoma correlate well with our results both in the low-grade subtype and in the blastic variant type, the majority of cases demonstrating t(14; 18) and its variants and t(11; 14), respectively. In contrast, the group of diffuse large B-cell (DLB) lymphomas proved to be heterogeneous on the basis of our cytogenetic results. Accordingly, we would suggest keeping the immunoblastic lymphoma (IB) subtype defined by the KC. IB demonstrates no stem line aberration in common with any other group and seems to be characterized by stem line aberrations involving chromosomes 3 and 6. As some DLB lymphomas have a t(14;18) or variant translocations involving chromosome 18, they should either be separated as a subgroup or included into the group of follicle center lymphomas.

Adult↗