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PubMed2001

[Doppler ultrasonography in the diagnosis of ovarian cysts: indications, pertinence and diagnostic criteria].

To discriminate ovarian lesions is of particular importance in gynecological practice. Two main problems need answers: discrimination of benign and malignant adnexal masses and choice of the appropriate surgical treatment if necessary. Nearly 2% of the adnexal masses are ovarian carcinomas or border line tumors. It is now well established that ultrasonography is the gold standard for ovarian cyst diagnosis. The purpose of this work was to review the literature and to establish, with the evidence based medicine model, which parameters and existing diagnostic models using ultrasound and Doppler performs best in the evaluation of adnexal masses. Transvaginal sonography has demonstrated considerable advantage over conventional transabdominal sonography. However, transparietal sonography is still useful in large tumors. It is no longer reasonable to subject all patients undergoing pelvic sonography to bladder distension. Functional ovarian cyst characterization seems easy using sonography and Doppler. In case of complication, discrimination of such functional cyst may be difficult but spontaneous regression confirms usually the expectative management. Dermoid cysts and endometriomas seem to be easier to discriminate from other adnexal masses. Papillary formations on the inside of the cyst wall and masses with a non hyperechoic solid component are the most statistically significant predictors of a malignant ovarian mass. Ultrasound and morphologic parameters have a sensitivity of 80% and a specificity of 93%, that make this exam the gold standard for ovarian masses diagnosis. Another parameter is important: experienced hands with subjective evaluation seems to be one of the best ultrasound method for adnexal masses discrimination. Scoring system help differentiate benign from malignant masses (sensitivity 90%, VPP 50%). Doppler flow measurement and assessment of tumor vascularity by doppler energy increase the confidence with which a correct diagnosis is made. Moreover, combined US techniques and a diagnostic algorithm perform significantly better than morphologic assessment, color doppler or CA125 measurement alone. Logistic regression and neural network models are good methods and may be useful for malignancy prediction but the improvement is small and the concordance with histology far from 100%. In front of a benign and maybe functional cyst, spontaneous resolution may be controlled by sonographic exam at 3 and 6 months. Three-dimensional ultrasound and power doppler, contrast enhanced sonography, and sonography during the laparoscopic procedure are not still validated. Every suspicious ovarian mass needs sonography by an expert which can first use all the techniques and the different parameters to discriminate benign and malignant tumors. Secondly, after control if necessary, he can propose the patient for appropriate surgical treatment.

Diagnosis, Differential↗
PubMed2001

Possibilities of spatial imaging of carotid arteries pathologies in Power-Doppler US.

The aim of the study was to assess the value of Power-Doppler US spatial reconstructions in examining pathologies of carotid arteries for determining its role in the diagnostic algorithm. 3D Power-Doppler US reconstructions were performed in 19 patients with pathologies of carotid arteries qualified for surgical treatment on the basis of Color-Doppler examinations. Digital data of 2D US sections secondarily gave spatial pictures. Most frequently, 14 times, different degrees of carotid artery stenosis were found, in 3 cases critical, and complete impatency was observed twice. The narrowings were caused by both atheromas and parietal clots. In 3 cases the internal carotid artery formed an angular refraction. Spatial pictures also determined the geometry of division of common carotid arteries. It was found that Power-Doppler 3D US perspectively visualizes the configuration of carotid vessels and the range of their pathology facilitating understanding of the extent of changes and mutual topographic relationships. Spatial imaging let visualize atheromas and ulcerations of their surfaces besides the degree of carotid arteries narrowing.

Algorithms↗
PubMed2002

[Fever and skin hemorrhages in children--is it meningococcal disease?].

INTRODUCTION: Our main aims were to establish criteria for early distinction between meningococcal disease and other conditions with similar clinical features, and to identify other causes of haemorrhagic rashes accompanied by fever. MATERIALS AND METHODS: This prospective study comprised 264 infants and children hospitalised with fever and skin haemorrhages. RESULTS: We identified an aetiological agent in 28%: 15% had meningococcal disease, 2% another invasive bacterial infection, 7% enterovirus infection, and 4% adenovirus infection. Five clinical variables discriminated meningococcal disease from other conditions on admission: skin haemorrhages of (1) characteristic appearance; (2) universal distribution and (3) a maximum diameter of > 2 mm; (4) poor general condition; and (5) nuchal rigidity. DISCUSSION: If any two or more of these clinical variables were present, the probability of identifying a patient with meningococcal disease was 97% and the false-positive rate was only 12%. This diagnostic algorithm did not identify children in whom septicaemia was caused by other bacterial species.

Child↗
PubMed2002

[Traumatic rupture of the diaphragm in blunt injuries].

The authors present a group of 12 casualties operated on account of a traumatic rupture of the diaphragm. The rupture of the diaphragm was part of an associated thoracoabdominal injury or multiple injury. The casualties were examined within the framework of the diagnostic algorithm, in 11 of them rupture of the diaphragm was proved by spiral computed tomography. The diaphragm was injured in 7 subjects on the left and in 5 on the right. In 8 casualties during injury of the diaphragm also a serious intrathoracic injury was treated (in 5 laceration of the lungs) and of intraabdominal organs (in 4 laceration of the liver and in 2 laceration of the spleen). On the left side injuries of the diaphragm were always treated from laparotomy, on the right in 4 patients from thoracotomy. In 4 patients with concurrent injury of the intrathoracic and intraabdominal organs a thoracoabdominal approach was selected. During the postoperative period one female patient with multiple injuries died. The cause of death was contusion of the brain. According to the authors' experience it is useful to apply for early diagnosis of diaphragmatic injuries modern non-invasive imaging methods (spiral post-contrast computed tomography). The surgical approach depends on the presence of associated intrathoracic and intraabdominal injuries. The therapeutic results are limited by the presence of serious associated injuries.

Adult↗
PubMedDate not supplied

A new method for diagnosing fever of unknown origin (FUO) due to infection of muscular-skeletal system in elderly people: leukoscan Tc-99m labelled scintigraphy.

Twenty patients affected by fever of unknown origin (FUO), due to a likely infection of the muscular or skeletal tissues, were studied by a Total Body scan with a monoclonal antibody fragment (Leukoscan) labelled with Tc-99m. The diagnostic procedure helped reach a final diagnosis in 8 out of the 20 patients because it identified the focus of the infection of the muscles or bones in joint proximity. Our data show that Leukoscan deserves to become a first line diagnostic procedure in the diagnostic algorithm for the evaluation of patients with FUO.

Aged↗
PubMed2002

Wireless capsule endoscopy -- beyond the frontiers of flexible gastrointestinal endoscopy.

Wireless capsule endoscopy is currently the outstanding technical innovation in diagnostic gastrointestinal endoscopy. Especially for small bowel diseases this new technique offers several potential advantages compared to traditional diagnostic tools. Capsule endoscopy is a painless procedure that can be performed as an ambulatory endoscopic examination. First experimental studies proved the good tolerance of the capsule endoscopy and the possibility of a complete visual investigation of the small bowel. Clinical studies demonstrated possible fields of application: Obscure chronic or intermittent gastrointestinal blood loss and inflammatory bowel disease. The major risk of the procedure - intestinal obstruction by the capsule - may hinder its use in the diagnosis of polyps or tumors in the small bowel. In the next years it will be exciting to see whether capsule endoscopy will finally reach the clinical significance we expect at the moment. Possibly, the diagnostic algorithm for obscure gastrointestinal bleeding has to be changed in the future due to the abandonment of less effective procedures.

Endoscopy, Gastrointestinal↗
PubMed2002

Failure patterns of combined modality treatment in lung cancer: the impact of staging.

BACKGROUND: Patients with locally advanced non-small cell lung cancer (NSCLC) may be treated with induction chemotherapy (IC) followed by surgery with curative intent. The impact of staging inaccuracies on the failure rate of this intensive combined modality treatment approach, i.e. non-curative chemotherapy and thoracotomy, requires further investigation. METHODS: The records of a cohort of 38 consecutive NSCLC IIIA-N2 patients treated with IC followed by surgery were reviewed. RESULTS: The clinical course strongly suggested that the standard diagnostic algorithm failed to demonstrate stage IV disease in 34% of the cases. Surgery instigated by CT-based response criteria at restaging after chemotherapy proved to be irradical in 70% of cases. CONCLUSION: Our data confirm the limitations of the current work-up of patients with apparently locally advanced NSCLC. This applies to the selection of patients to be assigned to combined modality treatment as well as to the post-chemotherapy assessment of resectability. Improved (re)staging of these patients will enhance the efficiency of intervention trials and prevent patients from being exposed to intensive and toxic therapy from which they derive no benefit.

Adult↗
PubMed2002

[Diagnosis and choice of surgery of non-parasitic cysts of the liver].

Results of treatment of 342 patients with non-parasitic cysts of the liver (NCL) were analyzed. Based on obtained data diagnostic algorithm was developed. Indications and contraindications for transcutaneous and laparoscopic methods in NCL are clarified and substantiated. Features of laparoscopic operations in different location of cysts are presented. In mini-invasive surgeries postoperative complications rate was minimum, there were no lethal outcomes. The authors believe that conventional surgeries in NCL should be performed in critical states only.

Adult↗
PubMed2002

Male breast carcinoma.

OBJECTIVE: To review the epidemiology, presentation, diagnosis, molecular genetics, treatment and prognosis of male breast cancer. DATA SOURCES: Articles, written in English or French, selected from the Medline database (1966 to January 2001), corresponding to the key words "male breast cancer," according to the following criteria: covering institutional experience or comparing diagnostic and treatment modalities, and epidemiologic or general reviews. STUDY SELECTION: Of 198 articles found 50 fulfilled the review criteria. DATA SYNTHESIS: Risk factors included advanced age, a positive family history, Jewish origin, black race, excess exposure to female hormones (Klinefelter's syndrome), environmental exposure (irradiation), alcohol, obesity, higher socioeconomic or higher educational status and childlessness. Gynecomastia remains a controversial factor, this term being used for both a histologic reality and a physical finding. Advanced disease is characterized by pain, bloody discharge and skin ulceration. There is no definitive diagnostic algorithm. Experience with male breast mammography is limited, and imaging is less informative for patients under 50 years of age. Fine-needle aspiration tends to overestimate the rate of malignancy. The commonest histologic finding is infiltrating ductal adenocarcinoma. Treatment includes modified radical mastectomy, followed by cyclophosphamide-methotrexate-5-fluorouracil or 5-fluorouracil-Adriamycin-cyclophosphamide chemotherapy for disease of stage II or greater. Radiotherapy does not seem to add any benefit. The disease is highly receptor-positive; however, many patients discontinue tamoxifen due to side effects. The most important prognostic factors are tumour size, lymphatic invasion and axillary node status. CONCLUSIONS: Because of the low incidence of male breast cancer, advances will be obtained mainly with the rapid transfer of newly gained knowledge in female mammary neoplasia. The increased use of adjuvant chemotherapy combined with tamoxifen postoperatively may have a positive impact on survival. Public education should be oriented toward men at higher risk to reduce the interval between appearance of symptoms and consultation. Rigorous data collection will allow for thorough reporting of risk factors and thus the possibility of characterizing the etiology of this disease.

Algorithms↗
PubMed2001

Value of magnetic resonance cholangiography (MRC) in primary sclerosing cholangitis (PSC).

BACKGROUND: Magnetic resonance cholangiography is a relatively new method, hence it has not gained a proper status yet in the diagnostic algorithm in patients with bile duct diseases. Many authors believe that MRC is an effective method for the visualisation of bile ducts. The aim of the study is to evaluate MRC usefulness in patients with PSC. MATERIAL AND METHODS: The study material consisted of 4 patients with PSC (3 men and 1 woman) aged 23-50 years. Patients were subjected to liver MRI in transverse plane, and T1 and T2-weighted images were obtained. Additionally, magnetic resonance cholangiography was performed with Gyroscan 0.5 T unit and Magnevist contrast medium. RESULTS: The patients manifested cholestasis and hepatitis of different duration (range: 2-14 years). The biochemical analyses revealed FA ranging from 563 to 1114 IU/l, GGTP 157-1270 IU/L, AlAT 56-295 IU/L, AspAT 80-190 IU/L. Three out of four patients displayed significant increase in the level of ANCA antibodies. Histopathological investigation of the liver, conducted in 3 out of 4 patients, showed cholangitis et pericholangitis. ERCP was attempted in all the patients. In one case, irregular, overlapping and narrowed bile ducts were found, while in two cases it was impossible to fill intrahepatic ducts. ERCP was not performed due to technical obstacles encountered in one patient. All the subjects underwent MRC. In three cases, the segmental irregular dilatation of intrahepatic ducts was observed, while in one case intrahepatic ducts were poorly marked. The defect in the filling of initial segment of common bile duct was diagnosed in one patient. Another patient had a lesion adjacent to common bile duct--low signal intensity in T1 and the intensification after the administration of contrast medium indicate the presence of expansive process. CONCLUSIONS: 1. MRC is an accurate examination enabling the visualisation of all bile ducts in their natural size. 2. Simultaneous MRI of the liver allows for the diagnosis of focal lesions. 3. MRC may be used in those cases, where ERCP cannot be performed for technical reasons or when it is objected by the patient.

Adult↗
PubMed2002

[Sialodiagnostika-2000, an automated system for differential diagnosis of the salivary glands chronic diseases].

Automated system for differential diagnosis of chronic diseases of the salivary glands Sialodiagnostika-2000 is based on an original differential diagnostic algorithm. Complex differential diagnosis of chronic diseases of the salivary glands can be carried out using this software. Tentative and final clinical diagnosis can be made on the basis of the results of examinations using the optimal complex of accessory methods. The authors claim that Sialodiagnostika-2000 makes the experience gained by the leading specialists available for practicing dentists and thus improves the diagnosis of diseases of the salivary glands.

Algorithms↗
PubMed2002

[Detection of lactoferrin in feces for differential diagnosis in diarrhea].

INTRODUCTION: Routine stool culture is used to evaluate patients with diarrheal illness. However, the results are often delayed, and the tests are very expensive. Therefore a rapid, simple method for screening would be a helpful adjunct in a diagnostic algorithm. Fecal leukocytes are found in diarrhea patients with diffuse colonic inflammation but missing in non-inflammatory cases, and are most commonly identified in infectious diarrheas of bacterial origin. It supports the use of immediate empiric therapy in very young, elderly and immunocompromised individuals. When negative, it may eliminate the need for stool culture in some cases of diarrhea. Recently, a new latex bead assay has been developed for the detection of lactoferrin, an iron binding glycoprotein found in polymorphonuclear leukocytes. AIMS: Evaluate the value of fecal leukocytes and lactoferrin in the workup of patients with diarrhea. METHODS: Fecal samples of 50 consecutive adult patients with acute or chronic diarrhea were tested for fecal leukocytes and lactoferrin. The results were compared with findings from fecal cultures, tests for parasite, Clostridium difficile A toxin latex test, data of the gastrointestinal examination and clinical evaluation. The authors defined two groups of the cases: the inflammatory and non-inflammatory diarrheas. RESULTS: The sensitivity, specificity, positive and negative predictive value of microscopic leukocyte count and the lactoferrin test were 42 and 63%, 87 and 87%, 67 and 75%, 71 and 79% respectively. CONCLUSIONS: In agreement with the literature the results of the present study indicate that fecal lactoferrin appears more sensitive than fecal leukocyte smear, and accurately rules out inflammatory diarrhea.

Adult↗
PubMed2002

[Diagnosis and surgical treatment of pathologic tortuosity of carotid and vertebral arteries].

The article summarizes an experience with 179 surgical interventions on patients with pathological tortuosity of brachiocephalic arteries. The optimal described diagnostic algorithm for this pathology included ultrasonic dopplerography, transcranial dopplerography, angiography or magnetic resonance tomography in the angiography regimen. Clinical and angiographic indications to surgical treatment of this pathology were determined. The operative treatment was carried on in patients with neurological symptoms having kinks of brachiocephalic arteries. The intraoperative strategy depending on the type and localization of the disease are analyzed. Stabile regression of manifestations of vascular cerebral insufficiency after surgical correction of the pathological tortuosity of the brachiocephalic arteries was achieved in 76% of the patients.

Adult↗
PubMed2002

[Scintimammography in breast cancer imaging].

Scintimammography is a rarely used method of breast cancer imaging. The aim of the study was to find its place among other radiological methods. Routine methods of breast cancer detection were compared considering their advantages and disadvantages. Scintimammography seems to be a promising complementary method. Indications for scintimammography are considered and suggestion of a diagnostic algorithm in breast cancer, including of this method is proposed.

Algorithms↗
PubMed2003

Identifying new diseases and their causes: the dilemma of illnesses in Gulf War veterans.

Since the Gulf War, investigation continues of symptoms and illnesses among its veterans. Yet, identifying a specific "Gulf War Syndrome" remains elusive. With new disease entities, causal associations are relatively easily established when the condition is serious, verifiable, and has excess disease rates in specific groups. In common conditions, many excess cases are required to establish association with a specific exposure. Establishing causality in syndromes with variable symptoms is difficult because specific diagnostic algorithms must be established before causal factors can be properly investigated. Searching for an environmental cause is futile in the absence of an operational disease case definition. Common subjective symptoms (without objective physical or laboratory findings) account for over one-half of all medical outpatient visits, yet these symptoms lack an identified physical cause at least one-third of the time. Our medical care system has difficulty dealing with disorders where there is no identified anatomic abnormality or documented metabolic/physiological dysfunction.

Causality↗
PubMedDate not supplied

[New contributions of the usefulness of electromyography of cavernous bodies in the diagnosis of erectile dysfunction].

OBJECTIVES: To test the concordance between clinical and neurophysiologic data of the various types of erectile dysfunction, and to describe a diagnostic algorithm based on corpus cavernosum electromyography (cc-EMG). METHODS: 32 patients with a mean age of 50.6 years (typical deviation 13.2 years) referred with the diagnosis of erectile dysfunction underwent medical history, neuroandrologic physical exam, neurophysiologic studies (bulbocavernous muscle electromyography, S2-S4 latency period, threshold and latency of pudendal nerve somatosensory potentials, as well as genital sympathetic evoked potentials-SSR-), and corpus cavernosum electromyography(cc-EMG) both in basal conditions and after administration of 20 micrograms of E-1 prostaglandin (PGE-1). RESULTS: 1--A significative relationship was shown between clinical data of arterial or corpus cavernosum intrinsic origin erectile dysfunction and patients with vascular or structural lesion on cc-EMG data. 2--A significative relationship was shown between patients without previous pathologic history and patients with normal or anxiety cc-EMG. 3--No significative relationship was shown between patients with neurologic lesion and patients with autonomic lesion on cc-EMG. 4--No significative relationship was found between patients with peripheric neurologic lesion and patients with inferior autonomic lesion on cc-EMG. 5--A significative relationship was shown between patients with suprasacral neurologic lesion and patients with superior autonomical lesion on cc-EMG. CONCLUSIONS: Isolated application of pudendal nerve neurophysiologic techniques for the diagnosis of erectile dysfunction is not enough. Autonomic innervation studies should be included, with a cc-EMG dichotomic qualitative interpretation.

Algorithms↗
PubMed2002

[Current diagnosis of pulmonary embolism].

In this article the current imaging techniques that may be helpful in diagnosing pulmonary embolism are reviewed. The controversy concerning the optimal diagnostic algorithm of the disease is also covered.

Algorithms↗
PubMedDate not supplied

[Diagnosis of diaphragmatic hernia].

Diaphragmatic hernias (congenital and traumatic) belongs to thoracoabdominal surgery which is a borderline chapter. Considering frequency, they are on the second place in the diaphragmatic pathology, after hiatal hernias. The author presents the criterias of the clinical examination, based on the bibliographic datas: also by presents the imagistic investigations used for identification of the diaphragmatic hernias, excepting the oesophageal hiatus hernias. There are some particular features appearing in the diagnostical algorithm, too.

Diagnosis, Differential↗