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800 patients with stomach cancer were operated in Saratov Military Medical Institute from 1990 to 2000. Results of radical surgery in advanced stomach cancer are presented. The most frequent postoperative complications and causes of lethal outcomes are described. Treatment and diagnostic algorithm in stomach cancer is proposed to optimize work of general surgery units.
A case of giant fibroadenoma of the breast (size 23x20x13 cm and weight 2680 grams) in a 43-year-old woman with short stature and gracile body build is presented. Pericanalicular fibroadenoma was detected histologically. One year after mastectomy the patient is in good health, with no recurrences. The case is discussed in the light of the diagnostic difficulties, which lead to radical mastectomy. Giant fibroadenomas have to be differentiated from phylloid cystosarcoma by the lack of leaf-like structures and stromal cell atypia and from the breast hamartoma and asymmetric breast hypertrophy in girls by the lack of mammary lobules. Giant fibroadenoma should take its due place in the diagnostic algorithm of the breast tumors.
Delirium in elderly people is a severe condition that requires vigorous medical attention. Therefore, the Dutch College of General Practitioners has duly chosen to develop a practice guideline 'Delirium in elderly people'. It is likely that many general practitioners are only partly familiar with delirium in elderly people because the prevalence of delirium in general practice is low. Therefore, one of the objectives of the practice guideline should be to improve the diagnostic process. However, several diagnostic issues merit further attention. For example, the guideline does not contain a diagnostic algorithm and the description of the clinical presentation of a delirium is brief. In addition, the guideline lacks a clear overview of the most important risk factors for a delirium as well as a careful description of the difference between delirium and dementia.
Despite a widespread application of computer technologies in medicine, there is currently a lack of diagnostic computer programs, meeting neurological needs. Most of the existing programs depend on some subjective factors. The authors propose their own computer program named "indicated diagnosis", and demonstrate its potential for diagnosis of peripheral monoparesis. Indicated diagnosis included testing and structuring of clinical and anatomical traits, along with the data of instrumental examination of the patients, ranging from patients complaints to establishing topic and nosologic diagnosis. Indicated diagnostics algorithm may be used for measuring of the lesions of nerves, plexuses, terminals and spinal cord segments involved in limb innervation.
Basing on the results of a combined clinical and laboratory examination of 193 children treated in the Research Institute of Urology in 1992-1999, the authors studied causes underlying intermittent vesicoureteral reflux (IVR) in correlation with anatomo-functional changes in vesicoureteral anastomosis and severity of inflammation in the urinary bladder. They suggest a diagnostic algorithm of detecting IVR with assessment of gas cystography role in the diagnosis; give definition of IVR; describe therapeutic policy in accordance with functional state of the affected kidney and cause of IVR onset; analyse short- (6-12 months) and long-term (12-36 months) treatment results; outline methods of IVR prophylaxis to save and improve renal function.
OBJECTIVE: To discuss a comprehensive diagnostic approach to an active duty patient presenting with dyspnea on exertion, fatigue, and pallor. A 50-year-old active duty E-6 white male in Al Udeid, Qatar, presented with progressive dyspnea on exertion, fatigue, and new pallor. This case illustrates the course of events from Al Udeid to the Walter Reed Army Medical Center, where the final diagnosis was made. Along the way, questions with discussions explore the various diagnostic and management aspects of his case and highlight military relevant issues that include efficient diagnostic algorithms in the field and transfusion of scarce blood products.
The diagnosis of osteomyelitis in the presence of fracture and orthopedic appliances and in the diabetic foot can be a formidable challenge to radionuclide imaging. Radiophosphate is highly sensitive in detecting bone disease, but of low specificity; to improve specificity it must be complemented by 67Ga or radiolabeled leukocytes. These latter agents are not without limitations, and the search for new agents and novel imaging strategies continues. The relative roles of nuclear medicine and MR imaging are coming into focus, and a diagnostic algorithm based on the shortcomings of both methods is suggested.
Sick sinus syndrome is characterized by disturbance of its automatic function and (or) sinu-atrial conductivity caused by organic or vegetative defects. Diagnostic algorithm includes: clinical evidence, ECG, Holter monitoring, electrophysiological investigation, pharmacological test. Treatment is pharmacological and surgical.
BACKGROUND: Autosomal recessive polycystic kidney disease (ARPKD) is a genetic disorder inherited in a recessive manner. The ARPKD gene is located on chromosome 6. The disease is characterised by specific changes in the kidney and liver. AIM: To make a review of modern achievements in studying the clinical, genetic and diagnostic problems concerning ARPKD and contribute an illustrative case. RESULTS: We reviewed modern research on the molecular genetics of autosomal recessive polycystic kidney disease related to PKHD1 gene located on chromosome 6p21-cen, as well as on the role of fibrocystin in the terminal differentiation of the collecting and biliary ductules. The clinical manifestations of the disease in infancy and in early childhood are analysed. A diagnostic algorithm is proposed incorporating both clinical and genetic methods. The illustrative case we reported of a 22-year-old patient with ARPKD supports the view that the disease occurs, though rarely, later than in childhood. CONCLUSION: The authors recommend that in cases with late manifestation of the disease in adolescence with chronic renal failure, possibilities be searched for extracorporeal replacement (renal transplantation) when this is allowed by the complications associated with the congenital liver fibrosis.
The authors developed a table differential-diagnostic algorithm designed for improvement of the differential diagnosis of pulmonary tuberculosis and cancer. This algorithm allows to establish precise diagnosis of cancer or tuberculosis of the lungs at district and regional health service levels, enhances the time of diagnosis and favours rational treatment.
The main purpose of the authors is to present their view of a place of present-day ultrasonography in the diagnosis of acute small and large intestinal obstruction. A comparatively sizable material covering 218 verified cases of acute ileus, including 77 patients with large intestinal obstruction and 141 patients with impaired passage of the intestinal contents along the small bowel was used to outline the aspects of ultrasound techniques and the symptomatology of ileus, by differentiating its some types. Along with the general assessment of the methodological and semiotic aspects of ultrasound diagnosis of acute uleus, the authors emphasizes a role of sonography in the detection of large intestinal obstruction by outlining their modified procedure of ultrasound irrigoscopy. For greater objectivization of their positive assessment of the place of ultrasound in the diagnosis of acute ileus and large intestinal obstruction, the authors comparatively studied X-ray and ultrasound studies to reveal this pathology. In addition to their purely personal assessment of a role of ultrasound in the diagnosis of large intestinal obstruction, the lecture also shows its authors' opinion as to the organizational issues associated with the necessity of correcting the existing diagnostic algorithm to detect large intestinal obstruction.
The observation of a patient with a malignant tumor of the prostate initially classified as adenocarcinoma with desmoplasia, reclassified as adenocarcinoma with a malignant spindle cell component of uncertain cell line following two large tumor recurrences over a period of 4 months, and subsequently as carcinosarcoma with heterologous mesenchymal areas has prompted us to review the 11 reported cases of prostatic carcinosarcoma and the diagnostic algorithm of the proliferative processes of the prostate with elongated cells in order to recognize (from the histological features and the inclusion and exclusion immunophenotypes) the pseudosarcomatous stromal reactions, fusicellular changes of the carcinoma, benign and malignant phyllodes tumors and carcinosarcoma.
BACKGROUND: Magnetic resonance cholangiopancreaticography (MRCP) is based on heavily weighted T2 sequences (ETSE--echo-train spin echo) with suppression of fat, giving visualisation of slowly flowing or stagnating fluid. MRCP are short sequences in coronary plane with thickness of 8 cm or 4 mm. Retrospective analysis of all MRCP examinations performed during last 12 months is presented. METHODS AND RESULTS: Eighty-eight examinations were done, of which 67 ones with both adequate technical quality and clinical indication were included into the study (20 males aged 25-83 years, 47 women aged 19-82 years). Patients were divided into 4 groups regarding to the indications (group I.--temporary cholestasis, normal abdominal ultrasound, II.--definite cholestasis, III.--pathologic findings on pancreas, IV.--other). Vast majority of patients were included into group I (35 subjects). In 7 (20%) of them choledocholithiasis and/or stenoses (including multiple stenoses in primary sclerotizing cholangoitis) were found. MRCP brought diagnostic information in subjects with cholestasis (group II.) and answered questions given by clinicians. However, in 1 of 4 subjects with primary sclerotizing cholangoitis, MRCP did not reveal intra-hepatic stenoses, which were later visualised by classical ERCP. Only the extrahepatic stenoses were diagnosed by MRCP in the latter subject. CONCLUSIONS: MRCP should become a standard examination in the diagnostic algorithm in patients with cholangiopathies. MRCP has its value not only in subjects with unsuccessful or contraindicated ERCP, but also in subjects with temporary cholestasis with negative ultrasound finding.
In a study on 51 patients with histologically confirmed soft tissue tumors (STT), we retrospectively evaluated the preoperative use of imaging procedures (MRI, CT, ultrasound, angiography, plain film) for identification of tumor size, delineation, and determination of malignancy and tissue type. The findings were correlated with intraoperative findings and histological diagnosis. The overall diagnostic method of choice for preoperative imaging of STT is MRI, followed by CT. Ultrasound, although sensitive, lacks the required specificity. Angiography and plain film can only be used for specific indications, as they generally do not make it possible to stage the tumor. Combining our results with those from the more recent literature, we propose a diagnostic algorithm according to which MRI would generally be performed for preoperative staging of STT. CT and plain film should only be used if bony infiltration is suspected; angiography is indicated for planning intraarterial chemotherapy or embolization or if vascular infiltration is probable.
Careful HRCT evaluation of the preferential distribution of micronodular lesions within the secondary lobule provides a fundamental contribution in the correct interpretation of the different associated patterns. This paper suggests a modern diagnostic algorithm that, together with clinical-anamnestic data and additional imaging features, is able to provide a definitive diagnosis or to reduce the possible differential diagnoses.
Allergic rhinitis and bronchial asthma are characterized by an Ig-E-mediated allergic reaction of the upper and lower airways. The Hungarian and international epidemiological data show significant increase of prevalence of these diseases with a relevant increase of the cost producing a relevant socioeconomic problem. Authors present the frequent inhalative allergens, summarize diagnostical algorithms and therapy based on international therapeutic guidelines.
Dr Ivan Illich, the devoted fighter for the elimination of the various complications of modern medicine, died last year. This caused us to re-read and to remind the readers about the various ingredients of this iatrogenic phenomenon: polyphragmasia, the false diagnosis of "non-diseases", over-activity and over confidence of the medical establishment, non-adherence to logical work-up of diagnostic algorithm, etc. Although medicine has progressed immensely, we often encounter the various maladies of modern medicine. In rehabilitation medicine practice, we also often face a few more aspects of this subject.
Results of treatment of 3372 patients with acute pancreatitis for the period from 1990 to 2002 are analyzed. The authors have developed a medico-diagnostic algorithm for acute pancreatitis. The introduction of it into clinics allowed the general lethality from acute pancreatitis to be reduced to 2.9% for 11 years.