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PubMed1975

[Study of interventricular septal defects with equal aortic and pulmonary artery pressures. Classification by clinical and computer methods of 70 cases].

Application of various methods of classification to a group of 70 cases of ventricular septal defect with high pulmonary artery hypertension allowed a comparative study between the various methods aiming at distinguishing the forms with low from high pulmonary artery resistance. The reference clinical classification provides supplementary informations derived from the natural or post-operative course and eventually from the microscopic examination. The first automatic classification relies on the study of a single criterion: the pulmonary arteriolar resistance and the systemic resistance ratio. A second classification is based on the attribution of points to some clinical or haemodynamic signs resulting in a score orienting the classification of every individual. Multifactorial analysis methods deal with all the available informations for the overall group, and suppose the use of a computer. The informatic methods make it possible to study the classifying value of every sign. Correlations were established between these various techniques and the medical classification.

Adolescent↗
PubMed1993

[Functional classification of cardiac insufficiency].

Several systems have been proposed for assessing the degree of functional impairment of chronic cardiac failure in order to be able to compare patients and to appreciate progression of the condition in individual patients. The NYHA classification is subjective, not very reproducible, and does not provide a good prediction of exercise capacity. The Canadian classification is not much better. Feinstein's classification is too complex, impractical and has never been validated. The specific activity scale proposed by Goldman indicates the degree of functional incapacity by comparison with activities of everyday life selected for their variability and classified according to the effort required to perform them. This classification has a good reproducibility and correlates well with exercise stress testing (exercise duration, VO2 max). However, it is not particularly well suited to the French population. The examples are not very precise; in addition, contradictions are possible, making it difficult to classify some patients. The authors propose a specific activity scale adapted for French patients. This classification was studied in 45 patients with chronic primary dilated cardiomyopathy. It was reproducible and correlated well with peak VO2. The progressive design of the symptom questionnaire avoids contradiction. This classification could be useful both in everyday practice and for multicentre research studies.

Activities of Daily Living↗
PubMed1995

Histological classification of the neoplastic changes arising in ulcerative colitis: a new proposal in Japan.

Patients with total ulcerative colitis with a longstanding course of the disease have a high risk of developing colorectal carcinoma. Colonoscopic surveillance to detect precancerous tissue and/or cancer in these patients has been carried out in countries with a high incidence of ulcerative colitis. Riddell's classification has been widely used for the interpretation of biopsy specimens obtained from the colonoscopic surveillance. In Japan, however, there are problems in accepting Riddell's classification, mainly because the intramucosal carcinomas diagnosed by Japanese histopathologists are included in the category of high-grade dysplasia in Riddell's classification. Based on the results of a meticulous slide review carried out by seven histopathologists in this study, a new classification is proposed: UC-I, inflammatory change; UC-II, indefinite; UC-IIa, probably inflammatory; UC-IIb, probably neoplastic; UC-III, neoplastic but not carcinomatous; and UC-IV, carcinoma. Intramucosal carcinomas is included in the category UC-IV. We consider that the diagnosis of intramucosal carcinoma is to be made when there is a high grade of cytological and structural atypia consistent with carcinoma. Interobserver and intraobserver variability with this classification was acceptable. We believe this new classification will be widely use in cancer surveillance in ulcerative colitis in Japan.

Biopsy↗
PubMed1995

[Clinical diagnosis in sleep laboratory patients based on ICD-10, DSM-III-R and ICSD classification criteria].

For the diagnosis of sleep disorders, 3 different standardized classification systems are available: the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R/DSM-IV) and the International Classification of Sleep Disorders (ICSD). These 3 classification schemata were comparatively evaluated in 50 sleep-disturbed patients who were admitted within 1 year to a non-specialized sleep laboratory for diagnostic evaluation and treatment. 17 female and 33 male sleep-disturbed patients, aged 54 +/- 12 years, were recorded polysomnographically in 3 subsequent nights (adaptation night, baseline/diagnosis night, treatment night) for measuring objective sleep quality. The subjective sleep quality as well as the subjective and objective awakening quality was assessed by means of rating scales, as well as psychometric and psychophysiological test battery. During the day, EEG, EEG-mapping, psychodiagnostic tests as well as, in many cases, pulmonary function, otolaryngological, CT, MRT and pharyngometric investigations were carried out. Psychic disorders were the leading cause for sleep problems in all 3 classification systems. Based on the ICD-10, the most frequent diagnosis was non-organic insomnia (46%), followed by sleep apnea (18%) and other organic sleep disorders (14%). Based on the DSM-III-R, 46% of the patients were diagnosed as insomnias based on another mental disorder, 38% as organic hypersomnias and 14% as parasomnias. Based on the ICSD Classification, sleep disorders associated with anxiety disorders were leading (30%), followed by sleep disorders based on affective disorders (16%), obstructive snoring (14%), primary snoring (8%) and sleep disorders based on neurological disorders (6%). While the broader ICD-10 and DSM-III-R diagnoses are syndrome-etiologically oriented and may be easily utilized by the practicing physician, the more narrowly defined, extensive, pathogenetically oriented polysomnographic features including ICSD diagnoses are suited better for the specialist.

Adult↗
PubMed1977

An intregrated medical record and data system for primary care. Part 2: classifications of health problems for use by family physicians.

Health problems encountered in the ambulatory setting differ from those of hospitalized individuals. For that reason disease classifications of morbidity devised for inpatient categorization are not totally applicable in the ambulatory setting. Numerous classification systems have been devised to overcome this discrepancy and have enjoyed varying levels of success. The International Classification of Health Problems in Primary Care (ICHPPC) is one of the more useful for family physicians and other primary care physicians. Its hierarchical structure and compatibility with the International Classification of Diseases (ICD) permits comparative use. The history, characteristics, and uses of ICHPPC are discussed as are those of additional classification systems recently developed for other purposes. One of these, a classification of performed procedures, may be used in conjunction with ICHPPC to provide a useful record for the provider as well as facilitating the referral of health-care information to third-party payors.

Ambulatory Care↗
PubMed1996

Comparison between the Japanese general rules and the TNM system in the regional lymph node classification of carcinoma of the colon.

BACKGROUND: Metastasis to regional lymph nodes from carcinoma of the colon is an important prognostic factor. In the tumor, node, metastasis classification, node metastases are classified into four grades based on the number and distribution of metastatic nodes. In the Japanese General Rules for Clinical and Pathological Studies on Cancers of the Colon, Rectum and Anus, node metastases are classified into four grades based solely on the distribution of metastatic nodes. STUDY DESIGN: Based on the findings of node metastases in 152 patients with carcinoma of the colon obtained by the clearing method, the node classifications by the Japanese General Rules and tumor, node, metastasis classifications were compared. RESULTS: The case distribution by the Japanese General Rules grading was 38.2 percent in n(-), 30.3 percent in n1(+), 19.7 percent in n2(+), and 11.8 percent in n3(+) disease. In the tumor, node, metastasis classification, the distribution was 22.4 percent in pN1 and pN3 and 17.1 percent in pN2 disease. The five-year survival rate by the Japanese General Rules was 97.9 percent in n(-), 72.6 percent in n1(+), 51.2 percent in n2(+), and 30.0 percent in n3(+) disease, whereas in tumor, node, metastasis classification, this rate was 79.4 percent in pN1, 45.2 percent in pN2, and 44.8 percent in pN3 disease. CONCLUSIONS: In the classification of regional node metastases from carcinoma of the colon, the Japanese General Rules showed a wider range in distribution and 5-year survival rate compared with the tumor, node, metastasis system.

Colonic Neoplasms↗
PubMed1997

[Surgical classification of liver local lesions].

There is a variety of liver focal lesions (LFL) and every clinical case should be considered carefully in deciding the problem of indications to surgical treatment. The existing classifications, including the TNM classification, are limited by the peculiar features of liver anatomy. The authors propose an original surgical classification of LFL that combines TNM principles and segmental characteristics of volume of lesion. The classification takes into account intraorganic and extraorganic location of LFL, and marks it by special letter indices. The indication of nosology of LFL in combination with letter and a B digital indices provides the universality of classification. The authors recommend to use the classification in evaluation of malignant and benign liver lesions, as well as alveococcosis and liver trauma.

Humans↗
PubMed1997

[Classification of pesticides according to carcinogenicity to man].

A classification of pesticides according to their carcinogenic hazard is presented. It is part of a more comprehensive classification of toxic, mutagenic and other pesticides. All the agents are divided into four classes: extremely hazardous, hazardous, moderately hazardous and slightly hazardous. Class I corresponds to Group 1 of the classification of the International Agency for Research on Cancer (IARC)-the agent confirmed as hazardous to humans. Class 2 (hazardous agents) is subdivided into three subclasses (2A, 2B and 2C) to ensure a more differentiated approach to evaluation of pesticides; the corresponding group of the classification is divided into two groups. Like group 3 of the IARC classification, class 3 (moderately hazardous agents) covers substances with limited evidence of carcinogenicity to animals. Unlike the IARC classification, it does not include unclassifiable agents which are not subject to consideration when pesticides are submitted for registration. Another distinction from the IARC group 3 is the inclusion of agents on sufficient evidence of their carcinogenicity but obtained with maximum tolerated dose only. Regulatory actions to be taken depending upon the class of hazard are discussed.

Carcinogens↗
PubMed1997

Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy.

OBJECTIVES: To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS: To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES: 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE: Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and classification, as well as documents on diagnosis and classification from authorities in the United States, Europe and Australia and from special interest groups. VALUES: High priority was given to the principle of preventing adverse maternal and neonatal outcomes through the provision of diagnostic criteria for severity and prognosis and through dissemination of reliable and pertinent information and research results using a common language. BENEFITS, HARMS AND COST: Higher degree of vigilance in diagnosing hypertensive disorders in pregnancy, allowing for earlier assessment and intervention, and more efficient dissemination of comparative information through common language. No harm or added cost is perceived at this time. RECOMMENDATIONS: (1) A diastolic blood pressure of 90 mm Hg or more should be the criterion for a diagnosis of hypertension in pregnancy and should trigger investigation and management. Except for very high diastolic readings (110 mm Hg or more), all diastolic readings of 90 mm Hg or more should be confirmed after 4 hours. (2) A regularly calibrated mercury sphygmomanometer, with an appropriate-sized cuff, is the instrument of choice. A rest period of 10 minutes should be allowed before taking the blood pressure. The woman should be sitting upright and the cuff positioned at the level of the heart. (3) Both Korotkoff phase IV and V sounds should be recorded, but the phase IV sound should be used for initiating clinical investigation and management. (4) A urine protein level of more than 0.3 g/d should be the criterion for a diagnosis of proteinuria; 24-hour urine collection should be the standard method for determining proteinuria. (5) Edema and weight gain should not be used as diagnostic criteria. (6) Hypertensive disorders diagnosed during pregnancy should be classified as pre-existing hypertension; gestational hypertension with or without proteinuria; pre-existing hypertension with superimposed gestational hypertension with proteinuria; and unclassifiable antenatally but final classification 42 days after delivery. VALIDATION: Except for expert opinions and reviews solicited for this project, these recommendations need to be field tested and validated in Canada. Guidelines endorsed by the Canadian Hypertension Society and the Society of Obstetricians and Gynaecologists of Canada.

Blood Pressure Determination↗
PubMed1997

Classification and grading of chronic venous disease in the lower limbs. A consensus statement. Ad Hoc Committee, American Venous Forum.

Advances in modern technology have made available a large number of both invasive and non-invasive investigations that can provide information not only on the presence, absence or anatomic extent but also quantitation of the abnormalities. It was soon realised that the combinations of presence, absence, extent and severity of reflux and/or obstruction in the deep, superficial or perforating veins are so large that the classification of chronic venous disease would be a major challenge. This challenge has been taken up by the Consensus Committee which met in Maui on 22-26 February 1995. The Consensus that developed is in three parts. Part I deals with a classification system that covers the Clinical picture, the Etiology, the Anatomic distribution and the Pathophysiology (the CEAP Classification). Part II suggests a scoring system intended to be evaluated on patients classified according to the CEAP classification, and Part III provides guidelines on the use of various investigations which according to the current medical literature will aid in the classification. The Consensus Committee has retained the copyright of the document so that it can be made available for reproduction to all interested parties. Reproduction is free provided there is no alteration and it is always reproduced in its entirety. The development of this consensus document is a continuous process. Suggestions for improvement are expected from all involved in the study and management of patients with chronic venous disease. The classification has already been presented and debated at several national and international meetings and plans for an updated version are already in progress.

Chronic Disease↗
PubMed1997

Medical classification systems in Canada: moving toward the year 2000.

The use of different standards for coding diagnoses and procedures has been identified as a major obstacle to the collection and analysis of data across the various jurisdictions in Canada. In this article the authors briefly describe the current and future situation of medical classification systems in Canada and discuss some of the potential benefits and implications of adopting the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and a revised procedure classification, the Canadian Classification of Health Interventions, as national standards for classification systems in Canada. They further describe some of the key features of the proposed new classification systems and highlight some of the actions being taken by the Canadian Institute for Health Information to support implementation of these standards in Canada over the next few years.

Canada↗
PubMed1998

[The TNM classification of cancer--from the viewpoint of pathology].

The 5th international TNM classification (proposed in 1997) is an anatomical classification of cancers used all over the world. In Japan, various kinds of Japanese classification of cancers have widely been accepted since 1962. Researchers may be confounded at international cancer conferences because of some differences in these classification. We here summarize the history and criteria of the present TNM classification and describe the concept of new N factors additional and in the 5th edition. In the Japanese versions of cancer classification, the concepts of H and P factors should be reconsidered. The importance of the cytologic diagnosis in ascites is discussed and pathological grades of differentiation into the new cancer staging are introduced.

Humans↗
PubMed1998

[Case report of the right-sided aortic arch (N-type): new classification based on macroscopic observations].

We report on a case with unusual origin of the left subclavian artery, so-called N-type found in a 62-year-old Japanese male in 1995. We took the opportunity in proposing for a new classification based on macroscopic observations. In the present observation, the following arteries branched off from the aortic arch in the order of the left common carotid, the right common carotid, the right subclavian and the left subclavian arteries. There was an aortic diverticum between the left subclavian artery and the dissending aorta. The left subclavian artery passed between the esophagus and the thoracic vertebrae. The arterial ligament connected the left pulmonary artery with the aortic diverticulum of the left subclavian artery. According to our observations, the arch of the aorta, descending aorta, aortic diverticulum of the left subclavian artery, arterial ligament and pulmonary artery joined to foam an incomplete vascular ring around the trachea and esophagus. This case can be classified into the N-type according to classifications by Adachi (1928), Williams (1932, 1935) and Nakagawa (1939). This may be the 22nd report in Japan regarding this kind of combined variations. Our classification also includes those by Takemura (1990) and Edwards (1964). An explanation of the new classification is described below and is also shown in Fig. 3. Abbreviations for classification types have been arranged in the order of the relation to the esophagus, the mirror-image subtyping of the Takemura's classification and the location of the arterial ligament. For example, type Na1 (present case) represents the left subclavian artery passing behind the esophagus, mirror-image to the Takemura's G-type, and left arterial ligament.

Aorta, Thoracic↗
PubMed1998

[Diagnostic capabilities of a classification program of the Heidelberg retina tomograph for early glaucomatous changes].

We investigated the diagnostic capabilities of a new glaucoma diagnostic softwave (classification program) of the Heidelberg retina tomograph for early glaucoma. Thirty eyes of 30 patients with early glaucoma (average visual field mean deviation = -3.7 dB) and 30 eyes of 30 normal subjects were enrolled. The criterion for early glaucomatous change was a visual field defect appearing earlier than Aulhorn classification stage II without considering the disc configuration. The diagnostic ability of three glaucoma specialists for the same eyes was evaluated using the Heidelberg retina tomograph analysis map. The agreement of two or three glaucoma specialists was accepted as the final judgment. Sensitivity, specificity, and diagnostic precision were calculated for all evaluations. The agreement between the classification program and glaucoma specialists was calculated with kappa statistics. Sensitivity, specificity, and diagnostic precision of the classification program were 80%, 83% and 82%, respectively. Those of the by glaucoma specialists were 83%, 90% and 87%, respectively. The agreement between the classification program and glaucoma specialists was excellent (kappa 0.73, % agreement 86.7%). The classification program will aid the diagnosis of early glaucomatous damage with high sensitivity and specificity.

Adult↗
PubMedDate not supplied

Correlation of Braunwald's clinical classification of unstable angina pectoris with angiographic extent of disease, lesion morphology and intra-luminal thrombus.

One hundred consecutive patients (81 male and 19 female) with unstable angina pectoris undergoing coronary angiography were divided according to Braunwald's clinical classification. Seventeen (17%) patients had new onset angina (class I), 68 (68%) sub-acute angina (class II) and 15 (15%) had acute rest angina (class III). Twenty-seven (27%) patients had secondary unstable angina pectoris (class A), 49 (49%) primary unstable angina (class B) and 24 (24%) had post-infarction unstable angina (class C). ST-T wave changes on ECG were present in 54 (54%) while absent in 46 (46%) patients. On coronary angiography, 26 (26%) patients had single vessel disease, 30 (30%) double vessel disease and 39 (39%) patients had triple vessel disease. Five (5%) patients were found to have normal coronaries. Classification of patients according to Braunwald's clinical classification showed single vessel disease to be higher in class I as compared to class II (47% vs 22%; p = 0.04) and classes III (47% vs 20%; p<0.01). Single vessel disease was found to be higher in class C as compared to class B (41.7% vs 16.4; p = 0.01). Double vessel disease was higher in class B as compared to class A (40.8% vs 18.5%, p = 0.04). Triple vessel disease incidence was not found to be significantly different among different clinical classes. Morphology of coronary artery lesions was classified according to Ambrose's classification. Out of the total of 248 lesions in the whole study group, there were 68 (27.42%) concentric lesions, 55 (22.18%) eccentric type I lesions, 23 (9.27%) eccentric type II lesions, 42 (16.94%) multiple irregularity lesions and 60 (24.19%) totally occluded lesions. Concentric lesions were found to be higher in class C as compared to class B (40% vs 19.8%; p = 0.014). Statistically significant difference was not present in the distribution of other morphological type of lesions among different clinical classes. In the whole study group, intra-luminal thrombus was found to be present in 17 (17%) of patients. Distribution of intra-luminal thrombus according to Braunwald's classification showed that none of the patients in class I had intra-luminal thrombus, while 13 (19.1%) patients in class II and 4(26.7%) in class III had intra-luminal thrombus. The difference in the occurrence of intra-luminal thrombus between class I and class II (p = 0.004) and class I and class III (p = 0 .03 was found to be significant. Thus, majority of patients undergoing coronary angiography had primary sub-acute rest angina. Single vessel disease was higher in new onset angina. Patients with unstable angina pectoris and ST-T changes on ECG had higher number of lesions per patient and higher eccentric type I lesions. Intra-luminal thrombus was more frequently encountered with acute rest angina. However, the distribution of different morphological type of lesions on coronary angiography did not differ significantly in different clinical classes of unstable angina pectoris divided according to Braunwald's classification.

Adult↗
PubMed2000

Classification of advanced colorectal carcinomas by tumor edge morphology: evidence for different pathogenesis and significance of polypoid and nonpolypoid tumors.

BACKGROUND: Increasing evidence suggests that a substantial proportion of colorectal carcinomas develop without a preexisting polypoid adenomatous lesion, but it is difficult to detect the possible origin of advanced carcinomas. The purpose of this study was to test the validity and significance of a new histopathologic classification system based on the histologic analysis of the tumor edge. METHODS: One hundred eighty-six unselected cases of colorectal carcinoma were included. A new classification method to distinguish polypoid and nonpolypoid growth type was based on the presence or absence of elevation of tumor as compared with adjacent mucosa. Inter- and intraobserver agreement of classification was tested. Association with other clinicopathologic features including histopathologic characteristics of the tumors, presence or absence of lesional and concurrent adenoma, K-ras mutations, and prognosis was evaluated. RESULTS: Classification could be made in 75% of the tumors, and 25% were unclassifiable, mostly due to absence of tumor margin in sections. Of the classifiable carcinomas, 45% were classified as polypoid, of which 52% had lesional adenoma. Nonpolypoid tumors formed 48% of classifiable cases, and only 2% had lesional adenoma. Features of both polypoid and nonpolypoid carcinomas were present in 7% of cases. Concurrent extralesional adenomas were found more frequently in association with polypoid carcinomas. K-ras mutations were more common in polypoid (43%) than in nonpolypoid tumors (8%; P = 0.018). Nonpolypoid carcinomas were significantly (P = 0.03) more aggressive than polypoid carcinoma, with 38% and 20% recurrence rates, respectively. CONCLUSIONS: The authors' results indicate that advanced colorectal carcinomas can be classified according to growth pattern by observing the tumor edge. This classification has prognostic significance because nonpolypoid carcinomas appeared to have a worse prognosis than polypoid ones.

Adenoma↗
PubMed2002

Hepatoblastoma: assessment of criteria for histologic classification.

BACKGROUND: Comparison of outcomes in different clinicopathologic studies of hepatoblastoma requires reproducible histologic classification. This review examines the diagnostic criteria employed by different pathologists for the classification of subtypes of hepatoblastoma and identifies specific problem areas. PROCEDURE: A selected review of published literature is provided. RESULTS: Published studies demonstrate that uniform criteria have not been applied in the classification of hepatoblastoma. These discrepancies hinder attempts to compare outcome data from different studies. Sampling error and potential treatment effects further complicate analysis of the published literature on the relationship between morphologic classification and outcome. CONCLUSIONS: Standardized criteria are essential to allow reproducible histologic classification of hepatoblastoma. There is significant variation in diagnostic criteria used to define the major subtypes of hepatoblastoma in published studies. Additional potential problems are identified in sampling methods and treatment effects.

Child↗
PubMed1999

A quadratic discriminant analysis of protein structure classification based on the Helix/Strand content.

Based on the 210 non-homologous proteins (domains) classified manually by Michie et al. (J. Mol. Biol. 262, 168-185, 1996), a new structure classification criterion of globular proteins relying on the content of helix/strand has been proposed, using a quadratic discriminant method. Each protein is classified into one of the three classes, i.e. those of alpha class, beta class and alphabeta class (including alpha/beta and alpha+beta classes). According to the new structure classification criterion, of the 210 proteins in the training set, 207 are correctly classified and thus the accuracy is 207/210=98.57%. Multiple cross-validation tests are performed. The jackknife test shows that of the 210 proteins 207 are correctly classified with an accuracy of 98.57%. To test the method further, of 3577 proteins (domains) extracted from SCOP, 91.39% of them are correctly reclassified by the new classification criterion. On average, the accuracy of the new criterion is about 8 percentage points higher than that of the criterion proposed by Nakashima et al. (J. Biochem. 99, 153-162, 1986). Our result shows that the classification based solely on structures is basically consistent with that combining both structural and evolutionary information. Further complete automated classification scheme should consider both structures and evolutionary relationship. The methodology presented provides an appropriate mathematical format to reach this goal.

Animals↗