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PubMed2004

[Laparoscopy and puncture biopsy in diagnosis of focal lesions of the liver].

Based on the results of examination of 208 patients with different tumors of the liver it is concluded that in the majority of cases it is possible to avoid puncture biopsy of the liver and laparoscopy for diagnosis of focal lesion of the liver (FLL) before surgery because these invasive procedures don't improve efficacy of diagnosis. On the contrary it may lead to complications including implantation metastases (3.33%). Correct appliance of modern diagnostic algorithms permits to increase efficacy of FLL diagnosis to 82.27% without invasive procedures.

Adolescent↗

PubMed2004

[Forty-year experience of surgical treatment of generalized myasthenia].

Forty-year experience with surgical treatment of generalized myasthenia (GM) based on 2977 cases is analyzed. Role of special methods of mediastinum examination (CT, MRT) is demonstrated, indications to thymectomy are validated. It is noted that developed diagnostic algorithm, surgical technique, management before and after surgery improved significantly immediate and long-term results. Development of clinical, immunological and morphologic criteria of thymectomy effect permitted to predict course of GM and to optimize complex therapy after surgical treatment.

History, 20th Century↗

PubMedDate not supplied

[Diagnostic approach in vesicular and bullous dermatoses].

Vesicular and bullous dermatoses are etiopathologically different dermatoses, whose basic manifestations are vesicles or bullae. There are hereditary and acquired vesicular and bullous dermatoses. The diagnosis is based on the anamnesis, dermatologic status and laboratory findings, which are presented in detail. The aim of this paper is to show a diagnostic algorithm for vesicular and bullous diseases of the skin and mucous membranes. Correct diagnosis is the precondition an adequate treatment in patients as well as for a better prognosis.

Algorithms↗

PubMed2003

[Postprandial hypotension and autonomic neuropathy in diabetic patients].

UNLABELLED: Postprandial hypotension is commonly defined as the decrease in systolic blood pressure of 20 mm Hg and more, observed within 2 hours after meal ingestion. This phenomenon was described in subjects with comprised function of autonomic nervous system. However, the data on its prevalence in diabetic patients are scarce. The aim of the study was to assess the concordance of postprandial hypotension and autonomic cardiovascular neuropathy in diabetes mellitus. The study included 67 patients (26 males, 41 females, mean age: 47.5 +/- 16.2 years) with diabetes type 1 or 2 (mean disease duration: 13.3 +/- 8.8 years), treated with diet and insulin injections. Postprandial hypotension was diagnosed based on results of automatic blood pressure recordings performed within 90 minutes after test meal ingestion. Tests of Ewing's battery were used to evaluate autonomic cardiovascular neuropathy. RESULTS: Mean postprandial decrease in systolic blood pressure of 17.7 +/- 11.7 mm Hg was noted at 48.0 +/- 13.7 min after meal ingestion. The study patients were divided into 2 groups based on results of systolic blood pressure recordings. In group A of 39 subjects (58.2%) the mean fall in systolic blood pressure of 8.9 +/- 4.4 mm Hg was observed. In group B of 28 (41.8%) subjects fulfilling the criteria of postprandial hypotension systolic blood pressure decreased after the meal of 30.0 +/- 6.2 mm Hg, the difference between groups was statistically significant (p < 0.001). Autonomic cardiovascular neuropathy was recognized in 41 (61.2%) of the study patients. The more advanced neuropathy was stated in group B (neuropathy scale score: group A--1.54 +/- 1.48 points, group B--5.11 +/- 1.93 points, p < 0.001). Statistically significant correlation between the magnitude of postprandial systolic blood pressure fall and cardiovascular neuropathy scale score was noted (Spearman's correlation co-efficient R: -0.612: p < 0.01). Postprandial blood pressure fall correlated significantly with orthostatic systolic blood pressure changes (correlation co-efficient R: 0.610; p < 0.001). CONCLUSIONS: Postprandial hypotension is an important symptom of diabetic cardiovascular neuropathy. It is recommended to include postprandial blood pressure measurements in diagnostic algorithm of autonomic nervous system dysfunction in diabetic patients.

Adult↗

PubMed1992

[The differential electrocardiographic diagnosis of dilated cardiomyopathy and ischemic heart disease (the data from precordial mapping)].

The authors suggest a new criterion for differential diagnosis according to the mapping of 35 ECG leads (PECG-35) in dilated cardiomyopathy (DCMP) and coronary heart disease (CHD). Analysis was made of 12 and 35 ECG leads in 120 patients. There were 60 cases of DCMP and 60 cases of CHD. According to the ECG-12 data the signs of focal cicatricial myocardial lesions were detectable in 34 cases of DCMP. According to echocardiography, the end diastolic size exceeded 5.9 cm in 23 CHD patients. The diagnostic algorithm was devised to distribute the patients into two groups. The algorithm consists in the following: 1) the sum of the areas of R waves is calculated in leads 6, 7, 13, 4, 20, 21 (+/- aR6-7I-IV parameter); 2) the sum of the areas of S waves is calculated in leads 22, 23, 24, 29, 30, 31 (sigma aS1-3V-VI parameter); 3) the parameter sigma aR6-7I-IV + sigma aS1-3V-VI is computed; 4) if sigma aR6-7I-IV + sigma aS1-3V-VI greater than 0.55 mB/s, the patient is diagnosed to have DCMP, if aR + aS less than 0.55 mB/s, the patient is diagnosed to have CHD. The sensitivity of the algorithm offered is 70-82%, with the specificity being 80%.

Adolescent↗

PubMed2003

Variability of spectra of laser-induced fluorescence of colonic mucosa: its significance for fluorescence detection of colonic neoplasia.

To determine the extent of a natural variability of the spectra of the autofluorescence and its significance for a reproducibility of different approaches typically used in studies on fluorescence detection of colonic lesions. Two independent series of experiments have been conducted during three years in the same laboratory. Macroscopic tissue specimens obtained during operations of patients with colonic cancers were studied in vitro. The tissues were excited using UV lines of c.w. He-Cd laser and pulsed nitrogen laser and the autofluorescence spectra were recorded for areas visually diagnosed as normal or pathologically changed mucosa. Natural variability of the autofluorescence spectra of colonic tissues seems to be most important factor limiting sensitivity and specificity of the diagnostic algorithms. The mean fluorescence spectra obtained for normal mucosa and its neoplastic lesions differ significantly but the differences are difficult to observe because of the high natural variability among the individual spectra. Further studies of biological basis of the colonic autofluorescence are necessary for a progress in the field of fluorescence detection of colonic neoplastic lesions.

Colon↗

PubMed2004

[Diabetes and celiac disease].

Celiac sprue is permanent lifelong intolerance of gluten which in some sensitive individuals leads to an inflammation of various grades followed by atrophy of jejunum mucosa. Diagnosis of celiac sprue is based on proof of histopathological changes in jejunum mucosa as a result of presence of gluten in food. In recent years, serum endogenous myosin and tissue transglutaminase antibodies were used in a diagnostic algorithm. We distinguish active, silent, latent, and potential celiac sprue. Simultaneous incidence of type I diabetes mellitus and celiac sprue has been documented in a range of studies. Both diseases have common immunology and genetic characters. Prevalence of celiac sprue in patients with type I diabetes is several times higher compared to prevalence of this disease in the population. There is the prevalence of celiac sprue 3.6-5.1% in children with type I diabetes mellitus in the Czech Republic, silent form of the disease is the most frequent one. An effect of a strict gluten free diet on a metabolic control of diabetes has not been proved. It is necessary to assess (at least once per two years) actively and on regular basis endogenous myosin and/or tissue transglutaminase antibodies in patients with type I diabetes.

Celiac Disease↗

PubMed1992

Clinical nuclear imaging techniques for the diagnosis and evaluation of acute myocardial infarction.

The use of nuclear imaging techniques allows the accurate detection of myocardial infarction, determination of the impact of infarction on ventricular performance, assessment of the myocardial salvage with thrombolysis, identification of preserved regional metabolism in jeopardized myocardial segments, and the elucidation of inducible reversible ischemia requiring aggressive therapeutic intervention. Assessment of myocardial salvage after thrombolysis or revascularization can be accomplished with serial perfusion imaging. Infarct-avid imaging with Tc-99m-PYP can be used to rapidly determine the size and location of the acute transmural myocardial infarction. In the future, however, the improved image quality and diagnostic accuracy of immunoscintigraphy with antimyosin antibodies may supplant PYP imaging. Studies of global ventricular function can be performed at rest, or with multiple interventions using portable scintigraphic devices. The measurement of the dynamic response of left ventricular ejection fraction over time shows promise for risk stratification. As yet, there has been no comprehensive comparison of the relative predictive value of metabolic imaging parameters, perfusion/antibody uptake mismatch, Tl-201 redistribution, or ejection fraction response data. Such a comparison could optimize the diagnostic algorithm for post-infarction damage assessment and risk stratification.

Coronary Disease↗

PubMed1992

Special problems in the older cancer patient: spinal cord compression and pleural effusions.

Spinal cord compression due to epidural metastases, and malignant pleural effusions are devastating complications of advanced cancer that can destroy the quality of a life that is already limited in quantity. Neither need do so. A diagnostic algorithm has been developed for each of these complications. Early diagnosis of cord compression can be accomplished by prompt myelography or magnetic resonance imaging of the affected area of the spine. A malignant pleural effusion, even one that initially appears cytologically negative, can be promptly diagnosed. Radiation and steroids are optimal therapy for most patients with cord compression, and few require surgery. Intrapleural bleomycin appears to be the most effective agent for pleurodesis.

Aging↗

PubMed2004

[Diagnosis and treatment policy in trauma of duodenum].

Experience of treatment of 70 patients aged from 17 to 71 years with trauma of duodenum (TD) was analyzed. Majority of them was men -- 57 (81.4%). Open TD were seen in 61.4% cases, closed -- in 38.6%. There were no pathognomonic symptoms. X-ray examination of abdominal cavity is the important procedure permitted to suspect TD. Diagnostic algorithm in abdominal trauma for exclusion of TD before surgery was developed. Yellow-green imbibition, mass of air vesicles in retro-abdominal space, hematomas in duodenal zone were the indications for revision of duodenum during surgery. Hematoma of duodenal wall was indication for it revision for exclusion of penetrating wound. In 55 (77.1%) patients with wounds penetrating into duodenum (or disruption of duodenum) suture of defects was performed. "Exclusion" of duodenum was performed in 20 (28.6%) patients when there was threat of sutures insufficiency. Lethal outcome was seen in 20 (28.6%) patients including 13 (18.6%) cases during first day due to combined injuries and massive blood loss. Developed algorithm and treatment policy permitted to improve results of this severe variant of abdominal trauma.

Adolescent↗

PubMed2004

[Differential diagnosis in cholestatic liver diseases].

Causes of cholestasis include disturbed bile flow out of the hepatocyte into the biliary capillaries, or obstruction (stone, tumor, inflammation) of small or larger intrahepatic or extrahepatic. In the event of acute or subacute onset, Cholestatic liver disease becomes manifest by its clinical presentation; in the case of a chronic course it tends to be an incidental finding based on liver parameters. For the differential diagnosis, the history (duration of symptoms, general symptoms, family history, drug history), clinical picture, laboratory investigations (alkaline phosphatase, g-GT, possibly specific autoantibodies) and imaging procedures (in particular ultrasonography and ERCP) point in the right direction. The present article provides an overview of the major differential diagnoses of intrahepatic and extrahepatic cholestasis. A diagnostic algorithm is presented.

Algorithms↗

PubMed2004

Clinical insights into the diagnosis and management of renovascular disease. An evidence-based review.

Renovascular disease is a common, but complex disorder, the most common causes of which are fibromuscular dysplasia and atherosclerosis. It usually presents in 1 of 3 forms: asymptomatic renal artery stenosis, renovascular hypertension, or ischemic nephropathy. The clinical index of suspicion remains paramount in developing an appropriate diagnostic strategy. Although subject to certain limitations, conventional contrast angiography is usually considered the gold standard in confirming the diagnosis. In addition, there are a number of available non-invasive tests that can aid in decision-making. These tests can be divided into those that detect the anatomic presence of a stenosis and those that identify the functional consequences of the renal artery obstruction. No one study is appropriate for every patient. Treatment options include medical, surgical or percutaneous approaches. Generally, in patients with fibromuscular disease the results of surgery and percutaneous approaches appear superior. In patients with atherosclerotic disease, the data are less consistent, and there does appear to be a group of patients who will respond well to medical management. Potential diagnostic algorithms for diagnosis and treatment are presented in this review.

Aged↗

PubMed2003

[Anorectal functional tests--essence and value].

Anorectal disturbances are one of the most frequent functional bowel disorders. A lot of motor- and sensor anorectal tests are available. At the same time in Bulgaria anorectal disorders are unknown for the most of the gastroenterologists and surgeons, and that's why they are misdiagnosed and not treated correct. The aim of our paper is to summarize the experience with these techniques in patients with anorectal disorders. We are giving the definition of fecal incontinence, constipation, levator ani syndrome and proctalgia fugas. We revue some aspects of anatomy and physiology of the anorectum. We introduce all anorectal functional tests, the place of the tests in diagnostic algorithm, and the real value of each single test to conform diagnosis of common syndromes.

Algorithms↗

PubMed2004

[Infection with Chlamydophila pneumoniae as a cause of female infertility of tubal origin?].

OBJECTIVE: A contribution to the role of Chlamydophila pneumoniae in women from the IVF program. DESIGN: A serological study proving the antibodies against the antigens of Chlamydophila pneumoniae (C. pneumoniae) and Chlamydia trachomatis (C. trachomatis) in women from the IVF program suffering from different factor of infertility. SETTING: Veterinary Research Institute, Brno. METHODS: The complement fixation test with chlamydial antigen and ELISA tests proving IgA and IgG antibodies against genus-specific antigen (cLPS) and species-specific chlamydial major outer membrane protein (cMOMP) of C. trachomatis and C. pneumoniae in the blood serum of 32 females being in the fertilization program due the tubal factor infertility have been estimated and the results compared with those obtained in 26 females being in the fertilization program due the ovarian factor and in 42 female with andrological factor, respectively. RESULTS: The frequency of positive complement fixation test proved in the group of women with tubal factor infertility was significantly higher than in the groups with ovarial and andrological factor, respectively. The number of the strongly positive reactions (with high titres) in the group with tubal factor infertility was higher than in two remaining groups. The occurrence of species-specific IgG antibodies (anti-C. trachomatis) and chlamydia genus-specific IgA antibodies proved by means of ELISA in the group with tubal factor was statistically more frequent. The difference of the species-specific anti-C. pneumoniae antibodies in all three groups examined was not significant. The simultaneous occurrence of species-specific antibodies against anti-C. pneumoniae and C. trachomatis in the group with tubal factor was higher than in other groups (in comparing with the group with andrological factor statistically significant). CONCLUSION: The opinion of the authors being in agreement with the view of most specialists is that the most important agent in the pathogenesis of tubal factor fertility is C. trachomatis. C. pneumoniae is above all a respiratory pathogen with a high prevalence and its impact for fertility disorders may be in the synergismus with C. trachomatis. The serological examination of both chlamydial infections should be a standard part of diagnostic algorithm.

Adolescent↗

PubMed2004

[Mamography and core biopsy value in diagnosis of nonpalpable breast tumors].

Nonpalpable breast tumors are of great importance in order to achieve early diagnosis and improve the treatment results of breast cancer. Three hundred and sixty six patients with such pathology were investigated at the Institute of Oncology, Vilnius University. The core biopsy was performed for all patients. Benign breast tumors were diagnosed to 260 patients and conservative treatment was administered to patients with benign breast disease. One hundred and six patients with diagnosed or suspected nonpalpable breast carcinoma underwent surgery. In 64 patients (63.7%) invasive or non-invasive breast carcinoma (0 and 1(st) stage - 71.9%) was diagnosed. The diagnostic algorithm of nonpalpable breast tumor was described. The techniques of surgery for nonpalpable breast tumors and the results of treatment are discussed.

Adult↗

PubMed2004

Vascular graft infection in aortoiliac and aortofemoral bypass surgery: clinical presentation, diagnostic strategies and results of surgical treatment.

OBJECTIVES: Evaluation of the prevalence, diagnostic procedures and clinical outcome of infections of aortoiliac and aortofemoral vascular grafts presented in our centre. DESIGN: Retrospective study. MATERIALS: All patients who underwent a surgical aortoiliac or aortofemoral revascularisation between 1991 and 2001. METHODS: Evaluation of several hospital databases. RESULTS: 32 cases of aortoiliac and aortofemoral vascular graft infection with varied clinical presentation were found. Enteral bleeding was the first clinical manifestation in 31% of the cases, inguinal swelling, wound, or fistula in 59% and fever or sepsis in 6.3%. In 3% the cause was unknown. The vast majority (84.5%) of the infections presented three or more months after surgery (late infections). In cases of enteral bleeding, endoscopy procedures only revealed the diagnosis in 55%. Diagnostic algorithms including an abdominal CT scan appeared to have a sensitivity of 94% for establishing an accurate diagnosis. Remarkably, no specific risk factors for graft infection could be demonstrated. Furthermore, a 30-day survival of 20% or less was observed in early graft infections, whereas late infections managed with extra-anatomical bypasses appeared to have a better survival rate of up to 70%. CONCLUSION: Endoscopy in cases of enteral bleeding and CT scanning overall were shown to be very useful for establishing the diagnosis. Clinical outcome and survival after treatment remain poor.

Aged↗

PubMed2004

[Treatment of arrhythmias and syncope in the elderly with heart failure].

A review of the huge literature on syncope and arrhythmias has been conducted with special regard to older subjects with heart failure. All the available data show that aging is a risk factor for syncope spells and that the risk is almost doubled in patients with heart failure. In older patients as well, syncope may be classified as non-cardiac, cardiac and unknown in origin and in the aging cardiac syncope has been clearly demonstrated to have a worse prognosis. Syncope, whatever the mechanism involved in, may hardly impair the quality of life. The diagnostic algorithm in spells of unknown origin is extensively discussed and the troubling problem related to vasovagal (and carotid sinus hypersensitivity) syncope and to iatrogenic episodes (very frequent in patients often treated with multiple drugs acting on pressure regulation) is highlighted. A review of the management options is performed with special emphasis on the difficulties due to the scarce relevance of the older groups in clinical trials regarding the treatment strategies of syncope and arrhythmias. Finally, the authors suggest a brief decision-making protocol extrapolated by their experience to manage these difficult clinical conditions.

Aged↗

PubMed2005

[The diagnosis of pulmonary embolism: the best strategies according to the results of a large Dutch multicentre study].

The Dutch national guidelines for the diagnosis of patients with clinically suspected pulmonary embolism (from 1992 en 1998) are poorly followed in clinical practice, due especially to practical objections. A large multicentre trial to investigate the diagnostic accuracy of the available modalities and of recently developed techniques such as D-dimer determination, (99m)Tc-gas-scintigraphy and spiral CT scanning was started in I997. In the first phase, the diagnostic value was assessed of: spiral CT (sensitivity 69%, specificity 84%; sensitivity for segmental and larger pulmonary embolisms (PE) 86% and for subsegmental PE 21%), (99m)Tc-gas-ventilation scintigraphy (no improvement compared to conventional ventilation scintigraphy), D-dimer determination (sensitivity for segmental PE 93% and for subsegmental PE 53%, specificity 63%), clinical decision rules (in combination with D-dimer determination; sensitivity 100%, specificity 11%) and echography of the deep venous system (sensitivity 26% for segmental PE and 7% for subsegmental PE, specificity 97%). In the second phase, the feasibility of two new potentially cost-effective diagnostic algorithms was evaluated on the basis of the results obtained in the first phase and data in the literature. In 631 patients, a clinical risk estimate was made and D-dimer determination was done, followed by a ventilation-perfusion scan and serial compression echography of the leg veins. An apparent recurrence of PE occurred in 6 of 466 patients in whom no PE had been found originally (1.3%; 95% CI: 0.5-2.8). The average costs were 812 Euro,--per patient. In 510 patients, a spiral CT followed by compression echography was performed. Recurrent PE occurred in 3 of 378 patients with initial normal tests (0.8%; 95% CI: 0.2-2.3). The average costs were 883 Euro,--per patient. A combination of both strategies can be cost-effective with a cost 674 Euro,--per patient (recurrence rate: 1.9%). Both the strategy starting with a clinical-risk estimate and a D-dimer determination as well as the strategy consisting of spiral CT and serial echography were safe and cost-effective. According to the results of a survey of hospital directors, internists and pulmonologists, both are well accepted in clinical practice.

Algorithms↗