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PubMed1996

Evaluation of preventive and health promotion activities in 166 primary care practices in Spain. The Coordinating Group For Prevention and Health Promotion in Primary Care in Spain.

BACKGROUND: Since January 1989 the Spanish Society of Family and Community Medicine has supported the Program of Prevention and Health Promotion (PAPPS) with the following objectives: to detect possible difficulties in the implementation of recommendations especially among asymptomatic low-risk adults and children in Spain, to disseminate those recommendations, and to encourage research in prevention and health promotion in primary care. OBJECTIVE: We wished to evaluate the implementation of PAPPS in primary care practices. METHODS: A retrospective audit of medical records in practices enrolled in the programme was carried out. From 166 primary care practices widely distributed in Spain 21,631 patients were selected using systematic sampling. RESULTS: Age was positively associated with correct performance in the adult population, while in the paediatric population it was negatively associated. Females had higher probability than males of having blood pressure measurement (OR 1.34, 95% CI 1.24-1.45) and smoking counselling (OR 1.38, 95% CI 1.33-1.43) correctly performed. Practices not using the preventive chart had a lower probability than user practices of correctly performing blood pressure measurement (OR 0.69, 95% CI 0.62-0.76), alcohol counselling (OR 0.66, 95% CI 0.60-0.73) and smoking counselling (OR 0.69, 95% CI 0.63-0.76). Non-teaching practices had a higher probability than teaching centres of correct performance of blood pressure measurement (OR 1.47, 95% CI 1.35 to 1.59), alcohol counselling (OR 1.67, 95% CI 1.54 to 1.79) and smoking counseling (OR 1.39, 95% CI 1.29 to 1.51). CONCLUSIONS: There is an unequal level of performance depending on the procedure and on the target population. A preventive chart might be useful in improving implementation of periodic health maintenance. Teaching centres with training physicians need to put more emphasis on prevention and health promotion activities.

Adolescent↗
PubMed2006

Accommodating unmodeled heterogeneity in double-observer distance sampling surveys.

Mark-recapture models applied to double-observer distance sampling data neglect the information on relative detectability of objects contained in the distribution of observed distances. A difference between the observed distribution and that predicted by the mark-recapture model is symptomatic of a failure of the assumption of zero correlation between detection probabilities implicit in the mark-recapture model. We develop a mark-recapture-based model that uses the observed distribution to relax this assumption to zero correlation at only one distance. We demonstrate its usefulness in coping with unmodeled heterogeneity using data from an aerial survey of crabeater seals in the Antarctic.

Animals↗
PubMed1998

Detection and typing of the virulence determinants cagA and vacA of Helicobacter pylori directly from biopsy DNA: are in vitro strains representative of in vivo strains?

BACKGROUND: The relationship of Helicobacter pylori genotypes to gastrointestinal disease has relied on cultured isolates. This assumes that cultured strains are representative of in vivo strains. OBJECTIVE: To detect and type the cagA status and the vacA genotypes directly from biopsy DNA without the need for culture, and to further define the relationship between H. pylori genotypes and gastroduodenal pathology. METHODS: Fifty-two Caucasian patients undergoing routine endoscopy for dyspepsia had additional biopsies taken from four gastric sites and one duodenal site for biopsy DNA preparation. An antral sample was taken for biopsy culture. All recruited patients were H. pylori-positive on rapid urease test for Campylobacter-like organisms (CLO test) and/or histology. By polymerase chain reaction (PCR), the cagA status and the vacA s and m types were detected directly from biopsy DNA. RESULTS: H. pylori isolates were cultured from 28/52 patients in whom infection was detected by PCR. Two isolate types differed from biopsy types. Fifty of the 52 patients, strains were typable from all four gastric sites and in 51/52 the same strain predominated throughout. The cancer strains were all cagA-positive/vacA s1 type. There was a correlation between cagA positivity and vacA s1 (41/43). There was no difference between the cagA-positive/vacA s1 strains and the presence or absence of ulcers. There were only 5/52 vacA s2 m2 and four were in the non-ulcer dyspeptic group. CONCLUSION: cagA status and the vacA genotyping was successful with tissue samples taken directly from gastric and duodenal biopsies. Discrepancies between isolate and biopsy strain types stress the need for caution when interpreting in vitro strain types and suggest that direct PCR of biopsies is the preferred typing technique. The cagA status and the s1 vacA allele are unreliable as single markers in determining the risk of developing peptic ulcer disease.

Antigens, Bacterial↗
PubMed2003

Automated enumeration of groups of marine picoplankton after fluorescence in situ hybridization.

We describe here an automated system for the counting of multiple samples of double-stained microbial cells on sections of membrane filters. The application integrates an epifluorescence microscope equipped with motorized z-axis drive, shutters, and filter wheels with a scanning stage, a digital camera, and image analysis software. The relative abundances of specific microbial taxa are quantified in samples of marine picoplankton, as detected by fluorescence in situ hybridization (FISH) and catalyzed reporter deposition. Pairs of microscopic images are automatically acquired from numerous positions at two wavelengths, and microbial cells with both general DNA and FISH staining are counted after object edge detection and signal-to-background ratio thresholding. Microscopic fields that are inappropriate for cell counting are automatically excluded prior to measurements. Two nested walk paths guide the device across a series of triangular preparations until a user-defined number of total cells has been analyzed per sample. A backup autofocusing routine at incident light allows automated refocusing between individual samples and can reestablish the focal plane after fatal focusing errors at epifluorescence illumination. The system was calibrated to produce relative abundances of FISH-stained cells in North Sea samples that were comparable to results obtained by manual evaluation. Up to 28 preparations could be analyzed within 4 h without operator interference. The device was subsequently applied for the counting of different microbial populations in incubation series of North Sea waters. Automated digital microscopy greatly facilitates the processing of numerous FISH-stained samples and might thus open new perspectives for bacterioplankton population ecology.

Automation↗
PubMed1995

Flow cytometric DNA analysis of ulcerative colitis using paraffin-embedded biopsy specimens: comparison with morphology and DNA analysis of fresh samples.

OBJECTIVES: The detection of aneuploidy in colonic mucosa by flow cytometric DNA analysis has been advocated as an indicator of high risk for ulcerative colitis (UC) patients developing colon carcinoma. To date, studies have primarily utilized fresh tissue and have had two limitations: a significant number of possible false-positive findings (aneuploidy in the absence of detectable dysplasia) that may be due to DNA degradation, and the inherent inability to perform retrospective studies. The latter has compromised the adequate assessment of flow cytometric DNA analysis for its clinical utility in UC patients. Our objective was to attempt to overcome the limitations that have been present in DNA analysis by flow cytometry. METHODS: After having established, in our laboratory, an optimal method that allowed reliable DNA analysis on paraffin-embedded mucosal biopsy specimens, we conducted three separate studies to address the above problems associated with DNA analysis with fresh colonic samples: 1) comparison of DNA analysis between fresh and paraffin-embedded colonic mucosal samples from UC patients without dysplasia, 2) correlation between morphology and DNA ploidy on paraffin-embedded tissues showing no dysplasia and various degrees of dysplasia, and 3) sequential analysis of fresh, normal colonic mucosal samples to further evaluate possible causes of false aneuploidy. RESULTS: We observed 1) that there is discordance in DNA ploidy between paraffin-embedded and fresh samples showing no dysplasia in that aneuploidy was found in 33/46 (72%) of fresh samples, whereas 3/40 (7.5%) were aneuploid by biopsies from the corresponding anatomic sites. 2) There is excellent correlation between dysplasia and DNA ploidy results with paraffin-embedded tissue, i.e., none of 16 samples negative for dysplasia, none of seven samples indefinite for dysplasia, and seven of eight samples positive for dysplasia were aneuploid. 3) DNA degradation produced a spurious, near-diploid aneuploid peak in a normal colonic mucosal sample when it was left in saline more than 1 hr before analysis. CONCLUSIONS: The above-described results demonstrate that performing flow cytometric DNA analysis with formalin-fixed paraffin-embedded biopsy samples is feasible and that this technique may provide more reliable ploidy results than does the use of fresh samples, when rapid refrigeration and/or freezing of the fresh samples cannot be accomplished consistently, and will permit retrospective DNA ploidy studies assessing risk of cancer in UC patients.

Adult↗
PubMed2003

An irrelevant light enhances auditory detection in humans: a psychophysical analysis of multisensory integration in stimulus detection.

Physiological and behavioral studies in animal models have revealed that information from the different senses can be used synergistically to enhance the detection of objects and events. Although a great deal of evidence exists which demonstrates the synergistic use of multisensory cues in human behavior and perception, there is conflicting evidence about whether such interactions can be used to aid in stimulus detection. To examine this issue, we had volunteers indicate the presence or absence of a brief, low-intensity sound that was either presented alone or paired with a simultaneous light in a one-interval signal detection task. In the first experiment, the task-irrelevant light was found to enhance the detectability of the sound, but also to increase the subject's willingness to report the presence of a sound (i.e., response bias). In the second experiment, designed to eliminate this response bias, we found an improvement in stimulus detectability in the absence of any change in bias. These findings demonstrate the presence of a significant multisensory-mediated gain in stimulus detection in human subjects.

Acoustic Stimulation↗
PubMed2000

Lea symbols: visual acuity assessment and detection of amblyopia.

OBJECTIVE: Lea symbols can be used for measuring visual acuity in childhood. Therefore, these symbols might be useful for early detection of amblyopia. We evaluated whether the visual acuity determined with Lea symbols (LS) corresponds to the visual acuity determined with the Landolt-C (LC). PATIENTS AND METHODS: In 55 strabismic amblyopic volunteers aged 5-59 years, the monocular visual acuity of both eyes was determined using LC and LS. For comparison, the right eye of 20 healthy volunteers was examined. Single optotypes (LC, LS) were used in 55 amblyopes and crowded optotypes (LC(17.2), LC(2.6), CLS) in 40 amblyopes. The luminance of the test charts was 180-200 cd/m(2), with a contrast >85%. The refraction of the subjects was corrected beforehand. RESULTS: In the 40 amblyopic eyes tested under each condition, LS exceeded CLS and LC by about 1 line (dB), LC(17.2) by 2 lines and LC(2.6) by 3 lines (mean values +/- SD: LS 0.62+/-1.8 dB, CLS 0.46+/-1.7 dB, LC 0.5+/-2. 0 dB, LC(17.2) 0.41+/-2.3 dB, LC(2.6) 0.29+/-2.3 dB). The non-amblyopic fellow eyes and healthy eyes showed smaller differences (fellow eyes LS 1.32+/-1.1 dB, CLS 1.17+/-1.1 dB, LC 1. 15+/-0.9 dB, LC(17.2) 1.05+/-0.9 dB, LC(2.6) 0.93+/-1.1 dB; healthy eyes LS 1.74+/-0.9 dB, CLS 1.58+/-0.8 dB, LC 1.48+/-0.6 dB, LC(17.2) 1.41+/-0.7 dB, LC(2.6) 1.32+/-1.1 dB). In the amblyopic eyes, the reduction of LC was more distinct than the reduction of LS. Fifty-two amblyopes had an amblyopia >1 dB of LC, LC(17.2) and LC(2. 6), while 50 had an interocular acuity difference >1 dB CLS. CONCLUSIONS: Using Lea symbols, a recognition acuity can be determined and amblyopia can reliably be detected. Due to their design, the Lea symbols are particularly suitable and recommendable for application in young children. However a slight systematic difference between LS and LC has to be considered.

Adolescent↗
PubMed2004

Validation of a discharge summary term search method to detect adverse events.

OBJECTIVE: Adverse events are poor health outcomes caused by medical care. Measuring them is necessary for quality improvements, but current detection methods are inadequate. We performed this study to validate a previously derived method of adverse event detection using term searching in physician-dictated discharge summaries. DESIGN: This was a retrospective, chart review study of a random sample of 245 adult medicine and surgery patients admitted to a multicampus academic medical center in 2002. MEASUREMENTS: The authors used a commercially available search engine to scan discharge summaries for the presence of 104 terms that potentially indicate an adverse event. Summaries with any of these terms were reviewed by a physician to determine the term's context. Screen-positive summaries had a term that was contextually indicative of an adverse event. We used a two-stage chart review as the gold standard to determine the true presence or absence of an adverse event. RESULTS: The average patient age was 62 years (standard deviation 18.6) and 55% were admitted to a medical service. By gold standard criteria, 48 of 245 patients had an adverse event. Term searching classified 27 cases with an adverse event, with 11 true positives; 218 cases were classified as not having an adverse event, with 181 true negatives. The sensitivity, specificity, and positive and negative predictive values were 0.23 (95% confidence interval [CI]=0.11-0.35), 0.92 (95% CI=0.88-0.96), 0.41 (95% CI=0.25-0.59), and 0.83 (95% CI=95% 0.77-0.97), respectively. CONCLUSION: Although the sensitivity of the method is low, its high specificity means that the method could be used to replace expensive manual chart reviews by nurses.

Academic Medical Centers↗
PubMedDate not supplied

Modelling dual isotope parathyroid scans: objective decision making for tumour detection.

Parathyroid subtraction imaging using the radioisotopes thallium-201 and technetium-99m was first described in 1983. Since then it has become a routine method for the pre-operative localization of parathyroid tumours. Despite its widespread use, the interpretation of the subtraction images remains very subjective. This paper describes and evaluates an automatic objective method for the analysis of parathyroid scans. The method is based on the calculation of a likelihood ratio (the probability of obtaining a count in a given pixel if a tumour is present divided by the probability of obtaining that same count if a tumour is not present). The likelihood ratio is calculated for each pixel in a subtraction image. The calculated value is compared with a threshold. Pixels with likelihood ratios greater than the threshold are classified as belonging to tumour sites. Pixels with likelihood ratios less than, or equal to, the threshold are classified as belonging to 'no tumour' sites. The probability density functions required were obtained from computer simulated images. The likelihood ratio technique has a similar sensitivity and specificity to that of experienced human observers analysing computer simulated images. Furthermore, it is a completely automatic method which can provide the basis of a decision support system.

Computer Simulation↗
PubMed1982

[Continuous non-invasive monitoring in respiratory resuscitation].

Non-invasive methods of monitoring have two principal objectives: --the detection of vital problems requiring immediate treatment : reflex monitoring or type I; --continuous surveillance, as sophisticated as possible, of a large number of parameters which help to predict the outcome either spontaneously or as a result of treatment. These two objectives are reached in different ways according to whether the patients are or are not artificially ventilated. At present it seems that the best compromise between cost, ease of operation, reproducibility and non-invasiveness are obtained by the following techniques: --type I Monitoring (reflex) in patients artificially ventilated : pressure or spirometric alarm; if spontaneously breathing : electrical impedance or simple E.C.G.; --type II Monitoring (or reflection) in patients on ventilators : study of expired CO2, careful analysis of pressure curves, compliance; for those breathing spontaneously : PO2 and PCO2 picked up transcutaneously and possibly impedance of the lungs separately.

Critical Care↗
PubMed1993

Silent myocardial ischemia.

The documentation of abnormalities related to myocardial ischemia, whether symptomatic or silent, is of central importance. Whenever this information is available, it should be used in the overall assessment of the patient at risk for adverse outcome. The level of concern for treatment of CAD should be based on the risk implications associated with the ischemia-related abnormalities detected during objective testing rather than on the presence or absence of pain. The exercise stress test is still the single most useful test to begin the evaluation of a patient with an analyzable ST segment. In persons suspected of having CAD, the detection of ischemic-type ST-segment depression, at a low workload (e.g., < 120 beats/min or < 6.5 METS) of > 2 mm magnitude or persisting for more than 6 min implies high risk for adverse outcome. Asymptomatic ischemia during everyday activities, detected by Holter monitoring, in the high-risk patient, most probably adds additional risk beyond the risk of an abnormal stress test alone. Left ventricular imaging by two-dimensional echocardiography, RNA, angiogram, vest, etc, showing an ejection fraction > or = 40%, reversible wall motion abnormalities in multiple regions and redistribution defects or a failure to increase ejection fraction during exercise even if the patient remains asymptomatic, also imply high risk. The presence of any of these abnormal findings, regardless of symptoms, should therefore prompt as high a degree of concern as with ischemia-related signals associated with pain. Thus any therapy chosen should be directed toward elimination of transient ischemia, not just relief of symptoms that may or may not be ischemia related. If this course is chosen, the efficacy of the therapeutic regimen and possible progression of CAD should be assessed with follow-up testing for ischemia. We believe that risk factor modification and aspirin should be considered for most, if not all, patients in whom ischemia, silent or symptomatic, is suspected or detected. If symptoms or ischemia suggesting low risk is present, anti-ischemic medical therapy may be considered, but follow-up is advised. If a high-risk ischemic signal, even without symptoms, is detected, medical therapy should be used to attempt to modify the signal. If the ischemic signal suggesting high risk persists despite medical therapy, revascularization should be considered. Until additional data from large clinical trials are available, this approach appears to have the greatest likelihood of modifying the adverse outcome of CAD.

Angina Pectoris↗
PubMed2004

[Simple method to detect factors influencing drug expenditures].

BACKGROUND: Analysis of drug expenditures as part of an assessment of various forms of management interventions is rarely reported. Several strategies have been used to decrease injudicious drug use: restricted availability of specific drugs under formulary instructions, educational programs for prescribing practices and streamlining to discontinue or limit therapy. Each intervention has limited effectiveness. OBJECTIVE: To detect factors influencing drug expenditures by a simple and accessible method. METHOD: Data analysis on drug utilization and expenditures was performed according to the "Pareto" technique and changes were calculated. Changes in expenditure due to inflation were also calculated; the cost value of each drug in 2000 was multiplied by its quantity used in years 2000 and 2001. Comparison of expenditures using this method of calculation enabled us to find the inflation rate of the drugs used in the hospital. RESULTS: Five important factors were found to have an impact on the pharmacy budget and calculations: drug inflation rate (-1%), new drugs introduced through the Pharmaceuticals & Therapeutic Committee (1.9%), extended usage of drugs due to new approved clinical indications (0.7%), opening of new services or widening of special old services (3.4%) and usage of commonly high volume prescribed drugs in various wards of the hospital (-8.9%). Quantities and costs for the 80 most expensive pharmaceuticals showed factors responsible for the drug expenditure when compared with the leading drug classes, as well as with leading drugs. Antimicrobials (27.5%), high volume IV infusions (11.0%), small volume infusions (8.5%), and anticoagulants (6.7%) were the most prominent drug classes that contributed to the high cost of the drug budget. Small volume infusions of Sodium Chloride 0.9% (7.8%), Piperacillin and tazobactam injections (5.6%). Ofloxacin & Ciprofloxacin drugs (4.7%), and Enoxaparin injections (4.6%) were the highest costing drugs. CONCLUSION: This simple method based on comparison of costs, utilization and judicious drug use, can provide accurate information that can be useful in planning and implementing a reasonable drug budget.

Costs and Cost Analysis↗
PubMed2003

Sensitivity and specificity of various diagnostic tests in the detection of Helicobacter pylori.

OBJECTIVE: This study was conducted to detect the sensitivity and specificity of various diagnostic tests on biopsy specimens obtained from patients undergoing elective endoscopy, by culture, histopathology (special stain), urease (biochemical test) and the presence of specific antibodies by serology for the detection of Helicobacter pylori. PLACE AND DURATION OF STUDY: This study was conducted in Civil Hospital, Karachi, in collaboration with Dr. Essa Laboratories and IIDRL (Immunology and Infectious Disease Research Laboratory), Karachi University, from June 99-to July 2000. SUBJECTS AND METHODS: Biopsy material was taken from 50 patients referred for elective endoscopy with symptoms of various upper gastrointestinal diseases. Non-endoscopic methods serology and endoscopic biopsy specimens using urease test, by culture and histopathology using special stain, detected presence of H. pylori. Sensitivity and specificity was calculated using the standard formula, only those cases were taken as true positive which were positive by either culture test and/or special stain. Those cases giving positive results only by serology or urease test not supported by either of the direct tests were taken as false positive RESULTS: The percentage of positive cases detected was 81% by serology, 80% by histopathology, 9% by culture and 56% by urease test. Sensitivity and specificity was by serology 84% and 60%, histopathology (special stain) 83% and 100%, culture 64% and 100% and by urease test 67% and 85% respectively. CONCLUSION: H. pylori infection can be detected by a variety of methods. The simplest and least expensive method is serology. Positive serology does not distinguish between active and chronic infection and is less specific as compared to other methods. Histopathology (special stain) allows simultaneous evaluation of tissue injury and has a high degree of sensitivity and specificity. Culture can be used to detect antibiotic resistant organisms.

Adolescent↗
PubMed2002

Prognostic significance of the mode of detection in renal tumours.

OBJECTIVE: To evaluate the mode of detection of 400 renal tumours as a prognostic factor compared with the usual clinical and pathological prognostic variables. PATIENTS AND METHODS: The data were reviewed for 400 patients operated for a renal tumour at our institution between 1984 and 1999, analysing the prognostic value of age, sex, tumour size, stage, grade, vein invasion, adrenal gland invasion, lymph node invasion, metastasis, and mode of detection (incidental or not). The survival rates were assessed using the Kaplan-Meier method and log-rank test, and the data evaluated using multivariate analysis with the Cox proportional-hazard model. RESULTS: In all, 151 (38%) renal tumours were discovered incidentally. There was no significant difference in the percentage of renal cell carcinoma found between the groups of patients discovered incidentally or not (94.4% vs 93.9%). Tumours were smaller in the incidental group (5.7 cm vs 8.7 cm, P < 0.001). In the incidental group, 15.2% of the tumours were treated with partial nephrectomy, against 1.2% in the symptomatic group (P < 0.001). The specific survival was significantly better in patients with renal tumours discovered incidentally (log-rank test, P < 0.001). The multivariate analysis showed that the mode of detection, stage, grade, metastasis (all P < 0.001), and lymphatic extension (P = 0.005) were independent prognostic factors. CONCLUSION: The incidental discovery of renal tumours gives a supplementary benefit to patients in terms of survival, and should be considered as a prognostic factor in addition to stage and grade.

Carcinoma, Renal Cell↗
PubMedDate not supplied

Prenatal detection of facial clefts.

OBJECTIVES: To determine (1) the antenatal detection rate for isolated cleft lip and/or cleft palate during the routine anomaly scan; (2) the correlation between prenatal diagnosis and postnatal findings, and (3) the association of apparently isolated cleft lip and/or cleft palate with other anomalies, in particular chromosomal abnormalities. METHOD: A population-based retrospective analysis of all cases of isolated cleft lip and/or cleft during an 8-year period in an academic teaching hospital in the UK. RESULTS: Thirty-nine cases of isolated cleft lip and/or cleft palate were identified among deliveries at the hospital. Twenty-eight cases had a routine anomaly scan. Fourteen cases were detected prenatally (sensitivity 50%). None of the isolated cleft palates was detected, while 14 of 20 cases of cleft lip (70%) were detected. One of the isolated cases of cleft lip was associated with trisomy 21, while 3 of the isolated cleft palate cases were associated with the Pierre Robin syndrome. In all cases, an antenatal diagnosis of cleft was confirmed following delivery or post-mortem examination (specificity 100%). CONCLUSIONS: Ultrasound is a useful tool in screening for cleft lip with or without cleft palate, but not for cleft palate alone. Even with an isolated cleft lip, there is an increased risk of chromosomal abnormality. The role of prenatal education and support is extremely important in the preparation of prospective parents and can help alleviate the shock which occurs when there is an unexpected cleft at birth.

Cleft Lip↗
PubMed2006

Conventional high-resolution CT versus helical high-resolution MDCT in the detection of bronchiectasis.

OBJECTIVE: The purpose of this study was to compare conventional high-resolution CT (HRCT) with helical 16-MDCT in the detection of bronchiectasis. MATERIALS AND METHODS: We retrospectively evaluated 80 patients including 61 with bronchiectasis (mean age, 64 years; range, 22-87 years) and a control group of 19 patients with normal MDCT of the chest. Two sets of images were blindly, randomly analyzed by two observers: contiguous 1-mm slices (MDCT set) and 1-mm slices every 10 mm (HRCT set) derived from the MDCT set. Images were scored independently for presence, extent, and severity of bronchiectasis, followed by a consensus interpretation. Kappa analysis assessed inter- and intraobserver agreement. MDCT was the radiologic gold standard. RESULTS: Of the 61 patients with bronchiectasis diagnosed with MDCT, 56 (92%) were positive for bronchiectasis on conventional HRCT. Seven patients had positive MDCT scans only, and two patients had positive HRCT scans only. Of 479 lobes, 59 were positive for bronchiectasis on MDCT and negative on HRCT, and 19 lobes were positive for bronchiectasis on HRCT and negative on MDCT (p < 0.0001). MDCT showed 25 more lobes with cylindric, 11 more lobes with varicose, and four more lobes with cystic bronchiectasis than did HRCT. Sensitivity, specificity, and positive and negative predictive values of HRCT in detecting bronchiectasis were 71%, 93%, 88%, and 81%, respectively. Interobserver agreement for presence, extent, and severity of bronchiectasis ranged from moderate to good for MDCT (kappa values, 0.64, 0.5, and 0.48, respectively) and poor to good for HRCT (kappa values, 0.65, 0.46, and 0.25, respectively). CONCLUSION: Contiguous helical 16-MDCT with 1-mm collimation is superior to HRCT at 10-mm intervals in showing the presence and extent of bronchiectasis.

Adult↗
PubMed1992

Use of a specimen-evaluation device for the diagnosis of impalpable breast lesions detected by mammography.

OBJECTIVE: To describe a method for accurate excision and exact histopathological diagnosis of impalpable breast lesions, considered suspicious of carcinoma, and detected on mammographic examination alone. SETTING, PATIENTS AND INTERVENTIONS: Eight-five patients referred with a suspicious but impalpable mammographic lesion underwent preoperative radiological localisation followed by surgical excision biopsy. Specimen radiology with a radiolucent acrylic compression-grid specimen-evaluation device confirmed that the lesion had been excised. By use of the grid coordinates, exact histopathological examination of the radiological area of suspicion was carried out to provide a definitive pathological diagnosis. RESULTS: Twenty-eight patients (33%) were found to have invasive carcinoma or extensive intraduct breast carcinoma requiring further surgical and adjuvant management. Nineteen of these patients (68%) had no axillary node metastases. CONCLUSION: The use of an acrylic compression-grid specimen-evaluation device in the diagnosis of suspicious mammographic breast lesions facilitates confirmation of excision by specimen radiology, and expedites accurate histological examination of suspicious radiological lesions.

Breast Neoplasms↗
PubMed1999

[Digital rectal examination, transrectal ultrasonography and prostate specific antigen for diagnosis of prostate cancer in clinical urological practice-detection of impalpable cancer].

OBJECTIVE: The clinical usefulness of multimodality detection for prostate cancer by digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum PSA determination (PSA) was evaluated in this retrospective study. PATIENTS AND METHODS: A total of 1344 symptomatic male patients who underwent DRE, TRUS and PSA in our outpatient clinic were studied. Prostate biopsies were performed when at least one diagnostic test was positive. RESULTS: Of 1344 patients, 436 (32.4%) had positive test results. Among 403 patients who underwent biopsy, 121 patients (30.0%) were found to have prostate cancer. The overall cancer detection rate was 9.0%. Among the 121 cancer patients, if examination had been carried out using only one or two tests, cancer would have not been detected in 22 patients (18.2%) by DRE alone, 27 patients (22.3%) by TRUS alone, 18 patients (14.9%) by PSA alone, 12 patients (9.9%) by a combination of DRE and TRUS, and 6 patients (5.0%) by a combination of DRE and PSA. Among the 121 patients with cancer, 22 (18.2%) had impalpable cancer. Impalpable cancer was more likely to be localized (77.3%) than palpable cancer (28.3%, p < 0.001) and more likely to be well or moderately differentiated (72.7%) than palpable cancer (41.4%, p = 0.008). CONCLUSION: This study confirmed the need for multimodality detection using DRE, TRUS and PSA as complementary methods in order to minimize decrease in cancer detection. In particular, impalbable cancers not detectable by DRE were detected and were revealed to be more likely to be localized and amenable to curative therapy. These results therefore underscore the importance of multimodality detection for early diagnosis of prostate cancer in urological practice.

Adult↗