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At least 1,135 records · Page 63Linked to original sources
PubMed2005

[Detection of mycobacteria tuberculosis in patients with urogenital tuberculosis by PCR method].

The study was carried out in hospital patients as well as in outpatients at the National Centre of Tuberculosis and Lung Diseases of Georgia (2002-2004). The group consisting of 32 patients with tuberculosis of urogenital system has been studied (newly detected forms). Except clinical laboratory, culture and X-ray contrast methods, two additional methods were used in testing of this group of patients. The examination of their urine, at the same time, was carried out by the Polymerase Chain Reaction method in order to detect Kochi bacillus and by three-time bacterioscopy of urine for acid resistant bacteria. Mycobacterium tuberculosis in urine has been detected in 26 (81,25%) patients by PCR method, and by urine bacterioscopy--acid fast bacilli (AFB+) in 18 (56,25%) patients. The histo-morphological investigation of specimens obtained by surgery confirmed the TB diagnosis in all patients. This study on patients suspected of Tuberculosis of genital-urinary system gives us an opportunity to update the diagnostic algorithm by including the modern molecular methods. This algorithm will help in timely detection of Tuberculosis, in selection of adequate therapy and in prevention of the further progression of the disease.

Adult↗
PubMedDate not supplied

Lung cancer screening with spiral CT.

Lung cancer is the main cause of death from malignancies due to the high prevalence and adverse prognosis when diagnosis is established in symptomatic patients. With early diagnosis, survival is far better; this led to perform some trials of screening in subjects at high risk with chest X-ray since 1970 but outcomes were contrasting. The technological evolution with the introduction of spiral CT and low dose techniques in the last decade led to a new interest in lung cancer screening. Numerous trials were performed and several diagnostic algorithms based on the dimensional and densitometric analysis of CT-evidenced nodules were designed. In spite of the encouraging outcome achieved so far, the high rate of false positives, the high costs and the use of ionizing radiation advise caution at least until a decreased mortality rate from lung cancer is evidenced.

Clinical Trials as Topic↗
PubMed2005

[A case of femoral osteomyelitis caused by Lactococcus].

The authors report on a case of osteomyelitis of the femur, where the causative agent was Lactococcus. These bacteria are mainly pathogenic in endocardial implants and extremely rare in osteomyelitis. The osteomyelitis was complicated with endocarditis, cerebral and pulmonary abscess. In the reported case the occurrence of osteomyelitis was similar to bone tumor formation, so there was a challenging diagnostic approach. Based upon this case, the diagnostic algorithm, the treatment strategy and the outcome of the treatment are reported. Authors also give a short overview of the literature published on this rare microorganism in bone and joint diseases.

Adult↗
PubMed2004

[Basic methods in the prevention of breast cancer--diagnostic radiography].

Breast cancer is one of the most common neoplasms of women in Poland. The study presents the diagnostic possibilities for early detection of neoplastic lesions and their differentiation from the radiologist point of view. Advantages and restrictions of individual methods and current views on prophylactic and diagnostic algorithms have been considered. The study has been based on long-term observation of patients coming to Breast Diseases Outpatient Clinic as well as on scientific reports. The importance of cooperation between radiologists and physicians with other specializations who deal with breast diseases has been stressed.

Adult↗
PubMed2005

[Pulmonary hypertension and HIV: implementation of a Regional Registry].

In the era of new, potent antiretroviral therapy, much more attention is being given to non-infectious complications of HIV diseases, such as cardiomyopathy, pericardial effusion and pulmonary hypertension (PH). PH diagnosis is based on a mean pulmonary artery pressure of more than 25 mmHg at rest, or more than 30 mmHg with exercise. The incidence of PH is about 0.1% per year among HIV-positive patients, while in the general population it is 1 to 2 cases per million people. The histopathology of HIV-associated PH (HAPH) is similar to that of idiopathic PH, although its pathogenesis is still unclear. In patients with HAPH secondary causes of PH must be ruled out, such as intravenous drug abuse, valvulopathy, congenital heart disease and previous tricuspid endocarditis. The treatment of HAPH is not substantially different from that of idiopathic PH and is essentially based on the use of vasodilators. The Regional Authority of Lazio (Italy) has instituted a Registry for PH in HIV-positive patients; its aims are to evaluate the real incidence and prevalence of primitive and secondary PH among patients with HIV infection, and optimise the management of patients with suspected PH through the definition of a diagnostic algorithm.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Anemia in workers exposed to lead: update on differential diagnosis].

Occupational lead exposure can cause anemia at blood lead levels >50 microg/dl, as high as rarely occurs in industrialized countries nowadays. Whereas other forms of anemia are fairly probable to be found in lead exposed workers, especially in areas highly endemicfor extraoccupational anemias, such as beta thalassemia and iron deficiency anemia. The etiology of anemias has to be correctly defined in order to assess suitable therapeutical approaches and medicolegal consequences. The objective of this study is to verify in male lead exposed workers whether an accurate evaluation of hemocromocytometric parameters and of usual biological indices of lead exposure and effect on heme can differentiate the most common forms of anemia in Southern Italy. 68 workers occupationally exposed to low to moderate lead doses were studied and 59 workers of an alimentary plant have been taken as control group. On venous blood samples collected from these workers a complete hemocromocytometric test was performed and blood lead and erythrocytic zincoprotoporphyrin were determined. Anemia (Hb <l3 g/dl) was detected in six lead exposed workers and in a nonexposed worker. The reasoned evaluation of laboratory parameters led to identify among lead exposed workers four subjects with high probability of beta-thalassemic trait and two with lead poisoning anemia. Moreover a diagnostic algorithm was developed based on literature that seems to be able to discriminate lead poisoning from other causes of anemia in lead exposed workers in this study.

Adult↗
PubMed1992

[Ultrasonography in urologic ambulatory care].

Ultrasonography holds an important place in urological diagnostics. The number of urological departments which have their own apparatus is increasing. So far, however, the opportunity of ultrasonic examination in routine practice of the urologist in out-patient departments is not common, despite the fact that it would be a great asset. In order to make maximum use of ultrasonographic equipment in the urological out-patient department is important to know also some potential negative aspects. Therefore the authors present their experience and compare it with data in the professional literature. The authors demonstrate on examples the impact of ultrasonography on diagnostic algorithms of some urological diseases.

Ambulatory Care↗
PubMed2005

CT-angiography for the detection of a lower gastrointestinal bleeding source.

The evaluation of lower gastrointestinal bleeding (LGIB) often involves the collaborative efforts of the gastroenterologist, radiologist, and surgeon. Efforts to localize the acute LGIB have traditionally involved colonoscopy, technetium-labeled red blood cell (RBC) scintigraphy, angiography, or a combination of these modalities. The sensitivity of each method of diagnosis is limited, with the most common cause of a negative study the spontaneous cessation of hemorrhage. Other technical factors include vasospasm, lack of adequate contrast volume or exposure time, a venous bleeding source, and a large surface bleeding area. We report the use of multidetector computed tomography (MDCT), or CT-angiography (CT-A), in the initial evaluation of LGIB, and speculate on the incorporation of this technique into a diagnostic algorithm to treat LGIB. MDCT may offer a very sensitive means to evaluate the source of acute LGIB, while avoiding some of the morbidity and intense resource use of contrast angiography, and may provide unique morphologic information regarding the type of pathology. Screening with the more rapid and available MDCT, followed by either directed therapeutic angiography or surgical management, may represent a reasonable algorithm for the early evaluation and management of acute LGIB in which an active bleeding source is strongly suspected.

Adult↗
PubMed2005

The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1- blood pressure measurement, diagnosis and assessment of risk.

OBJECTIVE: To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with high blood pressure (BP). OPTIONS AND OUTCOMES: For persons in whom a high BP value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of BP, the level of the BP elevation and the duration of follow-up. In addition, the presence of cardiovascular risk factors and target organ damage should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, estimating overall risk of adverse cardiovascular outcomes requires an assessment of other vascular risk factors and hypertensive target organ damage. EVIDENCE: MEDLINE searches were conducted from November 2003 to October 2004 to update the 2004 recommendations. Reference lists were scanned, experts were polled, and the personal files of the authors and subgroup members were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content and methodological experts. As per previous years, only studies that had been published in the peer-reviewed literature were included; evidence from abstracts, conference presentations and unpublished personal communications was not included. RECOMMENDATIONS: This document contains recommendations for BP measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high BP. These include the accurate measurement of BP, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory BP monitoring, and the role of echocardiography for those with hypertension. Key features of the 2005 recommendations include an expedited diagnostic algorithm for hypertension and an endorsement of the use of home/self and ambulatory BP assessment as validated techniques in establishing the diagnosis of hypertension. VALIDATION: All recommendations were graded according to the strength of the evidence and voted on by the 43 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported in the present paper received at least 95% consensus. These guidelines will continue to be updated annually.

Blood Pressure Monitoring, Ambulatory↗
PubMed2005

Poncet's disease (tuberculous rheumatism): two case reports and review of the literature.

We report two human leukocyte antigen (HLA) B27-positive cases of urogenital tuberculosis (TB) with asymmetric polyarthritis. Stained smears with Ehrlich Ziehl-Neelsen and polymerase chain reaction (PCR) tests for Mycobacterium tuberculosis complex (MTC) of the ejaculate were positive in both cases, despite negative cultures. Stained smear, culture and PCR results of the synovial fluid for mycobacteria were negative. The patients were diagnosed with Poncet's disease. Polyarthritis was resolved rapidly with anti-tuberculosis treatment. We suggest that in cases with unexplained arthritis and non-articular TB, Poncet's disease should be considered. PCR can be used in the routine diagnostic algorithm when conventional methods fail to identify MTC.

Adult↗
PubMed2005

Primary lymphedema tarda in an 88-year-old African-American male.

Primary lymphedema tarda is considered to be a congenital disease with delayed manifestations. We report a case of isolated lymphedema of the left upper extremity in an 88-year-old African-American male. The diagnosis of lymphedema was confirmed by lymphoscintigraphy, and appropriate diagnostic studies were done to rule out other known causes of lymphedema. Lymphoscintigraphic findings were consistent with idiopathic primary lymphedema. During the course of investigations, the patient was found to have adenocarcinoma in situ of the sigmoid colon with no evidence of metastatic spread. Based on the available data, we were unable to establish a causative relationship between colonic carcinoma and lymphedema in our patient. Therefore, this case can best be described as a case of Idiopathic primary lymphedema tarda. We emphasize the use of histopathologic examination in the diagnostic algorithm to rule out underlying malignant process only in patients with radionuclide findings suggestive of secondary lymphedema with no obvious etiology.

Black or African American↗
PubMed2005

[Adenomas of the thyroid gland].

Different methods of diagnosis and treatment of thyroid gland's adenomas are analyzed. Current surgical treatment of euthyroid goiter is reviewed. Basing on long-term studies, the role and place of special diagnostic methods (ultrasonic scanning and fine needle biopsy) and indications for their use and surgical treatment were determined. The proposed treatment and diagnostic algorithm reduces the number of unjustified surgeries. When elective histological examination reveals thyroid cancer, reoperation is not necessary. The groups of patients with confirmed diagnosis "thyroid adenoma" and high cancer risk were distinguished. Optimization of differential diagnosis of thyroid adenoma and cancer based on cytological and immunogenotypic tests will help determine indications to surgical treatment in adequate scope.

Adenoma↗
PubMedDate not supplied

[Renal tumors and pregnancy].

The article presents a retrospective analysis of literature data on combination of renal tumors with pregnancy, three cases are reported. The diagnostic algorithm in such patients is based, first of all, on ultrasonography, in complicated cases MR imaging is used. Therapeutic policy depends on the tumor stage and size, pregnancy term. Urgent radical nephrectomy is recommended in trimester I and III. Follow-up with delivery may be employed upon 28 week pregnancy in trimester II. Basic therapeutic algorithm of renal angiomyolipoma is follow-up. To make a final conclusion on efficacy of therapeutic policy, it is necessary to conduct a multicenter prospective trial aimed at assessment of long-term results of each therapy.

Adult↗
PubMedDate not supplied

[Medullary thyroid carcinoma: from molecular studies to clinical decision].

The paper is focused on guidelines of practice in inherited medullary thyroid cancer, diagnosed on the basis of DNA analysis. Identification of RET mutation implies further steps of diagnostic procedure, some of them - USG, FNAB and calcitonin level tests - are common for all types of mutation, other are related to ascertained type of mutation. In asymptomatic RET mutation carriers, prophylactic thyroidectomy is indicated. In MEN2B inherited cancer reveals its symptoms quickly and shows dynamic progress. In MEN2A/FMTC the clinical picture is diversified - in some patients the course of disease is mild, however in some other cases the progression of disease and even death occur regardless of the proper treatment. Unfortunately, there are no molecular prognostic markers in medullary thyroid carcinoma. Recent papers and also our own unpublished results show that gene expression profile, is similar in MEN2A and sporadic cancer. This group differs from MEN2B by its expression profile. In conclusion it is to be emphasized that although inherited medullary thyroid carcinoma is a rare disease, the diagnostic algorithm is well established and maximizes the chance for early diagnosis. Moreover, it needs to be stressed that DNA analysis results inform us not only about the necessity of further therapy, but also suggest different ways of proceeding in particular type of mutation.

Carcinoma, Medullary↗
PubMed2005

Qualitative troponin I estimation in the diagnosis of acute coronary syndromes in three rural hospitals.

OBJECTIVE: To examine the utility of point-of-care qualitative troponin I (TnI) testing in patients with possible acute coronary syndromes (ACS). METHODS: A retrospective chart review of all patients undergoing qualitative TnI testing between September 2001 and February 2002 was conducted at the emergency departments of 3 rural hospitals in Alberta. We looked at the incidence of ACS, the comparison between TnI and creatine kinase (CK) testing and the timing of testing. RESULTS: Of the 235 patients tested, 8 had ST-elevation myocardial infarctions and 11 non ST-elevation infarctions. One patient had unstable angina with minimal myocardial damage. Qualitative TnI testing was positive in all 14 cases of infarction tested more than 6 hours after symptom onset, and CK elevation occurred in 15/17 cases (TnI sensitivity 1.0 [95% confidence interval (CI) 0.78-1.0], CK sensitivity 0.882 [95% CI 0.66-0.97]). There were 3 positive TnI tests and 33 raised CK levels in patients without evidence for ACS (TnI specificity 0.986 [95% CI 0.96-0.99], likelihood ratio [LR] 72.0 [95% CI 23.4-221.5]); CK specificity 0.847 [95% CI 0.79-0.89], LR 5.8 [95% CI 4.0-8.3]). In 44 patients (20.8%) TnI testing was inappropriately not repeated more than 6 hours after symptom onset. CONCLUSION: Qualitative TnI testing appears highly sensitive and more specific than CK estimation in detecting myocardial infarction. Diagnostic algorithms must emphasize the importance of testing 6 or more hours after symptom onset.

Angina, Unstable↗
PubMed2006

[From the clinical to the genetic diagnosis of Prader-Willi and Angelman syndromes].

INTRODUCTION AND DEVELOPMENT: Angelman syndrome (AS) is characterised by severe mental retardation (MR), the absence of language, ataxia and/or tremors in the extremities and a characteristic behavioural phenotype with a happy behaviour and hyperactivity. Patients often show signs of microcephaly and convulsions. Prader-Willi syndrome (PWS) is characterised by acute hypotonia and feeding problems in the neonatal period, and triggers an uncontrollable appetite in the infant that leads to obesity. Most patients have some degree of MR, behavioural disorders and hypogonadism. Both pathologies are caused by a number of genetic mechanisms that affect the 15q11-q13 region regulated by genomic imprinting, which means that only one of the two copies of the genes in this region will be functional, depending on which parent they come from. The physical or functional absence of genes that are only expressed by the mother's chromosome 15 causes PWS and gentic anomalies which affects the UBE3A gen mother's copy causes AS. CONCLUSIONS: It is important to confirm the clinical diagnosis and to establish the genetic mechanism responsible for the two syndromes, both for their consequences as regards the prognosis and for genetic counselling; it is therefore important to draw up a diagnostic algorithm.

Algorithms↗
PubMed2006

[Specific interferon-gamma assays: a modern tool for tuberculosis diagnosis].

Compared with the tuberculin skin test, the antigen-specific interferon-gamma assays, using a combination of two antigens ESAT-6 and CFP-10, has higher specificity for the diagnosis of latent tuberculosis, better correlation with exposure to M. tuberculosis, no cross-reactivity due to BCG vaccination and less towards nontuberculous mycobacterial infection. Fewer false positive results in uninfected persons avoid the costs of unnecessary therapy and its possible side effects. In low endemic areas, interferon-y assays are useful in addition of diagnostic algorithm for individuals with suspected tuberculosis. Further studies are required to evaluate the utility of the interferon-gamma assays in specialised subgroups of patients (immunocompromised, young children, patients with extrapulmonary disease,...) and as a marker of disease activity.

Humans↗
PubMed2002

[Advances in the diagnosis and therapy of chronic pancreatitis].

Chronic pancreatitis is a permanent diagnostic and therapeutic problem. There is no method diagnosing early stages of the disease. Contemporary diagnosis is based on morphological methods. The gold standard is ERCP, but similar results are provided also by non-invasive NMR cholangiopancreatography. Ultrasound examination provides reliable information on the presence of cystoids and major solid formations. Spiral CT is the method which by visualizing the pancreatic duct and structural changes is indispensible. Functional tests are in the diagnostic algorithm only marginal. Treatment of the disease involves dietetic provisions, prohibition of alcohol, supplementation with pancreatic enzymes and administration of analgetics. If this treatment fails, endoscopic or surgical solutions are indicated. Chronic pancreatitis is associated with the risk of development of carcinoma of the pancreas and this is another reason why it calls for permanent and systematic dispensarization.

Humans↗