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At least 1,153 records · Page 64Linked to original sources
PubMedDate not supplied

[CSF leaks--diagnostic and therapeutic approach].

The paper presents the classification of the CSF leaks and their etiology. The authors insist on the post surgical causes and on the modem diagnostic procedures such as 2 transferrin and trace protein determination and high resolution CT. They also present their own experience in repairing defects from the anterior skull base under endoscopic control. A lot of 20 patients with CSF leak is presented and the types of approach are discussed. If the defect is in the sphenoid sinus the obliterative techniques are preferred. The ethmoidal roof defects are covered with onlay or underlay procedures depending on their dimensions. The results are compared with those from the literature. The authors conclude that the CSF leaks in the anterior and middle skull base are mainly due to trauma or iatrogenic. A clear diagnostic algorithms and a correct selection of the cases suitable for endoscopic approach are required.

Adult↗
PubMed2006

[Guideline for gynecological malignant tumors I. Standard--a complex therapy of ovarian epithelial malignant tumors].

OBJECTIVE: Elaboration of guideline for primary and secondary treatment of ovarian cancer. DESIGN: Review, consensus between proposers and opponents. METHOD: A retrospective review of published data, analysis of Czech statistics and consensus between proposers and opponents. RESULTS: We underline importance of comprehensive approach in therapy of ovarian cancer. We notice importance of expert ultrasound and CA 125 level in diagnostic algorithm. Extension of surgery depends on result of frozen section. All departments which want to perform surgery for ovarian resistance must have possibility to do peroperative histopathology. We can perform conservative fertility sparing surgery in patient with wishing of pregnancy and low stage disease. The effort of maximal debulking with radical surgery including lymphadenectomy is the standard procedure. When we diagnose ovarian cancer during laparoscopy, we have to convert on laparotomy procedure. We define the role of the neoadjuvant chemotherapy followed by surgery after 3-4 cycles of chemotherapy. We define adequate surgery treatment, indication for adjuvant chemotherapy and indication for second line therapy. CONCLUSION: Guideline for the treatment of epithelial ovarian cancer should become directions for clinicians and others, who participate in the process of treatment of the ovarian cancer. The guidelines include all parts of the process from diagnosis, treatment to follow up. All topics of the guidelines arose from a voting of the proposers and opponents.

Carcinoma↗
PubMed2005

[Negative D-dimers and exclusion of venous thromboembolism--own experience].

The assessment of D-dimer concentration has become essential step during diagnostic algorithm of venous thromboembolism (VTE). This test characterizes high sensitivity but limited specificity. Negative D-dimer with high probability excludes VTE. The aim of this study was to assess the percentage of patients treated in Department of Internal Medicine, Endocrinology and Haemostatic Disorders, Medical University of Gdańisk, who in spite of clinical signs of VTE showed normal D-dimer level. Between 2000 and 2004 in our department 57 cases with recent deep vein thrombosis (DVT) were diagnosed, in 2 cases with co-existence of pulmonary embolism (PE). The D-dimer concentration was assessed in patients' plasma with the use of immunoturbidometry. Between 57 cases with VTE, 7 patients (12%) showed normal D-dimer level (<500 microg/ml). This group consisted of 4 men and 3 women, aged from 40 to 82 years (the mean age of 58 years). In all 7 cases DVT was diagnosed, in 2 patients with concomitent PE. The final diagnosis was confirmed by compression ultrasonography and pulmonary scintigraphy. Our analysis underlines the observation that occurrence of VTE and negative d-dimer concentration is possible and may probably be related to methodological limitations. However, the lack of increase of D-dimer could also be caused by fibrinolysis alteration.

Adult↗
PubMed2006

A combination of five short tandem repeats of chromosome 15 significantly improves the identification of Prader-Willi syndrome etiology in the Argentinean population.

Prader-Willi syndrome (PWS) is a multisystemic disorder caused by the loss of expression of paternally transcribed genes in the PWS critical region of chromosome 15. Various molecular mechanisms are known to lead to PWS: deletion 15q11-q13 (75% of cases), maternal uniparental disomy (matUPD15) (23%) and imprinting defects (2%). FISH and microsatellite analysis are required to establish the molecular etiology, which is essential for appropriate genetic counseling and care management. We characterized an Argentinean population, using five microsatellite markers (D15S1035, D15S11, D15S113, GABRB3, D15S211) chosen to develop an appropriate cost-effective method to establish the parental origin of chromosome 15 in nondeleted PWS patients. The range of heterozygosity for these five microsatellites was 0.59 to 0.94. The average heterozygosity obtained for joint loci was 0.81. The parental origin of chromosome 15 was established by microsatellite analysis in 19 of 21 non-deleted PWS children. We also examined the origin of the matUPD15; as expected, most of disomies were due to a maternal meiosis I error. The molecular characterization of this set of five microsatellites with high heterozygosity and polymorphism information content improves the diagnostic algorithm of Argentinean PWS children, contributing significantly to adequate genetic counseling of such families.

Argentina↗
PubMedDate not supplied

[Giardiasis in children - clinical diversity and diagnostic problems based on own experience].

UNLABELLED: Parasitosis still remains a significant pediatric health problem, despite improving hygienic conditions and social awareness. THE AIM OF THIS STUDY: was to analyze clinical manifestations of Giardia lamblia infection in children hospitalized in the Department of Pediatrics, Pediatric Gastroenterology and Oncology of Medical University of Gdansk. MATERIAL AND METHODS: studied children included 49 patients aged 2.2 - 17.3 years: group I children below and group II above 5 years of age. The patients were admitted for further diagnosis of unexplained clinical manifestations in outpatient care. Parasitosis was confirmed by immuno-enzymatic technique detecting protein GSA 65; only in one child parasites cysts were found by microscopic technique in faecal samples obtained from infected children. RESULTS: chronic abdominal pain was noted in 16 (72.7%) children in group I and in 22 (81.5%) patients in group II. Chronic diarrhea was observed in 20 (90.9%) children in group I and in 4 (14.8%) in group II. Ultrasound scans revealed mesenteric lymphadenopathy in 42 children (16 in group I and 26 in group II). CONCLUSIONS: chronic and recurrent abdominal pain was the main clinical complain and chronic diarrhea in children under 5 years of age. In few cases hepatobiliary involvement was observed, which might suggest a changing clinical course of giardiasis. Most of the children presented with mesenteric lymphadenopathy, which was confirmed by abdominal ultrasound scan. Thus, this method should be included in the diagnostic algorithm, if parasitosis is considered.

Adolescent↗
PubMed2002

No clear winner in differing imaging modalities for cervical radiculopathy.

We review the literature pertaining to the strengths and limitation of myelography, computerized tomography (CT) and magnetic resonance imaging (MRI) relative to developing a diagnostic algorithm in the evaluation of cervical radiculopathy. To obtain the relevant literature, a Medline search was conducted using selected keywords and phrases. In addition, the bibliography of all retrieved articles was searched and pertinent articles were obtained and evaluated. The analysis revealed that developing a research based algorithm of imaging studies for the evaluation of cervical radiculopathy is not currently realistic. Furthermore, we found that most studies on the predictive value of imaging studies for cervical radiculopathy are outdated by more recent technology.

Journal Article↗
PubMedDate not supplied

[Early diagnosis of ankylosing spondylitis].

The present study surveys the problems of diagnostics of early ankylosing spondylitis (AS) and axial spondylarthritis (SpA). Epidemiologic studies repeatedly identified seven- to nine-year delay of diagnosis of AS from its development to its first manifestations. Delayed diagnostics is caused both by unfamiliarity of rheumatologists with the disease and the inappropriateness of New York classification criteria for early stages of AS. In this study, we suggest diagnostic algorithms allowing high probability diagnosis of AS/axial in X-ray silent stage (the so-called pre X-ray stage). Spondylarthritis represents approximately 5% of a total number of chronic low back pain (CLBP) cases. The probability grows up to 15% with the presence of inflammatory character of back pain. The presence of HLA B 27 increases the probability to 59% and the occurrence of other 1 or 2 clinical signs raises the probability up to 90%. Probability reaches 95% with positive MRI. The overall concept requires verification of new samples in a prospective study. After certification of such study, it will be possible to use biological medications for much more efficient therapy of patients in early AS stages.

Early Diagnosis↗
PubMed2006

[Diagnosis of deep vein thrombosis in the perioperative period].

Deep vein thrombosis and pulmonary thromboembolism have been common illness even in Japan and are receiving increased social as well as medical attention, especially during postoperative period. Vital Statistics of Japan compiled by Ministry of Health, Labor and Welfare indicated that the number of patients who died of pulmonary thromboembolism had increased about ten-fold in this half a century. The most effective way of reducing unexpected death from venous thromboembolism is to institute a comprehensive institutional policy of primary prophylaxis and early diagnosis in patients at risk. The diagnostic strategy has changed along with the improvement especially of venous ultrasound sonography and multidetector-raw CT. The diagnosis of venous thromboembolism is now more noninvasive and accurate. However, we still have no screening test, although symptoms and signs of venous thromboembolism are more complex in perioperative period. Therefore, we need to observe more carefully. We have to find venous thromboembolism among patients with single leg swelling and pain, or sudden dyspnea and transient loss of consciousness, and link to this finding diagnostic algorithm.

Humans↗
PubMed2006

[Surgical treatment of fracture of the ring of axis - "hangman's fracture"].

PURPOSE OF THE STUDY: To evaluate surgical management of the fracture of the ring of axis (FRA), known as "hangman's fracture", and to discuss adequacy of this treatment. MATERIAL AND METHODS: Between 1994 and 2004, 41 patients with FRA were surgically treated in our hospital. We present a retrospective study of 30 cases treated by anterior cervical fixation and fusion and 11 cases treated by a posterior, CT-guided approach (published recently). Our diagnostic algorithm for evaluation of FRA included plain radiographs for basic diagnosis, detailed CT scan, MRI and finally passive lateral flexion-extension fluoroscopy (performed by physician) to assess stability. We also consider discography in selected cases, allowing further evaluation of discoligamentous injury. Fractures were classified according to Levine. Posterior compressive osteosynthesis according to Judet was performed in 11 patients with Levine type I fractures with fracture fragment distraction > 3 mm. Anterior graft and plate fixation was chosen in 30 patients with type II (25 patients) and type I (5 patients) fractures where C2/3 disc injury was confirmed by MRI or discography. There was no case of facet dislocation in our series (type III). Pain, motion restriction and overall satisfaction with neck status were assessed on a scale 1-5 (1 = best) in patients treated with anterior approach. Self-evaluation questionnaires were administered during follow-up (average, 7.3 years; 24 months to 11 years). RESULTS: Anatomically reduced fracture fusion was achieved in all cases (100%) at one year follow-up. Both autologous tricortical (22) and fibular allografts (8) were used for anterior approach. No perioperative complications occurred and no case was aborted. Average hospital stay in patients with standalone FRA was 6.8 days (3-15). Patients wore Philadelphia collar for 4-6 weeks. One patient died during follow up due to unrelated causes. None of the 29 patients treated with the anterior approach reported severe or very severe pain (grades 4 or 5). The average pain score was 1.28. Three patients with isolated FRAs reported slight subjective restriction of movement (grade 2). The "satisfaction with overall neck status" scale showed an average score of 1.62, never worse than grade 2. DISCUSSION: Despite increasing popularity of anterior surgical approach in the treatment of type II FRA, most authors still recommend conservative treatment. Surgical treatment is consensually recommended in type III fractures only. Type I is treated exclusively conservatively. There is currently no evidence-based data supporting any method of treatment of so called "hangman's fracture". The majority of treating surgeons do not consider the status of the intervertebral disc. Dynamic films, simulating the peak point of injury, are usually not performed. Hence, potentially unstable fractures are overlooked. This also explains the lack of long term follow-up data regarding the radiological status of C2/3 intervertebral disc as well as patients' subjective complaints. CONCLUSIONS: Surgery provides plausible results. Compared to conservative treatment, it can offer significant benefits: 1) immediate, better and stable reposition; 2) high fusion rate; 3) shortening of the treatment period with better quality of life. Contrary to conservative treatment modalities, surgery possesses a potential for further development.

Adolescent↗
PubMed2006

Update on the american urological association guidelines for the treatment of benign prostatic hyperplasia.

The updated 2003 American Urological Association (AUA) Guidelines for the treatment of benign prostatic hyperplasia (BPH) are the culmination of an exhaustive effort predicated on scientifically accepted methods of reviewing the medical literature. In this second publication of the guidelines, a multidisciplinary panel reviewed a new meta-analysis of outcome data from the BPH literature from before and after 1994. The major differences between the 2 guidelines are the changes in our understanding of the biology of the prostate and the introduction of new therapies. The vast majority of randomized controlled trials, particularly with respect to minimally invasive therapies and progression of BPH, were performed after the release of the 1994 guidelines. Also, the most recent AUA panel carefully reviewed unpublished data to make the guidelines as timely as possible. Studies that were subsequently published included those on the value of combination medical therapy for BPH. The panel agreed on updated recommendations for the treatment of moderate-to-severe lower urinary tract symptoms associated with BPH, and diagnostic algorithms were revised. The durability and utility of the present guidelines should exceed that of its predecessor.

Journal Article↗
PubMed1991

[Principles of differential diagnosis of diffuse lesions of the lungs].

Intricate questions related to the differential diagnosis of diverse diffuse pulmonary disorders are analysed in more than 1500 patients. Among them 1100 patients had sarcoidosis, 284 alveolitis of different etiology (including 62 patients with fibrotic alveolitis of autoimmune genesis), 45 rare pulmonary diseases, 5 carcinomatosis and 40 disseminated tuberculosis. 70% of the patients were hospitalized for pulmonary tuberculosis. Each disease had its typical diagnostic algorithm. In most cases (86-98%) the diagnosis was morphologically evidenced by intrapulmonary transbronchial biopsy. The cytogram of bronchoalveolar washout was examined. Immunologic methods and immunodiagnosis were used to specify the patients' immune status. Considerable attention was given to external respiratory function. The diagnosis of disseminated tuberculosis was verified by bacteriologic examinations and tuberculin diagnosis.

Algorithms↗
PubMedDate not supplied

[Echotomography in the diagnosis of pleural effusion].

USI of the pleural cavities was performed in 119 patients (65 men and 54 women) aged 30 to 90 with different abnormalities. Pleural fluid in 106 patients was the leading symptom of the main pathological process, in 13 patients it was a sign of pleural disease. USI was combined with routine x-ray methods. Minimum amounts of pleural fluid could be clearly visualized by ultrasound scanning. Echo-tomographic symptoms of free and encapsulated fluid as well as ultrasound signs permitted differentiation of pleural thickening and exudate accumulation. A program of diagnostic algorithm was worked out for pleural fluid.

Adult↗
PubMed1991

[Evaluation of radiologic and echosonographic examinations in the detection and confirmation of pleural effusions].

In everyday practice, the attention of the radiologists was driven by patients who were admitted for clinical examination for different reasons and in whom pleural effusion was diagnosed by ultrasonography but not on standard radiograms, i.e. patients with strongly suspected pleural effusion standard radiograms could not reveal. Investigations from different aspects and the use of several conventional roentgenological methods were usually sufficient since now in diagnosing most of the cases. This, however, includes prolonged examinations and higher radiation doses received both by patients and by medical staff; besides, all this is not always enough for the effusion to be proven. What is more important, however, is the fact that critical general status of a patient often makes such thorough examination impossible, especially in additional and forced positions. The aim of the authors was to determine, on the basis of its use in everyday practice, to which extent ultrasonography, being a new diagnostic method, can become a routine method and contribute to rationalization of radiodiagnostics for pleural effusions as well as to determine diagnostic algorithm for the detection and confirmation especially of small and smaller pleural effusions.

Humans↗
PubMed1991

[Tactics of the surgical treatment of combined occlusive diseases of the coronary arteries, the abdominal aorta and the arteries of the lower extremities].

On the basis of experience in reconstructive operations on 250 patients with combined affection of the coronary arteries, abdominal aorta, and arteries of the lower limbs the authors discuss the diagnostic and tactical features of surgical management of these patients. The article dwells upon the necessary preoperative diagnostic algorithm as well as that in tactical variants of surgical treatment: (1) one-stage reconstructive operations on several vascular beds; (2) successive stage-by-stage treatment of patients with combined vascular pathology; (3) reconstructive vascular intervention on only one of the vascular beds. Correct practical solution of all these problems allowed the authors to reduce postoperative lethality to 5.4% among this grave contingent of patients with combined vascular pathology.

Aorta, Abdominal↗
PubMed1991

Auricular diagnostics used in the system of screening surveys.

Specific features of the automated computerized diagnostic complex based on electrometric methods and used for the auricular diagnostics have been considered. A functional scheme of the complex is given. Biophysical aspects of measuring the skin conductivity in acupuncture zones of the auricle are discussed. Special attention is paid to the diagnostic algorithms and to the control for their efficiency.

Acupuncture Points↗
PubMedDate not supplied

[Supraventricular tachycardia with PR interval shorter than RP interval. Electrogenetic mechanisms and diagnostic criteria].

The Authors report their experience on the different clinical-electrocardiographic patterns of tachycardias with P'R interval shorter than RP'. The electrocardiographic criteria, in basal conditions and after autonomic stimulation, and the role of electrophysiologic study, particularly in transesophageal way, are discussed. Finally the Authors propose a noninvasive diagnostic algorithm for a correct clinical approach.

Algorithms↗
PubMed1991

Etiology of stroke subtypes.

The definitions and terms currently used to categorize and describe various stroke syndromes clearly reflect a change from years past when a stroke diagnosis was based on little more than clinical presentation. With the advent of sophisticated diagnostic technology and the development of precise diagnostic algorithms, diagnoses may be made more confidently for the various stroke subtypes. With more accurate diagnoses and a better understanding of the cause of certain stroke subtypes, perhaps the incidence of this condition will continue to decline and the management of those people who are at risk for stroke or already affected will improve.

Arteries↗
PubMed1991

[The results of a mass psychoprophylactic examination using computers in a military unit].

84 patients who were wounded in Armenian earthquake (1988) have been examined. It was marked that all the purulent wounds of soft tissues of the extremities had been infected by bacterial associations. The most of them were resistant to penicillinum, tetracyclinum, laevomycetinum, kanamycinum, kefzol, keflin, and highly sensible to mezlocilinum, cyprofloksacinum, cefaperazonum and ceftazidimium. The article formulates the organization and methodical principles, determines a diagnostic algorithm for clinico-microbiological examination of patients with purulent wounds.

Electronic Data Processing↗