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PubMed2006

[Adenosine deaminase in the complex diagnosis of different forms of extrapulmonary tuberculosis].

The paper summarizes the results of studies of the activity of adenosine deaminase (ADA) in biological fluids (including that during tuberculin tests) as a tool for the differential diagnosis of different forms of extrapulmonary tuberculosis, such as pleuritis, synovitis, meningitis, tuberculosis of female genitals and peripheral lymph nodes, and uveitis. The threshold for the activity of ADA or the magnitude of its increase in antigenic stimulation, which provides the optimum ratio of the sensitivity to specificity of the tests and their maximum diagnostic efficiency, are given. The optimization of diagnosis of tuberculous synovitis is shown to facilitate the study of ADA activity concomitantly with the determination of the level of antituberculosis antibodies. The tests under discussion are economically sound and yield results in several hours and, in case of a provocative test, in 3 days.

Adenosine Deaminase↗
PubMedDate not supplied

[Estimation of the prevalence of attention deficit hyperactivity disorder among the standard population on the island of Majorca].

AIM: To determine the rate of prevalence of attention-deficit/ hyperactivity disorder (ADHD) in children of school age (6-11 years) in the Island of Mallorca. SUBJECTS AND METHODS: The epidemiological study was conducted using a community sample extracted by means of multi-stage stratified sampling according to areas (rural, city and touristy) and schooling (public, private and concerted) and consisted in 1,509 children of both sexes. The ADHD Rating Scales-IV (ADHD RS-IV) for home and school setting were used to collect data. The optimal approach to do a diagnostic evaluation, according with the literature, was using a cut-off point of 90 centil. RESULTS: The estimated prevalence of ADHD was 4.57% (CI at 99%: 3.0-5.8%) and we also obtained 1.26% for the hyperactive subtype, 1.06% for the disattentional subtype, and 2.25% for the combined subtype. Contrary to what was expected, prevalence was higher for females but no statistically significant. There were no statistically significant differences between levels, schools or areas. CONCLUSIONS: The estimates for prevalence found in this study are consistent with those reported in the literature (between 3-5%). Using the ADHD rating scale which has different cut-off point regarding age, sex and setting and the fact that it was a poblational based study could explain the higher prevalence in the females. We propose a normalization of the scales in our area in other to confirm our findings.

Attention Deficit Disorder with Hyperactivity↗
PubMed1991

[Therapy of cardiac arrhythmias: when, how and where?].

Despite major advances in the understanding of mechanisms, better diagnostic methods and a wide array of new modes of therapy, management of cardiac arrhythmias continues to be a challenge. Because of possible deleterious effects of antiarrhythmic therapy, the decision about when and how to treat should be weighed carefully with emphasis on symptoms and the prognostic significance of the arrhythmia. When possible, the high risk patients should be referred to a center where expertise and diagnostic and therapeutic possibilities allow optimal treatment.

Anti-Arrhythmia Agents↗
PubMed1977

Diagnosis and treatment planning.

A diagnosis based upon a haphazard examination is an invitation to failure. A thorough diagnostic service is essential for optimal results. Successful resolution of the complete denture problem depends upon many factors. The dentist's knowledge, possession of the necessary technical skills, sound clinical judgment, experience, and psychological management of the case, combined with the patient's willingness and capacity to persevere and master the use of well constructed dentures, are factors of major consideration which are vital to the ultimate result.

Attitude to Health↗
PubMed1988

[The surgical treatment concept in acute intestinal hemorrhage].

A clinically developed and prospectively verified therapeutic concept for acute intestinal bleeding is presented in this paper. Emphasis is laid on orthograde lavage likely to enable sooner and more effective use of diagnostic means and to provide optimal conditions for surgical therapy. Prognosis can be further improved by differentiated use of therapeutic endoscopy and early elective surgery. The effectiveness of this new therapeutic concept has been successfully verified on 81 patients, between 1975 and 1986. Lethality amounted to five per cent.

Colectomy↗
PubMedDate not supplied

Acetylcholinesterase activity in rectal biopsies: an assessment of its diagnostic value in Hirschsprung's disease.

Acetylcholinesterase (AChE) activity was measured in rectal suction biopsies from 392 patients investigated for Hirschsprung's disease (HD). Results in HD (2.7-23.7 RU; n = 37) were not clearly differentiated from those in patients without HD (0.6-18.0 RU; n = 355). Sample instability was shown not to be a significant cause of error. From analysis of duplicate biopsies and a consideration of false-negative results, tissue inhomogeneity or incorrect siting of the biopsy appeared likely causes of error. Examination of a number of possible diagnostic decision levels indicated an optimal choice of AChE activity greater than 10 RU with an AChE activity not less than 60% of total cholinesterase activity. At a prevalence of 10%, this decision level resulted in sensitivity of 64.9%, specificity 98.7%, predictive value of positive 85.7%, and predictive value of negative 96.3%. The false positives (n = 4) and false negatives (n = 13) by these criteria were examined to detect possible common features.

Acetylcholinesterase↗
PubMed1979

[Clinical pathology of colonic mucosal polyps].

Of 636 polyps removed during endoscopy between 1973 and 1975 at the University Hospital, Zurich, 36 (5.5%) were of the hyperplastic and 18 (2.8%) of the juvenile type. One polyp was seen in a female patient with Peutz-Jeghers syndrome. The vast majority of the polyps (581, 91.5%) were neoplastic in origin; 70% were tubular adenomas, 16% villous adenomas, and 14% intermediate forms or tubulo-villous adenomas. On the basis of a continuous spectrum in histologic structure and similar cellular dedifferentiation, these three types of adenoma may be viewed as different forms in the development of the same neoplastic process. Hyperplastic and hamartomatous polyps are innocuous, whereas the neoplastic forms may well turn aggressive. Malignant change was observed in 5.1% of our material, particularly in villous adenomas and in polyps exceeding 1 cm in diameter. The presence or absence of invasive growth through the muscularis mucosae is of prime importance for therapy. In accordance with WHO nomenclature, the term carcinoma is used only in the presence of such infiltration. If, in addition, the tumor tissue is not well differentiated, additional segmental resection may be required. The term "focal carcinoma" is no longer in use and has been replaced by "severe focal atypia". In these cases, primary polypectomy for diagnostic purposes is also the optimal therapy, and is as effective here as in cases of benign adenoma.

Adenoma↗
PubMed1994

Making the diagnosis.

Dramatic changes have occurred in the approach to the diagnosis of breast cancer. Increased screening has resulted in the diagnosis of occult lesions, many of which represent tumors that are not invasive, and smaller invasive cancers. It is now generally accepted that the diagnosis and treatment of breast cancer requires a multidisciplinary approach and that open biopsy not only provides the histologic diagnosis but also may represent definitive surgical treatment. Thus, diagnostic studies should represent the optimal approach to establishing the histology of the lesion without compromising later definitive treatment.

Biopsy↗
PubMedDate not supplied

Pathophysiology and management of fecal incontinence.

The successful management of fecal incontinence requires an understanding of anorectal function, careful delineation of the disorder by a detailed history and physical examination, and specialized studies of anorectal and pelvic floor function in selected patients. These studies include anorectal manometry, dynamic radiographic studies of the anorectum, pelvic floor neurophysiologic tests and anal endosonography. Therapeutic options include dietary modifications, behavioral programs, pharmacologic agents and surgery. Currently available diagnostic tests should result in optimal management of these patients.

Aged↗
PubMed1993

Anterior aesthetic considerations for the placement and restoration of nonsubmerged endosseous implants.

Nonsubmerged endosseous dental implants should be considered when planning optimal anterior implant rehabilitation. Detailed diagnostic records are a necessity, along with preoperative and preprosthetic treatment plans that are designed to address the unique challenges of anterior restorations. This paper discusses these concerns and presents two case reports which utilize some of the techniques that can be incorporated into achieving predictable anterior aesthetic rehabilitation using a single-stage implant. The learning objective of this article is to familiarize the reader with those challenges and techniques.

Adolescent↗
PubMed1993

Strategy for screening pregnant women for chlamydial infection in a low-prevalence area.

OBJECTIVE: To assess the prevalence and risk factors for chlamydial infection in pregnant women in the Quebec City area and to propose strategies for a screening program. METHODS: From January 1990 to July 1991, pregnant women from six centers were cultured for Chlamydia trachomatis. One hundred thirty-six with positive results and 536 with negative results were included in a case-control study on risk factors for this infection. RESULTS: The prevalence of C trachomatis was 1.9% (136 of 7305). In a logistic regression analysis, young age (P < .0001, test for trend), nulliparity (odds ratio [OR] 3.3; P < .00001), and a new sexual partner in the last year (OR 3.3; P = .0012) were independently associated with infection. With screening restricted to pregnant women under age 25 or those with at least one risk factor, 81.7% of women positive for C trachomatis would have been detected, whereas only 40.6% of all women would have been cultured. CONCLUSION: In a low-prevalence area for chlamydial infection in pregnant women, pre-screening criteria could optimize the use of specific diagnostic tests.

Adult↗
PubMed1997

[Severe mitral regurgitation with ejection fraction below 40%: pharmacologic therapy is the treatment of choice].

Severe chronic mitral regurgitation with severe left ventricular dysfunction is uncommon. Mitral valve repair is not appropriate and unpredictable in a large proportion of these patients. Mitral valve replacement results in a poor outcome for patients with severe left ventricular dysfunction. Therefore, surgery is not the first therapeutic option for this patient group. Surgery may be considered after optimal medical stabilization and extensive diagnostic evaluation for each individual patient.

Algorithms↗
PubMed1997

Rehabilitation of an edentulous mandible with an implant-supported prosthesis.

The advances in osseointegration have resulted in an increased utilization of implants for restoration of the edentulous jaw. The success of osseointegrated implants supporting full arch prostheses has become more predictable. All implant restorations require a thorough diagnosis and a definitive treatment plan. Following a diagnostic wax-up, an optimal surgical implant template must be fabricated; it serves as a guide or prescription for placement of implants in an optimal anatomic location. The slightest misangulation of an implant may create restorative limitations. In such circumstances, alteration of the restorative design or selection of alternate materials may be required. The learning objective of this article is to review the fabrication of a combined ceramometal and resin-metal fixed/removable implant-supported mandibular hybrid prosthesis. Diagnosis, surgical template fabrication, vertical dimensions, buccal/lingual space limitations, and aesthetics are discussed.

Aged↗
PubMed1998

[The treatment of basal cell carcinoma patients by dermatologists in Netherland].

OBJECTIVE: To determine the policy of dermatologists practising in the Netherlands in the treatment of basal cell carcinoma. DESIGN: Written enquiry. SETTING: Catharina Hospital, Eindhoven, the Netherlands. METHOD: All 293 dermatologists practising in the Netherlands were sent a questionnaire in May 1996 containing 15 questions about diagnosis and treatment of basal cell carcinoma. RESULTS: Eighteen forms dropped off because of termination of the practice or joint completion in group practices. The response was 76% (208/275). The diagnosis was made usually on the basis of histological examination (71% of the respondents; 84% in a tumour recurrence). Excision was the preferred treatment for all subtypes of basal cell carcinoma; second choices were cryosurgery or curettage/electrocoagulation. Roentgen contact therapy has been practically abandoned. New methods such as photodynamic therapy and immunotherapy are being used only sporadically on an experimental basis. Most dermatologists regarded tumour recurrences as a bigger problem than primary tumours. They attempt to reduce the percentage of recurrences by giving advice about risk factors (sunlight). CONCLUSION: Too little use is being made of diagnostic biopsy to enable an optimal choice of therapy of basal cell carcinomas, especially in cases of recurrence tumours.

Basal Cell Carcinoma↗
PubMed1998

Studying the mental health of a nation: a preliminary report on a population survey in Singapore.

AIM: A Singapore Mental Health Survey was designed to study the prevalence and pattern of psychiatric morbidity of the general population. Community surveys reveal the true pattern of mental disorders, free from any self-selection into, or referral within the health care system. METHODS: A cross-sectional survey design was used to estimate the point prevalence of minor psychiatric morbidity (MPM) in an area-probability sample drawn from different regions. Disproportionate quota sampling yielded approximately equal numbers of Chinese, Malays and Indians for inter-ethnic comparison. The General Health Questionnaire, 28-item version (GHQ-28) measured psychoemotional symptoms in 3,020 subjects aged between 13-65 years. The GHQ-28 was validated against ICD-10 psychiatric diagnoses derived from structured psychiatric interview with the Composite International Diagnostic Interview (CIDI). RESULTS: The optimal cut-off point for the GHQ-28 was determined to be 4/5 for Chinese, and 5/6 for Malays and Indians. Using the validated ethnic-specific cut-offs, MPM rate for Chinese was 17.4%, Malays 15.1% and Indians 17.8%. The population MPM prevalence rate was estimated to be 16.6% after standardisation with population census data. Specific types of ICD-10 psychiatric disorders which give rise to MPM were mainly anxiety and depressive disorders. Twelve percent of individuals with MPM had at least one ICD-10 disorder in the previous year. CONCLUSION: Two-staged methodology is an efficient, cost-effective approach to study population prevalence of mental illness. Screening instruments utilised should be validated specifically for the culture and setting. Information from population surveys of psychiatric morbidity are important for the planning of mental health services for the country.

Adolescent↗
PubMed2001

Diagnostic performance of antineutrophil cytoplasmic antibody tests for idiopathic vasculitides: metaanalysis with a focus on antimyeloperoxidase antibodies.

OBJECTIVE: The diagnostic value of tests for antimyeloperoxidase antibodies (anti-MPO) for systemic vasculitis is less established than that for cytoplasmic antineutrophil cytoplasmic antibody (cANCA)/antiproteinase 3 antibodies (anti-PR3). Controversy exists regarding the optimal utilization of indirect immunofluorescence (IIF) ANCA testing versus antigen-specific ANCA testing. To summarize the pertinent data, we conducted a metaanalysis examining the diagnostic value of ANCA testing systems that include assays for anti-MPO. METHODS: We performed a structured Medline search and reference list review. Target articles in the search strategy were those reporting the diagnostic value of immunoassays for anti-MPO for the spectrum of systemic necrotizing vasculitides that includes Wegener's granulomatosis, microscopic polyangiitis, the Churg-Strauss syndrome, and isolated pauci-immune necrotizing or crescentic glomerulonephritis, regardless of other types of ANCA tests. Inclusion criteria required specification of a consecutive or random patient selection method and the use of acceptable criteria for the diagnosis of vasculitis exclusive of ANCA test results. Weighted pooled summary estimates of sensitivity and specificity were calculated for anti-MPO alone, anti-MPO + perinuclear ANCA (pANCA), and anti-MPO/pANCA + anti-PR3/cANCA. RESULTS: Of 457 articles reviewed, only 7 met the selection criteria. Summary estimates of sensitivity and specificity (against disease controls only) of assays for anti-MPO for the diagnosis of systemic necrotizing vasculitides were 37.1% (confidence interval 26.6% to 47.6%) and 96.3% (CI 94.1% to 98.5%), respectively. When the pANCA pattern by IIF was combined with anti-MPO testing, the specificity improved to 99.4%, with a lower sensitivity, 31.5%. The combined ANCA testing system (anti-PR3/cANCA + anti-MPO/pANCA) increased the sensitivity to 85.5% with a specificity of 98.6%. CONCLUSION: These results suggest that while anti-MPO is relatively specific for the diagnosis of systemic vasculitis, the combination system of immunoassays for anti-MPO and IIF for pANCA is highly specific and both tests should be used together given the high diagnostic precision required for these conditions. Because patients with ANCA associated vasculitis have either anti-MPO with pANCA or anti-PR3 with cANCA, and rarely both, a combined ANCA testing system including anti-PR3/cANCA and anti-MPO/pANCA is recommended to optimize the diagnostic performance of ANCA testing.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2004

Detection of multiple human herpes viruses by DNA microarray technology.

BACKGROUND: The detailed characterization of virus DNA is a challenge, and the genotyping that has been achieved to date has only been possible because researchers have sent a great deal of time and effort to do so. Instead of the simultaneous detection of hundreds of viruses on a single high-density DNA-chip at very high costs per chip, we present here an alternative approach using a well-designed and tailored microarray which can establish whether or not a handful of viral genes are present in a clinical sample. METHODS: In this study we applied a new concept of microarray-based, optimized and robust biochemistry for molecular diagnostics of the herpesviruses. For comparison, all samples were genotyped using standard procedures. RESULTS: The biochemical procedure of a knowledge-based, low-density microarray was established based on the molecular diagnostics of human herpes viruses: herpes simplex virus (HSV) HSV-1, HSV-2, varicella zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), and HHV-6. The study attempted to optimize parameters of microarray design, surface chemistry, oligonucleotide probe spotting, sample labeling and DNA hybridization to the developed DNA microarray. The results of 12 900 hybridization reactions on about 150 configured herpes virus microarrays showed that the established microarray-based typing procedure was reproducible, virus-specific and sufficiently sensitive with a lower limit of 100 viral copies per mL sample. CONCLUSIONS: The developed method utilizes low-fluorescence background coverslips, epoxy surface chemistry, standardized oligonucleotide probe spotting, PCR-labeling with Cy3 of isolated DNA, array hybridization, and detecting of specific spot fluorescence by an automatic microarray reader. We expect the configured microarray approach to be the method for high-throughput associated studies on human herpes viruses.

Carbocyanines↗
PubMed1991

Comparison of the diagnostic utility of timed serial (slope) creatine kinase measurements with conventional serum tests in the early diagnosis of myocardial infarction.

We compared the diagnostic utility of recently proposed slope assays for serum creatine kinase and creatine kinase-2 with the optimized decision threshold assays. The former approach has been claimed to be superior to any other single diagnostic technique. We show, by ROC curve and likelihood ratio analyses, that the total creatine kinase slope assay possesses the same diagnostic power, when confidence intervals are used, as the optimized decision threshold assay. Moreover, slope assays of creatine kinase-2 were diagnostically inferior to the optimized decision threshold assays. Indeed, these latter, optimized, assays have the highest likelihood ratios for a positive test result of the available assays, and they should always be used in situations of diagnostic doubt.

Adult↗