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[A classification of light reflexes of the ocular fundus (author's transl)].

The proposed classification resulted from many years of studying the light reflexes and their clinical importance in diseases of the fundus. The generally used term "retinal reflexes" is rejected; it is more appropriate to call them "light reflexes of the ocular fundus". They are divided into normal and pathologic reflexes. Pathologic reflexes are seen in diseases of the fundus. Within the group of normal reflexes it is possible to discern pathologic variants. The macular reflex, for example, may be normal or pathologic. Normal reflexes are the foveolar, the macular, the intramacular, the paramacular, the perimacular, the plane-like reflexes, Frost's points, the vertically linear reflexes, and the light streaks of the vessels. The pathologic reflexes comprise the fan-like, the focal, the peridiscal, the linear, the stationary, the metalloid reflexes, and the crystalline ones. This classification is intended not only for standardizing the nomenclature of the reflexes, but also for facilitating the recognition and differentiation of the numerous reflexes of the ocular fundus.

Diagnosis, Differential↗

Automatic identification of significant graphoelements in multichannel EEG recordings by adaptive segmentation and fuzzy clustering.

A new approach to visual evaluation of long-term EEG recordings is proposed. The method is based on multichannel adaptive segmentation, subsequent feature extraction, automatic classification of the acquired segments by fuzzy cluster analysis (fuzzy c-means algorithm), and on the distinguishing of thus identified EEG segments by colour directly in the EEG record. The black and white variant of the described automatic system is presented. The method was evaluated by applying it to simulated artificial data and to real EEG recordings; some of the illustrative results are shown. In addition, the performance of this system is evaluated and the first experience with its application to routine EEG recordings is discussed.

Algorithms↗

Differentiation, histogenesis and morphogenesis: their implications for tumor diagnosis.

Differentiation, as employed in tumor classification for histopathology, refers to the resemblance of neoplastic cells to their presumed cell/tissue of origin. Since differentiation for diagnosis is obtained by analysing histological images, this histogenetic concept creates practical limitations. Morphogenesis, a variant of differentiation, is a wider concept since it takes into consideration the nature of the tumor cells, their organization and their synthetic products. Consequently, morphogenesis, rather than differentiation, seems to be a better predictor of histogenesis in tumor diagnosis.

Cell Differentiation↗

The ultrastructural diagnosis of diffuse large-cell ("histiocytic") lymphoma. Fine structural study of 30 cases.

Thirty cases of diffuse large-cell ("histiocytic") lymphoma were studied with the electron microscope. The purpose was to define the criteria requisite for the ultrastructural diagnosis of large-cell lymphoma. The fine structural features of the lymphoma cells were compared to those of similar appearing reticuloendothelial neoplasms and other tumors that may simulate large-cell lymphoma by light microscopy. Two variants of large-cell lymphoma were recognized, each composed of neoplastic lymphoid cells with the morphologic features of transformed lymphocytes. The larger group represents large noncleaved cell lymphoma of Lukes and Collins' functional classification, while the second type corresponds to lymphoma of large cleaved cells. The ultrastructural features of large-cell lymphoma are uniform and usually easily identified. By utilizing diagnostic electron microscopy, large-cell lymphoma can often be distinguished from similar appearing tumors presenting as diagnostic problems at the light microscopic level.

Adolescent↗

Correction of respiratory motion in hepatic scintigraphy.

An analog device to correct for respiratory motion was used in 100 consecutive liver scans to determine its clinical utility. The sets of scan images generated were reviewed separately, then together, without knowledge of clinical presentation or imaging technique. When the images were reviewed separately, there was no clinical significant change in patient classification. When the images were reviewed together, 57% of the patients had detectable differences in image features, and in most instances this difference was limited to a clearer definition of organ outline or normal variants (e.g., gallbladder fossa). Of the 17 patients with focal hepatic disease, 14 had these defects better defined or additional lesions identified. Of the 18 patients with definite, diffuse, nonhomogeneous tracer distribution as seen in the uncorrected images, 12 had changes in scan appearance with motion correction. In eight patients the scan pattern became more normal, but in four the abnormal pattern was modified to that of focal defects.

Humans↗

Mouse proteome analysis.

A general overview of the protein sequence set for the mouse transcriptome produced during the FANTOM2 sequencing project is presented here. We applied different algorithms to characterize protein sequences derived from a nonredundant representative protein set (RPS) and a variant protein set (VPS) of the mouse transcriptome. The functional characterization and assignment of Gene Ontology terms was done by analysis of the proteome using InterPro. The Superfamily database analyses gave a detailed structural classification according to SCOP and provide additional evidence for the functional characterization of the proteome data. The MDS database analysis revealed new domains which are not presented in existing protein domain databases. Thus the transcriptome gives us a unique source of data for the detection of new functional groups. The data obtained for the RPS and VPS sets facilitated the comparison of different patterns of protein expression. A comparison of other existing mouse and human protein sequence sets (e.g., the International Protein Index) demonstrates the common patterns in mammalian proteomes. The analysis of the membrane organization within the transcriptome of multiple eukaryotes provides valuable statistics about the distribution of secretory and transmembrane proteins

Animals↗

Diffuse, multicentric neurogenic tumors in two macerated fetuses: a possible intrauterine form of neurofibromatosis.

Two tiny macerated fetuses with a remarkably similar pattern of multicentric neurogenic neoplasms of both paravertebral autonomic structures and peripheral nerves are described. Maceration precluded further histologic classification of the neoplasms in either fetus. The first fetus had a Meckel's diverticulum, short attachment of the small bowel mesentery, pulmonary hypoplasia, and intrauterine growth retardation. The second had the sympus bipus variant of sirenomelia sequence. The multicentric neoplasms in these two fetuses are very similar to those previously described in a few neonates and one stillborn with well-documented or suspected neurofibromatosis. It is reasonable to hypothesize that these two fetuses may represent an early intrauterine expression of neurofibromatosis characterized by multicentric neurogenic neoplasms of autonomic structures and peripheral nerves. Detailed examination of early abortuses, especially those from families with neurofibromatosis, may help to confirm or disprove the hypothesis.

Autonomic Nervous System Diseases↗

[Immunohistochemical research on human breast tumors using monoclonal antibodies to intermediate filament proteins. Cancer of the breast].

Immunomorphologic study of 29 breast cancer cases using monoclonal antibodies to proteins of intermediate filaments shown to differentiate the lining epithelium from myoepithelium in the non-proliferating epithelial structures of the mamma, has shown the cells in the majority of tumours (according to the International WHO Classification defined as infiltrating ductal, lobular, and tubular cancer forms) to contain prekeratin (PK) C12, specific for normal lining epithelium, but not for the myoepithelium. In cases of cancer with chondroid metaplasia (a malignant variant of the so-called "mixed tumour") the cells contained PK E3, vimentin and structural myosin, normally specific for myoepithelium. The cell heterogenicity in PK C12 content or its absence noted in the infiltrating cancers with predominance of a solid component can indicate a high degree of tumour anaplasia. It is concluded that usage of monoclonal antibodies to PK C12, invariably found in the cells of fibrotic invasion foci, can be a useful indicator for early diagnosis of infiltrative tumour growth.

Antibodies, Monoclonal↗

[Clinical aspects and differential diagnosis of cutaneous lupus erythematosus].

On the basis of LE cases treated at the Department of Dermatology, Düsseldorf University, during the last few years, we present the various forms of cutaneous lupus erythematosus (CLE). 72% of the patients showed discoid lupus erythematosus (DLE), whereas disseminated discoid LE (DDLE) and lupus panniculitis were found in 3% each. Lupus erythematosus tumidus (LET), as well, must be regarded as exceptional. Subacute cutaneous LE (SCLE) and systemic LE (SLE) showed nearly similar frequency (10 and 12%, resp.). Bullous LE is also very rare and must be considered a variant of SLE. The various forms of cutaneous LE can be differentiated according to clinical presentation and histopathology. Direct immunofluorescence, in contrast, has but limited diagnostic value, except with lesions on the scalp. Exact classification of cutaneous LE is the more essential, as it implies considerable therapeutic and prognostic consequences for the patient.

Diagnosis, Differential↗

[Results of long-term catamnesis of neurotic and psychopathic states and assessment of the prognosis].

The results of long-term follow-up studies indicate the existence of significant differences in the outcome of neurotic and psychopathic states. The most unfavorable outcome was seen in patients with asthenic and unstable psychopathy. A classification of a "good" and "poor" outcome of the disease by means of a computer permitted to distinguish the most significant anamnestic and clinical signs indicating a possible unfavorable prognosis. In the most unfavorable variant of the disease (21% of 124 psychopathic patients) in asthenic, unstable, excitative and hysterical psychopathy there were states with prevalently neurotic and psychopathic symptomatology, nonspecific for any of the above-mentioned forms of psychopathy.

Adjustment Disorders↗

[Asthenic disorders in persons infected with HIV at the initial stages of the disease].

Clinical psychopathological, follow-up and neuropsychological evaluation was made for 125 HIV-infected patients in stage 2B of the disease (general lymphadenopathy by V. I. Pokrovskiĭ's classification). It is shown that seropositive subjects had asthenic syndrome for the initial 6 months of the disease. According to the manifestations, asthenia was defined as psychogenic-reactive and organic. In the former variant the treatment involved psychotherapy and occasionally drugs, the latter was treated with chemotherapy and psychopharmacological modalities as the first-line and psychotherapy as adjuvant means. The authors expect that a differential approach to HIV-infection-related asthenia at the disease onset may contribute to better life quality and prognosis in AIDS patients.

AIDS-Related Complex↗

[Carcinoid lung tumors: clinico-morphologic characteristics, diagnosis].

Review of the literature on carcinoid lung tumors covers classification, macro- and microscopical structure, prognosis of typical and atypical carcinoids, role of special staining methods and electron microscopy in their diagnosis. The role of electron microscopy in the diagnosis of a rare structural variant, oncocytic carcinoid, is emphasized.

Carcinoid Tumor↗

[Definition, diagnosis, and classification of lupus].

Polysystemic lupus erythematosus is a disease of unclear origin. Spontaneous course is characterized by flares followed by remissions. The classification criteria are often used as diagnostic criteria, but they are insensitive for early diagnosis purpose. Decisional trees and ponderation of the various criteria have been reported to help clinicians for early diagnosis. Clinical variants of lupus erythematosus are numerous such as initial clinical manifestations; epidemiological considerations have shown different subsets with different manifestations depending on ethnicity, age at first symptoms, environmental factors (drug-induced lupus). Genetic background influences the autoantibody profile. Correlations have been reported between serological and clinical presentation.

Decision Trees↗

Prognostic value of CD44 isoform expression in thymic epithelial neoplasms.

BACKGROUND: Many histologic classifications of thymic epithelial tumors have been reported to date, but to the authors' knowledge, none of them closely reflect the clinical behavior or prognosis of the tumor. Therefore, it is necessary to establish a biologic marker for thymic epithelial tumors. Variants of CD44 may be important in promoting tumor progression and metastasis. Accordingly, the expression of CD44 isoforms in thymic epithelial neoplasms was investigated using immunohistochemistry to assess their possible value as prognostic indicators. METHODS: Expression of CD44v6 in thymic epithelial tumors was investigated with immunohistochemistry using consecutive surgical specimens resected from 108 patients between 1983 and 2002 at Juntendo University Hospital in Tokyo, Japan. RESULTS: Among the 108 thymic epithelial tumors, 70 were negative for CD44v6, 20 were weakly positive, and 18 were strongly positive. The status of CD44v6 expression (negative vs. weakly plus strongly positive) was found to be correlated with the tumor stage according to the Masaoka staging system (noninvasive vs. invasive tumors) (P = 0.0214). When patients with tumors that were negative and weakly positive for CD44v6 expression were combined, the 5-year, 10-year, and 15-year recurrence-free survival rates were 98.2%, 95.9%, and 86.1%, respectively, whereas the corresponding rates for patients with strongly positive tumors were 73.5%, 73.5%, and 55.1%, respectively. Therefore, these two groups demonstrated a significant difference with regard to recurrence-free survival (P = 0.0172). CONCLUSIONS: CD44v6 expression in thymic epithelial neoplasms demonstrated a significant difference based on the World Health Organization classification, the Masaoka stage (invasive vs. noninvasive tumors), and recurrence, if an appropriate cutoff value was chosen in each case. This suggests that CD44v6 can be used as a marker that reflects the stage of thymic tumors.

Adult↗

Clinical characteristics of first-admitted patients with ICD-10 schizotypal disorder.

BACKGROUND: The clinical picture of schizotypal disorders is rarely comprehensively described. AIMS: To describe psychopathological profiles of patients with ICD-10 schizotypal disorder. METHOD: A total of 151 first-admitted patients (with affective and somatic disorders excluded) were given a comprehensive psychopathological evaluation, including the Bonn Scale for the Assessment of Basic Symptoms. Patients with schizotypal disorder (n=50) were compared with those with psychosis (n=51) and those outside the schizophrenia spectrum (other diagnoses, n=50) on a number of psychopathological scales. RESULTS: Patients with schizotypal disorder scored intermediately between patients with psychosis and other diagnoses on scales related to positive and negative symptoms, disorders of emotional contact and formal thought disorder, but had the same scores as patients with schizophrenia for subtle aberrations of subjective experience. Schizotypal criteria were not normally distributed with an excess of patients between 2 and 6 criteria. Family history of schizophrenia was equally elevated among those with schizotypal disorder and those with psychosis. CONCLUSIONS: ICD-10 schizotypy represents a milder, less psychotic, variant of schizophrenia but there is no clear-cut division between the two disorders.

Adult↗

Guillain-Barré syndrome in Pakistan: similarity of demyelinating and axonal variants.

Guillain-Barré syndrome (GBS) comprises multiple subtypes whose nosological and pathophysiologic interrelationships are unclear. In an attempt to better understand the relationship between the disease's major subtypes, we reviewed the characteristics of GBS cases consecutively admitted to a tertiary care hospital in Karachi, Pakistan, over a 13-year period. Of 175 cases, 80 (46%) were demyelinating and 55 (31%) axonal, whilst 40 (23%) had ambiguous electrophysiological findings precluding classification. The three groups differed in severity of weakness at presentation (axonal approximately ambiguous > demyelinating; P = 0.002 for arm strength and P = 0.025 for leg strength); mean age (demyelinating > axonal > ambiguous; P = 0.05); and mean cerebrospinal fluid protein concentration (demyelinating > ambiguous > axonal; P = 0.05). However, they were similar in several other respects, including gender ratio, proportion of pediatric cases, history of antecedent infection, length of hospital stay, need and duration of mechanical ventilation, and functional outcome at discharge. Stool culture data was available for 146 (83%) cases in the study; none was positive for Campylobacter jejuni. GBS in Pakistan comprises a high proportion of axonal cases. Similarity of outcomes in axonal and demyelinating variants and lack of C. jejuni stool culture positivity are atypical features.

Adolescent↗

Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection.

The purpose of the present study was to evaluate the anatomical variability of the superior labrum and to compare the value of MR arthrography and multi-slice CT arthrography in the diagnosis of variants of the labro-bicipital complex. Forty-three human shoulder specimens (age range and mean age at death, 61-89 years and 78.3 years) were examined with the use of MR arthrography and multi-slice CT arthrography prior to joint exploration and macroscopic inspection of the superior labrum and labro-bicipital complex. Two radiologists evaluated MR and CT arthrograms, and the results were compared with macroscopic assessments. Anatomical dissection of all shoulder specimens revealed a sublabral recess in 32/43 (74%) cases. The attachment of the superior labrum was categorised as type 1 in ten (23%) cases, as type 2 in eight (19%), as type 3 in ten (23%), and as type 4 in 14 (33%) cases. One superior labrum showed detachment consistent with a superior labral anteroposterior (SLAP) type 3 lesion. On MR arthrography and CT arthrography the attachment of the superior labrum was categorised in concordance with macroscopic assessments in 79% and 84% of cases, respectively. The anteroposterior extension of sublabral recesses was accurately determined with MR and CT arthrography in 59% and 81% of cases, respectively. The attachment of the superior labrum shows considerable variability. Thus, exact depiction of variants is essential in order to avoid the false positive diagnosis of a superior labral tear (SLAP or Andrews lesion). Both, MR arthrography and multi-slice CT arthrography were effective in the detection and classification of sublabral recesses.

Aged↗

Phakomatosis pigmentovascularis: A new case with renal angiomas and some considerations about the classification.

We report phakomatosis pigmentovascularis detected in a Caucasian child characterized by the presence of a nevus flammeus and nevus anemicus on the face, a telangiectatic linear nevus of the right leg, and a very extensive blue spot covering 60% of the body surface, with ocular melanosis. Multiple angiomatous lesions of the kidney are associated without alterations of the central nervous system (CNS). This association has not been reported before; it could be a further expression of the complex of developmental defects. Our case corresponds exactly to type IIb in the classification of phakomatosis pigmentovascularis proposed by Hasegawa. As this classification seems very extensive, the higher incidence of cases corresponding to the second subtype suggests that we should identify it by the term phakomatosis pigmentovascularis, while the others could be considered as only very uncommon variants.

Facial Neoplasms↗