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At least 1,207 records · Page 67Linked to original sources
PubMed1995

Ectopic pregnancy: new advances in diagnosis and treatment.

Recent reports affirm that ectopic pregnancy has become a medical rather than a surgical disease. Early diagnosis is the key to effective nonsurgical treatment. Diagnostic algorithms using serum progesterone, serial beta-human chorionic gonadotropin measurements, ultrasound, and office curettage now make definitive diagnosis possible without laparoscopy. Laparoscopic salpingostomy, the surgical gold standard, is an effective therapy but carries surgical complications and is expensive. Systemic variable dose methotrexate produces outcomes close to laparoscopic salpingostomy in similar patients. Single dose systemic methotrexate and intratubal methotrexate appear to be less effective. In many cases, ectopic pregnancies do not meet suitable medical criteria and still require surgery. The challenge today is identifying patients at risk and bringing them into the system during the early first trimester when treatment is simple.

Female↗
PubMed1993

[Radiographic diagnosis of sacral meningeal cysts].

The aim of this study was to establish the incidence and morphological variety of sacral meningeal cysts as well as proposing diagnostic algorithm in dubious cases. A series of 1800 radicular-radiographies has been retrospectively analysed and 17 cases of a terminal cistern enlargement have been found (0.94%). Three types of cysts have emerged depending on its communication with the cerebral fluid reservoir. Two cases have illustrated the suggestion of performing CT scan instead of epidural administration of the contrast agent in case of suspected pathological mass within sacral spinal canal.

Adult↗
PubMed1993

Rapid diagnosis of cytomegalovirus pneumonia in marrow transplant recipients by bronchoalveolar lavage using the polymerase chain reaction, virus culture, and the direct immunostaining of alveolar cells.

The objective was to compare the use of the polymerase chain reaction (PCR), virus culture, and immunostaining of alveolar cells used alone and in combination as diagnostic methods for the rapid diagnosis of cytomegalovirus (CMV) pneumonia in marrow transplant recipients. Seventy-five marrow transplant recipients with clinical and radiological evidence of pneumonitis were used as subjects. Bronchoalveolar lavage was performed on all patients to obtain material for conventional and/or rapid CMV culture, immunostaining of alveolar cells with monoclonal antibodies (MoAbs), and amplification of CMV-DNA by PCR. Assay results were then prospectively correlated with clinical outcome. Seven of the 75 patients (9.3%) had CMV pneumonitis and 6 patients (8%) had CMV infection without pneumonia. PCR is the most sensitive assay for the detection of CMV in bronchoalveolar lavage fluid. For the diagnosis of CMV pneumonitis, the sensitivity of alveolar cell immunostaining and PCR were both 100%. The sensitivity of virus culture was 85.7%. The positive predictive value for each test, used alone, for the identification of CMV pneumonitis was low. However, when the result of the PCR assay was assessed in combination with CMV immunostaining of alveolar cells, the sensitivity, specificity, positive, and negative predictive value of this strategy was 100%. The concomitant use of PCR and the rapid immunostaining of alveolar cells for CMV has facilitated the development of a sensitive and specific diagnostic algorithm for the detection and early treatment of CMV pneumonitis in transplant recipients.

Animals↗
PubMed1995

[Preoperative instrumental diagnosis of postoperative choledocholithiasis].

Experience in examination of 221 patients with postoperative cholangiolithiasis is discussed. Analysis of the results of instrumental examination ERPCG to surpass all the existing methods of diagnosis of stones in the bile ducts in informativeness and safety. A diagnostic algorithm of examination is suggested by means of which the necessary tactical problems connected with the forthcoming operation were solved in 98.2% of cases.

Adult↗
PubMed1994

[Renal infarction following pulmonary surgery in a 13-year-old boy].

We report a case of renal polar infarction in a 13-year old boy following surgical excision of contralateral congenital lobar emphysema. Patient history was unremarkable and yielded no data suggestive of any other underlying pathology or systemic disease. The diagnosis was made on the CT, arteriography and DMSA scan findings. The etiology could not be determined. The patient was treated conservatively with prophylactic antibiotic therapy and followed closely. There were no complications; the patient was asymptomatic one month after the episode. The control IVP showed residual segmental atrophy and ultrasound evaluation disclosed cortical atrophy. The most common cause of this condition, the diagnostic algorithm, treatments and their indications are discussed. Renal graft infarction, which may be associated with acute rejection or venous and/or arterial thrombosis, warrants special attention. The treatment and clinical course are significantly different, although the diagnosis is made using the same methods.

Adolescent↗
PubMed1994

[The pharmaco-erection test].

Intracavernous administration of vasoactive drugs induces an erection in absence of erotic stimuli; we can use this property in the study of impotent patients, inducing the appearance on an erection to examine it in all its phases (FIC Test). In case of the appearance of a good erection, the test should rule out the presence of a penile arterial disease or of a corpora-veno-occlusive deficiency. When the administration of the drug does not cause complete tumescence, it is very probable that the erectile dysfunction is caused by arterial vascular alterations or by organic disorders of veno-occlusion mechanism, but we cannot exclude for a certainty a psychogenic dysfunction. In fact an excessive noradrenergic autonomic control, as during stress condition, may limit FIC Test response. Therefore we hope that more efficacious molecules will be available in a near future. Nevertheless, we consider the opportunity of enclosing tests in the diagnostic algorithm of impotent patients to reveal an excessive adrenergic tone, such as, for example, psychological tests, study of cavernous potential, or intracavernous catecholamine dosage.

Alprostadil↗
PubMed1994

Prompt diagnosis of ectopic pregnancy in an emergency department setting.

OBJECTIVE: To evaluate quantitative hCG measurements and transvaginal ultrasound in the diagnosis of ectopic pregnancy in patients presenting to the emergency department. METHODS: A discriminatory zone for detecting the presence or absence of an intrauterine pregnancy by transvaginal ultrasound was established prospectively. Women presenting to the emergency department were evaluated prospectively using a diagnostic algorithm consisting of clinical examination, quantitative serum hCG, and transvaginal ultrasound. Finally, ectopic pregnancies diagnosed over a 22-month period were evaluated prospectively. RESULTS: All viable intrauterine pregnancies were identified in those subjects with hCG levels of 1500 mIU/mL (First International Reference) or greater. One thousand two hundred sixty-three subjects were evaluated prospectively; 59.8% were diagnosed with intrauterine pregnancy, 26.8% with spontaneous abortion, and 7.8% with ectopic pregnancy. At presentation, 13.2% of intrauterine pregnancies were diagnosed by clinical examination, whereas 82.9% were diagnosed by transvaginal ultrasound. Only 4% of normal intrauterine pregnancies were not confirmed on initial visit. Of 205 ectopic pregnancies diagnosed, 81.5% were hemodynamically stable; of these, 49.1% were diagnosed on initial presentation. Of all ectopics, 59% never reached an hCG level of 1500 mIU/mL and 35.8% had an hCG lower than the level at presentation. This protocol diagnosed ectopic pregnancies with a sensitivity of 100% and a specificity of 99.9%. CONCLUSION: A protocol of quantitative hCG levels (available within hours of presentation to an emergency department) combined with transvaginal ultrasound is effective in diagnosing ectopic pregnancy.

Chorionic Gonadotropin↗
PubMedDate not supplied

The failed back syndrome.

In vertebral surgery we frequently observe patients who complain of lumbar pain at intervals of time which vary after surgery. The causes that may involve the persistence or the recurrence of these symptoms are many, after both decompression surgery, and spinal fusion. In order to favor a more rapid and accurate diagnosis, in our clinical we use a diagnostic algorithm based on the time at which the symptoms occurred. The most modern radiodiagnostic methods allow for a more accurate preoperative diagnosis and a more accurate diagnosis of the pathologies capable of perpetuating or re-accentuating lumbar pain postsurgery.

Algorithms↗
PubMed1994

A new approach to the study of diagnostic procedures in the United States.

Significant changes in the medical environment in the United States pose difficult questions for small medical specialties such as nuclear medicine. How do we get our voice heard in the debates that surround the reform process? What type of information is required to demonstrate the efficacy of nuclear medicine procedures? The older measures of sensitivity and specificity do not carry the same weight in health planning circles as they do in science. Data demonstrating the impact on the outcome for the patient are preferred. American nuclear medicine has started producing outcome data. We have high hopes that we can demonstrate to health planners both the medical and economic benefits of our specialty. Cardiac procedures seem to have an excellent chance of withstanding the challenges of analysis. Some oncologic procedures such as bone imaging are likely to survive unscathed as well. However, where procedure costs are very high, and the gains marginal, such as oncologic antibody imaging, there are serious questions about how these procedures will be reviewed. Likewise, while PET systems still hold great promise, unless data showing a positive impact on medical and economic outcome can be presented, this area is also in jeopardy. Where there is little challenge to the procedure, such as lung scanning, in all likelihood the procedure will retain its current place in the diagnostic algorithm. In closing, clearly as resources become increasingly scarce in medicine, difficult choices must be made. In the past, many of these decisions were made by those with the loudest voices.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1994

Prosthetic graft infection.

This article outlines the tenets and basic data critical for the management of prosthetic graft infections. Diagnostic algorithms and treatment options appropriate for patients with symptoms and signs suggestive of graft infection are presented.

Anti-Bacterial Agents↗
PubMed1993

[The differential diagnosis of the main forms of paroxysmal tachycardias and tachyarrhythmias].

A study is presented of 150 in-patients with paroxysmal tachycardias and tachyarrhythmias. Urgent management was carried out using a diagnostic algorithm designed by the authors that helped to establish early diagnosis using clinical adequate rational methods. Identification of clinico-pathogenetic form was realized in 95% of patients. Invasive examination was carried out in dubious cases. Transesophageal examination of the heart is of high value in emergency cardiology.

Adolescent↗
PubMed1993

Gallium-67 scintigraphy in tuberculous and nontuberculous infectious spondylitis.

Vertebral osteomyelitis is a difficult condition to diagnose clinically. A retrospective review of 21 cases of infectious spondylitis (6 tuberculous, 15 nontuberculous) confirmed the utility of 67Ga scintigraphy in imaging this process. Gallium-67 scans were positive at all sites of disease in this patient population. They anticipated the presence of spondylar infection in 23% of regions where radiographic abnormalities were originally lacking, while confirming a current and ongoing septic process at the other sites where vertebral destruction was already present on x-ray. Gallium-67 studies, as compared to the 99mTc-MDP bone scans, also provided important information as to the extent of disease by documenting the presence of eight paraspinal abscesses and the location of remote extraspinal foci of infection both in soft tissues and in bone. The relative merits of all radiologic imaging procedures are discussed. A diagnostic algorithm is also suggested.

Adolescent↗
PubMed1995

[Spontaneous bladder rupture with no apparent reason, a peculiar clinical occurrence].

OBJECTIVES: Herein we describe a case of spontaneous rupture of the bladder presenting with uncommon clinical features that led to difficulty in making the diagnosis. The literature on similar cases in briefly reviewed. METHODS/RESULTS: A case of rupture of the bladder arising from no apparent cause is described. Oliguria and abdominal pain were the presenting features and analysis disclosed renal failure. CONCLUSIONS: Rupture of the bladder may cause acute renal failure and acute abdomen and should therefore be included in the diagnostic algorithms of both disease entities.

Aged↗
PubMed1995

Non-paraganglioma jugular foramen lesions masquerading as glomus jugulare tumors.

Pulsatile tinnitus, hearing loss, lower cranial nerve deficits, and radiographic evidence of a vascular lesion of the jugular foramen have been considered diagnostic of a glomus jugulare tumor. Angiographic evidence of a blood supply from the external carotid artery system, including the ascending pharyngeal artery, further substantiates this diagnosis. This diagnostic algorithm for tumors of the jugular fossa is usually followed by either a surgical exenteration of a presumed glomus jugulare tumor via an infratemporal fossa approach or radiation therapy in selected patients. Pre-treatment biopsy of such lesions is typically not done, nor is it recommended widely in the literature. As demonstrated in this report, a number of lesions, including hemangiopericytoma and extramedullary plasmacytoma presenting in the jugular foramen can mimic glomus jugulare tumors in all aspects of their clinical and radiographic presentation. Omission of a pre-treatment biopsy can lead to a treatment plan appropriate for glomus tumors but suboptimal for these rare pathologic entities. A pre-treatment biopsy of lesions of the jugular foramen by exploratory tympanotomy or postauricular mastoidotomy provides a pathologic diagnosis on which to base treatment of lesions of the jugular foramen, without adding substantial morbidity or decreasing the chances of cure.

Adult↗
PubMed1995

[DSM IV and research. The problem of clinical trials].

Like its predecessors, DSM IV allows the prospective study population for clinical trials to be defined as accurately possible. The inclusion and exclusion criteria allow clear definition of the diagnostic category to which patients belong, and the simplest way of allowing the clinician to find his way through the criteria under consideration is to place the latter in a "checklist". The clinician then checks whether or not a given criterion is present, and after completing the checklist calculates whether the checked criteria are sufficient to warrant inclusion of a given patient. This approach, though methodical nevertheless, contains a significant drawback. The diagnostic criteria of DSM IV are at once "positive" (symptoms which a patient must present to qualify for inclusion in a diagnostic category) and "negative" (symptoms which the patient must not present in order to qualify for inclusion). In some cases it is relatively simple to establish the existence of such negative criteria (e.g. cases in which it must be ascertained that symptoms are due neither to ingestion of a toxic substance nor to recent bereavement). However, very often these negative symptoms are not presented one by one in the list of criteria, but are instead grouped together in an allusive phrase such as: "the symptoms must not be due to any associated disorder", or, "the symptoms must not occur exclusively during episodes of an associated disorder", or again, "the criteria of such and such a disorder are not met". Thus, in theory, each time a negative criterion of this type is encountered, the investigator must refer to the disorder for which diagnosis constitutes an exclusion criterion and verify that the conditions of this disorder are not met. For example, criterion B for major depressive episodes states that "the symptoms do not meet criteria for a mixed episode". It is therefore necessary to verify that the exclusion criteria are indeed absent. This type of "Chinese box" procedure thus implies that checklists should not only contain the diagnostic criteria for the particular disorder being sought, but that they should include a complete list of diagnostic criteria for all other disorders requiring exclusion. Since such an awkward procedure would make it impossible to draw up reasonable case report forms, a selection of exclusion criteria is generally made, often on a somewhat arbitrary basis. It might in fact prove more useful to adopt diagnostic algorithms.

Arousal↗