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PubMed1987

[Bilateral and familial occurrence of germ cell tumors of the testis].

A reclassification study based on the W.H.O. nomenclature was made of 255 testicular germ cell tumours examined in the Department of Pathology of the District Hospital Schwerin between 1958 and 1985. Thereby some cases of bilateral and familial occurrence were found. 4 cases (1.6%) with bilateral tumours were observed. Only in one of the four cases both tumours were discovered at the same time. The longest interval before contralateral occurrence was 19 years. Familial connections were found in 6 cases (2.4%), in one twin-pair and twice in brothers.

Adolescent↗
PubMed1987

The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system. An empirical determination from a nationally representative sample.

To clarify the financial incentives for hospitals to prevent nosocomial infections, we analyzed 9423 nosocomial infections identified in 169 526 admissions selected randomly from the adult admissions to a random sample of US hospitals. By classifying each admission into a baseline diagnosis related group (DRG) (after first excluding all diagnoses of nosocomial infection) and a final DRG (after including these diagnoses), we found that only 5% to 18% of nosocomial infections would have caused the admission to be reclassified to a higher-paying DRG, depending on the extent to which physicians recorded nosocomial infection diagnoses in patients' medical records. The extra payment from the reclassification, averaged over all nosocomial infections, would have been no more than $93 per infection (in 1985 reimbursement rates), constituting only 5% of the hospitals' costs for treating these infections. Thus, at least 95% of the cost savings obtained from preventing nosocomial infections represents financial gains to the hospital.

Adult↗
PubMed1988

T cell recognition of Mlsc,x determinants.

Among a large number of cow insulin-specific T cell clones derived from both C57BL/10 and B10.A strains, several were found to react to non-MHC-linked gene products of a number of allogeneic strains. The stimulatory moiety for three of these clones correlates, in part, with expression of Mlsc, as defined by mouse strains C3H/HeJ and A/J. In addition, all three of these clones are stimulated by cells from strain PL/J, which has the poorly defined Mlsx allele. The data strongly suggest that Mlsx may, in fact, be Mlsc or is, at least, highly cross-reactive with Mlsc. Segregation analysis by using (B10.D2 X PL/J)F2 mice demonstrates that the Mlsx gene is genetically independent of the Mlsa linked Ly-9 marker on chromosome 1. Further studies with the use of these Mlsc,x-reactive clones reveal that they also recognize a gene product present in many mouse strains including DBA/2 which were previously phenotyped as Mlsa. However, testing of BxD recombinant inbred lines excludes Mlsa as being the stimulatory moiety. We therefore propose reclassification of the Mls phenotypes of several mouse strains based upon a two-locus model for Mls.

Animals↗
PubMed1977

[Multivariant discriminance analytical computation methods for the evaluation of clinico-chemical parameters in liver and biliary tract diseases].

Multivariate variance and discriminance-analytic investigations on the value of evidence of clinico-chemical tests in the diagnostics of diseases of the liver and the biliary tract gave the following results: 1. By means of clinico-chemical methods and discriminance-analytic functions we succeed in 50% of the cases in formulating a correct diagnosis, in more than 75% of the cases a correct probability diagnosis (3 first places in the rank of diagnoses). Sensitivity and specificity of discrimination were established for 15 classes of diagnoses. 2. Due to the intercorrelations of test results biochemical maximum programmes contain numerous redundant parameters measured on diagnostic information values. With the help of a test for indispensability (redundance test) among 20 parameters owy 5-6 were characterized as indispensable. An optimal combination of parameters should not transgress an extent of 14 tests. 3. Results of reclassifications with discriminance analytic functions confirmed that the discriminance analysis is an extraordinarily suitable method for the computer-supported finding of a decision, on which basis aimed additional investigations might be performed.

Analysis of Variance↗
PubMed1988

[Use of methods of pattern recognition in the detection of evoked potentials].

Pattern recognition methods based on parameters and on geometry are described briefly and the results obtained with different characteristics in 79 patients with single potential recognition and subsequent sequential testing are presented. In subjectively very safely identifiable potentials accurate results in a proportion of up to 92% are obtained; if all tests with a subjective rating are considered, one obtains a correct automatic reclassification quota of 69% for the randomly selected sample. This system can help the examining person by supplying him with decision criteria. However, without additional processing of the entire context automatic processing is not sufficiently safe. Possibilities for the use of the automatic recognition method in scientific problems are demonstrated by means of examples.

Algorithms↗
PubMedDate not supplied

Inflammatory atypia. An apparent link with subsequent cervical intraepithelial neoplasia explained by cytologic underreading.

A review of 5,752 cervical smears done on college students at a medium-sized midwestern university in a 24-month period showed 496 cytologic diagnoses of inflammatory atypia and 132 of dysplasia (cervical intraepithelial neoplasia: CIN). Further retrospective review of a nonselected cohort (178 cases) of the 496 patients with inflammatory atypia showed that their subsequent cytologic smears were more likely to show CIN than could be explained by chance alone. Only ten cases accounted for this difference, and a case-controlled blind review of the original cytologic smears of these ten patients resulted in the reclassification to CIN (mild dysplasia) of seven who had subsequently "progressed" from inflammatory atypia to dysplasia. Only one control smear was reclassified. In this population, underreading of a small number of cervical smears explained a strong statistical apparent correlation between inflammatory atypia and the subsequent development of CIN.

Adult↗
PubMedDate not supplied

Standardized model for diagnosing cervical carcinoma in situ based on the cytologic signs.

An attempt was made to optimize the recognition of cervical intraepithelial carcinoma in situ (CIS) by the adoption of a standard set of rules derived from a case-control study of 50 histologically confirmed incidence cases of CIS and a simple random sample of 100 controls from the same mass screening population examined between 1977 and 1984. One cytotechnologist screened the slides for all occurrences of a standard set of classic cytopathologic signs. Chromatin clumping, dyskeratosis, anisonucleosis and an increased nuclear-cytoplasmic ratio in cells from the deep layer and chromatin clumping and anisonucleosis in cells from the superficial layer showed an association with the diagnosis of CIS, in decreasing order of magnitude. These variables make up a binary discriminant model; adding vacuolization, anisocytosis, prominent nucleoli and multinucleation to this model did not appear to improve its discriminatory power. The discrimination function accommodates any a priori judgment regarding the probability and utility of diagnostic outcomes. Cytologists normally manipulate the probabilities and utilities intuitively; the model requires the translation of intuitive judgments into quantitative estimates. For example, in our cytology laboratory, the CIS pick-up rate is approximately 1 per 1,000 smears; a 1:1,000 negative utility ratio of a false positive versus a false negative is thus used in our model. Given this, our model has a sensitivity of 86% and a specificity of 96% upon reclassification, and its predictive power (true positives/false positives) is 21.5. This standardized cytodiagnosis model is relevant to any local diagnosis-specific probability and utility estimates.

Carcinoma in Situ↗
PubMed1987

Differential WAIS/WAIS-R IQ discrepancies among institutionalized mentally retarded persons.

Compared to the Wechsler Adult Intelligence Scale, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) is generally reported to result in IQs that are somewhat lower for nonretarded subjects and unchanged for retarded subjects. In the present study these findings were replicated with subjects in a residential treatment center, except that the moderately retarded subgroup demonstrated significantly higher WAIS-R IQs (mean increase of 6 points in Full Scale IQ), with reclassification as mildly mentally retarded possible for 64% of these persons. Such differential, level-specific effects require careful interpretation of WAIS-R IQs of retarded persons in the context of actual adaptive skills.

Adolescent↗
PubMedDate not supplied

Comparison between magnetic resonance imaging and other techniques in 39 multiple sclerosis patients.

Till now there are no specific laboratory tests to confirm the diagnosis of Multiple Sclerosis (MS). For this reason the diagnosis of MS is based on the clinical evidence of central nervous system white matter disease with temporal and spatial dissemination of the lesions. Recent advances in neurophysiology and imaging techniques can provide more objective criteria towards more accurate and earlier diagnosis, detecting clinically unsuspected lesions. We evaluated 39 MS patients (23 definite, 7 probable, 9 possible) by Magnetic Resonance Imaging (MRI), CT scan, Evoked Potentials (EPs) testing and Cerebrospinal Fluid analysis. MRI was abnormal in 34 cases (87%) and CT scan in 14 (36%); EPs were also abnormal in 34 cases. 30 patients had both EPs and MRI alterated and 4 patients had alterated only one of the two investigations. The frequency of EPs alterations was: VEP 74%, Median SEP 44%, Tibial SEP 59% and BAEP 54%. The BAEP was more sensitive than MRI in detecting brainstem involvement. On the other hand MRI was more sensitive than SEPs in detecting somatosensory pathways involvement. The combined use of the two techniques allowed a reclassification of 10 out of 16 possible or probable MS cases.

Adult↗
PubMedDate not supplied

Computer discriminant analysis of atypical urothelial cells.

Prior computer studies of digitized cell images by the TICAS system have shown that the category of urothelial cells classified visually as atypical may be composed of 2 subgroups, one clustering mainly with benign cells and the other with malignant cells. As a consequence, a visual review of the group of atypical cells was conducted and tested by computer discriminant analysis. The computer classification confirmed the visual reclassification and subdivision of atypical urothelial cells into 2 subgroups, ATY I and ATY II. This is yet another example of feedback from computer diagnosis to visual assessment of cells. The significance of these observations in terms of diagnosis will be the subject of subsequent communications.

Computers↗
PubMed1987

Multimodal evoked potentials in multiple sclerosis: a contribution to diagnosis and classification.

The adoption of multimodal evoked potential procedures for the diagnosis and classification of multiple sclerosis is recommended as capable of revealing subclinical lesions of the central nervous system. The CSF test is also helpful, though in a different way. We present the results obtained by VEP, BAEP, SEP-median and SEP-tibial examinations and by CSF analysis (OB+) in a group of 189 MS patients, of whom 103 were diagnosed as definite. 58 as probable and 28 as suspected MS cases according to McDonald and Halliday, criteria. EPs frequently displayed clinically silent lesions, enabling us to reclassify 14 of the 37 potentially reclassifiable subjects (37.8%). The CSF test (OB+) allowed the reclassification of 31 out of the 58 reclassifiable cases (53.4%). In the present report we discuss the usefulness of the two methods.

Adolescent↗
PubMed1986

Exercise physiology in the 1990's: mechanistically defining the exercise model.

Definition of the exercise model via a mechanistic approach is a goal which should be of high priority among sport researchers in the 1990's, in an attempt to further qualify previous phenomenological observations of exercising man. Prolonged argument on the "theory-versus-practice" issue is one which is counter-productive in the advancement of knowledge in our discipline, and must be addressed and resolved. With specific emphasis on the neuromuscular control of movement, current research literature suggests that the components limiting to human performance may reside in the muscle, motoneurone and in the supraspinal of movement. Mechanistically defining the limits in each component, related to patterns of movement during exercise, may soon herald a reclassification of exercise types and their limits, defined by the particular system involved. Similarly, new evidence on adaptations throughout the neuromuscular system calls for a systematic study of these adaptations, how they influence structure and function of cell and organ systems, and their effects on the performance of the voluntarily exercising human. A mechanistic approach to these problems, using "simple" experimental models to more precisely define cause-effect, are justifiable and necessary in our field on the basis of the potential applicability of such information in the fields of design of exercise programmes, and the evaluation of their effectiveness, for normal and special populations. The problems associated with increased academic specialization and the communication gap which might result, are not inevitable. An enhancement of the proliferation of this knowledge and its interpretation in practical terms will result through our own awareness of the necessity of doing this, and through sensitization of our students to this issue.

Humans↗
PubMed1986

[Value of multimodal evoked potentials in the diagnosis of multiple sclerosis].

94 Patients diagnosed as having multiple sclerosis (MS) were examined by multimodal evoked potentials. According to the criteria of Bauer and Poser the patients were classified as possible, probable and certain forms of MS. Abnormalities were found in the VEP in 82.6% of cases (possible - 44.4%, probable - 87.5%, certain - 95.2%), in the BAEP in 51.3% of cases (possible - 27.3%, probable - 46.2%, certain - 68.8%) and in the SSEP in 71.1% of cases (possible - 35.3%, probable - 67.7%, certain - 88.1%). Subclinical lesions were detected by VEP in 37.0% of cases, by BAEP in 43.6% and by SSEP in 21.1%. Reclassification according to the results of the evoked potentials studies was required in 21.2% of cases. The value of evoked potentials in the diagnosis of MS is discussed with regard to the different forms of evoked potentials, as well as in comparison with other examination techniques.

Adolescent↗
PubMed1987

[Reproducibility of a non-Hodgkin's lymphoma classification].

In a retrospective reclassification of 148 non-Hodgkin's lymphomas the reproducibility of the Lukes--Collins classification used was tested by comparing a joint diagnosis with that of each author separately. The cases of disagreement were usually proved to have happened within lymphoma groups with an equivalent prognosis. An exception was the relatively high disagreement rate between the subclasses of small lymphocytic and small non-cleaved lymphomas, and this represents the most important finding clinicopathologically.

Female↗
PubMed1985

Survival, myocardial infarction, and employment status in a prospective randomized study of coronary bypass surgery.

This report from the European Prospective Randomised Study presents 8 year results on survival and 5 year results on myocardial infarction and employment status. The 768 recruited patients were all men under age 65 with mild or moderate angina, 50% or greater stenosis in at least two major coronary arteries, and a left ventricular ejection fraction of 50% or greater. One "surgical" patient was lost to follow-up immediately after randomization and is therefore excluded from the statistical analysis. Thus 394 patients allocated to surgery were compared with 373 patients allocated to medical treatment, regardless of what subsequently happened to the patients. The policy of early surgery improved survival significantly compared with the conventional medical treatment policy in the total population (89% to 80%, respectively; p = .0013) and in the subgroup with three-vessel disease (92% and 77%, respectively; p = .00015). Reclassification of vessel disease by greater than 75% instead of 50% or greater stenosis as the criterion was undertaken to facilitate comparison of these results with those of other studies, which apply 70% or greater stenosis as the criterion of significant disease. Of the 767 patients, a cohort of 711 were identified as having greater than 75% obstruction in one, two, or three vessels. A significant improvement in survival with surgery was found in the total cohort (89% and 80%, respectively; p = .0022), the subgroup with three-vessel disease (91% and 73%, respectively; p = .0044), and that with two-vessel disease in which one of the diseased vessels was the proximal segment of the left anterior descending artery (LAD) (90% and 79%, respectively; p = .013). There was no significant difference in survival between the two treatments in patients with one-vessel disease and those with two-vessel disease without proximal LAD stenosis. Four noninvasive prognostic variables were independently predictive of the effect of surgery: resting electrocardiogram (in 767 patients), ST segment response to exercise (in 656), history and physical signs of peripheral arterial disease (in 722), and age (in 767). A reduction in cardiac deaths was entirely responsible for the improved survival with surgery. The incidence of myocardial infarction in the medical group (11%) was not significantly different from that in the surgical group (15%). Repeat angiography in 71 patients showed 6% graft closure between 1 and 5 years of follow-up. Surgery did not influence the gradually increasing annual rate of retirement from work.

Adult↗
PubMed1985

Cell marker analysis of extranodal lymphoid infiltrates: to what extent does the determination of mono- or polyclonality resolve the diagnostic dilemma of malignant lymphoma v pseudolymphoma in an extranodal site?

Lymphoid cell marker analysis has provided objective immunologic criteria by which to distinguish between benign pseudolymphomas and malignant lymphomas occurring in extranodal sites and has improved our understanding of extranodal lymphoid proliferations, thereby substantially altering our perspective of these lesions. These studies have resulted in a dramatic reclassification of the majority of the extranodal small lymphocytic proliferations (previously designated pseudolymphomas by histopathologic criteria) as malignant lymphomas, based upon immunologic criteria. However, this redefinition has not truly resolved the diagnostic dilemma of the extranodal small lymphocytic proliferation, nor has it measurably improved our ability to accurately predict patient outcome. It appears that the majority of patients with a monoclonal B small lymphocytic lymphoma localized to a solitary extranodal site enjoy a benign clinical course and long survival with only minimal therapeutic intervention.

B-Lymphocytes↗
PubMed1986

Prednimustine v cyclophosphamide-vincristine-prednisolone in the treatment of non-Hodgkin's lymphoma with favorable histopathology: results of a national cancer care program in Sweden.

In a nationwide multicenter study, single-agent treatment with prednimustine (PM) was compared with combination chemotherapy with CVP (cyclophosphamide, vincristine, and prednisolone) in patients with stage III-IV non-Hodgkin's lymphoma (NHL) with favorable histology (Rappaport groups nodular lymphocytic poorly differentiated, nodular mixed, and diffuse lymphocytic poorly and well-differentiated). From January 1979 to May 1982, 217 evaluable patients were randomized, and at present analysis, the median follow-up time is 42 months. Overall response rate in the PM group was 63% (complete, 40%; partial, 23%) compared with 66% in the CVP group (complete, 32%; partial, 34%). There was no significant difference in relapse-free survival (RFS) or survival between the two groups, median RFS being 30 months and median survival being 42 months, respectively. Reclassification of the lymphomas according to the Kiel system (possible in 80%) revealed high-grade malignant NHL in 22 patients (12 in PM group, 10 in CVP group). Within this small group, there was a marked difference in survival in favor of CVP-treated patients. However, treatment with PM was less toxic and better tolerated than the CVP regimen. It was concluded that for patients with low-grade malignant NHL treatment with PM is equally effective and less toxic than the CVP regimen.

Adolescent↗