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At least 1,297 records · Page 72Linked to original sources
PubMed2001

[The diagnostic concept of acute infection of the shoulder joint].

INTRODUCTION: It is generally accepted that septic conditions of the shoulder often lead to an earnest situation with joint damage. Because of the low incidence of shoulder infections there are only a few cases reported in the literature. Therefore, unlike joint infections of the knee no diagnostic and therapeutic standard procedure is documented for the shoulder. MATERIALS AND METHODS: In a retrospective study the results of 15 patients with a surgical revision at the BG-Clinic-Bergmannsheil-Bochum between 1 January 1989 and 31 August 1999 after an infection of the shoulder joint were analyzed. We registered the following parameters: etiology, intervall until the first clinical symptoms, clinical signs, diagnostic procedure, intraoperative site (Gächter classification), and operative treatment. The diagnostic procedure followed an algorithm, including CRP-determination, ultrasound of the shoulder, ultrasound-guided aspiration and a Gram stain. If the result was positive, surgical joint revision followed. The infection stage was classified intraoperatively according to the criteria of the Gächter classification. Eight patients were reexamined after an average follow-up of 4.8 years. RESULTS: Fourteen infections followed injection. All patients demonstrated increasing CRP levels and a painful limited range of motion. In all Gram stains we detected bacterial organisms. The diagnosis of an acute infection according to the criteria of this diagnostic algorithm was verified intraoperatively in all 15 joints. Two patients with delayed admission died postoperatively due to septic multiorgan failure despite maximal treatment under intensive care conditions. CONCLUSION: If there are suspicious clinical symptoms after a typical anamnesis, we recommend an immediate diagnostic algorithm, including CRP determination, ultrasound of the shoulder, ultrasound-guided joint puncture and a Gram stain. If there is acute joint infection, time-consuming diagnostic procedures must be avoided because of the risk of secondary reduced joint mobility or life-threatening complications.

Acute Disease↗
PubMed1995

Recent developments in cardiac pacing.

Indications for cardiac pacing continue to expand. Pacing to improve functional capacity, which is now common, relies on careful patient selection and technical improvements, such as complex software algorithms and diagnostic capabilities.

Algorithms↗
PubMed1995

Standardisation of primers and an algorithm for HIV-1 diagnostic PCR evaluated in patients harbouring strains of diverse geographical origin. The Belgian AIDS Reference Laboratories.

Eight Belgian AIDS Reference Laboratories established a multicentre quality control to evaluate the performance of their diagnostic human immunodeficiency virus type 1 (HIV-1) DNA polymerase chain reaction (PCR). A set of Belgian and African HIV-1 seropositive and seronegative patient samples, collected in Belgium, and the British Medical Research Council (MRC) HIV-1 PCR reference reagent kit, containing plasmid HIV-1 DNA at several dilutions in human carrier DNA with appropriate negative controls, were tested by the laboratories. No false positive results were reported. All laboratories were able to detect one to two copies of HIV-1 DNA. Among the 17 Belgian and African HIV-1 seropositives, some laboratories reported up to four indeterminate results, mainly due to failure of the SK38-39, SK68-69 (Ou et al. (1988) Science 239, 295-297) and/or gag881-882 (Simmonds et al. (1990) J. Virol. 64, 864-872) primers and a poorly performing algorithm. Only the H1POL4235-4538 nested pol primer set, developed by one of the laboratories, correctly identified all the tested HIV-1 positive and negative samples. Consequently, the laboratories decided to evaluate these pol primers as a reference primer set and to standardise the testing algorithm. All laboratories achieved a sensitivity and specificity of 100% on testing 10 additional Belgian and African patient samples, when adapting a standardised algorithm based on three HIV-1 primer sets, one of which is the H1POL4235-4538 primer set.

Africa↗
PubMedDate not supplied

Imaging evaluation of suspected pulmonary embolism.

Venous thromboembolism (VTE) is a common disorder that is difficult to diagnose clinically but carries significant morbidity and mortality if untreated. Additionally, although demonstrated to be of benefit in cases of proven deep vein thrombosis (DVT) and pulmonary embolism (PE), anticoagulation therapy is not without risk. Because the clinical exam is known to be unreliable for the detection of both DVT and PE, many imaging modalities have been used in the diagnostic imaging algorithm for the detection of VTE, including chest radiography, ventilation/perfusion (V/Q) scintigraphy, pulmonary angiography, and recently, spiral computed tomography (CT) and magnetic resonance imaging (MRI). Chest radiographic findings in acute PE include focal oligemia, vascular enlargement, atelectasis, pleural effusions, and air space opacities representing pulmonary hemorrhage or infarction. The chest radiograph can occasionally be suggestive of PE but is more often nonspecifically abnormal. The main use of the chest radiograph in the evaluation of suspected PE is to exclude entities that may simulate PE and to assist in the interpretation of V/Q scintigraphy. Lower extremity venous compression ultrasonography (CU) is both sensitive and specific for the diagnosis of femoropopliteal DVT, and the value of negative CU results has been established in outcomes studies. However, the reliability of CU for the detection of isolated calf vein thrombosis is not well established, and the clinical significance of such thrombi is debatable. Additional methods such as color and spectral Doppler analysis are also useful in the diagnostic evaluation of DVT but are best considered as adjuncts to the conventional CU examination rather than as primary diagnostic modalities themselves. Compression ultrasonography and Doppler techniques are useful in the evaluation of suspected upper extremity DVT; spectral Doppler waveform analysis is particularly useful to assess for the patency of veins that cannot be directly visualized and compressed with conventional gray-scale sonography. V/Q scintigraphy has been the initial modality obtained in patients suspected of PE for a number of years. Although many studies have investigated the role of V/Q scintigraphy in the evaluation of VTE, the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study has provided the most useful information regarding the utility of V/Q scintigraphy in this setting. A high probability scan interpretation is sufficient justification to institute anticoagulation, and a normal perfusion scan effectively excludes the diagnosis of PE. A normal/near normal scan interpretation also carries a sufficiently low prevalence of angiographically proven PE to withhold anticoagulation. Although the prevalence of PE in the setting of low probability scan interpretations is low and several outcomes studies have demonstrated a benign course in untreated patients with low probability scan results, patients with inadequate cardiopulmonary reserve do not necessarily have good outcomes. Such patients deserve more aggressive evaluation. Patients with intermediate probability scan results have a 20% to 40% prevalence of angiographically proven PE and thus require further investigation. The radionuclide investigation of DVT includes such techniques as radionuclide venography and thrombus-avid scintigraphy. Although these methods have not been as thoroughly evaluated as CU, studies thus far have indicated encouraging results, and further investigations are warranted. Pulmonary angiography has been the gold standard for the diagnosis of PE for decades. Studies have indicated that angiography has probably been underutilized by referring physicians for the evaluation of suspected PE, likely because of the perception of significant morbidity and mortality associated with the procedure. (ABSTRACT TRUNCATED)

Algorithms↗
PubMed1986

[Is systematic syphilis serology still useful in a department of internal medicine? A one-year prospective study using a diagnostic and therapeutic decision algorithm].

During one year syphilis serology was systematically studied, using the TPHA and VDRL tests, in each of the 1,279 patients hospitalized in an Internal Medicine department. In all cases diagnosis and treatment were analyzed by means of a decision algorithm. Only 37 patients were found to have one or both serological tests positive. No evolutive syphilis was observed, and none of these positive tests was contributive to the diagnosis of another disease. Only 14 patients received a specific antibiotic treatment on the grounds that their positive test confirmed a late asymptomatic syphilis. We conclude that systematic syphilis serological tests are not useful in an Internal Medicine department, except in some patients epidemiologically at high risk of syphilis.

Algorithms↗
PubMed1981

[Differential diagnostic possibilities based on algorithms from histological study in cervical and vaginal diseases].

An algorithm of histological description of pathological processes in the cervix uteri and vagina is proposed to improve the quality of differential histological diagnosis of diseases of these organs. The algorithm ensures a better analysis of the data obtained by organizing the thinking of a pathologist, contributes to fuller and more fruitful use of recommendations of both descriptive and morphometric nature, and may be used for research and training and self-training of morphologists.

Biopsy↗
PubMed1996

Myocardial perfusion scintigraphy: effect on diagnostic and clinical management algorithms.

UNLABELLED: Research has demonstrated that myocardial perfusion imaging increases the sensitivity and specificity of stress electrocardiography. However, the additional effect of the perfusion component of a stress study on clinical management algorithms remains poorly defined. METHODS: We prospectively assessed the decision-making process in 518 patients, from 191 clinicians, undergoing stress myocardial perfusion imaging in our departments. Each clinician was asked, by telephone interview, to define the probability of reversible myocardial ischemia and their management plan (i.e., no antianginal treatment, medical therapy or an invasive intervention) in three stages: pretest, after the stress data was made available and after completion of the perfusion study. RESULTS: The results of the stress data alone influenced the estimate of the probability of reversible ischemia in 149 of 518 patients, and management strategy in 50 of 518 patients. The data from the perfusion component in isolation changed probability of reversible disease in 219 of 518 patients and altered clinical management in 77 of 518 patients. Of 103 patients in whom an invasive procedure was planned after the stress data, the availability of the perfusion data led to deferral of catheterization in 48 cases (46.6%). Conversely, of the 415 patients triaged to a noninvasive plan after stress data, only 29 (7.0%) were changed to an invasive strategy. Of note, only 2.3% of women changed from a conservative strategy as a consequence of the perfusion data, compared to 9.1% of men. CONCLUSION: The perfusion component of a stress study has a significant effect on both estimation of clinical probability and the definition of patient management strategy. Myocardial perfusion imaging reduced the number of catheterizations in patients initially triaged to an invasive management strategy. Conversely, the effect of stress and perfusion data in patients triaged to conservative management on clinical grounds, especially women, remains less well defined.

Algorithms↗
PubMed1992

Combining discrepant diagnostic information from multiple sources: are complex algorithms better than simple ones?

Optimizing methods of combining discrepant diagnostic information from multiple sources is one of the more daunting tasks facing the field of child psychopathology. Several researchers have asserted that complex information-combining schemes, those in which certain information or sources of information are weighted differently from others, are preferable. This study provides theoretical and empirical evidence that simple information-combining schemes, those in which all information from all sources is weighted equally, will as a rule work as well as complex schemes and may even work better. The implications of these findings for diagnostic instrument and algorithm design are discussed. A two-step diagnostic procedure utilizing a simple information-combining scheme is presented.

Algorithms↗
PubMed1999

Taking advantage of sophisticated pacemaker diagnostics.

The ever-increasing complexity of pacing systems, combined with functions that vary from one manufacturer to another, can pose challenges during analysis of device function. Standard pacemaker diagnostics are measured data, electrogram telemetry, maker annotations and event counters, albeit with their current limitations. New diagnostic features discussed include time-based diagnostics, histograms of sensed amplitudes, pacing thresholds, or impedance trending. Mode-switching algorithms, combined with diagnostic features, facilitate the use of dual-chamber devices in patients with paroxysmal atrial tachyarrhythmias. The introduction of electrogram storage into pacemakers further improves diagnostic capabilities and allows a permanent validation and optimization of diagnostic and therapeutic algorithms. External diagnostic devices, which provide Holter recordings with continuous marker annotations and patient-triggered diagnostics, are additional features that will become increasingly important.

Arrhythmias, Cardiac↗
PubMed2002

[The value of magnetic resonance cholangiography for the expedient diagnosis of choledocholithiasis].

INTRODUCTION: Management of symptomatic cholecystolithiasis is vitally influenced by dilated biliary tract and choledocholithiasis. The objectives of this prospective pilot study were to evaluate the diagnostic value of preoperative magnetic resonance cholangiography (MRC) compared to diagnostic endoscopic retrograde cholangiography (ERC) and to establish an efficient algorithm for diagnostics and treatment of choledocholithiasis. METHODS: All consecutive patients with cholecystolithiasis and dilated biliary tract proven by sonography as well as elevated liver function tests were enrolled within 12 months. Patients without evidence of bile duct calculi underwent preoperative MRC, whereas patients with choledocholithiasis immediate ERC. RESULTS: 58 patients (30 male, 28 female) with a median age of 59.4 years underwent preoperative MRC. In 18 patients (10 male, 8 female; median age 63.5 years) with evidence of choledocholithiasis we subsequently performed ERC and papillotomy. Bile duct stones were detected and removed after papillotomy in 10 patients, whereas calculi could not be found anymore in 8 patients. The remaining 40 patients without calculi evident on MRC were transferred to magnetic resonance tomography and ERC in case of suspected malignancy or to cholecystectomy and intraoperative cholangiography (IOC), which could definitely exclude choledocholithiasis. In comparison to ERC respectively IOC, MRC was able to detect bile duct stones with a sensitivity of 100% and a specificity of 83.3%. CONCLUSIONS: Non-invasive MRC seems to replace diagnostic ERC concerning the presence of choledocholithiasis in case of cholecystolithiasis and dilated biliary tract with a high sensitivity. The preoperative ERC with stone extraction is still the therapy of choice in case of radiologically confirmed choledocholithiasis.

Aged↗
PubMed2003

[Linear endoscopic ultrasound in the diagnosis of diseases of the digestive system].

This article reviews the recent literature on the role of endoscopic ultrasonography (EUS) as diagnostic and therapeutic tool, defines it's place in the algorithm of diagnostic procedures and informs how to treat gastroenterologic patients evaluated by EUS. Endoscopic ultrasonography utilizes the technology of endoscopy to introduce high-frequency ultrasound probes in the upper or lower part of gastrointestinal tract to visualize gastrointestinal wall and adjacent structures. Longitudinal endoscopic probe is different, compared to radial probe, and advantage is use of Doppler technique. This method has came out as an important modality for the diagnosis and staging of benign and malignant lesions of the gut wall and surrounding structures of the mediastinum, abdomen and pelvis. It is also used as a diagnostic tool for the evaluation of submucosal masses of the upper gastrointestinal tract and the rectosigmoid, for locating pancreatic endocrine tumors, and for the assessment of vascular disease. The widest application of EUS is, however, in the diagnosis and staging of esophageal, gastric, rectal, and pancreaticobiliary carcinoma. EUS has been shown to change the approach to clinical management in a significant proportion of patients to a less costly, risky, or invasive strategy.

Digestive System Diseases↗
PubMed1987

Computer aids to mammographic diagnosis.

The improvement of mammographic specificity was investigated by means of identifying specific radiological features. Data are presented on the first 500 patients studied who had previously undergone mammography followed by biopsy. The presence of specific mammographic features on each radiograph, first determined by retrospective examination, was entered into a computer database. Subsequent discriminant function analysis demonstrated the importance of a small number of features whose presence could be used in an algorithm to predict diagnostic outcome. Using this algorithm, this feature-identification approach correctly identified 87.6% of benign and 79% of malignant cases. Specificity was improved to 88% as compared with the original radiological diagnosis of 49%. It is argued that this approach is very promising and a computer-assisted diagnosis based on these findings is described.

Algorithms↗
PubMed2001

[Giant cell tumor--osteoclastoma: part II].

Authors present current views on the comprehensive diagnostics, treatment and prognosis of giant cell tumours. They include an exact algorithm of diagnostics necessary for a timely treatment. They describe an often unexpected behaviour of these tumours which is frequently active and aggressive, to a small extent these tumours show the tendency to become malignant. The treatment prefers curretage, antibiotic irrigation and filling in with bone cement. In case of recurrence and an extensive process, block resection and replacement by an individual implant, in hardly accessible locations (spine, sacrum, pelvis) or radiotherapy is recommended. The authors present in detail results of a 10-year systematic follow-up of 56 patients, of which 61.6% were in active stage, 36.8% in aggressive stage. The most frequently used method (in 73.2%) was curretage, irrigation and filling in with bone grafts, in 12.5% of cases block resection and replacement by bone grafts. Total results after all these types of operations evaluated in the interval of 3 years after the operation were very good, i.e. 85.7% remissions, there were 14.3% of recurrence. Of these setbacks 5.4% were in remission for more than 3 years and thus conduced to the increase of the number of remissions to 94.6% which can be evaluated as an excellent result. Local recurrence occurs in 10-15% with the application and 15-25% without the application of local adjuvant therapy. In the third stage in case of extensive destruction we perform resection en bloc, radiotherapy in hardly accessible locations (spine, sacrum, pelvis). In case of extensive destruction in the region of joints the method of choice is the application of both individual and total replacement.

Adolescent↗
PubMedDate not supplied

[Diagnostic approach in patients with kidney tumors].

The basic reason for the rationalization of diagnostic procedure is the cost benefit relation and making of the diagnostic course algorithms. On the basis of the Receiver Operating Characteristic (ROC) analysis of the diagnostic procedure (excretory urography, ultrasonography, computed tomography, digital subtraction angiography) the significance ranking has been established for certain kidney tumor diagnostic procedures. Angiography has been determined to be the most precise method, but the high degree of sensitivity (98%) and accurate diagnosis probability (98%), as well as noninvasiveness and relative inexpensiveness of ultrasonographic examination procedure, all argue for ultrasonography as the cornerstone, of renal tumor diagnosis. Using conditional probabilities and the Bayes analysis the advantage of the newly suggested over the standard diagnostic course has been calculated. The study has shown a significant decrease in the number of examinations: in 60 patients 16 excretory urographies, 10 computed tomographies, and 22 digital subtraction angiographies can be spared.

Adult↗
PubMed1999

[Esophageal carcinoma: accurate staging thanks to modern diagnostic methods open up new therapeutic strategies].

INTRODUCTION: Since the tumour stage has significant prognostic and therapeutic implications, accurate preoperative staging is decisive. ALGORITHM FOR DIAGNOSTIC STUDIES: Flexible endoscopy of the oesophagus with biopsies is the first diagnostic step in patients with signs of oesophageal cancer and allows assessment of (1) tumour localisation, (2) tumour size, (3) grade of stricture, (4) type of histology, and (5) cellular grading. Thereafter, CT scan of the chest and upper abdomen is performed to assess the provisional TNM stage. The local TN stage is verified in operable patients by endosonography and additionally by bronchoscopy if the tumour is located in the upper half of the oesophagus. The M stage can be preoperatively verified by laparoscopy. CONCLUSION: Modern diagnostic methods yield accurate staging, which makes it possible to optimise selection of the most appropriate therapeutic strategy.

Algorithms↗