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PubMed2000

Safety and prognostic value of early dobutamine-atropine stress echocardiography in patients with spontaneous chest pain and a non-diagnostic electrocardiogram.

AIMS: To risk stratify and shorten hospital stay in patients with spontaneous (resting) chest pain and a non-diagnostic electrocardiogram (ECG). METHODS AND RESULTS: The study comprised 102 patients (mean age 58+/-12 years, 67 men) with spontaneous chest pain and a non-diagnostic ECG. Forty-three patients had suspected coronary artery disease and 59 had known (but of unknown actual significance) coronary artery disease. All patients underwent serial creatine kinase enzyme measurements, continuous ECG monitoring for at least 12 h and early dobutamine-atropine stress echocardiography in patients with negative creatine kinase enzymes and normal findings at ECG monitoring. Dobutamine-atropine stress echocardiography was considered positive in patients with new or worsening wall thickening abnormalities. Patients with negative dobutamine-atropine stress echocardiography were discharged after the test. In-hospital and 6 month follow-up events noted were cardiac death, non-fatal myocardial infarction, unstable angina, and coronary artery bypass surgery or angioplasty. Thirteen patients had evidence of evolving myocardial infarction by elevated creatine kinase enzymes, or unstable angina by ECG monitoring. In the remaining 89 patients, dobutamine-atropine stress echocardiography was performed after a median observation period of 31 h (range 12-68 h). During dobutamine-atropine stress echocardiography no serious complications (death, non-fatal myocardial infarction, sustained ventricular tachycardia or ventricular fibrillation) occurred. Dobutamine-atropine stress echocardiography results were of poor quality in three, non-diagnostic in six, negative in 44 and positive in 36 patients. In the 80 patients with diagnostic dobutamine-atropine stress echocardiography, variables associated with in-hospital events (n=7) were history of exertional angina (P<0. 005), chest pain score (P<0.005), stress-induced angina (P<0.001) and positive dobutamine-atropine stress echocardiography (P<0.005). Variables associated with follow-up events (n=11) were history of exertional angina (P<0.05), chest pain score (P<0.001), stress-induced angina (P<0.01) and positive dobutamine-atropine stress echocardiography (P<0.01). At multivariate analysis the only significant predictor of events was positive dobutamine-atropine stress echocardiography (P<0.01). CONCLUSION: Early dobutamine-atropine stress echocardiography may safely distinguish between low- and high-risk subsets for subsequent cardiac events in patients with spontaneous chest pain and a non-diagnostic ECG.

Atropine↗
PubMed2004

[Clinical relevance of computed tomography under emergency conditions--diagnostic accuracy, therapeutic consequences].

PURPOSE: To evaluate the diagnostic accuracy and therapeutic consequences of computed tomography performed on an emergency basis in a primary care hospital. MATERIAL AND METHODS: In 418 patients, 463 computed tomographies (thorax, abdomen, pelvis, spine, aorta, neck and extremities) were performed with-in 12 months, providing 999 diagnoses. The computed tomography diagnoses were retrospectively evaluated and correlated to surgery and discharge diagnoses. Therapeutical consequences were analyzed and allocated to a time period < 36 h (urgent) and > or = 36 - 72 h (elective). Average age was 49 (1 - 94) years (41% female and 59% male). Discharge diagnosis was defined as gold standard, provided that it was supported by clinical, blood chemical, diagnostic and possible surgical data. RESULTS: In 176 of 999 diagnoses (18%), the diagnoses were classified as "non-correlatable". Of the 823 correlated diagnoses, 431 were true positive, 14 false positive, 66 false negative and 312 true negative. Sensitivity, specificity and diagnostic accuracy of computed tomography was 87, 96 and 90%. Computed tomography had therapeutic consequences (surgery, drainage, puncture, reposition, thrombolytic therapy, chemotherapy, bronchoscopy, endoscopy, percutaneous transluminal angioplasty, coiling etc.) in 57% and no direct therapeutic interventions in 43%. Computed tomography excluded the suspected diagnosis in 36% and resulted in a conservative therapeutic regiment in 7%. Surgery was performed on 134 of the 418 patients (32%) who underwent computed tomography, with the surgery urgent in 71 (17%) and elective in 63 (15%) of the 418 patients. CONCLUSION: The high diagnostic accuracy and consecutive therapeutic consequences of computed tomography in establishing a precise, timely and reproducible diagnosis confirm its important role as primary diagnostic method on an emergency basis.

Adolescent↗
PubMed2004

[Diagnostic utility of capsule endoscopy in occult gastrointestinal bleeding].

BACKGROUND AND OBJECTIVE: The video-capsule endoscopy (CE) of the small intestine is a novel innovative procedure for outpatient use that can detect even small lesions of the mucosa of the small intestine. Aim of this retrospective clinical study was to evaluate the diagnostic value of CE in a clinical routine setting. PATIENTS AND METHODS: Between July 2001 and October 2002 we investigated 42 patients with suspected gastrointestinal bleeding by CE. In all patients, the previous upper and lower endoscopy work-up was normal. In some cases additional procedures such as bloodpool scintigraphy, angiography, small-bowel enteroclysis or push-enteroscopy were performed. RESULTS: CE detected relevant pathological findings in 23 out of 42 Patients (55 %). The majority of findings in the CE consisted of angiodysplasia (n = 16), ulcer and haemorrhagical erosions (n = 10), one Ulcus Dieulafoy and additional polyps of the small intestine (n = 2). In 4 cases an inflammatory small-bowel disease was detected. These findings could be confirmed by Re-endoscopy. The information provided was helpful to direct further diagnostic and treatment options. In 14 cases (33 %) CE-findings steered additional diagnostic and therapeutic steps. We conclude that CE is safe and has a high diagnostic yield. CONCLUSION: M2A video CE is likely to become an integral part of the algorithm of diagnostic of occult gastrointestinal bleeding after exclusion of other causes of anemia and negative upper and lower endoscopy work-up.

Adult↗
PubMed2005

[The Vogt-Koyanagi-Harada syndrome: a rare differential diagnosis of uveitis in childhood. A case report taking into account the revised diagnostic criteria].

BACKGROUND: The diagnosis of the multisystemic Vogt-Koyanagi-Harada (VKH) syndrome including ocular, neurological and dermatological manifestations is difficult due to the absence of diagnostic serological parameters and the variable onset of clinical signs and symptoms in the course of the disease. PATIENT: A 12 year old female patient was admitted to our clinic , presenting with bilateral choroiditis, vitiligo and episodes of headache. After having ruled out an underlying rheumatological or infectious disease, a VKH syndrome was suspected and effectively treated with systemic steroids. The initial diagnosis of VKH syndrome would not have been possible, if the existing diagnostic criteria had been applied. DISCUSSION: As can be seen in the case of our patient, the existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome, particularly at the onset of the disease. Considering, that early diagnosis and treatment is crucial in improving the outcome of the disease, current diagnostic criteria have been revised. Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria.

Child↗
PubMed2006

A randomized controlled trial comparing the accuracy of general diagnostic upper gastrointestinal endoscopy performed by nurse or medical endoscopists.

BACKGROUND AND STUDY AIMS: Rising demand for general diagnostic upper gastrointestinal endoscopy in the UK is outgrowing the capacity of doctors to provide this service within a reasonable time. One solution is to train nurses to carry out the procedure, but it is not known whether nurses can perform general diagnostic upper gastrointestinal endoscopy as competently as doctors. PATIENTS AND METHODS: A randomized controlled non-inferiority trial compared the adequacy and the accuracy of diagnostic upper gastrointestinal endoscopies performed by five medical and two nurse endoscopists. The videotaped procedures were assessed by a consultant gastroenterologist blinded to the identity of the endoscopist. RESULTS: 641 patients were randomly allocated (before attendance and consent procedure) to endoscopy carried out either by a doctor or a nurse. Of these, 412 were enrolled and 367 (89 %) were included in the analysis. An adequate view was obtained throughout in 53.4 % (93/177) of doctor endoscopies and 91.6 % (174/190) of nurse endoscopies (difference 38.2 %, 95 % CL 30.5 %, 47.2 %). In adequately viewed areas, the mean agreement between doctor and expert was 81.0 % and between nurse and expert it was 78.3 % (difference between the means 2.7 %, 95 % CL - 1.0 %, 6.4 %). There was no difference between doctors and nurses in the rate of biopsy performance (90.4 % and 91.1 %, respectively, P = 0.862). Nurses took longer (8.1 minutes vs. 4.6 minutes, P < 0.001) and used intravenous sedation more often (57.6 %, P = 0.027). Adequacy of view correlated positively with endoscopy duration ( P < 0.001), but diagnostic accuracy correlated inversely with duration ( P < 0.001). Neither adequacy or accuracy correlated significantly with use of intravenous sedation. CONCLUSIONS: In endoscopies performed by nurses, the proportion of adequate examinations was much higher than that found for doctors. In areas with an adequate view, there is no significant difference in accuracy between nurses and doctors. Nurses can provide an accurate general diagnostic upper gastrointestinal endoscopy service as competently as doctors.

Clinical Competence↗
PubMed1984

[Borderline--a diagnostic entity?].

In the last years, there has been considerable controversy as to whether the term "borderline" should be introduced into psychiatric diagnostic nomenclature to designate psychiatric disorders not classifiable as psychoses, neuroses or traditional forms of personality disorders. Whereas many psychiatrists, especially those who are psychodynamically oriented, have been using this term for a long time, the more phenomenologically oriented psychiatrists refuse to do so while pointing to its lack of clear-cut definitions and its confusing abundance of meanings. The definitions of the term "borderline" used in the various "borderline" -concepts are reviewed. Some authors (Knight, Kety et al.) consider "borderline schizophrenia" to be a subgroup of schizophrenic psychoses. Others (Klein, Stone) take "borderline" disorders as a heterogeneous group of psychiatric illness encompassing especially some atypical affective disorders. Thirdly the concepts of those authors who conceive "borderline" as a distinct diagnostic entity are reviewed: Kernberg's "Borderline personality organization", Grinker's "Borderline syndrome", Gunderson and Singer's "Borderline personality disorders", Spitzer and Endicott's "Borderline (unstable) personality disorder" and "Schizotypical personality". The "borderline" definitions of all concepts are examined as to whether they fulfil the requirements of a "useful" (according to Kendell) diagnostic category, i.e. whether they yield reliably defined diagnostic criteria, and whether they can be validated by genetic and biological studies, therapy response, and long-term studies. It is pointed out that attempts have been made to establish operationally defined diagnostic criteria for some of the "borderline" concepts, but that research aiming at their validation is still in an initial stage.

Affective Disorders, Psychotic↗
PubMed1984

[Diagnostic value of increased lactate dehydrogenase activity in vaginal secretions for the early detection of diseases requiring treatment of the female genitals and breast].

The Diagnostic Validity of Enhanced Lactate Dehydrogenase Activity in the Vaginal Secretion for Early Diagnosis of Diseases of the Female Genitals and the Mamma in Need of Treatment. An impregnated hygiene tampon (Gynaegnost) was used, which by a colour reaction permits the determination of augmented activity of lactate dehydrogenase (LDH) in vaginal secretion. The diagnostic validity of the results of the findings by this method in the detection of diseases of the female genitals and the mamma needing treatment was examined in two clinical diagnostic studies. The first study including 486 patients chiefly suffering from manifest carcinoma was aimed at solving a deliberately limited question. In patients with carcinoma stages I to IV of the most important genital locations augmented LDH-activity (correct positive results) was found in about 90%. A second study comprised 1955 women entering into outpatient gynaecological services for preventive examination; the definition of this series was difficult. Three categories of diagnostic groups can be determined by the results of this study. In the first category with the most important subgroup "routine examination without specification of a pathological finding" less than 20% "false" positive test results by the indicator were observed. A second category with inflammatory diseases (colpitis, endometritis) showed positive results in about one-third of the examinations. The third category comprised a minor number of malignant tumors roughly with a percentage of positive results corresponding to that of the first study. Augmented LDH activity in vaginal secretion is a diagnostic criterion which detects not only cancer; it is similar to the test of occult blood in faeces.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗
PubMed1991

Diagnostic relevance of clonal cytogenetic aberrations in malignant soft-tissue tumors.

BACKGROUND: Malignant soft-tissue tumors often present substantial diagnostic challenges. Chromosome aberrations that might be diagnostic have been identified in some types of soft-tissue tumors, but the overall frequency and diagnostic relevance of these aberrations have not been established. METHODS: We attempted to determine the karyotypes of a series of 62 consecutive, unselected malignant spindle-cell or small round-cell soft-tissue tumors (from 46 adults and 16 children) after direct harvesting of cells or short-term culture. All tumors were examined independently by immunohistochemical staining in addition to routine light-microscopical evaluation, and all but two tumors were examined by electron microscopy. RESULTS: Metaphases were obtained from 61 of the 62 tumors, and clonal chromosome aberrations were identified in 55 (89 percent). In the six tumors that yielded metaphases but lacked apparent clonal aberrations, the normal metaphases were found to originate from non-neoplastic stromal elements within the tumor specimens. Thus, all tumors in which karyotyping was successful contained clonal chromosome aberrations. Forty of 62 tumors (65 percent) contained clonal chromosome aberrations that either suggested or confirmed a specific diagnosis; in 15 of these tumors (24 percent of all tumors), the aberrations were important in establishing the final diagnosis. Cytogenetic analyses were particularly informative about small round-cell tumors from children: 8 of 14 round-cell tumors contained diagnostically important chromosome aberrations. Using the combined approaches of light and electron microscopy, immunohistochemistry, and cytogenetics, we established an unambiguous diagnosis for 60 of 62 tumors. CONCLUSIONS: Cytogenetic analyses reveal clonal chromosome aberrations in virtually all malignant soft-tissue tumors. These clonal chromosome aberrations, particularly in small round-cell tumors in children, often have diagnostic relevance.

Adult↗
PubMed2000

D-Dimer is an early diagnostic marker of coronary ischemia in patients with chest pain.

BACKGROUND: Chest pain is a frequent symptom in the emergency department and often presents a diagnostic challenge. Because coronary thrombosis is a hallmark of acute ischemic syndromes, the substrates of the coagulation and fibrinolysis cascades may be markers of coronary ischemia. The objective of this study was to determine the diagnostic value of several hemostatic markers in patients presenting to the emergency department (ED) with chest pain syndromes. METHODS: Two hundred fifty-seven consecutive patients with acute chest pain were studied in this prospective study conducted in an urban ED. D-Dimer levels were measured at admission to the ED in all patients. We also measured thrombin-antithrombin complexes, prothrombin fragment 1+2, activated factor VII, and fibrinogen. We used regression analysis to estimate the likelihood of myocardial infarction and the diagnostic value of D-dimer. RESULTS: D-Dimer and fibrinogen levels were significantly higher in patients with acute ischemic events (myocardial infarction and unstable angina) than in nonischemic patients (P <.01 and P =.02, respectively). The other hemostatic markers were not significantly elevated in patients with ischemic events. D-Dimer level >500 microg/L had an independent diagnostic value for myocardial infarction and increased the diagnostic sensitivity of the electrocardiogram and history from 73% to 92%. CONCLUSION: D-Dimer, an expression of ongoing thrombus formation and lysis, is a marker of substantial incremental value for the early diagnosis of acute coronary syndromes presenting with chest pain. It adds independent information to the traditional assessment for myocardial infarction. D-Dimer can be incorporated into clinical decision models in the ED.

Adult↗
PubMed2001

Validity of clinical diagnostic criteria for temporomandibular disorders: clinical versus magnetic resonance imaging diagnosis of temporomandibular joint internal derangement and osteoarthrosis.

OBJECTIVES: Research is needed to assess the validity of clinical decision criteria for the diagnoses of temporomandibular disorders. The objective of this study was to assess the reliability of clinical diagnoses in predicting magnetic resonance imaging diagnoses of temporomandibular joint internal derangement and osteoarthrosis in a patient pain group with temporomandibular disorders. METHODS: One clinician used the Clinical Diagnostic Criteria for Temporomandibular Disorders to classify 163 consecutive patients with temporomandibular disorders on physical diagnosis. The radiologist subsequently performed magnetic resonance imaging on 326 temporomandibular joints. Diagnostic agreement was determined for the diagnostic categories of absence of internal derangement, disk displacement with reduction, disk displacement without reduction, and osteoarthrosis. RESULTS: Use of the Kappa statistic test indicated a poor diagnostic agreement between the clinician and the radiologist. CONCLUSIONS: The classification system of the Clinical Diagnostic Criteria for Temporomandibular Disorders provides insufficient reliability for determination of the presence of temporomandibular joint internal derangement and osteoarthrosis. It should be supplemented by evidence from cross-sectional and longitudinal investigations to assess decisive differences in the areas of pathogenesis, treatment, and prognosis.

Adolescent↗
PubMed2002

Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria.

OBJECTIVES: We sought to measure the diagnostic yield of relevance to treatment on routine panoramic radiographs taken of new adult (ie, 18 years and over) patients in general dental practice. STUDY DESIGN: Routine panoramic radiographs (n = 1817) obtained from general dental practice were assessed and radiologic yield recorded using consensus viewing by 2 dental radiologists. A modified diagnostic yield of relevance to treatment for each radiograph was calculated by omission of findings that would have been identified on bilateral posterior bitewing radiographs and of radiologic findings of no relevance to treatment. Stepwise logistic regression analysis was used in attempt to identify clinical indicators of a high diagnostic yield of relevance to treatment. RESULTS: The diagnostic yield of relevance to treatment was zero for the majority (56%) of patients. This figure rose to 71% when the symptom-free patients were considered. Five clinical indicators for panoramic radiography were identified, as follows: clinical suspicion of teeth with periapical pathologic conditions, presence of partially erupted teeth, clinically evident caries lesions, swelling, and clinically suspected unerupted teeth. CONCLUSION: Routine panoramic radiography of adult dental patients is not supported by the results of this study. The use of clinical indicators to select patients may help to improve diagnostic yield.

Adult↗
PubMed2001

Impact of Medicare denials on noninvasive vascular diagnostic testing.

PURPOSE: The purpose of this study was to evaluate the impact of Medicare coverage limitations and claim denials on noninvasive vascular diagnostic testing. METHODS: All Medicare claims for noninvasive vascular diagnostic studies from January 1, 1999, to December 31, 1999, were identified from the hospital billing database according to Current Procedural Terminology codes for carotid artery duplex ultrasound scan, venous duplex ultrasound scan, and lower-extremity arterial Doppler scan. Reasons for Medicare denial of payment for these tests were reviewed and a cost analysis was performed. RESULTS: During the 1-year period, there were 1096 noninvasive vascular diagnostic studies performed on Medicare patients. Of these 1096 tests, 176 (16.1%) were denied by Medicare (19.6% of 408 carotid duplex ultrasound scans, 16.8% of 345 venous duplex ultrasound scans, and 11.1% of 343 lower-extremity arterial Doppler scans). Of the noninvasive vascular tests denied by Medicare, an abnormal result was present in 72.5% of carotid duplex ultrasound scans, 32.8% of venous duplex ultrasound scans, and 78.9% of lower-extremity arterial Doppler scans. Overall, 88.1% of all initially denied claims (N = 176) were ultimately reimbursed by Medicare after resubmission, including 77.1% of the 118 claims denied based on compliance rules for "medical necessity." CONCLUSION: Because of coverage limitations, Medicare denials of noninvasive vascular diagnostic tests can lead to potential uncompensated physician and hospital technical fees if denied claims are unrecognized. Vascular laboratories performing these tests need to review compliance with Medicare guidelines. Improvements may need to be made at both the provider and Medicare carrier levels in obtaining reimbursement for appropriately ordered noninvasive vascular diagnostic studies.

Carotid Arteries↗
PubMed1991

Genetic flanking markers refine diagnostic criteria and provide insights into the genetics of Von Hippel Lindau disease.

Von Hippel Lindau disease (VHL) is a hereditary syndrome, associated with tumors and cysts in multiple organ systems, whose expression and age of onset are highly variable. The availability of a genetic test for the early and reliable detection of individuals carrying the defective gene would be beneficial for VHL patients and their relatives, since many of the manifestations of VHL can be successfully treated if detected in their early stages, while the complications of undetected disease can be devastating. We have previously shown that the VHL gene maps to chromosome 3p. To provide genetic markers for the development of a reliable diagnostic test, and to further narrow and eventually clone the VHL defect, we have generated DNA markers for chromosome 3p. With these markers, we have performed a multipoint genetic linkage analysis in 28 VHL pedigrees, comprising 470 individuals, 164 of whom were affected with VHL. Here we report the identification of tightly linked markers, including flanking markers that bracket the VHL gene to a small region on chromosome 3p25-p26. This finding has several major implications. While visceral cysts of the kidney, pancreas, and epididymis are commonly found in VHL and are considered diagnostic criteria for this disorder, they also occur in the general population. The presence of cysts, unaccompanied by other more typical lesions such as retinal and cerebellar hemangioblastoma, may therefore represent a major diagnostic problem, leading to errors in the assessment of disease status. The application of flanking markers for the VHL gene for presymptomatic diagnostic testing confirms that epididymal cysts are indeed not suitable as a diagnostic criterion in this disorder. Pheochromocytomas occur nonuniformly in VHL families and may also be associated with other hereditary tumor syndromes; our genetic studies imply that the phenotype in VHL families with and without pheochromocytomas is caused by defects within the same gene. The absence or presence of this tumor type is therefore due to the pleiotropic expression of a single gene rather than to the existence of several different genes for VHL. The region on chromosome 3p13-p14 known to contain several chromosomal translocation breakpoints in families with "pure familial renal cell carcinoma" is quite proximal to the VHL locus in 3p25-p26 we have identified. Chromosome 3p may therefore contain two loci for renal cell carcinoma: one gene (or genes) in 3p13-p14 and the VHL gene in 3p25-p26, whose aberration is also associated with other typical manifestations of VHL. Since renal cell carcinoma, pheochromocytoma, and visceral cysts can occur sporadically even in young people and may also be associated with other tumor syndromes, the availability of flanking markers for the VHL gene will be useful in identifying VHL gene carriers, particularly among those individuals at risk in whom these are the only manifestations of disease. The isolation and characterization of the VHL gene, based on the identification of flanking markers, will have important implications for diagnosis and treatment of patients with VHL, as well as for a much larger number of individuals having the sporadic counterparts of VHL-associated tumor types.

Cell Line↗
PubMed2001

Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: comparison of Rome II versus previous criteria in a general population.

BACKGROUND: Irritable bowel syndrome (IBS) prevalence estimates are essential for measuring the importance of the problem and the burden of the illness. However, IBS diagnosis is based on clinical criteria which have changed over time. The aim of this study was to assess how the use of different diagnostic criteria influences estimated IBS prevalence and, in particular, to compare how this prevalence varies using the new Rome II criteria and previous diagnostic criteria. METHODS: An epidemiological survey was conducted in the general population using personal interviews in a home setting. Two thousand individuals stratified by gender, age, social class and geographic location were randomly selected from the general population of Spain. Participants were classified as 'potential IBS subjects' (n = 281) or 'non-potential IBS subjects' (n = 1719) as a result of their response to a screening question regarding the presence of abdominal pain, constipation or diarrhoea. Thus, we estimated IBS prevalence according to the following diagnostic criteria: Manning, Rome I, Rome II, Drossman, Talley and Kay & Jorgensen. RESULTS: Prevalences of IBS according to the Manning and Rome I criteria were 10.3% and 12.1%, respectively. These were higher than the prevalences obtained with the other criteria used, which varied from 2.1% to 4.9%. IBS was more prevalent in females than males irrespective of the criteria used (the female:male ratio ranged from 2.33 to 4.33). Subjects who fulfilled the Rome II, Drossman, Talley or Kay & Jorgensen criteria also fulfilled the Rome I and Manning criteria. However, between 44% and 80% of subjects who fulfilled the Rome I or Manning criteria did not fulfil the more stringent diagnostic criteria. CONCLUSIONS: The prevalence of IBS varies enormously depending on the diagnostic criteria employed. Criteria based on the frequency of symptoms, such as the Rome II criteria, produce much lower prevalence values compared to criteria based solely on the presence of symptoms. In fact, more than two-thirds of subjects who fulfilled the Rome I criteria would not have been diagnosed with IBS if Rome II criteria had been employed.

Adolescent↗
PubMed2002

The serological gastric biopsy: a non-endoscopical diagnostic approach in management of the dyspeptic patient: significance for primary care based on a survey of the literature.

BACKGROUND: Measurement of the serum concentration of the secretory products of the gastric mucosa, pepsinogen A (PgA), pepsinogen C (PgC) and gastrin is called the serological gastric biopsy. Additional measurement of Helicobacter pylori antibodies and antibodies to parietal cells and intrinsic factor supports the non-invasive diagnostic value of the serum markers. In many clinical studies, the diagnostic potential of the serum markers in predicting the topography and severity of gastric mucosal disorders has been established. The aim was to assess the diagnostic value of the serological gastric biopsy for primary care. METHOD: Survey of the literature. RESULTS: The cell-physiological background of the serological gastric biopsy, the interpretation of the outcome of serum markers and the relation of these parameters to various gastric mucosal disorders are described. Measurement of PgA is a reliable way to discriminate between mucosal gastritis and functional dyspepsia. PgA is raised in duodenal, gastric and pyloric ulcer even though gastrin is normal. Both PgA and gastrin are raised in renal insufficiency and the Zollinger-Ellison syndrome. A low PgA is indicative of mucosal atrophy and a good indicator for gastric hypoacidity. An additional low PgA:C ratio is indicative of atrophic gastritis or extensive intestinal metaplasia of the stomach. A hypopepsinogenaemia can also be an alarm symptom for gastric cancer. A low PgA and a high gastrin is indicative of corpus atrophy. CONCLUSION: In primary care, the serological gastric biopsy might be a feasible and appropriate diagnostic method for management of the dyspeptic patient. Further research in general practice has to be done to validate the predictive value of the serological gastric biopsy and to define a diagnostic strategy.

Biomarkers↗
PubMed1998

Variations in the diagnostic process among urologists in one region recorded using an interactive computer program.

To analyse how male cases suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are handled within a well-defined health-care region in Scandinavia, an interactive computer program containing 20 cases suffering from LUTS due to BPH was used for recording the diagnostic process and the treatment decisions; 37 out of a total of 50 urologists practicing within a small health region participated. The diagnostic process varied considerably due to a varying choice of diagnostic tests and the large differences in interpreting the qualities described by the tests. The probability that a patient would be offered a treatment within the region was analysed. For many patients the probability that a treatment was chosen was in the vicinity of 50%. No treatment probability was correlated to the symptom score of the patients. While the probability that a transurethral prostatic resection would be offered to the patients within the region was correlated significantly to urodynamic variables, residual urine and to cystoscopy findings, the probability that transurethral microwave or finasteride therapy would be offered was not correlated to any of the described qualities. The costs of the diagnostic process in all the patients incurred by each of the urologists varied by up to 500%. It was estimated that approximately 40% of the costs involved diagnostic tests that did not influence the decision to offer or not to offer treatment. In conclusion, the enormous variations in the handling of the cases recorded in the study stress the need that a management formula should be used in the handling of patients with LUTS.

Decision Making, Computer-Assisted↗
PubMed1993

The use of the multiaxial diagnostic system for sexual dysfunctions in the assessment of hypoactive sexual desire.

Hypoactive sexual desire disorders (HSD) are currently recognized as one of the most prevalent and difficult sexual disorders to operationally define, evaluate, and treat. At present, no instrument for the diagnostic assessment has yet prevailed. The present study compared two groups of 20 couples with and without desire problems in order to evaluate the diagnostic utility and discriminative power of the Sexual History Form (SHF), a 28-item questionnaire used to classify sexual dysfunctions following the Multiaxial Diagnostic System for Sexual Dysfunctions (MDSSD). Analysis of the SHF revealed couples with desire problems significantly differed on 15 diagnostic items. Eight of these questions corresponded to the 12 SHF items used by the MDSSD to establish desire-phase diagnoses, and six were most predictive of subjects with desire disorders. Although the current data suggest the SHF is a reliable instrument for the assessment of desire disorders, more studies are needed to further substantiate the diagnostic efficacy of this measure.

Adult↗
PubMedDate not supplied

A diagnostic marker for speech delay associated with otitis media with effusion: the intelligibility-speech gap.

The goal of this study was to determine if notably reduced intelligibility is a potential diagnostic marker for children with speech delay and histories of early recurrent otitis media with effusion (SD-OME). Intelligibility was assessed in one 5-10 minute conversational speech sample from each of 281 speakers. The OME histories of 148 of these children with normal speech acquisition were described in two prior reports. OME histories of 85 additional children with speech delay were obtained from case history reports. For both groups, the children with positive OME (OME+) histories had significantly lower intelligibility scores but significantly higher speech production scores than children with negative OME (OME-) histories. Findings for a diagnostic marker to discriminate speech delayed children with OME+ versus OME- histories were promising, considering that the data were obtained retrospectively and did not include audiological information characterizing children's concurrent fluctuant hearing loss. The formula for the diagnostic marker, termed the Intelligibility-Speech Gap, was identified by a machine learning routine. Diagnostic accuracy findings for the marker were as follows: positive predictive value = 74%, negative predictive value = 86%, sensitivity = 79%, specificity = 83%, positive likelihood ratio = 4.6 and negative likelihood ratio = 0.25. Discussion considers speech processing perspectives on the source of the intelligibility-speech gap in children with suspected SD-OME, and methodological perspectives on its development as a diagnostic marker of one etiological subtype of speech delay.

Child↗