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PubMed1997

Intermittent claudication associated with persistent sciatic artery: report of two cases.

Two elderly women complaining of intermittent claudication complicated with persistent sciatic artery are herein reported. A direct femoral arteriogram showed hypoplasty of the superficial femoral artery and an unnatural anatomical relationship between the distal superficial femoral artery and the proximal popliteal artery, thus suggesting the presence of persistent sciatic artery. The diagnosis of persistent sciatic artery was finally made based on the aortography findings including the iliac arterial system and computed tomography (CT) scan. Magnetic resonance imaging (MRI) was helpful to demonstrate the entire image of this anomaly in cases with non-thrombolized sciatic artery. These diagnostic methods were useful in designing the optimal surgical strategy. The first case with a gluteal pulsating mass underwent exclusion of the persistent sciatic artery including the aneurysm through a retroperitoneal approach with a combination of femorotibial bypass, while the second case with thrombosed persistent sciatic artery only underwent femoropopliteal bypass. To recognize such a rare lesion, awareness of the differential diagnosis is important, and to provide appropriate treatment, an accurate whole image including adequate angiography, a CT scan, and magnetic resonance imaging is necessary.

Aged↗

PubMed1998

[Complex trauma of the shoulder girdle].

Complex injuries of the shoulder require differentiated management. Interestingly there is a relative lag of warranted information on this subject. Generally the different lesions are discussed separately. However it is not acceptable to simply add the standard diagnostic and therapeutic measures, because major tactic, strategic and rehabilitation incompatibilities could occur. Diagnostic and therapeutic difficulties are frequent for the following injuries: complex proximal humerus dislocation fractures, dislocation fractures with associated lesions of the rotator cuff, posterior dislocation fractures, peri- and intraarticular segmental fractures and fractures or dislocations associated with major neurovascular lesions. Increased awareness of the most relevant diagnostic and therapeutic aspects should contribute to optimize treatment protocols.

Fracture Fixation, Internal↗

PubMed1991

Predictions of epidemiology and the evaluation of cancer control measures and the setting of policy priorities.

Cancer incidence predictions may be constructed for administrative and scientific purposes. For administrative purposes it is often important that the predictions come true. The resources planned on the basis of the predictions and allocated on the diagnostics, treatment and rehabilitation can then be optimally utilized. However, predictions that do not materialize can also be useful. The effects of intervention or early detection programmes express themselves as failures of predictions that have been made in the absence of such programmes. Predictions of cancer incidence in Finland are used as examples. The prerequisite for the predictions is a well-functioning population-based cancer registry. The predictions were constructed using time trends and differentials in cancer incidence with or without the aetiological or other risk factors. Short-term, 10-15 year predictions with no explicit use of risk factors, have proven successful with most cancers, e.g. those of the colon, rectum, pancreas and urinary organs, and lymphomas. The marked prediction failures have occurred for cancers of the lung and breast. Predictions for these cancers have been improved by taking aetiological or other risk factors explicitly into account. The cancer consequences of the preventive cardiovascular programme in North Karelia have been evaluated using predictions. The effectiveness of screening for cervical cancer at population level was predicted on the basis of estimated parameters of the natural history of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Unraveling the spectrum of left bundle branch block in acute myocardial infarction: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT 2 and 3) trials.

BACKGROUND: Left bundle branch block (LBBB) complicates the diagnosis of acute myocardial infarction (AMI). The Sgarbossa criteria were developed from GUSTO I to surmount this diagnostic challenge but have not been prospectively validated in a large population with presumed AMI. We evaluated their utility in the diagnosis and risk stratification of AMI patients in ASSENT 2 & 3. METHODS: Baseline electrocardiograms (ECG) of LBBB patients were scored using Sgarbossa's criteria (0-10) by 2 readers blinded to the CK/CK-MB data and clinical outcomes; 267 (1.2%) patients had LBBB on their baseline ECG. RESULTS: Among 253 LBBB patients with available peak CK/CK-MB data, 158 (62.5%) had peak CK/CK-MB levels > 2x ULN, thereby qualifying for the diagnosis of AMI. A Sgarbossa score of 3 was shown in 48.7% of LBBB patients with elevated CK/CK-MB versus in 12.6% of those without a CK/CK-MB rise (P < .001). Patients with higher Sgarbossa scores, ie, 3, had a higher mortality compared with those with a score < 3, (23.5% vs 7.7% at 30 days P < .001; and 33.7% vs 20.2% at 1 year, P < .001, respectively). CONCLUSIONS: Our findings validate the utility of Sgarbossa criteria for diagnosing AMI in the setting of LBBB. These criteria provide a simple and practical diagnostic approach to risk stratify this diagnostically challenging high-risk group and optimize risk-benefit of acute therapy.

Aged↗

PubMed1982

A direct assay for carcinoembryonic antigen in serum and its diagnostic value in metastatic breast cancer.

The development of an optimized direct assay for carcinoembryonic antigen (CEA) in serum is described. CEA was purified from liver metastases from colorectal carcinomas, and avid anti-CEA antibodies (Ka 1.0-1.6x10(11) L/mol) were produced in rabbits. Radiolabelling of CEA was performed by the "Iodo-Gen" method. Experiments performed in order to characterize antigen-antibody specificity and to work out assay conditions are described. In the separation step of the assay, problems associated with non-specific binding of radioligand were virtually eliminated by using a new solid-phase second antibody, based on monodisperse polymer particles. The clinical performance of the assay is demonstrated by its high ability to detect relapses in patients with mammary carcinoma.

Breast Neoplasms↗

PubMed2002

Sample collection and preparation in cytology: increasing diagnostic yield.

Cytology is a valuable diagnostic tool for examining many types of lesions. The diagnostic yield of cytology is dependent on optimal sample collection and smear preparation. This article outlines the basic techniques for collection of samples via fine-needle biopsy, imprints, scrapings, and swabs. Tips are given on how to avoid some of the most common problems that lead to nondiagnostic samples.

Animal Diseases↗

PubMed2004

[MRI of the GI tract: technical considerations and future applications].

Barium enema remains the reference method for the detection of morphological intraluminal alterations of the bowel. Optimal filling of intestinal loops allows high diagnostic sensitivity and specificity. US, CT and MRI are useful diagnostic procedures in the evaluation of mural and extramural alterations. In recent years, MR-enteroclysis and MR colonography have been developed, both enable the evaluation of luminal, extraluminal and mural alterations of the bowel. While these modalities provide good imaging evaluation of the bowel, visualization of the different layers, as seen on US, is still not available. Use of high resolution endoluminal coil on MR could improve mural evaluation of bowel to differentiate inflammatory diseases and provide accurate TNM classification of tumoral lesion with minimally invasive procedure.

Humans↗

PubMed2002

Rapid diagnosis of enterovirus infections by real-time PCR on the LightCycler using the TaqMan format.

A 2 h single-tube, reverse-transcription(RT)-PCR/hybridization assay using the TaqMan format for rapid diagnostic screening of enterovirus (EV) infections was optimized for the real-time LightCycler (LC) technology. For low EV load clinical samples an additional 30 min reamplification step using a novel primer-mix/probe design resulted in a 100% concordance with AMPLICOR EV PCR Test and in-house RT-PCR. Combined with maximum specificity, the sensitivity of LC-PCR was 10- to 100-fold higher compared to AMPLICOR EV Test.

Enterovirus↗

PubMed1996

Surgical revascularization versus thrombolysis for nonembolic lower extremity native artery occlusions: results of a prospective randomized trial. The STILE Investigators. Surgery versus Thrombolysis for Ischemia of the Lower Extremity.

PURPOSE: Early results of a prospective study that compared surgical revascularization and thrombolysis for lower extremity arterial and graft occlusions have been published. This report details the final results in patients who have native artery occlusions. METHODS: Two hundred thirty-seven patients who had lower extremity ischemia as a result of iliac-common femoral (IF; 69 patients) or superficial femoral-popliteal (FP; 168 patients) occlusion, and had symptomatically deteriorated within the past 6 months were randomized to catheter-directed thrombolysis (150 patients) or surgical revascularization (87 patients). After diagnostic arteriographic examination but before randomization, the optimal surgical procedure was determined. Lytic patients were randomized to recombinant tissue plasminogen activator (rt-PA; 84 patients) or urokinase (UK; 66 patients). Recurrent ischemia, morbidity, amputation, and death rates were determined at 30 days, 6 months, and 1 year, and were analyzed on an intent-to-treat basis. RESULTS: For patients randomized to lysis, a catheter was properly positioned and the lytic agent delivered in 78%. This provided a reduction in the predetermined surgical procedure in 58% of patients who had an FP occlusion and 51% of those who had an IF occlusion. rt-PA and UK were equally effective and safe, but lysis time was shorter with rt-PA (8 vs 24 hr; p < 0.05). At 1 year, the incidence of recurrent ischemia (64% vs 35%; p < 0.0001) and major amputation (10% vs 0%; p = 0.0024) was increased in patients who were randomized to lysis. Factors associated with a poor lytic outcome included FP occlusion, diabetes, and critical ischemia. No differences in mortality rates were observed at 1 year between the lysis and surgical groups. CONCLUSION: Surgical revascularization for lower extremity native artery occlusions is more effective and durable than thrombolysis. Thrombolysis used initially provides a reduction in the surgical procedure for a majority of patients; however, long-term outcome is inferior, particularly for patients who have an FP occlusion, diabetes, or critical ischemia.

Arterial Occlusive Diseases↗

PubMed1998

Three-dimensional CT angiography: renal applications.

CT angiography has become an effective noninvasive imaging modality for evaluating the renal vasculature. The current clinical applications for CT angiography and three-dimensional (3D) imaging related to the kidneys and renal vasculature include evaluation of renal artery stenosis, renal diseases related to aortic diseases, living-related renal donor candidates, and preoperative evaluation of renal masses for possible nephron sparing surgeries. Imaging parameters need to be individually prescribed for renal CT angiography depending on the diagnostic goal of the examination. Methods for optimizing spiral CT protocols including patient preparation, contrast administration, image acquisition parameters, and image reconstruction will be covered.

Angiography↗

PubMed1999

MR pancreatography.

Recent innovations in the field of ultrafast MR imaging have increased the robustness of MR cholangiopancreatography (MRCP). Its complete noninvasiveness and flexible physiological approaches in detecting pancreaticobiliary pathologic conditions are gaining the acceptance of many clinicians. The procedure is also safer and more comfortable both for physicians and patients compared with direct pancreatography or cholangiography. Because of its cost effectiveness and safety, optimized MRCP technologies will gradually replace the diagnostic use of endoscopic retrograde cholangiopancreatography (ERCP). It is also notable that MRCP techniques can be used to obtain physiological/dynamic information that ERCP cannot provide. This article addresses recent advances in MRCP from technological and clinical aspects, focusing on its unique features as a hydrographic technique, and also refers to its limitations.

Aged↗

PubMed1997

The pill and thrombosis: epidemiological considerations.

The oral contraceptive is one of the most widely taken medications in the healthy population. The clinically important side-effects are venous and arterial thrombosis. Accurate estimates of incidence of these side-effects have proven to be difficult. Diagnostic modalities for thrombosis are sub-optimal and the problems of study methodology, primarily a reliance on non-experimental studies, have limited the ability to define the attributable risk of thrombosis from oral contraception. Pharmacological attempts to further decrease venous thrombotic side-effects by the use of third-generation oral contraceptives have failed. This places a greater emphasis on the selection of patients to help avoid giving medication to those patients with underlying thrombotic risk factors. An example of this approach has been the clear confirmation of the adverse effects of cigarette smoking and arterial thrombosis in oral contraceptive users. At the biochemical level, hypercoagulability testing may be useful. Screening for high-frequency prothrombotic abnormalities, such as the Factor V Leiden genotype, represents an important addition to the process by which patients are selected, and may be prototypic of further advances.

Adult↗

PubMed1997

The evaluation of palpable breast masses: common pitfalls and management guidelines.

The management of a palpable breast mass starts with identification of the lesion and a suspicion of malignancy. While seemingly simple, the initial evaluation can significantly impact upon treatment options and outcomes. The management of two patients recently referred to this Institution highlights common pitfalls and technical considerations in the diagnosis and treatment of palpable breast masses. The case histories of two patients referred after open breast biopsy were examined. The English language medical literature was searched manually and by Medline for publications related to the evaluation of palpable breast masses. Imaging, diagnostic techniques and technical considerations in the management of palpable lesions were reviewed. The initial use of carefully selected diagnostic and therapeutic measures is critical in optimizing outcomes measured in improved quality of life and survival. Inappropriate choices at this first stage can have extremely negative consequences. The early evaluation of two patients highlighted these considerations. Management pitfalls included serial examination of a suspicious lesion, failure to obtain a mammogram prior to excisional biopsy and unnecessary testing. Technical problems included piecemeal excision of the tumor with positive margins, use of a drain, closure of deep tissues with dimpling of the breast, and incision placement in a location that subsequently necessitated mastectomy. Careful adherence to the clinical and operative principles of breast cancer management optimizes outcomes in the evaluation of palpable breast masses.

Aged↗

PubMed2001

Comparison of systems performance for TT virus detection using PCR primer sets located in non-coding and coding regions of the viral genome.

BACKGROUND: the heterogeneity of the TT virus (TTV) DNA prevalence values reported from comparable human cohorts suggests that diagnostic PCR protocols still require to be optimized. OBJECTIVES: to design TTV PCR primer sets with low genotype restriction and to compare their performances with commonly used amplification systems. STUDY DESIGN: we compared full length TTV genomic sequences and identified conserved nucleotide patterns in the 5' and 3' non-coding regions of the viral genome. This permitted to design two new primer sets usable for the PCR amplification of the most divergent human isolates of TTV described to date. The performances of these amplification systems were compared with those of three other PCR systems earlier used for prevalence studies. RESULTS: the primer systems P5Bx and P3Bx exhibited higher PCR scores than the other systems tested; 14 to 34% improvement values were obtained, and divergent positive results of earlier described PCR systems were confirmed systematically by our new detection assays. CONCLUSIONS: an optimized detection of TT virus DNA is a pre-requisite for the accurate epidemiological survey of viral infection and for the realization of phylogenetic studies. Such PCR systems with low genotype restriction will be helpful in the future for a better knowledge of natural history of TT virus infection.

3' Untranslated Regions↗

PubMed2026

Hereditary cancer: Germline testing practices across ERN GENTURIS member countries.

Germline genetic testing practices for hereditary cancer vary across the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS) member countries. We surveyed experts in genetic testing from 20 EU member countries and Norway to assess multi-gene panel usage, availability of genome-wide sequencing, first-tier testing approaches, implementation of polygenic risk scores, and the roles of non-genetic healthcare professionals. National experts and members of the ERN GENTURIS completed a structured questionnaire covering founder germline pathogenic variants (gPV) testing, panel testing for common genetic tumour risk syndromes, use of whole-exome sequencing (WES) and whole-genome sequencing, polygenic risk score implementation, use of formalin-fixed paraffin-embedded tumour samples, laboratory accreditation, and the clinical roles of physicians, genetic counselors and nurses. Significant inter-country heterogeneity was observed. Most countries rely on next-generation sequencing (NGS) multi-gene panels. Founder gPV testing is first-line in a few high-prevalence populations (e.g., BRCA1/2 founders). All 21 countries offer NGS panel tests for hereditary breast and ovarian cancer, and ≥19 countries do so for colorectal and prostate cancers. However, NGS panel size and gene composition exhibit substantial variability. WES is available in 12 countries on a routine basis. Most countries implemented genetic testing on stored tumour tissue from deceased patients. In all countries, clinical geneticists can order germline genetic tests, and in 9 countries, any physician can do so. These findings show differences in accessibility to germline genetic testing of hereditary cancer in Europe. We propose EU-wide guidance via pathways, standards of care, and sharing of best practices to further optimize access to hereditary cancer genetic molecular diagnostics.

Humans↗

PubMed2002

Childhood acute lymphoblastic leukemia.

As cure rates in childhood acute lymphoblastic leukemia reach 80%, emphasis is increasingly placed on the accurate identification of drug-resistant cases, the elucidation of the mechanisms involved in drug resistance and the development of new therapeutic strategies targeted toward the pivotal molecular lesions. Pharmacodynamic and pharmacogenomic studies have provided rational criteria for individualizing therapy to enhance efficacy and reduce acute toxicity and late sequelae. Currently, assessment of the early response to treatment by measurement of minimal residual disease (MRD) is the most powerful independent prognostic indicator. MRD is affected by both the drug sensitivity of leukemic cells and the pharmacodynamic and pharmacogenetic properties of the host cells. Rapid advances in biotechnology and bioinformatics should ultimately facilitate the development of molecular diagnostic assays that can be used to optimize antileukemic therapy and elucidate the mechanisms of leukemogenesis. In the interim, prospective clinical trials have provided valuable clues that are further increasing the cure rate of childhood acute lymphoblastic leukemia.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1978

Tissue-puncher and loop-ligation--new aids for surgical-therapeutic pelviscopy (laparoscopy) = endoscopic intraabdominal surgery.

The optimal development of the pelviscopic instruments for diagnostic purposes provides us with the start in the field of surgical therapeutic pelviscopy. Newly developed instruments: Loop ligation-applicator, Tissue-Puncher (morcellation-forceps), Aqua-Purator and the new CO2-PNEUS-AUTOMATIC (S = security) have enabled us to replace some of the prior operations requiring classic gynecologic laparotomy with surgical-therapeutic pelviscopy: Ovarectomy, adnectomy, myomectomy, cystectomy, resection of the tube-pregnancy. After more than 2,200 smaller surgical interventions were performed successfully since 1973 via pelviscopy with the hemostasis aided by 100 degrees C destructive heat (Endocoagulatory, Crocodile-Forceps and Point-Coagulator) more than 50 ovarectomies etc, could be performed in 1977 via pelviscopy without intra- or postoperative complications.

Abdomen↗

PubMed2002

Maternal psychological impact of fetal echocardiography.

The maternal psychological impact of fetal echocardiography may be deleterious in the face of newly diagnosed congenital heart disease. This questionnaire-based study prospectively examined the psychological impact of both normal and abnormal fetal echocardiography. Normal fetal echocardiography decreased maternal anxiety, increased happiness, and increased the closeness women felt toward their unborn children. In contrast, when fetal echocardiography detected congenital heart disease, maternal anxiety typically increased, and mothers commonly felt less happy about being pregnant. However, among women who had recently delivered infants with congenital heart disease, those who had had fetal echocardiography during the pregnancy felt less responsible for their infants' defects and tended to have improved their relationships with the infants' fathers after the prenatal diagnosis of congenital heart disease. Further study of the psychological and medical impact of fetal echocardiography will be necessary to define and optimize the clinical value of this powerful diagnostic tool.

Anxiety↗