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At least 1,441 records · Page 80Linked to original sources
PubMed1995

Diagnostic yield of transthoracic needle aspiration biopsy following negative fiberoptic bronchoscopy in 103 patients with peripheral circumscribed pulmonary lesions.

The diagnostic potential of secondary transthoracic needle biopsy (TNB) following negative fiberoptic bronchoscopy (FOB) in patients with peripheral circumscribed pulmonary lesions was evaluated in a retrospective study. The records from 224 patients who had TNB over a 5-year period were reviewed. Of these, 103 patients met the criteria for inclusion in this series. The overall diagnostic yield of TNB in malignancy was 73.8% (54 of 73 patients). TNB allowed cytologic classification of the tumor type in 72.2% (39 of the 54 patients). Five of the 54 patients (9.3%) presented with small-cell anaplastic bronchogenic carcinoma, diagnosed at TNB, and were referred to chemotherapy. Of the 49 patients with a negative TNB, 27 went on to diagnostic surgical procedures; 19 had malignancy, 3 benign tumor, 2 infection, and 3 sequelae after pulmonary infarction. The remaining 22 undiagnosed patients were followed up over a long period of time, 5 showed progression of the pulmonary lesion suggesting malignancy. TNB appeared unsuitable for the diagnosis of benign lesions. Unspecific inflammation was not considered evidence of benignity, and therefore no definitive benign diagnosis was made by TNB in this series. There were no serious complications to TNB. In 18.1% of the procedures a pneumothorax developed, indicating a chest tube in 8.6% of the procedures. TNB is a suitable diagnostic procedure with a high diagnostic yield in patients with peripheral localized malignant pulmonary lesions.

Adult↗
PubMed1984

Heterogeneity of delusional syndromes: diagnostic criteria and course prognosis.

In addition to genetic findings and treatment response, the course prognosis is also meant to be a possible validating criterion for diagnosis and diagnostic systems. In our study we used the polydiagnostic approach (i.e. the simultaneous application of various criteria for diagnosing a given disorder to one and the same population) to test the ability of several diagnostic systems to create homogeneous groups regarding the course (episodic/chronic). We applied Schneider's FRS, ICD-9, DSM-III, Spitzer's RDC and the Vienna Research Criteria to 90 patients with the diagnosis of delusional syndrome (aside from any nosological classification), who underwent 6-9 years of follow-up. At the index examination, schizophrenia was most frequently diagnosed with Schneider's FRS, which apparently encompasses a very heterogeneous group of patients regarding psychopathology and course. Diagnostic systems which allowed the diagnosis of affective disorders despite the presence of mood-incongruent delusional symptomatology (DSM-III, RDC, Vienna Criteria) or offered the diagnosis of schizoaffective disorder (DSM-III, RDC) succeeded in separating subgroups with an episodic course on a statistically significant level. In ICD-9 this significance appeared only after exclusion of the schizoaffective cases from the group of schizophrenias. Our data thus uphold the old rule of thumb that affective symptomatology apparently has a very high prognostic value regarding the course of the illness and is in this respect superior to productive symptomatology (such as delusions and hallucinations), still taken to be pathognomonic for schizophrenia by some of the diagnostic criteria under study. This aspect warrants further investigation and should be taken into account in the development and improvement of diagnostic manuals (e.g. ICD-10, DSM-IV).

Adolescent↗
PubMed1994

Confounding diagnostic systems: a major risk in the use of criteria-based manuals.

In psychiatry, the new classification of diseases, the ICD-10/chapter V(F), will be introduced worldwide in the near future. As in the USA in the case of the DSM-III, psychiatrists will have to change their diagnostic procedures from traditional typology to criteria orientation. 83 West German psychiatrists in practice, who were unfamiliar with the use of criteria-oriented diagnostic systems, documented not only the ICD-9 diagnoses of 10,902 depressive patients but also their DSM-III diagnoses. A comparison between the results of the diagnostic distribution of this sample and a smaller sample diagnosed by well-trained interviewers reveals that, to a great extent, systematic mistakes were made, especially by confounding typological and criteria-oriented diagnostic entities. In a vulnerable period of changing diagnostic procedures, such as during the introduction of ICD-10, facilities for training and discussion should be supplied.

Adult↗
PubMed1996

Mood (affective) disorders (F3). Results from the ICD-10 field trial of the Diagnostic Criteria for Research in German-speaking countries.

The present study reports results of the ICD-10 research criteria trial concerning the diagnosis of affective disorders (section F3). On the basis of written case reports and videotapes a total of 451 clinicians from 34 centres in German-speaking countries prepared 2.228 diagnostic ratings on 39 different psychiatric patients. Three of the 39 cases met the diagnostic criteria for affective disorders, and 248 of the diagnostic assessments referred to these cases. The majority of clinicians rated the reliability, the ease and the suitability of the diagnostic criteria positively. The reliability of the affective disorders was extremely good, with a kappa of 0.93 in the range of 2-character diagnoses. The reliability of the 3-character categories was much smaller: Kappa values for depressive episode (F31) and recurrent depressive disorder (F33) were 0.68 and 0.54, respectively. The lowest concordance had a kappa value of 0.22 and was found in the case report of dysthymia (F34.1). Therefore a more precise definition of the diagnostic criteria for dysthymia would be desirable.

Germany↗
PubMed1995

Assessment of comorbidity in the diagnosis of psychosomatic and neurotic disorders: results from the ICD-10 field trials with the diagnostic criteria for research in Germany.

Operational diagnostic systems like ICD-10, Chapter V (F) are introducing the concept of comorbidity covering the symptomatology of patients with multiple descriptive diagnoses. Focusing on this concept, the relevance of rater variables in the diagnostic assessment with ICD-10 is studied. Based on data from the German ICD-10 Research Criteria Study in 11 centres of psychosomatic medicine, diagnostic ratings of 129 clinicians for 20 patients are discussed. Significant differences concerning the agreement of the clinicians with expert main diagnoses are correlated with their familiarity with DSM-III-R, the age of the clinicians and subjective ratings of the diagnostic process. Clinicians with a greater familiarity with DSM-III-R and ICD-10 and older diagnosticians with more professional experience in psychosomatic medicine show a better ability to cover comorbidity in their diagnostic assessments. Furthermore, behavioural therapists are assessing comorbidity more adequately than psychoanalytic therapists.

Adult↗
PubMed1982

Diagnostic accuracy of exercise ECG lead systems in clinical subsets of women.

The diagnostic accuracy of 14-lead exercise electrocardiography was evaluated in 112 women who had no history of myocardial infarction and underwent coronary angiography. The sensitivity of ST-segment displacement of 0.1 mV or more in any of 14 ECG leads was 0.79 for coronary artery stenosis of at least 70%; the specificity was 0.66. Results were similar using bipolar ECG leads CC5 and CM5 or 11 standard ECG leads. The ST-segment shifts that occurred only during exercise were associated with a 77% false-positive rate (10 of 13). Downsloping ST-segment depression did not provide more diagnostic information than horizontal ST-segment depression in the three clinical subsets of women. In women with typical angina pectoris, ST-segment depression of at least 0.15 mV for 0.08 second after the J point or a final treadmill time less than 360 seconds was predictive of proximal left or multivessel coronary artery disease. In the women with probable angina or nonspecific chest pain, this finding was not of diagnostic value. ST-segment elevation of 0.1 mV or more in leads V1-2 or a VL predicted proximal stenosis of at lest 80% in the left anterior descending coronary artery in all six women with typical angina pectoris. Maximal exercise testing in women with typical angina provides important diagnostic information when 11 standard ECG leads are recorded. In women with probable angina or nonspecific chest pain, diagnostic exercise testing is less useful and bipolar leads CC5 and CM5 are sufficient for most clinical purposes.

Adult↗
PubMed2006

Safety of cerebral digital subtraction angiography in children: complication rate analysis in 241 consecutive diagnostic angiograms.

BACKGROUND AND PURPOSE: Catheter-based cerebral angiography remains an important diagnostic tool in the pediatric population, particularly considering the currently growing interest in diagnosing and treating cerebrovascular disorders in children. There are no recent estimates of the complication rate associated with modern diagnostic digital subtraction angiography (DSA) in the pediatric population. The purpose of this study was to estimate the rate of complications occurring during cerebral angiography in children. METHODS: Data from 241 consecutive pediatric cerebral angiograms performed at a single institution were entered into an institutional review board-approved database. Information on patient demographics, DSA indication, neurovascular diagnosis, and intra procedural and postprocedural complications was collected. RESULTS: Our population included 115 boys and 90 girls, with age ranging from 1 week to 18 years (mean+/-SD, 12+/-5 years). All angiograms were technically successful. No intraprocedural complication was noted; in particular, there was no occurrence of iatrogenic vessel injury (dissection) and no transient or permanent neurological deficit secondary to a thromboembolic event. One child with a complex dural arteriovenous fistula experienced a fatal intracranial rehemorrhage secondary to a posterior fossa varix rupture 3 hours after completion of an uneventful diagnostic angiogram. The rates of intraprocedural and postprocedural complications were therefore 0.0% (95% CI, 0.0% to 1.4%) and 0.4% (95% CI, 0.012% to 2.29%), respectively. CONCLUSIONS: The rate of immediate complications occurring during diagnostic cerebral angiography in children is very low. No intraprocedural complication was documented in the reported series. DSA performed by experienced angiographers is a safe procedure that can provide critical diagnostic information.

Adolescent↗
PubMedDate not supplied

Diagnostic reliability of the percutaneous ultrasonic Doppler technique for vertebral arterial occlusive diseases.

There is little data on the diagnostic reliability of the ultrasonic Doppler technique for vertebral arterial occlusive lesions. Percutaneous vertebral Doppler examination and the vertebral angiograms were compared to determine the diagnostic reliability of this technique in 64 vertebral arteries of 53 patients with cerebrovascular disease. The percutaneous vertebral Doppler findings were quantitatively analyzed using a sound spectrograph and were classified into three types: no flow signal type, poor flow type and normal flow type. In nine patients with the no flow type the angiograms revealed vertebral occlusion or a missing vertebral artery in six, giving a diagnostic reliability of 67%. In 17 patients with poor flow type the angiograms revealed vertebral occlusion or a missing vertebral artery in five, terminal narrowing of the artery in nine, and hypoplasia in two giving a diagnostic reliability of 94%. For all vertebral arteries examined with this technique, including normal ones, the diagnostic reliability was 92% (59/64). Percutaneous vertebral Doppler examination has clinical usefulness as a screening test for occlusive vertebral arterial diseases.

Adult↗
PubMed2007

The effects of study design and spectrum bias on the evaluation of diagnostic accuracy of confocal scanning laser ophthalmoscopy in glaucoma.

PURPOSE: To assess the effects of study design and spectrum bias on the evaluation of diagnostic accuracy of confocal scanning laser ophthalmoscopy (CSLO) in glaucoma. METHODS: Analysis 1 included 67 eyes with glaucomatous visual field loss and 56 eyes of normal volunteers. Estimates of diagnostic accuracy in this analysis were compared to those obtained from analysis 2, which included a cohort of patients with suspected glaucoma, but without visual field loss at the time of CSLO imaging. For analysis 2, 40 eyes with progressive glaucomatous optic disc change were included in the glaucoma group and 43 eyes without any evidence of progressive damage to the optic nerve that were observed untreated for an average time of 9.01 +/- 3.09 years were included in the normal group. Areas under the receiver operating characteristic (ROC) curves (AUC) were used to evaluate diagnostic accuracy of CSLO parameters. RESULTS: There was a statistically significant difference between the performance of the parameter with largest AUC, discriminant function Bathija, in analysis 1 (AUC = 0.91) compared with its performance in analysis 2 (AUC = 0.71; P = 0.002). For the contour-line-independent parameter glaucoma probability score, a statistically significant difference was also observed in the performance obtained in analysis 1 (AUC = 0.89) compared with analysis 2 (AUC = 0.65; P < 0.001). CONCLUSIONS: Estimates of diagnostic accuracy of CSLO in glaucoma can be largely different depending on the population studied and the reference standard used to define disease. Diagnostic accuracy estimates obtained from case-control studies including well-defined groups of subjects with or without disease may not be applicable to the clinically relevant population.

Adult↗
PubMed1979

Use of the Research Diagnostic Criteria and the Schedule for Affective Disorders and Schizophrenia to study affective disorders.

In a pilot study of 150 manic or depressive patients, the authors used the Research Diagnostic Criteria (RDC) and the Schedule for Affective Disorders and schizophrenia (SADS) to perform preliminary analysis of symptom pictures of the index episode of different diagnostic groups, joint diagnostic classification of the different subtypes of major depressive disorder, and differential outcome by diagnostic groups. The results suggest that schizophrenic symptoms in affective disorders do have diagnostic and prognostic significance, that the term "psychotic depression" should be limited to impaired reality testing without reference to degree of incapacitation, that situational-nonsituational and endogenous-nonendogenous classifications are separate depressive subtypes, and that it may not be true that patients with endogenous major depressive disorder have a better prognosis than patients with nonendogenous depression.

Adjustment Disorders↗
PubMed1985

The diagnostic validity of anxiety disorders and their relationship to depressive illness.

Several serious questions exist regarding the diagnostic classification of anxiety disorders. The authors examine the diagnostic validity of generalized anxiety disorder and panic disorder and explore their relationship to major depression, critically reviewing relevant descriptive, lifetime occurrence, family and genetic, drug treatment, and neurobiological studies. There is strong support for the diagnostic validity of panic disorder, but few data are found to support a separate diagnostic classification of generalized anxiety disorder. In addition, several lines of evidence suggest that a common vulnerability may exist for some forms of panic disorder and major depression. The implications of these findings for diagnostic application, treatment, and future research are discussed.

Anti-Anxiety Agents↗
PubMed1991

Comparison of the diagnostic utility of timed serial (slope) creatine kinase measurements with conventional serum tests in the early diagnosis of myocardial infarction.

We compared the diagnostic utility of recently proposed slope assays for serum creatine kinase and creatine kinase-2 with the optimized decision threshold assays. The former approach has been claimed to be superior to any other single diagnostic technique. We show, by ROC curve and likelihood ratio analyses, that the total creatine kinase slope assay possesses the same diagnostic power, when confidence intervals are used, as the optimized decision threshold assay. Moreover, slope assays of creatine kinase-2 were diagnostically inferior to the optimized decision threshold assays. Indeed, these latter, optimized, assays have the highest likelihood ratios for a positive test result of the available assays, and they should always be used in situations of diagnostic doubt.

Adult↗
PubMed2005

A tutorial on the use of ROC analysis for computer-aided diagnostic systems.

The application of the receiver operating characteristic (ROC) curve for computer-aided diagnostic systems is reviewed. A statistical framework is presented and different methods of evaluating the classification performance of computer-aided diagnostic systems, and, in particular, systems for ultrasonic tissue characterization, are derived. Most classifiers that are used today are dependent on a separation threshold, which can be chosen freely in many cases. The separation threshold separates the range of output values of the classification system into different target groups, thus conducting the actual classification process. In the first part of this paper, threshold specific performance measures, e.g., sensitivity and specificity, are presented. In the second part, a threshold-independent performance measure, the area under the ROC curve, is reviewed. Only the use of separation threshold-independent performance measures provides classification results that are overall representative for computer-aided diagnostic systems. The following text was motivated by the lack of a complete and definite discussion of the underlying subject in available textbooks, references and publications. Most manuscripts published so far address the theme of performance evaluation using ROC analysis in a manner too general to be practical for everyday use in the development of computer-aided diagnostic systems. Nowadays, the user of computer-aided diagnostic systems typically handles huge amounts of numerical data, not always distributed normally. Many assumptions made in more or less theoretical works on ROC analysis are no longer valid for real-life data. The paper aims at closing the gap between theoretical works and real-life data. The review provides the interested scientist with information needed to conduct ROC analysis and to integrate algorithms performing ROC analysis into classification systems while understanding the basic principles of classification.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

Using treatment-tradeoff preferences to select diagnostic strategies: linking the ROC curve to threshold analysis.

Selection of optimal diagnostic strategies depends on the accuracy of diagnostic tests, the prevalence of disease, and the relative benefits and harms resulting from test/treatment choices. One can characterize diagnostic strategies according to their net benefit-to-harm ratios. Within the framework of expected-utility theory, the benefit-to-harm ratio is equivalent to the marginal tradeoff between erroneous and correct treatment choices. Consequently, a physician can identify his or her preferred strategy by asking the question: "How many additional treatment errors am I willing to make in order to treat one additional person correctly?" Family physicians were asked to indicate their lowest and highest acceptable tradeoff ratios in a survey about streptococcal pharyngitis. All 53 respondents indicated uncertainty about their preferred treatment-tradeoff ratios. For 58% of respondents, the midpoints of the acceptable range of tradeoff ratios corresponded to generally accepted diagnostic strategies: 1) test all or 2) treat if classic, test all others. In contrast, previously published patient utilities yield a treatment-tradeoff ratio that corresponds to the strategy of treating all cases. The analysis illustrates the linkage between the optimal operating point on a receiver operating characteristic (ROC) curve and the selection of a preferred diagnostic strategy based on treatment thresholds derived from benefit-to-harm ratios. The survey results indicate that physicians can respond directly to questions assessing their preferences for such treatment thresholds. Differences between patients and physicians have significant impacts on choices of test and treatment strategies.

Clinical Medicine↗
PubMed1993

Diagnostic potential of host response mediators.

This review summarizes the data which relate the validation and application of host response markers as diagnostic tests for periodontal diseases. Practical considerations regarding the general application and evaluation of a diagnostic test for periodontal disease are presented. Experiments which have documented the performance of host response markers as diagnostic measures of disease activity in terms of sensitivity, specificity, and predictive values are summarized. Particular emphasis is placed on the diagnostic potential of gingival crevicular fluid (GCF) components. The considerable body of evidence supporting the potential application of GCF-PGE2 levels for predicting episodes of disease progression and reflecting disease activity is summarized and placed into perspective for the development of future diagnostic tools.

Biomarkers↗
PubMed1992

Evaluation of the sensitivity and specificity of two diagnostic tests for antibodies to pseudorabies virus glycoprotein X.

The diagnostic performance of 2 enzyme-linked immunosorbent assays (gX-T, gX-H) for antibodies to pseudorabies virus (PRV) glycoprotein X (gX) were evaluated using 311 serum samples from a nonvaccinated quarantined herd. When the standardized virus neutralization (VN) test, which uses the Shope strain (VN Shope), was used as the comparative diagnostic standard, the gX-T test had a 7% false-negative rate and a 52% false-positive rate, and the gX-H test had a 19% false-negative rate and a 19% false-positive rate. When the VN test with a Bartha recombinant strain (VN Bartha gIIIKa) was used as the diagnostic standard, the gX-T test had a 9% false-negative rate and a 26% false-positive rate, and the gX-H test had a 24% false-negative rate and a 11% false-positive rate. Thus, the gX-T test was more sensitive and the gX-H test was more specific. Additional diagnostic tests on 79 serum samples from a noninfected herd did not produce false positives for the gX-H test, but there was an 8% false-positive rate for the gX-T test. Previous studies from our laboratory have demonstrated that VN Bartha gIIIKa has higher sensitivity than VN Shope, without losing specificity, and thus is a better comparative diagnostic standard. When adding a suspect range to the gX-T test, using the same criteria as the suspect range for the gX-H test, the false-positive rate of the gX-T test was reduced to 5% when evaluated versus VN Bartha gIIIKa in the infected herd and to 1% for the PRV-negative herd.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

Diagnostic laparoscopy outside of the operating room.

Laparoscopy is increasingly being used as a diagnostic technique to characterize intraperitoneal processes. This technique can be highly informative when applied in settings such as the intensive care unit, the emergency room, the trauma bay, and the office. Diagnostic laparoscopy is an excellent method to evaluate intraperitoneal processes and should be part of the general surgeon's armamentarium of skills. In this paper, the technique of diagnostic laparoscopy and its role outside of the operating room setting is reviewed. Diagnostic laparoscopy is also compared with other diagnostic modalities.

Contraindications↗
PubMed2006

High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions.

A prospective study was performed to evaluate the diagnostic accuracy of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels, measured simultaneously in serum and pleural fluid, in identifying pleural effusions due to heart failure. Pleural fluid and serum samples from all patients presenting for thoracentesis between April 2004 and May 2005 were simultaneously collected. The discriminative properties of NT-proBNP levels in identifying pleural effusions due to heart failure were determined by receiver operating characteristic curve analysis and compared to the diagnostic value of finding a transudate by Light's criteria. Ninety-three patients were evaluated, 27% with cardiac effusion and 73% with exudative effusions of various cause. Levels of NT-proBNP in pleural fluid and serum correlated closely. Serum and pleural fluid NT-proBNP levels were significantly elevated in patients with cardiac effusion. With a cut-off value of 4,000 ng.L(-1), NT-proBNP levels in pleural fluid and serum displayed comparably high diagnostic accuracies of 92 and 91%, respectively. All patients misclassified by Light's criteria were correctly identified by measuring NT-proBNP levels. N-terminal-pro-B-type natriuretic peptide levels in either pleural fluid or serum showed a high diagnostic accuracy compared to traditional criteria. Thus measuring N-terminal-pro-B-type natriuretic peptide is a valuable additional diagnostic tool for the detection or exclusion of cardiac origin of pleural effusions.

Aged↗