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PubMedDate not supplied

[The diagnostic questionnaires and their use in epidemiological studies in psychiatry].

The paper presents diagnostic instruments employed in psychiatric; brief history of their development with regard to their importance for progress in psychiatric epidemiology, the characteristic of the most important diagnostic questionnaire (Present State Examination--PSE, Composite International Diagnostic Interview--CIDI, Schedules for Clinical Assessment In Neuropsychiatry--SCAN, Structured Clinical Interview for DSM IV--SCID, Schedule for Affective Disorders and Schizophrenia--SADS, Diagnostic Interview Schedule--DIS). It also describes some features that should be considered while choosing a proper instrument for a given study. The authors call attention to some differences between instruments, e.g., those related to the structure of the questionnaire, involving diagnostic categories, the sort of information that an instrument allows to collect, competence of interviewers and their training, and also population for which the instrument is assigned. Presenting advantages and disadvantages of instruments, the authors emphasize that there is no best instrument. The choice of questionnaire depends, first of all, on the purpose of the study and the funds that the researches have at their disposal.

Epidemiologic Methods↗
PubMed2000

Toward a checklist for reporting of studies of diagnostic accuracy of medical tests.

BACKGROUND: : "Diagnostic accuracy" refers to the ability of medical tests to provide accurate information about diagnosis, prognosis, risk of disease, and other clinical issues. Published reports on diagnostic accuracy of medical tests frequently fail to adhere to minimal clinical epidemiological standards, and such failures lead to overly optimistic assessments of evaluated tests. Our aim was to enumerate key items for inclusion in published reports on diagnostic accuracy, with a related aim of making the reports more useful for systematic reviews. METHODS: : We examined published reports on shortcomings of studies of diagnostic accuracy. We prepared an initial draft of a checklist to address common errors and presented it at a meeting of editors. After incorporation of comments from editors, we published a revised version in Clinical Chemistry in 1997 for comment from readers. One of us (E.M.) additionally circulated copies of the draft to methodologists and others interested in Evidence-Based Medicine. We updated the checklist with input from these sources. RESULTS: : The updated document lists items for inclusion in the title, abstract, methods, results, and discussion sections of published papers. Depending on the nature of the study, the total number of items for a single paper is approximately 40. We invite comments on this document, which is freely available at Clinical Chemistry Online, where it can accessed readily from the Table of Contents for the July 2000 issue at www. clinchem.org/content/vol46/issue7/. Comments (eLetters) can be posted there for general reading. CONCLUSIONS: : The suggested revisions incorporated in this report appear useful to ensure inclusion of additional information that can allow assessment of the validity of the conclusions and the applicability of the study in other settings. The list can be useful in formulating guidelines and a checklist, which will require testing by authors and study of their effect on published studies of diagnostic accuracy.

Clinical Chemistry Tests↗
PubMedDate not supplied

[Clinical assessment of schizophrenic syndrome (CASS): validity evaluation of the new diagnostic tool].

AIM: The aim of the study was an evaluation of validity measures of the CASS (Clinical Assessment of Schizophrenic Syndromes)--a new multi-purpose and multi-level clinical diagnostic instrument consisting of a diagnostic questionnaire (CASS-D) allowing to analyze a diagnosis of schizophrenia according to DSM-IV and ICD-10 criteria as well as of three rating scales designed for description and intensity evaluation of schizophrenic syndromes on the global (CASS-G), dimensional (CASS-P, a profile of 13 basic dimensions) or symptomatological (CASS-S, a set of 31 symptoms) level. SUBJECTS: 194 inpatients consecutively admitted to the Department within approximately 6 months were assessed twice (at the start and end of their hospitalization) by 12 trained diagnosticians. METHOD: Several measures of validity were analyzed. Results obtained by means of CASS were compared with results of the SANS/SAPS, BPRS, and PANSS as reference rating scales (diagnostic validity). Characteristics of frequency, intensity, dynamics and specificity of scale items were used to analyze content validity. Factorial structure of CASS scales was applied as a measure of construct validity. FINDINGS: Diagnostic validity of the new instrument seems to be confirmed by its very high correlation coefficients with rating scales recognized as international standards: BPRS, PANSS, and SANS/SAPS. Reasonable characteristics of frequency, intensity, dynamics and specificity of individual items (dimensions, symptoms) and sum scores of CASS scales and relationships between their values strongly suggest their content validity. Both sum (CASS-P, CASS-S) and global (CASS-G) scores of scales under study revealed some specificity--they had significantly higher values in patients with schizophrenia than in patients with other diagnoses. It allows to distinguish in a schizophrenic syndrome described by CASS components which are specific and not specific for this disorder. The latter have been left also in the final version for their practical and clinical importance. Construct validity of the CASS was studied separately for different scales (CASS-P, CASS-S) and different groups (all or only schizophrenic patients) by means of several factor analyses, and performed along identical statistical procedure (principal component method of extraction with criterion eigenvalue > 1, followed by Equamax rotation). Resulting solutions could be interpreted reasonably and consistently with contemporary attempts to find adequate factorial models of intrinsic structure of schizophrenic syndrome. Thus they support confidence for constructive aspect of the CASS validity. CONCLUSIONS: Ultimately, results obtained in the study suggest that the CASS may be considered as an instrument with some promising indices of diagnostic, content and construct validity, which may be potentially useful for clinical and research purposes.

Humans↗
PubMed2000

[Feto-maternal immunization and fetal hemolytic disease: invasive diagnostics and therapy in the Warsaw center of serological collision in years 1992-1999].

OBJECTIVE: The objective of this study was the assessment of intrauterine procedures, which are performed during the diagnostic phase and therapy of fetal hemolytic disease in the Warsaw Center of Serological Collision. MATERIALS AND METHODS: The study covered 146 women, who were patients of the Center from 1992 to 1999. Analyzed were the time of commencement of diagnostic and treatment, type of operations, duration of therapy, time and manner of delivery after the past intrauterine procedures, the medical condition of infants born as a result of these deliveries and the necessity for blood treatment in the early neonatal stage. RESULTS: 451 intrauterine procedures were carried out, of which 159 were diagnostic punctures of the umbilical vessel and 292 were fetal transfusions. The diagnostics and treatment was performed between the 19 and 38 week of pregnancy. The number of punctures for each patient ranged from 1 to 4, and 1 to 10 for intrauterine transfusions. The therapy, which on average lasted 42 days, significantly improved the fetal blood morphology results. During the therapy 5 intrauterine demises were noted--3 as a result of advanced fetal hemolytic disease and 2 related to operation complications. The average pregnancy duration in the analyzed group was 36.4 for treated women and 37.4 weeks for diagnosed women. 52.7% of deliveries were vaginal, 47.3% were performed by cesarean section. The general condition of 87% of infants was good. However, 77% of infants required blood treatment during the early neonatal period. CONCLUSIONS: Invasive methods of fetal hemolytic disease diagnostics and intrauterine therapy assure high efficiency in the guiding of serological collision and fetal hemolytic disease conflicted pregnancies. At the same time, these methods are safe and carry a low risk of complications.

Anemia, Hemolytic↗
PubMed2000

Effect of a diagnostic dose of 185 MBq 131I on postsurgical thyroid remnants.

UNLABELLED: Stunning of thyroid remnants after diagnostic scanning with 131I may limit 131I therapy. The follow-up scans and serum thyroglobulin levels of such patients have been studied. METHODS: Three-hundred seventy-eight patients who underwent thyroidectomy for differentiated thyroid carcinoma were studied. Diagnostic scans were obtained with 185 MBq 131I; 7.2 wk afterward, the patients received 489 ablative treatments with 4 GBq 131I. A total of 1575 scans were obtained (pre- and posttreatment scans and 615 follow-up scans). The evolution of serum thyroglobulin levels was determined. RESULTS: In all patients, the thyroid-stimulating hormone level was more than 30 microIU/mL. Posttherapy scans showed less uptake than did diagnostic scans or even showed negative findings in 99 patients (21%). In these patients, the mean time between diagnostic scanning and therapy was 7.9 wk. In 61 of these 99 patients (61.6%), follow-up scans have shown negative findings, serum thyroglobulin was less than 3 ng/mL, and antithyroglobulin antibodies were not present. Twenty-three patients (23.2%) have not undergone follow-up scanning yet. In 8 patients (8.1%), follow-up scans showed negative findings but serum thyroglobulin was more than 3 ng/mL. In 7 patients (7.1%), follow-up scans showed less uptake than posttherapy scans, but the findings were not yet negative and thyroglobulin was less than 3 ng/mL. CONCLUSION: Our data suggest that a stunning effect does not exist for doses of 185 MBq 131I for diagnostic scans. However, a therapeutic effect may exist.

Adolescent↗
PubMed2000

[The current state of the diagnostics of breast diseases in Lombardy].

PURPOSE: The SIRM study group for senology in Lombardy set the following goals: to quantify the number of radiologist working in public radiology centers and in private credited hospitals in Lombardy; to quantify the number of radiologists working in diagnostic senology and the mean time they devote to this field; to survey the diagnostic equipment used for senology purposes and check its adequacy. MATERIAL AND METHODS: We considered 58 centers of senology diagnostic imaging in the radiology departments of general hospitals in 8 Lombardy provinces. First we evaluated the screening programs for early breast cancer detection carried out with clinical mammography. All data were evaluated with reference to female residents aged 40 to 69, to the average adherence rates reported in the literature, to the protocols adopted in different centers relative to the examination frequency. Mammography was always associated with a physical examination and then the patient was submitted to radiological investigations to make the final diagnosis. The form we used for data report is summarized in Table I. RESULTS: In the centers for diagnostic senology we surveyed in 1998, in all 182,724 mammograms, 58,686 breast US examinations and 7,097 needle biopsies for cytology or microhistology were performed; 35.5% of the female population which should have been screened actually underwent the examination and 32.6% of them was also submitted to breast US, while 3.88% underwent FNAB. Sixty-three mammographic units and 62 US units were operated by 152 radiologists. An average 2,900 radiographic investigations per mammographic unit were performed yearly. Each radiologist reported an average 1,202 mammograms a year. Refer to the tables for detailed data reporting by province. Thirty-six per cent of radiologists presently reads more than 1,500 breast examinations a year. The radiologists working in diagnostic imaging in senology devote an average 20% of their working time to this field. As for the technical adequacy of mammographic and US equipment relative to some reference levels reported in detail in the paper, only 42% of the former and 48% of the latter were up to standards. DISCUSSION AND CONCLUSIONS: Despite the massive work done in the field of senology, the estimated needs of the female population have not been met yet, given the increased demand for senologic examinations and women's growing awareness of the need of early breast cancer diagnosis. The answer to this problem lies in a political health care policy that should promote the current clinical programs increasing both instrumental and human resources. Alternatively screening programs could be planned on a regional basis, with the pro of reaching a larger female population and that of a more homogeneous methodological approach. Our data indicate that breast cancer detection is best achieved with clinical and screening tools: the former can be easily promoted in a short time and could thus make our first goal, while the latter, which is more complex, could be implemented later. Thus, a growing clinical activity could make a very good basis for high quality breast screening programs. Finally, it is necessary to guarantee high quality standards for equipment, methods and training of medical and nonmedical staff.

Adult↗
PubMed2000

Poor diagnostic accuracy and applicability of Siriraj stroke score, Allen score and their combination in differentiating acute haemorrhagic and thrombotic stroke.

OBJECTIVE: To evaluate the relevance of bed side clinical diagnostic scoring systems--Siriraj stroke score (SSS), Allen score and their combined use for differentiating acute haemorrhagic and thrombotic stroke. MATERIAL AND METHODS: The study was conducted on 240 admitted patients of stroke over a period of two years. SSS was calculated immediately and Allen score, 24 hours after admission. CT scan was done immediately and 48 hours after admission if required. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic gain were calculated for both the scores. Comparability between the scores and CT scan finding was determined with the help of kappa statistic programme. Receiver operating characteristic curves (ROC) were plotted to assess the diagnostic accuracy of both scores over a range of cut-off points. RESULTS: One hundred and thirty four patients (55.83%) had infarction and 106 patients (44.17%) had haemorrhage. SSS was applicable in 66.25% patients (159 out of 240) while Allen score was applicable in only 61.25% patients (147 our of 240). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic gain for SSS were 73%, 85%, 85%, 71% and 30% for infarction and 85%, 73%, 71%, 85% and 27% for haemorrhage respectively, whereas the corresponding figures for Allen score were 91%, 60%, 77%, 82% and 18% for infarction and 60%, 91%, 82%, 77% and 41% for haemorrhage respectively. There was overall moderate comparability between SSS and Allen score for diagnosing supratentorial stroke (k = 0.396). The comparability of these scores in terms of certain results was worse (k = 0.143). However when the results that were within the diagnostic range with both the scores were considered, the agreement in diagnosing infarction and haemorrhage was almost perfect (k = 0.874). While considering CT scan finding as gold standard for differentiation of infarction and haemorrhage, the overall accuracy of SSS and Allen score was seventy eight percent. CONCLUSION: (a) Applicability of SSS only in 66.25% patients and wrong diagnosis in 22.01% patients does not reflect its usefulness because adequate management of stroke requires a gold standard diagnosis which is only possible by immediate CT scan. (b) Allen score is not useful because it can be assessed only after 24 hours of onset of stroke. This deprives the management to all thrombotic patients in speculated time window of modern management.

Acute Disease↗
PubMed2001

[Contrast agent improves diagnostic value of dobutamine stress echocardiography].

OBJECTIVES: Suboptimal endocardial definition reduces the diagnostic value of stress echocardiography for coronary artery disease, but intravenous infusion of a left ventricular contrast agent (Albunex) may enhance endocardial border delineation and improve the diagnostic value of dobutamine stress echocardiography. METHODS: Fifty-six patients, 38 with myocardial infarction, 16 with angina pectoris and two normal subjects, were enrolled in this study. Dobutamine was infused in scalar doses of 5 to 40 micrograms/kg/min. Intravenous infusion of Albunex (0.15 ml/kg) was administered at rest and during peak dobutamine stress during monitoring of the apical four-chamber view. The left ventricle in the apical four-chamber view was divided into six segments and an endocardial delineation score of 0 to 3 (none to excellent visualization) was given to each segment. RESULTS: Endocardial delineation score was increased after Albunex infusion from 2.0 to 2.3 in the basal-septal, 2.0 to 2.4 in the mid-septal, 1.1 to 1.8 in the apical-septal, 0.7 to 1.2 in the apical-lateral, 0.9 to 1.6 in the mid-lateral, and 1.2 to 1.9 in the basal-lateral segments during peak dobutamine administration. Endocardial border resolution in the lateral wall showed greater improvement than in the septal wall after Albunex infusion. Diagnostic values in the left anterior descending artery territory failed to improve with Albunex infusion (sensitivity 82% to 89%, specificity 94% to 89%, and accuracy 86% to 89%), whereas a higher diagnostic accuracy was noted in the left circumflex artery territory with Albunex compared to without Albunex (sensitivity 63% to 81%, specificity 88% to 98%, and accuracy 80% to 93%, p < 0.05). CONCLUSIONS: Contrast agent improves the diagnostic accuracy of dobutamine stress echocardiography in the left circumflex artery territory.

Aged↗
PubMed2001

Hematological observations as diagnostic markers in dengue hemorrhagic fever--a reappraisal.

OBJECTIVE: To determine the utility of certain clinical and hematological parameters as diagnostic markers of dengue hemorrhagic fever (DHF), namely, (i) tourniquet test, (ii) association of bleeding manifestations with the platelet count, and (iii) "cut off" value of hematocrit diagnostic of DHF in Indian population. DESIGN: Prospective study. SETTING: Tertiary care hospital. SUBJECT: 304 children of DHF presenting between September 1996 to December 1996. RESULTS: The tourniquet test had a low sensitivity and was positive only in 61/239 (25.5%) cases. There was no statistical difference in the incidence of bleeding manifestations between thrombocytopenic and non-thrombocytopenic individuals highlighting poor association of thrombocytopenia with bleeding manifestations. A "cut off" hematocrit value of 36.3% diagnostic of DHF was estimated by discriminant analysis in Indian population. CONCLUSION: The study highlights tourniquet test as a less sensitive diagnostic marker of DHF, poor association of thrombocytopenia with bleeding manifestations and also defines the hematocrit value diagnostic of DHF in Indian population.

Child↗
PubMed2000

[Diagnostic efficacy of glutamic acid decarboxylase antibody and islet cell antibody in type I diabetes mellitus].

OBJECTIVE: To investigate the diagnostic efficacy of glutamic acid decarboxylase antibody (GAD65-Ab) and islet cell antibody (ICA) in type I diabetes mellitus. METHODS: 104 cases of type I diabetes mellitus and 102 normal controls were recruited, GAD65-Ab was determined with radioligand assay and ICA with ELISA. The diagnostic efficacy of GAD65-Ab and ICA was analysed by receiver-operating characteristic (ROC) curve with sensitivity, specificity and curve area. RESULTS: (1) The optimal cut-off point of GAD65-Ab was at 0.30, while that of ICA was at 0.45. The area under the curve of GAD65-Ab and ICA were 0.835 and 0.715 respectively. Compared with 0.5, the area under curve of GAD65-Ab and ICA was higher (P < 0.0001). The area under curve of GAD65-Ab was higher than that of ICA(P < 0.01). (2) In type I diabetes mellitus patients, the positivity of GAD65-Ab was not correlated to the age of onset and duration of the disease, while the positivity of ICA was correlated to the age of onset and duration. CONCLUSION: Type I diabetes mellitus can be diagnosed with GAD65-Ab and ICA. The diagnostic efficacy of GAD65-Ab is higher than that of ICA. In patients of type I diabetes mellitus with adult-onset and duration more than one year, the diagnostic efficacy of GAD65-Ab is higher than that of ICA, while in patients of type I diabetes mellitus with adolescent-onset and duration less than one year, the diagnostic efficacy of ICA is higher than that of GAD65-Ab.

Adolescent↗
PubMed2001

Diagnostic performance of antineutrophil cytoplasmic antibody tests for idiopathic vasculitides: metaanalysis with a focus on antimyeloperoxidase antibodies.

OBJECTIVE: The diagnostic value of tests for antimyeloperoxidase antibodies (anti-MPO) for systemic vasculitis is less established than that for cytoplasmic antineutrophil cytoplasmic antibody (cANCA)/antiproteinase 3 antibodies (anti-PR3). Controversy exists regarding the optimal utilization of indirect immunofluorescence (IIF) ANCA testing versus antigen-specific ANCA testing. To summarize the pertinent data, we conducted a metaanalysis examining the diagnostic value of ANCA testing systems that include assays for anti-MPO. METHODS: We performed a structured Medline search and reference list review. Target articles in the search strategy were those reporting the diagnostic value of immunoassays for anti-MPO for the spectrum of systemic necrotizing vasculitides that includes Wegener's granulomatosis, microscopic polyangiitis, the Churg-Strauss syndrome, and isolated pauci-immune necrotizing or crescentic glomerulonephritis, regardless of other types of ANCA tests. Inclusion criteria required specification of a consecutive or random patient selection method and the use of acceptable criteria for the diagnosis of vasculitis exclusive of ANCA test results. Weighted pooled summary estimates of sensitivity and specificity were calculated for anti-MPO alone, anti-MPO + perinuclear ANCA (pANCA), and anti-MPO/pANCA + anti-PR3/cANCA. RESULTS: Of 457 articles reviewed, only 7 met the selection criteria. Summary estimates of sensitivity and specificity (against disease controls only) of assays for anti-MPO for the diagnosis of systemic necrotizing vasculitides were 37.1% (confidence interval 26.6% to 47.6%) and 96.3% (CI 94.1% to 98.5%), respectively. When the pANCA pattern by IIF was combined with anti-MPO testing, the specificity improved to 99.4%, with a lower sensitivity, 31.5%. The combined ANCA testing system (anti-PR3/cANCA + anti-MPO/pANCA) increased the sensitivity to 85.5% with a specificity of 98.6%. CONCLUSION: These results suggest that while anti-MPO is relatively specific for the diagnosis of systemic vasculitis, the combination system of immunoassays for anti-MPO and IIF for pANCA is highly specific and both tests should be used together given the high diagnostic precision required for these conditions. Because patients with ANCA associated vasculitis have either anti-MPO with pANCA or anti-PR3 with cANCA, and rarely both, a combined ANCA testing system including anti-PR3/cANCA and anti-MPO/pANCA is recommended to optimize the diagnostic performance of ANCA testing.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2001

Percutaneous conchotome muscle biopsy. A useful diagnostic and assessment tool.

OBJECTIVE: To evaluate the diagnostic yield, performance simplicity, and safety of the percutaneous conchotome muscle biopsy technique for clinical and research purposes in an outpatient rheumatology clinic. METHODS: Biopsies taken by rheumatologists in an outpatient clinic during 1996 and 1997 were evaluated for histopathological and clinical diagnoses. RESULTS: A total of 149 biopsies were performed on 122 patients. Physicians learned the method easily. Samples were of adequate size and quality to allow for diagnostics. In total 106 biopsies were taken due to different diagnostic suspicions: 24 polymyositis (PM) or dermatomyositis (DM); 43 PM, DM, or vasculitis in addition to another rheumatic condition; 19 systemic vasculitis; and 20 myalgias. Criteria for definite or probable PM/DM were fulfilled in 21 patients, 18 with positive biopsies. Thirteen patients received vasculitis as clinical diagnosis, 3 with positive biopsies. No patient with myalgia had a biopsy with inflammatory changes. Fifteen of 43 rebiopsies performed to assess disease activity had signs of active inflammation. In 48% there were changes in immunosuppressive therapy after biopsy results. Four complications occurred; one was a serious subfascial hematoma. CONCLUSION: The percutaneous conchotome muscle biopsy technique gives a good size sample that allows for diagnostic evaluation and has a high yield in patients with myositis. It is a simple procedure, easy to learn and to perform, with a low complication rate and minimum discomfort for the patient. The method can preferably be used as a diagnostic tool and to perform repeated biopsies to assess the effect of a given therapy for both clinical and research purposes.

Adolescent↗
PubMed2000

[Diagnostic DNA testing for Huntington disease].

Direct DNA testing for the autosomal dominant neurodegenerative disorder, Huntington's disease, may be performed in a diagnostic setting, as a presymptomatic procedure or prenatally. This paper is intended for physicians practising outside departments of medical genetics who are considering diagnostic testing of patients presenting with symptoms or signs compatible with Huntington's disease. It offers a brief overview of practically relevant clinical, epidemiological, molecular and legal aspects of diagnostic genetic testing for Huntington's disease in Norway. We stress the need for adequate information before sampling and after the test has been performed, and for close contact with the genetics centre which offers the test for Huntington's disease and provides genetic counselling. As with other diagnostic tests, the treating physician is responsible for informing the patient about the result of the test and for ensuring adequate follow-up. The physician will often need the assistance of an expert in clinical genetics. A positive DNA test for Huntington's disease in a patient may have a profound impact on family members, who should be offered genetic counselling and support. Since asymptomatic at-risk family members may ask for a presymptomatic test in the future, diagnostic confirmation at the DNA level is warranted in any person examined because of clinical signs of Huntington's disease, even when the clinical diagnosis is considered unquestionable.

DNA Mutational Analysis↗
PubMed2001

Diagnostic, prognostic, and cost assessment of coronary artery disease in women.

Women with obstructive coronary disease appear to be more challenging diagnostically and suffer a more adverse prognosis than men. More than one half of women with symptoms of ischemic heart disease have no obstructive coronary artery disease at coronary angiography, yet these women frequently have persistent symptom-related disability and consume large amounts of healthcare resources. Prior evidence has been limited regarding effective diagnostic strategies for the assessment of symptomatic women. The current report synthesizes existing evidence on diagnostic testing in women, including research from the ongoing National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. In addition to recent published evidence (drawn from much larger cohorts of women) that stress echocardiography and nuclear imaging are similar in their ability to risk-stratify women, the WISE study is exploring new pathophysiological mechanisms of microvascular dysfunction in women. An unfolding body of evidence suggests that as tests become more diagnostically and prognostically accurate, the process will become more cost efficient. The results from a growing number of large observational series and National Institutes of Health-sponsored studies are expected to be the foundation for cost-effective diagnostic and prognostic strategies for the approximately 5 million women who undergo evaluation for coronary disease annually.

Chest Pain↗
PubMed2001

[Macrophage-colony stimulating factor (M-csf) in diagnostic and monitoring of non-small-cell lung cancer (NSCLC)].

Lung cancer is biologically and clinically classified as non-small-cell lung cancer (NSCLC) or small cell lung cancer (SCLC). NSCLC is accounting for about 80% of lung cancers. Serum tumour markers may be helpful in diagnostic of this cancer and in monitoring of the tumour growth or tumour volume reduction. Recent studies have focused on a new family of markers--hematopoietic cytokines, defined also hematopoietic growth factors (HGFs). It has been shown that the actions of HGFs are not limited to hematopoietic cells but can also affect the proliferation of nonhematopoietic cells. Some clinical investigations have shown cell surface receptors for macrophage--colony stimulating factor (M-CSF) in cancer cells and autologous production of M-CSF in various human cell lines derived from cancer. The purpose of this investigation was to compare serum levels of M-CSF in NSCLC patients to a control group, to assess pre- and post treatment levels of M-CSF in relation to levels of commonly accepted tumour markers such as carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1), and to define the diagnostic sensitivity of G-CSF in NSCLC. In this study, the serum levels of tumour markers were measured in 34 patients with NSCLC and in 20 healthy subjects. Serum samples were drawn before surgery and 10, 30, 90, 180 and 270 days after surgery. M-CSF and CEA were assayed using ELISA system and CYFRA 21-1 was measured by radioimmunoassay (RIA). The serum level of M-CSF was significantly increased in cancer patients relative to the control group on the 10th day after operation. Concentrations of CYFRA 21-1 were decreased on the 10th day, CEA on the 30th day and M-CSF on the 90th day after surgery. The diagnostic sensitivity of M-CSF was 55%, CEA--62% and CYFRA 21-1-51%. The diagnostic sensitivity and the serum level of M-CSF were related to the stage of NSCLC. These results suggest that M-CSF may be useful in diagnostic and monitoring of NSCLC, but it needs further studies.

Adult↗
PubMed2001

Systematic reviews of selected dental caries diagnostic and management methods.

A systematic review of the English-language literature was conducted to address three related questions concerning the diagnosis and management of dental caries: a) the performance (sensitivity, specificity) of currently available diagnostic methods for carious lesions, b) the efficacy of approaches to the management of noncavitated or initial carious lesions, and c) the efficacy of preventive methods among individuals who have experienced or are expected to experience elevated incidence of carious lesions. From 1,328 caries diagnostic and 1,435 caries management reports originally identified, thirty-nine diagnostic studies and twenty-seven management studies were included in the final evidence tables. Point estimates or reasonable range estimates for the diagnostic validity of methods for the diagnosis of carious lesions could not be established from the literature reviewed. There are insufficient numbers of reports of diagnostic performance involving primary teeth, anterior teeth, and root surfaces. For posterior occlusal and proximal surfaces, quality issues and the variation among studies precludes establishing such estimates. The apparent differences in sensitivity among methods are generally smaller than the variation reported within methods. The literature on the management of noncavitated carious lesions consisted of five studies describing seven experimental interventions. Because these interventions varied extensively in terms of management methods tested as well as other study characteristics, no conclusions about the efficacy of these methods were possible. The literature on the management of individuals at elevated risk of carious lesions consisted of twenty-two studies describing twenty-nine experimental interventions. The strength of the evidence for the efficacy of fluoride varnish for prevention of dental caries in high-risk subjects was fair, and the evidence for all other methods was incomplete. Because the evidence for efficacy for some methods, including chlorhexidine, sucrose-free gum, and combined chlorhexidine-fluoride methods, is suggestive but not conclusive, these interventions represent fruitful areas for further research.

Anti-Infective Agents, Local↗
PubMed2000

Periodontal diagnostics.

Periodontitis affects a subset of the population and our current thinking is that progression of periodontal disease may be either continuous or cyclical (burst hypothesis). These features make screening and diagnostic tools desirable in the management of this disease. Although many potential markers exist, several difficulties hamper our ability to declare them diagnostic tests with proven utility. The 'gold standard' for active periodontal disease is not available and inflammation due to gingivally confined lesions (gingivitis) and periodontal inflammation which results in attachment loss is a potential confounder of any test based on assessing the host response elements of the disease. The current absence of proof for the progression of periodontal disease i.e., whether or not the burst hypothesis is correct, is a further problem. Although much is written about the need for markers of current or future disease which will prevent us from overtreating pockets, the time, effort and cost involved in testing these sites has to be balanced against the relative ease and speed of routine therapy such as root planing. In addition, we are still some way from the development and validation of reliable host or microbial testing methods. In terms of screening tests for diseases such as the early-onset forms of periodontitis, the research and development on diagnostic tools involving genetic polymorphisms, specific genes, systemic antibodies or leucocyte cell surface markers of the patients, may become a clinical reality in time. One could envisage chairside tests using blood from thumb pricks being capable of determining a young individual's risk of developing disease at a later age, and thus the need for a timely prevention programme. Before applying any test we should reconsider what treatment planning effects a positive or negative result will have, and any test which does not influence the treatment plan is redundant. Whether periodontal diagnostic tests will be developed which will indicate to the clinician the need for various treatment regimes other than root planing, is still an open question. For example, in the future, a test of specific antibody levels in patients prior to treatment might indicate their likely response to therapy and thus the need for additional therapeutic agents such as antibiotics. Periodontal diagnostic tests are still at an early stage of development and much work remains to be performed to fully validate their utility such that they become an important and cost effective aspect of clinical treatment planning, screening or patient monitoring.

Aggressive Periodontitis↗
PubMedDate not supplied

[The beginnings and development of diagnostic imaging in nuclear medicine].

INTRODUCTION: The phenomenon of radioactivity was discovered in 1896 by Antoin Henri Becquerel, but its application in visual diagnostics started about fifty years later. RECTILINEAR SCANNER: It was constructed by B. Cassen and ass. in 1949, when first scintiscans were obtained. Technical improvements have been made 1950-1956 (B. Cassen and ass., R. Newall and ass., P. Bell, D. Kuhl). Soon after appearance of the first Cassen's scanner, commercial production began. GAMMA CAMERA: It was invented and constructed by H. Anger in 1957, improvements being made from 1958 to 1963. Gamma cameras are being commercially produced and sold since 1962; about ten years later they become widely used, and soon they pushed out the scanner from visual diagnostics. COMPUTER: Its use in scintigraphic diagnostics started in 1964 (H. Shepers, D. Wincler, D. Brown). From 1965 to 1974 various centers developed their own computer programs; after 1974 computers with incorporated nuclear medicine software packages became commercially available. TOMOSCINTIGRAPHY (SPET) AND POSITRON TOMOGRAPHY (PET): Numerous attempts to obtain tomographic images of organs using scanners and gamma cameras were made between 1963 and 1973 (D. Kuhl and R. Edwards, H. Anger, N. Charkes and R. Somburanasin et al.). The concept of contemporary single photon emission tomography (SPET) device was developed between 1974 and 1977 (J. Keyes and ass. and R. Jaszczak and ass.), while commercial production started in 1982. First cyclotrons for production of positron emitters, a prerequisite for positron emission tomography (PET) diagnostics, emerged in hospitals in 1955, and in last ten years they are being commercially made for these purposes. H. Anger (1959), M. Phelps, E. Hoffman and M. Ter-Pogossian (1975) set the grounds of PET; commercial production of PET systems started thereafter. CONCLUSION: Visual diagnostics in nuclear medicine reached its zenith in clinical practice during 1970-1980. It is partly pushed into the background by new imaging techniques (US, CT, MRI), but it only initiated further improvements (SPET, PET).

History, 19th Century↗