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PubMed1984

Approach to the foetus with congenital hydronephrosis.

Recent technological advances in prenatal ultrasonography have been responsible for the detection of a variety of congenital abnormalities in utero. The widespread use of this study during pregnancy has led to an increased recognition of foetal hydronephrosis. It has been postulated that unrelieved, high-grade urinary obstruction in utero may produce progressive renal damage. This supposition has resulted in the development of techniques for foetal intervention in attempts to correct obstructive uropathy and arrest renal dysplasia. Herein we review the techniques for assessment of foetal renal function and treatment options available for the foetus with hydronephrosis in utero. Most foetuses with hydronephrosis have dilated, low pressure systems with adequate urinary output and amniotic fluid volume and can be followed safely to term delivery. The accumulated experience to date indicates that the foetus with congenital hydronephrosis detected in utero should be managed expectantly with serial ultrasound examinations after delivery to establish an accurate diagnosis and to evaluate the status of the contralateral kidney. Functional tests after birth, such as renal scans and excretory urography, are mandatory to establish the proper diagnosis and assess the need for operative intervention.

Female↗
PubMed1993

Risk factors for HIV infection among Thai laborers during 1992-1993.

From June 1992 to May 1993, 39,939 Thai men attended the clinic for laborers going abroad at Siriraj Hospital in Bangkok for a pre-assignment physical exam and mandatory blood screen for HIV and syphylis. Of this total, 438 tested positive for HIV antibody (1.1%). Of these, 215 men returned for post test interview and physical exam and were compared with 1,348 men randomly selected HIV-1 seronegative men. None of the HIV-1 seropositive had a history of injecting drug use or had received blood transfusion in the past seven years. HIV-1 seropositivity was associated with the TPHA serological marker for syphylis > 1.160 (p = 0.015, odd ratio 1.8), history of urethritis (p = 0.009, odd ratio 1.92) (Table 4). This study found that HIV-1 seropositive men were mostly single, were likely to be from the rural northern provinces of Thailand or Bangkok. History of purchase of low-fee commercial sex and less condom use were significantly associated with HIV-1 seropositivity as was a history of STD in the year prior to interview. Information on HIV disease and pre-test/post test counselling is needed for Thai laborers who are applying for work abroad to countries which require HIV and syphylis screening. In this effort, the Ministry of Labor and Social Welfare, the Ministry of Public Health and the clinic for laborers going abroad should join forces to provide this service. This will serve to increase awareness and self-determination among an increasingly vulnerable segment of the population who also have the potential to spread HIV infection to their spouse and other sex partners.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1993

Familial medullary thyroid carcinoma: report of three cases in a family.

Familial medullary thyroid carcinoma is a distinct clinical entity in which early diagnosis by screening of family members for elevated calcitonin levels can be useful. A 33-year-old female was hospitalized because of an enlarging left thyroid mass. Resected thyroid showed medullary thyroid carcinoma. Her mother had received a total thyroidectomy due to the same disease 10 years previously, and her younger brother had an elevated basal calcitonin level of 468 pg/mL when the index case was diagnosed. The younger brother was advised to undergo surgery; a total thyroidectomy also revealed medullary thyroid carcinoma. There was no evidence of multiple endocrine neoplasia in the family. Recognition of new cases by screening with a basal or provocative test in families of patients with medullary thyroid carcinoma should be mandatory.

Adult↗
PubMed1998

[Intravesical instillation in the treatment of superficial tumors of the bladder].

Bladder instillations represent the most significant progress in the management of superficial bladder cancer over the past twenty years. Intravesical chemotherapy significantly alters the rate of recurrence. Intravesical BCG reduces significantly the risk of recurrence and progression. Side effects are common and in the case of BCG severe but rare complications may be encountered during intravesical instillations. Therefore proper use, prevention of complication and careful follow up for tolerance and efficacy of bladder instillations are mandatory. They represent for high risk superficial bladder cancer a therapeutic test. An early failure for these tumors means a potential aggressiveness requiring radical therapy. These various aspects are developed from a practical point of view.

Administration, Intravesical↗
PubMedDate not supplied

The prick by prick test is safe and reliable in 58 children with atopic dermatitis and food allergy.

The initial diagnostic approach of food allergy (FA) is to take a detailed history and to perform a careful physical examination in the gastrointestinal, cutaneous and respiratory systems. Subsequently, verification of the relationship between the symptom(s) and the ingestion of the offending food(s) is mandatory, and finally determination of the immunologic mechanisms involved with in vivo and in vitro tests should be performed. The diagnosis of FA in infancy and in childhood is a challenge both for the pediatrician and allergist because it can be easily accomplished only when there is a correlation between the ingestion of the offending food(s) and the onset of the symptoms, and when it can be demonstrated that these symptoms are the consequence of an immunological reaction. However the underlying immunologic mechanisms may be difficult to document, and the only immunologic mechanism easily to prove in current practice is the IgE-mediated one. In this paper on 58 food-allergic children and 60 nonatopic controls we demonstrate that the prick + prick (P+P) tests are very effective and easy to perform. In addition we stress that FA cannot be excluded only because skin prick tests (SPTs) are negative, as recently suggested.

Child↗
PubMed1984

Initial management of penetrating neck wounds--a selective approach.

The management of anterior penetrating neck injuries remains highly controversial. This is a review of our treatment of such injuries over the preceding decade. During the first 6 years all injuries were explored. Of 75 patients explored, only 33 (44%) had significant injuries. During the last 4 years, patients were managed selectively. Patients with bleeding, crepitation, dysphagia, compromised airways, or for whom full clinical evaluation was not possible underwent prompt formal operative exploration. All other patients were observed. Of 48 patients who underwent explorations, 41 (85%) had significant injuries. Thirty-six patients were observed with no adverse sequelae. Ancillary diagnostic testing was only routinely done in level I injuries. Over the last 10 years we evolved from mandatory exploration to selective exploration of anterior penetrating neck injuries. Our experience confirms the safety and cost-effectiveness of a selective exploration policy. Furthermore, observation does not mandate extensive ancillary diagnostic testing for level II and level III injuries.

Adult↗
PubMed2004

Past, present and future of bovine spongiform encephalopathy in France.

The bovine spongiform encephalopathy (BSE) epidemic has been monitored in France since the end of 1990. The surveillance has been considerably enhanced since 2000, and today every cow aged 2 years or more is tested at the time of slaughter, culling or death. As of 1 May 2002, 613 native cases have been identified, 287 of them by the mandatory reporting system of suspect clinical cases or complementary programs, 213 by active surveillance of fallen stock and 113 by testing at the abattoir. The analysis of reported BSE cases shows a higher number of cases born between 1993 and 1995, which can be linked to a greater exposure at that time and to an increase in surveillance efficiency. When the clinical onset related to overexposure ends, the future trend of the BSE epidemic in France will depend on the efficiency of the control measures implemented since 1996. An indicator of this will be the number of BSE cases born among recent cohorts. Bovine spongiform encephalopathy (BSE) was described first in 1987 in Great Britain (Wells et al. 1987), where a huge epidemic started, and more than 180,000 cases have been detected since then in this country. A risk analysis undertaken in France in 1990, in part because of the amount of meat and bone meal (MBM) imported from Great Britain during the 1980s, led to the conclusion that BSE might have spread to France, and that sporadic cases might be observed (Savey et al. 1991). Epidemiological surveillance was therefore set up at the end of 1990, and control measures were taken to prevent the development of the disease. The trends in the number of BSE cases detected in France must be analyzed in the light of both the detection system and the control measures, as well as their changes over time.

Animals↗
PubMed2000

[Automatic blood pressure monitors. Even with seal of approval they are often inaccurate!].

Owing to the permissible tolerances, even successfully tested automatic blood pressure devices may deliver quite false values. In the largest hypertension study (HOT study) so far carried out, the use of an oscillometric device cannot be considered to provide the "evidence base" for the tacit abandonment of the nonautomatic Korotkoff method, in particular in view of the contradictions in the published data on the device employed. When automatic devices are used in clinical trials, special regulations in the testing protocols of the devices, and a critical consideration of measuring methods in the discussion of the results, are mandatory.

Blood Pressure Monitors↗
PubMed2003

Mandatory reporting of "imminent" death to identify organ donors: history, controversy, and potential solutions.

PURPOSE: To review the history of mandatory reporting for the purpose of identifying potential organ and tissue donors, and the controversy around the terms, "imminent" or "impending" death, and to suggest a solution to this controversy. SOURCE: In this narrative review, published papers were retrieved based on a Medline search using the terms, "mandatory reporting" and "organ donation." In addition, unpublished data from the United Network for Organ Sharing and the Pennsylvania Gift of Life Program were reviewed. PRINCIPAL FINDINGS: There has been no demonstrable effect of mandatory reporting of "imminent" death independent of educational activities on numbers of organ donors or organs transplanted. Furthermore, mandatory reporting of "imminent" death does not meet criteria of an acceptable screening test. CONCLUSION: Education of health care providers about eligibility for organ and tissue donation and about whom to report as a potential donor will hopefully lead to identification of more individuals who meet criteria for organ donation and who will go on to donate organs to the many potential recipients.

Death↗
PubMed2001

Targeted screening of high-risk cattle populations for BSE to augment mandatory reporting of clinical suspects.

In Switzerland, the first case of bovine spongiform encephalopathy (BSE) was diagnosed in November 1990. Case numbers peaked in 1995, with a total of 352 BSE cases identified by 30 April 2000. Reporting of clinically suspect cattle is currently the most commonly used method world-wide to detect BSE cases. The effectiveness of mandatory reporting depends on a variety of factors; for other diseases passive surveillance underestimates the incidence of clinical cases. The efficiency of passive surveillance systems for BSE will remain unknown until screening tests able to identify clinically affected cattle have been applied in several countries. This paper provides the first detailed description of a targeted screening programme for BSE. Two populations of cows >24 months of age were included in the targeted screening: (i) cows found dead or culled on site where the carcass was submitted to rendering (fallen stock) and (ii) cows with health-related problems unfit for routine slaughter that were slaughtered under emergency procedures (emergency slaughter). Between 1992 and 1999, on average 81 clinical BSE suspects per year were reported to the veterinary authorities (passive surveillance), of which 43% were confirmed with BSE. A total of 30 clinical cases were captured by passive surveillance and an additional 20 BSE cases detected by targeted screening between May 1999 and April 2000. The odds of finding a BSE case was 49 times higher in the fallen stock and 58 times higher in emergency-slaughtered cattle when compared to passive surveillance. The targeted screening of fallen stock and emergency-slaughtered cattle considerably increased the number of detected cases in this 12-month period. Targeted-screening cases were on average 4 months younger than the clinical suspect cases. In conclusion, post-mortem testing of fallen stock and emergency-slaughtered cows >24 months for BSE is an important active surveillance element within a total surveillance system that principally is based on mandatory reporting of clinical suspect cases. Without ante-mortem screening tests to detect BSE-infected cattle during the incubation period, a combination of effectively functioning passive and active BSE surveillance strategies might be the only approach to assess the BSE situation reliably in a given country or region - and it is necessary to substantiate claims of freedom from the disease.

Animals↗
PubMed2002

[Measurement of evoked acoustic otoemissions: an early screening test of neonatal deafness].

Every child born with deafness displays a pathological language development. An early and specific approach is mandatory, hence requiring an universal hearing screening. Available evidence indicate that performing acoustic otoemissions prior to six months of age is the most reliable method. The recording of the AOE is performed successfully from the 30th week of conceptual age. To obtain AOE in the newborn, one needs to wait until the 3rd day post delivery in 98% of cases. The reliability of the test, the socio-economical cost, the consequences of the screening and the role of the family have to be discussed.

Deafness↗
PubMed1977

Laboratory support of drug abuse control programs: an overview.

Labeling an individual a drug abuser has serious sociologic and legal implications that only laboratory testing can effectively allay. A proper specimen (both qualitatively and quantitatively) must be obtained for analysis. Positive identification of specimen with subject is of paramount importance. The problems of specimen substitution--other people's urine, tap water, apple juice--directly impinge here, as does the possibility of drug degradation by heat, light, and microbial attack and of drug adsorption by the container and urinary sediment. Confirmation of postives indicated by screening tests (thin layer chromatography and immunoassays) by gas chromatography and/or ultraviolet spectrophotometry is, in most situations, mandatory. An effective quality control program is an absolute requirement. Even under ideal circumstances, laboratory results can sometimes wrongly indicate the abuse of drugs; and conversely, drug abuse can take place without detection by the laboratory. As in any clinical situation, laboratory tests are only a part (albeit an important one) of the entire evaluation of the individual involved.

Chemistry, Analytic↗
PubMed2003

The impact of iodine prophylaxis on thyroid 131-iodine uptake in the region of Krakow, Poland.

Iodine prophylaxis was introduced in Poland in 1935. It was interrupted twice, the first time between 1939 and 1947 (due to the Second World War and its aftermath), and then between 1980 and 1986, due to the economical crisis in Poland at that time. A voluntary model of iodine prophylaxis (20 +/- 10 mg/kg of household salt) introduced in Poland in 1986, was followed by a mandatory model, implemented at the beginning of 1997, with 30 +/- 10 mg/kg of household salt. In the early sixties, in our Department of Endocrinology 24-hour iodine uptake test was introduced as a routine procedure for evaluating the thyroid gland. The reference value of this test increased in 1986 after discontinuation of iodine prophylaxis, and decreased in 1998, two years after re-implementation of the mandatory model of iodine prophylaxis. In 167 patients (147 with endemic goiter and 20 with no thyroid disturbances) examined between 1998 and 2000 the mean value of 24-hour iodine uptake was 27.3 +/- 10.4%, as compared to the mean value of 45,7 +/- 6.6 % in 1986. In patients with thyrotoxicosis the mean value of iodine uptake was 41.9% +/- 16.2 in 1999 (no.=614), 42.4% +/- 16.9 in 2000 (no.=644) and 37,7% +/- 17.2 at the beginning of 2001 (no.=328). The mean value of iodine uptake in patients with thyrotoxicosis before implementation of iodine prophylaxis was over 60%. The 24-hour thyroid radioiodine uptake test proved to be a useful indicator of changes of iodine intake in a iodine-deficient population. The data presented in this study confirm the importance and efficacy of the iodine prophylaxis introduced in Poland.

Adult↗
PubMed2003

Parental attitudes regarding newborn screening of PKU and DMD.

The ability to perform predictive genetic testing of children raises ethical concerns. Current guidelines support the screening of newborns for conditions in which early treatment reduces morbidity and mortality, and oppose most other predictive genetic screening and testing in childhood. Little is known, however, about parental attitudes. We conducted focus groups to gain information on the attitudes, beliefs, and concerns of parents about newborn screening and testing for both treatable and untreatable conditions that present in childhood. Respondents across racial groups support mandatory newborn screening for treatable conditions like phenylketonuria (PKU), citing lack of parental knowledge, and concerns about immature parental decision-makers. Parents do, however, want more information. Citing a variety of psychosocial concerns, respondents believe that parents should have access to predictive genetic testing for childhood onset conditions, even when there are no proven treatments. Respondents want this information to make reproductive and non-reproductive plans and decisions. Although respondents varied in their personal interest in testing, overwhelmingly they believed that the decisions belong to the parents. Professional guidelines that proscribe predictive testing for untreatable childhood onset conditions should be re-examined in light of consumer attitudes.

Age of Onset↗
PubMed1996

The diagnostic information of tests for the detection of cancer: the usefulness of the likelihood ratio concept.

No single test is perfect and without false-negative and/or false-positive results. Consequently, the clinician is perpetually confronted with incertitude about the true disease state of the patient. In oncology, these diagnostic errors may have harmful consequences for the patient. It is, therefore, imperative that the clinician knows how often these errors occur, which implies a quantitative evaluation of a test. With this knowledge, the test result must subsequently be interpretated within the clinical framework. Bayes' theorem provides a simple and useful mathematical model for the integration of measures of test performance and clinical data. Traditionally, sensitivity and specificity are used to describe test performance. However, this approach requires that the conclusion of the test is dichotomised into 'normal' and 'abnormal'. Few tests have a natural binary outcome. A test parameter that is applicable to all types of test outcome scales and, at the same time, provides the opportunity to determine the gain in diagnostic information by applying Bayes' theorem, is therefore mandatory. The likelihood ratio meets these conditions. The application of this concept for both the evaluation and the interpretation of various types of tests used in cancer patients is demonstrated.

Bayes Theorem↗
PubMed2002

[Mounting device for constancy tests of linear accelerators according to DIN 6847-5].

According to the German Industrial Norm DIN 6847-5 for constancy tests of linear accelerators, the measurements of the dose-monitor calibration and of the flatness of electron and photon beams for four different gantry angles are mandatory. The mounting devices developed in the Clinic for Radiation Therapy in Augsburg offer the possibility to perform all necessary constancy tests.

Electrons↗
PubMed1998

Testing for technical files: avoiding too little and too much.

Since 13 June 1998, it has been mandatory for all new and existing medical devices to be CE-marked according to the Medical Device Directive. However, for certain electromedical devices full compliance with the requirements of EN 60601-1 as a means of obtaining the CE mark may not be necessary. This article looks at some of these products and explains how they may still qualify for distribution in the European medical market.

Electric Stimulation↗
PubMed2003

[Application of molecular biology to blood transfusion safety: the nucleic acid testing].

Nucleic Acid Testing (NAT) for HIV-1 and HCV has been introduced in France and became mandatory for all homologous blood donations since July 1st 2001 in addition to serology screening. Previously, a feasibility study led to the selection of 2 technologies : a TMA based assay (Chiron) uses the Procleix HIV-/HCV assay on pools of 8 samples and a PCR based assay from BioMérieux-Roche which is a combination of an RNA extraction system (NucliSens, BioMérieux) with a fully automated system for nucleic acid amplification and detection (Cobas Amplicor, Roche). This system uses the Cobas Ampliscreen HCV test v.2.0 and the The Cobas Ampliscreen HIV test v1.5, on 24 sample pools. Pooling was required because single-donation testing is not yet feasible, as a result of the limitations in automation available for all current NAT technologies. The two technologies were easily implemented and showed nearly the same detection limit for HCV RNA and HIV-1 RNA. During a one-year period, from July 1st 2001 to June 30, 2002, out of the 2.5 million donations tested, the NAT yield resulted in one HIV-1 RNA positive-antibody negative donation and one HCV RNA positive-antibody negative donation. Two HIV NAT positive-antibody negative donations were missed by minipool NAT because a very low viral load. Moreover, the NAT implementation did not impact on blood component availability, including platelet concentrates.

Blood Transfusion↗