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At least 1,621 records · Page 90Linked to original sources
PubMed2003

[Lowering of nephropathy risk during angiography procedure. What are choice criteria for the radiocontrast media?].

The paper analyses current data of monomer and dimmer iodine-containing radiocontrast agents used for diagnosis of cardiovascular diseases and radiovascular interventions. Considering the risk factors of nephropathy as the most common and threatening complication of radiocontrast agents the authors conclude that non-ionic monomers are the most advisable as they demonstrate optimal balance of viscosity, water solubility, osmolality and diagnostic effectiveness.

Aged↗
PubMed2005

[Bacterial infections of the lungs in mucoviscidosis patients].

The pathogenesis of lung infections in patients with mucoviscidosis (cystic fibrosis, CF) is multifactorial. Both host- and pathogen-related factors are involved. The most important germ in terms of progression and pulmonary damage is Pseudomonas aeruginosa. However, the clinical relevance of other CF-typical pathogens has not yet been determined with certainty, and must be assessed on the basis of the clinical presentation of the individual case. To ensure optimal patient management, a CF-specific microbiological diagnostic work-up is mandatory. Since ever more patients now survive into adulthood, the problems associated with chronic infection are gaining in importance. In light of increasing multiresistance, the use of inhalation antibiotics, as well as combined antibiotic treatment, is becoming more and more determinative for the therapeutic outcome.

Administration, Inhalation↗
PubMed1992

Blunt trauma of the diaphragm: a 15-county, private hospital experience.

During a 6-year period, 52 patients with nonpenetrating trauma to the diaphragm were treated in eight acute care hospitals, serving a 15-county area of Michigan. Charts were reviewed to identify patterns of injury, treatment, and outcome. Preoperative diagnosis was made in 50 per cent of cases based on chest x-ray findings; the remainder were diagnosed intraoperatively. Clinical examination revealed respiratory distress, decreased breath sounds, or elevated hemidiaphragm in 81 per cent of patients. Forty-two per cent of patients sustained significant head injuries. Fractures were present in 75 per cent of patients. Major chest injury was found in 92 per cent. Intra-abdominal organs were herniated in 67 per cent of cases with the stomach being most common (54%). The spleen was the most commonly injured abdominal organ (60%). The left diaphragm was injured in 75 per cent of cases; 2 per cent were bilateral. The most common postoperative complication was pneumonia. Mortality in this series was 13 per cent, with no case being related to the diaphragmatic injury. The authors conclude that blunt injuries to the diaphragm in the multiply-injured patient present a clinical diagnostic challenge requiring a high index of suspicion. Optimal care requires a multi-disciplinary critical care team to manage the high incidence of associated central nervous system, orthopedic, and chest injuries and associated high mortality rates.

Adolescent↗
PubMed2005

[Cloning and expression of the Apx IVA gene of Actionbacillus pleuroneumoniae and development of an indirect ApxIVA-ELISA].

Apx IV, a forth RTX toxin indentified in Actionbacillus pleuropneumoniae recently, is expressed by all A. pleuropneumoniae regardless the serotypes and inducible only in vivo toxin, so it is the optimal to develop species-specific and differentiated diagnostic assay. Here the 2445bp DNA fragment of apxIVA gene of A. pleuroneumoniae was amplified and fused in-frame to the downstream of the T7 promoter and 6 His Tag of the prokaryotic expression vector pET-28b. The construct was transformed into E. coli BL21(DE3). After induction by 1.0 mol/L IPTG, a recombinant protein about 90 kD in size, designed as ApxIVAN, was detected, which was present as inclusion bodies and reacted specifically with swine antisera to the APP-serotype-1 by dot-blot. An indirect ELISA (ApxIVA-ELISA) was developed using purified recombinant ApxIVAN from the inclusion bodies as described previously, which had excellent specificity to A. pleuroneunoniae. Using the ApxIVA-ELISA, the ApxIV antibodies were not detected in the inactivated APP bacterins vaccinated pigs, but were detected in A. pleuropneumoniae serotype 1, 2 and 7 infected pigs and mice. These results suggested that ApxIVA-ELISA can be used not only to detect all serotypes of APP, but also to differentiate the naturally infected and inactivated vaccine immunized pigs.

Actinobacillus Infections↗
PubMedDate not supplied

[Variation in the plasma concentration of B-type natriuretic peptide in emergent paroxysmal atrial fibrillation, in acute pulmonary embolism, in acute coronary syndrome and in dilated cardiomyopathy].

Our research is based on the critical evaluation of plasma concentration variation of B-type natriuretic peptide (BNP)--in emergency--in paroxysmal atrial fibrillation, acute pulmonary edema, acute coronary syndrome and dilated cardiomyopathy. The aim of our research was to assess if the BNP concentration variation may be useful in the diagnosis and therapy. Peptide synthesis takes place mainly in the ventricular myocardium. We selected 102 patients: 27 control subjects, and 75 admitted to the emergency and reception department for dyspnea and/or precordialgia and/or palpitations. At the beginning they were considered as one group only, and then they were divided into groups according to the diagnosis: 20 with paroxysmal atrial fibrillation with reversion to sinus rhythm in the first week; 20 with acute pulmonary edema; 22 with acute coronary syndrome without electrocardiographic ST-segment changes; 13 with compensated dilated cardiomyopathy. Our research assessed that the BNP activation and secretion are evident especially in patients with heart failure and remains at the high level until the administration of an effective therapy and then they reach a balance with values higher than the standards, while in the paroxysmal atrial fibrillation and in acute coronary syndrome they rise and come back to the standard levels or even at lower levels after the disease solution. For this reason, BNP reiterated measurements allow to assess treatment efficacy, even at home, and to optimize the therapy. The main limit of BNP diagnostic role is in the need of knowing in advance the specific values for each patient. The BNP concentration evaluation in the acute phase is necessary to differentiate patients with dyspnea due to heart failure from those with pulmonary pathologies, while the BNP assessment in the acute coronary syndrome predicted exitus or heart failure manifestations.

Acute Disease↗
PubMedDate not supplied

Rate of hospitalization and inpatient care costs for HIV-1-infected patients in Pune, India.

BACKGROUND: The transition of human immunodeficiency virus (HIV) infection to acquired immune deficiency syndrome (AIDS) has begun in India, and an increase in AIDS-related hospitalizations and deaths is an anticipated challenge. We estimated the rates of hospitalization and inpatient care costs for HIV-1-infected patients. METHODS: Data were analysed on 381 HIV-1-infected persons enrolled in a HIV-1 discordant couples' cohort between September 2002 and March 2004. Inpatient care costs were extracted from select hospitals where the study patients were hospitalized and the average cost per hospitalization was calculated. RESULTS: A majority of the patients were in an advanced state of HIV-1 disease with the median CD4 counts being 207 cells/cmm (range: 4-1131 cells/cmm). In all, 63 participants who did not receive antiretroviral therapy required hospitalization, 53 due to HIV-1-related illnesses and the remaining 10 due to worsening of pre-existing conditions. The overall HIV-1-related hospitalization rate was 34.2 per 100 person-years (95% CI: 26.94-42.93). The median duration of HIV-1-related hospitalization was 10 days (range 2-48 days) and the median cost was Rs 17,464 (range: Rs 400-63,891). CONCLUSION: It is necessary to strengthen the inpatient care infrastructure and supporting diagnostic set-up, and work out economically optimized treatment algorithms for HIV-1-infected patients. Although this analysis does not cover all costs and may not be generalizable, these baseline data might be a useful reference while planning related studies accompanying the government-sponsored programme to roll out antiretroviral therapy to AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Evaluation of three rapid tests for diagnosis of P. falciparum and P. vivax malaria in Colombia.

The diagnostic capacity of three malaria rapid diagnostic tests (RDTs), NOW-Malaria-ICT, OptiMAL-IT, and Paracheck-Pf, was evaluated against expert microscopy in Colombia. We tested 896 patients, of whom microscopy confirmed 139 P. falciparum, 279 P. vivax, and 13 mixed P.f/P.v infections and 465 negatives. Paracheck-Pf and NOW-malaria-ICT were more accurate in detecting P. falciparum (sensitivities 90.8% and 90.1%, respectively) in comparison with Optimal-IT (83.6%). NOW showed an acceptable Pf detection rate at low densities (< 500/microL), but resulted in a higher proportion of false positives. For P. vivax diagnosis, Optimal-IT had a higher sensitivity than NOW (91.0% and 81.4%, respectively). The choice between the two Pf/Pv detecting RDTs balances P. falciparum and P. vivax detection rates. Considering some degree of P. falciparum overtreatment and failure to detect all P. vivax cases as more acceptable than missing some cases of P. falciparum, we recommend careful implementation of NOW-malaria-ICT in areas where microscopy is lacking. The price is however still a constraint.

Adolescent↗
PubMed1991

[Erythrocytic immunoreagents for diagnosing autoimmune disorders of the pancreas].

Amidol sensitization of formalin-treated sheep red blood cells was found to be the optimal method for the preparation of an erythrocytic diagnostic agent from the summary antigen of the pancreas. Organ specificity of serum antibodies detection with the use of the developed diagnostic agent was provided by preliminary adsorption of the tested sera with rhesus-positive human red cells, group IV (AB). Use of this diagnostic agent in the neutralization test permitted a highly specific detection of the pancreatic antigen. Antigen-specific lymphocytes detectable in the indirect rosette-formation test with the erythrocytic diagnostic agent from the pancreatic summary antigen, based on chicken red cells were found highly specific.

Autoimmune Diseases↗
PubMed1991

[New methods of image creation in the diagnosis of superior vena cava syndrome].

A program for the examination of patients with the superior vena caval syndrome, including digital subtraction angiography and computed-tomographic phlebography, is discussed. A combination of these methods is optimal and makes it possible to obtain detailed diagnostic information which is necessary for determining the therapeutic tactics in cases with the compression syndrome.

Adolescent↗
PubMed1982

The pathologist's role in management of patients with Hodgkin's disease.

The pathologist's role in the management of patients with Hodgkin's disease may be summarized as follows: (a) to establish a firm diagnosis of Hodgkin's disease: (b) to recognize the value of the Lukes-Butler classification in histologic diagnosis as well as its limitations as a prognostic indicator in patients undergoing modern therapy; (c) to carefully examine and identify all sites of involvement in staging laparotomy material; and (d) to prepare tissues for appropriate histopathologic studies and for new techniques in the investigation of Hodgkin's disease. The pathologist should demand of his or her technician optimal histopathologic sections since technical artifacts frequently compound diagnostic problems. Poor-quality sections clearly constitute one of the major obstacles to the diagnosis and subclassification of Hodgkin's disease and allied disorders.

Diagnosis, Differential↗
PubMedDate not supplied

[Evolution of the growth of multiple intracranial tumors in a case of type 2 neurofibromatosis].

A sporadic case of neurofibromatosis type 2 in a 23-year old woman is described with clinical and neuroimaging (CT or MRI) 4 years follow-up. Together with bilateral acoustic tumours multiple intracranial tumours and solitary orbital meningioma were present, the latter being confirmed surgically and histopathologically. Ocular findings of congenital cataract but lack of other external stigmata of neurofibromatosis completed the clinical picture of the disease. Diagnostic criteria of NF2, difficulties in establishing the optimal management options are described and the importance of evaluating of family members is underlined. Neuroimaging pictures showed tumour expansion over 4 years leading to severe disability with total blindness, deafness, paresis and cerebellar syndrome.

Adult↗
PubMed1996

[Secondary liver lesions studied with double-helix spiral computed tomography: first experience].

The authors report their early personal experience with double-helix spiral CT (CT Twin Elscint) in the study of liver metastases. This work was aimed at optimizing the study technique and at assessing the diagnostic accuracy of this method. The high temperature developed by CT Twin and the presence of a double row of detectors permit to acquire proper length sequences (with 6.5 mm slice thickness) within a short scanning time which is easy for the patient to tolerate without breathing and moving. Two hundred and thirty patients were examined with US for focal hepatic lesions and then submitted to spiral CT: spatial and density resolution were higher with spiral CT than with US, and the former technique permitted the whole liver to be studied without any partial volume artifacts, which allowed us to confirm all the lesions depicted with US and to detect other lesions, missed at US, in 20% of patients. The choice of the proper time between contrast administration and sequence acquisition is sufficient to permit the detection of focal lesions, if the liver is studied in the portal phase. The authors stress the yield of spiral CT, especially with the double-helix technique, in studying liver metastases.

Adult↗
PubMed1996

The lymphomas.

Hodgkin's disease and the malignant lymphomas are, by all available evidence, eminently curable neoplasms. The debates, therefore, on how best the largest numbers of individuals in any community can receive appropriate treatment and this implies their ready access to an experienced multi disciplinary combined clinic. It is important that proper perspective be retained in the African context so that preventive medicine can be employed where appropriate but, based on current understanding, those with lymphoreticular malignancy become immediate beneficiaries of whatever diagnostic and therapeutic resources need to be expended in ensuring optimal outcome. The last word is far from written on how we, as inhabitants of the African continent, will achieve this goal and so measure up to our obligation. However, as resources continue to contract, three observations justify reiteration. Firstly, diagnostic skills need to be honed by experienced pathologists together reviewing all biopsy material and, wherever possible, participating in national or international study groups. Secondly, the silly distinction propagated by some self serving individuals who fantasize that state hospitals and private clinics somehow differ, must be replaced by a more responsible attitude in which resources are pooled in the common quest for maintaining academic standards. Thirdly, given acceptance of the above common sense proposals, a mechanism will exist for the establishment and constant upgrading of national guidelines for management on agreed and achievable protocols. Whilst the theme remains that of tested conventional treatment, flexibility must exist, where appropriate, for palliative care on the one hand with scientific growth and exploration of innovative options on the other. One might conclude by observing that Africa is most certainly unique and this extends to the frequency with which some of these tumours occur; a classical example would be Burkitt's Lymphoma. This places an obligation on all of us to gather and record such experiences and, from this basis, sustain our intellectual drive by forging international bonds with colleagues in the First World. Such collaboration will provide the natural bridge between clinical studies in Africa and the more sophisticated cellular and molecular biology that is being provided by basic scientists in other parts of the world. Such a marriage is practical and both parties stand to gain significantly in the research, development and evaluation of new drugs and protocols that, ultimately, serve the best interests of patients and do so on a world-wide basis.

Africa↗
PubMed1998

[Value and technique of laparoscopic choledochus revision in choledocholithiasis].

Despite a large scale indication to ERCP, 5% of unsuspected stones are shown by principally intraoperative cholangiography in our patients. Praeoperative diagnostic makes it possible to select the individual optimal therapy for each patient, the possibility of saving the Papilla vateri gives the large scale indication to laparoscopic common bile duct exploration. Also suspected stones gets a one-time cure therapy by complete laparoscopic operation. After balloon-dilatation of cysticus duct to 6 mm, the laparoscopic choledochoscopy is possible through the cysticus duct. Little stones are flushed into the duodenum or extracted by Segura-basket through the cysticus duct. Big stones needs a Laser- or electrohydraulic lithotripsy, the stonefragments can be flushed into the duodenum or aspirated through the cysticus duct. Multiple big or proximal incarcerated stones gives the indication for laparoscopic choledochotomy. Effective extraction is possible by big Segura-basket, residual stones are taken out under choledochoscopic control by little Segura-basket. Incarcerated stones needs the lithotripsy. Microdrainage of the common bile duct and only in special indication the T-tube saves the gall-flow to restitution of papilla function, the common bile duct is closed by running suture in Lahodny-technique. After the regular postoperative cholangiography on third day after operation, the microdrainage can be taken out. In 96% of all laparoscopic cholecystectomies the intraoperative cholangiography was successful. Only 3 of 103 patients needs a postoperative EPT because of residual fragments after trans cystic duct exploration. 8 laparoscopic choledochotomies shows the successness of endoscopic techniques, the postoperative complications can be the same then in conventional operation.

Cholecystectomy, Laparoscopic↗
PubMed2006

Optimization of recovery of RNA from formalin-fixed, paraffin-embedded tissue.

Formalin-fixed, paraffin-embedded (FFPE) tissue is the most common specimen available for application of diagnostic assays on tissue after microscopic examination. Not only is there a substantial archive of tissue available, but FFPE tissue remains the best method of preparation for microscopic examination in a routine clinical environment. Molecular assays, especially reverse transcription and polymerase chain reaction and expression array-based assays, offer significant potential as diagnostic, prognostic, and predictive tools, but require high quality RNA. Herein, we have optimized a reliable RNA extraction method for FFPE tissue. It is based on deparaffinization at high temperature coupled with a 3-day lysis at 65 degrees C. The average total RNA yield is 4.5 to 5.5 pg per 1 microm of archival FFPE tissue, and 260/280 ratios are between 1.80 and 1.95. The extracted RNA has a modal fragment length between 100 and 200 nt by the Bioanalyzer analysis. Although modal lengths of RNA fragments were shorter, reverse transcription and polymerase chain reaction was able to amplify amplicons in range of 300 bp. Pretreatment with RNA, later followed by formalin fixation, did not result in improving the RNA quality, but did improve RNA yield. Our method improves the utility of FFPE tissue for molecular profiling studies.

Animals↗
PubMedDate not supplied

Understanding birthing mode decision making using artificial neural networks.

BACKGROUND: This study examined obstetricians' decisions to perform or not to perform cesarean sections. The aim was to determine whether an artificial neural network could be constructed to accurately and reliably predict the birthing mode decisions of expert clinicians and to elucidate which factors were most important in deciding the birth mode. METHODS: Mothers with singleton, live births who were privately insured, nonclinic, non-Medicaid patients at a major tertiary care private hospital were included in the study (N = 1508). These mothers were patients of 2 physician groups: a 7-obstetrician multispecialtygroup practice and a physician group of 79 independently practicing obstetricians affiliated with the same hospital. A feedforward, multilayer artificial neural network (ANN) was developed and trained. It was then tested and optimized until the most parsimonious network was identified that retained a similar level of predictive power and classification accuracy. The performance of this network was further optimized using the methods of receiver operating characteristic (ROC) analysis and information theory to find the cutoff that maximized the information gain. The performance of the final ANN at this cutoff was measured using sensitivity, specificity, classification accuracy, area under the ROC curve, and maximum information gain. RESULTS: The final neural network had excellent predictive accuracy for the birthing mode (classification accuracy = 83.5%; area under the ROC curve = 0.924; maximum information = 40.4% of a perfect diagnostic test). CONCLUSION: This study demonstrated that a properly optimized ANN is able to accurately predict the birthing mode decisions of expert clinicians. In addition to previously identified clinical factors (cephalopelvic disproportion, maternal medical condition necessitating a cesarean section, arrest of labor, malpresentation of the baby, fetal distress, andfailed induction), nonclinical factors such as the mothers' views on birthing mode were also found to be important in determining the birthing mode.

Decision Making↗
PubMed2001

Blood pressure response to standing in the diagnosis of autonomic neuropathy: the EURODIAB IDDM Complications Study.

Autonomic neuropathy is associated with poor prognosis. Cardiovascular reflexes are essential for the diagnosis of autonomic nerve dysfunction. Blood pressure response to standing is the most simple test for the evaluation of sympathetic integrity, however it is still discussed which diagnostic criteria of abnormal response should be considered as optimal. The EURODIAB IDDM Complications Study involved the examination of randomly selected Type 1 diabetic patients from 31 centres in 16 European counties. Data from 3007 patients were available for the present evaluation. Two tests of autonomic function (response of heart rate /R-R ratio/ and blood pressure from lying to standing) just as the frequency of feeling faint on standing up were assessed. R-R ratio was abnormal in 24% of patients. According to different diagnostic criteria of abnormal BP response to standing (>30 mmHg, >20 mmHg, and >10 mmHg fall in systolic BP), the frequency of abnormal results was 5.9%, 18% and 32%, respectively (p < 0.001). The frequency of feeling faint on standing was 18%, thus, it was identical with the prevalence of abnormal blood pressure response to standing when >20 mmHg fall in systolic blood pressure was considered as abnormal. Feeling faint on standing correlated significantly with both autonomic test results (p < 0.001). A fall >20 mmHg in systolic blood pressure after standing up seems to be the most reliable criterion for the assessment of orthostatic hypotension in the diagnosis of autonomic neuropathy in patients with Type 1 diabetes mellitus.

Adolescent↗
PubMed2003

Virus diagnostics on microarrays.

Whereas the majority of microarray applications still deal with expression analysis for gathering information about levels of gene products at certain cell states, other approaches simply ask the question whether particular genes, which are usually indicative for particular microorganisms and pathogens, are present in a sample or not. Investigations that are more detailed try to evaluate the presence of particular subtypes of a given pathogen. The combination of microarray technology and virus diagnostics promises to generate an ideal platform for fast, sensitive, specific, and parallelized virus diagnostics. Performing virus diagnostics on microarrays, however, requires other basic techniques to be optimized. This is necessary in order to obtain unambiguous and reproducible results, which are compatible with the needs for clinical routine. Parameters that have to be considered include supports, coupling chemistry, chemical oligonucleotide synthesis, signal enhancement strategies, and optimal coordination of PCR reactions, hybridizations, and signal detection, as well as interpretation strategies. Finally, considerations should be given to economic aspects, one chip-one patient strategies and low integrated arrays as a custom-tailored way to fast and accurate diagnostic tools.

Animals↗