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PubMedDate not supplied

[Diagnostic house call within the scope of inpatient geriatric assessment].

The value of a diagnostic home visit as part of hospital-based geriatric assessment was examined in a prospective study. 141 subjects admitted from home to the geriatric hospital and showing functional decline with risk of nursing home placement underwent a comprehensive geriatric assessment and a diagnostic home visit. In 19.1% of the patients, the diagnostic visit resulted in a change of time, and in 14.9% in a change of location of discharge. Up to seven problems were newly discovered (mean 2.1). To maintain independence up to six technical aids were prescribed (mean 2.3). The most common recommendations were related to safety (59.2% of all cases). In 89.3% the diagnostic home visit was judged necessary by the home intervention team. A follow-up visit after 3 months revealed that about 80% of all recommendations were implemented and approximately the same amount of technical aids were still used. The diagnostic home visit allows individual prescription of technical aids, when necessary. It contributes meaningful information to the geriatric assessment process and helps to achieve successful in-hospital therapy and discharge planning. It can be recommended especially for elderly patients at risk for losing their independence.

Activities of Daily Living↗
PubMed1994

Diagnosis of tuberculous lymphadenitis in an area of HIV infection and limited diagnostic facilities.

In order to evaluate procedures leading to the diagnosis of tuberculous lymphadenitis, a prospective clinical study was carried out of patients with lymphadenopathy admitted to the medical wards of a referral hospital in Tanzania. The yield of diagnostic procedures (direct auramine/Ziehl-Neelsen (ZN) stained smears, Löwenstein-Jensen (LJ) cultures, cytology and histological examinations of fine needle aspirations (FNA) and biopsy material of lymph nodes, respectively, was compared. We also tried to identify clinical diagnostic markers. One hundred and twenty-eight (99 HIV-seropositive) patients were included. In 89 (67 HIV-positive) patients TB lymphadenitis could be proven. Histology and LJ culture of a lymph node biopsy had the highest diagnostic yield, 85% and 88% respectively, followed by detection of acid-fast bacilli (AFB) in biopsy smear (53%) and in fine-needle aspirations (35%). The diagnostic yield of the several procedures was not affected by associated HIV infection. Macroscopic caseation was 100% predictive for TB with a sensitivity of 69%. Firm and matted lymph nodes, ESR > 100 mm/hr, a positive PPD skin test and pleural opacity on a chest x-ray proved to be independent predictors for TB. Retrospective testing of a stepwise diagnostic approach based on direct smears of FNA, macroscopic visible caseation and direct smear of biopsy tissue, suggests that in 93% of the patients a definite diagnosis of TB lymphadenitis could have been made. Our data suggest that in HIV/TB epidemic areas most of the cases of TB lymphadenitis can be diagnosed correctly by simple and cheap methods which are generally available at district hospitals. Our findings need further prospective validation, however.

Adolescent↗
PubMed1994

Craniosynostosis: diagnostic imaging with three-dimensional CT presentation.

PURPOSE: To measure diagnostic performance and preference of two three-dimensional CT reconstruction modalities (voxel-gradient and surface-projection) displayed two ways (conventional and unwrapped) in craniosynostosis confirmed by surgical inspection and histologic analysis of resected sutures. METHODS: High-resolution 2-mm contiguous CT sections were obtained and three-dimensional reconstruction images generated for 25 infants and children with skull deformities before surgical treatment of craniosynostosis. Two pediatric radiologists and two neuroradiologists first ranked images by their own preferences for diagnostic use. Then they diagnosed craniosynostosis from images presented in random order and blinded. The standard of reference was inspection during surgery and histologic evaluation of excised sutures. Finally, reviewers repeated their subjective preference tests. RESULTS: The least experienced radiologist had 100% sensitivity for all imaging modalities and specificities ranging from 43% to 83%. The two most experienced radiologists performed nearly identically, with sensitivities of 96% and specificities of 100%. After performing diagnostic tasks using all image types, all radiologists preferred conventional surface projections. CONCLUSION: Experienced readers can achieve nearly perfect diagnostic performance using the latest three-dimensional CT reconstruction images, making it a contribution to the diagnostic process. Although performance is nearly identical for all modalities, readers strongly prefer conventionally presented surface-projection images.

Algorithms↗
PubMed1994

Endomyocardial biopsy: a meta-analysis of diagnostic value.

To clarify the controversy of endomyocardial biopsy (EMB) in terms of its diagnostic value, we performed a meta-analysis of EMB studies published between 1982 and 1993, including our own experience. A total of 255 articles was retrieved using both a computer search of the Medline database and a manual bibliographic search, but only 30 studies with 4,313 patients met the predefined inclusion/exclusion criteria. The diagnostic value of EMB was classified into four categories, according to the effect of EMB findings on the discharge diagnosis: aetiology uncovered, new diagnosis of heart muscle disease (HMD) revealed, clinical diagnosis confirmed, and no useful information obtained. Clarification of aetiology of HMD was reported in 28 out of 30 studies with a total of 4,195 patients and it was achieved by EMB in 17.9% of these patients (95% confidence interval (CI) was 16.8-19.1%). A new unexpected diagnosis of HMD was arrived at in 25 of 30 studies (3,947 patients) and this occurred in 19.3% of patients (95% CI = 18.1-20.6%). Confirmed clinical diagnosis of HMD by EMB was covered by 12 studies (1,231 patients) and was proven in 40.1% of patients (95% CI = 37.3-42.7%). EMB not providing any useful clinical information was mentioned in seven of 30 studies (857 patients); this happened in 5.9% of patients (95% CI = 4.5-7.4%). Therefore, these results confirmed the remarkable diagnostic value of EMB. It was equally helpful in all diagnostic categories and had considerable overall diagnostic utility.

Adolescent↗
PubMed1994

[Adding atropine improves the diagnostic accuracy of dipyridamole-echo test].

BACKGROUND: The clinical experience with dipyridamole stress echocardiography for the diagnosis of coronary artery disease (CAD) revealed that patients with less severe extent of CAD and limited impairment of coronary reserve are frequently not recognized by the test. Increasing myocardial oxygen consumption adding atropine to dipyridamole may improve the diagnostic accuracy of dipyridamole for the detection of CAD. METHODS: Fifty-two patients (48 men, aged 53 +/- 7 years) underwent a high-dose dipyridamole-echo stress test (0.84 mg/kg over 10 minutes) and coronary arteriography within 15 days from the test. Eighteen out of 52 patients were referred for chest pain; 11 suffered from a previous myocardial infarction (MI) and 23 were studied in the early phase after a first acute MI. Starting after 4 minutes from the end of dipyridamole infusion, atropine was added, in 2 doses of 0.5 mg each, at 1-minute interval in those patients with no echocardiographic evidence of myocardial ischemia after dipyridamole alone. Left ventricular wall motion was analyzed on a 11-segment left ventricular model in a qualitative manner. RESULTS: Dipyridamole-echo stress test was positive in 23/52 (44%) and negative in 29/52 (56%) patients. In these patients atropine was added resulting in an additional echo positivity in 14/29 patients. Coronary arteriography was normal in 6 patients (12%); 1-vessel CAD was diagnosed in 23 (44%), 2-vessel CAD in 13 (25%) and 3-vessel CAD in 10 (19%) cases. The sensitivity for CAD diagnosis was 48% (22/46) for dipyridamole alone and 76% (35/46) for dipyridamole-atropine echo (p < .005), while the specificity was 83% (5/6) and 80% (4/5) respectively. Diagnostic accuracy increased from 52% (27/52) to 75% (39/52) (p < .001). The better diagnostic accuracy of dipyridamole-atropine echo stress test was mainly related to the increased sensitivity of the combined test in patients with 1-vessel CAD (from 39% to 70%) (p < .005). Peak heart rate was significantly higher after the addition of atropine (100 +/- 17 beats/min) compared to basal (64 +/- 10) and dipyridamole (85 +/- 12) in those patients with a positive dipyridamole-atropine echo stress test. No limiting side effects were elicited with the addition of atropine to dipyridamole. CONCLUSIONS: The combination of atropine and dipyridamole induces a chronotropic stress adjunctive to flow maldistribution phenomena that permits to increase diagnostic accuracy of dipyridamole-echo stress test particularly in patients with less severe extent of CAD; it is usually well tolerated and safe and may be considered as a useful procedure for optimizing diagnostic value of dipyridamole-echo stress test.

Aged↗
PubMed1994

Enzymes in diagnostics: achievements and possibilities of recombinant DNA technology.

We discuss, from an industrial point of view, the scope and possibilities of recombinant DNA technology for "diagnostic enzyme" production and application. We describe the construction of enzyme-overproducing strains and show how to simplify downstream processing, increase product quality and process profitability, improve diagnostic enzyme properties, and adjust enzymes to harsh assay conditions. We also consider some safety and environmental aspects of enzyme production. Other aspects of diagnostic enzymes that we cover are the facilitation of enzyme purification by attachment of short amino acid tails, the introduction of tails or tags for site-specific conjugation or oriented immobilization, the construction of bi- or multifunctional enzymes, and the production of enzyme-based diagnostic tests as demonstrated by the homogeneous immunoassay system of CEDIA tests. We use as examples of diagnostic enzymes glucose-6-phosphate dehydrogenase (EC 1.1.1.49), glucose oxidase (EC 1.1.3.4), alkaline phosphatase (EC 3.1.3.1), alpha-glucosidase (EC 3.2.1.20), pyruvate oxidase (EC 1.2.3.3), creatinase (EC 3.5.3.3), and beta-galactosidase (EC 3.2.1.23).

Amino Acid Sequence↗
PubMed1993

[Ultrasonographic diagnosis of breast diseases: a review of diagnostic criteria of sonomammography on a real-time scanner].

Fifteen sonomammographic findings of 341 histologically proved breast masses were reviewed to improve and objectify the current diagnostic criteria of sonomammography enacted by the Japan Society of Ultrasonics in Medicine. The author suggested revised diagnostic criteria and a method of evaluating benign or malignant breast masses on a real time scanner, especially an electronic linear scanner, and presented an original diagnostic concept based particularly on shape and internal echo. By examining sensitivity, specificity and accuracy, shape, border and internal echo were set up as major criteria, while boundary echo, posterior echo, DW ratio, transverse direction, anterior borderline and posterior borderline were set up as minor criteria. If two or more major criteria or one major and two or more minor criteria are found, the breast mass is diagnosed as malignant, whereas if one major and one or no minor criteria, or only three or fewer minor criteria are recognized, the mass is diagnosed as benign. This diagnostic approach demonstrated a sensitivity of 93.2%, specificity of 85.9%, and accuracy of 89.7%, which were superior to current diagnostic criteria for the differential diagnosis of breast masses.

Adult↗
PubMed1993

The clinicopathological meeting. A means of auditing diagnostic performance.

The clinicopathological meeting is one of the major areas of contact between clinician and pathologist, and the review of histology reports at such meetings can be regarded as an aspect of quality control for diagnostic pathology. To assess the effects of this review, we have conducted a formal analysis of clinicopathological meetings in the Southampton University Hospitals. Over a 14-week period, 416 cases were reviewed at 58 meetings. Seven categories of meeting were involved; Breast; Dermatology; Ear, Nose, and Throat (ENT) and Oral Surgery; Gastroenterology; General Surgery; Oncology; and Urology. A proforma was completed for each case that was reviewed, evaluating changes in diagnosis, the reason for such changes, and the effect, if any, on patient management. Participating consultants, both clinicians and pathologists, were questioned regarding the aims of their particular meeting, and how successful they felt the meeting to be. Histological review resulted in an altered diagnosis in 9% of cases, a refined diagnosis in 10% of cases, and no diagnostic change in 81%. Most (88.1%) of the diagnostic changes were attributable to the specialist expertise of the reviewing pathologist, and only 4.8% resulted from the clinicians providing extra information. Amended diagnoses led to major management changes in 16 cases (3.8%), minor management changes in 12 cases (2.9%), and no management change in 388 cases (93.3%). The Gastroenterology meeting showed the highest figures for clinically significant diagnostic changes; there was an amended diagnosis in 44.2% of cases reviewed, 83.3% of which altered patient management. These figures were related to the specialist review of endoscopic biopsy specimens. Although the variation in the methods used to select cases for review and the different roles of individual meetings prevent their adoption into a formal systematic audit scheme, analysis of case review at clinicopathological meetings can yield valuable information concerning departmental diagnostic performance.

Dermatology↗
PubMed1995

Observer-based dynamic patient modeling for diagnostic computer programs in long term treatment.

This article shows the dynamic patient model concept, the major argument of which is that the state of the patient could change during the computer aided diagnostic procedure. It introduces the definition of quasi parallel diagnostic systems and quasi parallel sensitive points. A kind of verification procedure can be seen for classical diagnostics, examining diagnostic systems by temporally behavior. The rest of the paper represents an adaptive diagnostic structure, convenient for observing and monitoring a dynamically modeled patient in long term treatment. The basis of the structure shown here is the observer theory presented and applied previously in signal processing.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

[Diagnostic approach in patients with kidney tumors].

The basic reason for the rationalization of diagnostic procedure is the cost benefit relation and making of the diagnostic course algorithms. On the basis of the Receiver Operating Characteristic (ROC) analysis of the diagnostic procedure (excretory urography, ultrasonography, computed tomography, digital subtraction angiography) the significance ranking has been established for certain kidney tumor diagnostic procedures. Angiography has been determined to be the most precise method, but the high degree of sensitivity (98%) and accurate diagnosis probability (98%), as well as noninvasiveness and relative inexpensiveness of ultrasonographic examination procedure, all argue for ultrasonography as the cornerstone, of renal tumor diagnosis. Using conditional probabilities and the Bayes analysis the advantage of the newly suggested over the standard diagnostic course has been calculated. The study has shown a significant decrease in the number of examinations: in 60 patients 16 excretory urographies, 10 computed tomographies, and 22 digital subtraction angiographies can be spared.

Adult↗
PubMed1996

Long distance transmission of diagnostic cardiovascular information.

Availability of advanced cardiac diagnostic procedures has proven to decrease the morbidity and mortality associated with common cardiovascular diseases. It was requested that the University of Nebraska Medical Center (UNMC) provide a rural hospital with advanced cardiology services. The services included monitoring of inpatients and rapid interpretation of cardiac diagnostic tests. UNMC proposed to solve this problem by building a computer-based system to transmit diagnostic cardiac information from a rural hospital to UNMC for interpretation by a cardiologist. The information transmitted to UNMC was grouped into two categories: 1) cardiovascular ultrasound, 2) ambulatory and 12-lead electrocardiograms. The information consisted of digital and analog waveform information, static images, and 30 fps video. The system provided rapid data transmission to UNMC over a T-1 line. The system utilized a compression technology which did not degrade the interpretation quality of the data. This system has increased the availability of advanced cardiac diagnostic services to general medical practitioners in a rural hospital. In addition, the system has significantly reduced the time and cost to transmit vital cardiac diagnostic information, thus improving the quality of care received by rural patients.

Cardiovascular Diseases↗
PubMed1996

Acute poisonings in the course of drug addiction: chemicotoxicological diagnostics.

A demand for a quick and reliable diagnostics of acute and chronic poisonings with drugs of abuse, monitoring of the treatment of drug abusers and controlling their abstinence lead to a search for the most useful diagnostic methods for clinical aims and certification. Our observations concerning the importance of toxicological investigation, particularly the use of Triage rapid immunoassay, in the diagnostics of acute poisonings and the abstinence control of dependent people were presented. Urine of 418 poisoned people and 7 "detoxificated' patients treated at the Department of Toxicology in Kraków in the years 1991-1995 was examined, and in 54 cases Triage method was used (seven drugs of abuse were determined: amphetamine, barbiturates, benzodiazepines, cocaine, methadone, opiates and tetrahydrocannabinoids), which was later confirmed using the Fluorescence Polarisation immunoassay, measured with the Vitalab Eclair. An increase in number of admitted patients to the Department of Toxicology was noted and the need for reliable diagnostics concerning the increasing number of cases in which inconsistency of the drug declared in the interview with the toxicological findings was stated. Triage method used in the examinations proved to be very useful for clinical diagnostics in quick determination of drugs of abuse in urine. The result should be confirmed using another, preferential method for the poison found in biological material.

Adult↗
PubMed1996

[Evaluation of complaints and diagnostic methods, considered to be objective, in gastroesophageal reflux].

Authors analyse complaints of 166 patients suffering in gastroesophageal reflux disease, and results of different objective diagnostic methods (X-ray swallowing, endoscopy, 24 hour pH-monitoring, esophageal manometry). The degree of severity of typical complaints and changes found by diagnostic procedures were scored. Individual diagnostic proceduresindicated the characteristic changes of gastroesophageal reflux with great deviations. Hiatal hernia identified by x-ray, esophagitis observed by endoscopy, abnormal reflux revealed by pH-metry together occurred only at 36% of patients. Significant correlation could be revealed only between the degree of changes found by x-ray or pH-metry--applying them one by one--and the complaints of the patients, but with the combination of four diagnostic methods a tight, positive correlation could be demonstrated with the severity of the complaints of the patients in every case. Applying of diagnostic methods as much as possible completing each others, with consideration to the complaints of the patients is suggested for having the diagnosis been precise of the gastroesophageal reflux disease, and for measuring of efficacy of treatment. The importance of tight collaboration of internist, radiologist and surgeon and the significance of complex examination is underlined.

Esophagoscopy↗
PubMed1996

The results of the "essential laboratory tests" applied to new outpatients--re-evaluation of diagnostic efficiencies of the test items.

We have analyzed diagnostic efficiencies of the individual "Essential laboratory test" items when these tests were applied to 520 new outpatients in the division of comprehensive medicine in a teaching hospital. The integration of these test results with history-taking and physical examination resulted in 544 primary clinical diagnoses which corresponded to the patient's illness complained and in 361 additional diagnoses unrelated to their chief complaints but found by chance by the addition of the test results. Clinical usefulness of these test items were variable depending on the disease category, demonstrating a superior diagnostic efficiency in infectious or inflammatory diseases, liver and biliary tract diseases, hematological disorders or metabolic diseases such as hyperlipidemia and diabetes mellitus, but a lesser degree of usefulness in gastro-intestinal or neurogenic diseases. Urine urobilinogen could not establish its clinical usefulness because of extremely low diagnostic sensitivity even in liver diseases. The leukocyte differential count provided confirmatory information for infectious or inflammatory diseases and was helpful for the estimation of the etiologic nature of infectious diseases. This study failed to terminate a controversy for the adoption of sialic acid instead of erythrocyte sedimentation rate (ESR) in the "Essential laboratory test" items, since the former test showed lower sensitivity, even though higher specificity, in infectious or inflammatory status than ESR. Low albumin globulin ratio (A/G) revealed equivalent diagnostic sensitivity and specificity to the elevated levels in alpha 1 and/or alpha 2 globulin fractions in infectious or inflammatory status, being helpful for the evaluation of patient's general condition at a glance. Incidental analysis for diagnostic values of cholinesterase and random blood glucose for the detection of fatty liver and diabetes mellitus, respectively, suggested that these two tests may be included in the "Essential laboratory tests". Simultaneous measurement of serum creatinine and blood urea nitrogen levels was recommended for the ambulatory screening of renal insufficiency, rather than the measurement either alone. The results in this study provide scientific bases on the usefulness of the individual test items and should be taken into account in the next version of the "Essential laboratory tests".

Adolescent↗
PubMed1996

Diagnostic value of various serum antibodies detected by diverse methods in childhood celiac disease.

The diagnostic performances of antiendomysium IgA detected on monkey esophagus and human umbilical cord smooth muscle, of antireticulin IgA, and of antigliadin IgA and IgG were calculated in 74 children with celiac disease (CD) or other gastrointestinal disorders. We also compared four methods for gliadin antibody detection. With a diagnostic specificity of 100%, diagnostic sensitivity was 94% for antireticulin IgA, 93% for antiendomysium IgA when detected on human umbilical cord smooth muscle, and 97% when detected on monkey esophagus. The diagnostic sensitivity for gliadin antibody was highest with an ELISA procedure, followed by fluorogenic detection (94% for IgG, 91% for IgA, 97% with IgA and IgG combined). Because of its high diagnostic sensitivity and ease and speed of use, the combined antigliadin IgG and IgA antibody assay is suitable for screening large groups of patients. In IgG- or IgA-positive cases, the more demanding and more specific antiendomysium IgA evaluation is required to confirm suspected CD.

Animals↗
PubMed1996

Management of suspected ectopic pregnancy. Impact of new diagnostic tools in 686 consecutive cases.

OBJECTIVE: To analyze the impact of new diagnostic tools on the use of laparoscopy on patients with suspected ectopic pregnancy (EP). STUDY DESIGN: Analysis of 686 consecutive patients who underwent laparoscopy or laparotomy for suspected EP from 1983 to 1995 at the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. RESULTS: With the introduction of more sensitive urine pregnancy tests, the positive predictive value (PPV) of diagnostic management increased from 0.42 in 1983 to 0.91 in 1988. The introduction of transvaginal sonography improved this figure to 0.93 in 1989. More recently, a PPV of 0.95 was achieved by adding serum human chorionic gonadotropin measurements to the diagnostic workup. The sensitivity and specificity of this new strategy were 0.97 and 0.96. CONCLUSION: New diagnostic methods greatly reduced the need for laparoscopy to diagnose or rule out EP. The largest impact resulted from the introduction of better pregnancy tests. The effect of other sophisticated tools was less dramatic but eventually contributed to a near perfect noninvasive diagnostic management, thus opening new perspectives for nonoperative treatment modalities.

Chorionic Gonadotropin↗
PubMed1996

Reflections on the development of a host-response diagnostic test for periodontal disease.

This manuscript reviews the sequence of events surrounding the development of a proposed diagnostic test for periodontal disease based on analysis of a host mediator in gingival crevicular fluid (GCF). The mediator is lysosomal beta-glucuronidase (beta G), a marker of granule release from polymorphonuclear leukocytes. Preliminary studies were conducted to evaluate the most reproducible method of collecting GCF and analyzing the data. This was followed by analysis of the mediator in GCF in a variety of cross-sectional and short-term longitudinal studies, and eventually by a study of the relationship of beta G in GCF to disease progression (probing attachment loss) in a single center longitudinal trial. Development of an academic-industrial collaboration allowed the project to progress, as a rapid, practical assay system was developed, and a multi-center longitudinal trial was conducted. The multicenter trial indicated that patients with elevated beta G in GCF were at 6 to 14 times higher risk for experiencing probing attachment loss. The technical, regulatory, business and marketing issues surrounding the introduction of a diagnostic test for periodontal disease were considered. While technical and regulatory issues were not major impediments, business and marketing concerns contributed to a decision to halt development of the test. Specifically, there was concern about acceptance of the test by practitioners and third party reimbursement. Underlying these issues were the multifactorial nature of periodontal disease, and the lack of a direct cause and effect relationship of test results to disease outcome. While analysis of beta G in GCF is not currently available as a diagnostic test for periodontal disease, the development process has identified important issues for the introduction of diagnostic tests, including consideration of the relationship of test results to treatment, the need to integrate diagnostic tests into dental practice, and an appreciation of the financial and health care benefits derived by practitioners and patients with use of such tests.

Biomarkers↗
PubMed1996

Selling biotechnology in the dental medicine marketplace: the OmniGene Diagnostics DNA probe tests for periodontal pathogens.

OmniGene Diagnostics, Inc. has applied the principles of genetic engineering to develop species-specific DNA probe tests for eight periodontal pathogens (Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetem-comitans, Fusobacterium nucleatum, Eikenella corrodens, Campylobacter rectus, Bacteroides forsythus, and Treponema denticola). The test requires minimal effort on the part of the clinician: subgingival plaque samples are collected from the patient and sent through the mail for analysis by OmniGene Diagnostics' fully licensed clinical reference laboratory. Results are transmitted to the practitioner by phone, fax, or mail. The use of diagnostic tests for periodontal pathogens is a relatively new concept in dentistry and acceptance of the OmniGene Diagnostics tests by the dental marketplace has been slower than anticipated. OmniGene Diagnostics' challenge for the future is to persuade the dental community that monitoring periodontal pathogen levels, as well as other clinical indicators of disease, is essential to providing optimal care to the periodontitis patient.

Biotechnology↗