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PubMed1993

Diagnostic screen for assessment of the IHS criteria for migraine by general practitioners.

This study examines the sensitivity and specificity of a self-report screen for the diagnosis of migraine according to the IHS criteria in a sample of 1049 employees of the French National Railways. The diagnosis of migraine derived from the self-report instrument was compared to an unstructured diagnostic interview conducted by a neurologist specialized in the diagnosis and treatment of headache. The sensitivity of the diagnostic screen was poor, but the specificity was excellent. Optimal cut-off points for the questionnaire were determined by the Receiver Operator Characteristics (ROC) method. Assessment of the specific IHS criteria for migraine revealed that the following criteria failed to discriminate subjects with migraine from non-cases: "aggravation by physical activity" and "photophobia and phonophobia". Implications of the findings for modification of the IHS criteria were discussed.

Adult↗
PubMed2000

Soluble P-selectin in human plasma: effect of anticoagulant matrix and its levels in patients with cardiovascular disorders.

P-Selectin represents a cell surface glycoprotein that is constitutively present in the Weibel-Palade bodies of endothelial cells and in the alpha-granules of platelets. In inflammation and thrombogenic conditions, plasmatic P-selectin levels are markedly elevated, indicating the leakage of this marker from these sites. In this study, a quantitative sandwich enzyme-linked immunosorbent assay (ELISA) utilizing a monoclonal soluble P-selectin (sP-selectin) antibody was employed to assess this marker in blood samples collected in various anticoagulants such as heparin, hirudin, sodium citrate (3.2% and 3.8%), and ethylenediaminetetraacetic acid (EDTA). The soluble P-selectin levels ranged from 26 ng/mL to 44 ng/mL. Sodium citrate (3.8%) was used to collect platelet-poor plasma (PPP) from patients with heparin-induced thrombocytopenia (HIT), coronary angioplasty (CA), or coronary atherectomy (CAT). In comparison with the control group (approximately 30 ng/mL), all of these patient groups showed a marked elevation of sP-selectin levels (HIT = 96 ng/mL [n = 18], CA = 46 ng/mL [n = 6] and CAT = 60 ng/mL [n = 10]). In platelet-rich plasma (PRP) preparations using various anticoagulants, the sP-selectin levels were markedly higher, ranging from 87 ng/ mL to 117 ng/mL (n = 10). In patients recruited into a clinical trial (the argatroban [ARG] 911 Study), in which argatroban was used as an alternate anticoagulant in patients with HIT, a 25% to 35% decrease in sP-selectin levels was observed after 72 hours of argatroban treatment. In addition, the relative ratio between levels in PRP and PPP in these patients differed, suggesting that the anticoagulant matrix influences the sP-selectin levels. These data clearly suggest that the anticoagulant matrix and blood collection procedures may significantly influence the plasmatic P-selectin levels. Furthermore, in different clinical conditions, elevation of this marker may reflect endogenous platelet activation; however, optimal anticoagulant for blood collection is important for proper diagnostic validation.

Adult↗
PubMed2005

Spatial and spectral information in optical mammography.

This article reviews our research activities in the area of optical mammography and relates them to the historical developments and the current state and trends in the field. The guiding threads for this article are the roles played in optical mammography by spatial and spectral information. The first feature, spatial information, is limited by the diffusive nature of light propagation but can take advantage of the exceptionally high optical contrast featured by blood vessels and blood-rich areas in the breast. We describe a method to correct for edge effects, a spatial second-derivative algorithm, and a two-dimensional phased-array approach that enhance the image contrast, the spatial resolution, and the depth discrimination in optical mammograms. The second feature, spectral information, is the most powerful and unique capability of optical mammography, and allows for functional measurements associated with hemoglobin concentration and oxygenation, water concentration, lipids content, and the wavelength dependence of tissue scattering. We present oxygenation-index images obtained from multi-wavelength optical data that point to the diagnostic potential of oxygenation information in optical mammography. The optimization of the spatial and spectral information in optical mammography has the potential to create a role for this imaging modality in the detection and monitoring of breast cancer.

Breast Neoplasms↗
PubMed2004

Urinary tract infections during pregnancy.

OBJECTIVE: To provide a comprehensive review of urinary tract infections (UTIs) during pregnancy. All aspects of UTIs, including epidemiology, pathogenesis, resistance, clinical features, diagnosis, treatment, and prevention, were reviewed. DATA SOURCES: MEDLINE (1966-August 2003) and Cochrane Library searches were performed using the key search terms urinary tract infection, pyelonephritis, cystitis, asymptomatic bacteriuria, and resistance. STUDY SELECTION AND DATA EXTRACTION: All article abstracts were evaluated for relevance. Only articles pertaining to pregnancy were included. The majority of published literature were review articles; the number of original clinical studies was limited. DATA SYNTHESIS: UTIs are the most common bacterial infections during pregnancy. They are characterized by the presence of significant bacteria anywhere along the urinary tract. Pyelonephritis is the most common severe bacterial infection that can lead to perinatal and maternal complications including premature delivery, infants with low birth weight, fetal mortality, preeclampsia, pregnancy-induced hypertension, anemia, thrombocytopenia, and transient renal insufficiency. Enterobacteriaceae account for 90% of UTIs. The common antibiotics used are nitrofurantoin, cefazolin, cephalexin, ceftriaxone, and gentamicin. CONCLUSIONS: Therapeutic management of UTIs in pregnancy requires proper diagnostic workup and thorough understanding of antimicrobial agents to optimize maternal outcome, ensure safety to the fetus, and prevent complications that lead to significant morbidity and mortality in both the fetus and the mother.

Ambulatory Care↗
PubMed1995

Recombinant erythropoietin for prevention of anemia in preterm infants.

In order to prevent or to treat anemia of prematurity, more than 800 preterm infants were enrolled into controlled studies with recombinant erythropoietin (rhEPO) during the past five years. The effective dosage seems to be within the range of 300 to 1200 IU/kg per week, markedly higher than in adults or children with anemia due to renal failure. No adverse events nor impairment of granulopoiesis or platelet formation could be attributed to erythropoietin. Statistical metaanalysis of eight controlled trials revealed an 18% reduction of transfused infants. The preventive effect was scarce in very small and very sick preterm infants, and during the first two weeks of life, when hemorrhagic anemia due to diagnostic blood loss is predominant. rhEPO treatment is one step in the concept to prevent anemia of prematurity. This concept should also include placental transfusion, minimizing of diagnostic sampling, miniaturized laboratory tests, adequate iron supplementation, and optimal nutritive protein administration.

Anemia, Neonatal↗
PubMed2005

Proteomics in acute myelogenous leukaemia (AML): methodological strategies and identification of protein targets for novel antileukaemic therapy.

Enduring efforts into determination of the molecular biological status of acute myelogenous leukaemia (AML), a stem cell disease characterised by distinct blastic differentiation blocks and their extensive growth, continue to provide us with prognostically important information for more than half of all patients. In subsets of AML, molecular diagnostics rigorously guide the clinician toward the choice of optimal therapy. The in-depth characterization of leukemogenesis associated genetic alterations, such as the combined presence of activating mutations of tyrosine kinases together with altered transcription factors, and the documented impact of these mutations upon prognosis of AML, suggests AML as a primary candidate for pioneering proof-of-principle studies with new high throughput protein analysis techniques. This review aims to introduce the reader to proteomic methodology, e.g. two-dimensional polyacrylamide gel electrophoresis, mass spectrometry, SELDI and protein arrays. Examples of its use, including single cell phosphoprotein profiling in risk stratification, the probing of cellular effects of conventional chemotherapeutics and novel target determination are presented. Based on original proteomic analysis of AML, molecular characteristics of AML, in addition to knowledge of conventional therapeutics and novel drugs, we attempt to forecast the influence of proteomics in therapy development for AML.

Acetylation↗
PubMed2000

Fine-needle aspiration cytology of bone: accuracy and pitfalls of cytodiagnosis.

BACKGROUND: Fine-needle aspiration cytology has proved to be an accurate, cost-effective, and safe technique for diagnosing inflammatory and neoplastic lesions at different body sites. Its applicability in bone pathology, however, has been controversial due to a high percentage of inadequate samples and nonspecific results in the diagnosis of primary bone lesions. In this study, the diagnostic accuracy of the technique and its capacity for diagnosing primary bone lesions were assessed. In addition, the authors analyzed the diagnostic limitations with focus on specimen adequacy. METHODS: The authors reviewed 314 consecutive fine-needle aspirations of bone from 308 patients. Direct or cytospin smears from aspirated material were fixed in 95% alcohol and stained by a modified Papanicolaou technique. Ninety-seven smears (31%) initially were considered unsatisfactory and excluded from the study. A diagnosis was rendered in 217 cases (69%), which were classified into 4 categories: primary bone lesions (benign and malignant) (42%), metastatic bone tumors (37%), suspicious for malignancy (5%), and negative (16%). RESULTS: The overall accuracy was 95%. Seventy-eight percent of primary bone lesions were correctly diagnosed by cytology. All cases diagnosed as metastatic by cytology were correct. The authors encountered difficulties diagnosing fibro-osseous lesions. Thirteen percent of cases were erroneously diagnosed as "negative" or "inflammatory conditions." On review, the absence of adequate cytologic material was noted in all of them. This sampling error could have been avoided by the presence of an on-site cytopathologist. CONCLUSIONS: Fine-needle aspiration of bone is a simple, reliable, and accurate diagnostic technique that can facilitate patient management and preoperative decision-making and/or avoid unnecessary invasive procedures for patients with primary or metastatic bone lesions. However, the radiologist, cytopathologist, and orthopedic surgeon should work together for optimal results. Moreover, a definitive pathologic diagnosis should not be issued if diagnostic material is not adequate and/or clinicoradiologic information is incompatible.

Biopsy, Needle↗
PubMed2000

Intraoperative ultrasound (IOUS) is essential in the management of metastatic colorectal liver lesions.

Metastatic tumors to the liver account for the majority of hepatic neoplasms. Improvement in resection has been shown to be beneficial and has remained the treatment of choice, carrying a 5-year survival rate of approximately 20 to 30 per cent. In evaluating candidates for surgery, intraoperative assessment for resectability is a key factor and dictates surgical approach, as well as patient prognosis. Historically, imaging techniques such as CT scan, magnetic resonance imaging, and CT arterial portography (CTAP) have been used in preoperative evaluation. However, the sensitivities of these diagnostic tools have been found to be less than optimal. Intraoperative ultrasound (IOUS) has emerged as an important tool in accurately staging metastatic liver disease with a sensitivity of 98 per cent. From 1994 to 1996, 23 patients have undergone IOUS for evaluation of suspected liver neoplasms in an ongoing prospective study. All patients had colorectal carcinoma. All patients received preoperative CT scan, and 11 patients with positive CT scans had CTAP. Fifteen patients were found to have colorectal metastasis to the liver. Surgical management in 7 of the 15 patients was modified because of the use of IOUS. Two patients were found to have unresectable disease thus abandoning hepatic resection, two were found to have additional lesions undetected by preoperative evaluation and were resected, and in two patients margins of resection were changed. One patient was found to have benign hepatic cysts, and no resection was performed. The use of IOUS modified the management of 44 per cent of our patients with liver metastases. IOUS should be routinely used in patients undergoing liver resection for metastatic liver disease.

Aged↗
PubMed2000

Gallium-67 imaging in lymphoma: tricks of the trade.

OBJECTIVE: Although the use of 18F-fluorodeoxyglucose (FDG) PET for evaluating lymphoma is gaining in popularity, PET is not yet universally available and large prospective comparisons between 67Ga and 18F-FDG PET scans in predicting the long-term outcome after treatment are lacking. Scintigraphic imaging with 67Ga remains an important tool in evaluating the response of lymphoma to therapy. There are a variety of challenges and pitfalls inherent in 67Ga imaging for lymphoma. These are discussed and problem cases are illustrated. After reading this article, the nuclear medicine professional should be able to: (a) optimize the technical approach to and (b) maximize the diagnostic accuracy of 67Ga scintigraphy in assessing the response of lymphoma to therapy.

Fluorodeoxyglucose F18↗
PubMed2001

Understanding and managing ischemic stroke.

Transient or permanent focal brain injury following acute thromboembolic occlusion develops from a complex cascade of pathophysiological events. The processes of excitotoxicity, peri-infarct depolarisation, inflammation, and apoptosis within the ischemic penumbra are proposed. While the translation of therapeutic agents from the animal models to human clinical trials have been disappointing, there remains an atmosphere of optimism as a result of the development of new diagnostic and therapeutic approaches, which include physiological, as opposed to pharmacological, intervention. This article provides an insight into the understanding of cerebral ischemia, together with current and future treatment strategies.

Animals↗
PubMed2002

Staging of non-small-cell lung cancer and application of FDG-PET. A cost modeling approach.

BACKGROUND: The presence of (distant) metastases affects the therapy (operation) and prognosis of patients with non-small-cell lung cancer (NSCLC). Fifty percent of the operations are futile due to the presence of a locally advanced tumor or distant metastases. Therefore, more accurate preoperative staging is required with respect to the outcomes (reduction of futile operations) and costs. This study examines current staging procedures and assesses possible situations for incorporating positron emission tomography (PET). METHODS: A retrospective analysis was performed to assess actual clinical practice in the staging procedure of 337 patients with NSCLC in two Dutch hospitals. Consequently, by combining these data of actual clinical practice with a literature review, a model was developed to determine the influence of PET on the staging outcomes and the costs. In this model the accuracy and costs of PET can be varied as well as the extent of substitution of conventional diagnostic tests by PET. RESULTS: Practice variation was found between the two hospitals with regard to the setting in which the diagnostic staging took place (hospitalization, outpatient setting) and the extent of the use of mediastinoscopy. This was reflected in the costs and in the number of (futile) operations. CONCLUSION: Hospitalization is the major cost driver in these patients. From a cost viewpoint, the evaluation of PET in a strategy after diagnostic imaging but prior to invasive staging seems most optimal.

Aged↗
PubMed1992

[The optimal drainage of the bile ducts and subhepatic recess in the surgical treatment of complicated cholecystitis].

On the basis of the analysis of the results of surgical treatment of 478 patients with complicated cholecystitis, it was established that the Robson-Vishnevsky method (95 cases) was the optimal one for drainage of the bile ducts after diagnostic (19) or therapeutic (115) choledochotomy, and that of Halsted-Pikovsky (9)--in manipulations through the cystic duct. Drainage of the subhepatic space by means of a rubber tube drain is effective. The methods for active decompression and transdrain therapeutic measures used in presence of purulent-inflammatory process in the bile ducts, or subhepatic space are presented.

Adult↗
PubMed2003

[Current views on acquired valvular heart disease and the results of treatment].

The article deals with the problems of diagnosis of acquired valvular defects (AVD) and indication to surgical treatment of AVD in accordance with international recommendations and modern knowledge of this issue. The following AVD diagnosis methods are described: heart auscultation, echocardiography, tests with regulated load, angiographic and radionuclide methods. Among pathological conditions, more attention is placed on stenoses, aortic, mitral and tricuspid valve insufficiency, IHD. Of importance is interpretation of the data obtained at diagnostic tests in terms of indications to cardiosurgical interventions, optimization of the terms and outcomes of the surgery. Statistics are provided on natural survival of patients and efficacy of surgical treatment.

Aortic Valve↗
PubMedDate not supplied

[Invasion-free respiratory monitoring in thoracal surgery of oncology patients].

The results of intraoperative monitoring in thoracal surgery of 375 oncology patients with lung cancer were analyzed. The dynamic parameters of ventilation and blood gas composition were investigated in patients with uncomplicated anesthetic management and with complicated adequate ventilation. The diagnostic value of the above parameters is defined for optimizing the respiratory support in surgery for lung cancer.

Adult↗
PubMed2005

Potential gaps in congestive heart failure management in a rural hospital.

INTRODUCTION: Congestive heart failure (CHF) is increasingly recognized as an important cause of morbidity and mortality. Previous studies in urban settings have shown that patients frequently are not receiving recommended therapy. There is a paucity of studies that have evaluated CHF management in a rural setting. We therefore reviewed hospital and outpatient care in this setting as an initial step toward improving CHF care. METHOD: A retrospective chart review was used to examine the care of all 34 patients hospitalized for CHF from 2000-2001 in a small rural hospital, to assess the need for improved CHF management. RESULTS: The median age of the patients was 78 yr, and a number of them had many co-morbid cardiovascular risks. Similar to other studies, only 23% of patients were prescribed recommended doses of angiotensin-converting enzyme (ACE) inhibitors. Use of beta-blockers was far below expected rates. Although there was follow-up care for nearly all patients (97%), few patients had echocardiography performed (38%) or had their medications altered in the outpatient setting. CONCLUSION: There is a need for improved management of CHF in the rural setting. Approaches to improving CHF care should use the continuity of care advantage provided by primary care physicians to optimize outpatient medical treatment regimens and improve access to diagnostic services such as echocardiography.

Adult↗
PubMed2006

Survey of a pediatric hospital staff regarding cases of suspected child abuse and neglect.

BACKGROUND: The suspicion of child abuse and neglect may arise from manifestations such as physical or psychosomatic symptoms, eating disorders, suicidal behavior, impaired parental functioning, etc. Thus the arrival of an abused or neglected child at the hospital provides an opportunity for detecting the problem and beginning a process of change. Optimal utilization of this potential depends on the awareness, diagnostic ability and cooperation of the staff. OBJECTIVES: To assess knowledge about hospital policy, attitudes and actual behavior of hospital staff in cases of SCAN. METHODS: The questionnaire was adapted and distributed to a convenience sample of personnel at a children's hospital. The questionnaire included items on knowledge of hospital policy regarding SCAN, attitudes towards inquiring about cases that appear suspicious, and behaviors in cases in which the respondent was involved. The comparison of responses to specific questions and among members of different professions was analyzed by chi-square test. RESULTS: Eighty-two staff members completed the questionnaires. Most of the respondents were aware of hospital policy regarding suspected abuse (86.6%), with fewer regarding suspected neglect (77.2%). Physicians were the least aware of these policies, as compared to medical students, nurses and social workers. Although most considered the issue of SCAN a responsibility of members of their own profession, 35.4% considered it primarily the responsibility of the welfare or judicial systems. Over 40% felt uncomfortable discussing suspicions with the child and nearly half felt uncomfortable discussing them with parents. The most often reported reason for this was the sense that they lacked skills or training for dealing with the issue. Despite this, when asked about actual behavior, 94.7% responded that they do try to clarify the circumstances related to the suspicious symptoms. Respondents were more likely to contact the hospital social worker than community resources (91.5% vs. 47.2%). CONCLUSIONS: There is a need to encourage awareness, discourse and training of medical personnel regarding SCAN in order to maximize their potential to identify children at risk.

Adult↗
PubMedDate not supplied

[Preliminary approach towards construction of peptide libraries as potential tools for diagnosis of malignant thyroid tumors].

INTRODUCTION: Cancer of thyroid gland is the most common malignancy of the endocrine system. The treatment improvement could be achieved by early diagnosis. The aim of the study was to identify cancer specific antigenes with use of peptide libraries. MATERIAL AND METHODS: The material from 6 patients with thyroid cancer (4 with papillary cancer, 1 with follicular cancer and 1 with oxyphilic tumor) were analyzed. It was performed with use of lipophylic peptide libraries by direct comparison of staining of specimens prepared from normal and malignant tissue. RESULTS: Preliminary results confirm practical value of peptide libraries in early diagnostics of thyroid cancer. CONCLUSIONS: It is important to optimize construction of peptide libraries by using different staining agents hydrolyzed by proteases.

Adenocarcinoma, Follicular↗
PubMed1990

[Methodologic provisions for developing models of individual prognoses of pregnancy outcome].

The method of individual prognosis of spontaneous abortion in clinically indefinite conditions is considered. The diagnostic algorithm is based on the use of the optimal dendrite method to identify classes at the first stage and to classify a female as a healthy subject or a patient further (at the second stage). The algorithm is realized as a programme module operating in the FORTRAN language on a dialogue for a personal computer.

Algorithms↗