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PubMed2002

[The diagnosis and treatment of cholangiolithiasis after cholecystectomy].

Results of complex examination and treatment of 138 patients with postcholecystectomic cholangiolithiasis were analyzed. Residual cholangiolithiasis was diagnosed in 104 (75.4%), recurrent--in 34 (24.6%) patients. Differential-diagnostic symptoms of residual and recurrent cholangiolithiasis are specifiEd. Diagnostic and curative algorithm was developed, criteria of choice of curative (instrumental or surgical) methods were clarified. Mini-invasive surgeries (endoscopic papillosphincterotomy, suprapapillar choledochoduodenostomy, dissection of stenosed choledochoduodenoanastomosis, percutaneous transhepatic cholangiostomy, lithoextraction through external bile fistual, mechanical and laser lithotripsy, nasobiliar drainage) from different diapeutic approaches were performed in 137 (99.3%) patients. Diapeutic instrumental procedures were effective and final in 91.9% cases (in residual cholangiolithiasis--94.2%, in recurrent--82.4% cases). Lethality was 0.7%.

Acute Disease↗
PubMed2001

Main problems of modern medicine in diagnostics and learning: ways of optimal solution.

OBJECTIVE: 1. Selecting the key problems in medicine--I. Diagnostic problems, II. Didactic and training problems of medical education, III. Economical problems, IV. Communications technologies problems, V. Psychological problems, VI. Social problems, VII. Strategic problems. 2. Outline ways to optimal solution of these problems. METHODS: Innovative intellectual approach to medical diagnostic decision-making has been suggested. Knowledge levels and didactic systems, its limitations have been described. The methodologies and computerized technologies are tools to overcome the obstacles. RESULTS: Series of didactic experiments were carried out with the purpose to evaluate comparatively conventional and offered innovative methods of diagnostics and professional training shows significant advantages of the innovations. CONCLUSION: The above mentioned problems can be solved successfully by computerized diagnostics based on algorithmical evidence-based approach to disease recognizing, and mass professional education mainly based on eLearning.

Algorithms↗
PubMed2001

[Clinical-pathomorphologic preparation of patients after surgical treatment of differentiated thyroid cancer to adjuvant treatment with 131I].

UNLABELLED: Thyroid cancer treatment includes: surgery, radioiodine therapy, thyroxine therapy and radiotherapy. Selection of treatment's strategy depends on histopathological evaluation, age of patient and iodine uptake. The aim of the analysis was to verify how the medical documentation of patients treated by surgical treatment was prepared. All patients were directed to the Department of Endocrinology, Holycross Cancer Center in Kielce. Analysis encompassed 33 patients classified to 131I therapy for the first time. In each case patient's medical documentation and histopathological diagnosis made in Department of Tumor Pathology, Holycross Cancer Center, were compared. RESULTS: A conformity with primary cancer diagnosis was obtained in all but one patient in whom pathological consultation did not confirm oxyphilic carcinoma. In four cases the type of cancer was changed as a result of repeated consultation. pTMN classification was stated in 23 primary pathologic examination cases. After consultation of slides and inspection of surgery protocol, total or partial pTNM stage was obtained in other 9 patients. CONCLUSIONS: Establishment of diagnostic and therapeutic algorithm, accepted on Conference in Szczyrk, 1995 is inadequately executed in small centers. Routine consultation of histopathological slides creates a possibility to make a proper choice of treatment's strategy.

Humans↗
PubMed2002

[ICD-10 primary health care. WHO support for family practice psychotherapy].

In the year 2001, The World Health Organization (WHO) published a special edition of the International Classification of Mental Disorders (ICD-10, Chapter F) for use by general practitioners (ICD-10 PHC-Primary Health Care). In this GP version of the ICD-10, diagnostic categorizations and algorithms serving treatment requirements are summarized in simplified form. Unlike the general ICD-10 guidelines, this version also contains management guidelines for each disease category. These include information for the patient and family, advice on counseling, description of treatment methods, and indications for specialist referral. The treatment guidelines are differentiated, concrete and suitable for use in the doctor's office, and concise (in each case not more than a single page). The WHO also offers an education program to enable the interested GP to deepen his knowledge of the treatment guidelines and their theoretical basis. A particular feature of this program are patient information leaflets that guide the physician on what the patient needs to be told. The physician can use these as a basis for his talks with the patient, or give them to the patient for home study.

Family Practice↗
PubMed2002

[Surgical treatment of intervertebral disk herniation and spondylosis in degenerative diseases of the thoracic vertebrae--basic approach. Review of the literature and a group of 12 patients].

Prolapse of an intervertebral disc and neurologically important spondylosis of the thoracic vertebrae are not a frequent finding--in the wide spectrum of surgical treatment of degenerative diseases of the spine the numbers of operations in the thoracic section account only for a few percent. The authors give an account of 12 patients treated surgically during the 5-year period 1997-2001 at the Neurosurgical Department of the First Medical Faculty Charles University and Institute for Postgraduate Training in Prague-Stresovice. They describe the establishment of the neurological finding from the differential diagnostic aspect, the algorithm of radiological examination and selected treatment. In the group of surgically treated patients were two with spinal and radicular symptoms, 8 patients had only spinal and 2 patients had only root symptoms. Laminectomy was performed in one female patient, in 9 patients discectomy was performed from a transpedicular approach and in two patients discectomy from costotransversectomy. Complete normalization of clinical complaints was recorded in 2 patients, in 8 the condition improved and 2 patients did not improve. In 2 patients a revision was made and extension of the approach on account of persisting clinical complaints, in one patient after revision complete normalization of the clinical finding occurred, the second patient did not improve after revision. Selection and results of the surgical approach--in all instances different types of posterior approach were involved--are discussed. In the discussion also a brief review, indications and illustrations of posterior approaches are given. The discussion deals also with the advantages and disadvantages of the method as compared with the anterior approach or endoscopic technique. The authors emphasize the advantages of the microsurgical technique--the open posterior approach still holds an irreplaceable place in the spectrum of surgical therapeutic methods despite the onset of endoscopic methods.

Adult↗
PubMed2002

[Diagnosis and surgical treatment of primary hyperaldosteronism].

Primary hyperaldosteroneism (PHA) is one of the main causes of secondary arterial hypertension (AH). Medical histories of 62 patients with PHA were analyzed. aldosterone-produced adenoma (APA) was diagnosed in 37 (59.7%) patients (all of them were operated), idiopathic hyperaldosteroneism (IHA)--in 25 (40.3%) patients, 11 of them were operated. Complex clinical and instrumental examination (hormonal analysis, USI, CT, MRT, in difficult cases in 35 patients--selective phlebography with blood sampling) was carried out in all the patients. Clinical picture in the majority patients with PHA was unclear. Hypokaliemia is not obligatory symptom of PHA. AH is often the only symptom of PHA, therefore all the patients with AH require complex laboratory examination including repeated detection of potassium blood level, examination of serum aldosterone concentration and renin activity, diurnal urinary excretion of aldosterone. In difficult differential diagnosis between APA and IHA it is necessary to perform selective phlebography with blood sampling from inferior cava and adrenal veins with obligatory detection of aldosterone and hydrocortisone concentration. Diagnostic and curative algorithm are developed. Surgical treatment is indicated for patients with APA, and also for ones with IHA who had functionally dominant adrenal gland (based on selective blood sampling analysis) and resistant for drug therapy AH.

Adrenal Glands↗
PubMed2003

[Reporting studies of diagnostic accuracy according to a standard method; the Standards for Reporting of Diagnostic Accuracy (STARD)].

The objective of the 'Standards for Reporting of Diagnostic Accuracy' (STARD) initiative is to improve the reporting of studies of diagnostic accuracy, so as to allow readers to assess the potential for bias in a study and to evaluate the generalibility of its results. The group searched the literature to identify publications on the appropriate conduct and reporting of diagnostic studies. This was used to draw up a list of potential items. During a consensus meeting, a group of researchers, medical journal editors, and members of professional organisations reduced this list to a usable checklist. Wherever possible, evidence from the literature was used to justify the decisions made. The search for published guidelines about diagnostic research yielded 33 previously published checklists, from which a list of 75 potential items was extracted. At the consensus meeting, participants shortened the list to a 25-item checklist. A generic flow diagram was drawn up to provide guidance on the method for including patients, the order in which tests were to be conducted and the number of patients to undergo the test being evaluated, the reference standard, or both. A scientific publication can only be assessed when the reporting is both correct and complete. Use of the checklist and flow diagram will improve the quality of reports produced, to the advantage of clinicians, researchers, reviewers, journal editors and other interested parties.

Algorithms↗
PubMed2003

[Prognostic evaluation of the flying longevity of pilots with idiopathic mitral valve prolapse].

In the period of 1995-2001, 576 17- to 49-yr. old pilots of fighters and fighter-bombers with the idiopathic mitral valve prolapse (IMVP) were investigated at the Seventh Central military aviation clinical hospital. In this group, a very feebly marked mitral valve prolapse was found in 98.7% of cases. In 96.7% class-1 IMVP was accompanied by a mitral reguragitation, most often the first-degree one. Based on results of comprehensive examination, medically qualified to fly were 560 out of 576 pilots from the main group (97.0%) and 144 out of 150 pilots from the group of control (97.2%). In the next 5 years the flying career was continued by 76.3% and 78.7% of the pilots, respectively. A clinical-diagnostic and expert algorithm for medical certification of pilots of highly maneuverable aircraft with IMVP was developed which will reduce time of in-hospital medical certification and facilitate more accurately determination of the criteria for immediate and long-range estimation of the flying longevity.

Adolescent↗
PubMed2003

[Management of uterine myomas in women of fertile age].

OBJECTIVE: Review of current knowledge about uterine fibroids management in young women. Analysis of possible diagnostic and therapeutic algorithms regarding fertility preserving. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: Analysis of the facts in literature (texts in medical journals, monographies, textbooks, internet database Medline and Ovid) and authors' clinical experience. CONCLUSIONS: Alternatives of treatment of infertility in women with uterine fibroids have significantly enlarged in past 10 years. However none of the indicated methods is perfect. Expectation does not exclude the risk of growth of fibroids and abortion. The effect of pharmacological therapy is only temporary. Myomectomy is associated with the risk of surgical complications, fibroids' recurrence and uterine rupture in subsequent gestation. Although uterine artery embolisation (on an average) halves the fibroids volume, the long-term effect of the method on female fertility is still unknown. Nevertheless it seems convenient to advise the active approach to all women planning pregnancy and having significant (submucous or intramural) fibroid even before spontaneous or assisted conception. Most recent studies indicate significant improvement of reproduction outcomes after myomectomy, especially in young women with the absence of other factors of infertility. Only the results of randomized, controlled trials (that are still awaited) will inform us about comparison of the effects and risks of myomectomy and uterine artery embolization in management of infertility.

Adult↗
PubMed2003

[Urologic complications in pelvic injuries].

OBJECTIVE: Urological complications of pelvic fractures include in particular rupture of the urinary bladder (RUB), injury of the posterior urethra (IPU) and erectile dysfunction (ED). The authors present their own group of patients and in particular the diagnostic and therapeutic algorithm in IPU. MATERIAL AND METHODS: In the Plzen Faculty Hospital in 1/1998 to 8/2002 a total of 19 patients were treated with serious urological complications of pelvic fractures--9x RUB, 11x IPU (once with RUB). RUB was in one instance intraperitoneal, in the remainder extraperitoneal. RESULTS: IPU was without dislocation 6x, with dislocation 5x. Primary "realignment" of the urethra was made in 6 patients (in dislocations and in concurrent rupture of the bladder). In the remaining 5 an epicystostomy was established. In 4 after an interval of 3 months a posterior resection urethroplasty was made because of a distraction defect. One patient with a distraction defect was referred to the urological department of the catchment area and in another patient after-treatment is planned. Severe ED developed in 6 IPU of 10, always in dislocations of the urethra. In one patient we lack information on erections. CONCLUSION: When IPU is suspected (urethrorhagia), dislocation of the prostate on examination p.r.) ascendent urethrography and IVU are essential. Do not catheterize before completed examination. Then needle epicystostomy is performed, in major dislocations of the urinary bladder or in associated injuries primary "realignment" of the urethra open on a catheter or endoscopically. In distraction defects after 12 weeks a posterior resection plastic operation follows.

Adult↗
PubMed2003

Mild cognitive impairment: making headway by stepping backwards.

Mild cognitive impairment (MCI) is a prevalent medical problem and the concept and term have become a catch-phrase for research and clinical practice. However, little is known about the most effective tools for a clinical diagnosis of MCI, its potential significance for individual patients and the best possible intervention--at least as long as MCI is considered as a diagnostic entity. We propose a simplified diagnostic and interventional algorithm for the detection and management of patients with MCI. We argue that MCI is so important, because it represents the closest call for an identification of treatable diseases or risk factors before the final manifestation of irreversible brain changes. Stepping backward by focussing on underlying disease processes and attempting causal interventions must be preferred to a mere symptomatic treatment of MCI as a preclinical form of Alzheimer's disease.

Age of Onset↗
PubMed2003

[General issues of medical care in multiple trauma].

Experience in diagnosis and treatment of patients with combined trauma is presented. The clinicoanatomic classification of combined traumas with their division into 7 groups is proposed. The process of medical care is subdivided in 4 stages - prehospital, critical care, specialized clinical and rehabilitation. The number of patients and their qualitative characteristics at each stage are different. The majority of the lethal outcomes occur at prehospital and critical care stages. Improvement of medical care at the prehospital stage may be realized trough creation of diagnostic and treatment algorithms, at critical care stage - by adequate infusion-transfusion therapy and determination of surgical care priority. Prophylaxis and treatment of complications are very important at the second and third stages. At the rehabilitation stage 84,6% patients need treatment of locomotor lesions, 14.5% - damages of the brain, 0.5% - damages of the spinal cord. Traumas of the thorax and the abdomen don't require long rehabilitation.

Abdominal Injuries↗
PubMed2003

Lifetime costs of colon and rectal cancer management in Canada.

Colorectal cancer is the second leading cause of cancer-related mortality among Canadians. We derived the direct health care costs associated with the lifetime management of an estimated 16,856 patients with a diagnosis of colon and rectal cancer in Canada in 2000. Information on diagnostic approaches, treatment algorithms, follow-up and care at disease progression was obtained from various databases and was integrated into Statistics Canada's Population Health Model (POHEM) to estimate lifetime costs. The average lifetime cost (in Canadian dollars) of managing patients with colorectal cancer ranged from $20,319 per case for TNM stage I colon cancer to $39,182 per case for stage III rectal cancer. The total lifetime treatment cost for the cohort of patients in 2000 was estimated to be over $333 million for colon and $187 million for rectal cancer. Hospitalization represented 65% and 61% of the lifetime costs of colon and rectal cancer respectively. Disease costing models can be important policy- relevant tools to assist in resource allocation. Our results highlight the importance of performing preoperative tests and staging in an ambulatory care setting, where possible, to achieve optimal cost efficiencies. Similarly, terminal care might be delivered more efficiently in the home environment or in palliative care units.

Canada↗
PubMedDate not supplied

[Non-arteritic ischemic optic neuropathy].

An up-to-date review of the concepts on nonarteritic ischemic optic neuropathy (NION) is presented with special emphasis on its most common form, nonarteritic anterior ischemic optic neuropathy (NAION). Relevant clinical data are presented, along with the description of diagnostic and therapeutic algorithms. The methods used in clinical diagnosis and validity of expectations from particular methods during the clinical course of the disease are elaborated. Controversies of medical and surgical approach in the management of this entity are discussed, with special references to the use of aspirin and optic nerve sheath fenestration.

Humans↗
PubMed2004

Pulmonary embolism.

Pulmonary embolism (PE) is an important health problem and often a major clinical challenge, not only because of the low specificity of its clinical manifestations but also because of the increasing number of medical circumstances that are risk factors for this illness and the importance of early identification, since prompt and appropriate treatment can decrease mortality from this disease by about 25%. In recent years research on PE has been extensive, directed mainly at trying to determine and characterize its risk factors, establish new clinical probability algorithms, develop new diagnostic methods and put existing ones into perspective, seek new therapeutic approaches (pharmacological and non-pharmacological), and above all establish protocols that can guide the clinician from the stage of clinical suspicion to measures to prevent recurrence. It was the authors' aim to review the most significant literature on this subject, in order to produce a text that reflects the state of the art concerning PE and that can be used as a guide in the clinical approach to this pathology.

Diagnosis, Differential↗
PubMed2004

[Surgical infection in combat injuries of extremities].

A retrospective analysis was performed of treatment of 1612 patients with gunshot fractures of long bones of the extremities wounded in the Republic of Afghanistan and Chechen Republic. Under study was the infrastructure of the gunshot fractures, general and local factors responsible for the development of suppurations. A angioneurodystrophy theory of pathogenesis of gunshot osteomyelitis is proposed. The level of proinflammatory cytokines was determined in blood serum and wound discharge for the early diagnosis of purulent complications. An algorithm of the diagnostic search was developed with using modern radio- and electrophysiological methods. The standards of general and local treatment are proposed for different stages and spread of the purulent process.

Adjuvants, Immunologic↗
PubMed2004

[Drug-resistant partial epilepsy: pharmacological criteria].

Despite the number of new antiepileptic drugs marketed in the last decade, one third of epilepsies have remained refractory to medical treatment. The term of pharmacoresistance remains controversial and a diagnosis algorithm should be proposed to distinguish pseudoresistance related to the pathology and patient or to the treatment. Beyond resistance to the first prescribed antiepileptic, a lack of response to the sequential use of several monotherapies or antiepileptic drug associations should lead to the diagnosis of drug-resistance, when all causes of pseudoresistance have been ruled out. The presence of predicting factors or etiological factors should also be integrated into this decisional algorithm. Such a diagnostic process identifying real drug-resistant epilepsy is necessary to progress in knowledge of the pathophysiology and in treatment strategy of this category of epilepsy.

Anticonvulsants↗
PubMedDate not supplied

[Contemporary opinions on osteoporosis in neurological disorders].

Osteoporosis is a generalized skeletal disease characterized by low bone mass and leading to an increased fracture risk. It is classified by the World Health Organization as one of the main civilization diseases. Given the aging society, its significance is continuously increasing. There is also a number of neurological disorders predisposing to osteoporosis, such as poor mobility, exposure to corticosteroids, epilepsy and some rare congenital diseases. The present paper reviews literature concerning osteoporosis in the mentioned disorders and gives a diagnostic and therapeutic algorithm in chronic therapy with corticosteroids. Quoted studies show poor neurologists' vigilance regarding the possibility of osteoporosis in their patients and the need for improvement.

Algorithms↗