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The author reports clinical criteria of diagnosis of neuropsychic disintegration in the early ontogenesis of children (under 1 year of age and 1-3 years). The data are presented in the form of a diagnostic chart that allows with a certain probability to optimize the detection of these disorders.
The progress made in ultrasonography and improved in vitro tests have changed the field of application for scintigraphy of the thyroid. Thyroid scanning itself has been improved by the use of isotopes with better imaging properties and less radiation burden (99mTc, 123I) and by gamma cameras for imaging. Scintigraphy yields real topographic and functional information on the gland, in addition to which ultrasonography gives morphological data only. This holds true especially for autonomous nodular goiter with iodine deficiency. The goal of thyroid imaging is always to match the appropriate diagnostic procedure with all the clinical data available. When optimized techniques (gamma camera, on-line processor) are used thyroid scintigraphy is useful for the diagnosis, adequate therapy and follow-up of various thyroid disorders.
The analysis of a modern demographic situation, dynamics and causes of child mortality, the levels and patterns of pregnancy and childbirth pathology, the newborn and infants' disease rates in the Baltic Republics and the Byelorussian SSR enabled one to determine priority directions for the development of a complex programme on the improvement of mother and child health and reduction of child mortality in the Baltic Republics, these directions involve intensification of antenatal fetus protection due to the improvement of females' working conditions, development of medico-genetic counselling and wide application of prenatal diagnostic procedures for the detection of fetus developmental defects, optimization of women reproductive behavior under the conditions of complete provision with modern contraceptive means, propaganda of breast feeding.
The trend in peripheral nerve surgery is toward earlier definitive treatment of the lesion, based on the optimal use of preoperative and intraoperative electrodiagnostic techniques. Newer diagnostic tools include computed tomography (CT) and thermography. Knowledge is still being gained about the technology and limitations of the autogenous nerve grafts that are being used to overcome nerve gaps. The technique of nerve anastomosis is undergoing rapid improvement, and better methods have been developed for identifying motor and sensory fascicles at the time of operation. Research activity into the problem of nerve damage produced at the time of trimming nerve stumps promises to change to the technology of nerve repair in the near future. For benign nerve sheath tumors (schwannoma, neurofibroma), the trend is away from nerve excision and in the direction of tumor enucleation. Histologic methods for diagnosing malignant nerve tumors have been improved, making it possible to embark on radical excision with less hesitation. The pain syndromes (causalgia, phantom limb pain, and stump pain) that may follow nerve injury continue to present a problem in management, but steady progress is being made toward a rational program of management. A more distant prospect is for pharmacologic and electrophysiologic methods to accelerate axonal regeneration.
65 computer tomographs were taken of 79 patients with bronchial carcinoma for the purpose of determining operability. Included were 49 computer tomographs of the thoracic region, 7 of the epigastrium, and 9 of the skull. CT, a noninvasive radiological diagnostic method, was used in the above cases not only for diagnosis but even more for high-accuracy staging and thus therapy planning. CT accuracy regarding assessment of local operability amounted to 97.9 per cent (n = 49). There was only one case in which tumour infiltration into the aorta had been overlooked. Diagnosis restricted to conventional tomography gave rise to four thoracotomies which proved to be useless for local inoperability due to tumour infiltration of the mediastinum. The advantages of computed tomography over conventional radiological approaches were found to be primarily based on possible detection of mediastinal lymph node metastases as well as tumour infiltration of organs adjacent to the mediastinum and of the thoracic wall. The diagnostic potential implied in computed tomography could not be optimally utilised until CT was simultaneously applied to epigastric organs. Therefore, basic examinations for preoperative staging of bronchial carcinoma should by all means include computed tomography in addition to conventional radiological methods and bronchoscopy.
Effects of pH and heat were examined on the activity of enzyme catalase from human sources (normal and pathological sera, tissue homogenates, purified catalases). The pH optimum, temperature optimum and T50 values of purified catalases were lower than those of normal, or pathological sera and tissue homogenates. On contrast, the activation energy showed its highest value in purified catalase. These findings might be explained by the post-translational modification of enzyme catalase. The obtained results failed to enhance the diagnostic role of serum catalase determination, nevertheless, gave the optimal values of pH and temperature for catalase assay.
Surgical procedure appears as an optimal curative method for the treatment of advanced stages of all 4 types of chronic pancreatitis. Progress in diagnostic methods and defining of classification with more precision in last years led us to the idea to optimalize also surgical procedure for the treatment of chronic pancreatitis. Since 1985 we have been performing duodenum preserving pancreas head resection followed by pancreatogastroanastomosis in symptomatic form of chronic pancreatitis. Checking up of 28 patients operated on by this procedure confirm best results of all used methods. With regard to the character of the disease we are not able to improve external secretory function of the pancreas by this operation. External secretory insufficiency has to be substituted permanently by medicaments. Substantial contribution of this operation is in improvement of the quality of the life of the people suffering from chronic pancreatitis.
About 10% of undescended testis are non palpable. Surgical exploration of the inguinal region was the standard treatment, mainly because reliable "localisation tests" were not available. Today, laparoscopy is becoming the first step for optimal management of this problem. This technique combines relevant diagnostic information with therapeutic facilitations.
OBJECTIVE: To evaluate the utility of the serum progesterone level for discriminating pregnancy from gestational trophoblastic neoplasia. METHODS: Serum progesterone levels were measured in 61 women with histories of trophoblastic disease who developed a re-elevation in hCG during surveillance and underwent a work-up to differentiate pregnancy from gestational trophoblastic neoplasia. Progesterone levels were analyzed in the context of diagnostic outcome (pregnancy versus gestational trophoblastic neoplasia) to identify optimal threshold levels of progesterone to be used for classifying outcome. RESULTS: Of the 61 women, 37 proved to be pregnant and 24 had gestational trophoblastic neoplasia. Progesterone less than 2.5 ng/mL was predictive of trophoblastic malignancy, with a sensitivity of 83% (20 of 24 subjects were classified correctly as having gestational trophoblastic neoplasia) and a specificity of 95% (35 of 37 patients with progesterone levels at or above 2.5 ng/mL were correctly classified as pregnant). Progesterone of at least 10 ng/mL was associated with viable pregnancy in 97% of the cases. Furthermore, the progesterone level predicted outcome regardless of the serum hCG value. CONCLUSION: The serum progesterone level is useful for discriminating early pregnancy from gestational trophoblastic neoplasia.
SMANCS is the first commercially available polymer conjugated drug invented by the author, in which the protein antitumor agent neocarzinostatin is conjugated with two short chains of poly(styrene-comaleic acid) half-butylate. It exhibits the highest tumor/blood ratio (> 1,000) when injected arterially as an oily formulation in Lipiodol (SMANCS/Lipiodol). In addition, SMANCS/Lipiodol can give very high tumor contrasting image under X-ray (e.g., CT-scan), and thus the optimal dosing regimen can be determined and offers a diagnostic advantage. Phase I/II study of SMANCS was initiated in 1989 and it was approved by the Japanese Government in the fall of 1993 for the treatment of hepatoma. Exploitation of its application for other tumors such as renal cell cancer and pleural/ascitic carcinomatosis is anticipated. The response rate of Grad IV Lipiodol retention is 48.5% at 4 months; and those of 6 and 12 months are 50% and 90%, respectively. The major side effect is fever, which is only transitory, and no bone-marrow suppression, renal or hepatic toxicity were observed.
Arterial and venous compression about the shoulder girdle are rare clinical entities. Potential complications can be disastrous for the patient. A heightened awareness of the problem and careful physical examination may lead to earlier diagnosis. Controversy still exists as to the optimal treatment once diagnosis is confirmed. Evolution of noninvasive diagnostic techniques may be of considerable benefit in the future.
An immunoassay's minimal detectable concentration (MDC), the smallest analyte concentration the assay can reliably measure, is one of its most important properties. Bayes' theorem is used to unify the five current mathematical MDC definitions. The unified definition has significant implications for defining positive results for screening and diagnostic tests, setting criteria for immunoassay quality control and optimal design, reliably measuring biological substances at low concentrations, and, in general, measuring small analyte concentrations with calibrated analytic methods. As an illustration, we apply the unified definition to the microparticle capture enzyme immunoassay for prostate-specific antigen (PSA) developed for the Abbott IMx automated immunoassay system. The MDC of this assay as estimated by our unifying approach is shown to be 4.1-7.1 times greater than currently reported. As a consequence, the ability of the assay to measure reliably small concentrations of PSA to detect early recurrences of prostate cancer is probably overstated.
Normal digestion is a complex and coordinated process that breaks food into constitutive molecules, some of which are absorbed and others passed through the body as waste. Many of the conditions associated with wasting syndromes alter normal digestive function and can lead to or exacerbate malnutrition. Digestive function can be defined by applying the principles of normal physiology. Our laboratory has developed a relatively comprehensive stable isotope method to assess function, which shows promise as a screening tool in evaluating patients with wasting syndromes. This and other tests of digestive function can be used to define the abnormalities associated with wasting and to direct or optimize antiwasting therapy.
Three cases of traumatic rupture of the diaphragm were presented. In terms of the roentgen examination, one can differentiate between certain and incertain diagnostic criteria. The differential diagnosis was briefly metioned; an optimal examination technique is often not possible due to the severity of the injuries.
There is substantial evidence for a significant genetic component to the risk for alcoholism. In searching for genes that contribute to this risk, the diagnostic criteria for alcohol dependence may not be the optimal phenotype; rather, creation of a more homogeneous phenotype will lead to a more homogeneous genetic etiology. Items from the Semi-Structured Assessment for the Genetics of Alcoholism collected from 830 individuals in 105 alcoholic families were used in a latent class analysis to identify a more homogeneous alcoholism-related phenotype. A four-class solution was chosen: class 1, unaffected group; class 2, mildly problematic group; class 3, moderately affected group; and class 4, severely affected group. Classes 3 and 4 had higher symptom endorsement probabilities than classes 1 and 2 for items reflecting severe alcohol dependence, and were combined to provide enough sibling pairs for genetic linkage analysis. A total of 291 markers distributed throughout the genome, with an average intermarker distance of 14 cM, were genotyped. Linkage analysis was performed to detect loci underlying classes 3 and 4, the moderately and severely affected alcoholics, of whom 88% met the Collaborative Study of the Genetics of Alcoholism, and >99% met ICD-10 criteria for alcohol dependence. Evidence for a locus on chromosome 16, near the marker D16S675, was found with a maximum multipoint lod score of 4.0. Analysis of additional markers on chromosome 16 yielded a lod score of 3.2, narrowed the critical region, and placed the gene between D16S475 and D16S675 in a 15 cM interval.
PURPOSE: The increasing use of ultrasound (US) for both diagnostic and interventional procedures has not been supported yet by proper and adequate planning of dedicated rooms. Therefore we studied both the organization and the design of such areas. METHODS AND DISCUSSION: As for organization, we considered: a) the kind of examination performed; b) the main department activity (in-/outpatients, diagnostic or interventional procedures); c) the schedule for each room by examination type and timing (patient preparation, actual examination and read-out times). As for room design, we studied the size and location of the diagnostic unit, dressing rooms, entrances and restrooms, as well as the furniture in general. We also studied the location of waiting rooms and corridors, the location and size of the read-out areas, and the room for post-interventional monitoring, as well as all the details about microclimate and lighting. Then we designed two different modules with the relevant planimetry: one featuring two adjacent diagnostic rooms and the other featuring a single diagnostic room. Some ergonomic solutions are also proposed concerning the location of the US system relative to the stretchers entrance and the location of the post-interventional monitoring room relative to the radiologic room(s). Finally, we evaluated the size of some peculiar pieces of equipment of a radiologic room by their function. CONCLUSIONS: The functional arrangement of the diagnostic US unit and its space requirements, permits to optimize the use of the whole structure complying with the ergonomic criteria for operators and enabling the rapid throughout of patients with no waste of time.
Although the use of the insulin tolerance test (ITT) for the diagnosis of adult GH deficiency is well established, diagnostic peak GH cut-points for other commonly used GH stimulation tests are less clearly established. Despite that fact, the majority of patients in the United States who are evaluated for GH deficiency do not undergo insulin tolerance testing. The aim of this study was to evaluate the relative utility of six different methods of testing for adult GH deficiency currently used in practice in the United States and to develop diagnostic cut-points for each of these tests. Thirty-nine patients (26 male, 13 female) with adult-onset hypothalamic-pituitary disease and multiple pituitary hormone deficiencies were studied in comparison with age-, sex-, estrogen status-, and body mass index-matched control subjects (n = 34; 20 male, 14 female). A third group of patients (n = 21) with adult-onset hypothalamic-pituitary disease and no more than one additional pituitary hormone deficiency was also studied. The primary end-point was peak serum GH response to five GH stimulation tests administered in random order at five separate visits: ITT, arginine (ARG), levodopa (L-DOPA), ARG plus L-DOPA, and ARG plus GHRH. Serum IGF-I concentrations were also measured on two occasions. For purposes of analysis, patients with multiple pituitary hormone deficiencies were assumed to be GH deficient. Three diagnostic cut-points were calculated for each test to provide optimal separation of multiple pituitary hormone deficient and control subjects according to three criteria: 1) to minimize misclassification of control subjects and deficient patients (balance between high sensitivity and high specificity); 2) to provide 95% sensitivity for GH deficiency; and 3) to provide 95% specificity for GH deficiency. The greatest diagnostic accuracy occurred with the ITT and the ARG plus GHRH test, although patients preferred the latter (P = 0.001). Using peak serum GH cut-points of 5.1 microg/liter for the ITT and 4.1 microg/liter for the ARG plus GHRH test, high sensitivity (96 and 95%, respectively) and specificity (92 and 91%, respectively) for GH deficiency were achieved. To obtain 95% specificity, the peak serum GH cut-points were lower at 3.3 microg/liter and 1.5 microg/liter for the ITT and ARG plus GHRH test, respectively. There was substantial overlap between patients and control subjects for the ARG plus L-DOPA, ARG, and L-DOPA tests, but test-specific cut-points could be defined for all three tests to provide 95% sensitivity for GH deficiency (peak GH cut-points: 1.5, 1.4 and 0.64 microg/liter, respectively). However, 95% specificity could be achieved with the ARG plus L-DOPA and ARG tests only with very low peak GH cut-points (0.25 and 0.21 microg/liter, respectively) and not at all with the L-DOPA test. Although serum IGF-I levels provided less diagnostic discrimination than all five GH stimulation tests, a value below 77.2 microg/liter was 95% specific for GH deficiency. In conclusion, the diagnosis of adult GH deficiency can be made without performing an ITT, provided that test-specific cut-points are used. The ARG plus GHRH test represents an excellent alternative to the ITT for the diagnosis of GH deficiency in adults.
Echocardiography in the emergency room presents exciting practice possibilities that can facilitate prompt and reliable diagnostic evaluations in patients with suspected cardiovascular emergencies. Echocardiography has the diagnostic potentials to evaluate the entire spectrum of cardiovascular abnormalities short of delineating coronary anatomy and evaluation of the conduction system. By reliably assessing the global and regional function, visualizing the cardiovascular structures from multiple tomographic planes, and quantitating hemodynamic abnormalities, echocardiography should be able to assist emergency room physician's evaluation and triage of the patients with chest pain syndrome, unexplained dyspnea, hypotension, shock, chest trauma, and cardiac arrest, whereby hopefully minimizing the unnecessary admission to the hospital and facilitating inhospital evaluation of the admitted patients with echocardiographic information. However, the optimal echocardiography practice in the emergency room requires well trained sonographers and echocardiographers who can respond to the clinical needs at anytime. Whether an emergency room physician can perform and interpret echocardiographic examinations satisfactorily will depend on his/her level of training and continuing education in this area. Currently, there is no established guideline for performing echocardiography in the emergency room. Further clinical investigations are necessary to define the most optimal and economical utilization of this versatile imaging and hemodynamic diagnostic modality in the emergency room.