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At least 1,765 records · Page 98Linked to original sources
PubMed2004

Pharmacogenetics of inflammatory bowel disease.

Therapeutic outcome in inflammatory bowel disease has traditionally been related to disease activity. Recent data suggest that individual differences in drug disposition and metabolism, some of which are genetically determined, may play a significant role in the outcome of therapy for inflammatory diseases. Polymorphisms in the thiopurine methyl transferase gene (TPMT) are known to influence the outcome of therapy with azathioprine although pharmacogenetic analysis of outcome has not entered routine clinical use. The outcome of therapy with drugs such as steroids may be influenced by a wide range of genetic factors including polymorphisms in the multi-drug resistance 1 gene (MDR1), polymorphisms in glucocorticoid receptor genes and potentially other as yet undefined polymorphisms regulating the inflammatory process. Multiple polymorphisms have been identified in MDR1 but their direct contribution to changes in expression and function have not as yet been defined. Lastly, as novel biological agents such as infliximab become established in clinical practice, it is clear that their therapeutic efficacy will likely be modified by polymorphisms downstream of their target molecules. New diagnostic and therapeutic algorithms are needed to directly determine the functional importance of the influence of host genetic factors on choice and dosage scheduling of therapy.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2004

[A laparoscopic management of an iatrogenic lesion of the colon during a colonoscopy].

The colon injury during a colonoscopy is a rare, however a serious complication, requiring, mostly, a surgical management. Only few patients may undergo a conservative treatment. The authors discuss the problem of the iatrogenic colon perforation during the colonoscopy and they assess a benefit of the miniinvasive surgery in the diagnostics and treatment algorithm. The main benefit is seen in the reduction of the surgical intervention risks, in the surgical trauma minimalisation, in more favourable postoperative status and in the possibility of the definitive injury management.

Aged↗
PubMed2005

[Modern diagnosis and treatment of pancreatic cancer--from the viewpoint of the internist].

INTRODUCTION: Despite considerable progress in the areas of epidemiology and molecular genetics, pancreatic cancer is still characterized by a dismal prognosis. Pancreatic cancer remains a major unsolved health problem, with conventional cancer treatments having little impact on disease course. AIM: The authors purpose was to offer an overview of the modern diagnosis and treatment of pancreatic cancer for internists and every doctors who are interested in this subject. METHOD: The current literature has been reviewed and summarized. RESULTS AND CONCLUSIONS: Resectability rates and reduction in postoperative mortality are achieved by centralisation of treatment in high-volume speciality centres. For locally advanced, unresectable, and metastatic disease treatment is palliative, however, new methods are being investigated. The current overview provide recommendations for diagnostic and therapeutic algorithms.

Algorithms↗
PubMed2005

[Treatment of sclerotic stenosis of trachea].

An evident trend towards the increase of postintubational and posttracheostomic tracheal stenoses is observed in Georgia during the past 10-12 years. For example, during the period of 1998-2001 28 patients were admitted to our center with this diagnosis, while during 2001-2004 we treated 61 similar cases. According to several international publications overall frequency of postventilatory laryngotracheal stenoses is as high as 25%. At present time surgical intervention remains as a method of choice for treatment of tracheal stenoses including circular resection, step by step reconstructive plastic operations and different methods of tracheal recanalization. 89 patients 14-68 years of age were treated in our center during 1998-2004. 61 (68,5%) cases were presented with pathology within the cervical part of trachea and larynx. 28 (31,5%) cases were with intrathoracic tracheal stenosis. In 71 (79,8%) cases stenoses were induced by pulmonary ventilation by endotracheal tube and in 18 (20,2%) cases etiologic factor was posttracheostomic tracheal injury. Duration of intubations varied from 3 to 86 days. Mortality was 3 cases out of 89. In 2 cases mortality was due to anastomotic leakage, in 1 case--bleeding from brachiocephalic vessels. Based on our experience, an accurate follow up of diagnostic and treatment algorithms allows achievement of good results in 91% cases.

Adolescent↗
PubMed2004

[Contemporary treatment of diabetic foot].

The management of patients with diabetic foot presents an important challenge for health services research. Since today there is no algorithm describingkind of diagnostic tests and treatment is the best for patients with different extremity ulcers. This article could be helpful for future decisions regarding the management of patients with lower extremity ulceration.

Anti-Bacterial Agents↗
PubMed1991

[Various clinico-social aspects of differential diagnosis of schizophrenia].

Fifty-six cases where the diagnosis of psychopathy was replaced by that of schizophrenia, 44 cases where the diagnosis of organic brain damage was replaced by schizophrenia, and 45 cases of the replacement of the diagnosis of schizophrenia by organic brain damage on repeated forensic psychiatry expert evaluation were subjected to a ++clinico-catamnestic analysis. The author describes the main ++clinico-social phenomena imitating some signs of the initially diagnosed disease and/or "overshadowing" criteria for the catamnestically verified pattern of psychopathology in psychopath-like conditions and delineates some combinations of such conditions. Proceeding from limited potentialities of " algorithms " of the diagnostic problems in psychiatry, especially with regard to the pathomorphosis as well as because of the complexity of forecasting particular signs and their number that may form a sufficient basis for correct or erroneous diagnosis in spite of a comparatively low incidence of the majority of the phenomena considered, all of them are regarded as practically significant.

Adolescent↗
PubMedDate not supplied

Diagnostic and therapeutic approach to acute pulmonary embolism in an emergency department.

Pulmonary embolism (PE) is the obstruction of the pulmonary arteries by the dislodging and embolization of thrombotic material coming in most cases from the deep veins of the leg. PE is a relatively common disease with an estimated annual incidence up to 37 cases diagnosed per 100,000 persons it is the third cause of death in the United States. Clinical signs and symptoms are non specific and in the 70% of cases there isn't a correct diagnosis. The aim of this review is to summarize the state of the art of the diagnostic and treatment algorithms of PE in the evidence based medicine in order to minimize the "clinician gestalt" by the only guide for the early diagnosis and treatment of the disease. A correct diagnosis based on pre test probability, the use of computed tomographic pulmonary angiography, early anticoagulation/fibrinolysis started in the Emergency Department can change the natural history of the disease. In perspective, a combined approach of localyzed fibrinolysis and mechanical fragmentation could improve the overall outcome of these patients.

Acute Disease↗
PubMed2006

Hemorrhage from primitive rectal varices in patient with idiophatic thrombosis of portal vein: case report.

INTRODUCTION: Rectal varices, primitive or secondary to hypertensive or thrombotic disorders of mesenteric-portal circle, represent an uncommon cause of lower digestive bleeding. The presence of rectal varices associated to idiopathic venous portal thrombosis represents a distinct nosologic entity, with important clinical and therapeutic problems related to it. CASE REPORT: Patient of young age, with positive anamnesis for primitive rectal varices, admitted to our department for a serious recttorragy. The laboratory underlined moderate anaemia and the endoscopy documented the presence of multiple rectal varices, without evident signs of bleeding; the endoscopy documented the presence of two esophageal small varicose cords F1. The hepatobiliary sonography and the portography showed the massive thrombosis of the portal vein. The new serious episode of rectal bleeding induced us to subject the patient to a surgical operation of Hartmann recto-sigmoid resection. CONCLUSION: Because of the slight number of reported cases of primitive rectal varices and because of the scattering of many dates it is difficult to draw an univocal diagnostic and therapeutic algorithm. Clinical framing and subsequent therapeutic approach rise often up from personal experience rather than well defined guidelines. The treatment is controversial, time by time many therapeutic options are reported either conservative or interventionist. The failure of conservative therapy and the recurrent episodes of bleeding give indication to surgical treatment, that is represented by Hartmann colonic resection and/or the porto-systemic shunts in the cases of portal hypertension; in our case we made colonic resection sec. because of lapsed performing status of the patient.

Adult↗
PubMed2006

[Videoendosurgical diagnosis and treatment of abdominal injuries in combined trauma].

Experience with videolaparoscopy in 1332 patients with combined abdominal trauma is analyzed. The original method of diagnosis of traumatic abdominal multitraumas in shock patients was proposed and patented. Diagnostic and treatment algorithm for hemoperitoneum in patients with abdominal multitrauma based on USE or CT data on liquid in the abdominal cavity has been developed. Videolaparoscopy helped to avoid open surgery in 73.3% patients with dominating abdominal trauma.

Abdominal Injuries↗
PubMedDate not supplied

[Polymyalgia rheumatica and giant cell arteritis--first results of a year-long study].

INTRODUCTION: Due to ageing of population, gerontorheumatology becomes more and more important. Both polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) typically develop in later life and they have many other common features. The aim of our study was to explore diagnostic and prognostic markers and, prospectively, establish diagnostic and therapeutic algorithm for patients with PMR and GCA. SAMPLE AND METHODS: We examined 27 patients with suspected PMR or OBA. The diagnosis was verified in 22 patients. Three of them were in a long-term clinical remission. Besides examination for basic clinical and laboratory parameters, all other patients were subjected to ultrasonography of temporal artery and peripheral joints to detect any exudates. Also, they were examined for T-cell subpopulations in peripheral blood and HLA antigens. RESULTS: Exudate was confirmed in 7 patients; some of them had exudate in multiple joints. Puncture of synovial fluid was done in 4 patients. Increased resistance index of temporal artery was found in 2 patients with GCA and 4 patients with PMR. GCA patients showed lower level of T-cells and increased activation of CD8-cells. Decreased count of CD8+ T-cells was observed in 56 % of PMR patients. Analysis of HLA antigens indicates that GCA, rheumatoid arthritis and, probably, PMR are associated with HLA-DR4 antigen in Slovak population. CONCLUSION: The importance of assessment of disease activity and its prognosis in PMR or GCA patients via ultrasonographic evaluation of exudate in peripheral joints and resistance index of temporal artery as well as the analysis of T-cell distribution in peripheral blood and incidence of HLA-antigens has not been proved yet. Practical significance of monitoring the above-mentioned parameters can be verified only by further prospective study performed with a larger sample of patients.

Aged↗
PubMed2006

Venous leg ulcers in the elderly patient: associated stress, social support, and coping.

Although psychosocial issues in wound management are critical considerations when formulating diagnostic and treatment algorithms, they frequently are overlooked. Clinician consideration and evaluation of associated stresses, social support, and coping are particularly important when caring for elderly patients with recalcitrant venous ulcers. The Health Belief Model and health locus of control may help explain patient responses to health issues. The psychosocial effects of chronic illness, emotional impact of pain, physiological responses to stress, and issues related to treatment adherence must be considered. Recent research has contributed substantially to understanding of these concerns in the general patient population and in persons with venous ulcers. However, quantitative data are limited and studies examining the effects of educational level, ethnicity, socio-economic status, and clinician-patient relationships on psychosocial health in general, and wound healing in particular, are needed. Despite these limitations, increased awareness of the psychosocial dynamic in elderly patients should be integral to the wound care protocol.

Adaptation, Psychological↗
PubMed2006

Case studies in advanced monitoring: OptiVol.

Two cases of congestive heart failure with decompensation are presented. The OptiVol fluid index (Medtronic, Inc., Minneapolis, MN) provides an objective gauge of fluid status that can be difficult to obtain with routine clinical history or even with physical examination. The Cardiac Compass Report (Medtronic, Inc.) can identify a patient's ability to achieve euvolemia and the need for pharmacologic and nonpharmacologic interventions. Future studies will help define diagnostic and management algorithms using the OptiVol index, as well as in combination with other parameters in the Cardiac Compass Report, to facilitate proactive monitoring of patients with congestive heart failure.

Aged↗
PubMed2006

Is transcutaneous oxygen and carbon dioxide monitoring indispensable in short- and long-term therapeutic management of non-reconstructable lower critical limb ischemia?

AIM: The aim of this study was to evaluate the capacity of transcutaneous partial pressure of O(2) (TCpO(2)) and CO(2) (TCpCO(2)) to predict clinical response to pharmacological treatment in short- and long-term follow-up of unreconstructable critical limb ischemia (CLI) treated with prostanoids; to suggest a diagnostic and therapeutic algorithm able to define the possibility of prostanoid therapy in unreconstructable CLI at high risk of limb loss. METHODS: Twenty-six consecutive patients with CLI (21 with distal trophic lesions, 31 symptomatic limbs) considered unreconstructable after peripheral angiography and with a history of type 2 diabetes mellitus underwent daily parenteral Iloprost treatment for 2-3 weeks. RESULTS: Transcutaneous gas-analytic monitoring (TGM) in non-reconstructable CLI treated with Iloprost divided patients into 2 groups: early responders (ER) with increased TcpO(2) and normalization of TcpCO2, and non responders (NR) with unchanged TcpO(2) and TcpCO(2) parameters. In the NR who underwent a second cycle of Iloprost within a few months of the first, TGM further divided the patients into another subgroup of late responders (LR) with TcpO(2) and TcpCO(2) similar to the ER group and a subgroup of NR, who, after pharmacological treatment failure, should undergo eventual surgical re-timing and/or spinal cord stimulation in a final attempt to save the limb. CONCLUSIONS: In the short-term follow-up of CLI, a marked reduction in supine/dependent TcpO(2) and a marked increase in supine TcpCO(2) at the symptomatic forefoot proved to be significant predictors of major amputation risk. In the long-term follow-up period, TGM showed that, in ER and in LR, the favourable effect of pharmacological therapy observed in the first 6 months will disappear over the next 6 months, suggesting an algorithm of 2- to 3-week cycles of prostanoid therapy repeated every year. In NR treated with surgical and/or alternative therapies who did not undergo major amputations, prolonged instrumental TGM will provide a constant evaluation of metabolic parameters, thus providing the possibility to save the limb with additional pharmacological therapy.

Aged↗
PubMedDate not supplied

[Current approaches to intraoperative diagnosis and treatment of low cardiac output during cardiosurgical operations].

The paper deals with the development of a diagnostic and therapeutic algorithm of intraoperative heart failure during cardiosurgical operations on the basis of evaluation of systolic and diastolic functions of the left and right ventricles. The study included 101 patients with low cardiac output in the postperfusion period. All the patients suffered from coronary heart disease and they underwent myocardial revascularizing operations under extracorporeal circulation. In all the patients, in addition to traditional hemodynamic parameters (heart rate, blood pressure, central venous pressure), the functional status of the left and right ventricles was evaluated by transesophageal Doppler echocardiography (TED echoCG) and the thermodilution technique using a Swan-Ganz catheter having a prompt thermistor. Evaluating the diastolic and diastolic functions of the right and left ventricles makes it possible to identify 2 types of left and right ventricular failure: 1) that due to systolic dysfunction and 2) that due to concomitance of systolic and diastolic dysfunctions. Dobutrex (5-7.5 microg/kg/min) should be used in right ventricular systolic dysfunction. Amrinone (5-10 microg/kg/min) should be given to patients with concomitance of systolic and diastolic dysfunction; in this situation, a combination of dobutrex and nitroglycerin (100-150 ng/kg/min) may be used. The drugs of choice in impaired left ventricular systolic function are epinephrine (30-100 ng/kg/min), dopamine (5-10 microg/kg/min), or dobutrex (5-7.5 microg/kg/min). Their combination with sodium nitroprusside can enhance the efficiency of therapy. In patients with left ventricular failure caused by systolic and diastolic dysfunction, epinephrine, dopamine, or dobutrex may be combined with amrinone (5-10 microg/kg/min) or nitroglycerin (100-150 ng/kg/min).

Amrinone↗
PubMed1989

[Differential diagnosis of acute appendicitis and appendicular colic].

The use of the bias strategy of the statistical conclusion allows to substantially improve differential diagnostics of acute appendicitis and appendicular colic at the expense of complex account of clinical manifestations as a sum of their diagnostic coefficients. The algorithm of the assessment of the clinical manifestations is characterized by high sensitivity and specificity which allows to avoid missing the diagnosis of acute appendicitis where it takes place and to minimize (not more than 4%) hyperdiagnostics of appendicitis in appendicular colic.

Acute Disease↗
PubMed1988

Evaluation of the infertile couple.

The evaluation of the infertile couple is usually a lengthy investigation in which all possible etiologic factors in both partners have to be considered. Optimal and cost-effective investigation requires adequate recognition of significant historical data and physical findings. Males without stigmata of endocrinopathies or general medical illnesses require an analysis of their semen as the minimum initial step of evaluation. Those suspected of deficient androgen production and/or action and those with abnormal sperm counts, motility, and/or morphology need assessment of their serum concentrations of selected reproductive hormones. When these initial investigations are negative and there are no demonstrable etiologic female factors underlying the state of infertility, specialized sperm function and sperm allergy testing needs to be performed. The initial investigation of the female partner is best served by assessing the frequency of ovulation and adequacy of corpus luteum function. Women without ovulatory defects should be assessed for the presence of the hostile cervical mucus and structural anomalies of the reproductive tract. Investigations of patients with menstrual dysfunctions should be based upon the presence or absence of hirsutism, changes in body weight, and evidence of other endocrinopathies or medical illnesses. Following the identification and normalization of causes of anovulation, further work-up of patients who remain infertile is similar to those with regular menstrual cycles. The diagnosis of idiopathic infertility is essentially by exclusion of all other causes. Algorithms for the diagnostic evaluation of most infertile couples are provided.

Female↗
PubMed1987

Operations upon the biliary tract during transplantation of the liver.

Operation upon the biliary tract is a discipline within transplantation of the liver. There exists a background of basic science information concerning anatomy and physiology, an historical evolution of surgical techniques, a divergence of contemporary opinion regarding preferred approaches and a body of well described complications. The complication rate, once more than one-half with substantial contribution to mortality rates, now ranges from approximately 15 to 25 per cent. Current practice in most institutions is to use choledochocholedochostomy with T-tube stent when a recipient duct is present and Roux-en-Y choledochojejunostomy with internal stent when a suitable recipient duct is absent. Hepatic arterial thrombosis is an important cause of complications of the biliary tract. The overlap of symptoms and signs of rejection with those of biliary sepsis and other complications of the biliary tract underscores the need for algorithmic use of diagnostic modalities in the post-transplant period.

Biliary Tract Surgical Procedures↗
PubMed1987

Automated serial ECG-analysis within an epidemiological study.

Since 1980 we have performed a cohort study in order to develop diagnostic and predictive algorithms for myocardial infarction. These algorithms shall be based on cardiovascular risk factors, ECG-measurements and serial measurement changes. An intermediate analysis of 5524 study participants describes observed measurement changes stratified by age and sex. The values thus obtained may serve for reference purposes and illustrate the influence of age and sex on intraindividual ECG-measurement changes. Specific suggestions are made for future program developments in order to overcome some present problems in serial ECG-analysis.

Age Factors↗