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PubMed2003

Definition and classification of chronic pancreatitis.

Chronic pancreatitis has been defined by features that are clinical and etiologic in origin. From such definitions a number of classifications have been developed, starting with the Marseille Classification in 1963. Defining features of chronic pancreatitis must consider the etiology of the disease, which then presents characteristic clinical evidence through symptomatic sequelae of organ pathology, including complications of the disease. Advancing technology has improved the imaging capabilities available to document derangements of the pancreas. The main purpose of international classifications of disease states is to provide a common language for purposes of clinical, research, and health outcomes studies. Modification of the 10th World Health Organization I.C.D. classification may provide this tool.

Chronic Disease↗
PubMed2006

Comparison of five prognostic scoring systems, the French-American-British (FAB) and World Health Organization (WHO) classifications in patients with myelodysplastic syndromes: Results of a single-center analysis.

We retrospectively studied 89 consecutive patients diagnosed with primary myelodysplastic syndrome (MDS) over a period of 10 years to (1) identify prognostic factors for overall survival (OS) and leukemia-free survival (LFS); (2) to assess and compare the Bournemouth-, Spanish-, Düsseldorf-, Lille-, and the International prognostic scoring systems (IPSS); and to (3) compare the French-American-British (FAB) and World Health Organization (WHO) classifications. The median age of patients was 63 years (range, 26-85). Karyotype analyses were done in 85 patients (96%). Median OS was 3 years; 67 patients (75%) have died, and 28 (31%) had progression to acute myeloid leukemia (AML). Major independent prognostic variables for both OS and LFS (multivariate analysis) were percentage of bone marrow (BM) blasts (P < 0.0001), and in patients with cytogenetic data available, cytogenetic risk groups by Lille-score (OS, P = 0.031/LFS, P = 0.002) and IPSS (OS, P = 0.024). All five prognostic scoring systems successfully discriminated risk groups as regards OS and LFS, but in patients with cytogenetic data available, the major independent prognostic score for OS (P < 0.0001) and LFS (P = 0.006) was the IPSS. The FAB and WHO classifications also successfully discriminated between risk groups. The new WHO subgroups [refractory cytopenia with multilineage dysplasia (RCMD), with (RCMD-RS) or without ringed sideroblasts] showed a significantly (P = 0.0454) different prognosis for OS, but not for LFS (P = 0.0839), in comparison to the subgroups having erythroid dysplasia only (RA/RARS). Risk stratification into refractory anemia with excess blast-I (RAEB-I) and RAEB-II tended to yield different prognoses for OS and LFS. The 5q-minus syndrome strongly predicted for a good prognosis. In patients treated with the demethylating agent decitabine (n = 24), IPSS "poor risk" cytogenetics were unable to predict for the expected worse prognosis when compared to "intermediate-risk" cytogenetics. In conclusion, we confirm in a single-center patient cohort that the use of the WHO classification improves the predictive value of the FAB classification and that, in patients with cytogenetic data available, the IPSS can be used for clinical decision-making.

Adult↗
PubMed2002

[The new WHO classification of tumors of the nervous system 2000. Pathology and genetics].

New developments in neuro-oncology have prompted an update of the World Health Organization (WHO) classification of tumors of the nervous system. Major changes include the addition of new entities and the refinement of criteria for the diagnosis and grading of various neoplasms, in particular the meningiomas. As novel clinico-pathological entities, the chordoid glioma of the third ventricle, the atypical teratoid/rhabdoid tumor (AT/RT), the solitary fibrous tumor, and the perineurioma have been listed. The former lipomatous medulloblastoma of the cerebellum, previously incorporated in the family of embryonal tumors, is now classified as cerebellar liponeurocytoma. The term mixed pineocytoma/pineoblastoma has been replaced by pineal parenchymal tumor of intermediate differentiation. Furthermore, the large cell medulloblastoma and the tanycytic ependymoma were established as novel tumor variants. A separate chapter on the peripheral neuroblastic tumors has now been included in the classification. Substantial revisions were introduced in the meningioma chapter. For both atypical meningioma WHO grade II and anaplastic meningioma WHO grade III, histopathological criteria are now precisely defined. An important new addition to the WHO 2000 classification of nervous system tumors is the inclusion of molecular pathology findings. With this combination of pathology and genetics it has set the stage for a new format of the WHO tumor classification series.

Astrocytoma↗
PubMed2004

Evaluation of classification criteria for juvenile-onset spondyloarthropathies.

OBJECTIVE: The aim of this study was to investigate the adequacy of the following criteria for the classification of juvenile-onset spondyloarthropathies (JSpA): European Spondyloarthropathy Study Group criteria (ESSGCr) and Amor criteria (ACr) (proposed for adult SpA), Garmisch-Partenkirchen (G-PCr), seronegative enthesopathy and arthropathy syndrome (SEACr), and atypical spondyloarthropathies classification criteria (ASpCr) (proposed for JSpA). METHODS: Sixty-two patients with JSpA (48 male and 14 female) and 64 with juvenile idiopathic arthritis (27 male and 37 female) (excluding enthesitis-related and psoriatic arthritis) were enrolled in the study group. Twenty-nine of the patients with JSpA were diagnosed with definite JSpA and the remaining 35 with undifferentiated JSpA. One hundred six patients in the study group were evaluated by one investigator, who was unaware of the diagnosis, according to the following: ESSGCr, ACr, G-PCr, ASpCr, and SEACr. RESULTS: Analysis of the patients diagnosed with JSpA showed 83.9%, 82.3%, 95.2%, 61.3%, and 62.9% sensitivity and 87.5%, 95.3%, 78.1%, 98.4%, and 92.2% specificity for the ESSGCr, ACr, G-PCr, ASpCr, and SEACr sets, respectively. CONCLUSION: None of the criteria evaluated above is sufficient for the classification of JSpA. There is a definite need for a new set of criteria with high specificity and sensitivity for early recognition and classification.

Adolescent↗
PubMed2002

Classification of hypervascularized lesions in CE MR imaging of the breast.

The purpose of this paper is to define and evaluate a classification category for contrast-enhanced (CE) MR imaging of the breast based on the BI-RADS mammographic categories of the American College of Radiology. Using five evaluation criteria for MR findings (initial signal increase, post-initial signal behavior, shape, border, and contrast material distribution within enhancing tumors) 522 patients (1031 breasts) were analyzed. Scores were given from 0 to 8 points and classified into five categories (group I: 0 points, negative; group II: 1-2 points, benign; group III: 3 points, probably benign; group IV: 4-5 points, suspicious abnormality; group V: 6-8 points, highly suspicious for malignancy) to 265 focal hypervascularized breast lesions in 244 breasts (patient group A). These findings were correlated with histology or follow-up. Additionally, this classification was correlated to the contrast medium uptake within the parenchyma of the remaining 787 breasts without any focal lesion (patient group B). Two hundred sixty-five hypervascularized lesions in 238 patients (244 breasts, patient group A) were classified into group I: 0%; group II: 27.3%; group III: 22.3%; group IV: 18.6%; and group V: 31.8%. Histology revealed 115 benign and 134 malignant tumors in these groups. Sixteen benign lesions were controlled by follow-up. Sensitivity for the detection of malignancy using the presented multifactorial MRM classification was 92%, and specificity was 92%. Excluding cases of ductal carcinoma in situ specificity increased to 95%. Seven hundred eighty-seven breasts without any focal hypervascularized lesion (patient group B) were classified into groups I or II. Follow-up ( n=771) or histology ( n=14) confirmed the diagnosis in 785 of these breasts. Histopathology revealed, however, malignant tumors in the remaining two cases. The classification of lesions based on a multifactorial analysis is very helpful in the interpretation of CE MRI of the breast. The evaluation of all diagnostic imaging modalities, however, is essential in determining the correct diagnosis and/or in deciding on the appropriate therapeutic procedure.

Breast↗
PubMed2005

[Classification of biomedical research reports as a reference for evidence-based medicine in ophthalmology. A survey considering as example the journal Der Ophthalmologe].

BACKGROUND: Evidence-based medicine requires careful appraisal of published data derived from experimental and clinical studies. Based on classification of biomedical research reports, evidence levels can be determined and recommendations for therapeutic decisions can be made. METHODS: A classification system for clinical studies was developed. It was evaluated in classifying the reports published in Der Ophthalmologe during 2003-2004 (study design: descriptive cross-sectional study, case series). RESULTS: In the 2-year interval, 70 longitudinal and 95 cross-sectional studies were published. The vast majority of the longitudinal studies were interventional cohort studies. Not considering case reports, 73% of the original articles were longitudinal prospective studies, 1% were retrospective (case-control) studies, and 26% were cross-sectional studies. CONCLUSIONS: The study design of all published articles could be classified using the classification system. This classification system proves to be applicable in the context of clinical studies in ophthalmology and may be helpful in the process of critical appraisal of the literature and synthesis of clinical evidence and an evidence-based recommendation.

Bibliometrics↗
PubMed2005

Management and classification of children with head injury.

BACKGROUND: Traumatic brain injury is the most common cause of morbidity and mortality during childhood. AIM: This study was conducted to describe the primary management and classification of children admitted to the emergency department for head trauma. SERIES: All children (0-15 years) with a history of head injury who were admitted to the outpatient emergency department at a single paediatric trauma centre in the Stockholm region during 1 month were included. RESULTS: There were 242 children (137 girls and 105 boys; mean age 5.3+/-4.4 years) who fulfilled the inclusion criteria. Based on the Scandinavian Head Injury Classification, 73% were classified as minimal, 17% mild and 2% moderate head injury. This classification seemed to be more accurately reflective than the ICD-10-based classification in the management of the children with head trauma.

Adolescent↗
PubMed2003

Genetic abnormalities and clinical classification of epidermolysis bullosa.

Genetic abnormalities for different subtypes of epidermolysis bullosa (EB) have been described. In dominant simplex type EB, mutations of the K5 or K14 gene lead to disruption of basal cells and the formation of bullae. The recessive simplex types include EB with muscular dystrophy due to abnormal plectin, EB without muscular dystrophy in patients homozygous for K14 gene abnormalities, and skin fragility syndrome, with formation of acantholytic vesicles within the epidermis due to PKP1 gene mutations. In junctional EB, mutations of the laminin 5, type XVII collagen, and alpha 6 beta 4 integrin genes have been reported. Dystrophic type EB is associated with various abnormalities of the type VII collagen gene. A new classification of EB based on these genetic abnormalities has been proposed. However, some concern has been voiced regarding the clinical utility of a classification based solely on genetic abnormalities. Although the reasons are unclear, identical genetic abnormalities have been known to be associated with different clinical features. A classification including a component based on clinical features would therefore be preferable. This article describes recently discovered genetic abnormalities and offers a new classification scheme for EB.

Epidermolysis Bullosa↗
PubMed2005

Two types of classification for male opioid dependence: identification of an opioid addict with depressive features.

OBJECTIVE: There are similarities between alcoholics and opioid addicts and an overlap between both diagnostic groups. We tested the hypothesis that the type I and II classification, well established in male alcoholism, could also be relevant in a population of male opioid addicts. METHODS: A sample of 100 hospitalized adult opioid dependent men were studied with the help of an extended semi-structured clinical interview, considering four classification criteria sets devised by Cloninger et al. (1981, 1982), von Knorring et al. (1985, 1987), Buydens-Branchey et al. (1989) and Babor et al. (1992). RESULTS: The two types of classification could be confirmed with all four criteria sets. In at least three of four analyses, 52 patients were allocated to the same larger cluster C1, and 25 patients to a smaller cluster C2. These two groups were compared with each other with the help of the stepwise discriminant analysis. Seven variables were identified which excellently discriminate between the groups: The C2 patient is younger, has a history of therapy because of depression and a history of severe suicide attempts, also abuses benzodiazepines and becomes violent while intoxicated. His father suffers from alcoholism and received treatment because of depression. The C1 patient lacks these characteristics. CONCLUSIONS: The hypothesis was confirmed, showing that the two types of classification for male opioid addicts is feasible. A depressive type of male opioid dependent patient was identified. Early identification of patients of this type is clinically important.

Adult↗
PubMed2004

Validation of common classification systems for assessing the mineralization of third molars.

One major criterion for dental age estimation is the evaluation of third molar mineralization. There are various methods for evaluating tooth mineralization based on classification by stages. The aim of the present work is to assess the validity of the common classification systems. To this end, we analyzed 420 conventional orthopantomograms of German females aged 12-25 years old. The mineralization status of tooth 38 was determined using the stages defined by Gleiser and Hunt, Demirjian et al., Gustafson and Koch, Harris and Nortje and Kullman et al., respectively. Of the methods tested, the most accurate results were obtained with Demirjian et al.'s classification system, which performed best not only for observer agreement but also for the correlation between estimated and true age. It is argued that this is due to the fact that Demirjian et al.'s classification is based on a sufficient number of stages which are defined independently of speculative estimations of length. This leads to the conclusion that the method devised by Demirjian et al. should be used for evaluating the mineralization of third molars for purposes of forensic age determination.

Adolescent↗
PubMed1997

Computer-assisted classification system for chest X-ray and computed tomography findings in occupational lung disease.

The ILO classification of pneumoconiotic changes in the lungs and pleura has become a standardized and widely accepted method of documentation in occupational medicine. Recently a classification system for computed tomography/high-resolution computed tomography (CT/HRCT) findings in the lung has been proposed as well. For both classification systems, computed-assisted programs have been developed that allow the storage and archiving of the results as well as further statistical processing. The programs are compatible with usual hardware configurations, have a comprehensible and transparent structure, and are easy to learn and adaptable to individual needs. The use of the computer-assisted classification systems is presented in the example of an insulator exposed to asbestos. The system of data documentation and processing has proved to be very practicable in the more than 2000 patients studied thus far.

Asbestosis↗
PubMed2000

Assessment of necrosis and hypoxia in ductal carcinoma in situ of the breast: basis for a new classification.

Modern classifications of ductal in situ carcinoma (DCIS) of the breast suffer from unsatisfactory reproducibility in inter-observer circulation analyses. Ducts in DCIS are markedly enlarged in the range of 360 microm in diameter. Since the diffusion of oxygen from peri-ductal vessels is limited to 100 microm, cells in the center of DCIS are poorly oxygenated and become either necrotic or remain hypoxic but viable. There is evidence that such alternative fate is dictated by the biological characteristics of the neoplastic cells. Therefore, determination of presence or absence of necrosis in ducts up to 360 microm in diameter might represent a simple, reproducible, and biologically sound criterion to classify DCIS. In the present work, following this criterion, we classified 32 cases of intra-ductal lesions as either "necrotic" or "hypoxic" and tested the reproducibility of such classification using K statistics. These cases had already been circulated among a group of European pathologists, who classified the lesions using five different classifications. The K statistics value obtained with the presently proposed system was extremely high (0.91). It remains to be established whether the classification "necrotic/hypoxic" withstands large inter-observer circulation analyses, whether it is predictive of the clinical evolution of DCIS, and whether it might constitute a reproducible basis for selecting appropriate treatments.

Breast Neoplasms↗
PubMed2003

Polymerase chain reaction-based genotype classification among human Blastocystis hominis populations isolated from different countries.

Since the genotype of human Blastocystis hominis isolates is highly polymorphic, PCR-based genotype classification using known sequenced-tagged site (STS) primers would allow the identification or classification of different genotypes. Five populations of human B. hominis isolates obtained from Japan, Pakistan, Bangladesh, Germany, and Thailand were subjected to genotype analysis by using seven kinds of STS primers. Ninety-nine out of 102 isolates were identified as one of the known genotypes, while one isolate from Thailand showed two distinct genotypes and two isolates from Japan were negative with all the STS primers. The most dominant genotype among four populations, except for all four isolates from Thailand, was subtype 3 and it varied from 41.7% to 92.3%. The second most common genotype among four populations was either subtype 1 (7.7-25.0%) or subtype 4 (10.0-22.9%). Subtype 2, subtype 5, and/or subtype 7 were only rarely detected among the isolates from Japan and Germany, while subtype 6 was not detected. The phylogenetic position of the two isolates which were negative with all STS primers, was inferred from the small subunit rRNA (SSU rRNA) genes with the known sequence data of 20 Blastocystis isolates. Since the two isolates were positioned in an additional clade in the phylogenetic tree, this suggested they were a new genotype. These results demonstrated that PCR-based genotype classification is a powerful tool with which to analyse genotypes of Blastocystis isolates obtained from clinical samples. In addition, two groups of the isolates from 15 symptomatic and 11 asymptomatic patients in Bangladesh were compared with the PCR-based subtype classification. Since both groups were only classified into two distinct genotypes of subtype 1 or subtype 3 and no statistically significant difference was observed between the two groups, in this study it could not be shown that the specific genotype correlated with the pathogenic potential of B. hominis.

Animals↗
PubMed2006

A proposal for a surgical classification of pediatric lumbosacral spondylolisthesis based on current literature.

The classification presented in this paper is the first specifically designed to guide surgical treatment of L5-S1 spondylolisthesis in children and adolescents. It also presents objective criteria to differentiate between low- and high-dysplastic spondylolisthesis and incorporates recent knowledge in the study of sagittal spinopelvic balance. The proposed classification is based on the following: (1) the degree of slip, (2) the degree of dysplasia, and (3) the sagittal spinopelvic balance. To classify a patient, the degree of slip is quantified first to determine if it is low-grade, high-grade, or a spondyloptosis. Then, the degree of dysplasia is evaluated based on seven criteria, in order to separate patients with low- and high-dysplastic spondylolisthesis. Finally, the sagittal spinopelvic balance is assessed from the measurement of the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). For low-grade spondylolisthesis, it is classified as low PI/low SS (nutcracker type) or high PI/high SS (shear type). For high-grade spondylolisthesis, it is classified as high SS/low PT (balanced pelvis) or low SS/high PT (retroverted pelvis). Such a comprehensive classification could allow to better evaluate and compare available surgical techniques, and to optimize the treatment of L5-S1 spondylolisthesis. Because the classification was designed so that groups are organized in an ascending order of severity, it becomes easier and more intuitive to develop an associated surgical algorithm because the complexity of the surgery should increase as the severity of the spondylolisthesis increases. A tentative treatment algorithm is proposed but it is not definitive because further studies are required to define the most appropriate treatment for each group.

Adolescent↗
PubMed2006

Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches.

Percutaneous endoscopic lumbar discectomy (PELD) for migrated disc herniations is technically demanding due to the absence of the technical guideline. The purposes of this study were to propose a radiologic classification of disc migration and surgical approaches of PELD according to the classification. A prospective study of 116 consecutive patients undergoing single-level PELD was conducted. According to preoperative MRI findings, disc migration was classified into four zones based on the direction and distance from the disc space: zone 1 (far up), zone 2 (near up), zone 3 (near down), zone 4 (far down). Two surgical approaches were used according to this classification. Near-migrated discs were treated with "half-and-half" technique, which involved positioning a beveled working sheath across the disc space to the epidural space. Far-migrated discs were treated with "epiduroscopic" technique, which involved introducing the endoscope into the epidural space completely. The mean follow-up period was 14.5 (range 9-20) months. According to the Macnab criteria, satisfactory results were as follows: 91.6% (98/107) in the down-migrated discs; 88.9% (8/9) in the up-migrated discs; 97.4% (76/78) in the near-migrated discs; and 78.9% (30/38) in the far-migrated discs. The mean VAS score decreased from 7.5 +/- 1.7 preoperatively to 2.6 +/- 1.8 at the final follow-up (P < 0.0001). There were no recurrence and no approach-related complications during the follow-up period. The proposed classification and approaches will provide appropriate surgical guideline of PELD for migrated disc herniation. Based on our results, open surgery should be considered for far-migrated disc herniations.

Adolescent↗
PubMed2005

Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma.

BACKGROUND: Contemporary understanding of the biomechanics, natural history, and methods of treating thoracolumbar spine injuries continues to evolve. Current classification schemes of these injuries, however, can be either too simplified or overly complex for clinical use. METHODS: The Spine Trauma Group was given a survey to identify similarities in treatment algorithms for common thoracolumbar injuries, as well as to identify characteristics of injury that played a key role in the decision-making process. RESULTS: Based on the survey, the Spine Trauma Group has developed a classification system and an injury severity score (thoracolumbar injury classification and severity score, or TLICS), which may facilitate communication between physicians and serve as a guideline for treating these injuries. The classification system is based on the morphology of the injury, integrity of the posterior ligamentous complex, and neurological status of the patient. Points are assigned for each category, and the final total points suggest a possible treatment option. CONCLUSIONS: The usefulness of this new system will have to be proven in future studies investigating inter- and intraobserver reliability, as well as long-term outcome studies for operative and nonoperative treatment methods.

Algorithms↗
PubMed2004

An updated traditional classification of inguinal hernias.

The traditional classification of inguinal hernias is the most widely used system today; however, it does not categorize all inguinal hernias nor their levels of complexity. The named systems of Gilbert, Nyhus, and Schumpelick are reviewed, and their common features are analyzed. A simple updating of the traditional classification along with the use of common modifiers creates a system that is all-inclusive and easy to use for data registries. The traditional classification of inguinal hernias (indirect, direct, and femoral) has withstood the test of time for almost 150 years. In this interval, inguinal hernia repairs have experienced significant evolution from simple ligation of the sac or suturing of the muscular defect to improved primary tissue repairs (e.g., Bassini, McVay, Shouldice) based upon better anatomic principles. Also during the past 30 years, two major revolutions in operative repairs have occurred. First, there is the use of mesh and, second, its placement laparoscopically. As a consequence, hernia surgeons today must choose among multiple competing operative techniques. No one operative technique has proven to be best for all inguinal hernias. Also different levels of complexity and severity exist among inguinal hernias, and thus it is essential that we accurately classify the various inguinal hernias, such that we surgeons can provide the best operative solution for each patient. As Fitzgibbons [1] states, "The primary purpose of a classification for any disease is to stratify for severity so that reasonable comparisons can be made between various treatment strategies."

Hernia, Inguinal↗
PubMed2005

The global burden of migraine: measuring disability in headache disorders with WHO's Classification of Functioning, Disability and Health (ICF).

This overview of the published epidemiological evidence of migraine helps to identify the size of the public-health problem that migraine represents. It also highlights the need for further epidemiological studies in many parts of the world to gain full understanding of the scale of clinical, economic and humanistic burdens attributable to it. This paper presents some of the work on migraine undertaken by the World Health Organization (WHO) in the Global Burden of Disease study conducted in 2000 and reported in the World Health Report 2001. Migraine was not included in the first Global Burden of Disease 1990. The paper also discussed the measurement of disability attributable to headache disorders using WHO ICF Classification. Using disability-adjusted life years (DALYs) as a summary measure of population health (which adds disability to mortality), WHO have shown that mental and neurological disorders collectively account for 30.8% of all years of healthy life lost to disability (YLDs) whilst migraine, one amongst these, alone accounts for 1.4% and is in the top 20 causes of disability worldwide. This information is combined with the increasingly widely accepted belief that disability and functioning are relevant parameters for monitoring the health of nations and that there is an increasing need to measure them. WHO's Classification of Functioning, Disability and Health (ICF) provides a model of human functioning and disability, as well as a classification system, that allows us to highlight and measure all dimensions of disability. ICF applied to headache disorders allows comparability with other health conditions as well as evaluation of the role of the environment as a cause of disability amongst people with headache. Migraine causes a large proportion of the non-fatal disease-related burden worldwide. Our knowledge of headache related burden is incomplete and it is necessary to add to it epidemiological studies in many parts of the world and to combine this with measurements of disability using both DALYs and WHO's ICF Classification. The work described here has been the base for the Global Campaign against Headache disorders: "Lifting the Burden", launched in 2004 jointly by WHO, IHS (International Headache Society), WHA (World Headache Alliance) and EHF (European Headache Federation).

Cost of Illness↗