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PubMed2004

Optimal cutoff point of glutamate decarboxylase antibody titers in differentiating two subtypes of adult-onset latent autoimmune diabetes.

The optimal cutoff point of glutamate decarboxylase antibody (GAD-Ab) titers for differentiating two latent autoimmune diabetes (LADA) subtypes remains unclear. One hundred and forty-five GAD-Ab-positive patients screened from phenotypic type 2 diabetes were diagnosed as LADA. The clinical features were compared among LADA patients with different GAD-Ab titers. The receiver-operating characteristic (ROC) curve was used to evaluate the diagnostic value of GAD-Ab titers and to define the optimal cutoff point. The heterogeneity of clinical features in LADA could be discriminated by five GAD-Ab titers, with maximal differences at the titer of 175 U/mL. The ROC curve analysis showed that the optimal cutoff point for discriminating two LADA subtypes was at the titer of 175 U/mL, with sensitivity and specificity of 54.5% and 92.1%, respectively. These findings demonstrated that the two clinically distinct subtypes of LADA can be optimally discriminated by the GAD-Ab titers.

Adult↗
PubMed1999

Steam heat with an EDTA buffer and protease digestion optimizes immunohistochemical expression of basal cell-specific antikeratin 34betaE12 to discriminate cancer in prostatic epithelium.

In select cases of prostatic carcinoma, antikeratin 34betaE12 immunohistochemical analysis is diagnostically useful for specific labeling of basal cells. This antibody, however, is prone to variability in staining, and the optimal conditions were not, to our knowledge, previously defined. We combined steam heat with EDTA buffer (steam-EDTA) and protease digestion (steam-EDTA + protease) to optimize epitope retrieval of antikeratin 34betaE12 in 42 cases of prostatic cancer. Results were judged by the percentage of cells staining and by staining intensity. In benign epithelium, steam-EDTA + protease significantly increased the percentage of immunoreactive cells (from 74 to 93%) and the intensity of staining (from 2.1 to 3.0 on a scale of 0-3+) by comparison with protease alone (all P<.001). In high-grade prostatic intraepithelial neoplasia, the percentage of cells staining increased from 55 to 73% and intensity increased from 1.7 to 2.8 (both P<.001). Steam-EDTA + protease also minimized variability in results between cases, with essentially no background stromal staining. Cancer was negative in all of our cases by both methods. We conclude that steam-EDTA + protease significantly enhances basal cell immunoreactivity compared with protease treatment alone in noncancerous prostatic epithelium. This helps to prevent misinterpretation of histologic mimics of cancer, such as atrophic acini and high-grade prostatic intraepithelial neoplasia, that result from false-negative staining.

Antibodies, Monoclonal↗
PubMed1994

The role of the restorative dentist in the diagnosis and maintenance phases of implant therapy--Part II: Prosthetic planning.

Prosthetic planning is critical to the success of the diagnostic phase of implant therapy and is used to establish fixture numbers, position and the optimal occlusal scheme, based on the design of the definitive prosthesis. The prosthetic needs of the patient, anticipated functional and parafunctional forces, restoration fabrication and serviceability are all considered. A clear picture of the intended rehabilitation is provided to the surgical team and expedites the consultation between implant team members. Comprehensive diagnostic planning using mounted diagnostic casts and diagnostic wax-ups will provide definite parameters for fixture number, position and alignment, and permit the fabrication of radiographic and surgical templates as the treatment sequence progresses. Patients need to be informed of the time and expense involved in the diagnostic phase of implant therapy prior to the initiation of the planning process. The practitioner conducting the selection and planning phase is entitled and should expect financial remuneration commensurate with the time and effort required to achieve the objectives of this phase of implant therapy. The Planning Process Using mounted diagnostic casts and diagnostic wax-ups: 1. Establish fixture numbers and position; 2. Establish the optimal occlusal scheme; 3. Design the definitive prosthesis; 4. Fabricate a surgical template. Design Principles--Summary 1. The location and number of fixtures dictates the prosthetic design and influences restorative success. 2. A restoration must be designed to distribute forces to the fixtures without overloading the bone, and therefore be able to withstand anticipated functional and parafunctional loading. 3. Design for optimal function and esthetics with a regard for patient comfort and maintenance.

Bite Force↗
PubMed2001

Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection.

OBJECTIVE: We describe a shared-resource intraoperative magnetic resonance imaging (MRI) design that allocates time for both surgical procedures and routine diagnostic imaging. We investigated the safety and efficacy of this design as applied to the detection of residual glioma immediately after an optimal image-guided frameless stereotactic resection (IGFSR). METHODS: Based on the twin operating rooms (ORs) concept, we installed a commercially available Hitachi AIRIS II, 0.3-tesla, vertical field, open MRI unit in its own specially designed OR (designated the magnetic resonance OR) immediately adjacent to a conventional neurosurgical OR. Between May 1998 and October 1999, this facility was used for both routine diagnostic imaging (969 diagnostic scans) and surgical procedures (50 craniotomies for tumor resection, 27 transsphenoidal explorations, and 5 biopsies). Our study group, from which prospective data were collected, consisted of 40 of these patients who had glioma (World Health Organization Grades II-IV). These 40 patients first underwent optimal IGFSRs in the adjacent conventional OR, where resection continued until the surgeon believed that all of the accessible tumor had been removed. Patients were then transferred to the magnetic resonance OR to check the completeness of the resection. If accessible residual tumor was observed, then a biopsy and an additional resection were performed. To validate intraoperative MRI findings, early postoperative MRI using a 1.5-tesla magnet was performed. RESULTS: Intraoperative images that were suitable for interpretation were obtained for all 40 patients after optimal IGFSRs. In 19 patients (47%), intraoperative MRI studies confirmed that adequate resection had been achieved after IGFSR alone. Intraoperative MRI studies showed accessible residual tumors in the remaining 21 patients (53%), all of whom underwent additional resections. Early postoperative MRI studies were obtained in 39 patients, confirming that the desired final extent of resection had been achieved in all of these patients. One patient developed a superficial wound infection, and no hazardous equipment or instrumentation problems occurred. CONCLUSION: Use of an intraoperative MRI facility that permits both diagnostic imaging and surgical procedures is safe and may represent a more cost-effective approach than dedicated intraoperative units for some hospital centers. Although we clearly demonstrate an improvement in volumetric glioma resection as compared with IGFSR alone, further study is required to determine the impact of this approach on patient survival.

Adolescent↗
PubMed1978

An improved technic for examining urinary casts and a review of their significance.

Casts represent an important, diagnostic component of urinary sediment, and may signal renal parenchymal disease in asymptomatic individuals. Accurate, precise identification of certain casts may be difficult due to poor visualization by current technics. Casts from freshly voided urine specimens, cytocentrifuged and stained by the Papanicolaou method, can be visualized optimally from permanent slide preparations. The genesis of these casts and their diagnostic potential related to renal disease and acute renal allograft rejection are discussed.

Erythrocytes↗
PubMed1985

Evaluation of optimized biplane pulmonary cineangiography.

Biplane pulmonary cineangiograms utilizing a short cine pulse width and automatic brightness control were performed in 47 patients during normal respiration. The diagnostic quality of the arteriograms was categorized as good in 33 patients, fair in 12 patients, and poor in two patients. Of the 18 patients in whom pulmonary emboli were identified, cineangiography displayed certain diagnostic features to advantage, including motion of emboli in ten and respiratory scissoring of vessels overcoming vascular superimposition in three. Optimized pulmonary cineangiography is an acceptable alternative to serial film pulmonary angiography for the diagnosis of pulmonary embolism.

Cineangiography↗
PubMed2001

Assessment of response bias in mild head injury: beyond malingering tests.

The evaluation of response bias and malingering in the cases of mild head injury should not rely on a single test. Initial injury severity, typical neuropsychological test performance patterns, preexisting emotional stress or chronic social difficulties, history of previous neurological or psychiatric disorder, other system injuries sustained in the accident, preinjury alcohol abuse, and a propensity to attribute benign cognitive and somatic symptoms to a brain injury must be considered along with performances on specific measures of response bias. This article reviews empirically-supported tests and indices. Use of the likelihood ratio and other statistical indicators of diagnostic efficiency are demonstrated. Bayesian model averaging as a statistical technique to derive optimal prediction models is performed with a clinical data set.

Algorithms↗
PubMed2025

Image-guided biopsy of breast lesions-when to use what biopsy technique.

In recent years, minimally invasive diagnostic options for breast lesions have expanded, but consensus on optimal biopsy techniques and imaging combinations remains lacking. This study, driven by an adapted RAND-UCLA Appropriateness Method and insights from eight experts in breast biopsy from across the world, aims to create consensus for selecting biopsy techniques. Highlighted findings suggest Vacuum-Assisted Biopsy (VAB) for lesions visible exclusively at mammography/tomosynthesis (with or without contrast enhancement) or MRI. Core-needle biopsy (CNB) takes precedence for masses over 5&#x2009;mm visible under US. The selection of other biopsy techniques during US-guided procedures depends on lesion type, size, and sampling indication. VAB is preferred for smaller masses (<&#x2009;5&#x2009;mm), complex cystic and solid lesions with small solid parts, small intraductal masses, architectural distortions, and calcifications visible on US. In re-biopsy scenarios for inconclusive findings or high-risk lesions, the panel suggests two VAB extensions: Extended Vacuum-Assisted Biopsy (EVAB) for unambiguous lesion classification and Vacuum-Assisted Excision (VAE) for complete lesion removal. Furthermore, the panel provides detailed input on how to handle specific cases, such as re-biopsy for lobular neoplasia, flat epithelial atypia and atypical ductal hyperplasia. Surgical excision is advised for DCIS and benign or borderline phyllodes tumors found through initial CNB or VAB. In conclusion, an international expert group formulated recommendations on diagnostic breast biopsies under image guidance, aiming to ensure accurate diagnosis worldwide by providing practical advice on needle selection and biopsy approach. KEY POINTS: Evidence-based literature on the preferred biopsy technique and imaging combination for the diagnosis of breast lesions is sparse, and a general consensus is not available. The selection of biopsy technique for different image-guided procedures depends on lesion type, size, and sampling indication. This international expert panel consensus statement addresses standard approaches for varying biopsy indications.

Breast cancer↗
PubMed1998

Inhalation delivery systems with compliance and disease management capabilities.

Non-compliance with prescribed medication is a major reason for poor therapeutic outcomes, leading to unnecessary contributions to healthcare costs. Poor technique in self-administration of inhalation therapy is a special type of non-compliance associated with this route of administration. However, pulmonary drug delivery has fundamental advantages for therapy of diseases of the respiratory tract because it is site-directed. The lung is also a promising portal for drug delivery into the systemic circulation. Incorporation of microprocessors into pulmonary drug delivery systems facilitates sophisticated compliance management of chronic diseases such as asthma and diabetes. Microprocessor-assisted systems afford control of patients' administration technique during the therapeutic inhalation event, thus leading to efficient and reproducible regional deposition of the inhaled drug or diagnostic agent. SmartMist is a hand-held asthma disease management device that aids patients to use optimally metered dose inhalers. It also measures pulmonary lung function and provides a long term downloadable electronic record of the therapeutic and diagnostic events. The AERx pulmonary delivery system utilizes similar microprocessor capabilities; however, it employs a novel means of generating aqueous aerosols from unit dose packages, thus providing a broad inhalation technology base for delivery of a wide variety of therapeutic and diagnostic agents into the respiratory tract, and via the lung into the systemic circulation.

Administration, Inhalation↗
PubMed1979

[Drainage and lavage in abdominal trauma].

Peritoneal lavage is a reliable procedure in diagnosis of posttraumatic intra-abdominal bleeding. The method is extremely sensitive. If the return is found weakly positive, the lavage catheter should be left in position until the situation is cleared. Insufflation of air through the catheter may be used in diagnosis of a ruptured diaphragm. In the first days after trauma, peritoneal lavage may as well be helpful to detect secondary bleeding (for example in delayed rupture of the spleen) in unconscious patients or during mechanical ventilation. Postoperative drainage of the abdomen, too, is of considerable diagnostic value: for assessment of postoperative bleeding and in diagnosis of delayed intestinal perforation or insufficiency of a sutured bowel lesion. In pancreatic trauma, adequate drainage of pancreatic secretions prevents arterial arrosion or the formation of a pseudocyst. Determination of amylase in the drained fluid guides the further therapy: duration of total parenteral nutrition, suppression of pancreatic activity by drugs, removal o the drains. Tactics in draining the abdominal cavity after trauma should take into consideration an optimal removal of blood and secretions as well as the mentioned diagnostic value. In specially indicated cases the drainage system also should allow to perform peritoneal dialysis.

Abdominal Injuries↗
PubMed2002

Assessment of portal venous system patency in the liver transplant candidate: a prospective study comparing ultrasound, microbubble-enhanced colour Doppler ultrasound, with arteriography and surgery.

AIM: To determine the role of microbubble-enhanced colour Doppler ultrasound (CDUS) in assessing portal venous patency prior to liver transplantation. MATERIALS AND METHODS: Over a 2-year period, all patients with chronic liver disease undergoing routine pre-transplant CDUS examination in whom the portal venous system was inadequately demonstrated were recruited to the study. CDUS was performed in 368 patients and 33 patients (9%) were recruited. A repeat CDUS examination following an intravenous bolus injection of the microbubble contrast agent Levovist (Schering Healthcare AG, Berlin, Germany) was performed. Diagnostic confidence was recorded on a free linear analogue scale for both examinations. Findings were compared with indirect portography and surgery. RESULTS: Of the 33 patients with sub-optimal baseline examinations, improvement in portal vein visualization was achieved in 31 patients (94%). Median diagnostic confidence increased from 50% (interquartile range 30-60) to 90% (interquartile range 75-98) (P < 0.001) following administration of Levovist. Overall accuracy of portal vein assessment using microbubble-enhanced CDUS in 15 patients in whom a definitive diagnosis was made within 2 months was 87%. CONCLUSION: Microbubble-enhanced CDUS is a simple, inexpensive adjunct to standard pre liver transplant screening of the portal vein. It is particularly helpful in patients with end-stage cirrhosis who are at high risk of portal vein thrombosis and in whom the conventional examination is sub-optimal.

Adolescent↗
PubMed1998

Neurogenic sarcomas: experience at the University of Toronto.

OBJECTIVE: Elucidation of the natural history and optimal management of neurogenic sarcomas is not straightforward, because of diagnostic difficulties and the low incidence of this disease. The majority of neurogenic sarcomas are categorized and treated as soft tissue sarcomas, and only a few centers have sufficient experience to add to our understanding of these malignant tumors. This article proposes an algorithm for the management of these tumors. METHODS: A cohort of 18 cases of neurogenic sarcoma (overall mean follow-up period after oncological diagnosis, 33.7 mo), representing approximately 3% of all soft tissue sarcomas treated at the University of Toronto Musculoskeletal Oncology Unit (Toronto, Canada) between 1989 and 1995, were reviewed. The clinical and pathological criteria used to establish the diagnosis of neurogenic sarcoma, the presenting symptoms, the tumor size and grade, the ability to obtain tumor-free margins during en bloc resection, the time to recurrence, and the overall survival rates were noted. A centralized pathological review of the biopsy was undertaken in all cases. RESULTS: A metastatic survey demonstrated localized disease for 16 of the 18 patients. The overall management strategy for these 16 neurogenic sarcomas with localized disease was to obtain local control by en bloc resection. Tumor size, tumor grade, and, most importantly, the ability to obtain tumor-free margins were all relevant prognostic factors for survival. Tumor-free surgical margins were obtained for 11 of 16 patients, with 9 of these 11 patients remaining disease-free. In contrast, all patients for whom tumor-free margins could not ultimately be achieved died as a result of their disease. CONCLUSION: Based on our experience, we propose an algorithm for the management of these rare tumors, for both optimal patient care and oncological research.

Adolescent↗
PubMed1988

Frontal-plane QRS axis revisited: accuracy of current approximations and reappraisal of their merit in the diagnosis of right ventricular hypertrophy.

The frontal-plane mean QRS vector orientation (AQRSxy)--the so-called electrical axis--is an ECG feature commonly used for the diagnosis of right ventricular hypertrophy and is correctly measured by calculating the areas subtended by QRS deflections in two different leads. To overcome the drawbacks of doing this by hand, two alleged approximations of AQRSxy have become popular and are in current use: one is based on the measurement of QRS component wave peak amplitudes and the other on the estimation of the half-area vector of the frontal plane loop. The values obtained with the correct and the two more practical methods are compared and their diagnostic efficiency is assessed by means of a procedure for ECG criteria optimization based on the receiver operating characteristics (ROC) curve analyzed in terms of information theory. The authors conclude that the two more popular methods for AQRSxy determination provide similar values that, although correlated with the true measure of the parameter are statistically different from it. On the other hand, the diagnostic efficiency of AQRSxy alone, regardless of the method by which it is computed, is only as good as, if not bettered by, other much more easily measurable frontal-plane parameters (ie, left to rightward forces amplitude ratio in adults and rightward forces amplitude in pediatric patients).

Adolescent↗
PubMed2004

External loop recorders: determinants of diagnostic yield in patients with syncope.

OBJECTIVES: The purpose of the current study was to determine the optimal duration of external loop recorder (ELR) monitoring in patients with presyncope or syncope and to identify factors that predict failure to activate the device effectively. DESIGN: A multivariate analysis was performed using data from the Comparison Of Loop Recorders Against Holter in Patients with Syncope (COLAPS) trial, a prospective study comparing diagnostic utility of ELRs and Holter monitors for assessment of syncope. METHODS: Patients with failure to effectively activate ELRs were compared to those who were successful. This analysis was performed separately for failure of test transmission and for failure to successfully record and transmit data from symptomatic episodes. Patient characteristics were compared among the groups to determine risk factors for device failure. RESULTS: Among 78 patients who received ELRs, a test transmission was successfully performed by 84.5% of patients. Twenty-one percent of diagnoses were made within 48 hours, 50% at 15 days, and 90% at 33 days. Patients performing a successful test transmission were more familiar with technology, with ability to use a bank automatic teller machine being a significant independent predictor. Patients with a successful test transmission were, in turn, significantly more likely to record and transmit data from symptomatic episodes. Patients living alone were much less likely to use the loop recorder effectively. The presence of factors that may influence motivation to reach a diagnosis (degree of worry/fear of symptoms and impact on daily life) were associated with successful use of the device in a univariate analysis. CONCLUSION: ELRs should be worn for at least 30 days to maximize their diagnostic yield. Patients who are unfamiliar with technology, live alone, or have low motivation to reach a diagnosis have a lower diagnostic yield from ELRs for assessment of syncope.

Electrocardiography, Ambulatory↗
PubMed1984

Bayesian analysis of data from radionuclide angiocardiograms for diagnosis of coronary artery disease.

A continuous Bayesian model was developed by fitting a beta-function to the frequency distributions of resting ejection fraction, exercise ejection fraction, and change in end-systolic volume during exercise measured by radionuclide angiocardiography in a group of 249 men with coronary artery disease (CAD) and in a group of 56 men without disease. This model, then prospectively applied to 250 men with chest pain, did not increase the overall accuracy of the test but did increase the diagnostic content for individual patients. The diagnostic efficacy of the continuous Bayesian model was compared with previously determined optimal discrete criteria of a positive or negative test. Patients with CAD showed a maximum and mean increase in probability of disease of +0.58 and +0.11, respectively, by the continuous Bayesian model and +0.14 and +0.05, respectively, by discrete criteria. Men without significant disease showed a maximum and mean decrease in probability of disease of -0.73 and -0.38, respectively, by Bayesian analysis and -0.36 and -0.27, respectively, by optimal discrete criteria. Moreover, all 29 patients who died during a 35 month interval after study had a probability of CAD of 0.95 or greater by the continuous Bayesian model. These findings indicate that Bayesian analysis of radionuclide angiocardiographic test results with continuous distributions of left ventricular function measurement enhances the diagnostic and prognostic information for individual patients with symptoms suggestive of CAD.

Adult↗
PubMed1981

Association of CEA test and liver scan in detection of hepatic metastases of gastrointestinal carcinoma.

The authors evaluate the combined use of liver scan and the CEA test in the diagnosis of hepatic metastases of carcinoma of the gastrointestinal tract. Association of the two tests is justified by the fact that the liver scan is very specific but not very sensitive, whereas the CEA test is more sensitive and not very specific. The sensitivity of the CEA test, on the other hand, can be increased by increasing the threshold of normality. However, the associated diagnostic use of the liver scan and the CEA test gives a loss of specificity with respect to the use of the liver scan alone. The present study, carried out on a series of 376 patients affected by gastrointestinal tumors of which 79 were of the stomach (9 with hepatic metastases), 133 of the colon and higher sigmoid (25 with hepatic metastases), and 164 of the lower sigmoid and rectum (29 with hepatic metastases), proposed to establish by use of a statistical method the optimal threshold of the CEA test that would give the best diagnostic specificity of the combined CEA test and liver scan without any relevant loss of sensitivity. A threshold of 26 ng/ml of the CEA test and gave a specificity of 92%, a sensitivity of 80%, and an accuracy of 90%. The authors think that in the detection of liver metastases of gastrointestinal tumors, the combined test can be more helpful the less the probability, for a given patient, for other metastatic localizations.

Carcinoembryonic Antigen↗
PubMed2006

Tuberculosis in elephants: antibody responses to defined antigens of Mycobacterium tuberculosis, potential for early diagnosis, and monitoring of treatment.

Tuberculosis (TB) in elephants is a re-emerging zoonotic disease caused primarily by Mycobacterium tuberculosis. Current diagnosis relies on trunk wash culture, the only officially recognized test, which has serious limitations. Innovative and efficient diagnostic methods are urgently needed. Rapid identification of infected animals is a crucial prerequisite for more effective control of TB, as early diagnosis allows timely initiation of chemotherapy. Serology has diagnostic potential, although key antigens have not been identified and optimal immunoassay formats are not established. To characterize the humoral responses in elephant TB, we tested 143 serum samples collected from 15 elephants over time. These included 48 samples from five culture-confirmed TB cases, of which four were in Asian elephants infected with M. tuberculosis and one was in an African elephant with Mycobacterium bovis. Multiantigen print immunoassay (MAPIA) employing a panel of 12 defined antigens was used to identify serologic correlates of active disease. ESAT-6 was the immunodominant antigen recognized in elephant TB. Serum immunoglobulin G antibodies to ESAT-6 and other proteins were detected up to 3.5 years prior to culture of M. tuberculosis from trunk washes. Antibody levels to certain antigens gradually decreased in response to antitubercular therapy, suggesting the possibility of treatment monitoring. In addition to MAPIA, serum samples were evaluated with a recently developed rapid test (RT) based on lateral flow technology (ElephantTB STAT-PAK). Similarly to MAPIA, infected elephants were identified using the RT up to 4 years prior to positive culture. These findings demonstrate the potential for TB surveillance and treatment monitoring using the RT and MAPIA, respectively.

Animals↗
PubMed1980

[Ultrasound diagnosis of non-aneurysmic pulsating abdominal tumors].

Ninety-two patients with a pulsating abdominal mass and suspected abdominal aortic aneurysm (AAcA) were examined by ultrasonography. We diagnosed 48 cases (52%) of AAA and 5 unexpected lesions ventral to the aorta (5%), but in 39 cases (42%) we were not able to explain the symptom in spite of extensive diagnostic efforts and follow-up. Changes of the aorta or transmission of the pulse by adjacent structures are the main cause of a pulsating abdominal mass. Ultrasound examination appears to be optimal screening method for diagnosing AAA as well as the other symptoms no further diagnostic efforts are necessary after a negative ultrasound study.

Abdominal Neoplasms↗