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Diagnostic and differential diagnostic aspects in histiocytosis X diseases.

Diagnostic and differential diagnostic aspects of the known manifestations of histiocytosis X are discussed with respect to our own findings. It is our considered opinion that the term "histiocytosis X" should not be employed in isolation for diagnostic purposes. Rather, one should make an effort to designate the disease exactly in stating the prognosis for a particular patient. Both clinical and morphologic parameters must be considered in making this exact diagnosis.

Diagnosis, Differential

[Diagnostic and differential diagnostic value of cytological findings in toxoplasmic lymphadenitis].

The cytologic investigation of needle biopsy material from lymphomas of unclear genesis may give valuable diagnostic references in patients with lymphadenitis toxoplasmotica. Findings of 19 patients are explained. Suspicious for a toxoplasmogenic genesis are colouredness of the cell picture with large basophilic roundnuclear cells, conspicious macrophagocytosis in reticulum cells and small-focal proliferation of the epitheloid cell. In own material these 3 criteria only 5 times appeared together. Two simultaneously existing, suspicious for Piringer's lymphadenitis findings, were shown in 11 patients. Most frequently was found the coloured picture of the round-nuclear cells (16/19). A conspicuous RHS-phagocytosis was to be observed in 12 smears. In careful clinical and serological controls only in 4 out of 19 patients a histological investigation was necessary. In the cytological findings also other lymphomatous processes must differential-diagnostically be taken into consideration.

Adolescent

[Diagnostic and differential diagnostic considerations in osteopmyelitis].

A report is drawn up of the available diagnostic procedures in the detection of the different forms of osteomyelitis. Special reference is made to the problems involved in the clinical diagnosis of the mitigated and non-typical forms of haematogenous osteomyelitis which occur more frequently in the present antibiotics era. Early diagnosis of haematogenous osteomyelitis is of the greatest importance, since, in our experience, a cure can only be expected with very early initiation of antibiotic therapy. In regard to the differential diagnosis, abortive manifestations of haematogenous osteomyelitis must be differentiated from rheumatoid arthritic diseases and soft-part inflammations of all kinds, whilst caution must be taken to avoid a mistaken diagnosis of osteosarcoma.

Anti-Bacterial Agents

Rabbit dysentery: 3. Diagnostic differentiation.

The diagnostic differentiation of rabbit mucoid enteritis from rabbit dysentery by age and post mortem findings is described. The condition termed as "rabbit dysentery" affects three- to 10-week-old growing rabbits and is essentially an acute coccidiosis, while "mucoid enteritis" develops in older rabbits as a sequel to constipation for six to eight days. The main differentiating feature of the two conditions, which have often been confused with one another owing to similarity of symptoms, is the characteristics dissimilarity of gross changes in the caecum.

Animals

[Cerebral sclerosis. Diagnostic criteria and differential diagnostic consideration in practice].

In"cerebral arteriosclerosis" the diffuse sclerotic involvement of the cerebral vessels may produce acute softening of cerebral tissue. However this paper concentrates mainly on the clinical symptomatology which, in the absence of major vascular accidents, is characterized from the psychopathologic viewpoint by acute confusional states, aggressive behaviour, fluctuating loss of memory, disturbances of concentration and finally dementia. The chief neurologic symptoms are motor disturbance with short-stepping gait, stooped position of the body, pseudobulbar symptoms with dysarthric speech and disturbances of swallowing, and increased perioral reflexes. A complete case history and a thorough neurologic and psychopathologic examination are the most important factors in diagnosis, while ancillary methods are of value only for differential diagnosis. Prophylaxis and therapy (cardiotherapy, treatment of diabetes and hypertension, lowering of serum cholesterol and sedation) are discussed. In the differential diagnosis of dementia in the elderly patient consideration should be given to chronic vascular diseases, degenerative cerebral atrophies, brain tumors, low pressure hydrocephalus, progressive paralysis and some other rare brain conditions.

Age Factors

[The diagnostic significance of immunoglobulin determination in chronic liver diseases. I. Differential diagnostic accuracy of immunoglobulin changes and enzyme activities (author's transl)].

715 patients with hepatobiliary diseases came for examination, who because of the morphological findings are classified in diagnostic groups. The immunoglobulin measurements of IGG, IGA, IGM were determined and assessed in combination with enzymatic investigations of GOT, GPT, AP and GGTP. Typical group-specific changes were only found in primary biliary liver diseases and toxic cirrhoses of the liver, all acute or chronic inflammatory liver diseases could not be separated and by inference from the final diagnosis showed great errors in classification. Data on the raised mean levels of immunoglobulins in the individual diagnostic groups were demonstrable, but the range limits were so widely scattered that their differential diagnostic valence is of no consequence. Immunoglobulins may appear to be of interest for the observation of the course of liver diseases, but they are unsuitable for diagnostic purposes.

Acute Disease

[Differential diagnostic difficulties in myoclonic-astatic petit mal status].

Myoclonic-astatic attack syndromes tend more than other attack forms to produce states. Their clinical picture can be various and therefore cause differential-diagnostic difficulties. On four own examples they are referred to. Most frequently it will be necessary to differentiate the hardly adjustable attack syndrome from on overdose of anticonvulsives. Also the state of absences, the state of psychomotoric attacks, and the impulsive-petit-mal state can make differential-diagnostic difficulties. Furthermore, additional encephalitic processes with cerebral decompensation in anyway injured children, and the myoclonic variants of familial amaurotic idiocy are to be to consider. An EEG examination is indispensable; consideration of the total situtation, observation of the course, and recording of the actual findings are necessary.

Anticonvulsants

[Differential diagnostic value of the aVR lead].

The one-pole peripheral AVR lead reflects the changes in the electromotive power of the heart in a frontal plane in a reverse (mirror) image. In 620 subjects with healthy hearts, with the aid of an extended ECG method; the variants of the auricle-ventricle complex in AVR lead in norm and the separate heart positions, were studied. The pathologically changed P-wave was established to be presented by its typical forms (P-mitrale, P-pulmonale), but in a mirror image in AVR lead. The positive auricle wave in AVR is an important sign for the presence of right-auricular ectopic rhythm. In 80 patients with left-ventricular loading, pathologically enlarged S deflection was found. In 232 patients with fight-ventricular loading (mitral stenosis, chronic pulmonary heart), the increase of the amplitude of the deflection R AVR and the change in the ratio R/Q aVR over 1, is a valuable information about the degree of the right-ventricular loading. Those changes closely correlate with the changes in the ventricular complex with the right thoracic leads and with the spirographic and X-ray examinations. the role of AVR lend in the differential diagnostic determination of the additional deflection r'R'aVR1 V1 in certain forms of disturbed intraventricular conductivity is emphasized. AVR lead reacts dynamically with the separate sites of myocardial necrosis, with the appearance of unusual forms of the ventricular complex in AVR (increased first R deflection AVR in posterior-inferior myocardial infarction, occurence of rSr' forms in AvR in posterior-basal infarction and wide split ventricular complexes in anterior (anteriorseptal)infarction, complicated with a bundle blockade. Myocardial ischemia (subpericardial and subendocardial) is represented in A V R in an image reverse to the left thoracic leads. A general conclusion is drawn that the separate interpretation of the changes in AVR lead is not reasonable. Its differential diagnostic value grows only with its synchronic analysis with the rest peripheral and especially precordial leads.

Adolescent

[Quantitative serum immunoglobulin determination: differential diagnostic significance for liver disease (author's transl)s].

The serum immunoglobulin (Ig) G, A, and M levels were investigated with respect to their differential diagnostic significance, pathogenesis and estimation of prognosis of different forms of liver disease. The sera of 204 patients with acute hepatitis, fatty liver I and II, and cirrhosis, and of 110 healthy adutls were quantitatively determined for immunoglobulins. 1. IgG- and IgA-concentrations higher than 2000 mg% and 330 mg%, respectively, indicate chronic aggressive hepatitis or cirrhosis, and exclude all other groups. 2. A clear correlation between HBsAG (Australia Antigen) and immunoglobulin content could not be demonstrated in any group; 3. A significantly elevated level of IgA was observed in alcoholic cirrhosis when compared to non-alcoholic cirrhosis. No such differences were found inhe other groups. 4. Acute and chronic persistent hepatitis show a similar increase of immunoglobulins. Thus persistent high levels of Ig following acute hepatitis indicate the development into a chronic hepatitis. 5. A relative increase of IgA rather than IgG corresponds to the degree of inflammatory activity of a liver process.

Chronic Disease