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Clinical Classification (clinical + classification)
Selected AbstractsItch and pruritus: what are they, and how should itches be classified?DERMATOLOGIC THERAPY, Issue 4 2005Jeffrey D. Bernhard ABSTRACT:, Itch and pruritus are two terms for the same thing. In this essay I will argue that casting about for a distinction between them creates only confusion. Once that matter is settled, it is still necessary to come up with a clinical classification for itches of different types. No system yet proposed, including the one that will be suggested here, is perfect. [source] Necrotising fasciitis: a new management algorithm based on clinical classificationINTERNATIONAL WOUND JOURNAL, Issue 3 2004Paul S Carter Abstract Necrotising fasciitis is a rare infection of the subcutaneous tissues. If untreated, it is invariably fatal, and thus a high index of suspicion for the diagnosis is required. The disease's manifestation can range from a fulminant presentation to a subtle and insidious development. The priority in every case is to proceed to radical surgical debridement. On review of the literature and based on our clinical experience, we propose a new classification based on clinical presentation and suggest an algorithm to facilitate the management of this devastating condition. Increasing awareness should be given to the management of the large wounds resulting from the surgical debridement of necrotising fasciitis. [source] Post-neonatal mortality by rurality and Indigenous status in QueenslandJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2006Michael Coory Aim: To compare post-neonatal mortality among urban and rural Indigenous babies in Queensland. Methods: Registrations of deaths at ages 28 days to 12 months were linked to routine data from the Queensland Perinatal Data Collection. Results: Indigenous babies were 2.52 times more likely to die during the post-neonatal period than non-Indigenous babies (95% confidence interval: 1.99, 3.20). The differential remained when urban and rural areas were examined separately: the differential was 2.53 (1.81, 3.54) in urban areas and 2.26 (1.58, 3.23) in rural areas. Conclusion: The key demographic variable that determines post-neonatal mortality in Queensland is Indigenous status, not rurality. This has important policy implications because it means that interventions to reduce the disparity in mortality between Indigenous and non-Indigenous babies should be delivered in urban as well as rural areas. Better routine data are needed and in particular clinical classification of deaths, so that interventions can be monitored and avoidable factors identified. [source] Epidemiology and clinical classification of onychomycosisJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2005I Effendy ABSTRACT Objectives, To review recent data , what is new in the epidemiology of onychomycoses? To identify the most relevant diagnostic criteria for effective therapy. Methods, The preliminary results of the European Onychomycosis Observatory (EUROO) study were analysed. In this international study, physicians completed questionnaires concerning patient profile and the disease. Results, One of the most interesting novel findings was that sampling requests were often not made [only 3.4% of general physicians (GPs) and 39.6% of dermatologists]. This means that no information about causative agent(s) was available, hindering appropriate treatment choice. Furthermore, contrary to previous findings, 70.7% of participants did not practice sports. Lastly, these preliminary findings showed that treatment strategy depends largely on the type of treating physician, with GPs preferring monotherapy and dermatologists preferring combination therapy. Conclusions, A consensus was reached that treatment strategy should depend on the severity of nail involvement and the causative fungus. It is thus important to promote the importance of sampling. To simplify the choice of an appropriate treatment, onychomycosis may be divided into just two clinical groups: onychomycosis with and without nail matrix area involvement. However, the distinct clinical findings (number and type of affected nails, multimorbidity, drug interaction, etc.) in each individual case must be taken into account to ensure an appropriate treatment decision. [source] Characterisation of isolates of Staphylococcus aureus from acute, chronic and subclinical mastitis in cows in NorwayAPMIS, Issue 9 2000TORE Tollersrud Eighty-six Staphylococcus aureus isolates from cases of bovine mastitis were characterised biochemically and with respect to serotype, multilocus enzyme electrophoresis genotypes, antibiotic sensitivity, and production of enterotoxins A through D (SEA-D) and toxic shock syndrome toxin-1 (TSST-1). The samples were obtained from 81 different cows from 79 Norwegian dairy herds in 10 different counties in southern Norway. There was an equal representation of isolates from cases of acute, chronic and subclinical mastitis. Multilocus enzyme electrophoresis using 13 genetic loci showed that 69 of 86 isolates had the same electrophoretic type. This common electrophoretic type comprised isolates that differed in the expression of other phenotypical characteristics studied. Fifty-eight percent of the isolates produced one or more enterotoxins, predominantly a combination of SEC and TSST-1. Capsular serotyping revealed that 95% of the isolates belonged to serotype 8. No correlation was found between the factors studied and the clinical classification of mastitis. It appears that the majority of S. aureus isolates recovered from cases of bovine mastitis in Norway are genetically closely related and express common phenotypical characteristics. [source] Routine investigations might be useful in pre-eclampsia, but not in gestational hypertensionAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2005David J. BAILEY Abstract Background:, Women referred to secondary care with suspected pregnancy-induced hypertension (PIH) are commonly investigated with blood tests and cardiotocography (CTG), regardless of the clinical severity of their condition. Over-investigation might lead to inappropriate intervention. Aims:, To investigate how often abnormal blood test and CTG results occur in women with pre-eclampsia and gestational hypertension and in women who do not have pregnancy-induced hypertension. Methods:, Retrospective case note review of 526 consecutive women referred with suspected pregnancy-induced hypertension to a district hospital. The frequency of abnormal test results and the pregnancy outcomes were analysed according to clinical classification. Results:, 36% of women referred did not meet the clinical criteria for a diagnosis of pregnancy-induced hypertension. Abnormalities of platelet count and/or liver function were seen in 11% of women with pre-eclampsia and in less than 2% of women with gestational hypertension and in a similar proportion of women who did not have pregnancy-induced hypertension. Gestational hypertension was associated with increased induction and caesarean birth rates, but not with low birthweight or preterm delivery. Progression from gestational hypertension to pre-eclampsia was not predicted by blood test abnormalities. Support for the routine use of antenatal CTG was not found. Conclusions:, A clinical diagnosis of pregnancy-induced hypertension should be confirmed before blood tests are ordered. The incidence of test abnormalities was only increased in pre-eclampsia and in gestational hypertension before term. CTG might only be of use in selected cases. [source] A clinical classification of the status of the pulp and the root canal systemAUSTRALIAN DENTAL JOURNAL, Issue 2007PV Abbott Abstract Many different classification systems have been advocated for pulp diseases. However, most of them are based on histopathological findings rather than clinical findings which leads to confusion since there is little correlation between them. Most classifications mix clinical and histological terms resulting in misleading terminology and diagnoses. This in turn leads to further confusion and uncertainty in clinical practice when a rational treatment plan needs to be established in order to manage a specific pathological entity. A simple, yet practical classification of pulp diseases which uses terminology related to clinical findings is proposed. This classification will help clinicians understand the progressive nature of the pulp disease processes and direct them to the most appropriate and conservative treatment strategy for each condition. With a comprehensive knowledge of the pathophysiology of pain and inflammation in the pulp tissues, clinicians may accomplish this task with confidence. [source] Comparison of liver hemodynamics according to doppler ultrasonography in alcoholic patients subtyped by Cloninger classification and non-alcoholic healthy subjectsACTA NEUROPSYCHIATRICA, Issue 1 2006Z. Sumru Cosar Background:, The aim of this study was to search for morphological and hemodynamic changes in hepatic and splanchnic vasculature in alcoholic patients without the signs of hepatic damage and subtyped by Cloninger classification by means of sonography, and compare the subtypes among themselves and with nonalcoholic healthy subjects. Methods:, Thirty alcohol dependent patients and 30 healthy subjects with no alcohol problem or hepatic impairment were included in the study. Patients were subtyped by Cloninger classification and all patients were evaluated by gray-scale and spectral Doppler ultrasound. The diameter of the portal vein, portal venous velocity, peak systolic and end diastolic velocities of hepatic and superior mesenteric arteries were assessed. RI, PI and systolic/diastolic velocity ratios were also calculated. Results:, Portal vein diameter (PV diameter), portal vein cross sectional area (PV area), portal vein velocity (PV PSV), hepatic artery peak systolic velocity (HA PSV), hepatic artery end diastolic velocity (HA EDV), hepatic artery resistive index (HA RI), hepatic artery pulsatility index (HA PI), and systolic/diastolic velocity ratios (HA S/D), superior mesenteric artery peak systolic velocity (SMA PSV), superior mesenteric artery end diastolic velocity (SMA EDV), superior mesenteric artery resistive indices (SMA RI), pulsatility index (SMA PI), and systolic/diastolic velocity rates (SMA S/D) showed no significant difference among the groups (P > 0.01). Although there is no significant difference in PV PSV, HA PSV, SMA PSV, SMA EDV values between the groups, mean values of Type II alcoholics is greater than other groups. Portal vein cross-sectional area was greater in alcoholic patients (Type I, II and III) compared to the control group (P = 0.000). Portal vein velocity, hepatic artery peak systolic and end diastolic velocity, superior mesenteric artery peak systolic and end diastolic velocity were significantly greater in alcoholic patients than in the control group (P < 0.001). No statistical difference was detected between other parameters evaluated. Conclusion:, In alcohol dependent patients, some hemodynamic and morphologic changes occur in hepatic and splanchnic circulation, even before the signs of hepatic damage develop, which can be detected by means of Doppler and gray-scale sonography. But as there is no significant difference between the Doppler ultrasonographic findings among alcoholics subtyped by a Cloninger classification, which is a clinical classification, it suggests that psychiatric classification doesn't show any correlation with biological parameters, and because of this Cloninger classification a psychiatric classification cannot be considered as a characteristic determinative factor in the prognosis of hepatic disorder due to alcohol use. However, higher values of Type II alcoholics can be attributed to the longer alcohol intake of this subtype. [source] 2465: Phenotype/genotype evolution in corneal embryologic malformationsACTA OPHTHALMOLOGICA, Issue 2010KK NISCHAL Purpose To describe the evolution of a clinically useful classification of corneal developmental anomalies which has also allowed more accurate phenotype/genotype correlation. Methods The use of clinical documentation using anterior segment photography, normal ultrasound of the eyeball, and high frequency ultrasound and where available histology of host tissue has allowed detailed phenotypes to be developed . Intraoperative recordings of phenotype have also been noted. Genotyping of specific patterns groupings of corneal developmental anomaly phenotypes. Retrospective analysis of clnical outcome with or without surgical intervention. Results Corneal developmental anomalies are best considered in terms of primary corneal disease and secondary corneal disease. The former includes dystophies ( CHED, PPCD and X-L ECD) , corneal dermoids and isolated sclerocornea ( CNA 1 and 2 ).Secondary corneal disease includes secondary to, iridotrabecular anomalies ( eg congenital glaucoma, aniridia, axenfeld -rieger anomaly), kerato-irido-lenticular dysgenesis ( iridolenticular adhesions( Peters type I), failure of lens to form,separate or move away from the cornea). Conclusion Using this classification prognosis for intervention can be shown to be mor successful in primary corneal developmental anomalies. Also by considering groups of patients with similar disease eg primary aphakia, appropriate genotyping can be done eg FOXE3 analysis for children with primary aphakia . More acccurate phenotype allows better clinical classification and ultimately better genotyping of corneal developmental anomalies [source] 2113: AO imaging in AMDACTA OPHTHALMOLOGICA, Issue 2010N MASSAMBA Purpose Two different systems, adaptive optics scanning laser ophthalmoscope (AOSLO), and Spectral Domain Ophtalmoloscopy (SD-OCT) were used to visualize cones in the outer neurosensory retina overlying soft macular drusen and the surrounding retinal areas. Methods High resolution images were obtained with Adaptive Optics (AO) in addition to complete ophthalmic examination including BCVA on ETDRS chart, biomicroscopic examination, autofluorescence imaging, fluorescein and indocyanine angiographies (HRA2 Heidelberg ,Germany) and SD-OCT. The AO image are then compared with conventional infrared and SD-OCT. Soft macular drusen from 50 patients (age between 65 and 85) visible on the scanning laser ophthalmoscope(SLO) examination were evaluated included in the study Results The soft drusen were visible in AO images as generally round areas delimited by a peripheral low-reflectance line. The highly reflective photoreceptor inner/outer segment junction (IS/OS) can be used as a pattern of photoreceptors integrity in SD-OCT images. In areas where the IS/OS junction is absent on SD-OCT, no cones are visualized in registered AOSLO images. In the inner area of many drusen, hyper reflective spots of a size between 2 and 15 µm were sometimes isolated, sometimes grouped into tight aggregates of 2 to 40 components. Cone photoreceptors were visible in areas between drusen in most AO images, however the mosaic image sharpness was significantly less uniform in these elderly patients than previously observed in younger, healthy retinas. Conclusion This study shows the synergistic nature of these two high-resolution retinal imaging systems The microscopic characteristics of soft drusen on AO imaging suggest some analogy with the anatomopathologic characteristics. AO technology will be a powerful tool to refine their clinical classification [source] Drusen in adaptive optics and SD-OCTACTA OPHTHALMOLOGICA, Issue 2009N MASSAMBA Purpose The study objective was to explore the microscopic structure of soft macular drusen and surrounding retinal areas using an adaptive optics (AO) camera and to compare the findings to those from standard clinical examinations. Methods 18 patients of age between 65 and 85 and presenting soft macular drusen were recruited after aninitial scanning laser ophthalmoscope (SLO) examination. We used an AO flood-illumination system to acquire high-resolution images of selected drusen areas. Every acquisition provided a series of 20 consecutive reflectance images, out of which 10 were numerically averaged to produce an enhanced final image. The resulting AO images were analyzed in comparison with conventional infrared and autofluorescence fundus images and spectral optical coherence tomography scans. Results The soft drusen were visible in AO images as generally round areas delimited by a peripheral low-reflectance line. Hyper reflective spots of size comprised between 2 and 15 ,m were observed in many drusen inner areas. These bright spots were sometimes isolated, sometimes grouped into tight aggregates of 2 to 40 components. Cone photoreceptors were visible in areas between drusen in most AO images. Conclusion The microscopic structures observed in the AO images of soft drusen presents analogies with their described anatomopathologic characteristics, which could not be identified using other in vivo imaging techniques. AO technology could help to refine the clinical classification of macular drusen and obtain deeper insight in their link with the development of different types of advanced AMD. Author Disclosure Information: N. Massamba, None; B. Lamory, Imagine Eyes, G. Soubrane, None. [source] Cutting Torque Measurements in Conjunction with Implant Placement in Grafted and Nongrafted Maxillas as an Objective Evaluation of Bone Density: A Possible Method for Identifying Early Implant Failures?CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2004Björn Johansson DDS ABSTRACT Background: Bone grafts are frequently used to enable the placement of dental implants in atrophied jaws. The biomechanical properties of bone grafts used in one- or two-stage implant procedures (in comparison with the use of nongrafted bone) are not well known. Purpose: The purpose of this study was (1) to measure cutting torques during the placement of self-tapping dental implants in nongrafted bone and in bone grafts, either as blocks or in a milled particulate form, in patients undergoing implant treatment in an edentulous maxilla and (2) to identify implants with reduced initial stability and to correlate these findings with a clinical classification of jawbone quality. Materials and Methods: The study included 40 consecutive patients with edentulous maxillas, 27 of whom were subjected to bone grafting prior to or in conjunction with implant placement (grafting group) and 13 of whom received implants without grafting (nongrafted group). Grafted bone from the iliac crest bone was used (1) as onlay blocks, (2) as maxillary sinus inlay blocks, or (3) in particulate form in the maxillary sinus. Implants were placed after 6 to 7 months of healing, except in the maxillary sinus inlay blocks, where implants were placed simultaneously. Cutting torque values were obtained from 113 grafted implant sites and from 109 nongrafted implant sites. Results: Significantly lower cutting torque values were assessed in grafted regions than in nongrafted regions, irrespective of grafting technique. Lower values were also seen for implants placed in block grafts after 6 months when compared to other grafting techniques used. The cutting torque values revealed an inverse linear relation to the Lekholm and Zarb bone quality index. Conclusion: The cutting torque values correlated well with the Lekholm and Zarb index of bone quality. Significantly lower cutting torque values were seen in grafted bone than in nongrafted bone. [source] | ||||||||||