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Clinical Confusion (clinical + confusion)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Frequently discordant results from therapeutic drug monitoring for digoxin: clinical confusion for the prescriber

INTERNAL MEDICINE JOURNAL, Issue 1 2010
N. M. Rogers
Abstract Background: Digoxin remains a commonly prescribed medication for the treatment of congestive cardiac failure or atrial tachyarrhythmias. Its utility is offset by its narrow therapeutic index requiring regular blood concentration monitoring. Recent evidence suggests that a lower therapeutic range (0.5,0.8 µg/L, or 0.6,1.0 nmol/L) is associated with reduced mortality in patients with congestive cardiac failure. Therapeutic drug monitoring for digoxin is carried out by immunoassays that are well established in routine clinical practice. Laboratories using different immunoassays may be involved in monitoring individual patients throughout the protracted course of therapy. These results should be concordant to ensure consistent dose individualization and optimum clinical management. We have investigated the discordance in digoxin measurements involving five different laboratories across the Adelaide metropolitan area. Methods: Aliquots from routine digoxin samples (n= 261) were analysed by accredited laboratories using commercially available immunoassays. Results: The results showed that 119 (46%) of 261 samples were so varied that a different clinical outcome was indicated when reviewed by the treating physician. The differences between the highest and lowest readings from any one sample were also substantial, with 45% of the measurements exceeding 0.3 µg/L. Conclusions: Our study shows the considerable variation in the routine monitoring of digoxin. This makes therapeutic drug monitoring difficult to interpret and complicates clinical management when treating physicians are endeavouring to avoid toxicity and optimize dosing. These results raise a significant concern for the quality of therapeutic drug monitoring of digoxin and have direct repercussions on patient care. [source]

New classification of oesophageal and gastric carcinomas

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2001
K. Dolan
Background: The current International Classification of Diseases (ICD)-O classification of carcinomas of the oesophagus and stomach causes epidemiological and clinical confusion, particularly the use of the term cardia and the overlapping subsites described in the stomach. This study compared the epidemiological and clinical features of each subtype and subsite of carcinoma of the oesophagus and stomach to assess requirements for a new classification of these carcinomas. Methods: Data were extracted with appropriate validity checks on all cases of oesophageal and gastric carcinoma identified throughout the period 1974,1993 by the Merseyside and Cheshire Cancer Registry, which covers a population of 2·5 million. Comparison of all identifiable epidemiological and clinical features of adenocarcinomas at four different subsites, namely the upper two-thirds of the oesophagus, the lower third of the oesophagus, cardia and subcardia of the stomach, was performed. Results: There were 5322 primary carcinomas of the oesophagus and 10 535 carcinomas of the stomach registered between 1974 and 1993. The incidence of adenocarcinoma of the lower oesophagus and cardia trebled in males and doubled in females, whereas adenocarcinoma of the subcardia region of the stomach declined in both sexes. The incidence of adenocarcinoma of the lower oesophagus and of the cardia was similar for median age at diagnosis, male: female ratio, percentage of patients who smoked, and survival; both were significantly different from values for carcinoma of the subcardia in these respects. Conclusion: These data suggest that there is considerable overlap between adenocarcinomas of the lower oesophagus and adenocarcinomas currently classified as of the cardia. The authors believe this is due to the group of carcinomas classified as cardia consisting mainly of carcinomas that traverse the gastro-oesophageal junction. These carcinomas were different in all studied parameters from carcinomas of the stomach and should be classified separately from gastric carcinomas. A new subsite classification of oesophageal and gastric carcinomas is proposed that includes the gastro-oesophageal junction as a subsite of the oesophagus and that simplifies the subsite classification of the stomach into proximal, distal and overlapping. © 2001 British Journal of Surgery Society Ltd [source]

Correlative analysis of gene expression profile and prognosis in patients with gliomatosis cerebri

CANCER, Issue 16 2009
Oscar Fernando D'Urso PhD
Abstract BACKGROUND: In modern clinical neuro-oncology, the pathologic diagnoses are very challenging, creating significant clinical confusion and affecting therapeutic decisions and prognosis. METHODS: TP53 and PTEN gene sequences were analyzed, and microarray expression profiling was also performed. The authors investigated whether gene expression profiling, coupled with class prediction methodology, could be used to determine the prognosis of gliomatosis cerebri in a more consistent manner than standard pathology. RESULTS: The authors reported the results of a molecular study in 59 cases of gliomatosis cerebri, correlating these results with prognosis. The well-known prognostic factors of gliomas (ie, age, Karnofsky performance status, histology [grade 2 vs 3], and contrast enhancement) were found to be predictive of response or outcome in only a percentage of patients but not in all patients. The authors identified a 23-gene signature that was able to predict patient prognosis with microarray gene expression profiling. With the aim of producing a prognosis tool that is useful in clinical investigation, the authors studied the expression of this 23-gene signature by real-time quantitative polymerase chain reaction. Real-time expression values relative to these 23 gene features were used to build a prediction method able to distinguish patients with a good prognosis (those more likely to be responsive to therapy) from patients with a poor prognosis (those less likely to be responsive to therapy). CONCLUSIONS: The results of the current study demonstrated not only a strong association between gene expression patterns and patient survival, but also a robust replicability of these gene expression,based predictors. Cancer 2009. © 2009 American Cancer Society. [source]

1254: Diagnostic techniques for adnexal tumours

ACTA OPHTHALMOLOGICA, Issue 2010
S SEREGARD
Purpose To outline clinical features and diagnostic techniques available for ocular adnexal tumours Methods Review of pertinent literature and personal unpublished data. Results Ocular adnexal tumours include a wide range of beningn and malignant neoplasms, some of which may be systemic. A correct pre-operative diagnosis is imperative for appropriate management of these tumours. In most cases a combination of distinct clinical features, pertinent review of the patient's history and the judicial use of salient diagnostic techniques, like exfolitaion cytology and punch biopsies will provide the clinician with an approach to manage these lesions. Conclusion The wide range of ocular adnexal tumours may cause significant clinical confusion. Recognition of distinct clinical features and judicial use of auxiliary diagnostic techniques will in most cases provide the clinician with a correct pre-operative diagnosis. [source]