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Diagnostic Clue (diagnostic + clue)
Selected AbstractsLate Perforation by Cardiac Implantable Electronic Device Leads: Clinical Presentation, Diagnostic Clues, and ManagementCLINICAL CARDIOLOGY, Issue 8 2010Marwan M. Refaat MD Late intracardiac lead perforation is defined as migration and perforation of an implanted lead after 1 month of cardiac electronic device implantation. It is an under-recognized complication with significant morbidity and mortality, particularly if not recognized early. Two patients with late perforation caused by passive-fixation leads are reported and the clinical features of their presentation and management are reviewed. We conducted a thorough review of the available English language literature pertaining to this complication to draw relevant conclusions regarding presentation, diagnosis, and management. Early recognition of this complication is important as the indications for and numbers of patients who receive cardiac implantable electronic devices continue to expand. Copyright © 2010 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose. [source] Diagnostic clues to megaloblastic anaemia without macrocytosisINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 3 2007C. W. J. CHAN Summary Masking of the macrocytic expression of megaloblastic anaemia (MA) by coexisting thalassaemia, iron deficiency and chronic illness has been widely reported. We described the haematological and clinical features of 20 Chinese patients with MA presenting with mean corpuscular volume (MCV) ,99 fl, and analysed the steps leading to the final diagnosis of MA with concomitant thalassaemia trait (n = 11), thalassaemia trait and iron deficiency (n = 3), iron deficiency (n = 4) and chronic illness (n = 2). We also compared the haematological characteristics of this group of patients with a group of normocytic anaemic patients without vitamin B12/folate deficiency, and identified certain laboratory information useful for differentiating the two groups. Statistically significant parameters included the mean values of haemoglobin, MCV, red cell distribution width (RDW), reticulocyte index, platelet count and serum bilirubin. All provided clues to maturation disorders within the marrow. A decision flowchart for the diagnosis of MA without macrocytosis was proposed. In the studied population, by using the parameters of haemoglobin <10 g/dl, MCV 80,99 fl, RDW , 16% and reticulocyte index , 2% as indicators, there was a 58% chance that a patient had MA without macrocytosis if he/she had all the four indicators, and a 2.2% chance of having it if he/she did not have these indicators. We emphasized the importance of including peripheral blood smear examination in the diagnostic procedures for such patients, as well as the importance of paying attention to patients' medical history, racial background and previous MCV value. [source] Diagnostic clues and more from photographsNEUROPATHOLOGY, Issue 1 2007Asao Hirano During over 50 years of the first author's career in neuropathology at Montefiore Medical Center in New York, we have come across certain interesting neuropathological findings. In this communication, some photographs showing macroscopic, microscopic and electron microscopic significant findings are selected to illustrate usefulness not only for the diagnosis but also for understanding of the nervous system. The six topics presented in this paper are: (i) unattached presynaptic terminals in cerebellar neuroblastoma; (ii) neurofibrillary tangle formation in the nucleus basalis of Meynert ipsilateral to a massive cerebral infarct; (iii) orderly arrangement of tumor cells in leptomeningeal carcinomatosis; (iv) interface between craniopharyngioma and brain tissue; (v) neurofibrillary tangles and Lewy bodies in a single neuron; and (vi) Cu/Zn superoxide dismutase positive Lewy body-like hyaline inclusions in anterior horn cells in familial motor neuron diseases. Analyses of these findings are presented for an educational purpose. [source] Headache as the Only Presentation of Intravascular LymphomaHEADACHE, Issue 4 2008So-Hyang Im MD Intravascular lymphoma (IVL) is a rare extranodal lymphoma, presenting with confusing clinical presentations and most cases have been diagnosed during the postmortem review. We report a case of IVL diagnosed by cerebrospinal fluid (CSF) examination and bone marrow biopsy in a patient with a daily headache from onset. In case of a daily headache from onset with normal neuroimagings, CSF examination may give any significant diagnostic clue and should be a consideration to exclude such causes as hematolymphoid malignancies, including the very rare IVL. [source] Utility of eosinophilia as a diagnostic clue in lower abdominal pain in northern Australia: a retrospective case,control studyINTERNAL MEDICINE JOURNAL, Issue 4 2008P. J. Clark Abstract Acute eosinophilic enteritis is a difficult diagnosis to make. Insufficient consideration of eosinophilia may commit patients to surgical treatment when medical therapy may be appropriate. The aim of the study was to determine whether the eosinophil count was considered in the diagnostic evaluation of patients presenting with acute abdominal pain who subsequently underwent appendectomy and whether eosinophilia was related to subsequent histology. The method used in the study was retrospective case,control. None of three patients with increased eosinophil counts had histologically proven appendicitis (Fisher's exact test 0.025); worm segments were seen in two patients. None of 39 patients who had histologically proven appendicitis had increased eosinophil counts. Eosinophilia may be underutilized and helminth infection may not be considered in the differential diagnosis of abdominal pain. A normal eosinophil count in the setting of clinically suspected appendicitis may make the diagnosis of eosinophilic enteritis less likely, but does not exclude it. Patients with abdominal pain and peripheral eosinophilia appear less likely to have acute appendicitis on subsequent histology; however, further study is required to validate these findings. The decision to operate remains one of clinical judgement. [source] Unusual Vaginal Angiomatous Neoformation in a 3-year Old PugREPRODUCTION IN DOMESTIC ANIMALS, Issue 2 2008M Beccaglia Contents A 3-year-old female pug (8 kg bodyweight) was referred by a local veterinarian for evaluation of vaginal bleeding. Historically, the owner indicated chronic haematic vaginal discharge initiated approximately 3 months ago, overall good appetite and slight general dullness. Two months prior to the visit, the bitch had been spayed by the local veterinarian, but vaginal bleeding persisted after surgery. Following a general examination and complete blood analysis, a genital tract examination was performed and, through vaginal endoscopy, a red, smooth, and apparently broad-based vaginal mass was found. An episiotomy was performed and on surgical exploration, the bleeding site was determined to be on the surface of a mass composed of two congested, adjacent cylindrical structures, symmetric to the vaginal sagittal midline, broad-based and quite regular on the surface. The mass appeared to be well delimited from the surrounding tissue by a thin capsula, and each cylindrical structure had a tributary vessel. Ectopic and dysplastic corpora cavernosa of the clitoris characterized by angiomatous proliferation, cavernous haemangioma and vascular hamartoma were considered in the differential diagnosis. The presence of small intralesional nerves identified by S100 immunostaining was used as a diagnostic clue to classify this unusual vaginal angiomatous neoformation as vascular hamartoma. [source] Portal venous gas , case report and review of the literatureANAESTHESIA, Issue 4 2007A. H. Mohammed Summary A 74-year-old man with chronic renal failure was admitted to the renal unit with non-specific symptoms and positive blood cultures. He later deteriorated and was admitted to the Intensive Care Unit with septic shock, respiratory failure and deranged liver function. Initial improvement was followed by abdominal distension and discomfort. Portal venous gas (PVG) and thrombosis were diagnosed on computed tomography. A conservative line of management was adopted. Improvement was soon followed by deterioration with septic shock. Extensive portal venous gas and free intra-abdominal gas were now evident on repeat computed tomography. The patient was too unwell to withstand surgery and a decision was made not to escalate therapy. He died on day 16. Portal venous gas is not a disease; it is a diagnostic clue in patients who may be harbouring an intra-abdominal catastrophe. Successful management of these cases requires early identification of the underlying pathology and can range from simple observation to extensive surgical intervention. [source] Diagnosis of nail psoriasis: importance of biopsy and histopathologyBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2005C. Grover Summary Background, Involvement of the nail is quite common in psoriasis and at times may be the sole diagnostic clue. However, the histopathology of nail psoriasis has not been adequately evaluated. A confirmation of the diagnosis is required in cases suspected to have nail psoriasis in order to plan long-term therapy. Objectives, To assess the diagnostic significance and safety profile of nail biopsy in cases with nail psoriasis. Methods, Clinical and mycological features were studied in 42 patients with nail psoriasis. Of these, 22 patients gave consent for nail biopsies to be taken and the histopathological changes were assessed. Results, Males were affected more commonly (57%) with a peak incidence in the age group of 10,20 years (29%). Distal onycholysis, discoloration of nail plate, subungual hyperkeratosis and fine nail pitting were the predominant clinical features. In the 22 biopsies done, hyperkeratosis with parakeratosis (91%) was found to be the most common and hypergranulosis was the least common histological finding (36%). Clinicohistological correlation was possible only in 55% cases. Periodic acid-Schiff (PAS) staining was done for all biopsies. Conclusions, Histopathological examination of nails is a valuable diagnostic aid, especially in the absence of skin lesions. Examination of the PAS-stained sections is necessary before making a histological diagnosis of nail psoriasis because onychomycosis and psoriasis may show similar histology. [source] Papillary thyroid carcinoma with atypical histiocytoid cells on fine-needle aspirationDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2009Manju Harshan M.D. Abstract Although papillary thyroid carcinoma (PTC) usually has classic cytological characteristics on fine-needle aspiration (FNA), it can present rarely with aberrant features resembling those of histiocytes in a cystic nodule. The aim of the current study was to describe PTC with atypical histiocytoid cells and distinguish it from benign histiocytes. A retrospective computerized search for FNAs with atypical features suggestive of PTC and cystic degeneration was performed, and if available, the corresponding resection specimens were compared. Four cases met the criteria for FNAs and three had surgical pathology follow-up, which showed PTC. One aspirate had some features typical of PTC, but the remaining FNAs had atypical histiocytoid cells, which had traits intermediate between those of PTC and histiocytes. Large cell size, pseudoinclusions, nuclear grooves, and multiple well-defined vacuoles in atypical histiocytoid cells favor PTC over benign histiocytes. Ancillary immunocytochemical studies can also be useful in confirming the diagnosis. Histiocytic cells are frequently present in thyroid aspirates, and occasionally, they have atypical features that represent an unusual presentation of PTC. Closer examination of these cells can provide diagnostic clues for preventing false-negative diagnosis of PTC. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Severe vitamin B12 deficiency resulting in pancytopenia, splenomegaly and leukoerythroblastosisEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2008Thorvardur R. Halfdanarson Abstract Deficiency of vitamin B12 is a well known cause of megaloblastic anemia and pancytopenia. Splenomegaly and leukoerythroblastosis are much less well known manifestations of B12 deficiency. We report a B12 deficient female with severe pancytopenia including normocytic anemia who also had enlarged spleen and circulating nucleated red blood cells as well as circulating immature myeloid cells. Although these findings are reported in the earlier literature, more modern reviews of the subject often fail to mention this association. We review the literature on these unusual manifestations of B12 deficiency and remind clinicians that splenomegaly and erythroblastosis can serve as diagnostic clues in cases of severe megaloblastic anemia secondary to B12 deficiency. [source] Clinical significance of dermoscopy in alopecia areata: analysis of 300 casesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2008Shigeki Inui MD Objective To determine dermoscopic findings of alopecia areata (AA) from a large-scale study that can be used as clinical indicators of disease. Methods Dermoscopic examination of areas of hair loss on the scalp of 300 Asian patients with AA was performed using a DermLite® II pro, which can block light reflection from the skin surface without immersion gels. Using the Spearman rank-order correlation coefficient by rank test, correlations between the incidence of each dermoscopic finding and the severity of disease and disease activity were examined. The sensitivity and specificity of the findings as diagnostic clues for AA were evaluated. Results Characteristic dermoscopic findings of AA included black dots, tapering hairs, broken hairs, yellow dots, and clustered short vellus hairs (shorter than 10 mm) in the areas of hair loss. Black dots, yellow dots, and short vellus hairs correlated with the severity of disease, and black dots, tapering hairs, broken hairs, and short vellus hairs correlated with disease activity. For diagnosis, yellow dots and short vellus hairs were the most sensitive markers, and black dots, tapering hairs, and broken hairs were the most specific markers. Conclusion Dermoscopic characteristics, such as black dots, tapering hairs, broken hairs, yellow dots, and clustered short vellus hairs, are useful clinical indicators for AA. [source] | |||||||||||||||||||