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Diagnostic Delay (diagnostic + delay)
Selected AbstractsDeath by midgut infarction: clinical lessons from 88 post-mortems in Auckland, New ZealandANZ JOURNAL OF SURGERY, Issue 1-2 2009O'Grady Gregory Abstract Background:, Mortality rates from acute arterial mesenteric ischaemia remain high. Early diagnosis is of prognostic importance; however, early features are often non-specific, necessitating a high index of suspicion and knowledge of the at-risk patient. This study reviewed three decades of fatal cases in Auckland, New Zealand, to identify risk factors and associated pathologies that might help guide early diagnosis. Diagnostic delay was also evaluated. Methods:, Cases were identified through a pathology database maintained from 1977 to 2006. Autopsy reports were assessed together with available clinical detail. Results:, Eighty-eight cases were recovered. Mean age was 75.4 years, with women predominating (57%). Thromboembolic occlusion was the leading cause, followed by thrombotic occlusion. Embolic sources included atrial disease, aortic disease and myocardial infarction. Patients routinely showed extensive comorbidities, especially cardiovascular. Pain was the most constant presenting symptom, but features were often subtle and clinicians frequently misdiagnosed more minor ailments. Of operated patients, 36% received operations within 6 h of admission, 33% within 24 h, 17% at between 1 and 2 days, and the remainder between 2 and 12 days. Conclusion:, Knowledge of risk factors defined here is important to guide early diagnosis of mesenteric ischaemia. Diagnostic delay is again shown to be significant and case experience gathered in this series may improve doctors' discernment when meeting this condition. [source] Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in DenmarkCOLORECTAL DISEASE, Issue 8 2006M. Korsgaard Abstract Objective, The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC). Patients and methods, Population-based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients' reported symptoms were determined through questionnaire,interviews. Dukes' stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: , 60, 61,150 and > 150 days. Stage was classified into nonadvanced (Dukes' A and B) or advanced (Dukes' C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals. Results, The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms. Conclusions, Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC , rectal bleeding , was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer. [source] Classification, presentation, and initial treatment of Wegener's granulomatosis in childhoodARTHRITIS & RHEUMATISM, Issue 11 2009David A. Cabral Objective To compare the criteria for Wegener's granulomatosis (WG) of the American College of Rheumatology (ACR) with those of the European League Against Rheumatism/Pediatric Rheumatology European Society (EULAR/PRES) in a cohort of children with WG and other antineutrophil cytoplasmic antibody (ANCA),associated vasculitides (AAVs), and to describe the interval to diagnosis, presenting features, and initial treatment for WG. Methods Eligible patients had been diagnosed by site rheumatologists (termed the "MD diagnosis") since 2004. This diagnosis was used as a reference standard for sensitivity and specificity testing of the 2 WG classification criteria. Descriptive analyses were confined to ACR-classified WG patients. Results MD diagnoses of 117 patients (82 of whom were female) were WG (n = 76), microscopic polyangiitis (n = 17), ANCA-positive pauci-immune glomerulonephritis (n = 5), Churg-Strauss syndrome (n = 2), and unclassified vasculitis (n = 17). The sensitivities of the ACR and EULAR/PRES classification criteria for WG among the spectrum of AAVs were 68.4% and 73.6%, respectively, and the specificities were 68.3% and 73.2%, respectively. Two more children were identified as having WG by the EULAR/PRES criteria than by the ACR criteria. For the 65 ACR-classified WG patients, the median age at diagnosis was 14.2 years (range 4,17 years), and the median interval from symptom onset to diagnosis was 2.7 months (range 0,49 months). The most frequent presenting features by organ system were constitutional (89.2%), pulmonary (80.0%), ear, nose, and throat (80.0%), and renal (75.4%). Fifty-four patients (83.1%) commenced treatment with the combination of corticosteroids and cyclophosphamide, with widely varying regimens; the remainder received methotrexate alone (n = 1), corticosteroids alone (n = 4), or a combination (n = 6). Conclusion The EULAR/PRES criteria minimally improved diagnostic sensitivity and specificity for WG among a narrow spectrum of children with AAVs. Diagnostic delays may result from poor characterization of childhood WG. Initial therapy varied considerably among participating centers. [source] Diagnostic delays and mis-management in cluster headacheACTA NEUROLOGICA SCANDINAVICA, Issue 3 2004A. Bahra Objectives , Cluster headache is a stereotyped form of primary headache that while common in terms of neurologic illnesses is much less common as a cause of disabling headache than migraine. Materials and methods , We directly interviewed 230 patients with cluster headache. National support groups contributed 76% and 24% came from the National Hospital for Neurology and Neurosurgery Headache Clinic. Results , Seventy-two percent were men and 28% women, giving a male to female (M:F) ratio of 2.5:1. Episodic cluster headache (ECH) was recorded in 79% while 21% had chronic cluster headache (CCH). The mean time to diagnosis has dropped from 22 years in the 1960s to 2.6 years in the 1990s, although the mean number of GPs seen before a diagnosis was made remains at three. Conclusions , While there has been improvement in the time to diagnosis for cluster headache, a number of physicians will be consulted, and better education is likely to reduce the overall patient suffering. [source] Case report of bilateral inflammatory breast cancerEUROPEAN JOURNAL OF CANCER CARE, Issue 4 2010Y.A. MASANNAT mrcsi, mrcsed, research fellow breast surgery MASANNAT Y.A., PETER M., TURTON P. & SHAABAN A.M. (2010) European Journal of Cancer Care Case report of bilateral inflammatory breast cancer Inflammatory breast cancer (IBC) is a rare entity that makes up 1,3% of breast cancers. As the diagnosis of IBC is mainly clinical, for the inexperienced the clinical appearance can mimic mastitis leading to diagnostic delay and it is often associated with a poor prognosis. Very few cases of bilateral IBC are reported in the literature, all of which have been synchronous. We report an unusual case of bilateral metachronous IBC each with complete clinico-pathological response after treatment with neoadjuvant chemotherapy and surgery on both occasions. [source] Increased levels of inflammatory chemokines in amyotrophic lateral sclerosisEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2009J. Kuhle Background and purpose:, Amyotrophic lateral sclerosis (ALS) is classically assumed to be a neurodegenerative disorder. Inflammation has been observed in CNS tissue in ALS patients. We investigated the expression and prognostic relevance of proinflammatory chemokines in ALS. Methods:, We analyzed nine chemokines, eotaxin, eotaxin-3, IL-8, IP-10, MCP-1, MCP-4, macrophage derived chemokine (MDC), macrophage inflammatory protein-1, (MIP-1,), and serum thymus and activation- regulated chemokine (TARC) in serum and cerebrospinal fluid (CSF) of 20 ALS- and 20 non-inflammatory neurological disease (NIND)-patients. Results:, MCP-1 and IL-8 levels in CSF in ALS were significantly higher than in NIND (1304 pg/ml vs. 1055 pg/ml, P = 0.013 and 22.7 pg/ml vs. 18.6 pg/ml, P = 0.035). The expression of MCP-1 and IL-8 were higher in CSF than in serum (P < 0.001). There was a trend towards higher MCP-1 CSF levels in ALS patients with shorter time between first symptoms and diagnosis (r = ,0.407; P = 0.075). Conclusions:, We confirmed previous findings of increased MCP-1 levels in CSF of ALS patients. Furthermore, increased levels of IL-8 in CSF suggest a stimulation of a proinflammatory cytokine cascade after microglia activation. We found a tendency for higher MCP-1 values in patients with a shorter diagnostic delay, who are known to have also a shorter survival. This may suggest an association of higher MCP-1 levels with rapidly progressing disease. [source] Proliferative activity and diagnostic delay in oral cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2010Juan Seoane PhD Abstract Background Tumor stage may relate to the chronology of neoplasm growth and has been used as an outcome variable when studying diagnostic delay in oral cancer. However, tumor growth rate may act as a confounding factor. Methods We reviewed a total of 63 incident cases of oral cancer. The variables considered for the study included age, sex, smoking history, tumor site, TNM stage, Ki-67 score, and diagnostic delay. Results Significant differences between survivors and exitus were found in terms of tumor stage at diagnosis (I,II vs III,IV), sex, and Ki-67 scores. When the analysis was adjusted for tumor stage at diagnosis (I,II vs III,IV), proliferative activity resulted to be an independent prognostic factor for survival, whereas diagnostic delay did not influence survival. Conclusion These results seem to suggest that survival from oral cancer is affected more by the biology of the cancer (rapid tumor growth) than by diagnostic delay. © 2010 Wiley Periodicals, Inc. Head Neck, 2010 [source] Intravascular lymphoma: a neoplasm of ,homeless' lymphocytes?HEMATOLOGICAL ONCOLOGY, Issue 3 2006Maurilio Ponzoni Abstract Intravascular lymphoma (IVL) is an extremely rare form of non-Hodgkin lymphoma characterized by almost exclusive growth of neoplastic lymphocytes within blood vessel lumen. IVL is morphologically characterized in most instances by large cells with B-cell lineage. IVL is an aggressive and usually disseminated disease that predominantly affects elderly patients, resulting in poor PS, B-symptoms, anemia, and high lactate dehydrogenase serum level. The brain and skin are the most commonly involved sites; nodal disease is rare. Survival after conventional chemotherapy is disappointing, with a relevant impact of diagnostic delay and lethal complications. Notwithstanding these results, IVL limited to the skin (cutaneous variant) is a favorable presentation with distinctive clinical characteristics. Moreover, differences in clinical presentation with Eastern Countries IVL cases, mostly associated with hemophagocytic syndrome, do exist. Intensive combinations containing drugs with higher central nervous system bioavailability are needed in cases with brain involvement; the role of high-dose chemotherapy with autologous stem cell transplantation should be investigated in younger patients with unfavorable features. The present review will discuss the most recent acquisitions related either to diagnosis and immunophenotypic/biologic characteristics as well as clinical/therapeutic issues of IVL. Copyright © 2006 John Wiley & Sons, Ltd. [source] Leprosy: Two case reports from Dresden, GermanyINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2006Andre Koch MD Leprosy is very rare in Germany. In 2003, only three cases were reported. In the Department of Dermatology, Dresden-Friedrichstadt, two cases from Asia had been diagnosed during the last 5 years, a paucibacillary tuberculoid leprosy and a multibacillary lepromatous leprosy. In both, there was a diagnostic delay of several months (3,7 months). The need for early detection of this mycobacteriosis also in nonepidemic areas of the world and the importance of a correct diagnosis by the dermatologist is hereby emphasized. [source] Experiences of diagnosis and treatment among people with multiple sclerosisJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2008Rhiannon G. Edwards MSc Abstract Rationale, aims and objectives, The aim of this qualitative study was to examine patients' experiences of being diagnosed with multiple sclerosis (MS), the information that they were given at this time, subsequent treatment and its impact on their lives. Method, Data were collected through semi-structured interviews with 24 people with MS. The use of interviews allowed participants' experiences to be explored in depth. Participants were recruited by the MS Society through membership details and through a press release in a local newspaper. Telephone interviews lasted between 30 and 60 minutes, were tape-recorded and transcribed verbatim. Data were analysed using thematic content analysis. Results, The majority of participants were female (n = 17), with ages ranging from 35 to 72 years. Disease duration ranged from 1 to 37 years. Many participants' diagnosed before and after 2000 had experienced long delays in diagnosis. At the point of diagnosis, participants had to make sense of and understand their diagnosis often with insufficient support. Some participants expressed anger about the way they had been given their diagnosis. Many felt they had not received sufficient information about their illness at this time and had responded by conducting their own searches for information to satisfy this need. Conclusion, Improving the way in which doctors communicate with patients experiencing diagnostic delay and at the point of diagnosis deserves further study, in order to avoid later adjustment problems. [source] Nodular melanomas: Analysis of the casistic and relationship with thick melanomas and diagnostic delayTHE JOURNAL OF DERMATOLOGY, Issue 10 2008Roberto BETTI ABSTRACT The present study aimed to: (i) define thick melanomas related to nodular melanomas and other melanoma subgroups; and (ii) establish diagnostic delay in relation to the biological behavior of these melanomas and prevention programs. Cutaneous primary melanomas were studied. Nodular melanoma (NM), lentigo maligna melanoma (LMM) and superficial spreading melanoma (SSM) were selected. A further category named vertical growth melanoma (VGM) was also utilized. Analysis for sex, age, different values of thickness (1,2 mm, >2 mm; 1,3 mm, >3 mm; >4 mm), delay to diagnosis and patterns of detection were performed in all of the different subtypes. Eighty-seven patients with melanomas more than 1 mm of Breslow's thickness out of 506 melanoma were collected. Twenty-six were nodular cases, 39 SSM, five LMM and 17 VGM. Of those patients with NM, 42% had a thickness of more than 1,2 mm, 34% of 2,4 mm, 23% of more than 4 mm; and 54% with 1,3, 46% with more than 3 mm; and 58% with more than 2 mm. Even considering different values of thickness of more than 1 mm, a delay to diagnosis was significantly lower in NM (4.79 months) than in other subgroups. The value of more than 1 mm of Breslow's thickness may be sufficient to consider a melanoma to be thick. The lower diagnostic delay of NM suggests that they represent faster growing lesions probably with a different biological behavior than other melanoma subtypes. VGM should not be confused with NM, having a longer delay and different clinical features compared with the latter. They represent an area of diagnostic carelessness than potentially be improved. [source] Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in DenmarkCOLORECTAL DISEASE, Issue 8 2006M. Korsgaard Abstract Objective, The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC). Patients and methods, Population-based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients' reported symptoms were determined through questionnaire,interviews. Dukes' stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: , 60, 61,150 and > 150 days. Stage was classified into nonadvanced (Dukes' A and B) or advanced (Dukes' C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals. Results, The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms. Conclusions, Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC , rectal bleeding , was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer. [source] Pathways to care for patients with bipolar disorderBIPOLAR DISORDERS, Issue 3 2005Dinesh Bhugra Bipolar disorder is a chronic, debilitating psychiatric illness with serious ramifications for patients, their families, and society. Despite the availability of effective treatments, this disease often goes untreated due to medical, financial, legal/governmental, and cultural barriers. In this review we explore possible reasons for this problem. Misdiagnosis of bipolar disorders is a common medical barrier. One pathway to care for individuals with bipolar disorder is through referral from primary care, but primary care physicians generally have not received special training in the recognition and management of bipolar disorder. This often leads to diagnostic delays or errors, which prevents timely ,filtering' of patients into specialized care. Using data bases we explored these pathways. Legislation in the USA, such as the Emergency Medical Treatment and Active Labor Act (EMTALA), designed to ensure access to inpatient mental health care, has instead given hospitals financial incentives to limit inpatient mental health care capacities. Reimbursement of mental health care expenses is a significant issue impacting a patient's ability to gain access to care, as bipolar disorder is a costly disease to treat. Improving access to care among the bipolar community will require multilateral strategies to influence the actions and attitudes of patients, communities, providers, health care systems, and state/national governments. In other cultures, barriers to care differ according to a number of factors such as type of services, explanatory models of illness, misdiagnosis and perceptions of care givers. It is essential that clinicians are aware of pathways and barriers so that appropriate and accessible care can be provided. [source] | ||||||||||||||||||||||||||||