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Diagnostic Option (diagnostic + option)
Selected AbstractsIntervertebral chondrocalcinosis: an exercise in differential diagnosis in palaeopathologyINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 1 2009S. A. Mays Abstract Intervertebral chondrocalcinosis (calcification of intervertebral discs and associated structures) may arise from a variety of causes. This work presents a discussion of intervertebral chondrocalcinosis and the identification of its most probable cause in skeletal remains, using as a case study a skeleton of an elderly male from medieval Ipswich, UK. The skeleton is examined using gross observation and radiography, and the intervertebral calcifications are subject to chemical analysis. In addition to intervertebral chondrocalcinosis (which has resulted in ankylosis of lumbo-sacral segments), lesions identified include chondrocalcinosis at some synovial joints, various soft tissue calcified bodies, and severe osteoarthritis particularly at the gleno-humeral joints. Interpretation of the results of the chemical analysis of the calcified deposits is complicated by diagenesis, but they are most consistent with apatite and/or whitlockite. Arriving at a most probable cause of the lesions in this case is difficult, but it is tentatively suggested that ochronosis may be the best diagnostic option. Copyright © 2008 John Wiley & Sons, Ltd. [source] A possible case of coccidioidomycosis from the Los Muertos site, Tempe, ArizonaINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 4 2006D. H. Temple Abstract Coccidioidomycosis is a fungal disease endemic to southwestern North America and parts of Central and South America. Coccidioidomycosis frequently disseminates to the human skeleton and produces mostly lytic skeletal lesions. However, this disease is infrequently described within archaeological populations. As a result, it is important to report potential cases in order to improve current understanding of the appearance and distribution of lesions resulting from coccidioidomycosis in archaeological specimens. This study describes skeletal lesions in an adult male recovered from the Los Muertos site, Tempe, Arizona (AD 500,1450). These lesions are present on the inferior border of the left scapular spine, the medial portion of the left first metacarpal head, and the medial portion of the right first metatarsal. The lesions are predominantly lytic with sclerotic and, in some cases, healed cortical bone distributed around their margins. Evidence of skeletal healing is recorded within the destructive focus of one lesion. Geographical information on pathogen endemism, overall lesion distribution, and agricultural-era Hohokom behaviour suggest that coccidioidomycosis is the most likely diagnostic option for these lesions. Mounting evidence for possible infections in the palaeopathological literature, combined with high frequencies of nutritional stress levels in endemic regions, suggests that coccidioidomycosis contributed at least moderately to morbidity in the American Southwest. Copyright © 2006 John Wiley & Sons, Ltd. [source] Case Series: Intraocular lymphoma diagnosed by fine-needle aspiration biopsyACTA OPHTHALMOLOGICA, Issue 6 2010Shaden Sarafzadeh Acta Ophthalmol. 2010: 88: 705,710 Abstract. Purpose:, To describe clinical experience in the diagnosis of intraocular lymphoma by fine-needle aspiration biopsy (FNAB) in patients with one or more discrete intraocular infiltrative lesions and limited or absent intravitreal tumour cells. Methods:, Retrospective descriptive analysis of patients who underwent intraocular FNAB of a solid retinal, subretinal pigment epithelial or uveal tumour that proved to be a malignant lymphoma. Results:, After exclusions, our study group consisted of seven patients, each of whom had one or more discrete intraocular infiltrative lesions and limited or absent intravitreal tumour cells and underwent a diagnostic intraocular FNAB that confirmed malignant intraocular lymphoma cytopathologically. These included three patients with one or more geographic yellow subretinal pigment epithelial infiltrates and one patient each with a prominent nodular white subretinal pigment epithelial tumour, a rapidly developing solid placoid choroidal mass, a haemorrhagic retinal infiltrative lesion and an infiltrative iris tumour, respectively. A prominent feature of virtually all aspirates was a large proportion of degenerated lymphoid cells in the background. Cytologically intact tumour cells ranged from relatively homogeneous small round cells with large nucleus to cytoplasm ratio to pleomorphic large cells with irregular knob-like nuclear protrusions. Immunocytochemical stains for lymphoid markers were helpful in confirming the pathological diagnosis of lymphoma in the five patients in whom this testing was performed. Conclusion:, FNAB was a useful diagnostic tool in the described subgroup of patients with suspected intraocular lymphoma. FNAB should be considered as a diagnostic option in selected patients with suspected intraocular lymphoma, especially if there are few or no vitreous cells. [source] When William of Ockham meets Thomas Bayes: finding a few diagnoses among a great many symptomsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2001A. Sonnenberg Bayes' formula is a means to estimate disease probability based on the presence of symptoms and the outcome of clinical tests. The probability helps to decide among competing diagnostic options. If, however, several diseases present with similar symptoms, they may appear equally probable, and Bayes' formula will fail as an aid to reach a diagnostic decision. The aim of this study is to show how a merger of Bayes' principle with that of Ockham can help to decide in favour of one diagnosis among multiple, seemingly equally probable diagnostic hypotheses. The hypotheses are compared to each other with respect to those tests and symptoms which they fail to explain. The unexplained tests and symptoms are used to estimate the probabilities for a set of secondary diagnoses that match each one of the primary diagnoses. The more likely a secondary diagnosis appears, the less likely its corresponding primary diagnosis will remain as the sole diagnosis to explain all the clinical findings. Even without a detailed calculation, the proposed concept of using unexplained tests and symptoms to rate competing differential diagnoses could help the clinician to select the most probable diagnosis. [source] Definitions of the phenotypic manifestations of sickle cell disease,AMERICAN JOURNAL OF HEMATOLOGY, Issue 1 2010Samir K. Ballas Sickle cell disease (SCD) is a pleiotropic genetic disorder of hemoglobin that has profound multiorgan effects. The low prevalence of SCD (,100,000/US) has limited progress in clinical, basic, and translational research. Lack of a large, readily accessible population for clinical studies has contributed to the absence of standard definitions and diagnostic criteria for the numerous complications of SCD and inadequate understanding of SCD pathophysiology. In 2005, the Comprehensive Sickle Cell Centers initiated a project to establish consensus definitions of the most frequently occurring complications. A group of clinicians and scientists with extensive expertise in research and treatment of SCD gathered to identify and categorize the most common complications. From this group, a formal writing team was formed that further reviewed the literature, sought specialist input, and produced definitions in a standard format. This article provides an overview of the process and describes 12 body system categories and the most prevalent or severe complications within these categories. A detailed Appendix provides standardized definitions for all complications identified within each system. This report proposes use of these definitions for studies of SCD complications, so future studies can be comparably robust and treatment efficacy measured. Use of these definitions will support greater accuracy in genotype,phenotype studies, thereby achieving a better understanding of SCD pathophysiology. This should nevertheless be viewed as a dynamic rather than final document; phenotype descriptions should be reevaluated and revised periodically to provide the most current standard definitions as etiologic factors are better understood, and new diagnostic options are developed. Am. J. Hematol. 2010. © 2009 Wiley-Liss, Inc. [source] | ||||||||||