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Invasive Tests (invasive + test)
Selected AbstractsCost-effectiveness of prenatal screening for thalassaemia in Hong KongPRENATAL DIAGNOSIS, Issue 11 2004K. Y. Leung Abstract Objectives To determine the cost effectiveness of a universal prenatal screening program for ,- and ,-thalassaemia. Methods We retrospectively reviewed our program from 1998 to 2002, and calculated the direct and indirect costs of various components. Results 18 936 women were screened at our prenatal clinic and 153 couples were subsequently referred to our Prenatal Diagnostic Centre for counselling and further investigations. In addition, there were 238 tertiary referrals and 157 self-referrals. After investigations, 84 fetuses were at risk of ,-thalassaemia major/,-E thalassaemia, 19 of them were affected and 18 were aborted. The total expenditure on our program (HK$10.0 million) would be less than the postnatal service costs (HK$40.4 million) for 18,-thalassaemia major fetuses if they were born. Of 361 women at risk of carrying a homozygous ,0 -thalassaemia fetus, 311 (86.2%) opted for the indirect approach (using serial ultrasound examinations to exclude Hb Bart's disease), and 76 (24.5%) subsequently underwent an invasive test for a definitive diagnosis. The sensitivity and false positive rate of this indirect approach was 100.0% and 2.9% respectively. Conclusion It is cost effective to run a universal prenatal screening program in an area where both ,-thalassaemia and ,-thalassaemia are prevalent. The indirect approach can effectively avoid an invasive test in unaffected pregnancies. Copyright © 2004 John Wiley & Sons, Ltd. [source] Prenatal diagnostic procedures used in pregnancies with congenital malformations in 14 regions of EuropePRENATAL DIAGNOSIS, Issue 11 2004Ester Garne Abstract Objective To investigate outcomes of ultrasound investigations (US) and invasive diagnostic procedures in cases of congenital malformations (CM), and to compare the use of invasive prenatal test techniques (amniocentesis (AC) versus chorionic villus sampling (CVS)) among European populations. Design Analysis of data from population-based registries of CM. Subjects 25 400 cases of CM recorded by 14 EUROCAT registries covering a total population of 1 013 352 births 1995,99. Results US were performed in 91% of cases, and positively detected CM in 35% of cases. AC was performed in 24% of the cases and CVS in 3% of cases. Thirty-eight percent of invasive tests gave positive results. Fifty-two percent of cases with maternal age , 35 years had an invasive test performed compared to 20% of cases with younger mothers. Considerable variation was found between registries in the uptake rate of invasive tests in cases with older maternal age and on the use of invasive tests with only four regions employing CVS techniques in at least a third of the cases having invasive tests. For chromosomal anomalies US gave positive results in 46% of cases with maternal age < 35 years with US performed and in 36% of cases with maternal age , 35 years with US performed. Conclusion Prenatal US was performed in 91% of all pregnancies with CM but the test was only positive in a third of the cases. There was large regional variation in the uptake rate of invasive tests with maternal age of 35 years or more. For every CVS carried out there were nine AC tests. US is an important tool in the prenatal diagnosis of chromosomal anomalies in Europe. Copyright © 2004 John Wiley & Sons, Ltd. [source] Evaluation of diagnostic criteria for atopic dermatitis: validity of the criteria of Williams et al. in a hospital-based settingBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2001H. Gu Background Surveys of the prevalence of atopic dermatitis (AD) have been carried out world-wide, but the results vary widely. The differences probably result from the use of different diagnostic criteria. Williams et al. proposed minimum, simplified, diagnostic criteria that require no invasive test and are easy to use. Pilot studies in European countries showed their suitability for implementation both in hospitals and in the community, and their high sensitivity and specificity. Objectives To evaluate the potential practical value of the criteria of Williams et al. in the Chinese population. Methods The criteria of Hanifin and Rajka (gold standard), Williams et al. and Kang and Tian were applied and compared in 111 patients with AD and 121 control subjects with other skin diseases in three out-patient centres in China. Results The criteria of Williams et al. showed a similar diagnostic efficiency to that of the gold standard, with the sensitivity, specificity and , value reaching 95·50%, 97·52% and 0·93, respectively. No significant difference was found between the criteria of Williams et al. and those of Kang and Tian (,2 = 0·69, P > 0·05). ,Onset under the age of 2 years', a criterion of Williams et al. could be used in subjects of any age. Conclusions The diagnostic efficiency of the criteria of Williams et al. was basically similar to those of Hanifin and Rajka and of Kang and Tian in our out-patient settings. However, those of Williams et al. were easier to apply and required no invasive tests. [source] Diagnosis of Helicobacter pylori InfectionHELICOBACTER, Issue 2006Katarzyna Dzier, anowska-Fangrat Abstract A growing interest in non-invasive tests for the detection of Helicobacter pylori has been observed recently, reflecting a large number of studies published this year. New tests have been validated, and the old ones have been used in different clinical situations or for different purposes. Stool antigen tests have been extensively evaluated in pre- and post-treatment settings both in adults and children, and the urea breath test has been studied as a predictor of bacterial load, severity of gastric inflammation, and response to eradication treatment. Several studies have also explored the usefulness of some serologic markers as indicators of the gastric mucosa status. With regard to invasive tests, molecular methods are being used more and more, but the breakthrough this year was the direct in vivo observation of H. pylori during endoscopy. [source] Diagnosis of Helicobacter pylori infectionHELICOBACTER, Issue 2003Hilpi Rautelin ABSTRACT Numerous studies are still published on diagnostic tests for Helicobacter pylori, essentially for noninvasive tests. The urea breath test is applied in different types of patients, and there are attempts to have quicker and simpler protocols. Stool tests using monoclonal antibodies are now evaluated while serology is still a subject of interest. The progress in PCR (multiplex PCR, real-time PCR) has also stimulated the research in this area of invasive tests, in order to get insight into virulence factors, macrolide susceptibility and to detect H. pylori in nonconventional specimens. [source] The impact of first-trimester screening on AMA patients' uptake of invasive testingPRENATAL DIAGNOSIS, Issue 5 2005Andrea M. Wray Abstract Objective Prenatal testing for AMA includes invasive procedures such as CVS and amniocentesis, which have risks. We sought to determine the effects of first-trimester screening (FTS) on referrals for genetic counseling and patients' decisions to pursue invasive testing after FTS was offered in 2002. Methods We compared AMA patients presenting for prenatal care who underwent early genetic counseling (<13 weeks' gestation) from 2001 to those from 2003. Charts were reviewed for maternal age, gestational age, past obstetric history, prior CVS or amniocentesis, abnormal ultrasound findings and decision to proceed with invasive testing. The two groups were compared using Student t -test and chi-square tests. Results In 2001, 552 AMA women enrolled in prenatal care; 68 presented for early genetic counseling. In 2003, 728 AMA women enrolled in prenatal care; 172 presented for early genetic counseling. More counseled women chose genetic testing in 2003 than in 2001 (95% vs 79%, p < 0.01). More patients elected an invasive procedure in 2001 compared to 2003 (71% vs 26%, p < 0.01). Conclusion Availability of FTS results in more AMA women having early prenatal genetic counseling and choosing some form of genetic testing. Such women are less likely to choose invasive tests than those without access to FTS. Copyright © 2005 John Wiley & Sons, Ltd. [source] Prenatal diagnostic procedures used in pregnancies with congenital malformations in 14 regions of EuropePRENATAL DIAGNOSIS, Issue 11 2004Ester Garne Abstract Objective To investigate outcomes of ultrasound investigations (US) and invasive diagnostic procedures in cases of congenital malformations (CM), and to compare the use of invasive prenatal test techniques (amniocentesis (AC) versus chorionic villus sampling (CVS)) among European populations. Design Analysis of data from population-based registries of CM. Subjects 25 400 cases of CM recorded by 14 EUROCAT registries covering a total population of 1 013 352 births 1995,99. Results US were performed in 91% of cases, and positively detected CM in 35% of cases. AC was performed in 24% of the cases and CVS in 3% of cases. Thirty-eight percent of invasive tests gave positive results. Fifty-two percent of cases with maternal age , 35 years had an invasive test performed compared to 20% of cases with younger mothers. Considerable variation was found between registries in the uptake rate of invasive tests in cases with older maternal age and on the use of invasive tests with only four regions employing CVS techniques in at least a third of the cases having invasive tests. For chromosomal anomalies US gave positive results in 46% of cases with maternal age < 35 years with US performed and in 36% of cases with maternal age , 35 years with US performed. Conclusion Prenatal US was performed in 91% of all pregnancies with CM but the test was only positive in a third of the cases. There was large regional variation in the uptake rate of invasive tests with maternal age of 35 years or more. For every CVS carried out there were nine AC tests. US is an important tool in the prenatal diagnosis of chromosomal anomalies in Europe. Copyright © 2004 John Wiley & Sons, Ltd. [source] Giant basal cell carcinoma masquerading as an osteogenic sarcomaAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2009Paul Cherian SUMMARY An 88-year-old man presented to the dermatology outpatient clinic with an 11-month history of a rapidly growing mass overlying a clavicular fracture site. The lesion was 8 × 6 cm, painful, fixed to deeper structures and ulcerated. Superficial and deep biopsies yielded invasive basal cell carcinoma. Imaging demonstrated extensive soft tissue invasion into muscle, bone and potentially into the lung parenchyma. Due to complications arising from subsequent diagnostic procedures, the patient declined further invasive tests. The cutaneous lesion was treated with palliative radiotherapy. We explore the literature regarding the tumorigenic effects of peri-fracture cytokines on the biological behaviour of basal cell neoplasms. [source] The Whitaker test: 35 years onBJU INTERNATIONAL, Issue 1 2010Eric W. Lupton Study Type , Diagnosis (case series) Level of Evidence 4 OBJECTIVE To describe a 25-year experience of using the Whitaker test in a single tertiary centre for assessing upper urinary tract dilatation, and to evaluate the role of perfusion pressure-flow studies in contemporary urological surgery for equivocal upper tract obstruction. PATIENTS AND METHODS In all, 143 patients with suspected upper urinary tract obstruction were investigated by at least one Whitaker test. The original method was extended to include observations on high flow-rate perfusion, abnormal renal pelvic peristalsis and loin pain with no pressure increase. Data on clinical presentation, perfusion pressure-flow studies, diuresis renography and choice of initial therapy were collected prospectively, and the long-term clinical outcome was analysed retrospectively. RESULTS In total, 145 studies were assessed; the Whitaker test showed obstructive features at conventional or higher flow rates in 61 cases and unobstructive patterns in 53. There were four equivocal results. Seventeen studies showed abnormal peristalsis within the renal pelvis and in 10 there was ,sensory' loin pain during the test. In patients with idiopathic hydronephrosis, there was agreement between the results of the pressure-flow studies and diuresis renography in 72%. The Whitaker test determined or contributed to the clinical management in 84% of the cases studied. It was accurate in its prediction of outcome in 77% of cases where obstruction was diagnosed and in 77% of unobstructive cases. CONCLUSIONS The Whitaker test continues to have a role in modern urological surgery. It should be reserved for assessing potential upper urinary tract obstruction in the following circumstances: equivocal results from less invasive tests; suspected obstruction with poor kidney function; loin pain with a negative diuresis renogram; suspected intermittent obstruction; and gross dilatation with a positive diuresis renogram. [source] Evaluation of diagnostic criteria for atopic dermatitis: validity of the criteria of Williams et al. in a hospital-based settingBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2001H. Gu Background Surveys of the prevalence of atopic dermatitis (AD) have been carried out world-wide, but the results vary widely. The differences probably result from the use of different diagnostic criteria. Williams et al. proposed minimum, simplified, diagnostic criteria that require no invasive test and are easy to use. Pilot studies in European countries showed their suitability for implementation both in hospitals and in the community, and their high sensitivity and specificity. Objectives To evaluate the potential practical value of the criteria of Williams et al. in the Chinese population. Methods The criteria of Hanifin and Rajka (gold standard), Williams et al. and Kang and Tian were applied and compared in 111 patients with AD and 121 control subjects with other skin diseases in three out-patient centres in China. Results The criteria of Williams et al. showed a similar diagnostic efficiency to that of the gold standard, with the sensitivity, specificity and , value reaching 95·50%, 97·52% and 0·93, respectively. No significant difference was found between the criteria of Williams et al. and those of Kang and Tian (,2 = 0·69, P > 0·05). ,Onset under the age of 2 years', a criterion of Williams et al. could be used in subjects of any age. Conclusions The diagnostic efficiency of the criteria of Williams et al. was basically similar to those of Hanifin and Rajka and of Kang and Tian in our out-patient settings. However, those of Williams et al. were easier to apply and required no invasive tests. [source] Gender Bias in Cardiovascular Testing Persists after Adjustment for Presenting Characteristics and Cardiac RiskACADEMIC EMERGENCY MEDICINE, Issue 7 2007Anna Marie Chang MD Objectives:Previous studies have found that female patients receive fewer invasive tests for cardiovascular disease than male patients. The authors assessed whether different clinical characteristics at emergency department presentation account for this gender bias. Methods:Patients with potential acute coronary syndrome (ACS) who presented to a university hospital were prospectively identified. A structured data instrument that included demographic information, chest pain description, history, physical examination, chest radiography, and electrocardiogram (ECG) data was completed. Hospital course was tracked daily. Patients received 30-day telephone follow-up. The main outcome was whether the patients received objective evaluation for coronary artery disease after adjustment for cardiac risk, including race, age, total number of risk factors, Thrombolysis in Myocardial Infarction (TIMI) score, ECG, and whether the patient sustained an acute myocardial infarction on index hospitalization. Results:There were 3,514 women (58%) and 2,547 men (42%) studied. They had similar presenting characteristics: chest pain quality (pressure/tightness: female 60% vs. male 59%, p = 0.6), location (substernal: female 82% vs. male 80%; p = 0.2), radiation (female 27% vs. male 26%; p = 0.3), and most associated symptoms. Men had more cardiac risk factors (mean 1.5 vs 1.4; p < 0.001), more abnormal ECGs (59% vs. 48%; p < 0.001), and a higher TIMI risk score (p < 0.001). With respect to the main outcome, men received more cardiac catheterizations (12.6% vs. 6.0%; odds ratio [OR], 2.25; 95% confidence interval [CI] = 1.88 to 2.70) and more stress tests (14.7% vs. 12.3%; OR, 1.22; 95% CI = 1.05 to 1.42). After adjustment for age, race, cardiac risk factors, ECG, and TIMI risk score, men still received more cardiac catheterizations (adjusted OR, 1.72; 95% CI = 1.40 to 2.11) and stress tests (adjusted OR, 1.16; 95% CI = 1.01 to 1.33). Models adjusting for acute myocardial infarction or death, high-risk initial clinical impression, or emergency department disposition found similar results for increased likelihood of cardiac catheterization in men but no difference in stress testing between men and women. Conclusions:Female patients with potential ACS receive fewer cardiac catheterizations than male patients, even when presenting complaint, history, ECG, and diagnosis are taken into account. The gender bias cannot be explained by differences in presentation or clinical course. [source] Accepting or declining the offer of prenatal screening for congenital defects: test uptake and women's reasonsPRENATAL DIAGNOSIS, Issue 1 2005Matthijs van den Berg Abstract Objectives Prenatal screening for Down syndrome has become standard practice in many western countries. In the Netherlands, however, prenatal screening tests for congenital defects are not offered routinely. The present study aims to assess test uptake in a large, unselected population of pregnant women, and to give more insight into the decision for or against prenatal screening through nuchal translucency measurement or maternal serum screening. Patients and Methods The study is part of a randomized controlled trial with two groups, each being offered a different prenatal screening test, and a control group. Pregnant women received postal questionnaires at three stages of their pregnancy. Results Of the women being offered the nuchal translucency measurement or the second trimester maternal serum test, 53 and 38% respectively accepted the test offer. The main reasons for accepting were ,gaining knowledge about the health of the foetus/curiosity' (50%), ,favourable characteristics of the screening test' (18%), and ,increased risk of having a child with DS' (15%). The main reasons for declining were ,unfavourable characteristics of the screening test' (42%), ,not applicable/not necessary' (35%), ,anxiety/uncertainty' (36%), ,adverse characteristics of the invasive tests' (32%), and ,being against abortion' (15%). Discussion The uptake of prenatal screening was relatively low, and different distributions of reasons were reported, compared to other studies. These differences may be due to the specific Dutch situation in which prenatal screening is not part of standard prenatal care. The question arises as to whether informed decision-making would be reduced if prenatal screening became routinised. Copyright © 2005 John Wiley & Sons, Ltd. [source] | ||||||||||