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Clinical Diagnosis (clinical + diagnosis)
Selected AbstractsPediatric hospital medicine core competencies: Development and methodologyJOURNAL OF HOSPITAL MEDICINE, Issue S2 2010Erin R. Stucky MD Abstract Background: Pediatric hospital medicine is the most rapidly growing site-based pediatric specialty. There are over 2500 unique members in the three core societies in which pediatric hospitalists are members: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA) and the Society of Hospital Medicine (SHM). Pediatric hospitalists are fulfilling both clinical and system improvement roles within varied hospital systems. Defined expectations and competencies for pediatric hospitalists are needed. Methods: In 2005, SHM's Pediatric Core Curriculum Task Force initiated the project and formed the editorial board. Over the subsequent four years, multiple pediatric hospitalists belonging to the AAP, APA, or SHM contributed to the content of and guided the development of the project. Editors and collaborators created a framework for identifying appropriate competency content areas. Content experts from both within and outside of pediatric hospital medicine participated as contributors. A number of selected national organizations and societies provided valuable feedback on chapters. The final product was validated by formal review from the AAP, APA, and SHM. Results: The Pediatric Hospital Medicine Core Competencies were created. They include 54 chapters divided into four sections: Common Clinical Diagnoses and Conditions, Core Skills, Specialized Clinical Services, and Healthcare Systems: Supporting and Advancing Child Health. Each chapter can be used independently of the others. Chapters follow the knowledge, skills, and attitudes educational curriculum format, and have an additional section on systems organization and improvement to reflect the pediatric hospitalist's responsibility to advance systems of care. Conclusion: These competencies provide a foundation for the creation of pediatric hospital medicine curricula and serve to standardize and improve inpatient training practices. Journal of Hospital Medicine 2010;5(4)(Suppl 2):82,86. © 2010 Society of Hospital Medicine. [source] Evidence-Based Guidelines for Interventional Pain Medicine according to Clinical DiagnosesPAIN PRACTICE, Issue 4 2009FIPP, Maarten Van Kleef MD First page of article [source] Clinical Diagnosis and Management of DystoniaEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2009K. A. Jellinger No abstract is available for this article. [source] Poster Session: Clinical Diagnosis and ComorbidityBIPOLAR DISORDERS, Issue 2008Article first published online: 24 JAN 200 [source] Clinical Diagnosis at the CrossroadsCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2006David Watson There is widespread dissatisfaction with the existing diagnostic system articulated in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current DSM system is atheoretical, cumbersome to use, and plagued by the problems of comorbidity and heterogeneity. We explore two possible alternative approaches: (a) reorganizing the diagnostic classes and (b) the implementation of fully dimensional schemes. We then discuss the possibility that DSM-V will be a hybrid system, with Axis I remaining categorical and Axis II becoming dimensional. We conclude with a discussion of the merits,as well as the disadvantages,of creating two different taxonomic systems, one designed for psychopathology researchers and the other for practicing clinicians. [source] Rowing, the ultimate challenge to the human body , implications for physiological variablesCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 4 2009Stefanos Volianitis Summary Clinical diagnoses depend on a variety of physiological variables but the full range of these variables is seldom known. With the load placed on the human body during competitive rowing, the physiological range for several variables is illustrated. The extreme work produced during rowing is explained by the seated position and the associated ability to increase venous return and, thus, cardiac output. This review highlights experimental work on Olympic rowing that presents a unique challenge to the human capacities, including cerebral metabolism, to unprecedented limits, and provides a unique opportunity to reveal the extreme range of many physiological variables. [source] Localized wall thickening of the gallbladder mimicking a neoplasmDIGESTIVE ENDOSCOPY, Issue 1 2004Katsumi Kimura Clinical diagnosis of chronic cholecystitis is made based on diffuse hyperechoic thickening of the gallbladder wall as shown by ultrasonographic examination. We herein report three cases of chronic cholecystitis showing localized hypoechoic thickening of the gallbladder wall that mimicked gallbladder cancer by ultrasonography. Histologically, hypertrophy of the muscularis propria was a common characteristic finding in these three patients. A smooth surface of the inner hypoechoic layer of the thickened wall was considered to be a reliable finding in the differential diagnosis between this type of chronic cholecystitis and gallbladder cancer. [source] Using faecal elastase-1 to screen for chronic pancreatitis in patients admitted with acute pancreatitisHPB, Issue 3 2006R.C. Turner Abstract Background: Patients presenting with acute pancreatitis may have co-existing chronic pancreatitis, the accurate diagnosis of which would potentially guide appropriate management. Gold standard tests are often invasive, costly or time-consuming, but the faecal elastase-1 assay has been shown to be comparatively accurate for moderate and severe exocrine deficiency. This study aimed to evaluate fecal elastase-1 concentration [FE-1] against clinical criteria for chronicity in an acute setting. Patients and methods: [FE-1] was performed on patients admitted with acute onset of epigastric pain and a serum lipase at least three times the upper limit of normal. Clinical diagnosis of chronic pancreatitis was defined by the presence of specific clinical, pathological or radiological criteria. A [FE-1] value of <200 µg/g was similarly considered indicative of chronic exocrine insufficiency. Thus a 2×2 table comparing [FE-1] and clinical diagnosis was constructed. Results: After exclusion of liquid stool specimens, 105 stool specimens from 87 patients were suitable for [FE-1] determination. [FE-1] was evaluated against the clinical diagnosis of chronic pancreatitis, initially for the whole sample, and then after exclusion of cases of moderate and severe acute pancreatitis (Ranson score >2). The latter analysis, based on an exocrine insufficiency threshold of 200 µg/g, yielded a sensitivity of 79.5%, specificity of 98.0%, positive predictive value of 96.9% and negative predictive value of 86.0%. Conclusion: [FE-1] is an accurate screening tool for underlying chronic exocrine insufficiency when taken in the course of a hospital admission for mild acute pancreatitis. [source] LDL-receptor mutations in Europe,HUMAN MUTATION, Issue 6 2004George V.Z. Dedoussis Abstract Familial hypercholesterolemia (FH) is a clinical definition for a remarkable increase of cholesterol serum concentration, presence of xanthomas, and an autosomal dominant trait of either increased serum cholesterol or premature coronary artery disease (CAD). The identification of the low-density lipoprotein (LDL)-receptor (LDLR) as the underlying cause and its genetic characterization in FH patients revealed more insights in the trafficking of LDL, which primarily transports cholesterol to hepatic and peripheral cells. Mutations within LDLR result in hypercholesterolemia and, subsequently, cholesterol deposition in humans to a variable degree. This confirms the pathogenetic role of LDLR and also highlights the existence of additional factors in determining the phenotype. Autosomal dominant FH is caused by LDLR deficiency and defective apolipoprotein B-100 (APOB), respectively. Heterozygosity of the LDLR is relatively common (1:500). Clinical diagnosis is highly important and genetic diagnosis may be helpful, since treatment is usually effective for this otherwise fatal disease. Very recently, mutations in PCSK9 have been also shown to cause autosomal dominant hypercholesterolemia. For autosomal recessive hypercholesterolemia, mutations within the so-called ARH gene encoding a cellular adaptor protein required for LDL transport have been identified. These insights emphasize the crucial importance of LDL metabolism intra- and extracellularly in determining LDL-cholesterol serum concentration. Herein, we focus on the published European LDLR mutation data that reflect its heterogeneity and phenotypic penetrance. Hum Mutat 24:443,459, 2004. © 2004 Wiley-Liss, Inc. [source] Ten novel mutations in the human neurofibromatosis type 1 (NF1) gene in Italian patientsHUMAN MUTATION, Issue 1 2002Paola Origone Abstract The entire NF1 coding region was analyzed for mutations in a panel of 108 unrelated Italian NF1 patients. Using PTT, SSCP, and DNA sequencing, we found 10 mutations which have never been reported before. Clinical diagnosis of NF1 was established according to the NIH consensus criteria in 100 individuals, while 8 were young children with only multiple cafč-au-lait spots. We detected 46 truncated fragments, and 24 of them were fully characterized by SSCP and direct sequencing. Of the 24, 14 were known mutations (R304X, R681X, Q682X, R1306X, R1362X, R1513X, R1748X, Q1794X, R1947X, Y2264X, R2237X, 2674delA, 6789delTTAC, 2027insC). The other 10 mutations represent novel changes that contribute to the germline mutational spectrum of the NF1 gene (K810X, Q2595X, 6772delT, 7190delCT, 7331delA, 1021insTT, 3921insT, 4106insTA, 7149insC, 2033insCG / 2034delA). PTT in a large number of Italian NF1 patients supports the usefulness of this method for characterization of mutations in disorders where the responsible gene is very large and the disease-causing mutations often create a stop codon. In agreement with previous reports, no mutational hotspots within the NF1 gene were detected. © 2002 Wiley-Liss, Inc. [source] Dermoscopic patterns of superficial basal cell carcinomaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2008Massimiliano Scalvenzi MD Background, Superficial basal cell carcinoma (BCC) presents as a scaly, pink to red,brown patch and is predominantly located on the trunk. Clinical diagnosis may not be always easy and implicates a variety of differential diagnoses; in this situation dermoscopy has been reported improving the diagnostic accuracy. This study investigated dermoscopic patterns of superficial BCC focalizing the most specific and frequent structures in order to improve the diagnostic accuracy. Limitations, Study population referred to skin lesion clinic. Methods, Dermoscopic patterns of 42 superficial BCCs were analyzed and photographed. These cases represented the 8% of all BCCs excised in our Department between 2005 and 2006. Results, Dermoscopic structures observed in the 42 superficial BCCs consisted of shiny white to red areas (100%), "erosions" (78.6%), short fine telangiectasias (SFTs) (66.6%), leaf-like areas (16.6%), arborizing telangiectasias (14.3%), blue,gray globules (14.3%) and large blue,gray ovoid nests (4.7%). Conclusions, Our study identifies the presence of shiny white to red areas, SFTs and "erosions" as main dermoscopic criteria of superficial BCC. Other dermoscopic features, such as leaf-like areas, arborizing telangiectasias, blue,gray globules and large blue,gray ovoid nests, are not strongly associated with the diagnosis of superficial BCC but they are useful in the differential diagnosis from other pigmented and nonpigmented skin lesions. [source] Oral histoplasmosis associated with HIV infection: a comparative studyJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 8 2004S. L. Hernández Objective:, Histoplasmosis is a granulomatous fungal disease caused by Histoplasma capsulatum. The objective of the present paper was to describe the prevalence of oral histoplasmosis (OH) in two services from an endemic area in Argentina between 1991 and 2002 and to compare the clinicopathological profile of OH between HIV-positive and HIV-negative patients. Methods:, About 733 HIV+ (group A) and 14 260 patients (group B) were examined. Clinical diagnosis was confirmed by cytology, biopsy or culture. Results:, About 21 (3%) and 10 (0.07%) cases of OH were diagnosed in group A and B respectively. Most patients were male. A total of 90% of patients in group A were <45 years old whereas 70% of group B were more than 45 years old. Palate, gingiva and oropharynx were the most frequent locations. The importance of including histoplasmosis in the differential diagnosis of ulcerated oral lesions in immunocompromised patients was discussed. [source] Novel Biomarkers for Diagnosis and Therapeutic Assessment of Overactive Bladder: Urinary Nerve Growth Factor and Detrusor Wall ThicknessLUTS, Issue 2009Hann-Chorng KUO Clinical diagnosis of overactive bladder (OAB) varies greatly and is based on subjective symptoms. A better way to diagnose and assess therapeutic outcome in patients who present with OAB needs to be developed. Evidence has shown that urinary proteins, such as nerve growth factor (NGF) and prostaglandin E2 (PGE2) levels increase in patients with OAB, bladder outlet obstruction (BOO) and detrusor overactivity (DO). Urinary NGF level increases physiologically in normal subjects at urge to void, but increases pathologically in OAB patients at small bladder volume and at urgency sensation. Patients with OAB dry and OAB wet have significantly higher urinary NGF levels compared to controls and patients with increased bladder sensation. Urinary NGF levels decrease after antimuscarinic therapy and further decrease after detrusor botulinum toxin injections in refractory OAB. A higher urinary NGF level could be a biomarker for sensory nerve-mediated DO. Urinary NGF levels could be a potential biomarker for diagnosis of OAB and serve for the assessment of the therapeutic effect of antimuscarinic therapy. Another potential biomarker for the diagnosis of OAB is detrusor wall thickness. It has been hypothesized that the bladder wall increases in thickness in patients with OAB. The thickened detrusor wall might decrease in response to antimuscarinic treatment, and measurement of detrusor wall thickness might be a useful biomarker for the evaluation of OAB. However, current investigations do not yet provide a uniform observation among various studies. [source] Learning to look: developing clinical observational skills at an art museumMEDICAL EDUCATION, Issue 12 2001Charles L Bardes Context Clinical diagnosis involves the observation, description, and interpretation of visual information. These skills are also the special province of the visual arts. We describe an educational collaboration between a medical school and an art museum, designed for the purpose of developing student skills in observation, description, and interpretation. Objectives In the programme, medical students first examine painted portraits, under the tutelage of art educators and medical school faculty. Then, the students examine photographs of patients' faces and apply the same skills. Conclusion This programme, well-received by students and faculty, appeared to help the students not only in improving their empirical skills in observation, but also in developing increased awareness of emotional and character expression in the human face. [source] Corticobasal degeneration as cause of progressive non-fluent aphasia: Clinical, radiological and pathological study of an autopsy caseNEUROPATHOLOGY, Issue 6 2006Masaki Takao A Japanese male developed gradual loss of spontaneous speech at age 60. Three years later meaningful speech had deteriorated to the point that it had become restricted to monotonous utterances. Neuropsychological examination at age 62 showed that he had severe non-fluent aphasia. A brain MRI demonstrated mild cortical atrophy with ischemic lesions in the cerebral white matter. He was diagnosed as having primary progressive aphasia. At age 63, he was admitted to the hospital to reevaluate the neurological condition. Neurologic examination showed severe non-fluent aphasia, hyperreflexia, snout and sucking reflexes. No alien hand was observed. He was able to walk, dress, wash himself and use chopsticks as well as name real objects. At age 65, 99mTc-hexamethylpropyleneamine oxime single photon emission computed tomography (HMPAO-SPECT) revealed diffuse cerebral hypoperfusion that was particularly prominent in the left frontal lobe. An MRI showed progressive cortical atrophy with the definite atrophy of the left paracentral gyrus. The hippocampal formation and putamen were also atrophic. He died of pneumonia at age 67. The brain weighed 810 g with atrophy of the frontal lobe, globus pallidus, enlargement of the lateral ventricles and depigmentation of the substantia nigra. Microscopic examination showed severe neuronal loss and gliosis in the cerebral cortex, globus pallidus interna and substantia nigra. Ballooned neurons were observed in the cerebral cortex. Gallyas-Braak method revealed numerous astrocytic plaques and argentophilic threads in the cerebrum. Clinical diagnosis of corticobasal degeneration sometimes is difficult in individuals with atypical clinical presentations. More exact clinical and radiological criteria may warrant a diagnosis of corticobasal degeneration. [source] Restored Atrial Excitability After Late Recanalization in a Patient with Atrial Standstill and Acute Myocardial InfarctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2002TAKA-AKI KOSHIMIZU KOSHIMIZU, T-A., et al.: Restored Atrial Excitability After Late Recanalization in a Patient with Atrial Standstill and Acute Myocardial Infarction. Atrial standstill is electrophysiologically characterized by the loss of spontaneous excitation in atrial muscle and the inability to cause action potential firing upon electrical stimulation. Clinical diagnosis of transient standstill of the right atrium was made in a patient with acute occlusion of the right coronary artery and acute renal failure. Percutaneous coronary intervention, performed 5 days after the onset, restored the coronary blood flow and resulted in full recovery of electrical activity and regular sinus rhythm. [source] Multiple Nevoid Hypertrichosis as An Isolated Developmental DefectPEDIATRIC DERMATOLOGY, Issue 4 2009Dimitrios Sotiriadis M.D., Ph.D. Neither similar or relevant family history nor associated extracutaneous abnormalities was detected after a thorough examination. Clinical diagnosis of patchy nevoid hypetrichosis was confirmed by histology. Nevoid hypertrichosis is a rare hair growth disorder that usually presents at or soon after birth. It is characterized by patches of hypertrichosis distributed in a segmental pattern. It may be accompanied by mental, ocular, or myoskeletal abnormalities. Cases of nevoid hypertrichosis with multiple patches presenting as a solitary developmental defect have been rarely described in the literature. [source] T1N0 Triple Negative Breast Cancer: Risk of Recurrence and Adjuvant ChemotherapyTHE BREAST JOURNAL, Issue 5 2009Henry G. Kaplan MD Abstract:, Adjuvant treatment of T1N0 breast cancer (BC) has evolved in recent years with chemotherapy options dependent on tumor size and cellular characteristics. Our goal is to describe the difference in outcome between T1N0 triple negative (TriNeg) and estrogen/progesterone receptor positive/her2/neu-negative BC. From our institute's registry, we identified primary BC patients diagnosed from 1998 to 2005, estrogen/progesterone receptor negative (ER,/PR,)/her-2/neu negative (her2,) (TriNeg = 110) and ER+/PR+/her2, (HR+/her2, = 919). Clinical diagnosis and treatment variables were chart abstracted. Vital and disease status were updated annually. Pearson chi-squared tests were used for bivariate analysis. Hazard ratios were calculated using the Cox proportional hazards model. Average patient age was 59 years, range 23,93 years and average length of follow-up was 4.22 years. T-stage distribution for HR+/her2, patients was 9% T1a (>0.1, ,0.5 cm), 34% T1b (>0.5 cm, ,1 cm), 57% T1c (>1 cm, ,2 cm) and for TriNeg, 6% T1a, 21% T1b, and 73% T1c. Sixty-five per cent of T1b and 73% T1c TriNeg patients received chemotherapy versus 7% of T1b and 32% of T1c HR+/her2, patients with TriNeg patients more likely to receive doxorubicin/cyclophosphamide/paclitaxel combined therapy. Recurrence rates were the following, T1b: 8.7%, TriNeg (2/23) versus 0%, HR+/her2, (0/315) and T1c: 8.8%, TriNeg (7/80) versus 2.1%, HR+/her2, (11/523). Five year relapse-free survival was 98% in the HR+/her2, group and 89% in the TriNeg group (log rank test = 27.77, p < 0.001). The hazard ratio for recurrence in the TriNeg group was 6.57 (95% CI = 2.34, 18.49) adjusted for age, tumor size, and adjuvant chemotherapy. Triple negative T1N0 patients have greater recurrence risk in spite of more aggressive therapy by both number treated and adjuvant chemotherapy type even in a low-risk category. New treatment modalities specific for triple negative disease are urgently needed. [source] Current and future use of the mannitol bronchial challenge in everyday clinical practiceTHE CLINICAL RESPIRATORY JOURNAL, Issue 4 2009Celeste Porsbjerg Abstract Objectives:, Asthma is a disease associated with inflammation, airway hyperresponsiveness (AHR) and airflow limitation. Clinical diagnosis and management of asthma often relies on assessment of lung function and symptom control, but these factors do not always correlate well with underlying inflammation. Bronchial challenge tests (BCTs) assess AHR, and can be used to assist in the diagnosis and management of asthma. Data Source:, Data presented at the symposium ,Use of inhaled mannitol for assessing airways disease' organised by the Allied Respiratory Professionals Assembly (9) of the European Respiratory Society (ERS) at the ERS Congress, Berlin 2008. Results:, Indirect challenge tests such as exercise testing, hypertonic saline or adenosine 5,-monophosphate (AMP) are more specific though less sensitive than direct challenge tests (such as methacholine) for identifying patients with active asthma. Indirect BCTs may be used to diagnose exercise-induced bronchoconstriction or AHR consistent with active asthma, to evaluate AHR that will respond to treatment with anti-inflammatory drugs and to determine the effectiveness and optimal dosing of such therapy. An ideal indirect challenge test should be standardised and reproducible, and the test result should correlate with the degree of airway inflammation. The mannitol BCT provides a standardised and rapid point-of-need test to identify currently active asthma, and is clinically useful in the identification of patients with asthma who are likely to benefit from inhaled corticosteroid therapy. Conclusion:, In the future, mannitol BCT may be added to lung function and symptom assessment to aid in the everyday management of asthma. Please cite this paper as: Porsbjerg C, Backer V, Joos G, Kerstjens HAM and Rodriguez-Roisin R. Current and future use of the mannitol bronchial challenge in everyday clinical practice. The Clinical Respiratory Journal 2009; 3: 189,197. [source] Clinical diagnosis and differential diagnosis of CJD and vCJD,APMIS, Issue 1 2002Inga Zerr The most widely distributed form of transmissible spongiform encephalopathy, sporadic Creutzfeldt-Jakob disease, typically affects patients in their sixties. Rapidly progressive dementia is usually followed by focal neurological signs and typically myoclonus. The disease duration in sporadic CJD is shorter than in variant CJD (6 months and 14 months, respectively). The clinical diagnosis in sporadic CJD is supported by the detection of periodic sharp and slow wave complexes in the electroencephalogram, hyperintense signals in basal ganglia on magnetic resonance imaging and elevated levels of neuronal proteins in the cerebrospinal fluid (such as 14-3-3). In contrast to the sporadic form, hyperintense signals in the posterior thalamus ("pulvinar sign") are seen in variant CJD. Following recent developments in diagnostic premortem techniques, clinical criteria for probable sporadic and probable variant CJD were established. Clinicopathological studies on sporadic CJD revealed different phenotypes which are characterized by neuropathological lesion profile, clinical syndrome, codon 129 genotype and type of proteinase K-resistant core of the prion protein. Alzheimer's disease and Lewy body dementia are the most frequent differential diagnoses in sporadic CJD in elderly patients, whereas chronic inflammatory disorders of the central nervous system have to be considered in younger patients. [source] The cervical wedge-shaped lesion in teeth: a light and electron microscopic studyAUSTRALIAN DENTAL JOURNAL, Issue 3 2009TJ Daley Abstract Background:, The cervical non-carious wedged-shaped lesion is controversial in that its aetiology may involve attrition, erosion, abrasion and stress-corrosion (abfraction). This study examined the histopathology of anterior teeth with cervical wedge-shaped lesions by light and electron microscopy to elucidate their pathogenesis. Methods:, Ten undecalcified human teeth with cervical lesions were available for investigation. Patency of the dentine tubules was tested using red dye penetration from the pulp chamber. The morphology of normal and sclerotic dentine adjacent to the cervical wedge-shaped lesions was investigated by scanning electron microscopy. The numbers and diameters of dentinal tubules were measured at different levels beneath the surfaces of the lesions. Results:, The gross and microscopic features of the worn teeth were described. Red dye penetration tests showed white tracts of sclerotic tubules contrasted with red tracts of patent tubules. Numbers of tubules per square area and diameters of patent and sclerotic tubules varied at different levels within the dentine due to deposits of intratubular dentine. Conclusions:, The cervical wedge is shaped by interactions between acid wear, abrasion and dentinal sclerosis. No histopathological evidence of abfraction was found. Clinical diagnosis, conservation and restoration of non-carious cervical lesions need to take into account the extent of sclerotic dentine beneath wedge-shaped lesions. [source] Clinical diagnosis and treatment of suspected neuropathic pain in three dogsAUSTRALIAN VETERINARY JOURNAL, Issue 1-2 2009RG Cashmore Three dogs were referred to The Queen's Veterinary School Hospital at University of Cambridge for chronic behavioural or locomotor disorders associated with pain. All three had been unsuccessfully treated with conventional analgesics, including non-steroidal anti-inflammatory drugs, glucocorticoids and opiate agonists, prior to referral, with minimal or no response. They were investigated by neurological examination plus conventional ancillary diagnostic tests and therapeutic drug trials. Ruling out other causes of pain and applying previously well-described criteria, each case was diagnosed as consistent with neuropathic pain, a poorly recognised condition in domestic dogs. Treatment with the tricyclic antidepressant drug, amitriptyline, or the antiepileptic drug, gabapentin, resulted in either a dramatic improvement or full resolution of clinical signs in all cases. [source] Clinical diagnosis of multiple system atrophy: level of agreement between Quinn's criteria and the consensus conference guidelinesACTA NEUROLOGICA SCANDINAVICA, Issue 4 2001C. Colosimo First page of article [source] Diagnosis of ophthalmic tumoursACTA OPHTHALMOLOGICA, Issue 2009T KIVELÄ Purpose To summarise clinical methods used to diagnose ophthalmic tumours. Methods Personal experience of the author as a member of the European Ophthalmic Oncology Group. Results Conjunctival tumours are excised based on provisional clinical diagnosis or, if they are extensive, atypical or part of systemic disease such as lymphoma, first biopsied to obtain a histopathologic diagnosis. Useful methods to diagnose and stage conjunctival tumours are high frequency ultrasonography (US) or ultrasound biomicroscopy (UBM) to measure their thickness, in vivo confocal microscopy or impression cytology to chart their extent, and exfoliative cytology to get a provisional diagnosis. Ciliary body tumours are visualised by radical biomicroscopy, transillumination and indirect ophthalmoscopy with scleral indentation, supplemented with high frequency US or UBM. Binocular indirect ophthalmoscopy and US form the basis or diagnosing choroidal tumours. In addition to fluorescein and indocyanine green angiography in atypical cases, optical coherence tomography to detect subretinal fluid and autofluorescence to detect orange pigment are useful adjuncts in telling a small melanoma from a naevus. The mnemonic "To Find Small Ocular Melanomas" (from Thickness >2mm, subretinal Fluid, Symptoms, Orange pigment, Margin touching disc) is also useful in this respect. Clinical diagnosis of medium-sized to large melanomas is 99% accurate, whereas a fine needle or vitrectomy biopsy may be necessary to diagnose atypical tumours and is also used for cytogenetic analysis of uveal melanomas. Conclusion Conjunctival tumours are mostly diagnosed histopathologically, whereas diagnosis of uveal tumours is usually based on clinical examination. While clinical diagnosis is usually reliable, biopsy of uveal tumours is increasingly used for prognostic purposes. [source] Using the SWAP-200 in a personality-disordered forensic population: is it valid, reliable and useful?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2005Luisa E. Marin-Avellan Background Treatment and risk management of forensic patients relies heavily on diagnosing psychopathology, yet the reliability of clinical diagnoses of personality disorder has been found to be only fair to low. Structured instruments for the global assessment of personality disorder are infrequently used in clinical assessments possibly due to their limited validity and clinical utility. Aims/methods The Shedler-Westen Assessment Procedure-200 (SWAP-200) was developed in an effort to address these limitations. Although good reliability and validity in relation to clinicians' diagnosis of personality disorder has been reported, to date the validity of this instrument has not been assessed in relation to other standardized instruments or in a personality-disordered, forensic population. This study aims to establish the reliability and validity of the SWAP-200 against other diagnostic instruments and measures of interpersonal functioning in a personality disordered forensic population. Results This paper reports the results of 30 subjects from a high secure hospital in the UK who were assessed with the SWAP-200, the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), the Adult Attachment Interview (AAI) and the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE). Preliminary results suggest that the SWAP-200 is a reliable instrument for the diagnosis of personality disorder in forensic patients. Conclusions Although the small sample size allows only preliminary conclusions about the validity of this instrument, early results show a reduction of the diagnosis of comorbidity compared with the SCID-II, together with an increased number of expected associations between independent measures of interpersonal functioning and categories of personality disorder. Copyright © 2005 Whurr Publishers Ltd. [source] A correlation study on diagnostic endoscopic ultrasound-guided fine-needle aspiration of lymph nodes with histological and clinical diagnoses, the UCLA Medical Center experienceDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2008Bita V. Naini M.D. Abstract Endoscopic ultrasound guided (EUS) FNA procedure has two aspects, the endoscopic sampling and the FNA interpretation. The two aspects of the procedure are performed in two different disciplines; gastroenterology (EUS) and pathology (FNA). The aim of this study was to evaluate the concordance, sensitivity, specificity, positive predictive (PPV), and negative predictive values (NPV). Sixty-one EUS-FNA procedures of the lymph nodes were analyzed by correlating the FNA results with histological or clinical diagnoses. The lymph nodes were divided in five groups; mediastinal, gastrohepatic, peripancreatic, portal, and perirectal. The study showed a concordance of 92% in mediastinal, 80% in gastrohepatic, 81% in peripancreatic, 95% in portal, and 100% in perirectal lymph nodes with an overall sensitivity of 84%, specificity of 92%, PPV of 88%, and NPV of 89%. In conclusion, EUS-FNA offers an invaluable approach for diagnostic examination of the internal lymph nodes where percutaneous FNA is either difficult or impossible. impossible. Diagn. Cytopathol. 2008;36:460,466. © 2008 Wiley-Liss, Inc. [source] Prevalence of Anti-cardiolipin, Anti-,2 Glycoprotein I, and Anti-prothrombin Antibodies in Young Patients with EpilepsyEPILEPSIA, Issue 1 2002R. Cimaz Summary: ,Purpose: To measure anti-cardiolipin (aCL), anti-,2 glycoprotein I (anti-,2GPI), and anti-prothrombin (aPT) antibodies in young patients with epilepsy, and to correlate their presence with demographic data, clinical diagnoses, laboratory and neuroradiologic findings, and antiepileptic drugs (AEDs). Methods: Sera from one hundred forty-two consecutive patients with epilepsy with a median age of 10 years were tested for aCL and anti-,2GPI autoantibodies by solid-phase assays. aPT antibodies also were assayed in sera from 90 patients. Positive results were confirmed after a minimum of 6 weeks. Antinuclear antibodies (ANAs) and antibodies against extractable nuclear antigens (ENAs) also were tested. Results: An overall positivity of 41 (28.8%) of 142 sera was found. Fifteen patients were positive for aCL, 25 for anti-,2GPI, and 18 for aPT antibodies. Several patients (12%) displayed more than one specificity in their serum. Only one of these patients had a concurrent positivity for ANAs and ENAs. A predominance of younger patients was found in the antibody-positive group. All types of epilepsy were represented in the positive group. No relation between antibody positivity and AEDs was found. Diffuse ischemic lesions at computed tomography (CT)/magnetic resonance imaging (MRI) scans were present in higher percentages in patients who were antibody positive. No positive patient had a history of previous thrombosis or other features related to systemic lupus erythematosus (SLE), and no patient was born of a mother with SLE. Conclusions: Our study suggests a relation between epilepsy and aPL in young patients. A pathogenetic role for these autoantibodies cannot be excluded, and their determination might prove useful even from a therapeutic point of view. [source] The impact of stomatological disease on oral health-related quality of lifeEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2003Carrie Diane Llewellyn The clinical diagnosis of stomatological disease may indicate its cause and prognosis; however, it says little about the resulting level of impairment from the patient's perspective. The primary objective of this study was to test whether patients attending an outpatient oral medicine clinic would have worse oral health related quality of life (OHR-QoL) compared with the general population. In addition, we aimed to assess whether anxiety or depression could be predicted by OHR-QoL and to explore the relationship between clinical diagnoses, OHR-QoL and anxiety/depression. Data were collected from patients (n = 97) through face-to-face interviews using the Oral Health Impact Profile Short form (OHIP-14) to measure OHR-QoL, the Hospital Anxiety and Depression Scale (HADS) for psychiatric morbidity, and a visual analogue scale for self-rated general health. Age- and sex-matched controls (n = 388) were provided from a normative data set collected in a UK national survey in 1998. Participants had significantly lower OHR-QoL scores than the general population on all domains and overall OHR-QoL scores. Of the variance in anxiety, 55% was predicted by general health ratings and OHR-QoL domains of ,psychological discomfort' and ,psychological disability'. Of the variance in depression, 54% was predicted by general health ratings and OHR-QoL domains of ,functional limitation' and ,social disability'. Patient centred, routine assessment of OHR-QoL provides an additional dimension that may help to improve awareness of the impact of disease on the individual's life and enhance the clinical decision-making process. [source] Application of the 1988 International Headache Society Diagnostic Criteria in Nine Italian Headache Centers using a Computerized Structured RecordHEADACHE, Issue 10 2002Virgilio Gallai MD Background.,The actual application of the current International Headache Society (IHS) diagnostic criteria in clinical practice has not been investigated thoroughly. Objectives.,To develop a computerized, structured, medical record based exclusively on the IHS classification system. Design and Method.,We tested the computerized structured record by entering and analyzing data reported on the case sheets of 500 consecutive patients attending nine headache centers in Italy. All clinical diagnoses in the study were made according to current IHS criteria. The rate of concordance between the diagnosis provided by the computerized structured record and that reported by clinicians on the case sheets was calculated, and reasons for any discrepancies between the two diagnoses were analyzed. Results.,Concordance between the two diagnoses was found in 345 of 500 cases examined (69%). In the remaining 155 cases, diagnoses reached with the computerized structured record and case sheets were impossible or discordant with respect to the diagnoses made by the clinician. In 144 of these cases (28.8%), this was due to missing information or errors in the diagnosis recorded by the clinicians on the patient case sheet. In particular, the diagnosis could not be reached using the computerized structured record in 105 cases (20.6%) because of a lack of one or more data needed in formulating a correct diagnosis according to the IHS operational criteria for one of the primary headache disorders. In the remaining 41 cases some data were missing, but the data available were sufficient to reach a diagnosis according to the IHS criteria. Moreover, the diagnoses reached using the computerized structured record were not in agreement with those made by the clinicians in another 39 cases (7.9%) due to an incorrect interpretation by the clinicians of the data reported on the patients' case sheets. In only 2.2% of the cases (n = 11) misdiagnoses were due to errors of the program that were promptly corrected. Conclusions.,The present study suggests that incorrect application of IHS criteria for the diagnosis of primary headache may occur in as many as one third of patients attending headache centers and that use of a computerized structured record based exclusively on current IHS criteria may overcome this deficiency. [source] BRIEF COMMUNICATIONS: A quantity survey of intravenous administration of metronidazole in its different forms in a tertiary teaching hospitalINTERNAL MEDICINE JOURNAL, Issue 8 2010L. L. Lee Abstract The aim of this paper is to examine the prescribing patterns and cost of various formulations of metronidazole in a hospital setting over a 3-month period. Oral metronidazole has high bioavailability (98.9%) with peak plasma concentrations averaged at 2.3 h after dosing. Despite the high bioavailability of oral metronidazole, many patients continue to receive metronidazole intravenously when they are suitable for oral preparation. An audit of 120 consecutive patients prescribed metronidazole was conducted at the Liverpool Hospital, NSW, from March to July 2005. There were 65 men and 55 women (age 18,93). Of the 120 patients, 16 were on oral, 1 on rectal and 103 were on intravenous metronidazole. Treatment was initiated based on clinical diagnoses. Potential pathogens were subsequently identified on only 21 occasions. The use of metronidazole as an oral preparation was contraindicated in 27 patients (22.5%) who were nil-by-mouth. Of these, rectally administered metronidazole was contraindicated in only eight patients. The average course of intravenous metronidazole was 8.0 ± 9.7 days (mean ± SD). The total number of intravenous metronidazole treatment days was 824. Oral metronidazole would have been possible in 618 out of the 824 days. The estimated cost to administer each dose of oral, suppository and intravenous forms of metronidazole is $A0.11, $A1.34 and $A6.09 respectively. Thus, substantial savings could be achieved if oral metronidazole were to be administered whenever possible. The early use of oral or rectal metronidazole should be encouraged when there are no clinical contraindications. [source] | ||||||||||||||||||||||||||||||||||||||||