Clinical Grading (clinical + grading)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Clinical grading of oral mucosa by curve-fitting of corrected autofluorescence using diffuse reflectance spectra

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2010
Rupananda Jayachandra Mallia PhD
Abstract Background Laser-induced autofluorescence (LIAF) and diffuse reflectance (DR) were collectively used in this clinical study to improve early oral cancer diagnosis and tissue grading. Methods LIAF and DR emission from oral mucosa were recorded on a fiber-optic spectrometer by illumination with a 404-nm diode laser and tungsten halogen lamp in 36 healthy volunteers and 40 lesions of 20 patients. Results Absorption dips in LIAF spectra at 545 and 575 nm resulting from changes in oxygenated hemoglobin were corrected using DR spectra of the same site. These corrected spectra were curve-fitted using Gaussian spectral functions to determine constituent emission peaks and their relative contribution. The Gaussian peak intensity and area ratios F500/F635 and F500/F685 were found to be useful indicators of tissue transformation. The diagnostic capability of various ratios in differentiating healthy, hyperplastic, dysplastic, and squamous cell carcinomas (SCCs) were examined using discrimination scatterplots. Conclusions The LIAF/DR technique, in conjunction with curve-fitting, differentiates different grades of dysplasia and SCC in this clinical trial and proves its potential for early detection of oral cavity cancer and tissue grading. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source]


Post pancreaticoduodenectomy haemorrhage: outcome prediction based on new ISGPS Clinical severity grading

HPB, Issue 5 2008
G. Rajarathinam
Abstract Objective & background data. Mortality following pancreatoduodenectomy (PD) has fallen below 5%, yet morbidity remains between 30 and 50%. Major haemorrhage following PD makes a significant contribution to this ongoing morbidity and mortality. The aim of the present study was to validate the new International Study Group of Pancreatic Surgery (ISGPS) Clinical grading system in predicting the outcome of post pancreaticoduodenectomy haemorrhage (PPH). Material and methods. Between January 1998 and December 2007 a total of 458 patients who underwent Whipple's pancreaticoduodenectomy in our department were analysed with regard to haemorrhagic complications. The onset, location and severity of haemorrhage were classified according to the new criteria developed by an ISGPS. Risk factors for haemorrhage, management and outcome were analysed. Results. Severe PPH occurred in 14 patients (3.1%). Early haemorrhage (<24 hours) was recorded in five (36%) patients, and late haemorrhage (>24 hours) in nine (64%) patients. As per Clinical grading of ISGPS 7 (50%) belongs to Grade C and 7 (50%) belongs to Grade B. Haemostasis was attempted by surgery in 10 (71%) patients; angioembolisation was successful in two (14%) and endotherapy in one (7%) patient. The overall mortality is 29%(n=4). Age >60 years (p=0.02), sentinel bleeding (p=0.04), pancreatic leak (p=0.04) and ISGPS Clinical grade C (p=0.02) were associated with increased mortality. Conclusion. Early haemorrhage was mostly managed surgically with better outcome when endoscopy is not feasible. Late haemorrhage is associated with high mortality due to pancreatic leak and sepsis. ISGPS Clinical grading of PPH is useful in predicting the outcome. [source]


Clinical grading of corneal staining of non-contact lens wearers

OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2001
Morven Dundas
Summary To distinguish normal from pathological corneal fluorescein staining requires knowledge of background levels of staining among otherwise healthy individuals. Corneal staining of 102 non-contact lens wearing subjects was assessed using a photographic grading scale that uses a generic (0 to 4) scale to score corneal staining. Some degree of corneal staining was found on 79% of the corneas. Low inter-observer variability suggests that the corneal staining grading scale can be used successfully with decimal rather than integer scale increments. [source]


Intense Pulsed Light Treatment of Photoaged Facial Skin

DERMATOLOGIC SURGERY, Issue 8 2004
Douglas E. Kligman MD
Background. It has been reported that intense pulsed light is efficacious for rejuvenation of photoaged skin, specifically the improvement of appearance of telangiectases and solar lentigines. Objective. The objective was to define the treatment variables for photodamaged facial skin using a newer intense pulsed light system. Methods. Twenty-three female subjects received three treatments using double-stacked pulses with fluences of 24 and 30 J/cm2. Response to treatment was evaluated using digital photography. Three signs of photoaging were evaluated: surface texture/roughness, mottled hyperpigmentation, and erythema/telangiectases. Results. There was a shift in clinical grading from more to less severe on all three measures of photoaging. Conclusion. Intense pulsed light therapy was efficacious in ameliorating the clinical signs of photoaging. The device was well tolerated with minimal side effects. [source]


A tool for scoring of acneiform skin eruptions induced by EGF receptor inhibition

EXPERIMENTAL DERMATOLOGY, Issue 9 2008
Andreas Wollenberg
The National Cancer Institute Common Toxicity Criteria allow for quick severity estimation of a patient, but are not suitable for monitoring the severity of the skin lesions over time, as needed for treatment studies. Here we present our scoring tool for acneiform skin eruptions, which is calculated from body involvement, facial involvement and clinical grading of the skin items erythema, papulation, pustulation and scaling/crusts. The final score is a number between 0 and 100. [source]


High-dose cytosine arabinoside-induced cutaneous reactions

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2002
P Cetkovská
Abstract Background High-dose cytosine arabinoside (HDAC) is being used increasingly to treat haematological malignancies. The therapy is associated with various non-haematological negative side-effects, frequently involving the skin. Objective Our aim was to evaluate the actual occurrence of adverse skin reactions to HDAC over the 10-year period from 1989 to 1999. Methods One hundred and seventy-two subjects, 118 with acute myelogenous leukaemia and 54 with acute lymphoblastic leukaemia, between 16 and 71 years of age were treated with 226 post-remission consolidation regimens with HDAC (54 subjects underwent two cycles of treatment). Treatment was combined with standard doses of other cytotoxic drugs. A prospective study of the skin changes was then performed. Results The overall incidence of cutaneous reactions was almost 53%, with rashes occurring in 72.7% and 40.6% of subjects who received total doses of 30 and 24 g/m2, respectively. In the group of subjects who received a second cycle of treatment not all of those who experienced exanthema after the first cycle (44.4%) experienced this reaction after the second cycle (only 33.3%). The most commonly observed reactions were morbilliform eruptions on the trunk and extremities and acral erythema, although severe reactions with swelling and generalized urticaria developed in some cases. Conclusions HDAC-induced cutaneous reactions in 53% of subjects. The skin changes were found to be dose related and most cleared spontaneously without requiring treatment. A clinical grading of cutaneous toxicity has been proposed to allow better comparison of cutaneous adverse effects in different reports. [source]


Limbal and Bulbar Hyperaemia in Normal Eyes

OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2008
Heiko Pult
Abstract Purpose:, To investigate the appearance of limbal and bulbar hyperaemia in normal eyes, their relationship and the inter-observer agreement of clinical grading. Methods:, The right eyes of 120 healthy, non-contact lens-wearing subjects (m = 57, f = 63, median age = 45 years, range 18,77 years) were examined by two trained observers. Limbal and bulbar hyperaemia were scored using the Cornea and Contact Lens Research Unit (CCLRU) redness grading scales interpolated into 0.1 increments. Redness of four quadrants, and overall, were assessed, and quadrant-average redness was calculated. Inter-observer agreement was assessed at the start and end of the study (20 subjects each). Results:, For limbal redness, the overall (1.62 ± 0.46) (mean units ± S.D.) was not significantly different from the quadrant-average (1.61 ± 0.40) score. For bulbar redness, the overall (2.02 ± 0.49) was higher than the quadrant-average (1.82 ± 0.39) score (p < 0.0001). Significant correlations were found between bulbar and limbal quadrants (Pearson: r , 0.43, p < 0.0001). Significant differences in redness were found between quadrants (p < 0.0001), with nasal and temporal redder than superior and inferior quadrants. Small effects of age and gender were found for limbal redness. The inter-observer 95% limits of agreement were similar at the start and end of the study. They were larger for overall (0.57) compared with quadrant-average (0.28) redness. Conclusions:, For similar populations, a limbal redness above 2.5 or a bulbar redness above 2.6 (quadrant-average) or 3.0 (overall) may be considered abnormal. Limbal and bulbar redness were correlated. Quadrant-average scores are recommended instead of overall scores, as inter-observer agreement was better. [source]


Digital image analysis of plus disease in retinopathy of prematurity

ACTA OPHTHALMOLOGICA, Issue 4 2009
Tariq Aslam
Abstract. An accurate assessment of retinopathy of prematurity (ROP) is essential in ensuring correct and timely treatment of this potentially blinding condition. Current modes of assessment are based upon clinical grading by expert examination of retinal changes. However, this may be subjective, unreliable and difficult and there has been significant interest in alternative means of measurement. These have been made possible through technological advancements in image capture and analysis as well as progress in clinical research, highlighting the specific importance of plus disease in ROP. Progress in these two fields has highlighted the potential for digital image analysis of plus disease to be used as an objective, reliable and valid measurement of ROP. The potential for clinical and scientific advancement through this method is argued and demonstrated in this article. Along with the potential benefits, there are significant challenges such as in image capture, segmentation, measurement of vessel width and tortuosity; these are also addressed. After discussing and explaining the challenges involved, the research articles addressing digital image analysis of ROP are critically reviewed. Benefits and limitations of the currently published techniques for digital ROP assessment are discussed with particular reference to the validity and reliability of outcome measures. Finally, the general limitations of current methods of analysis are discussed and more diverse potential areas of development are discussed. [source]