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Sample records for classification diagnosis treatment

  1. Initial diagnosis and treatment in first-episode psychosis: can an operationalized diagnostic classification system enhance treating clinicians' diagnosis and the treatment chosen?

    LENUS (Irish Health Repository)

    Coentre, Ricardo

    2011-05-01

    Diagnosis during the initial stages of first-episode psychosis is particularly challenging but crucial in deciding on treatment. This is compounded by important differences in the two major classification systems, International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). We aimed to compare the concordance between an operationalized diagnosis using Operational Criteria Checklist (OPCRIT) and treating clinician-generated diagnosis in first episode psychosis diagnosis and its correlation with treatment prescribed.

  2. [Headache: classification and diagnosis].

    Science.gov (United States)

    Carbaat, P A T; Couturier, E G M

    2016-11-01

    There are many types of headache and, moreover, many people have different types of headache at the same time. Adequate treatment is possible only on the basis of the correct diagnosis. Technically and in terms of content the current diagnostics process for headache is based on the 'International Classification of Headache Disorders' (ICHD-3-beta) that was produced under the auspices of the International Headache Society. This classification is based on a distinction between primary and secondary headaches. The most common primary headache types are the tension type headache, migraine and the cluster headache. Application of uniform diagnostic concepts is essential to come to the most appropriate treatment of the various types of headache.

  3. Classification, disease, and diagnosis.

    Science.gov (United States)

    Jutel, Annemarie

    2011-01-01

    Classification shapes medicine and guides its practice. Understanding classification must be part of the quest to better understand the social context and implications of diagnosis. Classifications are part of the human work that provides a foundation for the recognition and study of illness: deciding how the vast expanse of nature can be partitioned into meaningful chunks, stabilizing and structuring what is otherwise disordered. This article explores the aims of classification, their embodiment in medical diagnosis, and the historical traditions of medical classification. It provides a brief overview of the aims and principles of classification and their relevance to contemporary medicine. It also demonstrates how classifications operate as social framing devices that enable and disable communication, assert and refute authority, and are important items for sociological study.

  4. Progress in the diagnosis and classification of pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Luis V Syro

    2015-06-01

    Full Text Available Pituitary adenomas are common neoplasms. Their classification is based upon size, invasion of adjacent structures, sporadic or familial cases, biochemical activity, clinical manifestations, morphological characteristics, response to treatment and recurrence. Although they are considered benign tumors, some of them are difficult to treat due to their tendency to recur, despite standardized treatment. Functional tumors present other challenges for normalizing their biochemical activity. Novel approaches for early diagnosis as well as different perspectives on classification may help to identify subgroups of patients with similar characteristics, creating opportunities to match each patient with the best personalized treatment option. In this paper we present the progress in the diagnosis and classification of different subgroups of patients with pituitary tumors that may be managed with specific considerations according to their tumor subtype.

  5. Mixed-phenotype acute leukemia: state-of-the-art of the diagnosis, classification and treatment.

    Science.gov (United States)

    Cernan, Martin; Szotkowski, Tomas; Pikalova, Zuzana

    2017-09-01

    Mixed-phenotype acute leukemia (MPAL) is a heterogeneous group of hematopoietic malignancies in which blasts show markers of multiple developmental lineages and cannot be clearly classified as acute myeloid or lymphoblastic leukemias. Historically, various names and classifications were used for this rare entity accounting for 2-5% of all acute leukemias depending on the diagnostic criterias used. The currently valid classification of myeloid neoplasms and acute leukemia published by the World Health Organization (WHO) in 2016 refers to this group of diseases as MPAL. Because adverse cytogenetic abnormalities are frequently present, MPAL is generally considered a disease with a poor prognosis. Knowledge of its treatment is limited to retrospective analyses of small patient cohorts. So far, no treatment recommendations verified by prospective studies have been published. The reported data suggest that induction therapy for acute lymphoblastic leukemia followed by allogeneic hematopoietic cell transplantation is more effective than induction therapy for acute myeloid leukemia or consolidation chemotherapy. The establishment of cooperative groups and international registries based on the recent WHO criterias are required to ensure further progress in understanding and treatment of MPAL. This review summarizes current knowledge on the diagnosis, classification, prognosis and treatment of MPAL patients.

  6. Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment.

    Science.gov (United States)

    Lahaie, Marie-André; Boyer, Stéphanie C; Amsel, Rhonda; Khalifé, Samir; Binik, Yitzchak M

    2010-09-01

    Vaginismus is currently defined as an involuntary vaginal muscle spasm interfering with sexual intercourse that is relatively easy to diagnose and treat. As a result, there has been a lack of research interest with very few well-controlled diagnostic, etiological or treatment outcome studies. Interestingly, the few empirical studies that have been conducted on vaginismus do not support the view that it is easily diagnosed or treated and have shed little light on potential etiology. A review of the literature on the classification/diagnosis, etiology and treatment of vaginismus will be presented with a focus on the latest empirical findings. This article suggests that vaginismus cannot be easily differentiated from dyspareunia and should be treated from a multidisciplinary point of view.

  7. PSORIATIC ARTHRITIS: CLASSIFICATION, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

    Directory of Open Access Journals (Sweden)

    T. V. Korotaeva

    2014-01-01

    Full Text Available The lecture gives basic information about psoriatic arthritis (PsA, a chronic inflammatory disease of the joints, spine, and enthesises from a group of spondyloarthritis. It describes the epidemiology of the disease and considers current ideas on its pathogenesis and factors influencing the development of PsA in psoriatic patients. The classification and clinical forms of PsA are presented. The major clinical manifestations of the disease are indicated to include peripheral arthritis, enthesitis, dactylitis, and spondylitis. The diagnosis of the disease is noted to be established on the basis of its detected typical clinical and radiological signs, by applying the CASPAR criteria. A dermatologist, rheumatologist, and general practitioner screen PsA, by actively detecting complaints, characteristic clinical and radiological signs of damage to the joints, and/or spine, and/or enthesises and by using screening questionnaires. There are data that patients with PsA are observed to be at higher risk for a number of diseases type 2 diabetes mellitus hypertension, coronary heart disease, obesity, metabolic syndrome, inflammatory bowel diseases, etc. The aim of current pharmacotherapy for PsA is to achieve remission or minimal activity of clinical manifestations of the disease, to delay or prevent its X-ray progression, to increase survival, to improve quality of life in patients, and to reduce the risk of comorbidities. The paper considers groups of medicines used to treat the disease, among other issues, information about biological agents (BA registered in the Russian Federation for the treatment of PsA. Most patients are mentioned to show a good response to this therapy option just 3–6 months after treatment initiation; however, some of them develop primary inefficiency. In this case, switching one BA to another is recommended. Some patients using a BA develop secondary treatment inefficiency, which is firstly due to the appearance of

  8. HYPERCORTISOLISM: CLASSIFICATION, PATHOGENESIS, CLINICAL MANIFESTATIONS. DIAGNOSIS OF ENDOGENOUS HYPERCORTISOLISM

    Directory of Open Access Journals (Sweden)

    Nikonova L. V.

    2017-02-01

    Full Text Available The relevance of the study of Cushing's syndrome with different etiology as well as the states of hypercorticism, which is not associated with endogenous hypercortisolism, is due to the difficulty of the diagnosis of this disease. Accurate knowledge of the classification criteria for the diagnosis of hypercorticism enables subsequently to establish the correct diagnosis and to administer the appropriate treatment. It was found that the cause of hypercorticism can be endogenous and exogenous factors. There is a particular group of patients requiring screening for hypercorticism using special diagnostic tests. Only a clear understanding of etiopathogenesis of hypercorticism and its clinical manifestations by the specialist, the correct interpretation of diagnostic results make it possible to establish the diagnosis, to administer the appropriate treatment and significantly reduce the morbidity and mortality of patients of this profile and improve their quality of life.

  9. PULMONARY HEMORRHAGE. ENDOSCOPIC DIAGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    A. M. Gasanov

    2016-01-01

    Full Text Available In the article, we report the incidence and etiology of pulmonary hemorrhage, and modern classifications according to the literature data. Methods of endoscopic diagnosis and treatment of pulmonary hemorrhage are analyzed.

  10. Failure diagnosis using deep belief learning based health state classification

    International Nuclear Information System (INIS)

    Tamilselvan, Prasanna; Wang, Pingfeng

    2013-01-01

    Effective health diagnosis provides multifarious benefits such as improved safety, improved reliability and reduced costs for operation and maintenance of complex engineered systems. This paper presents a novel multi-sensor health diagnosis method using deep belief network (DBN). DBN has recently become a popular approach in machine learning for its promised advantages such as fast inference and the ability to encode richer and higher order network structures. The DBN employs a hierarchical structure with multiple stacked restricted Boltzmann machines and works through a layer by layer successive learning process. The proposed multi-sensor health diagnosis methodology using DBN based state classification can be structured in three consecutive stages: first, defining health states and preprocessing sensory data for DBN training and testing; second, developing DBN based classification models for diagnosis of predefined health states; third, validating DBN classification models with testing sensory dataset. Health diagnosis using DBN based health state classification technique is compared with four existing diagnosis techniques. Benchmark classification problems and two engineering health diagnosis applications: aircraft engine health diagnosis and electric power transformer health diagnosis are employed to demonstrate the efficacy of the proposed approach

  11. Objectification of Orthodontic Treatment Needs: Does the Classification of Malocclusions or a History of Orthodontic Treatment Matter?

    Science.gov (United States)

    Kozanecka, Anna; Sarul, Michał; Kawala, Beata; Antoszewska-Smith, Joanna

    2016-01-01

    Orthodontic classifications make it possible to give an accurate diagnosis but do not indicate an objective orthodontic treatment need. In order to evaluate the need for treatment, it is necessary to use such indicators as the IOTN. The aim of the study was to find (i) relationships between individual diagnosis and objective recommendations for treatment and (ii) an answer to the question whether and which occlusal anomalies play an important role in the objectification of treatment needs. Two hundred three 18-year-old adolescents (104 girls, 99 boys) were examined. In order to recognize occlusal anomalies, the classifications proposed by Orlik-Grzybowska and Ackerman-Proffit were used. The occlusal anomalies were divided into three categories: belonging to both classifications, typical of OrlikGrzybowska classification and typical of Ackerman-Proffit classification. In order to determine the objective need for orthodontic treatment, the Dental Health Component (DHC) of the IOTN was used. The occurrence of the following malocclusions covered by both classifications, namely abnormal overjet, crossbite and Angle's class, had a statistically significant (p 3). As for the classification by Orlik-Grzybowska, dental malpositions and canine class significantly affected the need for orthodontic treatment, while in the case of the Ackerman-Proffit scheme, it was asymmetry and crowding. There was no statistically significant correlation between past orthodontic treatment and current orthodontic treatment need. IOTN may be affected by a greater number of occlusal anomalies than it was assumed. Orthodontic treatment received in the past slightly reduces the need for treatment in 18-year-olds.

  12. Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology.

    Science.gov (United States)

    Linsenmaier, Ulrich; Wirth, Stefan; Reiser, Maximilian; Körner, Markus

    2008-10-01

    Pancreatic and duodenal injuries after blunt abdominal trauma are rare; however, delays in diagnosis and treatment can significantly increase morbidity and mortality. Multidetector computed tomography (CT) has a major role in early diagnosis of pancreatic and duodenal injuries. Detecting the often subtle signs of injury with whole-body CT can be difficult because this technique usually does not include a dedicated protocol for scanning the pancreas. Specific injury patterns in the pancreas and duodenum often have variable expression at early posttraumatic multidetector CT: They may be hardly visible, or there may be considerable exudate, hematomas, organ ruptures, or active bleeding. An accurate multidetector CT technique allows optimized detection of subtle abnormalities. In duodenal injuries, differentiation between a contusion of the duodenal wall or mural hematoma and a duodenal perforation is vital. In pancreatic injuries, determination of involvement of the pancreatic duct is essential. The latter conditions require immediate surgical intervention. Use of organ injury scales and a surgical classification adapted for multidetector CT enables classification of organ injuries for trauma scoring, treatment planning, and outcome control. In addition, multidetector CT reliably demonstrates potential complications of duodenal and pancreatic injuries, such as posttraumatic pancreatitis, pseudocysts, fistulas, exudates, and abscesses. (c) RSNA, 2008.

  13. Burning mouth syndrome: a review on diagnosis and treatment.

    Science.gov (United States)

    Coculescu, E C; Radu, A; Coculescu, B I

    2014-01-01

    Burning mouth syndrome (BMS) is defined as a chronic pain condition characterized by a burning sensation in the clinically healthy oral mucosa. It is difficult to diagnose BMS because there is a discrepancy between the severity, extensive objective pain felt by the patient and the absence of any clinical changes of the oral mucosa. This review presents some aspects of BMS, including its clinical diagnosis, classification, differential diagnosis, general treatment, evolution and prognosis.

  14. Advances in the diagnosis and treatment of pancreatic neuroendocrine neoplasms in Japan.

    Science.gov (United States)

    Ito, Tetsuhide; Hijioka, Susumu; Masui, Toshihiko; Kasajima, Atsuko; Nakamoto, Yuji; Kobayashi, Noritoshi; Komoto, Izumi; Hijioka, Masayuki; Lee, Lingaku; Igarashi, Hisato; Jensen, Robert Thomas; Imamura, Masayuki

    2017-01-01

    Several new developments have occurred in the field of pancreatic neuroendocrine neoplasm (PNEN) recently in Japan. First, the utility of chromogranin A (CgA), useful for the diagnosis and monitoring of the treatment response of neuroendocrine neoplasm (NEN), has been demonstrated in Japan. For PNEN diagnosis and treatment, grading and correct histological diagnosis according to the WHO 2010 classification is important. Regarding the histological diagnosis, the advent of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has enabled correct pathological diagnosis and suitable treatment for the affected tissue. Furthermore, EUS-FNA has also facilitates the assessment of the presence or absence of gene mutations. In addition, patients who have a well-differentiated neuroendocrine tumor (NET) showing a Ki-67 index of higher than 20 % according to the WHO 2010 classification, have also been identified, and their responses to treatment were found to be different from those of patients with poorly differentiated neuroendocrine carcinoma (NEC). Therefore, the concept of NET G3 was proposed. Additionally, somatostatin receptor type 2 is expressed in several cases of NET, and somatostatin receptor scintigraphy ( 111 In-octreoscan) has also been approved in Japan. This advancement will undoubtedly contribute to the localization diagnosis, the identification of remote metastasis, and assessments of the treatment responses of PNEN. Finally, regarding the treatment strategy for PNEN, the management of liver metastasis is important. The advent of novel molecular-targeted agents has dramatically improved the prognosis of advanced PNEN. Multimodality therapy that accounts for the tumor stage, degree of tumor differentiation, tumor volume, and speed of tumor growth is required.

  15. The method of diagnosis and classification of the gingival line defects of the teeth hard tissues

    Directory of Open Access Journals (Sweden)

    Olena Bulbuk

    2017-06-01

    Full Text Available For solving the problem of diagnosis and treatment of hard tissue defects the significant role belongs to the choice of tactics for dental treatment of hard tissue defects located in the gingival line of any tooth. This work aims to study the problems of diagnosis and classification of gingival line defects of the teeth hard tissues. That will contribute to the objectification of differentiated diagnostic and therapeutic approaches in the dental treatment of various clinical variants of these defects localization. The objective of the study – is to develop the anatomical-functional classification for differentiated estimation of hard tissue defects in the gingival part, as the basis for the application of differential diagnostic-therapeutic approaches to the dental treatment of hard tissue defects disposed in the gingival part of any tooth. Materials and methods of investigation: There was conducted the examination of 48 patients with hard tissue defects located in the gingival part of any tooth. To assess the magnitude of gingival line destruction the periodontal probe and X-ray examination were used. Results. The result of the performed research the classification of the gingival line defects of the hard tissues was offered using exponent power. The value of this indicator is equal to an integer number expressed in millimeters of distance from the epithelial attachment to the cavity’s bottom of defect. Conclusions. The proposed classification fills an obvious gap in academic representations about hard tissue defects located in the gingival part of any tooth. Also it offers the prospects of consensus on differentiated diagnostic-therapeutic approaches in different clinical variants of location.  This classification builds methodological “bridge of continuity” between therapeutic and prosthetic dentistry in the field of treatment of the gingival line defects of dental hard tissues.

  16. Chronic pancreatitis: diagnosis, classification, and new genetic developments.

    Science.gov (United States)

    Etemad, B; Whitcomb, D C

    2001-02-01

    The utilization of recent advances in molecular and genomic technologies and progress in pancreatic imaging techniques provided remarkable insight into genetic, environmental, immunologic, and pathobiological factors leading to chronic pancreatitis. Translation of these advances into clinical practice demands a reassessment of current approaches to diagnosis, classification, and staging. We conclude that an adequate pancreatic biopsy must be the gold standard against which all diagnostic approaches are judged. Although computed tomography remains the initial test of choice for the diagnosis of chronic pancreatitis, the roles of endoscopic retrograde pancreatography, endoscopic ultrasonography, and magnetic resonance imaging are considered. Once chronic pancreatitis is diagnosed, proper classification becomes important. Major predisposing risk factors to chronic pancreatitis may be categorized as either (1) toxic-metabolic, (2) idiopathic, (3) genetic, (4) autoimmune, (5) recurrent and severe acute pancreatitis, or (6) obstructive (TIGAR-O system). After classification, staging of pancreatic function, injury, and fibrosis becomes the next major concern. Further research is needed to determine the clinical and natural history of chronic pancreatitis developing in the context of various risk factors. New methods are needed for early diagnosis of chronic pancreatitis, and new therapies are needed to determine whether interventions will delay or prevent the progression of the irreversible damage characterizing end-stage chronic pancreatitis.

  17. ETIOLOGY CLASSIFICATION AND TREATMENT NEEDS (TN FOR ORAL MALODOR

    Directory of Open Access Journals (Sweden)

    Anton Raharjo

    2015-08-01

    Full Text Available Background: Oral malodor, a generic descriptor term for foul smells emanating from the mouth can be classified as either pathological or physiological halitosis. Some problems are often confounded by the clinician's mismanagement. Objective: This paper reviews the etiology of classification and determination of treatment needs (TN for oral malodor. Literature review and discussion: In the majority of cases the problem has been shown to originate in the oral cavity. Although oral malodor cases are often related to physiological aspects, sometimes they can be related to extra oral sources and psychological aspects. Classification methods of oral malodor with corresponding treatment needs (TN have already been established. Although PTC & tongue brushing and appropriate mouthrinses are both important and basic treatment measures for halitosis, other dental treatments are sometimes required. Conclusion: Accurate screening and diagnosis of halitosis followed by appropriate TN may give better results and consequently reduce the risk of mismanagement.

  18. Classification of MR brain images by combination of multi-CNNs for AD diagnosis

    Science.gov (United States)

    Cheng, Danni; Liu, Manhua; Fu, Jianliang; Wang, Yaping

    2017-07-01

    Alzheimer's disease (AD) is an irreversible neurodegenerative disorder with progressive impairment of memory and cognitive functions. Its early diagnosis is crucial for development of future treatment. Magnetic resonance images (MRI) play important role to help understand the brain anatomical changes related to AD. Conventional methods extract the hand-crafted features such as gray matter volumes and cortical thickness and train a classifier to distinguish AD from other groups. Different from these methods, this paper proposes to construct multiple deep 3D convolutional neural networks (3D-CNNs) to learn the various features from local brain images which are combined to make the final classification for AD diagnosis. First, a number of local image patches are extracted from the whole brain image and a 3D-CNN is built upon each local patch to transform the local image into more compact high-level features. Then, the upper convolution and fully connected layers are fine-tuned to combine the multiple 3D-CNNs for image classification. The proposed method can automatically learn the generic features from imaging data for classification. Our method is evaluated using T1-weighted structural MR brain images on 428 subjects including 199 AD patients and 229 normal controls (NC) from Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Experimental results show that the proposed method achieves an accuracy of 87.15% and an AUC (area under the ROC curve) of 92.26% for AD classification, demonstrating the promising classification performances.

  19. Urinary Tract Infections in Pregnancy - Diagnosis, Treatment and Prevention

    OpenAIRE

    Figueiredo, A; Gomes, G; Campos, A

    2012-01-01

    Objectives: Literature review of classification, epidemiology, pathophysiology, microbiology, clinical presentation, diagnosis, complications, treatment and prevention of urinary tract infections (UTI) in pregnancy. Data Sources and Review Methods: Bibliographic research in Medline, through PubMed and Medscape, of systematic reviews, observational studies, clinical guidelines, meta-analyses and randomized controlled trials published between January 1992 and December 2010. Results: Asymp...

  20. Optimized Neural Network for Fault Diagnosis and Classification

    International Nuclear Information System (INIS)

    Elaraby, S.M.

    2005-01-01

    This paper presents a developed and implemented toolbox for optimizing neural network structure of fault diagnosis and classification. Evolutionary algorithm based on hierarchical genetic algorithm structure is used for optimization. The simplest feed-forward neural network architecture is selected. Developed toolbox has friendly user interface. Multiple solutions are generated. The performance and applicability of the proposed toolbox is verified with benchmark data patterns and accident diagnosis of Egyptian Second research reactor (ETRR-2)

  1. Cascade classification of endocytoscopic images of colorectal lesions for automated pathological diagnosis

    Science.gov (United States)

    Itoh, Hayato; Mori, Yuichi; Misawa, Masashi; Oda, Masahiro; Kudo, Shin-ei; Mori, Kensaku

    2018-02-01

    This paper presents a new classification method for endocytoscopic images. Endocytoscopy is a new endoscope that enables us to perform conventional endoscopic observation and ultramagnified observation of cell level. This ultramagnified views (endocytoscopic images) make possible to perform pathological diagnosis only on endo-scopic views of polyps during colonoscopy. However, endocytoscopic image diagnosis requires higher experiences for physicians. An automated pathological diagnosis system is required to prevent the overlooking of neoplastic lesions in endocytoscopy. For this purpose, we propose a new automated endocytoscopic image classification method that classifies neoplastic and non-neoplastic endocytoscopic images. This method consists of two classification steps. At the first step, we classify an input image by support vector machine. We forward the image to the second step if the confidence of the first classification is low. At the second step, we classify the forwarded image by convolutional neural network. We reject the input image if the confidence of the second classification is also low. We experimentally evaluate the classification performance of the proposed method. In this experiment, we use about 16,000 and 4,000 colorectal endocytoscopic images as training and test data, respectively. The results show that the proposed method achieves high sensitivity 93.4% with small rejection rate 9.3% even for difficult test data.

  2. CURRENT PROBLEMS OF DIAGNOSIS AND TREATMENT OF MILD COGNITIVE IMPAIRMENTS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    G.A. Karkashadze

    2011-01-01

    Full Text Available In practical pediatrics specialists paid wrongly little attention to identification and treatment of cognitive disorders in children. At the same time it is difficult to overestimate the influence of cognitive functions on the formation of human personality and social maladjustment in this part of population. The paper is devoted to the diagnosis and treatment of cognitive impairments. In addition, the classification of this pathology, highlighting aetiopathogenetic factors, prognosis are showed. One of the important problems of early revealing of cognitive impairments and appropriate management of children with this pathology according to the authors opinion are the following: the deficiency of educational programs for training specialists in neurology, lack of knowledge concerning the possibilities of psychological-pedagogical correction, inefficient system of neurological techniques for primary care. Key words: cognitive function, mild cognitive impairment, classification, diagnosis, treatment, prognosis, social maladjustment, psychopedagogical support, children. (Pediatric Pharmacology. — 2011; 8 (5: 37–41.

  3. [Diagnosis and treatment of congenital biliary duct cyst: twenty-year experience].

    Science.gov (United States)

    Peng, S; Shi, L; Peng, C; Yang, D; Ji, Z; Wu, Y; Liu, Y; Gao, N; Chen, H

    2001-12-01

    To summarize the experience in diagnosis and treatment of congenital biliary duct cyst. Clinical data from 108 patients treated from 1980 to 2000 were analyzed retrospectively. Abdominal pain, jaundice and abdominal mass were presented in most pediatric patients. Clinical symptoms in adult patients were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatic biliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%). Ultrasonic examination was performed in 94 patients, ERCP in 46, and CT in 71. All of the patients were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985, the diagnosis and classification of congenital biliary duct cyst were established by ultrasonography preoperatively and confirmed during operation. The main procedure was internal drainage by cyst-enterostomy. After 1985, the diagnosis was decided with ERCP and CT, the procedure was cyst excision with Roux-en-Y hepaticojejunostomy. In 1994, we used a new and simplified operative procedure to reduce the risk of malignancy of choledochal cyst. Retrograde infection of the biliary tract the major postoperative complication, could be controlled by the administration of antibiotics. The concept in diagnosis and treatment of congenital choledochal cyst has been changed greatly. CT and ERCP are of great help in the classification of the disease. Currently, cyst excision with Roux-en-Y hepaticojejunostomy is strongly recommended as the treatment of choice for patients with type I and IV cysts. Piggyback orthotopic liver transplantation is indicated for type V cysts (Caroli's disease) with frequently recurrent cholangitis, resulting in biliary cirrhosis.

  4. A New Feature Ensemble with a Multistage Classification Scheme for Breast Cancer Diagnosis

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    Idil Isikli Esener

    2017-01-01

    Full Text Available A new and effective feature ensemble with a multistage classification is proposed to be implemented in a computer-aided diagnosis (CAD system for breast cancer diagnosis. A publicly available mammogram image dataset collected during the Image Retrieval in Medical Applications (IRMA project is utilized to verify the suggested feature ensemble and multistage classification. In achieving the CAD system, feature extraction is performed on the mammogram region of interest (ROI images which are preprocessed by applying a histogram equalization followed by a nonlocal means filtering. The proposed feature ensemble is formed by concatenating the local configuration pattern-based, statistical, and frequency domain features. The classification process of these features is implemented in three cases: a one-stage study, a two-stage study, and a three-stage study. Eight well-known classifiers are used in all cases of this multistage classification scheme. Additionally, the results of the classifiers that provide the top three performances are combined via a majority voting technique to improve the recognition accuracy on both two- and three-stage studies. A maximum of 85.47%, 88.79%, and 93.52% classification accuracies are attained by the one-, two-, and three-stage studies, respectively. The proposed multistage classification scheme is more effective than the single-stage classification for breast cancer diagnosis.

  5. PSORIATIC ARTHRITIS: CLASSIFICATION, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

    Directory of Open Access Journals (Sweden)

    T. V. Korotaev

    2018-01-01

    Full Text Available soriatic arthritis (PsA is a chronic inflammatory disease of the joints, spine and entheses from a group of spondyloarthritis (SpA, which is usually observed in patients with psoriasis (Ps. The diagnosis of PsA is based on the CASPAR criteria for psoriatic arthritis. The disease results from interactions between genetic, immunological and environmental factors. The main clinical manifestations of PsA include peripheral arthritis, enthesitis, dactylitis, and spondylitis. PsA must be differentiated from rheumatoid arthritis, gout, reactive arthritis, osteoarthritis, and ankylosing spondylitis. Due to the fact that PsA is a clinically heterogeneous disease, its activity is assessed using complex indices, by taking into account that the patient has arthritis, enthesitis, dactylitis, and spondylitis. The goal of treatment for PsA is to achieve remission or minimal activity of the main clinical manifestations of the disease, to slow down or prevent radiographic progression, to increase life expectancy and quality of life in the patients, and to reduce the risk of comorbidities, which is achieved through a wide range of drugs of different classes. Therapy should be chosen based on the clinical manifestations of PsA and comorbidities in the patients. 

  6. [Status of diagnosis and treatment devices of acupuncture based on SooPAT and bibliometrics in China].

    Science.gov (United States)

    Bai, Lin; Ren, Yulan; Guo, Taipin; Chen, Lin; Zhou, Yumei; Feng, Shuwei; Li, Ji; Liang, Fanrong

    2016-11-12

    To perform a bibliometrics analysis on patent literature regarding diagnosis and treatment devices of acupuncture in China, aiming to provide references for the development of diagnosis and treatment devices of acupuncture. Based on SooPAT, a patent database, the patent literature regarding diagnosis and treatment devices of acupuncture in China was collected. With bibliometrics methods, the annual distribution of type, quantity, classification and content of diagnosis and treatment devices of acupuncture were analyzed. The number of acupuncture diagnosis and treatment devices reached its peak in 2012 and 2013 in China. The A61N in patent and utility model patent were the most, which were mainly related to electrotherapy, magnetic therapy, radioactive therapy and ultrasound therapy, etc. The main content was acupuncture treatment devices and meridian treatment devices. The 24-01 in design patent was the most, involving fixation devices used by doctors, hospitals and laboratories, etc. Currently the majority of diagnosis and treatment devices of acupuncture is therapeutic apparatus, while the acupuncture diagnosis devices are needed.

  7. Malignant fatty tumors: classification, clinical course, imaging appearance and treatment

    International Nuclear Information System (INIS)

    Peterson, J.J.; Kransdorf, M.J.; Bancroft, L.W.; O'Connor, M.I.

    2003-01-01

    Liposarcoma is a relatively common soft tissue malignancy with a wide spectrum of clinical presentations and imaging appearances. Several subtypes are described, ranging from lesions nearly entirely composed of mature adipose tissue, to tumors with very sparse adipose elements. The imaging appearance of these fatty masses is frequently sufficiently characteristic to allow a specific diagnosis, while in other cases, although a specific diagnosis is not achievable, a meaningful limited differential diagnosis can be established. The purpose of this paper is to review the spectrum of malignant fatty tumors, highlighting the current classification system, clinical presentation and behavior, treatment and spectrum of imaging appearances. The imaging review will emphasize CT scanning and MR imaging, and will stress differentiating radiologic features. (orig.)

  8. Benign fatty tumors: classification, clinical course, imaging appearance, and treatment

    International Nuclear Information System (INIS)

    Bancroft, Laura W.; Kransdorf, Mark J.; Peterson, Jeffrey J.; O'Connor, Mary I.

    2006-01-01

    Lipoma is the most common soft-tissue tumor, with a wide spectrum of clinical presentations and imaging appearances. Several subtypes are described, ranging from lesions entirely composed of mature adipose tissue to tumors intimately associated with nonadipose tissue, to those composed of brown fat. The imaging appearance of these fatty masses is frequently sufficiently characteristic to allow a specific diagnosis. However, in other cases, although a specific diagnosis is not achievable, a meaningful limited differential diagnosis can be established. The purpose of this manuscript is to review the spectrum of benign fatty tumors highlighting the current classification system, clinical presentation and behavior, spectrum of imaging appearances, and treatment. The imaging review emphasizes computed tomography (CT) scanning and magnetic resonance (MR) imaging, differentiating radiologic features. (orig.)

  9. MERRF Classification: Implications for Diagnosis and Clinical Trials.

    Science.gov (United States)

    Finsterer, Josef; Zarrouk-Mahjoub, Sinda; Shoffner, John M

    2018-03-01

    Given the etiologic heterogeneity of disease classification using clinical phenomenology, we employed contemporary criteria to classify variants associated with myoclonic epilepsy with ragged-red fibers (MERRF) syndrome and to assess the strength of evidence of gene-disease associations. Standardized approaches are used to clarify the definition of MERRF, which is essential for patient diagnosis, patient classification, and clinical trial design. Systematic literature and database search with application of standardized assessment of gene-disease relationships using modified Smith criteria and of variants reported to be associated with MERRF using modified Yarham criteria. Review of available evidence supports a gene-disease association for two MT-tRNAs and for POLG. Using modified Smith criteria, definitive evidence of a MERRF gene-disease association is identified for MT-TK. Strong gene-disease evidence is present for MT-TL1 and POLG. Functional assays that directly associate variants with oxidative phosphorylation impairment were critical to mtDNA variant classification. In silico analysis was of limited utility to the assessment of individual MT-tRNA variants. With the use of contemporary classification criteria, several mtDNA variants previously reported as pathogenic or possibly pathogenic are reclassified as neutral variants. MERRF is primarily an MT-TK disease, with pathogenic variants in this gene accounting for ~90% of MERRF patients. Although MERRF is phenotypically and genotypically heterogeneous, myoclonic epilepsy is the clinical feature that distinguishes MERRF from other categories of mitochondrial disorders. Given its low frequency in mitochondrial disorders, myoclonic epilepsy is not explained simply by an impairment of cellular energetics. Although MERRF phenocopies can occur in other genes, additional data are needed to establish a MERRF disease-gene association. This approach to MERRF emphasizes standardized classification rather than clinical

  10. Classification, diagnosis, and approach to treatment for angioedema

    DEFF Research Database (Denmark)

    Cicardi, M; Aberer, W; Banerji, A

    2014-01-01

    Angioedema is defined as localized and self-limiting edema of the subcutaneous and submucosal tissue, due to a temporary increase in vascular permeability caused by the release of vasoactive mediator(s). When angioedema recurs without significant wheals, the patient should be diagnosed to have...... angioedema as a distinct disease. In the absence of accepted classification, different types of angioedema are not uniquely identified. For this reason, the European Academy of Allergy and Clinical Immunology gave its patronage to a consensus conference aimed at classifying angioedema. Four types of acquired...... and three types of hereditary angioedema were identified as separate forms from the analysis of the literature and were presented in detail at the meeting. Here, we summarize the analysis of the data and the resulting classification of angioedema....

  11. Barrett's esophagus. Diagnosis, follow-up and treatment

    DEFF Research Database (Denmark)

    Bremholm, Lasse; Funch-Jensen, Peter; Eriksen, Jan

    2012-01-01

    gastroesophageal junction. The extent of the endoscopic findings is described by the Prague classification. The metaplasia is histologically confirmed by the presence of intestinal metaplasia. The diagnosis of BE can only be made by a combined macroscopic and microscopic examination. The histological description...... and it is not recommended outside controlled studies. Treatment of high grade dysplasia and carcinoma in situ is handled in departments treating esophageal cancer. Follow-up with endoscopy and biopsy can be offered. Follow-up endoscopy with biopsy can only be recommended after thorough information to the patients...

  12. Diagnosis, treatment and prognosis of neuroendocrine tumor in stomach and duodenum

    Directory of Open Access Journals (Sweden)

    Xiang-yao WANG

    2016-04-01

    Full Text Available Objective  To investigate the clinicopathological characteristics and prognosis of patients with neuroendocrine tumor in stomach and duodenum for early diagnosis. Methods  The clinical, endoscopic and pathological data of 20 patients admitted to the PLA General Hospital from Jan. 2012 to Jan. 2015 and diagnosed as gastric and duodenal neuroendocrine tumor were collected for retrospective analysis. The histopathological classification of the disease was made according to the WHO 2010 Classification of the Neuroendocrine Neoplasms. Result  Ten male and 10 female patients aged between 35 and 77 (mean 55.5±10.6 years old were recruited in the present study. Tumor located in the stomach in 13 cases, and in duodenum in 7 cases. The maximum diameter of the tumor was 0.2-2.5cm. Endoscopic features included polypoid protrusion, hemispheric submucosal protrusion, and mucosal erosion. All the patients were treated endoscopically, among them, four patients were treated with electrocoagulation and electrosection, 10 by endoscopic resection (EMR, and 6 by endoscopic submucosal dissection (ESD. In one patient, surgical excision was done after ESD. Biopsy under gastroscopy and endoscopic ultrasonography were conducive to the diagnosis and treatment. According to the histopathological classification, 19 cases were classified as NET grade 1, and another one as NET grade 2. The follow-up study showed no metastasis and recurrence. Conclusions  The early diagnosis and treatment for gastric and duodenal neuroendocrine tumor can lead to satisfactory results. DOI: 10.11855/j.issn.0577-7402.2016.03.12

  13. X-ray diagnosis of esophageal cancer and application of Borrmann's classification

    International Nuclear Information System (INIS)

    Chin, Soo Yil

    1985-01-01

    In 126 cases and who were diagnosed as esophageal cancer and treated by radiation at Cancer Research Hospital, K. A. E. R. I., from January 1974 to July 1979, a study on the x-ray diagnosis of esophageal cancer was carried out mainly as to the type classification. The ordinary classification od esophageal cancer by x-ray picture was reviewed and Borrmann's classification using gastric cancer was tried to apply to the macroscopic classification of esophageal cancer, and also the application of this classification to x-ray diagnosis was discussed. And the effect of radiotherapy as to each type of cancer according to the ordinary x-ray classification and Borrmann's classification was studied too. The results were as follows: 1. The ordinary x-ray classification was not simple, because the degree of progression of cancer, difference of mural invasion, and position and method of radiography could make misinterpretation of the type of cancer and the therapeutic effect by radiation as to each type according to this classification did not represent a significant characteristic too, although the radiation was most effective in the polypoidal type and least effective in funnel type. 2. The Borrmann's classification was relatively easy even on the radiogram because of little overlapping between each type and the type became more evident on the resected specimen after operation. And also some correlation was recognized between the type of Borrmann's classification and radiotherapeutic effect. The effect was best in type I and It was gradually decreased in type II, III, and IV in the other. The radiotherapy was ineffective in about three quarters of type IV. 3. The Borrmann's classification is now employed to the carcinoma of large bowel, as well as to the gastric cancer. If it is applied to the esophageal cancer, the macroscopic classification for the cancer of digestive tract can be systemized and it will be convenient in clinical study.

  14. Inherited epidermolysis bullosa : Updated recommendations on diagnosis and classification

    NARCIS (Netherlands)

    Fine, Jo-David; Bruckner-Tuderman, Leena; Eady, Robin A. J.; Bauer, Eugene A.; Bauer, Johann W.; Has, Cristina; Heagerty, Adrian; Hintner, Helmut; Hovnanian, Alain; Jonkman, Marcel F.; Leigh, Irene; Marinkovich, M. Peter; Martinez, Anna E.; McGrath, John A.; Mellerio, Jemima E.; Moss, Celia; Murrell, Dedee F.; Shimizu, Hiroshi; Uitto, Jouni; Woodley, David; Zambruno, Giovanna

    Background: Several newtargeted genes and clinical subtypes have been identified since publication in 2008 of the report of the last international consensus meeting on diagnosis and classification of epidermolysis bullosa (EB). As a correlate, new clinical manifestations have been seen in several

  15. The diagnosis and management of pre-invasive breast disease: Pathological diagnosis – problems with existing classifications

    International Nuclear Information System (INIS)

    Van de Vijver, Marc J; Peterse, Hans

    2003-01-01

    In this review, we comment on the reasons for disagreement in the concepts, diagnosis and classifications of pre-invasive intraductal proliferations. In view of these disagreements, our proposal is to distinguish epithelial hyperplasia, lobular carcinoma in situ and ductal carcinoma in situ, and to abandon the use of poorly reproducible categories, such as atypical ductal hyperplasia or ductal intraepithelial neoplasia, followed by a number to indicate the degree of proliferation and atypia, as these are not practical for clinical decision making, nor for studies aimed at improving the understanding of breast cancer development. If there is doubt about the classification of an intraductal proliferation, a differential diagnosis and the reason for and degree of uncertainty should be given, rather than categorizing a proliferation as atypical

  16. Gastric cancer: epidemiology, prevention, classification, and treatment

    Directory of Open Access Journals (Sweden)

    Sitarz R

    2018-02-01

    Full Text Available Robert Sitarz,1–3 Małgorzata Skierucha,1,2 Jerzy Mielko,1 G Johan A Offerhaus,3 Ryszard Maciejewski,2 Wojciech P Polkowski1 1Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland; 2Department of Human Anatomy, Medical University of Lublin, Lublin, Poland; 3Department of Pathology, University Medical Centre, Utrecht, The Netherlands Abstract: Gastric cancer is the second most common cause of cancer-related deaths in the world, the epidemiology of which has changed within last decades. A trend of steady decline in gastric cancer incidence rates is the effect of the increased standards of hygiene, conscious nutrition, and Helicobacter pylori eradication, which together constitute primary prevention. Avoidance of gastric cancer remains a priority. However, patients with higher risk should be screened for early detection and chemoprevention. Surgical resection enhanced by standardized lymphadenectomy remains the gold standard in gastric cancer therapy. This review briefly summarizes the most important aspects of gastric cancers, which include epidemiology, risk factors, classification, diagnosis, prevention, and treatment. The paper is mostly addressed to physicians who are interested in updating the state of art concerning gastric carcinoma from easily accessible and credible source. Keywords: gastric cancer, epidemiology, classification, risk factors, treatment

  17. Computer-aided diagnosis scheme for histological classification of clustered microcalcifications on magnification mammograms

    International Nuclear Information System (INIS)

    Nakayama, Ryohei; Uchiyama, Yoshikazu; Watanabe, Ryoji; Katsuragawa, Shigehiko; Namba, Kiyoshi; Doi, Kunio

    2004-01-01

    The histological classification of clustered microcalcifications on mammograms can be difficult, and thus often require biopsy or follow-up. Our purpose in this study was to develop a computer-aided diagnosis schemefor identifying the histological classification of clustered microcalcifications on magnification mammograms in order to assist the radiologists' interpretation as a 'second opinion'. Our database consisted of 58 magnification mammograms, which included 35 malignant clustered microcalcifications (9 invasive carcinomas, 12 noninvasive carcinomas of the comedo type, and 14 noninvasive carcinomas of the noncomedo type) and 23 benign clustered microcalcifications (17 mastopathies and 6 fibroadenomas). The histological classifications of all clustered microcalcifications were proved by pathologic diagnosis. The clustered microcalcifications were first segmented by use of a novel filter bank and a thresholding technique. Five objective features on clustered microcalcifications were determined by taking into account subjective features that experienced the radiologists commonly use to identify possible histological classifications. The Bayes decision rule with five objective features was employed for distinguishing between five histological classifications. The classification accuracies for distinguishing between three malignant histological classifications were 77.8% (7/9) for invasive carcinoma, 75.0% (9/12) for noninvasive carcinoma of the comedo type, and 92.9% (13/14) for noninvasive carcinoma of the noncomedo type. The classification accuracies for distinguishing between two benign histological classifications were 94.1% (16/17) for mastopathy, and 100.0% (6/6) for fibroadenoma. This computerized method would be useful in assisting radiologists in their assessments of clustered microcalcifications

  18. Dry eye disease: pathophysiology, classification, and diagnosis.

    Science.gov (United States)

    Perry, Henry D

    2008-04-01

    Dry eye disease (DED) is a multifactorial disorder of the tear film and ocular surface that results in eye discomfort, visual disturbance, and often ocular surface damage. Although recent research has made progress in elucidating DED pathophysiology, currently there are no uniform diagnostic criteria. This article discusses the normal anatomy and physiology of the lacrimal functional unit and the tear film; the pathophysiology of DED; DED etiology, classification, and risk factors; and DED diagnosis, including symptom assessment and the roles of selected diagnostic tests.

  19. Semi-Supervised Classification for Fault Diagnosis in Nuclear Power Plants

    International Nuclear Information System (INIS)

    Ma, Jian Ping; Jiang, Jin

    2014-01-01

    Pattern classification methods have become important tools for fault diagnosis in industrial systems. However, it is normally difficult to obtain reliable labeled data to train a supervised pattern classification model for applications in a nuclear power plant (NPP). However, unlabeled data easily become available through increased deployment of supervisory, control, and data acquisition (SCADA) systems. In this paper, a fault diagnosis scheme based on semi-supervised classification (SSC) method is developed with specific applications for NPP. In this scheme, newly measured plant data are treated as unlabeled data. They are integrated with selected labeled data to train a SSC model which is then used to estimate labels of the new data. Compared to exclusive supervised approaches, the proposed scheme requires significantly less number of labeled data to train a classifier. Furthermore, it is shown that higher degree of uncertainties in the labeled data can be tolerated. The developed scheme has been validated using the data generated from a desktop NPP simulator and also from a physical NPP simulator using a graph-based SSC algorithm. Two case studies have been used in the validation process. In the first case study, three faults have been simulated on the desktop simulator. These faults have all been classified successfully with only four labeled data points per fault case. In the second case, six types of fault are simulated on the physical NPP simulator. All faults have been successfully diagnosed. The results have demonstrated that SSC is a promising tool for fault diagnosis

  20. Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China.

    Science.gov (United States)

    Shi, L B; Peng, S Y; Meng, X K; Peng, C H; Liu, Y B; Chen, X P; Ji, Z L; Yang, D T; Chen, H R

    2001-10-01

    To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years (1980-2000). The clinical data of 108 patients admitted from 1980 to 2000 were analyzed retrospectively. Abdominal pain,jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%). Ultrasonic examination was undertaken in 94 cases, ERCP performed in 46 cases and CT in 71 cases. All of the cases were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985 the diagnosis and classification of congenital choledochal cyst were established by ultrasonography preoperatively and confirmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedures.In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complication was mainly retrograde infection of biliary tract, which could be controlled by the administration of antibiotics, there was no perioperative mortality. The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly.CT and ERCP were of great help in the classification of the disease.Currently, cystectomy with Roux-en-Y hepaticojejunostomy is strongly recommended as the choice for patients with type I and type IV cysts. Piggyback orthotopic liver transplantation is indicated in type V cysts (Caroli's disease) with frequently recurrent cholangitis.

  1. Cutaneous Leiomyoma: Novel Histologic Findings for Classification and Diagnosis

    Directory of Open Access Journals (Sweden)

    Kambiz Kamyab Hesari

    2013-01-01

    Full Text Available Smooth muscle tumors rather benign or malignant can arise wherever the muscular tissue presents but cutaneous leiomyoma is one of the rare benign tumors of the which even the diagnostic criteria from the malignant type of the tumor is still in doubt. This study was aimed to compare the subtypes of cutaneous leiomyoma from different histologic aspects in order to find unique criteria for better classification and diagnosis. The six year data base of our center was reviewed and 25 patients with cutaneous leiomyoma were included in this study. Of 25 patients, 5 were female and 20 were male. 5 patients had angioleiomyoma (ALM and 20 had pilar leiomyoma (PLM. ALM had following characteristics: dilated vascular canals intermingled with compact smooth muscle bundles; well circumscribe counter and myxoid and hyaline changes through the tumor. In contrast, PLMs had following histologic features: poor defined outline, entrapped hair follicles and eccrine glands, acanthosis and elongated rete ridges with hyperpigmentation and smooth muscle bundles which are interdigitated with elongated rete ridges. Here we introduced some distinct histological features for each subtype of the cutaneous leiomyoma which can lead to create novel criteria for classification and diagnosis of the lesion.

  2. Improved Classification by Non Iterative and Ensemble Classifiers in Motor Fault Diagnosis

    Directory of Open Access Journals (Sweden)

    PANIGRAHY, P. S.

    2018-02-01

    Full Text Available Data driven approach for multi-class fault diagnosis of induction motor using MCSA at steady state condition is a complex pattern classification problem. This investigation has exploited the built-in ensemble process of non-iterative classifiers to resolve the most challenging issues in this area, including bearing and stator fault detection. Non-iterative techniques exhibit with an average 15% of increased fault classification accuracy against their iterative counterparts. Particularly RF has shown outstanding performance even at less number of training samples and noisy feature space because of its distributive feature model. The robustness of the results, backed by the experimental verification shows that the non-iterative individual classifiers like RF is the optimum choice in the area of automatic fault diagnosis of induction motor.

  3. Comparison of clinical causes of death with autopsy diagnosis using discrepency classification.

    Science.gov (United States)

    Ullah, Khalil; Alamgir, Wasim

    2006-12-01

    To determine the usefulness of autopsy findings in the quality improvement of patients care. An observational study. Departments of Pathology and Medicine, Combined Military Hospital (CMH) Kharian, a tertiary care hospital, from January 2001 to December 2003. The clinical and necropsy findings of all the cases, who died in hospital and had undergone autopsy examination at CMH, Kharian, from January 2001 to December 2003, were retrieved from record of clinical case sheet data and autopsy record of the hospital. The two were analyzed and compared according to the discrepancy classification. The exclusion and inclusion criteria, the international classification of disease (ICD) to code deaths, the global burden of disease (GBD) system to classify and group diseases, and the Goldman discrepancy classification to compare clinical and autopsy diagnosis and classify the discrepancies, were used as described. The death rate varied from 0.94% to 1.29% and autopsy rate from 4.69% to 10.10% annually between January 2001 and December 2003. The number of cases classified according to GBD system was 3 (5%) in Group 1, 26 (43.33 %) in Group 2 and 31 (51.66 %) in Group 3. The discrepancy classes included 9 (15 %) class I major discrepancies and 3 (5 %) class II major discrepancies. Non-discrepant diagnosis was seen in 37 cases (61.66 %) and 11 cases (18.32 %) were non-classifiable. This study showed the usefulness of autopsy findings in the quality improvement of the diagnosis and management of the disease by showing only a minority of cases with discrepant diagnosis of the cause of death.

  4. The prevalence, classification and treatment of mental disorders among attenders of native faith healers in rural Pakistan.

    Science.gov (United States)

    Saeed, K; Gater, R; Hussain, A; Mubbashar, M

    2000-10-01

    Although native faith healers are found in all parts of Pakistan, where they practice in harmony with the cultural value system, their practice is poorly understood. This study investigated the prevalence, classification and treatment of mental disorders among attenders at faith healers. The work of faith healers with 139 attenders was observed and recorded. The mental status of attenders was assessed using a two-stage design: screening using the General Health Questionnaire followed by diagnostic interview using the Psychiatric Assessment Schedule. The classification used by faith healers is based on the mystic cause of disorders: saya (27%), jinn possession (16%) or churail (14%). Sixty-one percent of attenders were given a research diagnosis of mental disorder: major depressive episode (24%), generalized anxiety disorder (15%) or epilepsy (9%). There was little agreement between the faith healers' classification and DSM-IIIR diagnosis. Faith healers use powerful techniques of suggestion and cultural psychotherapeutic procedures. Faith healers are a major source of care for people with mental health problems in Pakistan, particularly for women and those with little education. Further research should assess methods of collaboration that will permit people with mental health problems to access effective and culturally appropriate treatment.

  5. Texture Feature Extraction and Classification for Iris Diagnosis

    Science.gov (United States)

    Ma, Lin; Li, Naimin

    Appling computer aided techniques in iris image processing, and combining occidental iridology with the traditional Chinese medicine is a challenging research area in digital image processing and artificial intelligence. This paper proposes an iridology model that consists the iris image pre-processing, texture feature analysis and disease classification. To the pre-processing, a 2-step iris localization approach is proposed; a 2-D Gabor filter based texture analysis and a texture fractal dimension estimation method are proposed for pathological feature extraction; and at last support vector machines are constructed to recognize 2 typical diseases such as the alimentary canal disease and the nerve system disease. Experimental results show that the proposed iridology diagnosis model is quite effective and promising for medical diagnosis and health surveillance for both hospital and public use.

  6. Current status of achalasia management: a review on diagnosis and treatment.

    Science.gov (United States)

    Tuason, Joshua; Inoue, Haruhiro

    2017-04-01

    Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

  7. Dengue fever: diagnosis and treatment.

    Science.gov (United States)

    Wiwanitkit, Viroj

    2010-07-01

    Dengue fever is a common tropical infection. This acute febrile illness can be a deadly infection in cases of severe manifestation, causing dengue hemorrhagic shock. In this brief article, I will summarize and discuss the diagnosis and treatment of this disease. For diagnosis of dengue, most tropical doctors make use of presumptive diagnosis; however, the definite diagnosis should be based on immunodiagnosis or viral study. Focusing on treatment, symptomatic and supportive treatment is the main therapeutic approach. The role of antiviral drugs in the treatment of dengue fever has been limited, but is currently widely studied.

  8. Internet gaming disorder treatment: a review of definitions of diagnosis and treatment outcome.

    Science.gov (United States)

    King, Daniel L; Delfabbro, Paul H

    2014-10-01

    Internet gaming disorder (IGD) is a new disorder currently positioned in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Few clinical studies report that psychological and pharmacological interventions can significantly reduce the severity of IGD symptomatology. The aim of this review was to assess current knowledge of the short- and long-term benefits of IGD interventions. This review presents a systematic evaluation of definitions of diagnosis and treatment outcomes employed in IGD treatment studies, including an assessment of goodness of fit with the DSM-5 classification. A computer database search of Academic Search Premier, PubMed, PsychINFO, ScienceDirect, Web of Science, and Google Scholar was conducted to identify all available research evidence on Internet gaming disorder treatment (N = 8 studies). Diagnostic and treatment outcome parameters were systematically evaluated. Several weaknesses of IGD treatment literature were identified. Only 2 treatment studies have employed an equivalent method of diagnosis for IGD. Studies have not assessed formative change in diagnostic status at posttreatment or follow-up. Duration of follow-up has been inadequate to assess relapse and remission. Posttreatment assessment has been predominantly limited to IGD symptomatology, comorbidity, and frequency of gaming behavior. Currently, there is insufficient evidence to warrant suggestion that trialled IGD interventions confer a long-term therapeutic benefit. Several improvements to study design and reporting are proposed to guide future studies of IGD. © 2014 Wiley Periodicals, Inc.

  9. Diagnostic Criteria, Classification and Treatment Goals in Multiple Sclerosis: The Chronicles of Time and Space.

    Science.gov (United States)

    Ntranos, Achilles; Lublin, Fred

    2016-10-01

    Multiple sclerosis (MS) is one of the most diverse human diseases. Since its first description by Charcot in the nineteenth century, the diagnostic criteria, clinical course classification, and treatment goals for MS have been constantly revised and updated to improve diagnostic accuracy, physician communication, and clinical trial design. These changes have improved the clinical outcomes and quality of life for patients with the disease. Recent technological and research breakthroughs will almost certainly further change how we diagnose, classify, and treat MS in the future. In this review, we summarize the key events in the history of MS, explain the reasoning behind the current criteria for MS diagnosis, classification, and treatment, and provide suggestions for further improvements that will keep enhancing the clinical practice of MS.

  10. New insights in diagnosis and treatment for Retinopathy of Prematurity.

    Science.gov (United States)

    Cernichiaro-Espinosa, Linda A; Olguin-Manriquez, Francisco J; Henaine-Berra, Andree; Garcia-Aguirre, Gerardo; Quiroz-Mercado, Hugo; Martinez-Castellanos, Maria A

    2016-10-01

    The purpose of this study was to review current perspectives on diagnosis and treatment of Retinopathy of Prematurity (ROP). We performed a systematic review of how much has been produced in research published online and on print regarding ROP in different settings around the world. Early Treatment for ROP (ETROP) classification is the currently accepted classification of ROP. Fluorescein angiography and spectral domain optical coherence tomography (SD-OCT) may eventually lead to changes in the definition of ROP, and as a consequence, they will serve as a guide for treatment. Intravitreal anti-VEGF therapy has proven to be more effective in terms of lowering recurrence, allowing growth of the peripheral retina, and diminishing the incidence of retinal detachment when proliferative ROP is diagnosed. Whether anti-VEGF plus laser are better than any of these therapies separately remains a subject of discussion. Telemedicine is evolving everyday to allow access to remote areas that do not count with a retina specialist for treatment. A management algorithm is proposed according to our reference center experience. ROP is an evolving subject, with a vulnerable population of study that, once treated with good results, leads to a reduction in visual disability and in consequence, in a lifetime improvement.

  11. A practicable approach for periodontal classification

    Science.gov (United States)

    Mittal, Vishnu; Bhullar, Raman Preet K.; Bansal, Rachita; Singh, Karanprakash; Bhalodi, Anand; Khinda, Paramjit K.

    2013-01-01

    The Diagnosis and classification of periodontal diseases has remained a dilemma since long. Two distinct concepts have been used to define diseases: Essentialism and Nominalism. Essentialistic concept implies the real existence of disease whereas; nominalistic concept states that the names of diseases are the convenient way of stating concisely the endpoint of a diagnostic process. It generally advances from assessment of symptoms and signs toward knowledge of causation and gives a feasible option to name the disease for which etiology is either unknown or it is too complex to access in routine clinical practice. Various classifications have been proposed by the American Academy of Periodontology (AAP) in 1986, 1989 and 1999. The AAP 1999 classification is among the most widely used classification. But this classification also has demerits which provide impediment for its use in day to day practice. Hence a classification and diagnostic system is required which can help the clinician to access the patient's need and provide a suitable treatment which is in harmony with the diagnosis for that particular case. Here is an attempt to propose a practicable classification and diagnostic system of periodontal diseases for better treatment outcome. PMID:24379855

  12. Dystonia: an update on phenomenology, classification, pathogenesis and treatment.

    Science.gov (United States)

    Balint, Bettina; Bhatia, Kailash P

    2014-08-01

    This article will highlight recent advances in dystonia with focus on clinical aspects such as the new classification, syndromic approach, new gene discoveries and genotype-phenotype correlations. Broadening of phenotype of some of the previously described hereditary dystonias and environmental risk factors and trends in treatment will be covered. Based on phenomenology, a new consensus update on the definition, phenomenology and classification of dystonia and a syndromic approach to guide diagnosis have been proposed. Terminology has changed and 'isolated dystonia' is used wherein dystonia is the only motor feature apart from tremor, and the previously called heredodegenerative dystonias and dystonia plus syndromes are now subsumed under 'combined dystonia'. The recently discovered genes ANO3, GNAL and CIZ1 appear not to be a common cause of adult-onset cervical dystonia. Clinical and genetic heterogeneity underlie myoclonus-dystonia, dopa-responsive dystonia and deafness-dystonia syndrome. ALS2 gene mutations are a newly recognized cause for combined dystonia. The phenotypic and genotypic spectra of ATP1A3 mutations have considerably broadened. Two new genome-wide association studies identified new candidate genes. A retrospective analysis suggested complicated vaginal delivery as a modifying risk factor in DYT1. Recent studies confirm lasting therapeutic effects of deep brain stimulation in isolated dystonia, good treatment response in myoclonus-dystonia, and suggest that early treatment correlates with a better outcome. Phenotypic classification continues to be important to recognize particular forms of dystonia and this includes syndromic associations. There are a number of genes underlying isolated or combined dystonia and there will be further new discoveries with the advances in genetic technologies such as exome and whole-genome sequencing. The identification of new genes will facilitate better elucidation of pathogenetic mechanisms and possible corrective

  13. New Classification of Focal Cortical Dysplasia: Application to Practical Diagnosis

    Science.gov (United States)

    Bae, Yoon-Sung; Kang, Hoon-Chul; Kim, Heung Dong; Kim, Se Hoon

    2012-01-01

    Background and Purpose: Malformation of cortical development (MCD) is a well-known cause of drug-resistant epilepsy and focal cortical dysplasia (FCD) is the most common neuropathological finding in surgical specimens from drug-resistant epilepsy patients. Palmini’s classification proposed in 2004 is now widely used to categorize FCD. Recently, however, Blumcke et al. recommended a new system for classifying FCD in 2011. Methods: We applied the new classification system in practical diagnosis of a sample of 117 patients who underwent neurosurgical operations due to drug-resistant epilepsy at Severance Hospital in Seoul, Korea. Results: Among 117 cases, a total of 16 cases were shifted to other FCD subtypes under the new classification system. Five cases were reclassified to type IIIa and five cases were categorized as dual pathology. The other six cases were changed within the type I category. Conclusions: The most remarkable changes in the new classification system are the advent of dual pathology and FCD type III. Thus, it will be very important for pathologists and clinicians to discriminate between these new categories. More large-scale research needs to be conducted to elucidate the clinical influence of the alterations within the classification of type I disease. Although the new FCD classification system has several advantages compared to the former, the correlation with clinical characteristics is not yet clear. PMID:24649461

  14. Brake fault diagnosis using Clonal Selection Classification Algorithm (CSCA – A statistical learning approach

    Directory of Open Access Journals (Sweden)

    R. Jegadeeshwaran

    2015-03-01

    Full Text Available In automobile, brake system is an essential part responsible for control of the vehicle. Any failure in the brake system impacts the vehicle's motion. It will generate frequent catastrophic effects on the vehicle cum passenger's safety. Thus the brake system plays a vital role in an automobile and hence condition monitoring of the brake system is essential. Vibration based condition monitoring using machine learning techniques are gaining momentum. This study is one such attempt to perform the condition monitoring of a hydraulic brake system through vibration analysis. In this research, the performance of a Clonal Selection Classification Algorithm (CSCA for brake fault diagnosis has been reported. A hydraulic brake system test rig was fabricated. Under good and faulty conditions of a brake system, the vibration signals were acquired using a piezoelectric transducer. The statistical parameters were extracted from the vibration signal. The best feature set was identified for classification using attribute evaluator. The selected features were then classified using CSCA. The classification accuracy of such artificial intelligence technique has been compared with other machine learning approaches and discussed. The Clonal Selection Classification Algorithm performs better and gives the maximum classification accuracy (96% for the fault diagnosis of a hydraulic brake system.

  15. School Refusal Behavior: Classification, Assessment, and Treatment Issues.

    Science.gov (United States)

    Lee, Marcella I.; Miltenberger, Raymond G.

    1996-01-01

    Discusses diagnostic and functional classification, assessment, and treatment approaches for school refusal behavior. Diagnostic classification focuses on separation anxiety disorder, specific phobia, social phobia, depression, and truancy. Functional classification focuses on the maintaining consequences of the behavior, such as avoidance of…

  16. FEATURE EXTRACTION BASED WAVELET TRANSFORM IN BREAST CANCER DIAGNOSIS USING FUZZY AND NON-FUZZY CLASSIFICATION

    Directory of Open Access Journals (Sweden)

    Pelin GORGEL

    2013-01-01

    Full Text Available This study helps to provide a second eye to the expert radiologists for the classification of manually extracted breast masses taken from 60 digital mammıgrams. These mammograms have been acquired from Istanbul University Faculty of Medicine Hospital and have 78 masses. The diagnosis is implemented with pre-processing by using feature extraction based Fast Wavelet Transform (FWT. Afterwards Adaptive Neuro-Fuzzy Inference System (ANFIS based fuzzy subtractive clustering and Support Vector Machines (SVM methods are used for the classification. It is a comparative study which uses these methods respectively. According to the results of the study, ANFIS based subtractive clustering produces ??% while SVM produces ??% accuracy in malignant-benign classification. The results demonstrate that the developed system could help the radiologists for a true diagnosis and decrease the number of the missing cancerous regions or unnecessary biopsies.

  17. Value of multi-slice CT in the classification diagnosis of hilar cholangiocarcinoma

    International Nuclear Information System (INIS)

    Qian Yi; Zeng Mengsu; Ling Zhiqing; Rao Shengxiang; Liu Yalan

    2008-01-01

    Objective: To evaluate the value of multi-slice CT (MSCT) classification in the assessment of the hilar cholangiocarcinoma resectability. Methods: Thirty patients with surgically and histopathologically proved hilar cholangiocarcinomas who underwent preoperative MSCT and were diagnosed correctly were included in present study. Transverse images and reconstructed MPR images were reviewed for Bismuth-Corlette classification and morphological classification of hilar cholangiocarcinoma. Then MSCT classification was compared with findings of surgery and histopathology. Curative resectabilty of different types according to Bismuth-Corlette classification and morphological classification were analyzed with chi-square test. Results: In 30 cases, the numbers of Type I, II, IIIa, IIIb and IV according to Bismuth-Corlette classification were 1, 3, 4, 5 and 17. Seventeen patients underwent curative resections, among which 1, 2, 1, 4 and 9 belonged to Type I, II, IIIa, IIIb and IV respectively. However, there was no significant difference in curative resectability among different types of Bismuth-Corlette classification (χ 2 = 0.9875, P>0.05). In present study, the accuracy of MSCT in Bismuth-Corlette classification reached 86.7% (26/30). The numbers of periductal infiltrating, mass forming and intraductal growing type were 13, 13 and 4, while 6, 8 and 3 cases of each type underwent curative resections. There was no significant difference in curative resectability among different types of morphological classification (χ 2 =1.2583, P>0.05). The accuracy of MSCT in morphological classification was 100% (30/30) in this study group. Conclusion: MSCT can make accurate diagnosis of Bismuth-Corlette classification and morphological classification, which is helpful in preoperative respectability assessment of hilar cholangiocarcinoma. (authors)

  18. Benefits and limitations of fine needle aspiration cytology in the diagnosis and classification of leprosy in primary and secondary healthcare settings.

    Science.gov (United States)

    Ray, R; Mondal, R K; Pathak, S

    2015-08-01

    The goal of the World Health Organization (WHO) is to eliminate leprosy as a public health problem. This will only be possible when all patients are detected and cured using multidrug therapy, which requires accurate diagnosis prior to treatment. The objective of this study was to evaluate the possibility of the diagnosis of leprosy lesions by fine needle aspiration cytology according to a modification of the Ridley-Jopling scale, as it can be used in primary and secondary healthcare centres, especially in low-resource settings in which leprosy is prevalent. A prospective study comprising 54 cases with cardinal features of leprosy was performed. Among the 54 cases, 27 patients consented to a histopathological biopsy procedure. The slides were stained with Giemsa, modified Ziehl-Neelsen, Papanicolaou and haematoxylin and eosin methods. Among the 54 cases, 34 were reported as tuberculoid leprosy, five as mid-borderline (BB), three as borderline lepromatous (BL) and eight as lepromatous leprosy (LL); four were unsatisfactory. Histopathological study was performed in 27 cases, which showed cyto-histological correlation in 21 cases (78%). Agreement between histological and cytological diagnosis was achieved in 12 of the 15 tuberculoid cases, one of the three BB cases, one of the two BL cases and all seven LL cases. With the implementation of the WHO classification based on patch counting, there is the possibility of the over-treatment of paucibacillary cases and under-treatment of multibacillary cases. Cytology in terms of cellular type morphology and bacteriological study can complement the WHO classification. © 2014 John Wiley & Sons Ltd.

  19. Comparison of clinical causes of deth with autopsy diagnosis using discrepancy classification

    International Nuclear Information System (INIS)

    Ullah, K.; Alamgir, W.

    2006-01-01

    To determine the usefulness of autopsy findings in the quality improvement of patients care. The clinical and necropsy findings of all the cases, who died in hospital and had undergone autopsy examination at CMH, Kharian, from January 2001 to December 2003, were retrieved from record of clinical case sheet data and autopsy record of the hospital. The two were analyzed and compared according to the discrepancy classification. The exclusion and inclusion criteria, the international classification of disease (ICD) to code deaths, the global burden of disease (GBD) system to classify and group diseases, and the Goldman discrepancy classification to compare clinical and autopsy diagnosis and classify the discrepancies, were used as described. The death rate varied from 0.94% to 1.29% and autopsy rate from 4.69% to 10.10% annually between January 2001 and December 2003. The number of cases classified according to GBD system was 3 (5%) in Group 1, 26 (43.33 %) in Group 2 and 31 (51.66 %) in Group 3. The discrepancy classes included 9 (15 %) class I major discrepancies and 3 (5 %) class II major discrepancies. Non-discrepant diagnosis was seen in 37 cases (61.66 %) and 11 cases (18.32 %) were non classifiable. (author)

  20. Three-class classification in computer-aided diagnosis of breast cancer by support vector machine

    Science.gov (United States)

    Sun, Xuejun; Qian, Wei; Song, Dansheng

    2004-05-01

    Design of classifier in computer-aided diagnosis (CAD) scheme of breast cancer plays important role to its overall performance in sensitivity and specificity. Classification of a detected object as malignant lesion, benign lesion, or normal tissue on mammogram is a typical three-class pattern recognition problem. This paper presents a three-class classification approach by using two-stage classifier combined with support vector machine (SVM) learning algorithm for classification of breast cancer on mammograms. The first classification stage is used to detect abnormal areas and normal breast tissues, and the second stage is for classification of malignant or benign in detected abnormal objects. A series of spatial, morphology and texture features have been extracted on detected objects areas. By using genetic algorithm (GA), different feature groups for different stage classification have been investigated. Computerized free-response receiver operating characteristic (FROC) and receiver operating characteristic (ROC) analyses have been employed in different classification stages. Results have shown that obvious performance improvement in both sensitivity and specificity was observed through proposed classification approach compared with conventional two-class classification approaches, indicating its effectiveness in classification of breast cancer on mammograms.

  1. Association between the clinical classification of hypothyroidism and reduced TSH in LT4 supplemental replacement treatment for pregnancy in China.

    Science.gov (United States)

    Zhang, Lyu; Zhang, Zhaoyun; Ye, Hongying; Zhu, Xiaoming; Li, Yiming

    2016-01-01

    The study was aimed to evaluate the effects of levothyroxine (LT4) supplemental replacement treatment for pregnancy and analyze the associations between the clinical classification of hypothyroidism and reduced thyroid-stimulating hormone (TSH) in LT4 therapy. Totally, 195 pregnant women with hypothyroidism receiving routine prenatal care were enrolled. They were categorized into three groups: overt hypothyroidism (OH), subclinical hypothyroidism (SCH) with negative thyroperoxidase antibody (TPOAb), and SCH with positive TPOAb. The association between the clinical classification and reduced TSH in LT4 supplemental replacement treatment was assessed. The results indicated that reduced TSH was significantly different among the groups according to the clinical classifications (p = 0.043). The result was also significantly different between patients with OH and patients with SCH and negative TPOAb (p = 0.036). Similar result was reported for the comparison between patients with OH and patients with SCH and positive TPOAb (p = 0.016). Multiple variable analyses showed that LT4 supplementation, gestational age and the variable of clinical classifications were associated with reduced TSH independently. Our data suggested that the therapeutic effect of substitutive treatment with LT4 was significantly associated with different clinical classifications of hypothyroidism in pregnancy and the treatment should begin as soon as possible after diagnosis.

  2. Pediatric Hypothyroidism: Diagnosis and Treatment.

    Science.gov (United States)

    Wassner, Ari J

    2017-08-01

    Thyroid hormone has important physiologic functions in nearly every organ system. The critical role of thyroid hormone in growth and in physical and neurologic development lends particular importance to the prompt diagnosis and appropriate treatment of hypothyroidism in infants and children. Congenital hypothyroidism is common and has potentially devastating neurologic consequences. While the approach to diagnosis and treatment of severe congenital hypothyroidism is well established, data continue to emerge about the genetic causes, clinical significance, and prognosis of the milder forms of congenital hypothyroidism that are increasingly being diagnosed by newborn screening. Similarly, the diagnosis and treatment of severe acquired hypothyroidism is straightforward and clearly of clinical benefit, but uncertainty remains about the optimal management of mild subclinical hypothyroidism. This review summarizes current knowledge of the causes, clinical manifestations, diagnosis, treatment, and prognosis of hypothyroidism in infants and children, with a focus on recent developments and areas of uncertainty in this field.

  3. Classification of pyodestructive pulmonary diseases

    International Nuclear Information System (INIS)

    Muromskij, Yu.A.; Semivolkov, V.I.; Shlenova, L.A.

    1993-01-01

    Classification of pyodestructive lungs diseases, thier complications and outcomes is proposed which makes it possible for physioians engaged in studying respiratory organs pathology to orient themselves in problems of diagnosis and treatment tactics. The above classification is developed on the basis of studying the disease anamnesis and its clinical process, as well as on the basis of roentgenological and morphological study results by more than 10000 patients

  4. Small vessel vasculitis History, classification, etiology, histopathology, clinic, diagnosis and treatment

    International Nuclear Information System (INIS)

    Iglesias Gamarra, Antonio; Matteson, Eric L; Restrepo, Jose Felix

    2007-01-01

    Small-vessel vasculitis is a convenient descriptor for a wide range of diseases characterized by vascular inflammation of the venules, capillaries, and/or arterioles with pleomorphic clinical manifestations. The classical clinical phenotype is leucocytoclastic vasculitis with palpable purpura, but manifestations vary widely depending upon the organs involved. Histopathologic examination in leucocytoclastic vasculitis reveals angiocentric segmental inflammation, fibrinoid necrosis, and a neutrophilic infiltrate around the blood vessel walls with erythrocyte extravasation. The etiology of small-vessel vasculitis is unknown in many cases, but in others, drugs, post viral syndromes, malignancy, primary vasculitis such as microscopic polyarteritis, and connective tissue disorders are associated, The diagnosis of small- vessel vasculitis relies on a thorough history and physical examination, as well as relevant antibody testing including antinuclear antibody and anti neutrophil cytoplasmic antibody, hepatitis B and C serologies, assessment of complement, immunoglobulins, blood count, serum creatinine liver function tests, urinalysis, radiographic imaging and biopsy. The treatment is based primarily on corticosteroid and immunosuppressive agents

  5. Current Trends in the Molecular Classification of Renal Neoplasms

    Directory of Open Access Journals (Sweden)

    Andrew N. Young

    2006-01-01

    Full Text Available Renal cell carcinoma (RCC is the most common form of kidney cancer in adults. RCC is a significant challenge for pathologic diagnosis and clinical management. The primary approach to diagnosis is by light microscopy, using the World Health Organization (WHO classification system, which defines histopathologic tumor subtypes with distinct clinical behavior and underlying genetic mutations. However, light microscopic diagnosis of RCC subtypes is often difficult due to variable histology. In addition, the clinical behavior of RCC is highly variable and therapeutic response rates are poor. Few clinical assays are available to predict outcome in RCC or correlate behavior with histology. Therefore, novel RCC classification systems based on gene expression should be useful for diagnosis, prognosis, and treatment. Recent microarray studies have shown that renal tumors are characterized by distinct gene expression profiles, which can be used to discover novel diagnostic and prognostic biomarkers. Here, we review clinical features of kidney cancer, the WHO classification system, and the growing role of molecular classification for diagnosis, prognosis, and therapy of this disease.

  6. Cataract in small animals: classification and treatment

    Directory of Open Access Journals (Sweden)

    Fahiano Montiani Ferreira

    1997-02-01

    Full Text Available Cataract means any opacity present in the lens, lens capsule or both. The opacities may vary in size, location, shape and rate of progression. By slit-lamp biomicroscopy it is possible to examine them with precision, determining its exact location and peculiarities, resulting in a safe, accurate diagnosis. Due to its variable origin and appearance, several methods of classification have been used. Classification by aetiology, grade of maturity, location and age of the patients are presented in this review. Surgical removal is the only effective therapy for this disease. Among the surgical techniques available to this day, endocapsular phacoemulsification excells for its better results, despite of its high cost, if compared to classical intra and extra capsular facectomies.

  7. ILAE Classification of the Epilepsies Position Paper of the ILAE Commission for Classification and Terminology

    Science.gov (United States)

    Scheffer, Ingrid E; Berkovic, Samuel; Capovilla, Giuseppe; Connolly, Mary B; French, Jacqueline; Guilhoto, Laura; Hirsch, Edouard; Jain, Satish; Mathern, Gary W.; Moshé, Solomon L; Nordli, Douglas R; Perucca, Emilio; Tomson, Torbjörn; Wiebe, Samuel; Zhang, Yue-Hua; Zuberi, Sameer M

    2017-01-01

    Summary The ILAE Classification of the Epilepsies has been updated to reflect our gain in understanding of the epilepsies and their underlying mechanisms following the major scientific advances which have taken place since the last ratified classification in 1989. As a critical tool for the practising clinician, epilepsy classification must be relevant and dynamic to changes in thinking, yet robust and translatable to all areas of the globe. Its primary purpose is for diagnosis of patients, but it is also critical for epilepsy research, development of antiepileptic therapies and communication around the world. The new classification originates from a draft document submitted for public comments in 2013 which was revised to incorporate extensive feedback from the international epilepsy community over several rounds of consultation. It presents three levels, starting with seizure type where it assumes that the patient is having epileptic seizures as defined by the new 2017 ILAE Seizure Classification. After diagnosis of the seizure type, the next step is diagnosis of epilepsy type, including focal epilepsy, generalized epilepsy, combined generalized and focal epilepsy, and also an unknown epilepsy group. The third level is that of epilepsy syndrome where a specific syndromic diagnosis can be made. The new classification incorporates etiology along each stage, emphasizing the need to consider etiology at each step of diagnosis as it often carries significant treatment implications. Etiology is broken into six subgroups, selected because of their potential therapeutic consequences. New terminology is introduced such as developmental and epileptic encephalopathy. The term benign is replaced by the terms self-limited and pharmacoresponsive, to be used where appropriate. It is hoped that this new framework will assist in improving epilepsy care and research in the 21st century. PMID:28276062

  8. Diagnosis and treatment of ampullary tumors

    Directory of Open Access Journals (Sweden)

    YIN Tao

    2017-02-01

    Full Text Available Ampullary tumors mainly manifest as obstructive jaundice and ampullary mass in clinical practice and are difficult to be identified in early stage due to a complex structure of the anatomical site, a deep location, and hidden symptoms. Sometimes a qualitative diagnosis cannot be made. Based on the experience in the treatment of ampullary tumors for many years in our center, this article summarizes the features of ampullary tumors from the aspects of clinical manifestations, diagnosis, treatment, and prognosis, especially the issues regarding imaging evaluation of ampullary tumors, selection of surgical procedure, and prognosis. An early diagnosis is the key to the treatment of ampullary tumors, and early identification and treatment of lesions have great impacts on patients′ prognosis. Accurate preoperative imaging evaluation, a professional diagnosis and treatment team, accurate preoperative and intraoperative pathological analysis, and implementation of reasonable therapeutic strategy are the key to patients′ recovery.

  9. [Practice guideline. Diagnosis and treatment of type 2 diabetes mellitus].

    Science.gov (United States)

    Gil-Velázquez, Luisa Estela; Sil-Acosta, María Juana; Domínguez-Sánchez, Elia R; Torres-Arreola, Laura del Pilar; Medina-Chávez, Juan Humberto

    2013-01-01

    Our objective was to develop a guide based on the best available evidence that allow family physicians to establish criteria for screening, diagnosis, prevention, treatment of disease, early detection and management of complications; to standardize the organizing processes of the diabetic patient's care in the primary care level; and to achieve lifestyle modification for patients and promote self-care. Clinical questions were stated according to the diagram and structured patient-intervention-comparison-outcome. We used a mixed methodology-adoption adjustment, and include 32 guides. For recommendations not included in these, the search process was conducted in PubMed and Cochrane Library Plus with these terms: diabetes mellitus type 2, epidemiology, detection and diagnosis, classification, drug therapy, effects, prevention, control and complication. The clinical practice guideline emphasizes the fundamental change in lifestyle (diet and exercise), self-care and proactive participation of the patient, in addition to the dynamic prescription of medications that would achieve metabolic control in order to reduce late complications.

  10. Diagnosis-related groups for stroke in Europe: patient classification and hospital reimbursement in 11 countries.

    Science.gov (United States)

    Peltola, Mikko; Quentin, Wilm

    2013-01-01

    Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries' systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and

  11. Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

    Science.gov (United States)

    Baraff, L J; Cameron, J M; Sekhon, R

    1991-01-01

    To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. Three community hospital EDs in Los Angeles County during selected times in 1984. Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients

  12. Seasonal Allergies: Diagnosis, Treatment & Research

    Science.gov (United States)

    ... this page please turn JavaScript on. Feature: Seasonal Allergies Diagnosis, Treatment & Research Past Issues / Spring 2015 Table of Contents Diagnosis Testing for Allergies Knowing exactly what you are allergic to can ...

  13. Breast cancer: Diagnosis and treatment

    International Nuclear Information System (INIS)

    Ariel, I.M.; Clearly, J.B.

    1987-01-01

    This is a publication about the diagnosis and treatment of breast cancer with an appeal for unified reporting of end results. Nine chapters cover historical reviews, risk factors, pathology-receptors-immunology, detection and diagnosis, treatment of the potentially curable patient, and treatment of the patient with advanced disease. The three concluding chapters discuss reconstruction, special clinical situations, and support for the patient. The role of radiation therapy is presented well. The current status of chemotherapy, hormonal therapy and combined therapies is also addressed by authoritative authors

  14. Diagnosis and Treatment of Common Forms of Tremor

    Science.gov (United States)

    Puschmann, Andreas; Wszolek, Zbigniew K.

    2014-01-01

    Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson’s disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson’s disease, and tremor secondary to cerebral lesions, such as Holmes’ tremor (midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient’s life. PMID:21321834

  15. Classification and treatment of radiation maculopathy.

    LENUS (Irish Health Repository)

    Horgan, Noel

    2012-02-01

    PURPOSE OF REVIEW: Radiation maculopathy is a sight-limiting consequence of radiotherapy in the management of uveal melanoma and other intraocular tumors. In this review, we consider clinical, fluorescein angiographic and optical coherence tomographic findings, propose a classification for radiation maculopathy and discuss the management of this condition. RECENT FINDINGS: Radiation macular edema (RME) can be classified by optical coherence tomography into noncystoid or cystoid edema, with foveolar or extrafoveolar involvement. Optical coherence tomographic grading of RME has been found to correlate with visual acuity. Focal argon laser might have some limited benefit in the treatment of RME. Intravitreal triamcinolone and intravitreal antivascular endothelial growth factor agents can be of short-term benefit in the treatment of RME. In a randomized controlled trial, periocular triamcinolone significantly reduced rates of RME and vision loss up to 18 months following plaque radiotherapy for uveal melanoma. SUMMARY: Currently, there is no proven treatment for established RME, though periocular triamcinolone has been shown to have a preventive benefit. An accepted classification system for radiation maculopathy would be of benefit in planning and comparing future treatment trials.

  16. Small Intestinal Tumours: An Overview on Classification, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    Chiara Notaristefano

    2014-12-01

    Full Text Available The small intestinal neoplasia group includes different types of lesions and are a relatively rare event, accounting for only 3-6% of all gastrointestinal (GI neoplasms and 1-3% of all GI malignancies. These lesions can be classified as epithelial and mesenchymal, either benign or malignant. Mesenchymal tumours include stromal tumours (GIST and other neoplasms that might arise from soft tissue throughout the rest of the body (lipomas, leiomyomas and leiomyosarcomas, fibromas, desmoid tumours, and schwannomas. Other lesions occurring in the small bowel are carcinoids, lymphomas, and melanomas. To date, carcinoids and GIST are reported as the most frequent malignant lesions occurring in the small bowel. Factors that predispose to the development of malignant lesions are different, and they may be hereditary (Peutz-Jeghers syndrome, familial adenomatous polyposis, hereditary non-polyposis colorectal cancer, neuroendocrine neoplasia Type 1, von Hippel-Lindau disease, and neurofibromatosis Type 1, acquired (sporadic colorectal cancer and small intestine adenomas, coeliac disease, Crohn’s disease, or environmental (diet, tobacco, and obesity. Small bowel tumours present with different and sometimes nonspecific symptoms, and a prompt diagnosis is not always so easily performed. Diagnostic tools, that may be both radiological and endoscopic, possess specificity and sensitivity, as well as different roles depending on the type of lesion. Treatment of these lesions may be different and, in recent years, new therapies have enabled an improvement in life expectancy.

  17. [Diagnosis and classification of headache and temporomandibular disorders, a new opportunity].

    Science.gov (United States)

    Koole, P; Koole, R

    2011-05-01

    Patients with orofacial pains are generally treated by physicians. A small number of patients are treated for pain in the temporomandibular joint, the masticatory and the neck muscles, by dentists and orofacial surgeons. Among half of the patients being treated in neurological headache clinics, the temporomandibular joint and the masticatory muscles are the source of the pain. In order to achieve better research and a classification, the International Headache Society, consisting largely of neurologists, developed a classification system. A comparable development occurred among oral health specialists. Employing these 2 methods with the same patients leads to different diagnoses and treatments. Both the International Classification of Headache Disorders II and the Research Diagnostic Criteria for Temporomandibular Disorders are being revised. This creates the opportunity to establish a single classification for these orofacial pains, preferably within the new International Classification of Headache Disorders.

  18. Plague: Clinics, Diagnosis and Treatment.

    Science.gov (United States)

    Nikiforov, Vladimir V; Gao, He; Zhou, Lei; Anisimov, Andrey

    2016-01-01

    Plague still poses a significant threat to human health and as a reemerging infection is unfamiliar to the majority of the modern medical doctors. In this chapter, the plague is described according to Dr. Nikiforov's experiences in the diagnosis and treatment of patients, and also a review of the relevant literature on this subject is provided. The main modern methods and criteria for laboratory diagnosis of plague are briefly described. The clinical presentations include the bubonic and pneumonic form, septicemia, rarely pharyngitis, and meningitis. Early diagnosis and the prompt initiation of treatment reduce the mortality rate associated with bubonic plague and septicemic plague to 5-50 %; although a delay of more than 24 h in the administration of antibiotics and antishock treatment can be fatal for plague patients. Most human cases can successfully be treated with antibiotics.

  19. The rumination syndrome in adults: A review of the pathophysiology, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Papadopoulos V

    2007-01-01

    Full Text Available Rumination in adults is considered to be the effortless regurgitation of recently ingested food into the mouth, followed by either rechewing and reswallowing or expulsion of the regurgitate. On the basis of the definition of rumination as a unique category of functional gastroduodenal disorders, according to the newly established Rome III classification, a review of the pathophysiology, diagnosis and treatment of the rumination syndrome in adults is presented after systematic and critical approach of all articles that could be retrieved through PubMed using the term "rumination".

  20. Diagnosis and treatment of haemorrhoids

    DEFF Research Database (Denmark)

    Buntzen, Steen; Christensen, Peter Quist; Khalid, Ali

    2013-01-01

    These guidelines provide a review of diagnosis, conservative and surgical treatment of haemorrhoids with primary focus on the surgical treatment. In symptomatic hemorrhoids it is recommended, that conservative treatment is used as basic treatment regardless of grading. The vast majority of grade II...

  1. Symptoms, Diagnosis & Treatment

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Cover Story: Leukemia/Lymphoma Symptoms, Diagnosis & Treatment Past Issues / Summer 2008 Table of Contents For an enhanced version of this page please turn Javascript on. Leukemia Symptoms Frequent infections Fever and chills Anemia Easy ...

  2. Refinement of diagnosis and disease classification in psychiatry.

    Science.gov (United States)

    Lecrubier, Yves

    2008-03-01

    Knowledge concerning the classification of mental disorders progressed substantially with the use of DSM III-IV and IDCD 10 because it was based on observed data, with precise definitions. These classifications a priori avoided to generate definitions related to etiology or treatment response. They are based on a categorical approach where diagnostic entities share common phenomenological features. Modifications proposed or discussed are related to the weak validity of the classification strategy described above. (a) Disorders are supposed to be independent but the current coexistence of two or more disorders is the rule; (b) They also are supposed to have stability, however anxiety disorders most of the time precede major depression. For GAD age at onset, family history, biology and symptomatology are close to those of depression. As a consequence broader entities such as depression-GAD spectrum, panic-phobias spectrum and OCD spectrum including eating disorders and pathological gambling are taken into consideration; (c) Diagnostic categories use thresholds to delimitate a border with normals. This creates "subthreshold" conditions. The relevance of such conditions is well documented. Measuring the presence and severity of different dimensions, independent from a threshold, will improve the relevance of the description of patients pathology. In addition, this dimensional approach will improve the problems posed by the mutually exclusive diagnoses (depression and GAD, schizophrenia and depression); (d) Some disorders are based on the coexistence of different dimensions. Patients may present only one set of symptoms and have different characteristics, evolution and response to treatment. An example would be negative symptoms in Schizophrenia; (e) Because no etiological model is available and most measures are subjective, objective measures (cognitive, biological) and genetics progresses created important hopes. None of these measures is pathognomonic and most appear

  3. MR imaging-based diagnosis and classification of meniscal tears.

    Science.gov (United States)

    Nguyen, Jie C; De Smet, Arthur A; Graf, Ben K; Rosas, Humberto G

    2014-01-01

    Magnetic resonance (MR) imaging is currently the modality of choice for detecting meniscal injuries and planning subsequent treatment. A thorough understanding of the imaging protocols, normal meniscal anatomy, surrounding anatomic structures, and anatomic variants and pitfalls is critical to ensure diagnostic accuracy and prevent unnecessary surgery. High-spatial-resolution imaging of the meniscus can be performed using fast spin-echo and three-dimensional MR imaging sequences. Normal anatomic structures that can mimic a tear include the meniscal ligament, meniscofemoral ligaments, popliteomeniscal fascicles, and meniscomeniscal ligament. Anatomic variants and pitfalls that can mimic a tear include discoid meniscus, meniscal flounce, a meniscal ossicle, and chondrocalcinosis. When a meniscal tear is identified, accurate description and classification of the tear pattern can guide the referring clinician in patient education and surgical planning. For example, longitudinal tears are often amenable to repair, whereas horizontal and radial tears may require partial meniscectomy. Tear patterns include horizontal, longitudinal, radial, root, complex, displaced, and bucket-handle tears. Occasionally, meniscal tears can be difficult to detect at imaging; however, secondary indirect signs, such as a parameniscal cyst, meniscal extrusion, or linear subchondral bone marrow edema, should increase the radiologist's suspicion for an underlying tear. Awareness of common diagnostic errors can ensure accurate diagnosis of meniscal tears. Online supplemental material is available for this article. ©RSNA, 2014.

  4. A reliable Raman-spectroscopy-based approach for diagnosis, classification and follow-up of B-cell acute lymphoblastic leukemia

    Science.gov (United States)

    Managò, Stefano; Valente, Carmen; Mirabelli, Peppino; Circolo, Diego; Basile, Filomena; Corda, Daniela; de Luca, Anna Chiara

    2016-04-01

    Acute lymphoblastic leukemia type B (B-ALL) is a neoplastic disorder that shows high mortality rates due to immature lymphocyte B-cell proliferation. B-ALL diagnosis requires identification and classification of the leukemia cells. Here, we demonstrate the use of Raman spectroscopy to discriminate normal lymphocytic B-cells from three different B-leukemia transformed cell lines (i.e., RS4;11, REH, MN60 cells) based on their biochemical features. In combination with immunofluorescence and Western blotting, we show that these Raman markers reflect the relative changes in the potential biological markers from cell surface antigens, cytoplasmic proteins, and DNA content and correlate with the lymphoblastic B-cell maturation/differentiation stages. Our study demonstrates the potential of this technique for classification of B-leukemia cells into the different differentiation/maturation stages, as well as for the identification of key biochemical changes under chemotherapeutic treatments. Finally, preliminary results from clinical samples indicate high consistency of, and potential applications for, this Raman spectroscopy approach.

  5. Diagnosis and treatment of vascular damage in dementia.

    Science.gov (United States)

    Biessels, Geert Jan

    2016-05-01

    This paper provides an overview of cognitive impairment due to vascular brain damage, which is referred to as vascular cognitive impairment (VCI). Over the past decades, we have seen marked progress in detecting VCI, both through maturation of diagnostic concepts and through advances in brain imaging, especially MRI. Yet in daily practice, it is often challenging to establish the diagnosis, particularly in patients where there is no evident temporal relation between a cerebrovascular event and cognitive dysfunction. Because vascular damage is such a common cause of cognitive dysfunction, it provides an obvious target for treatment. In patients whose cognitive dysfunction follows directly after a stroke, the etiological classification of this stroke will direct treatment. In many patients however, VCI develops due to so-called "silent vascular damage," without evident cerebrovascular events. In these patients, small vessel diseases (SVDs) are the most common cause. Yet no SVD-specific treatments currently exist, which is due to incomplete understanding of the pathophysiology. This review addresses developments in this field. It offers a framework to translate diagnostic criteria to daily practice, addresses treatment, and highlights some future perspectives. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia, edited by M. Paul Murphy, Roderick A. Corriveau, and Donna M. Wilcock. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Polycystic echinococcosis in the state of Acre, Brazil: contribution to patient diagnosis, treatment and prognosis

    Science.gov (United States)

    de Siqueira, Nilton Ghiotti; de Siqueira, Cláudia Maria Villar Maziero; Rodrigues-Silva, Rosângela; Soares, Manoel do Carmo P; Póvoa, Marinete Marins

    2013-01-01

    The lack of knowledge regarding polycystic hydatid disease results in delayed or even incorrect diagnosis. The lack of systematic information regarding treatment also makes it difficult to assess the results and prognosis in patients with peritoneal and hepatic lesions caused by Echinococcus vogeli. Here we describe the clinical features of patients, propose a radiological classification protocol and describe a therapeutic option for the treatment of hydatid disease that previously had only been used for cases of cystic echinococcosis (Echinococcus granulosus). A prospective cohort study was initiated in 1999 and by 2009 the study included 60 patients. These patients were classified according to the PNM classification (parasite lesion, neighbouring organ invasion and metastases) and placed in one of three therapeutic modalities: (i) chemotherapy with albendazole at a dose of 10 mg/kg/day, (ii) surgical removal of cysts or (iii) percutaneous puncture of the cysts via puncture, aspiration, injection and re-aspiration (PAIR). The results were stratified according to therapeutic outcome: "cure", "clinical improvement", "no improvement", "death" or "no information". The PNM classification was useful in indicating the appropriate therapy in cases of polycystic hydatid disease. In conclusion, surgical therapy produced the best clinical results of all the therapies studied based on "cure" and "clinical improvement" outcomes. The use of PAIR for treatment requires additional study. PMID:23903966

  7. Classification of quantitative light-induced fluorescence images using convolutional neural network

    NARCIS (Netherlands)

    Imangaliyev, S.; van der Veen, M.H.; Volgenant, C.M.C.; Loos, B.G.; Keijser, B.J.F.; Crielaard, W.; Levin, E.; Lintas, A.; Rovetta, S.; Verschure, P.F.M.J.; Villa, A.E.P.

    2017-01-01

    Images are an important data source for diagnosis of oral diseases. The manual classification of images may lead to suboptimal treatment procedures due to subjective errors. In this paper an image classification algorithm based on Deep Learning framework is applied to Quantitative Light-induced

  8. Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment

    Science.gov (United States)

    Torres, Patrick A.; Helmstetter, John A.; Kaye, Adam M.; Kaye, Alan David

    2015-01-01

    Background Rhabdomyolysis is a complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle. Methods This review focuses on the epidemiology, pathophysiology, causes, presentation, diagnosis, complications, management, and anesthetic considerations related to rhabdomyolysis. Results Any form of muscle damage––and by extension any entity that causes muscle damage––can initiate rhabdomyolysis. One of the most important treatment goals when rhabdomyolysis is suspected is avoiding acute kidney injury. Conclusion All clinicians should be aware of common causes, diagnosis, and treatment options. PMID:25829882

  9. [PRIMARY HEADACHE IN CHILDREN AND ADOLESCENTS--DIAGNOSIS AND TREATMENT].

    Science.gov (United States)

    Matar, Amal Khourieh; Kerem, Nogah C; Srugo, Isaac; Genizi, Jacob

    2015-12-01

    Primary headaches are one of the most common disorders of childhood, with migraine and tension type headaches (TTHs) being the most frequent ones. In spite of their prevalence, there is paucity of knowledge regarding the underlying pathophysiological mechanisms that cause headaches and regarding the unique aspects of headaches in children and adolescents. To review the literature and summarize the knowledge regarding clinical features, diagnosis and management of primary headache in children and adolescents, mainly migraine and TTH. Most of our current knowledge regarding primary headaches in children and adolescents is driven from extrapolations from studies that were conducted with adult patients. Therefore, it needs to be validated for the different age groups. Migraines may be diagnosed effectively based on the 2nd edition of the International Classification of Headache Disorders (ICHD-II), however, TTH is diagnosed mainly by the absence of features found in other headache types. Treatment strategies for primary headaches vary according to patient's age, family structure, culture and beliefs, headache diagnosis, and based on the disability the headache imposes on the patient's daily living. It was shown that a multidisciplinary approach, that includes continuing counseling, education, and reassurance, in combination with pharmacological and non-pharmacological treatment, is an effective strategy for children and adolescents suffering from primary headaches. Further studies are needed to enrich our knowledge about the pathophysiological mechanisms that cause headaches in children and adolescents and to develop efficient strategies to alleviate their burden.

  10. Expert Systems: Implications for the Diagnosis and Treatment of Learning Disabilities.

    Science.gov (United States)

    Hofmeister, Alan M.; Lubke, Margaret M.

    1986-01-01

    Expert systems are briefly reviewed and applications in special education diagnosis and classification are described. Future applications are noted to include text interpretation and pupil performance monitoring. (CL)

  11. [Classification and treatment of endoleaks after endovascular treatment of abdominal aortic aneurysms].

    Science.gov (United States)

    Pitton, M B; Schmiedt, W; Neufang, A; Düber, C; Thelen, M

    2005-01-01

    This article describes the classification of endoleaks after endovascular treatment of abdominal aortic aneurysms, thereby summarizing the most important problems of this endovascular technique. The correct classification of endoleaks is a prerequisite for interdisciplinary discussion. It is indispensable for professional reporting of the pathological findings and for the decision making as to the adequate treatment of endoleaks. Irrespective of the types of stent graft and property of the material, five endoleak types are defined in the literature: leakage at the anchor sites (type I); leakage due to collateral arteries (type II); defective stent grafts (type III); leakage due to porosity of the graft material (type IV); and endotension (type V). The causes of endoleaks are discussed and treatment options are reviewed for the diverse pathologic findings.

  12. Classification and treatment of endoleaks after endovascular treatment of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Pitton, M.B.; Thelen, M.; Schmiedt, W.; Neufang, A.; Dueber, C.

    2005-01-01

    This article describes the classification of endoleaks after endovascular treatment of abdominal aortic aneurysms, thereby summarizing the most important problems of this endovascular technique. The correct classification of endoleaks is a prerequisite for interdisciplinary discussion. It is indispensable for professional reporting of the pathological findings and for the decision making as to the adequate treatment of endoleaks. Irrespective of the types of stent graft and property of the material, five endoleak types are defined in the literature: leakage at the anchor sites (type I); leakage due to collateral arteries (type II); defective stent grafts (type III); leakage due to porosity of the graft material (type IV); and endotension (type V). The causes of endoleaks are discussed and treatment options are reviewed for the diverse pathologic findings. (orig.)

  13. Single-Rooted Extraction Sockets: Classification and Treatment Protocol.

    Science.gov (United States)

    El Chaar, Edgar; Oshman, Sarah; Fallah Abed, Pooria

    2016-09-01

    Clinicians have many treatment techniques from which to choose when extracting a failing tooth and replacing it with an implant-supported restoration and when successful management of an extraction socket during the course of tooth replacement is necessary to achieve predictable and esthetic outcomes. This article presents a straightforward, yet thorough, classification for extraction sockets of single-rooted teeth and provides guidance to clinicians in the selection of appropriate and predictable treatment. The presented classification of extraction sockets for single-rooted teeth focuses on the topography of the extraction socket, while the protocol for treatment of each socket type factors in the shape of the remaining bone, the biotype, and the location of the socket whether it be in the mandible or maxilla. This system is based on the biologic foundations of wound healing and can help guide clinicians to successful treatment outcomes.

  14. Binge-eating disorder diagnosis and treatment: a recap in front of DSM-5.

    Science.gov (United States)

    Amianto, Federico; Ottone, Luisa; Abbate Daga, Giovanni; Fassino, Secondo

    2015-04-03

    Binge Eating Disorders is a clinical syndrome recently coded as an autonomous diagnosis in DSM-5. Individuals affected by Binge Eating Disorder (BED) show significantly lower quality of life and perceived health and higher psychological distress compared to the non-BED obese population. BED treatment is complex due to clinical and psychological reasons but also to high drop-out and poor stability of achieved goals. The purpose of this review is to explore the available data on this topic, outlining the state-of-the-art on both diagnostic issues and most effective treatment strategies. We identified studies published in the last 6 years searching the MeSH Term "binge eating disorder", with specific regard to classification, diagnosis and treatment, in major computerized literature databases including: Medline, PubMed, PsychINFO and Science Direct. A total of 233 studies were found and, among them, 71 were selected and included in the review. Although Binge Eating Disorder diagnostic criteria showed empirical consistency, core psychopathology traits should be taken into account to address treatment strategies. The available body of evidence shows psychological treatments as first line interventions, even if their efficacy on weight loss needs further exploration. Behavioral and self-help interventions evidenced some efficacy in patients with lower psychopathological features. Pharmacological treatment plays an important role, but data are still limited by small samples and short follow-up times. The role of bariatric surgery, a recommended treatment for obesity that is often required also by patients with Binge Eating Disorder, deserves more specific studies. Combining different interventions at the same time does not add significant advantages, planning sequential treatments, with more specific interventions for non-responders, seems to be a more promising strategy. Despite its recent inclusion in DSM-5 as an autonomous disease, BED diagnosis and treatment

  15. Classification of EMG signals using PSO optimized SVM for diagnosis of neuromuscular disorders.

    Science.gov (United States)

    Subasi, Abdulhamit

    2013-06-01

    Support vector machine (SVM) is an extensively used machine learning method with many biomedical signal classification applications. In this study, a novel PSO-SVM model has been proposed that hybridized the particle swarm optimization (PSO) and SVM to improve the EMG signal classification accuracy. This optimization mechanism involves kernel parameter setting in the SVM training procedure, which significantly influences the classification accuracy. The experiments were conducted on the basis of EMG signal to classify into normal, neurogenic or myopathic. In the proposed method the EMG signals were decomposed into the frequency sub-bands using discrete wavelet transform (DWT) and a set of statistical features were extracted from these sub-bands to represent the distribution of wavelet coefficients. The obtained results obviously validate the superiority of the SVM method compared to conventional machine learning methods, and suggest that further significant enhancements in terms of classification accuracy can be achieved by the proposed PSO-SVM classification system. The PSO-SVM yielded an overall accuracy of 97.41% on 1200 EMG signals selected from 27 subject records against 96.75%, 95.17% and 94.08% for the SVM, the k-NN and the RBF classifiers, respectively. PSO-SVM is developed as an efficient tool so that various SVMs can be used conveniently as the core of PSO-SVM for diagnosis of neuromuscular disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Anxiety disorders: diagnosis and treatment.

    Science.gov (United States)

    Jack, R A; Mathew, R J

    1985-07-01

    Pathologic anxiety, marked by inappropriate apprehension and/or fear, causes patients to seek help. Anxiety is associated with a wide variety of physical illnesses, and these must be initially considered when making a diagnosis. Similarly, anxiety associated with a wide variety of psychiatric syndromes must also be considered. Finally, the possibility of transient situational anxiety is ever present. Once it is determined that a primary anxiety disorder exists, then the presence or absence of phobias, panic attacks, and chronic "free-floating" anxiety will fully characterize the disorder. With an accurate diagnosis in hand, a multifaceted treatment approach can be designed. Effective treatments now exist for phobic and panic disorders, and more effective treatment for chronic generalized anxiety may be forthcoming.

  17. Plague Diagnosis and Treatment

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search the CDC Plague Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Plague Home Ecology & Transmission Symptoms Diagnosis & Treatment Maps & Statistics ...

  18. Pediatric urinary tract infections: diagnosis and treatment.

    Science.gov (United States)

    Bitsori, Maria; Galanakis, Emmanouil

    2012-10-01

    Urinary tract infection (UTI) is the most common serious bacterial infection in childhood. Prompt diagnosis and treatment are required for the optimal clinical outcome and the prevention of long-term morbidity and sequelae. Diagnosis and treatment of UTI may seem to be easy tasks, but they remain among the most controversial issues in pediatrics. Consequently, children suspected for UTIs are investigated and treated differently in different settings. The absence of typical clinical presentation and the uncertainties in setting the index of suspicion, collecting appropriate urine samples and interpreting results, combined with different antibiotic policies in the face of increasing resistance of uropathogens, contribute to the controversy. Recently issued guidelines have attempted to settle several thorny aspects in diagnosis and treatment, but quite a few issues still remain controversial. In this review, the authors explore the current situation on diagnosis and treatment of childhood UTI in better understanding their pathogenesis and prevalence in different child populations, discuss recently evaluated diagnostic tests and the new management guidelines.

  19. Advances in the classification and treatment of mastocytosis

    DEFF Research Database (Denmark)

    Valent, Peter; Akin, Cem; Hartmann, Karin

    2017-01-01

    Mastocytosis is a term used to denote a heterogeneous group of conditions defined by the expansion and accumulation of clonal (neoplastic) tissue mast cells in various organs. The classification of the World Health Organization (WHO) divides the disease into cutaneous mastocytosis, systemic...... leukemia. The clinical impact and prognostic value of this classification has been confirmed in numerous studies, and its basic concept remains valid. However, refinements have recently been proposed by the consensus group, the WHO, and the European Competence Network on Mastocytosis. In addition, new...... of mastocytosis, with emphasis on classification, prognostication, and emerging new treatment options in advanced systemic mastocytosis....

  20. Radiomic features analysis in computed tomography images of lung nodule classification.

    Directory of Open Access Journals (Sweden)

    Chia-Hung Chen

    Full Text Available Radiomics, which extract large amount of quantification image features from diagnostic medical images had been widely used for prognostication, treatment response prediction and cancer detection. The treatment options for lung nodules depend on their diagnosis, benign or malignant. Conventionally, lung nodule diagnosis is based on invasive biopsy. Recently, radiomics features, a non-invasive method based on clinical images, have shown high potential in lesion classification, treatment outcome prediction.Lung nodule classification using radiomics based on Computed Tomography (CT image data was investigated and a 4-feature signature was introduced for lung nodule classification. Retrospectively, 72 patients with 75 pulmonary nodules were collected. Radiomics feature extraction was performed on non-enhanced CT images with contours which were delineated by an experienced radiation oncologist.Among the 750 image features in each case, 76 features were found to have significant differences between benign and malignant lesions. A radiomics signature was composed of the best 4 features which included Laws_LSL_min, Laws_SLL_energy, Laws_SSL_skewness and Laws_EEL_uniformity. The accuracy using the signature in benign or malignant classification was 84% with the sensitivity of 92.85% and the specificity of 72.73%.The classification signature based on radiomics features demonstrated very good accuracy and high potential in clinical application.

  1. [Definition of the Diagnosis Osteomyelitis-Osteomyelitis Diagnosis Score (ODS)].

    Science.gov (United States)

    Schmidt, H G K; Tiemann, A H; Braunschweig, R; Diefenbeck, M; Bühler, M; Abitzsch, D; Haustedt, N; Walter, G; Schoop, R; Heppert, V; Hofmann, G O; Glombitza, M; Grimme, C; Gerlach, U-J; Flesch, I

    2011-08-01

    The disease "osteomyelitis" is characterised by different symptoms and parameters. Decisive roles in the development of the disease are played by the causative bacteria, the route of infection and the individual defense mechanisms of the host. The diagnosis is based on different symptoms and findings from the clinical history, clinical symptoms, laboratory results, diagnostic imaging, microbiological and histopathological analyses. While different osteomyelitis classifications have been published, there is to the best of our knowledge no score that gives information how sure the diagnosis "osteomyelitis" is in general. For any scientific study of a disease a valid definition is essential. We have developed a special osteomyelitis diagnosis score for the reliable classification of clinical, laboratory and technical findings. The score is based on five diagnostic procedures: 1) clinical history and risk factors, 2) clinical examination and laboratory results, 3) diagnostic imaging (ultrasound, radiology, CT, MRI, nuclear medicine and hybrid methods), 4) microbiology, and 5) histopathology. Each diagnostic procedure is related to many individual findings, which are weighted by a score system, in order to achieve a relevant value for each assessment. If the sum of the five diagnostic criteria is 18 or more points, the diagnosis of osteomyelitis can be viewed as "safe" (diagnosis class A). Between 8-17 points the diagnosis is "probable" (diagnosis class B). Less than 8 points means that the diagnosis is "possible, but unlikely" (class C diagnosis). Since each parameter can score six points at a maximum, a reliable diagnosis can only be achieved if at least 3 parameters are scored with 6 points. The osteomyelitis diagnosis score should help to avoid the false description of a clinical presentation as "osteomyelitis". A safe diagnosis is essential for the aetiology, treatment and outcome studies of osteomyelitis. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Appendectomy and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Quentin, Wilm; Scheller-Kreinsen, David; Geissler, Alexander; Busse, Reinhard

    2012-02-01

    As part of the EuroDRG project, researchers from 11 countries (i.e., Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their diagnosis-related groups (DRG) systems deal with appendectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a diagnosis of appendicitis treated with a procedure of appendectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify appendectomy patients according to different sets of variables (between two and six classification variables) into diverging numbers of DRGs (between two and 11 DRGs). The most complex DRG is valued 5.1 times more resource intensive than an index case in France but only 1.1 times more resource intensive than an index case in Finland. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the most complex case vignette amount to only 1,005 in Poland but to 12,304 in France. Large variations in the classification of appendectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons and national DRG authorities should consider how other countries' DRG systems classify appendectomy patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement.

  3. Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective

    Science.gov (United States)

    Zhao, Changbo; Li, Guo-Zheng; Wang, Chengjun; Niu, Jinling

    2015-01-01

    As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification. PMID:26246834

  4. Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective.

    Science.gov (United States)

    Zhao, Changbo; Li, Guo-Zheng; Wang, Chengjun; Niu, Jinling

    2015-01-01

    As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification.

  5. Sigmoid volvulus. Diagnosis and interdisciplinary treatment

    International Nuclear Information System (INIS)

    Schoen, G.; Offer, C.; Glaser, K.

    1991-01-01

    Sigmoid volvolus is an emergency which requires rapid diagnosis and immediate adequate treatment. Diagnosis is primarily radiological. Emergency laparotomy carries a high mortality and should therefore not be the immediate treatment. In our opinion, detorsion by colonoscopy under radiological control is a promising form of treatment. Selective resection of the sigmoid, thereby removing the cause of the abnormality, should not be forgotten, since this prevents recurrences. For this method, mortality after adequate gut preparation is only 5.4%. An exception to the above is gangrene of the bowel, when an emergency laparotomy cannot be avoided. (orig.) [de

  6. Intelligence system based classification approach for medical disease diagnosis

    Science.gov (United States)

    Sagir, Abdu Masanawa; Sathasivam, Saratha

    2017-08-01

    The prediction of breast cancer in women who have no signs or symptoms of the disease as well as survivability after undergone certain surgery has been a challenging problem for medical researchers. The decision about presence or absence of diseases depends on the physician's intuition, experience and skill for comparing current indicators with previous one than on knowledge rich data hidden in a database. This measure is a very crucial and challenging task. The goal is to predict patient condition by using an adaptive neuro fuzzy inference system (ANFIS) pre-processed by grid partitioning. To achieve an accurate diagnosis at this complex stage of symptom analysis, the physician may need efficient diagnosis system. A framework describes methodology for designing and evaluation of classification performances of two discrete ANFIS systems of hybrid learning algorithms least square estimates with Modified Levenberg-Marquardt and Gradient descent algorithms that can be used by physicians to accelerate diagnosis process. The proposed method's performance was evaluated based on training and test datasets with mammographic mass and Haberman's survival Datasets obtained from benchmarked datasets of University of California at Irvine's (UCI) machine learning repository. The robustness of the performance measuring total accuracy, sensitivity and specificity is examined. In comparison, the proposed method achieves superior performance when compared to conventional ANFIS based gradient descent algorithm and some related existing methods. The software used for the implementation is MATLAB R2014a (version 8.3) and executed in PC Intel Pentium IV E7400 processor with 2.80 GHz speed and 2.0 GB of RAM.

  7. Charting the landscape of priority problems in psychiatry, part 1: classification and diagnosis.

    Science.gov (United States)

    Stephan, Klaas E; Bach, Dominik R; Fletcher, Paul C; Flint, Jonathan; Frank, Michael J; Friston, Karl J; Heinz, Andreas; Huys, Quentin J M; Owen, Michael J; Binder, Elisabeth B; Dayan, Peter; Johnstone, Eve C; Meyer-Lindenberg, Andreas; Montague, P Read; Schnyder, Ulrich; Wang, Xiao-Jing; Breakspear, Michael

    2016-01-01

    Contemporary psychiatry faces major challenges. Its syndrome-based disease classification is not based on mechanisms and does not guide treatment, which largely depends on trial and error. The development of therapies is hindered by ignorance of potential beneficiary patient subgroups. Neuroscientific and genetics research have yet to affect disease definitions or contribute to clinical decision making. In this challenging setting, what should psychiatric research focus on? In two companion papers, we present a list of problems nominated by clinicians and researchers from different disciplines as candidates for future scientific investigation of mental disorders. These problems are loosely grouped into challenges concerning nosology and diagnosis (this Personal View) and problems related to pathogenesis and aetiology (in the companion Personal View). Motivated by successful examples in other disciplines, particularly the list of Hilbert's problems in mathematics, this subjective and eclectic list of priority problems is intended for psychiatric researchers, helping to re-focus existing research and providing perspectives for future psychiatric science. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. new aspects on epidemiology, classification, differential diagnosis and therapy of recurrent vertigo disorders

    OpenAIRE

    Radtke, Andrea

    2012-01-01

    This work presents new data on the epidemiology, classification, differential diagnosis and therapy of recurrent vestibular vertigo disorders: M. Menière, vestibular migraine and benign paroxysmal positional vertigo (BPPV). Epidemiological assessment of a nationwide, representative sample of the German adult population by means of a neurotological telephone interview revealed a low lifetime prevalence of Menière’s disease of less than 0.12% when the diagnostic criteria of the American Aca...

  9. Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura ...

    African Journals Online (AJOL)

    Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura. ... by features of microangiopathic hemolytic anemia and thrombocytopenia. ... Current knowledge in the etiopathogenesis, epidemiology, trends in the diagnosis and ...

  10. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

    Directory of Open Access Journals (Sweden)

    Hans Polzer

    2012-01-01

    Full Text Available Acute ankle injuries are among the most common injuries in emergency departments. However, a standardized examination and an evidence-based treatment are missing. Therefore, aim of this study was to systematically search the current literature, classify the evidence and develop an algorithm for diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analysis, systematic reviews, or if applicable observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations are given. The Ottawa Ankle/Foot Rule should be applied in order to rule out fractures, Physical examination is sufficient for diagnosing injuries to the lateral ligament complex. Classification into stable and unstable injuries is applicable and of clinical importance. The squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis. Magnetic resonance imaging is recommended to verify such injuries. Stable ankle sprains have a good prognosis, while for unstable ankle sprains conservative treatment is at least as effective as operative treatment without carrying possible complications. Early functional treatment leads to the fastest recovery and the least rate of re-injury. Supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we here present an applicable and evidence-based step by step decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor’s practice. It provides quality assurance for the patient and confidence for the attending physician.

  11. European evidence-based recommendations for diagnosis and treatment of paediatric antiphospholipid syndrome: the SHARE initiative.

    Science.gov (United States)

    Groot, Noortje; de Graeff, Nienke; Avcin, Tadej; Bader-Meunier, Brigitte; Dolezalova, Pavla; Feldman, Brian; Kenet, Gili; Koné-Paut, Isabelle; Lahdenne, Pekka; Marks, Stephen D; McCann, Liza; Pilkington, Clarissa A; Ravelli, Angelo; van Royen-Kerkhof, Annet; Uziel, Yosef; Vastert, Sebastiaan J; Wulffraat, Nico M; Ozen, Seza; Brogan, Paul; Kamphuis, Sylvia; Beresford, Michael W

    2017-10-01

    Antiphospholipid syndrome (APS) is rare in children, and evidence-based guidelines are sparse. Consequently, management is mostly based on observational studies and physician's experience, and treatment regimens differ widely. The Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative was launched to develop diagnostic and management regimens for children and young adults with rheumatic diseases. Here, we developed evidence-based recommendations for diagnosis and treatment of paediatric APS. Evidence-based recommendations were developed using the European League Against Rheumatism standard operating procedure. Following a detailed systematic review of the literature, a committee of paediatric rheumatologists and representation of paediatric haematology with expertise in paediatric APS developed recommendations. The literature review yielded 1473 articles, of which 15 were valid and relevant. In total, four recommendations for diagnosis and eight for treatment of paediatric APS (including paediatric Catastrophic Antiphospholipid Syndrome) were accepted. Additionally, two recommendations for children born to mothers with APS were accepted. It was agreed that new classification criteria for paediatric APS are necessary, and APS in association with childhood-onset systemic lupus erythematosus should be identified by performing antiphospholipid antibody screening. Treatment recommendations included prevention of thrombotic events, and treatment recommendations for venous and/or arterial thrombotic events. Notably, due to the paucity of studies on paediatric APS, level of evidence and strength of the recommendations is relatively low. The SHARE initiative provides international, evidence-based recommendations for diagnosis and treatment for paediatric APS, facilitating improvement and uniformity of care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use

  12. Clinical diagnosis and treatment of thyroid microcarcinoma

    International Nuclear Information System (INIS)

    Gao Xuemei; Zhang Yajing; Gao Zairong

    2013-01-01

    Thyroid cancer is the most common malignant carcinoma in the endocrine system. With the increasing incidence of thyroid cancer, the incidence of thyroid microcarcinoma has been elevating gradually. But there is still a large ambiguity on thyroid microcarcinoma about the diagnosis and treatment. The epidemiology, clinical diagnosis, biological behavior and treatment programs of thyroid microcarcinoma were reviewed in this article. (authors)

  13. Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group.

    Science.gov (United States)

    Lott, Jason P; Elmore, Joann G; Zhao, Ge A; Knezevich, Stevan R; Frederick, Paul D; Reisch, Lisa M; Chu, Emily Y; Cook, Martin G; Duncan, Lyn M; Elenitsas, Rosalie; Gerami, Pedram; Landman, Gilles; Lowe, Lori; Messina, Jane L; Mihm, Martin C; van den Oord, Joost J; Rabkin, Michael S; Schmidt, Birgitta; Shea, Christopher R; Yun, Sook Jung; Xu, George X; Piepkorn, Michael W; Elder, David E; Barnhill, Raymond L

    2016-08-01

    Pathologists use diverse terminology when interpreting melanocytic neoplasms, potentially compromising quality of care. We sought to evaluate the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) scheme, a 5-category classification system for melanocytic lesions. Participants (n = 16) of the 2013 International Melanoma Pathology Study Group Workshop provided independent case-level diagnoses and treatment suggestions for 48 melanocytic lesions. Individual diagnoses (including, when necessary, least and most severe diagnoses) were mapped to corresponding MPATH-Dx classes. Interrater agreement and correlation between MPATH-Dx categorization and treatment suggestions were evaluated. Most participants were board-certified dermatopathologists (n = 15), age 50 years or older (n = 12), male (n = 9), based in the United States (n = 11), and primary academic faculty (n = 14). Overall, participants generated 634 case-level diagnoses with treatment suggestions. Mean weighted kappa coefficients for diagnostic agreement after MPATH-Dx mapping (assuming least and most severe diagnoses, when necessary) were 0.70 (95% confidence interval 0.68-0.71) and 0.72 (95% confidence interval 0.71-0.73), respectively, whereas correlation between MPATH-Dx categorization and treatment suggestions was 0.91. This was a small sample size of experienced pathologists in a testing situation. Varying diagnostic nomenclature can be classified into a concise hierarchy using the MPATH-Dx scheme. Further research is needed to determine whether this classification system can facilitate diagnostic concordance in general pathology practice and improve patient care. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer – a classification tree approach

    International Nuclear Information System (INIS)

    Martin, Michael A; Meyricke, Ramona; O'Neill, Terry; Roberts, Steven

    2006-01-01

    A critical choice facing breast cancer patients is which surgical treatment – mastectomy or breast conserving surgery (BCS) – is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of 'propensity' is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA) data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects' treatment preferences were predicted from covariates using both classification trees and logistic regression. Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians' advice to patients

  15. Diagnosis and prognosis of primary breast cancer

    International Nuclear Information System (INIS)

    Robertson, J. F. R.; Evans, A. J.

    1997-01-01

    The diagnosis of breast cancer should be made in the context of a multidisciplinary team: preoperative diagnosis can be made in over 90 % of patients with symptomatic and screen-detected cancers. A preoperative diagnosis allows patients the opportunity to come to terms with the diagnosis of breast cancer and to consider their treatment options before progressing to therapeutic surgery. Surgery remains the primary therapeutic treatment for operable breast cancer with radiotherapy and systemic therapies as adjuvant treatments. Surgery in addition provides pathological specimens from which important prognostic information may be obtained. The traditional TNM classification in itself is no longer sufficient although there is still c considerable prognostic information to be gained in staging patients. Markers of tumour biology provide prognostic data independent of TNM staging. Both need to be considered in any overall assessment of patient prognosis

  16. Diagnosis of mild chronic pancreatitis (Cambridge classification): comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography.

    Science.gov (United States)

    Sai, Jin-Kan; Suyama, Masafumi; Kubokawa, Yoshihiro; Watanabe, Sumio

    2008-02-28

    To investigate the usefulness of secretin injection-MRCP for the diagnosis of mild chronic pancreatitis. Sixteen patients having mild chronic pancreatitis according to the Cambridge classification and 12 control subjects with no abnormal findings on the pancreatogram were examined for the diagnostic accuracy of secretin injection-MRCP regarding abnormal branch pancreatic ducts associated with mild chronic pancreatitis (Cambridge Classification), using endoscopic retrograde cholangiopancreatography (ERCP) for comparison. The sensitivity and specificity for abnormal branch pancreatic ducts determined by two reviewers were respectively 55%-63% and 75%-83% in the head, 57%-64% and 82%-83% in the body, and 44%-44% and 72%-76% in the tail of the pancreas. The sensitivity and specificity for mild chronic pancreatitis were 56%-63% and 92%-92%, respectively. Interobserver agreement (kappa statistics) concerning the diagnosis of an abnormal branch pancreatic duct and of mild chronic pancreatitis was good to excellent. Secretin injection-MRCP might be useful for the diagnosis of mild chronic pancreatitis.

  17. Giant cell arteritis. Part I. Terminology, classification, clinical manifestations, diagnosis

    Directory of Open Access Journals (Sweden)

    Azamat Makhmudovich Satybaldyev

    2012-01-01

    Full Text Available Giant cell arteritis (GCA is a vasculitis affecting mainly large and medium-sized arteries, which the classification of systemic vasculitides refers to as those mainly involving the large vessels. GCA is typified by the involvement of extracranial aortic branches and intracranial vessels, the aorta and its large vessels are being affected most frequently. The paper considers the terminology, classification, prevalence, major pathogenic mechanisms, and morphology of GCA. A broad spectrum of its clinical subtypes is due to target vessel stenosis caused by intimal hyperplasia. In 40% of cases, GCA is shown to be accompanied by polymyalgia rheumatica that may either precede or manifest simultaneously with GCA, or follow this disease. The menacing complications of GCA may be visual loss or ischemic strokes at various sites depending on the location of the occluded vessel. Along with the gold standard verification of the diagnosis of GCA, namely temporal artery biopsy, the author indicates other (noninvasive methods for detection of vascular lesions: color Doppler ultrasonography of the temporal arteries, fluorescein angiography of the retina, mag-netic resonance angiography, magnetic resonance imaging, and computed tomography to rule out aortic aneurysm. Dynamic 18F positron emission tomography is demonstrated to play a role in the evaluation of therapeutic effectiveness.

  18. Talar Fractures and Dislocations: A Radiologist's Guide to Timely Diagnosis and Classification.

    Science.gov (United States)

    Melenevsky, Yulia; Mackey, Robert A; Abrahams, R Brad; Thomson, Norman B

    2015-01-01

    The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. The predominantly extraosseous vascular supply of the talus predisposes it to significant injury in the setting of trauma. In addition, the lack of muscular attachments and absence of a secondary blood supply can lead to subsequent osteonecrosis. Although talar fractures account for less than 1% of all fractures, they commonly result from high-energy trauma and may lead to complications and long-term morbidity if not recognized and managed appropriately. While initial evaluation is with foot and ankle radiographs, computed tomography (CT) is often performed to evaluate the extent of the fracture, displacement, comminution, intra-articular extension, and associated injuries. Talar fractures are divided by anatomic region: head, neck, and body. Talar head fractures can be treated conservatively if nondisplaced, warranting careful radiographic and CT evaluation to assess rotation, displacement, and extension into the neck. The modified Hawkins-Canale classification of talar neck fractures is most commonly used due to its simplicity, usefulness in guiding treatment, and prognostic value, as it correlates associated malalignment with risk of subsequent osteonecrosis. Isolated talar body fractures may be more common than previously thought. The Sneppen classification further divides talar body fractures into osteochondral talar dome, lateral and posterior process, and shear and crush comminuted central body fractures. Crush comminuted central body fractures carry a poor prognosis due to nonanatomic reduction, bone loss, and subsequent osteonecrosis. Lateral process fractures can be radiographically occult and require a higher index of suspicion for successful diagnosis. Subtalar dislocations are often accompanied by fractures, necessitating postreduction CT. Familiarity with the unique talar anatomy and injury patterns is essential for radiologists to facilitate

  19. Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Glaucoma Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research Past Issues / Fall 2009 Table of Contents Symptoms and Diagnosis Glaucoma can develop in one or both eyes. Often ...

  20. Feature Hepatitis: Hepatitis Symptoms, Diagnosis, Treatment & Prevention

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Feature Hepatitis Hepatitis: Symptoms, Diagnosis, Treatment & Prevention Past Issues / Spring 2009 ... No appetite Fever Headaches Diagnosis To check for hepatitis viruses, your doctor will test your blood. You ...

  1. Diagnosis and treatment of breast cancer

    International Nuclear Information System (INIS)

    Doihara, Hiroyoshi; Taira, Naruhito

    2008-01-01

    This paper explains the outline of the present diagnosis and treatment of breast cancer essentially based on its therapeutic guideline by the Japan Breast Cancer Society (2005) and on authors' experiences. The diagnosis item contains the medical interview of patients, observatory and palpating examinations, mammography (for this, Japan-Breast Imaging Recording and Data System), ultrasonography (guideline for sonographic diagnosis of mammary gland, 2004), fine needle aspiration (FNA) or aspiration biopsy cytology, bases of triple test (palpation, mammography and FNA) for the cancer diagnosis, core needle biopsy, and mammotome biopsy of non-palpable calcified lesion. The treatment item contains the surgery involving conservation, sentinel lymph node biopsy (for this, lymphoscintigraphy with Tc-phytate is illustrated), radiofrequency ablation, adjuvant chemotherapy essentially using anthracycline and taxane, endocrinological therapy using tamoxifen, LH-RH analogues and aromatase inhibitors, and molecular target therapy with HER2 monoclonal antibody like trastuzumab. Recent progress of systemic therapy with medicals is remarkable, and the educational promotion of experts and medicare circumstances are concluded to be important. (R.T.)

  2. Diagnosis and classification of Addison's disease (autoimmune adrenalitis).

    Science.gov (United States)

    Brandão Neto, Rodrigo Antonio; de Carvalho, Jozélio Freire

    2014-01-01

    Autoimmune adrenalitis, or autoimmune Addison disease (AAD), is the most prevalent cause of primary adrenal insufficiency in the developed world. AAD is rare and can easily be misdiagnosed as other conditions. The diagnosis depends on demonstrating inappropriately low cortisol production and the presence of high titers of adrenal cortex autoantibodies (ACAs), along with excluding other causes of adrenal failure using other tests as necessary. The treatment corticosteroid replacement, and the prognosis following the treatment is the same as the normal population. Spontaneous recovery of adrenal function has been described but is rare. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment.

    Science.gov (United States)

    Eichelmann, K; González González, S E; Salas-Alanis, J C; Ocampo-Candiani, J

    2013-09-01

    Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

  4. Biased binomial assessment of cross-validated estimation of classification accuracies illustrated in diagnosis predictions.

    Science.gov (United States)

    Noirhomme, Quentin; Lesenfants, Damien; Gomez, Francisco; Soddu, Andrea; Schrouff, Jessica; Garraux, Gaëtan; Luxen, André; Phillips, Christophe; Laureys, Steven

    2014-01-01

    Multivariate classification is used in neuroimaging studies to infer brain activation or in medical applications to infer diagnosis. Their results are often assessed through either a binomial or a permutation test. Here, we simulated classification results of generated random data to assess the influence of the cross-validation scheme on the significance of results. Distributions built from classification of random data with cross-validation did not follow the binomial distribution. The binomial test is therefore not adapted. On the contrary, the permutation test was unaffected by the cross-validation scheme. The influence of the cross-validation was further illustrated on real-data from a brain-computer interface experiment in patients with disorders of consciousness and from an fMRI study on patients with Parkinson disease. Three out of 16 patients with disorders of consciousness had significant accuracy on binomial testing, but only one showed significant accuracy using permutation testing. In the fMRI experiment, the mental imagery of gait could discriminate significantly between idiopathic Parkinson's disease patients and healthy subjects according to the permutation test but not according to the binomial test. Hence, binomial testing could lead to biased estimation of significance and false positive or negative results. In our view, permutation testing is thus recommended for clinical application of classification with cross-validation.

  5. Radiographic caries diagnosis and restorative treatment decision making

    International Nuclear Information System (INIS)

    Mileman, P.A.

    1985-01-01

    This thesis is concerned with a single diagnostic technique: the bitewing radiograph, and the way it is used by dentists to decide on patient treatment need for interproximal caries. The variation in caries diagnosis and treatment decisions using bitewing radiographs is described and the radiographic criteria of choice for minimizing over and undertreatment according to a norm are investigated. Three possible diagnostic strategies in interproximal caries diagnosis using a decision analysis approach are described and evaluated, and the effect of the reported diagnostic behaviour and knowledge of practicing Dutch dentists in their use of bitewing radiographs for the diagnosis and treatment of interproximal caries is described and analyzed. (Auth.)

  6. Early breast cancer: diagnosis, treatment and survivorship.

    LENUS (Irish Health Repository)

    Meade, Elizabeth

    2013-01-11

    Breast cancer is the most common female cancer and globally remains a major public health concern. The diagnosis and treatment of breast cancer continues to develop. Diagnosis is now more precise, surgery is less mutilating and women now have the option of breast conserving therapy with better cosmesis, and without sacrificing survival. Radiotherapy is more targeted and the selection of patients for adjuvant chemotherapy is based not only on prognostic and predictive factors, but also on newer molecular profiling that will ensure that chemotherapy is given to the patients who need and respond to it. These developments all provide a more tailored approach to the treatment of breast cancer. Management now involves a multidisciplinary team approach in order to provide the highest standard of care for patients throughout their cancer journey from diagnosis through treatment and into follow-up care.

  7. Differential Diagnosis of Erythmato-Squamous Diseases Using Classification and Regression Tree.

    Science.gov (United States)

    Maghooli, Keivan; Langarizadeh, Mostafa; Shahmoradi, Leila; Habibi-Koolaee, Mahdi; Jebraeily, Mohamad; Bouraghi, Hamid

    2016-10-01

    Differential diagnosis of Erythmato-Squamous Diseases (ESD) is a major challenge in the field of dermatology. The ESD diseases are placed into six different classes. Data mining is the process for detection of hidden patterns. In the case of ESD, data mining help us to predict the diseases. Different algorithms were developed for this purpose. we aimed to use the Classification and Regression Tree (CART) to predict differential diagnosis of ESD. we used the Cross Industry Standard Process for Data Mining (CRISP-DM) methodology. For this purpose, the dermatology data set from machine learning repository, UCI was obtained. The Clementine 12.0 software from IBM Company was used for modelling. In order to evaluation of the model we calculate the accuracy, sensitivity and specificity of the model. The proposed model had an accuracy of 94.84% (. 24.42) in order to correct prediction of the ESD disease. Results indicated that using of this classifier could be useful. But, it would be strongly recommended that the combination of machine learning methods could be more useful in terms of prediction of ESD.

  8. Diagnosis and treatment of central diabetes insipidus

    Directory of Open Access Journals (Sweden)

    Ekaterina Aleksandrovna Pigarova

    2014-11-01

    Full Text Available Diabetes insipidus represents a serious disease that dramatically interferes with the everyday life of patients due to the need to constantly replenish of fluid lost in the urine, which comes amid shortage of synthesis, secretion or action of pituitary hormone vasopressin. The main difficulty is the differential diagnosis of types of diabetes insipidus in patients with the syndrome of polydipsia-polyuria as the correct differential diagnosis of these forms predetermine the safety and efficacy of further treatment. This lecture presents the current concepts of etiology, diagnosis and treatment of central diabetes insipidus (CDI. We give the comparative characteristics of various preparations of desmopressin for the treatment of the central form of the disease. We also consider the features of the management of selected patient populations with CDI: during pregnancy and lactation, pathology of the thirst sensation, after traumatic brain injury and neurosurgery.

  9. Pneumothorax: from definition to diagnosis and treatment.

    Science.gov (United States)

    Zarogoulidis, Paul; Kioumis, Ioannis; Pitsiou, Georgia; Porpodis, Konstantinos; Lampaki, Sofia; Papaiwannou, Antonis; Katsikogiannis, Nikolaos; Zaric, Bojan; Branislav, Perin; Secen, Nevena; Dryllis, Georgios; Machairiotis, Nikolaos; Rapti, Aggeliki; Zarogoulidis, Konstantinos

    2014-10-01

    Pneumothorax is an urgent situation that has to be treated immediately upon diagnosis. Pneumothorax is divided to primary and secondary. A primary pneumothorax is considered the one that occurs without an apparent cause and in the absence of significant lung disease. On the other hand secondary pneumothorax occurs in the presence of existing lung pathology. There is the case where an amount of air in the chest increases markedly and a one-way valve is formed leading to a tension pneumothorax. Unless reversed by effective treatment, this situation can progress and cause death. Pneumothorax can be caused by physical trauma to the chest or as a complication of medical or surgical intervention (biopsy). Symptoms typically include chest pain and shortness of breath. Diagnosis of a pneumothorax requires a chest X-ray or computed tomography (CT) scan. Small spontaneous pneumothoraces typically resolve without treatment and require only monitoring. In our current special issue we will present the definition, diagnosis and treatment of pneumothorax from different experts in the field, different countries and present different methods of treatment.

  10. [Practice guideline 'Prostate cancer: diagnosis and treatment'

    NARCIS (Netherlands)

    Reijke, T.M. de; Battermann, J.J.; Moorselaar, R.J.A. van; Jong, I.J. de; Visser, A.P.; Burgers, J.S.

    2008-01-01

    --A national, multidisciplinary practice guideline was developed concerning diagnosis and treatment of patients with prostate cancer. Because of the lack of sufficient scientific evidence at this moment no practice guideline on screening is included. --The diagnosis of prostate cancer is made by

  11. Parkinson's Disease: Diagnosis and Treatment

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Parkinson's Disease Parkinson's Disease: Diagnosis and Treatment Past Issues / Winter 2014 ... live productive lives and maintain mobility. How is Parkinson's Diagnosed? There are no blood or laboratory tests ...

  12. Acute Respiratory Viral Infection in Children: Modern Approaches to Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Alexander A. Baranov

    2017-01-01

    Full Text Available The article is devoted to acute respiratory viral infections (ARVI in children. ARVI take one of the leading places in a childhood morbidity structure. The article provides an overview of the clinical guidelines developed and approved by the professional association «Union of Pediatricians of Russia» for acute respiratory infections in children. These guidelines summarize the experience of the leading world and domestic specialists, contain scientific and practical data that correspond to the most relevant trends in the management of children with this pathology. The authors present modern information on the etiology, pathogenesis, classification, clinical findings and differential diagnosis of various nosological forms of acute respiratory tract infections in the pediatric population. The general (strategic principles of drug-free and drug treatment are discussed in detail.

  13. Definition and Classification of Heart Failure

    Directory of Open Access Journals (Sweden)

    Mitja Lainscak

    2017-01-01

    Full Text Available A review of the definition and classification of heart failure, updated since the recent 2016 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure. Heart failure is defined by the European Society of Cardiology (ESC as a clinical syndrome characterised by symptoms such as shortness of breath, persistent coughing or wheezing, ankle swelling and fatigue, that may be accompanied by the following signs: jugular venous pressure, pulmonary crackles, increased heart rate and peripheral oedema. However, these signs may not be present in the early stages and in patients treated with diuretics. When apparent, they are due to a structural and/or functional cardiac abnormality, leading to systolic and/or diastolic ventricular dysfunction, resulting in a reduced cardiac output and/or elevated intra- cardiac pressures at rest or during stress. According to the most recent ESC guidelines the initial evaluation of patients with suspected heart failure should include a clinical history and physical examination, laboratory assessment, chest radiography, and electrocardiography. Echocardiography can confirm the diagnosis. Beyond detecting myocardial abnormality, other impairments such as abnormalities of the valves, pericardium, endocardium, heart rhythm, and conduction may be found. The identification of the underlying aetiology is pivotal for the diagnosis of heart failure and its treatment. The authors review the definitions and classifications of heart failure.

  14. Survey of physician experiences and perceptions about the diagnosis and treatment of fibromyalgia

    Directory of Open Access Journals (Sweden)

    Perrot Serge

    2012-10-01

    Full Text Available Abstract Background Fibromyalgia (FM is a condition characterized by widespread pain and is estimated to affect 0.5-5% of the general population. Historically, it has been classified as a rheumatologic disorder, but patients consult physicians from a variety of specialties in seeking diagnosis and ultimately treatment. Patients report considerable delay in receiving a diagnosis after initial presentation, suggesting diagnosis and management of FM might be a challenge to physicians. Methods A questionnaire survey of 1622 physicians in six European countries, Mexico and South Korea was conducted. Specialties surveyed included primary care physicians (PCPs; n=809 and equal numbers of rheumatologists, neurologists, psychiatrists and pain specialists. Results The sample included experienced doctors, with an expected clinical caseload for their specialty. Most (>80% had seen a patient with FM in the last 2 years. Overall, 53% of physicians reported difficulty with diagnosing FM, 54% reported their training in FM was inadequate, and 32% considered themselves not knowledgeable about FM. Awareness of American College of Rheumatology classification criteria ranged from 32% for psychiatrists to 83% for rheumatologists. Sixty-four percent agreed patients found it difficult to communicate FM symptoms, and 79% said they needed to spend more time to identify FM. Thirty-eight percent were not confident in recognizing the symptoms of FM, and 48% were not confident in differentiating FM from conditions with similar symptoms. Thirty-seven percent were not confident developing an FM treatment plan, and 37% were not confident managing FM patients long-term. In general, rheumatologists reported least difficulties/greatest confidence, and PCPs and psychiatrists reported greatest difficulties/least confidence. Conclusions Diagnosis and managing FM is challenging for physicians, especially PCPs and psychiatrists, but other specialties, including rheumatologists, also

  15. Diagnosis and Treatment of Pityriasis Rubra Pilaris

    Directory of Open Access Journals (Sweden)

    Kubanov Alexey

    2014-12-01

    Full Text Available The article deals with clinical diagnosis and treatment of pityriasis rubra pilaris (PRP. The authors analyze the diagnostic errors, present literature review, and their own observations. The clinical study included 23 patients with pityriasis rubra pilaris: 18 women and 5 men, average age of 54 ± 7.2. The clinical diagnosis of all examined patients was subsequently confirmed by histological analysis of the skin. The primary clinical diagnosis was psoriasis in 15 (65.2% patients, 6 (26% patients received treatment for toxic exanthema, and only 2 (8.8% patients were presumptively diagnosed with pityriasis rubra pilaris. In conclusion, pityriasis rubra pilaris was initially misdiagnosed in 91.2% of patients. Considering the great number of diagnostic errors, we analyzed the main diagnostic and differential diagnostic features of PRP. The most effective of all synthetic retinoids in PRP treatment is acitretin. Although symptomatic improvement in PRP occurs within a month, substantial improvement, even clearing is possible within 4 - 6 months.

  16. Ambiguous diagnosis, futile treatments and temporary recovery ...

    African Journals Online (AJOL)

    Ambiguous diagnosis, futile treatments and temporary recovery: Meanings of medical treatment among HIV/AIDS family caregivers providing care without ARVs. ... to understand unstable treatment outcomes; and policy makers should strengthen home-based care by developing policies that integrate palliative care into HIV ...

  17. The diagnosis and treatment of the gummy smile.

    Science.gov (United States)

    Levine, R A; McGuire, M

    1997-08-01

    The diagnosis and treatment of the "gummy smile" (altered passive eruption, excessive gingival display) help the periodontist to provide the most beautiful smiles possible for patients. This article describes diagnosis, surgical planning, and case reports that show the benefits of treatment of this common clinical problem for the patient and restorative dentist who can now provide ideal cosmetic results for their patients.

  18. Biased binomial assessment of cross-validated estimation of classification accuracies illustrated in diagnosis predictions

    Directory of Open Access Journals (Sweden)

    Quentin Noirhomme

    2014-01-01

    Full Text Available Multivariate classification is used in neuroimaging studies to infer brain activation or in medical applications to infer diagnosis. Their results are often assessed through either a binomial or a permutation test. Here, we simulated classification results of generated random data to assess the influence of the cross-validation scheme on the significance of results. Distributions built from classification of random data with cross-validation did not follow the binomial distribution. The binomial test is therefore not adapted. On the contrary, the permutation test was unaffected by the cross-validation scheme. The influence of the cross-validation was further illustrated on real-data from a brain–computer interface experiment in patients with disorders of consciousness and from an fMRI study on patients with Parkinson disease. Three out of 16 patients with disorders of consciousness had significant accuracy on binomial testing, but only one showed significant accuracy using permutation testing. In the fMRI experiment, the mental imagery of gait could discriminate significantly between idiopathic Parkinson's disease patients and healthy subjects according to the permutation test but not according to the binomial test. Hence, binomial testing could lead to biased estimation of significance and false positive or negative results. In our view, permutation testing is thus recommended for clinical application of classification with cross-validation.

  19. Problems of diagnosis and treatment of echinococcosis

    Directory of Open Access Journals (Sweden)

    Тунзала Али кызы Велиева

    2015-05-01

    Full Text Available The lack of specificity of clinical and laboratory manifestations of echinococcosis allocates to the fore diagnostic tool methods of research, which are at present leading in identifying the disease.The widespread introduction into clinical practice of modern highly informative instrumental methods such as ultrasonography (US and computed tomography (CT, significantly improved the early detection of liver echinococcosis. In conjunction with the serological reactions to echinococcosis they allow in most cases the diagnosis of the disease. However, false-negative results of serological tests in more than 10–20 % of the patients and the difficulty of differential diagnosis with small brush size and "pseudotumoral" forms of ultrasound often lead to delayed diagnosis, and thus to a deterioration of treatment results. Moreover, failure to identify at an early stage of echinococcosis virtually eliminates the possibility of conservative treatment of echinococcosis without performing surgery.It is given the profound immune disorders in patients with echinococcosis, treatment should be complex and along with the surgical removal of hydatid cyst should be included in it and biostimulating. Immunocorrecting lechebnye event. Recent require further development.Methods. The work is based on an analysis of 25 cases operated on echinococcosis in the period from January 2013 to December 2014. To confirm the diagnosis using tools (ultrasound, computed tomography, X-ray, serology (detection of antibodies to echinococcus ELISA, histological (after removal of cysts methods. The data are processed by the method of variation statistics.Results. An analysis of 25 cases of echinococcosis showed that among the 15 cases dominated by women (60 % versus 10 (40 % men. Treatment – removal of cysts of 25 patients with echinococcosis is made surgically. Among the analyzed cases in 6 (20.4 % patients had the relapsing form of the disease. The factors leading to relapse of the

  20. Nursing diagnosis Noncompliance to treatment in men with hypertension

    Directory of Open Access Journals (Sweden)

    Talliton Uchôa de Araújo

    2016-01-01

    Full Text Available Objective : to identify the frequency of occurrence of nursing diagnosis Noncompliance of treatment in men with high blood pressure, its defining characteristics, and related factors. Methods : a Cross-sectional study involving 44 men with hypertension by applying a validated instrument for identification of nursing diagnosis. Results : the diagnosis frequency of occurrence was 56.8%, the most present defining characteristics were the inadequate management of nonpharmacological treatment (p=0.000 and adherence failure of indicative behavior (p=0.000. The most common related factors were deficient knowledge for the monitor of the non- drug treatment regimen (p=0.000 and insufficient teaching ability of health staff (p=0.002. Conclusion : it was found a high frequency of diagnosis in men and the data point to the need for training of health professionals for the development of skills in promoting adherence of men to the treatment of hypertension.

  1. [Symptoms diagnosis and treatment of dyscalulia].

    Science.gov (United States)

    Ise, Elena; Schulte-Körne, Gerd

    2013-07-01

    Children with dyscalculia show deficits in basic numerical processing which cause difficulties in the acquisition of mathematical skills. This article provides an overview of current research findings regarding the symptoms, cause, and prognosis of dyscalculia, and it summarizes recent developments in the diagnosis, early intervention, and treatment thereof. Diagnosis has improved recently because newly developed tests focus not only on the math curriculum, but also on basic skills found to be impaired in dyscalculia. A controversial debate continues with regard to IQ achievement discrepancy. International studies have demonstrated the effectiveness of specialized interventions. This article summarizes the research findings from intervention studies, describes different treatment approaches, and discusses implications for clinical practice.

  2. Hyperprolactinemia: causes, diagnosis, and treatment

    International Nuclear Information System (INIS)

    Karasek, M.; Pawlikowski, M.; Lewinski, A.

    2006-01-01

    The basic data on hyperprolactinemia (i.e. an excess of PRL above a reference laboratory's upper limits), the most common endocrine disorder of the hypothalamic-pituitary axis are given in this review. The following issues are discussed: regulation of prolactin (Prl) secretion, definition of hyperprolactinemia, its etiology and pathogenesis as well as its symptoms, diagnosis, and treatment (including medical and surgical therapy). It should be stressed that finding of elevated PRL serum concentrations constitute the beginning of diagnostic procedure and, after exclusion of physiologic, pharmacologic, and other organic causes of increased PRL levels, should be followed by detailed diagnosis including MRI. In patients in whom hyperprolactinemia has been confirmed the treatment with dopamine agonists (with prevalence of cabergoline, followed by quinagoline) is currently considered first-choice therapy. Surgery should be performed only in the patients resistant or intolerant to these agents, or in patients who refuse long-term therapy. (author)

  3. Diagnosis and treatment of upper limb apraxia.

    Science.gov (United States)

    Dovern, A; Fink, G R; Weiss, P H

    2012-07-01

    Upper limb apraxia, a disorder of higher motor cognition, is a common consequence of left-hemispheric stroke. Contrary to common assumption, apraxic deficits not only manifest themselves during clinical testing but also have delirious effects on the patients' everyday life and rehabilitation. Thus, a reliable diagnosis and efficient treatment of upper limb apraxia is important to improve the patients' prognosis after stroke. Nevertheless, to date, upper limb apraxia is still an underdiagnosed and ill-treated entity. Based on a systematic literature search, this review summarizes the current tools of diagnosis and treatment strategies for upper limb apraxia. It furthermore provides clinicians with graded recommendations. In particular, a short screening test for apraxia, and a more comprehensive diagnostic apraxia test for clinical use are recommended. Although currently only a few randomized controlled studies investigate the efficacy of different apraxia treatments, the gesture training suggested by Smania and colleagues can be recommended for the therapy of apraxia, the effects of which were shown to extend to activities of daily living and to persist for at least 2 months after completion of the training. This review aims at directing the reader's attention to the ecological relevance of apraxia. Moreover, it provides clinicians with appropriate tools for the reliable diagnosis and effective treatment of apraxia. Nevertheless, this review also highlights the need for further research into how to improve diagnosis of apraxia based on neuropsychological models and to develop new therapeutic strategies.

  4. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

    Science.gov (United States)

    Bellato, Enrico; Marini, Eleonora; Castoldi, Filippo; Barbasetti, Nicola; Mattei, Lorenzo; Bonasia, Davide Edoardo; Blonna, Davide

    2012-01-01

    Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable bowel disease, and heat and cold intolerance) can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2), milnacipran (NNT 19), and pregabalin (NNT 8.6) are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy. PMID:23213512

  5. Erectile dysfunction as a manifestation of urogenital autonomic neuropathy in patients with type 1 diabetes: epidemiology, classification, pathophysiology, diagnosis and treatment options

    OpenAIRE

    Gagik Radikovich Galstyan; yana Grigor'evna Shwarts; Sergey Anatol'evich Dubsky; Aleksandr Evgen'evich Lepetukhin; Roman Viktorovich Rozhivanov; Dmitry Gennadievich Kurbatov

    2014-01-01

    Sexual dysfunction characterized by a significant decline in the quality of life of patients and leading to infertility and problems in social life is diagnosed in more than 40% of patients with diabetes mellitus (DM).Erectile dysfunction is the most common sexual disorder in DM patients. The article describes epidemiology, classification, pathophysiology, diagnostic and treatment of erectile dysfunction in T1DM patients.

  6. Congenital neutropenia in the era of genomics: classification, diagnosis, and natural history.

    Science.gov (United States)

    Donadieu, Jean; Beaupain, Blandine; Fenneteau, Odile; Bellanné-Chantelot, Christine

    2017-11-01

    This review focuses on the classification, diagnosis and natural history of congenital neutropenia (CN). CN encompasses a number of genetic disorders with chronic neutropenia and, for some, affecting other organ systems, such as the pancreas, central nervous system, heart, bone and skin. To date, 24 distinct genes have been associated with CN. The number of genes involved makes gene screening difficult. This can be solved by next-generation sequencing (NGS) of targeted gene panels. One of the major complications of CN is spontaneous leukaemia, which is preceded by clonal somatic evolution, and can be screened by a targeted NGS panel focused on somatic events. © 2017 John Wiley & Sons Ltd.

  7. Diagnosis of periodontal diseases using different classification ...

    African Journals Online (AJOL)

    The codes created for risk factors, periodontal data, and radiographically bone loss were formed as a matrix structure and regarded as inputs for the classification unit. A total of six periodontal conditions was the outputs of the classification unit. The accuracy of the suggested methods was compared according to their ...

  8. Rheumatoid Arthritis: Early diagnosis and treatment outcomes.

    Science.gov (United States)

    Heidari, Behzad

    2011-01-01

    Rheumatoid arthritis (RA) is an inflammatory progressive disease which in the absence of appropriate treatment can lead to joint destruction and disability. Prognosis of RA may be predicted based on the presence of some clinical and laboratory evidences. New criteria for classification of RA provide opportunity for earlier treatment. Initiation of treatment particularly by combination of DMARDs concurrent with short duration of corticosteroid is expected to prevent progressive course and even change the natural course of RA. At present any patients with clinical synovitis in at least one joint may have definite RA, requiring agressive treatment.

  9. CT classification of chronic pancreatitis and the significance for differential diagnosis

    International Nuclear Information System (INIS)

    Hu Xueling

    2006-01-01

    Objective: To study the CT characteristics of chronic pancreatitis and a classification based on the CT manifestations was established. Methods: In total 59 patients with chronic pancreatitis, 43 males and 16 females, with an average age of 40 years old were enrolled in the study. History of acute pancreatitis was positive in 36 patients. Non contrast enhanced and contrast enhanced CT scans were performed. The sizes of lesions, contour of pancreas, as well as the number, density and margin of lesions were investigated on the CT images. Results: Atrophy of the entire pancreas was revealed in 27 patients (46%), complicated with different degree of calcification. Solitary cyst with amorphous wall calcification was demonstrated in 13 patients (22%); multiple intra-pancreatic and peri-pancreatic pseudo-cysts were shown in 7 patients (12%); dilated pancreatic duct was seen in 7 patients (12%); and regional well demarcated bulging of pancreas was presented in 5 patients (8%). Conclusion: The CT findings of chronic pancreatitis in our study could be classified into 5 types: atrophy type, solitary cystic type, multicystic type, pure pancreatic duct dilatation type and mass type. The classification had certain significance for the differential diagnosis and the etiological analysis of chronic pancreatitis. (authors)

  10. Mental Retardation: Diagnosis and Treatment.

    Science.gov (United States)

    Poser, Charles M., Ed.

    A collection of writings by 17 authors, the text includes the following discussions: general principles of diagnosis and management of mental retardation, neurologic evaluation of the infant and child, psychological evaluation, educational information, and treatment of pseudoretardation, communicative disorders, and metabolic and endocrine causes.…

  11. [Diagnosis and treatment characteristics of head-wind sha in She medicine].

    Science.gov (United States)

    Zou, Guangyi; Xu, Xiangdong; Zheng, Songming; Yan, Lianhe; Lei, Houxing; Zhang, Qiao-ling; Xiang, Yingmei; Ye, Yiping; Song, Liwei

    2015-03-01

    The diagnosis and treatment characteristics of head-wind sha in She medicine were analyzed and summarized. By visiting She-nationality villages and towns in Zhejiang province and Fujian province and interviewing hundreds of doctors of She medicine, the sha diagnosis, sha differentiation, experience and theory of treatment were arranged, and a comprehensive summary on theory and application of head-wind sha in She medicine such as pathogeny, name of disease, mechanism, diagnosis, differential diagnosis and treatment was made. It is believed that the methods of diagnosis and treatment in She medicine for head-wind sha could effectively enhance curative effect, safety and patients' quality of life, and the further research should be carried out.

  12. [Surgical treatment of chronic pancreatitis based on classification of M. Buchler and coworkers].

    Science.gov (United States)

    Krivoruchko, I A; Boĭko, V V; Goncharova, N N; Andreeshchev, S A

    2011-08-01

    The results of surgical treatment of 452 patients, suffering chronic pancreatitis (CHP), were analyzed. The CHP classification, elaborated by M. Buchler and coworkers (2009), based on clinical signs, morphological peculiarities and pancreatic function analysis, contains scientifically substantiated recommendations for choice of diagnostic methods and complex treatment of the disease. The classification proposed is simple in application and constitutes an instrument for studying and comparison of the CHP course severity, the patients prognosis and treatment.

  13. Diagnosis and treatment of gastroesophageal reflux disease complicated by Barrett's esophagus.

    Science.gov (United States)

    Stasyshyn, Andriy

    2017-08-31

    The aim of the study was to evaluate the effectiveness of a diagnostic and therapeutic algorithm for gastroesophageal reflux disease complicated by Barrett's esophagus in 46 patients. A diagnostic and therapeutic algorithm for complicated GERD was developed. To describe the changes in the esophagus with reflux esophagitis, the Los Angeles classification was used. Intestinal metaplasia of the epithelium in the lower third of the esophagus was assessed using videoendoscopy, chromoscopy, and biopsy. Quality of life was assessed with the Gastro-Intestinal Quality of Life Index. The used methods were modeling, clinical, analytical, comparative, standardized, and questionnaire-based. Results and their discussion. Among the complications of GERD, Barrett's esophagus was diagnosed in 9 (19.6 %), peptic ulcer in the esophagus in 10 (21.7 %), peptic stricture of the esophagus in 4 (8.7 %), esophageal-gastric bleeding in 23 (50.0 %), including Malory-Weiss syndrome in 18, and erosive ulcerous bleeding in 5 people. Hiatal hernia was diagnosed in 171 (87.7 %) patients (sliding in 157 (91.8%), paraesophageal hernia in 2 (1.2%), and mixed hernia in 12 (7.0%) cases). One hundred ninety-five patients underwent laparoscopic surgery. Nissen fundoplication was conducted in 176 (90.2%) patients, Toupet fundoplication in 14 (7.2%), and Dor fundoplication in 5 (2.6%). It was established that the use of the diagnostic and treatment algorithm promoted systematization and objectification of changes in complicated GERD, contributed to early diagnosis, helped in choosing treatment, and improved quality of life. Argon coagulation and use of PPIs for 8-12 weeks before surgery led to the regeneration of the mucous membrane in the esophagus. The developed diagnostic and therapeutic algorithm facilitated systematization and objectification of changes in complicated GERD, contributed to early diagnosis, helped in choosing treatment, and improved quality of life.

  14. Osteogenesis imperfecta: diagnosis and treatment.

    Science.gov (United States)

    Palomo, Telma; Vilaça, Tatiane; Lazaretti-Castro, Marise

    2017-12-01

    Here we summarize the diagnosis of osteogenesis imperfecta, discuss newly discovered genes involved in osteogenesis imperfecta, and review the management of this disease in children and adults. Mutations in the two genes coding for collagen type I, COL1A1 and COL1A2, are the most common cause of osteogenesis imperfecta. In the past 10 years, defects in at least 17 other genes have been identified as responsible for osteogenesis imperfecta phenotypes, with either dominant or recessive transmission. Intravenous bisphosphonate infusions are the most widely used medical treatment. This has a marked effect on vertebra in growing children and can lead to vertebral reshaping after compression fractures. However, bisphosphonates are less effective for preventing long-bone fractures. At the moment, new therapies are under investigation. Despite advances in the diagnosis and treatment of osteogenesis imperfecta, more research is needed. Bisphosphonate treatment decreases long-bone fracture rates, but such fractures are still frequent. New antiresorptive and anabolic agents are being investigated but efficacy and safety of these drugs, especially in children, need to be better established before they can be used in clinical practice.

  15. Kernel-based Joint Feature Selection and Max-Margin Classification for Early Diagnosis of Parkinson’s Disease

    Science.gov (United States)

    Adeli, Ehsan; Wu, Guorong; Saghafi, Behrouz; An, Le; Shi, Feng; Shen, Dinggang

    2017-01-01

    Feature selection methods usually select the most compact and relevant set of features based on their contribution to a linear regression model. Thus, these features might not be the best for a non-linear classifier. This is especially crucial for the tasks, in which the performance is heavily dependent on the feature selection techniques, like the diagnosis of neurodegenerative diseases. Parkinson’s disease (PD) is one of the most common neurodegenerative disorders, which progresses slowly while affects the quality of life dramatically. In this paper, we use the data acquired from multi-modal neuroimaging data to diagnose PD by investigating the brain regions, known to be affected at the early stages. We propose a joint kernel-based feature selection and classification framework. Unlike conventional feature selection techniques that select features based on their performance in the original input feature space, we select features that best benefit the classification scheme in the kernel space. We further propose kernel functions, specifically designed for our non-negative feature types. We use MRI and SPECT data of 538 subjects from the PPMI database, and obtain a diagnosis accuracy of 97.5%, which outperforms all baseline and state-of-the-art methods.

  16. Kernel-based Joint Feature Selection and Max-Margin Classification for Early Diagnosis of Parkinson’s Disease

    Science.gov (United States)

    Adeli, Ehsan; Wu, Guorong; Saghafi, Behrouz; An, Le; Shi, Feng; Shen, Dinggang

    2017-01-01

    Feature selection methods usually select the most compact and relevant set of features based on their contribution to a linear regression model. Thus, these features might not be the best for a non-linear classifier. This is especially crucial for the tasks, in which the performance is heavily dependent on the feature selection techniques, like the diagnosis of neurodegenerative diseases. Parkinson’s disease (PD) is one of the most common neurodegenerative disorders, which progresses slowly while affects the quality of life dramatically. In this paper, we use the data acquired from multi-modal neuroimaging data to diagnose PD by investigating the brain regions, known to be affected at the early stages. We propose a joint kernel-based feature selection and classification framework. Unlike conventional feature selection techniques that select features based on their performance in the original input feature space, we select features that best benefit the classification scheme in the kernel space. We further propose kernel functions, specifically designed for our non-negative feature types. We use MRI and SPECT data of 538 subjects from the PPMI database, and obtain a diagnosis accuracy of 97.5%, which outperforms all baseline and state-of-the-art methods. PMID:28120883

  17. Cardiorenal Syndrome: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    O.O. Melnyk

    2017-02-01

    Full Text Available In the diagnosis of cardiorenal syndrome (CRS, the biological markers are widely used, they can be applied to identify the pathophysiological stages of CRS, to assess the amount of risk, prognosis and outcome, as well as to monitor the effectiveness of treatment. CRS therapy includes diuretics, vasodilators, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, nitrates and cardiac glycosides. One of the most effective methods of CRS treatment is the use of renal replacement therapy.

  18. Classification system for acute and chronic radiation treatment sequelae

    International Nuclear Information System (INIS)

    Seegenschmiedt, M.H.; Sauer, R.

    1993-01-01

    A classification system in German language is proposed for scoring of acute and chronic treatment sequelae after radiotherapy. It includes all important organs and organ systems. The proposed grading corresponds to the four-scale-system of the WHO and UICC. The system is also compatible to the RTOG and EORTC acute and late radiation morbidity scoring criteria. This facilitates the data transfer for retrospective and prospective analysis of monomodal and multimodal radiotherapy treatment regimes. We recommend to use this scoring system in all German speaking countries for multicentric prospective studies. It is possible, that organ-specific sophistications of the toxicity grading will be developed in the future. These additions should conform with (inter)national standards and apply the same four-scale grading of this classification system. (orig.) [de

  19. Advances in Psychiatric Diagnosis: Past, Present, and Future

    Directory of Open Access Journals (Sweden)

    Carol S. North

    2017-04-01

    Full Text Available This editorial examines controversies identified by the articles in this special issue, which explore psychopathology in the broad history of the classification of selected psychiatric disorders and syndromes over time through current American criteria. Psychiatric diagnosis has a long history of scientific investigation and application, with periods of rapid change, instability, and heated controversy associated with it. The articles in this issue examine the history of psychiatric nomenclature and explore current and future directions in psychiatric diagnosis through the various versions of accepted diagnostic criteria and accompanying research literature addressing the criteria. The articles seek to guide readers in appreciating the complexities of psychiatric diagnosis as the field of psychiatry pushes forward toward future advancements in diagnosis. Despite efforts of many scientists to advance a diagnostic classification system that incorporates neuroscience and genetics, it has been argued that it may be premature to attempt to move to a biologically-based classification system, because psychiatric disorders cannot yet be fully distinguished by any specific biological markers. For now, the symptom-based criteria that the field has been using continue to serve many essential purposes, including selection of the most effective treatment, communication about disease with colleagues, education about psychiatric illness, and support for ongoing research.

  20. Clinical application of a microfluidic chip for immunocapture and quantification of circulating exosomes to assist breast cancer diagnosis and molecular classification.

    Science.gov (United States)

    Fang, Shimeng; Tian, Hongzhu; Li, Xiancheng; Jin, Dong; Li, Xiaojie; Kong, Jing; Yang, Chun; Yang, Xuesong; Lu, Yao; Luo, Yong; Lin, Bingcheng; Niu, Weidong; Liu, Tingjiao

    2017-01-01

    Increasing attention has been attracted by exosomes in blood-based diagnosis because cancer cells release more exosomes in serum than normal cells and these exosomes overexpress a certain number of cancer-related biomarkers. However, capture and biomarker analysis of exosomes for clinical application are technically challenging. In this study, we developed a microfluidic chip for immunocapture and quantification of circulating exosomes from small sample volume and applied this device in clinical study. Circulating EpCAM-positive exosomes were measured in 6 cases breast cancer patients and 3 healthy controls to assist diagnosis. A significant increase in the EpCAM-positive exosome level in these patients was detected, compared to healthy controls. Furthermore, we quantified circulating HER2-positive exosomes in 19 cases of breast cancer patients for molecular classification. We demonstrated that the exosomal HER2 expression levels were almost consistent with that in tumor tissues assessed by immunohistochemical staining. The microfluidic chip might provide a new platform to assist breast cancer diagnosis and molecular classification.

  1. Erectile dysfunction as a manifestation of urogenital autonomic neuropathy in patients with type 1 diabetes: epidemiology, classification, pathophysiology, diagnosis and treatment options

    Directory of Open Access Journals (Sweden)

    Gagik Radikovich Galstyan

    2014-05-01

    Full Text Available Sexual dysfunction characterized by a significant decline in the quality of life of patients and leading to infertility and problems in social life is diagnosed in more than 40% of patients with diabetes mellitus (DM.Erectile dysfunction is the most common sexual disorder in DM patients. The article describes epidemiology, classification, pathophysiology, diagnostic and treatment of erectile dysfunction in T1DM patients.

  2. [Differences between Chicago and traditional classifications in the diagnosis of esophageal motor disorders with high-resolution manometry and topography of esophageal pressure].

    Science.gov (United States)

    Abreu-Y Abreu, A T; González Sánchez, C B; Villanueva Sáenz, E; Valdovinos Díaz, M A

    2010-01-01

    With the introduction of high resolution manometry (HRM) and esophageal topography a novel classification (Chicago Classification) has been proposed for the diagnosis of esophageal motor disorders (EMD). Clinical differences with the traditional classification are currently under evaluation. To investigate differences between the Chicago (CC) and traditional (TC) classifications in the diagnosis of EMD. Consecutive patients with indication for esophageal manometry were studied. HRM was performed with a 36 sensors solid-state catheter and Manoview software (V2.0).Conventional manometric tracings were analyzed by an investigator blinded to the results of HRM. Diagnosis by CC and CT were compared. Two hundred patients were studied, 106 (53%) of them women (53%) with a mean patient age of 43.4 (range 16 - 84) years. Preoperative evaluation for GERD 152 (76%) was the most frequent indication. Achalasia (8), scleroderma (2) and peristaltic dysfunction (60 vs. 59) were similarly diagnosed by CC and CT. Spastic disorders were more frequently identified by CC: nutcracker esophagus (NC) in 3, spastic NC in3 and segmental NC in 11 patients versus TC: NC 5. Three patients had spasm with CC and 1 with TC. Non specific motor disorder was diagnosed by TC and 2 patients had functional obstruction with CC. Hypotensive lower esophageal sphincter was identified in 63 patients with CC vs.57 with TC. Spastic disorders and functional obstruction were the EMD better identified by HRM and CC.

  3. Diagnosis as the First Critical Point in the Treatment Trajectory

    DEFF Research Database (Denmark)

    Missel, Malene; Pedersen, Jesper H; Hendriksen, Carsten

    2015-01-01

    sociology. RESULTS: The findings are presented as themes that summarize and express the ways in which a diagnosis affects patients' daily lives: the cancer diagnosis comes as a shock, it changes everyday awareness; it presents the patient with an unfamiliar body, disturbs social relationships, forces......BACKGROUND: Significant advances have been made in the surgical treatment of lung cancer while patient experiences with diagnosis, treatment, and rehabilitation remain only sparsely researched. OBJECTIVE: The objective of this study was to investigate how the diagnosis affects the daily lives...... of patients with operable lung cancer in order to identify their needs for care interventions from the point of diagnosis to hospitalization. METHODS: We investigated patients' lived experiences from a longitudinal perspective at 4 critical time points during the treatment trajectory; we present here...

  4. Segmentation and Classification of Bone Marrow Cells Images Using Contextual Information for Medical Diagnosis of Acute Leukemias.

    Directory of Open Access Journals (Sweden)

    Carolina Reta

    Full Text Available Morphological identification of acute leukemia is a powerful tool used by hematologists to determine the family of such a disease. In some cases, experienced physicians are even able to determine the leukemia subtype of the sample. However, the identification process may have error rates up to 40% (when classifying acute leukemia subtypes depending on the physician's experience and the sample quality. This problem raises the need to create automatic tools that provide hematologists with a second opinion during the classification process. Our research presents a contextual analysis methodology for the detection of acute leukemia subtypes from bone marrow cells images. We propose a cells separation algorithm to break up overlapped regions. In this phase, we achieved an average accuracy of 95% in the evaluation of the segmentation process. In a second phase, we extract descriptive features to the nucleus and cytoplasm obtained in the segmentation phase in order to classify leukemia families and subtypes. We finally created a decision algorithm that provides an automatic diagnosis for a patient. In our experiments, we achieved an overall accuracy of 92% in the supervised classification of acute leukemia families, 84% for the lymphoblastic subtypes, and 92% for the myeloblastic subtypes. Finally, we achieved accuracies of 95% in the diagnosis of leukemia families and 90% in the diagnosis of leukemia subtypes.

  5. A simple phenotypic classification for celiac disease

    Directory of Open Access Journals (Sweden)

    Ajit Sood

    2018-04-01

    Full Text Available Background/Aims : Celiac disease is a global health problem. The presentation of celiac disease has unfolded over years and it is now known that it can manifest at different ages, has varied presentations, and is prone to develop complications, if not managed properly. Although the Oslo definitions provide consensus on the various terminologies used in literature, there is no phenotypic classification providing a composite diagnosis for the disease. Methods : Various variables identified for phenotypic classification included age at diagnosis, age at onset of symptoms, clinical presentation, family history and complications. These were applied to the existing registry of 1,664 patients at Dayanand Medical College and Hospital, Ludhiana, India. In addition, age was evaluated as below 15 and below 18 years. Cross tabulations were used for the verification of the classification using the existing data. Expert opinion was sought from both international and national experts of varying fields. Results : After empirical verification, age at diagnosis was considered appropriate in between A1 (<18 and A2 (≧18. The disease presentation has been classified into 3 types–P1 (classical, P2 (non-classical and P3 (asymptomatic. Complications were considered as absent (C0 or present (C1. A single phenotypic classification based on these 3 characteristics, namely age at the diagnosis, clinical presentation, and intestinal complications (APC classification was derived. Conclusions : APC classification (age at diagnosis, presentation, complications is a simple disease explanatory classification for patients with celiac disease aimed at providing a composite diagnosis.

  6. Diagnosis and treatment of cervico-omo-brachialgia

    International Nuclear Information System (INIS)

    Ogihara, Masahiro

    2008-01-01

    Described is the importance of exact diagnosis by complaint, physical and imaging findings, and of effective conservative or open surgical treatment in cervico-omo-branchialgia (COB). COB derives from diseases at cervical vertebra, thoracic outlet, upper limb and others. Imaging in the diagnosis involves the flat plate roentgenography, and MRI for lesions in the cervical vertebra, disk, vertebral canal, spinal cord, nerve root tube and muscle to evaluate hernia, tumor, infection, fracture, pressures of nerve root and spinal cord. CT is excellent for bony lesions of the cervical vertebra and ligament. Treatment with nerve block is done usually under X-ray fluoroscopy. Conservative treatment is usual and evaluation is important in its process not to miss the surgical timing. (R.T.)

  7. Clinical diagnosis and treatment of olfactory meningioma

    International Nuclear Information System (INIS)

    Li Xiangdong; Wang Zhong; Zhang Shiming; Zhu Fengqing; Zhou Dai; Hui Guozhen

    2005-01-01

    Objective: To analyze the clinical diagnosis and treatment of olfactory meningioma. Methods: In this group 17 olfactory meningiomas were operated, and the clinical presentations and the surgery results were obtained. Results: The symptoms of psychiatrical disorder, visual disturbances and eclipse at presentation was higher. In 16 cases the grade of resection was Simpson II, 1 case Simpson III, most of the cases had a good recovery. Conclusion: Attention should be paid to the early symptom at presentation such as psychiatrical disorder to obtain an early diagnosis. Microsurgery is useful in the treatment of olfactory meningioma. (authors)

  8. Diagnosis and treatment delays among elderly breast cancer patients with pre-existing mental illness.

    Science.gov (United States)

    Iglay, Kristy; Santorelli, Melissa L; Hirshfield, Kim M; Williams, Jill M; Rhoads, George G; Lin, Yong; Demissie, Kitaw

    2017-11-01

    This study aimed to compare diagnosis and treatment delays in elderly breast cancer patients with and without pre-existing mental illness. A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results-Medicare data including 16,636 women 68+ years, who were diagnosed with stage I-IIIa breast cancer in the United States from 2005 to 2007. Mental illness was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes recorded on inpatient and outpatient claims during the 3 years prior to breast cancer diagnosis. Patients were classified as having no mental illness, anxiety, depression, anxiety and depression, or severe mental illness (bipolar disorder, schizophrenia, and other psychotic disorder). Multivariable binomial regression was used to assess the association between mental illness and delays of ≥60 and ≥90 days after adjustment for confounders. Patients with comorbid anxiety and depression had an increased risk for diagnosis delay of ≥90 days from symptom recognition (RR 1.11; 95% CI 1.00, 1.23), and those with severe mental illness had an increased risk for initial treatment delay of ≥60 days from diagnosis (RR 1.36; 95% CI 1.06, 1.74). Patients with any mental illness experienced an increased risk for adjuvant chemotherapy delay of ≥90 days from last operation (RR 1.13; 95% CI 1.01, 1.26) and each category of mental illness, except depression, showed a non-significant trend for this association. Breast cancer patients with mental illness should be closely managed by a cross-functional care team, including a psychiatrist, a primary care physician, and an oncologist, to ensure adequate care is received within an appropriate timeframe.

  9. Analysis of the quality of diagnosis and treatment of primary headache in different social groups of the Ural Region

    Directory of Open Access Journals (Sweden)

    E. R. Lebedeva

    2015-01-01

    Full Text Available Objective: to analyze the quality of diagnosis and treatment of primary headache (HA in different social groups of the Ural Region. Patients and methods. The study enrolled 3124 persons who were divided into three groups: 1 1042 students; of them there were 719 women; mean age 20.6 years; range 17–40 years; 2 1075 workers; of them there were 146 women; mean age 40.4 years; range 21–67 years; 3 1007 blood donors; of them there were 484 women; mean age, 34.1 years; range 18–64 years. Semi-structured interviews involving the characteristics of HA and its prior diagnosis and treatment were conducted face-to-face in all those included in the study. HA was diagnosed using the International Classification of Headache Disorders, 3rd edition, beta version. Results and discussion. The following factors decreasing the quality of diagnosis and treatment of HA were identified in all the study groups: 1 low physician visit rates. Despite the high prevalence of all types of primary HA in 3 groups (67%, only 496 (23% out of 2110 participants with HA visited their physician with this problem. Among the patients with HA, physicians were visited most often by 342 (35% out of 968 students, least often by 60 (13% out of 457 workers and by 94 (14% out of 685 donors; 2 inadequate diagnosis of HA. Only 12 and 11.7% of the patients were correctly diagnosed with migraine and tension HA (THA, respectively; 3 the practically complete absence of preventive treatment for HA. The majority of patients used drugs to arrest HA attacks; preventive treatment for migraine was performed in 2 (0.4% and not performed in any of the patients with THA. It is necessary to improve the diagnosis and treatment of primary HA and to elaborate new Russian clinical guidelines for patient management on the basis of international standards. 

  10. Advances in Risk Classification and Treatment Strategies for Neuroblastoma

    Science.gov (United States)

    Pinto, Navin R.; Applebaum, Mark A.; Volchenboum, Samuel L.; Matthay, Katherine K.; London, Wendy B.; Ambros, Peter F.; Nakagawara, Akira; Berthold, Frank; Schleiermacher, Gudrun; Park, Julie R.; Valteau-Couanet, Dominique; Pearson, Andrew D.J.

    2015-01-01

    Risk-based treatment approaches for neuroblastoma have been ongoing for decades. However, the criteria used to define risk in various institutional and cooperative groups were disparate, limiting the ability to compare clinical trial results. To mitigate this problem and enhance collaborative research, homogenous pretreatment patient cohorts have been defined by the International Neuroblastoma Risk Group classification system. During the past 30 years, increasingly intensive, multimodality approaches have been developed to treat patients who are classified as high risk, whereas patients with low- or intermediate-risk neuroblastoma have received reduced therapy. This treatment approach has resulted in improved outcome, although survival for high-risk patients remains poor, emphasizing the need for more effective treatments. Increased knowledge regarding the biology and genetic basis of neuroblastoma has led to the discovery of druggable targets and promising, new therapeutic approaches. Collaborative efforts of institutions and international cooperative groups have led to advances in our understanding of neuroblastoma biology, refinements in risk classification, and stratified treatment strategies, resulting in improved outcome. International collaboration will be even more critical when evaluating therapies designed to treat small cohorts of patients with rare actionable mutations. PMID:26304901

  11. Influence of nuclei segmentation on breast cancer malignancy classification

    Science.gov (United States)

    Jelen, Lukasz; Fevens, Thomas; Krzyzak, Adam

    2009-02-01

    Breast Cancer is one of the most deadly cancers affecting middle-aged women. Accurate diagnosis and prognosis are crucial to reduce the high death rate. Nowadays there are numerous diagnostic tools for breast cancer diagnosis. In this paper we discuss a role of nuclear segmentation from fine needle aspiration biopsy (FNA) slides and its influence on malignancy classification. Classification of malignancy plays a very important role during the diagnosis process of breast cancer. Out of all cancer diagnostic tools, FNA slides provide the most valuable information about the cancer malignancy grade which helps to choose an appropriate treatment. This process involves assessing numerous nuclear features and therefore precise segmentation of nuclei is very important. In this work we compare three powerful segmentation approaches and test their impact on the classification of breast cancer malignancy. The studied approaches involve level set segmentation, fuzzy c-means segmentation and textural segmentation based on co-occurrence matrix. Segmented nuclei were used to extract nuclear features for malignancy classification. For classification purposes four different classifiers were trained and tested with previously extracted features. The compared classifiers are Multilayer Perceptron (MLP), Self-Organizing Maps (SOM), Principal Component-based Neural Network (PCA) and Support Vector Machines (SVM). The presented results show that level set segmentation yields the best results over the three compared approaches and leads to a good feature extraction with a lowest average error rate of 6.51% over four different classifiers. The best performance was recorded for multilayer perceptron with an error rate of 3.07% using fuzzy c-means segmentation.

  12. [Definition and classification of pulmonary arterial hypertension].

    Science.gov (United States)

    Nakanishi, Norifumi

    2008-11-01

    Pulmonary hypertension(PH) is a disorder that may occur either in the setting of a variety of underlying medical conditions or as a disease that uniquely affects the pulmonary vasculature. Because an accurate diagnosis of PH in a patient is essential to establish an effective treatment, a classification of PH has been helpful. The first classification, established at WHO Symposium in 1973, classified PH into groups based on the known cause and defined primary pulmonary hypertension (PPH) as a separate entity of unknown cause. In 1998, the second World Symposium on PPH was held in Evian. Evian classification introduced the concept of conditions that directly affected the pulmonary vasculature (i.e., PAH), which included PPH. In 2003, the third World Symposium on PAH convened in Venice. In Venice classification, the term 'PPH' was abandoned in favor of 'idiopathic' within the group of disease known as 'PAH'.

  13. Automatic classification of hyperactive children: comparing multiple artificial intelligence approaches.

    Science.gov (United States)

    Delavarian, Mona; Towhidkhah, Farzad; Gharibzadeh, Shahriar; Dibajnia, Parvin

    2011-07-12

    Automatic classification of different behavioral disorders with many similarities (e.g. in symptoms) by using an automated approach will help psychiatrists to concentrate on correct disorder and its treatment as soon as possible, to avoid wasting time on diagnosis, and to increase the accuracy of diagnosis. In this study, we tried to differentiate and classify (diagnose) 306 children with many similar symptoms and different behavioral disorders such as ADHD, depression, anxiety, comorbid depression and anxiety and conduct disorder with high accuracy. Classification was based on the symptoms and their severity. With examining 16 different available classifiers, by using "Prtools", we have proposed nearest mean classifier as the most accurate classifier with 96.92% accuracy in this research. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  14. [Treatment program for dual-diagnosis substance abusers].

    Science.gov (United States)

    Kandel, Isack

    2007-01-01

    Dual-diagnosis mentally ill patients, i.e. those characterized with substance abuse problems combined with mental health problems, are a challenge both for systems treating substance abusers and for mental health services. These patients are not easily integrated in either of these healthcare systems and/or are treated only for one aspect of their problem by each of these systems. For such patients it is necessary to create a separate treatment model, combining care of the problem of substance abuse and attention to the patient's mental pathology, according to his individual personality traits. For purposes of this programme a treatment setting operating on the model of a therapeutic community is proposed. This setting will open an affiliated treatment programme for dual-diagnosed patients in a separate treatment programme that is not part of the therapeutic community but will be affiliated with it and will accept dual-diagnosis patients.

  15. Malabsorption: causes, consequences, diagnosis and treatment

    African Journals Online (AJOL)

    2011-06-06

    Jun 6, 2011 ... Review Article: Malabsorption: causes, consequences, diagnosis and treatment. 2011;24(3) ... and osteopenia (malabsorption of calcium, vitamin D, phosphate and magnesium .... A lipase dosage in excess of 75 000 IU per.

  16. Evaluation of antigen detection and polymerase chain reaction for diagnosis of amoebic liver abscess in patients on anti-amoebic treatment

    Directory of Open Access Journals (Sweden)

    Jaiswal Virendra

    2012-08-01

    Full Text Available Abstract Background Diagnosis of amoebic liver abscess (ALA in patients on anti-amoebic drugs is difficult. There is scanty data on this issue using Entamoeba histolytica (E. histolytica lectin antigen and polymerase chain reaction (PCR. We studied utility of lectin antigen, PCR, and IgG antibody in diagnosis of liver abscess in patients on anti-amoebic treatment. Liver aspirate of 200 patients, of which 170 had anti-amoebic drug prior to drainage, was tested for E. histolytica lectin antigen by (ELISA, PCR, bacterial culture, and serum IgG antibody by (ELISA. Classification of abscesses was based on result of anti-amoebic IgG antibody and bacterial culture, E. histolytica PCR and bacterial culture, and E. histolytica lectin antigen and bacterial culture. Findings Using anti-amoebic IgG antibody and bacterial culture, 136/200 (68.0% were classified as ALA, 12/200 (6.0% as pyogenic liver abscess (PLA, 29/200 (14.5% as mixed infection, and 23/200 (11.5% remained unclassified. Using amoebic PCR and bacterial culture 151/200 (75.5% were classified as ALA, 25/200 (12.5% as PLA, 16/200 (8.0% as mixed infection, and 8/200 (4.0% remained unclassified. With E. histolytica lectin antigen and bacterial culture, 22/200 (11.0% patients were classified as ALA, 39/200 (19.5% as PLA, 2/200 (1.0% as mixed infection, and 137/200 (68.5% remained unclassified. Conclusions E. histolytica lectin antigen was not suitable for classification of ALA patients who had prior anti-amoebic treatment. However, PCR may be used as alternative test to anti-amoebic antibody in diagnosis of ALA.

  17. Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery.

    Science.gov (United States)

    van Helvoirt, Hans; Apeldoorn, Adri T; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W; Ostelo, Raymond W

    2016-04-27

    Prospective cohort study. Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain.These patients

  18. An Expert System for Diagnosis of Sleep Disorder Using Fuzzy Rule-Based Classification Systems

    Science.gov (United States)

    Septem Riza, Lala; Pradini, Mila; Fitrajaya Rahman, Eka; Rasim

    2017-03-01

    Sleep disorder is an anomaly that could cause problems for someone’ sleeping pattern. Nowadays, it becomes an issue since people are getting busy with their own business and have no time to visit the doctors. Therefore, this research aims to develop a system used for diagnosis of sleep disorder using Fuzzy Rule-Based Classification System (FRBCS). FRBCS is a method based on the fuzzy set concepts. It consists of two steps: (i) constructing a model/knowledge involving rulebase and database, and (ii) prediction over new data. In this case, the knowledge is obtained from experts whereas in the prediction stage, we perform fuzzification, inference, and classification. Then, a platform implementing the method is built with a combination between PHP and the R programming language using the “Shiny” package. To validate the system that has been made, some experiments have been done using data from a psychiatric hospital in West Java, Indonesia. Accuracy of the result and computation time are 84.85% and 0.0133 seconds, respectively.

  19. Prevalence and Features of a Probable Diagnosis in First-Visit Headache Patients Based on the Criteria of the Third Beta Edition of the International Classification of Headache Disorders: A Prospective, Cross-Sectional Multicenter Study.

    Science.gov (United States)

    Kim, Soo-Kyoung; Moon, Heui-Soo; Cha, Myong-Jin; Kim, Byung-Su; Kim, Byung-Kun; Park, Jeong-Wook; Park, Kwang-Yeol; Sohn, Jong-Hee; Chu, Min-Kyung; Song, Tae-Jin; Kim, Jae-Moon; Cho, Soo-Jin

    2016-02-01

    This study aimed to determine the characteristics and significance of a probable diagnostic entity for primary headache disorder (PHD). A diagnosis of probable primary headache disorder (PPHD) is given when a patient's headache fulfills all but one criteria of the third beta edition of the international classification of headache disorder (ICHD-3β). Despite the uncertainty regarding this diagnosis, the inclusion of a probable diagnosis entity in this manual may aid in the accurate classification of headache disorders and allow effective treatment strategies to be started at the patient's initial visit. This cross-sectional multicenter registry study assessed first-visit patients with complaints of headaches who presented at the outpatient clinics of 11 neurologists in Korea. The classification of a headache disorder was made according to the criteria of the ICHD-3β by each investigator based on the initial evaluation of the patient or by a consensus meeting for uncertain cases. The rates of a probable diagnosis among PPHD patients were assessed and the clinical characteristics of these patients were compared with those of patients with a diagnosis of definite primary headache disorder (DPHD). A total of 1429 patients were diagnosed with PHD, and 305 (21.3%) of these patients had PPHD. The proportions of PPHD differed among the subtypes of DPHD as follows: migraines (16.1%), tension-type headaches (TTH; 33%), trigeminal autonomic cephalalgia (TAC; 40.9%), and other PHD (14%, P headache intensity than patients with DPHD (5.8 ± 2.2 vs. 6.5 ± 2.1, respectively, P headache from onset (median: 1 vs. 4 months, respectively, P headaches. The incorporation of a probable diagnosis into the ICHD-3β may be useful for reducing the diagnoses of unspecified headaches. © 2016 American Headache Society.

  20. Hyperthyroidism: Diagnosis and Treatment.

    Science.gov (United States)

    Kravets, Igor

    2016-03-01

    Hyperthyroidism is an excessive concentration of thyroid hormones in tissues caused by increased synthesis of thyroid hormones, excessive release of preformed thyroid hormones, or an endogenous or exogenous extrathyroidal source. The most common causes of an excessive production of thyroid hormones are Graves disease, toxic multinodular goiter, and toxic adenoma. The most common cause of an excessive passive release of thyroid hormones is painless (silent) thyroiditis, although its clinical presentation is the same as with other causes. Hyperthyroidism caused by overproduction of thyroid hormones can be treated with antithyroid medications (methimazole and propylthiouracil), radioactive iodine ablation of the thyroid gland, or surgical thyroidectomy. Radioactive iodine ablation is the most widely used treatment in the United States. The choice of treatment depends on the underlying diagnosis, the presence of contraindications to a particular treatment modality, the severity of hyperthyroidism, and the patient's preference.

  1. An appraisal of current dysphagia diagnosis and treatment strategies.

    Science.gov (United States)

    Kaindlstorfer, Adolf; Pointner, Rudolph

    2016-08-01

    Dysphagia is a common, serious health problem with a wide variety of etiologies and manifestations. This review gives a general overview of diagnostic and therapeutic options for oropharyngeal as well as esophageal swallowing disorders respecting the considerable progress made over recent years. Diagnosis can be challenging and requires expertise in interpretation of symptoms and patient history. Endoscopy, barium radiography and manometry are still the diagnostic mainstays. Classification of esophageal motor-disorders has been revolutionized with the introduction of high-resolution esophageal pressure topography and a new standardized classification algorithm. Automated integrated impedance manometry is a promising upcoming tool for objective evaluation of oropharyngeal dysphagia, in non-obstructive esophageal dysphagia and prediction of post fundoplication dysphagia risk. Impedance planimetry provides new diagnostic information on esophageal and LES-distensibility and allows controlled therapeutic dilatation without the need for radiation. Peroral endoscopic myotomy is a promising therapeutic approach for achalasia and spastic motility disorders.

  2. Experimental Investigation for Fault Diagnosis Based on a Hybrid Approach Using Wavelet Packet and Support Vector Classification

    Directory of Open Access Journals (Sweden)

    Pengfei Li

    2014-01-01

    Full Text Available To deal with the difficulty to obtain a large number of fault samples under the practical condition for mechanical fault diagnosis, a hybrid method that combined wavelet packet decomposition and support vector classification (SVC is proposed. The wavelet packet is employed to decompose the vibration signal to obtain the energy ratio in each frequency band. Taking energy ratios as feature vectors, the pattern recognition results are obtained by the SVC. The rolling bearing and gear fault diagnostic results of the typical experimental platform show that the present approach is robust to noise and has higher classification accuracy and, thus, provides a better way to diagnose mechanical faults under the condition of small fault samples.

  3. Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries

    Science.gov (United States)

    Quentin, Wilm; Rätto, Hanna; Peltola, Mikko; Busse, Reinhard; Häkkinen, Unto

    2013-01-01

    Aims As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems. Methods and results National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland. Conclusions Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement. PMID:23364755

  4. Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Quentin, Wilm; Rätto, Hanna; Peltola, Mikko; Busse, Reinhard; Häkkinen, Unto

    2013-07-01

    As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland. Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement.

  5. Classification and Differential Diagnosis of Oral and Maxillofacial Pain.

    Science.gov (United States)

    Scrivani, Steven J; Spierings, Egilius L H

    2016-08-01

    Pain in the orofacial region is a common presenting symptom. The majority of symptoms are related to dental disease and the cause can readily be established, the problem dealt with, and the pain eliminated. However, pain may persist and defy attempts at treatment. Intractable oral or facial pain can be diagnostically challenging. To make a definitive diagnosis and initiate proper treatment, a rigorous protocol for evaluation includes a thorough history and an appropriate comprehensive clinical examination and diagnostic testing, including chief complaint, history of present illness, medical history, physical examination, diagnostic studies, including imaging, and psychosocial evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Vertigo in neurological practice (common problems of diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Olga Vladimirovna Kosivtsova

    2012-01-01

    Full Text Available Most patients with vertigo seek neurological advice. In spite of the availability of current examination techniques, a differential diagnosis of vertigo is not frequently made. The paper discusses the terminology and classification of vertigo and clinical methods for diagnosing central and peripheral vestibulopathies. It considers the common problems of management of patients with diseases of the central and peripheral vestibular systems, the use of piracetam and other drugs to stimulate rehabilitation.

  7. Multifunctional nanoparticle developments in cancer diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Sepideh Parvanian

    2017-04-01

    Full Text Available Nanotechnology, although still in the early stages, has the potential to revolutionize the early diagnosis, treatment, and monitoring of disease progression. Technological application of nanometer molecules in medicine with the aim of fighting and curing ailments is the globally definition of nanomedicine. The success of nanotechnology in the healthcare part is driven by the possibility to work at the same scale of several biological processes, cellular mechanisms, and organic molecules. With the growing understanding of methods to functionalize nanoparticles and the continued efforts of creative scientists to advance this technology, it is likely that functionalized nanoparticles will become an important tool in the above mentioned areas. This paper describes the role of multifunctional nanoparticle in diagnosis and treatment of cancer. Therefore, the aim of this review is to provide basic information on nanoparticles, describe previously developed methods to functionalize nanoparticles and discuss their potential applications in biomedical sciences and finally mention the therapeutic nanoparticle commercialization challenges. Keywords: Multifunctional nanoparticle, Cancer, Diagnosis, Treatment, Therapy

  8. [Infective endocarditis : Update on prophylaxis, diagnosis, and treatment].

    Science.gov (United States)

    Dietz, S; Lemm, H; Janusch, M; Buerke, M

    2016-05-01

    The diagnosis of infective endocarditis is often delayed in clinical practice. Timely diagnosis and rapid antibiotic treatment is important. Higher age of patients, new risk factors, and increasing use of intravascular prosthetic materials resulted in changes in microbial spectrum. Nowadays, nonspecific symptoms, critically ill patients, and immunocompromised patients require a high level of diagnostic expertise.The new guidelines from the European Society of Cardiology provide various diagnostic algorithms and recommendations for antibiotic treatment. The new guidelines also recommend the formation of an endocarditis team with various medical disciplines, including a cardiac surgeon, to improve treatment because in half of all endocarditis patients, antibiotic therapy alone does not result in successful management of the infection. If complications occur, early surgical treatment should be performed.In this overview, diagnostic strategies and therapeutic approaches for the treatment of infectious endocarditis according to the current guidelines and aspects of surgical treatment are provided.

  9. A New Classification of Endodontic-Periodontal Lesions

    Directory of Open Access Journals (Sweden)

    Khalid S. Al-Fouzan

    2014-01-01

    Full Text Available The interrelationship between periodontal and endodontic disease has always aroused confusion, queries, and controversy. Differentiating between a periodontal and an endodontic problem can be difficult. A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem. In some cases, the influence of pulpal pathology may cause the periodontal involvement and vice versa. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. An endo-perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. The differential diagnosis of endodontic and periodontal diseases can sometimes be difficult, but it is of vital importance to make a correct diagnosis for providing the appropriate treatment. This paper aims to discuss a modified clinical classification to be considered for accurately diagnosing and treating endo-perio lesion.

  10. A new classification of endodontic-periodontal lesions.

    Science.gov (United States)

    Al-Fouzan, Khalid S

    2014-01-01

    The interrelationship between periodontal and endodontic disease has always aroused confusion, queries, and controversy. Differentiating between a periodontal and an endodontic problem can be difficult. A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem. In some cases, the influence of pulpal pathology may cause the periodontal involvement and vice versa. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. An endo-perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. The differential diagnosis of endodontic and periodontal diseases can sometimes be difficult, but it is of vital importance to make a correct diagnosis for providing the appropriate treatment. This paper aims to discuss a modified clinical classification to be considered for accurately diagnosing and treating endo-perio lesion.

  11. Allergy Diagnosis and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... this page please turn Javascript on. Feature: Managing Allergies Allergy Diagnosis and Treatment Past Issues / Spring 2013 Table of Contents Diagnosis Testing for Allergies Knowing exactly what you are allergic to can ...

  12. Diagnosis and Treatment of Premature Ejaculation by Urologists in South Korea

    Directory of Open Access Journals (Sweden)

    Deok Ha Seo

    2016-12-01

    Full Text Available Purpose: This study discusses the treatment of premature ejaculation (PE using various approaches with the goal of evaluating the methods of diagnosis and treatment of PE in clinical practice in 2014 in South Korea. Materials and Methods: We surveyed 200 urologists and andrologists who treated patients with PE from July 1, 2014 to July 29, 2014 using an online questionnaire. The questionnaire was composed of 4 parts: disease, comorbidities, diagnosis, and treatment. Using the answers to this survey, current trends in the diagnosis and treatment of PE were investigated using weighted averages. Results: The median number per month of patients who were diagnosed with PE was 14 patients (interquartile range, 7∼24. The time to ejaculation necessary for a diagnosis of PE was considered to be <1 minute by 12% of respondents, <2 minutes by 27%, <3 minutes by 28%, <5 minutes by 13%, and 20% stated that diagnosis was based on a patient’s subjective complaint. The treatment methods preferred by PE patients were reported to be pharmacological treatment (87%, surgical treatment (9.5%, and behavioral management (3.5%. The treatment methods used by respondents were pharmacological treatment (77%, surgical treatment (15%, and behavioral management (14%. The most commonly used pharmacological treatment was the oral administration of dapoxetine (97%. Conclusions: In 2014 in South Korea, various methods were used to diagnose and treat PE. The most commonly used treatment for PE was the oral administration of dapoxetine. It was also found that surgical treatment was applied in some cases.

  13. Common Patterns of Congenital Lower Extremity Shortening: Diagnosis, Classification, and Follow-up.

    Science.gov (United States)

    Bedoya, Maria A; Chauvin, Nancy A; Jaramillo, Diego; Davidson, Richard; Horn, B David; Ho-Fung, Victor

    2015-01-01

    Congenital lower limb shortening is a group of relatively rare, heterogeneous disorders. Proximal focal femoral deficiency (PFFD) and fibular hemimelia (FH) are the most common pathologic entities in this disease spectrum. PFFD is characterized by variable degrees of shortening or absence of the femoral head, with associated dysplasia of the acetabulum and femoral shaft. FH ranges from mild hypoplasia to complete absence of the fibula with variable shortening of the tibia. The development of the lower limb requires complex and precise gene interactions. Although the etiologies of PFFD and FH remain unknown, there is a strong association between the two disorders. Associated congenital defects in the lower extremity are found in more than 50% of patients with PFFD, ipsilateral FH being the most common. FH also has a strong association with shortening and bowing of the tibia and with foot deformities such as absence of the lateral rays of the foot. Early diagnosis and radiologic classification of these abnormalities are imperative for appropriate management and surgical planning. Plain radiography remains the main diagnostic imaging modality for both PFFD and FH, and appropriate description of the osseous abnormalities seen on radiographs allows accurate classification, prognostic evaluation, and surgical planning. Minor malformations may commonly be misdiagnosed. ©RSNA, 2015.

  14. Anxiety disorders. Part 1: Diagnosis and treatment.

    OpenAIRE

    Labelle, A.; Lapierre, Y. D.

    1993-01-01

    Anxiety disorders often take second priority in clinical practice because many physicians do not understand them or their treatment. This paper reviews the diagnostic groupings of anxiety disorders according to the American Psychiatric Association's Revised Diagnostic and Statistical Manual of Mental Disorders (DSM 3-R) and discusses differential diagnosis and treatment.

  15. Current Approaches to Diagnosis and Classification Features of Neuroosteoarthropathy Charcot (literature review

    Directory of Open Access Journals (Sweden)

    Balatiuk Irina

    2016-12-01

    Full Text Available The article provides the analysis of the publications of domestic and foreign authors on such complication of diabetes as diabetic Charcot osteoarthropathy. It formulates modern domestic classification of diabetic foot syndrome. It has been stated that diabetic foot syndrome is a serious medical and social problem, due to the high level of disability of patients, it causes significant social and economic losses to society. Pathogenetic basis for the development of diabetic osteoarthropathy is a combination of uncontrolled bone resorption and the lack of sensitivity of the defense, which leads to the destruction of joints. The gold standard for diagnosis of Charcot osteoarthropathy is X-ray densitometry that allows you to objectively assess the state of bone mineral density.

  16. Current Diagnosis, Treatment and Etiology of Status Epilepticus

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    Çetin Kürşad Akpınar

    2014-03-01

    Full Text Available Status Epilepticus (SE is a medical emergency that causes significant morbidity and mortality and requires prompt diagnosis and treatment. Although SE can be divided into two subgroups as convulsive and nonconvulsive, treatment principles are generally similar. Treatment should be prompt and underlying cause should be corrected. Although intravenous lorazepam is the first-line treatment due to a lower risk of relapse, diazepam becomes the first choice since loeazepan is not available in our country. Even though intravenous benzodiazepine stops seizures, intravenous antiepileptic drug (phenytoin, etc. should be administered at a loading dose. Patients with refractory status epilepticus should be supported with respect to vital, respiratory, metabolic and hemodynamic aspects and followed up in an intensive care unit to monitor cerebral electrical activity. The most common cause in the etiology is the cessation of antiepileptic drugs. The aim of SE treatment is to stop seizures and prevent complications and recurrence. In this paper, current diagnosis, treatment and etiology of SE are reviewed.

  17. Cardiac device infections: definition, classification, differential diagnosis, and management.

    Science.gov (United States)

    Polewczyk, Anna; Janion, Marianna; Kutarski, Andrzej

    2016-04-13

    Cardiac device infections (CDIs) continue to be a serious clinical problem, with varying terminology and different classifications constituting one of the major diagnostic and therapeutic challenges in routine clinical practice. The problem invariably arises during an attempt to estimate the extent of the infection, which in consequence determines the choice of treatment strategy (duration of antibiotic therapy). The most serious form of CDI is lead-related infective endocarditis (LRIE). There are no clearly established diagnostic criteria for this disease; the available Duke University criteria are difficult to apply in patients with a suspicion of LRIE because of low sensitivity. As the treatment of LRIE is expensive and troublesome, there is a tendency to underdiagnose this condition and seek any intermediary forms between local pocket infection and definite LRIE. The present review includes suggestions for the systematization of CDIs with a clear definition of LRIE as a separate and most severe entity among CDIs.

  18. Imaging diagnosis of dural and direct cavernous carotid fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Daniela dos; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante, E-mail: danisantos2404@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2014-07-15

    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. (author)

  19. Interobserver and intraobserver reliability of radiographic classification of acromioclavicular joint dislocations.

    Science.gov (United States)

    Ringenberg, Jonathan D; Foughty, Zachary; Hall, Adam D; Aldridge, J Mack; Wilson, Joseph B; Kuremsky, Marshall A

    2018-03-01

    The classification and treatment of acromioclavicular (AC) joint dislocations remain controversial. The purpose of this study was to determine the interobserver and intraobserver reliability of the Rockwood classification system. We hypothesized poor interobserver and intraobserver reliability, limiting the role of the Rockwood classification system in determining severity of AC joint dislocations and accurately guiding treatment decisions. We identified 200 patients with AC joint injuries using the International Classification of Diseases, Ninth Revision code 831.04. Fifty patients met inclusion criteria. Deidentified radiographs were compiled and presented to 6 fellowship-trained upper extremity orthopedic surgeons. The surgeons classified each patient into 1 of the 6 classification types described by Rockwood. A second review was performed several months later by 2 surgeons. A κ value was calculated to determine the interobserver and intraobserver reliability. The interobserver and intraobserver κ values were fair (κ = 0.278) and moderate (κ = 0.468), respectively. Interobserver results showed that 4 of the 50 radiographic images had a unanimous classification. Intraobserver results for the 2 surgeons showed that 18 of the 50 images were rated the same on second review by the first surgeon and 38 of the 50 images were rated the same on second review by the second surgeon. We found that the Rockwood classification system has limited interobserver and intraobserver reliability. We believe that unreliable classification may account for some of the inconsistent treatment outcomes among patients with similarly classified injuries. We suggest that a better classification system is needed to use radiographic imaging for diagnosis and treatment of AC joint dislocations. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Examining applying high performance genetic data feature selection and classification algorithms for colon cancer diagnosis.

    Science.gov (United States)

    Al-Rajab, Murad; Lu, Joan; Xu, Qiang

    2017-07-01

    This paper examines the accuracy and efficiency (time complexity) of high performance genetic data feature selection and classification algorithms for colon cancer diagnosis. The need for this research derives from the urgent and increasing need for accurate and efficient algorithms. Colon cancer is a leading cause of death worldwide, hence it is vitally important for the cancer tissues to be expertly identified and classified in a rapid and timely manner, to assure both a fast detection of the disease and to expedite the drug discovery process. In this research, a three-phase approach was proposed and implemented: Phases One and Two examined the feature selection algorithms and classification algorithms employed separately, and Phase Three examined the performance of the combination of these. It was found from Phase One that the Particle Swarm Optimization (PSO) algorithm performed best with the colon dataset as a feature selection (29 genes selected) and from Phase Two that the Support Vector Machine (SVM) algorithm outperformed other classifications, with an accuracy of almost 86%. It was also found from Phase Three that the combined use of PSO and SVM surpassed other algorithms in accuracy and performance, and was faster in terms of time analysis (94%). It is concluded that applying feature selection algorithms prior to classification algorithms results in better accuracy than when the latter are applied alone. This conclusion is important and significant to industry and society. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Parasomnias: Diagnosis, Classification and Clinical Features

    Directory of Open Access Journals (Sweden)

    Fatma Ozlem Orhan

    2009-10-01

    Full Text Available Parasomnias, as described in the recent second edition of the International Classification of Sleep Disorders, are “undesirable physical events or experiences” occurring during sleep transition, during arousal from sleep, or within the sleep period. These events encompass abnormal sleep related movements, behaviors, emotions, perceptions, dreaming, and autonomic nervous system functioning. Parasomnias are classified as: 1 disorders of arousal (from non-rapid eye movement, or NREM, sleep; 2 parasomnias usually associated with REM (rapid eye movement sleep; and 3 other parasomnias. This sleep disorders in childhood are common, and often more frequent than in adults. Clinicians should be aware that many pediatric parasomnias have benign and self-limited nature. Most of the parasomnias may not persist into late childhood or adolescence. Parasomnias in adults often differ in type from childhood parasomnias and may portend significant psychiatric disturbances or neurodegenerative disorders. A reliable diagnosis can often be made from a detailed history from the patient and, if possible, the parents or bed partner. Detailed overnight investigations of parasomnias are usually not required. The non-REM parasomnias are more common in community although REM parasomnias are more likely to be seen in general neurological practice. Sleep related eating disorder, sleep related dissociative disorders and sleep related sexual behavior and sleep related violence are novel and rarely reported sleep disorders. REM sleep behavior disorder is common and should be sought in all neurodegenerative diseases. They are included among clinical disorders due to the resulting injuries, and adverse health and psychosocial effects, which may affect the bed partner as well as the patient. Finally, parasomnias are common disturbances of sleep that may significantly affect the patient’s quality of life and that of the bed partner. Therefore, appropriate diagnostic and

  2. Diagnosis and Treatment of Neurocysticercosis

    Directory of Open Access Journals (Sweden)

    Christina M. Coyle

    2009-01-01

    Full Text Available Neurocysticercosis, the infection caused by the larval form of the tapeworm Taenia solium, is the most common parasitic disease of the central nervous system and the most common cause of acquired epilepsy worldwide. This has primarily been a disease that remains endemic in low-socioeconomic countries, but because of increased migration neurocysticercosis is being diagnosed more frequently in high-income countries. During the past three decades improved diagnostics, imaging, and treatment have led to more accurate diagnosis and improved prognosis for patients. This article reviews the current literature on neurocysticercosis, including newer diagnostics and treatment developments.

  3. The quality of diagnosis and management of migraine and tension-type headache in three social groups in Russia

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Kobzeva, Natalia R; Gilev, Denis V

    2017-01-01

    BACKGROUND: Three successive editions of the International Classification of Headache Disorders and multiple guideline papers on headache care have described evidence based diagnosis and treatment of headache disorders. It remains unknown, however, to which extent this has improved the diagnosis ...

  4. New developments in epidemiology, diagnosis, and treatment of fascioliasis.

    Science.gov (United States)

    Cabada, Miguel M; White, A Clinton

    2012-10-01

    This review focuses on the recent developments in the epidemiology, burden of disease, diagnostic tests, and treatment of fascioliasis. Recent epidemiologic data suggest that either the endemic areas are expanding or disease is being recognized in areas where it was not previously observed. In addition, recent data highlight the effects of fascioliasis on childhood anemia and nutrition. Diagnosis remains problematic, but newer diagnostic tests including antibody, antigen, and DNA detection tests may facilitate earlier diagnosis. Recent studies suggest that point-of-care testing may soon be possible. Treatment with triclabendazole is effective, but resistance is emerging in livestock and may pose a threat for patients. Fascioliasis continues to emerge as an important neglected disease, with new studies highlighting the under-recognized burden of disease. Further studies are needed on burden of disease, improved diagnosis, and alternative to triclabendazole treatment.

  5. [Classification and Treatment of Sacroiliac Joint Dislocation].

    Science.gov (United States)

    Tan, Zhen; Huang, Zhong; Li, Liang; Meng, Wei-Kun; Liu, Lei; Zhang, Hui; Wang, Guang-Lin; Huang, Fu-Guo

    2017-09-01

    To develop a renewed classification and treatment regimen for sacroiliac joint dislocation. According to the direction of dislocation of sacroiliac joint,combined iliac,sacral fractures,and fracture morphology,sacroiliac joint dislocation was classified into 4 types. Type Ⅰ (sacroiliac anterior dislocation): main fracture fragments of posterior iliac wing dislocated in front of sacroiliac joint. Type Ⅱ (sacroiliac posterior dislocation): main fracture fragments of posterior iliac wing dislocated in posterior of sacroiliac joint. Type Ⅲ (Crescent fracturedislocation of the sacroiliac joint): upward dislocation of posterior iliac wing with oblique fracture through posterior iliac wing. Type ⅢA: a large crescent fragment and dislocation comprises no more than onethird of sacroiliac joint,which is typically inferior. Type ⅢB: intermediatesize crescent fragment and dislocation comprises between one and twothirds of joint. Type ⅢC: a small crescent fragment where dislocation comprises most,but not the entire joint. Different treatment regimens were selected for different types of fractures. Treatment for type Ⅰ sacroiliac joint dislocation: anterior iliac fossa approach pry stripping reset; sacroiliac joint fixed with sacroiliac screw through percutaneous. Treatment for type Ⅱ sacroiliac joint dislocation: posterior sacroiliac joint posterior approach; sacroiliac joint fixed with sacroiliac screw under computer guidance. Treatment for type ⅢA and ⅢB sacroiliac joint dislocation: posterior sacroiliac joint approach; sacroiliac joint fixed with reconstruction plate. Treatment for type ⅢC sacroiliac joint dislocation: sacroiliac joint closed reduction; sacroiliac joint fixed with sacroiliac screw through percutaneous. Treatment for type Ⅳ sacroiliac joint dislocation: posterior approach; sacroiliac joint fixed with spinal pelvic fixation. Results of 24 to 72 months patient follow-up (mean 34.5 months): 100% survival,100% wound healing,and 100

  6. Automated image processing method for the diagnosis and classification of malaria on thin blood smears.

    Science.gov (United States)

    Ross, Nicholas E; Pritchard, Charles J; Rubin, David M; Dusé, Adriano G

    2006-05-01

    Malaria is a serious global health problem, and rapid, accurate diagnosis is required to control the disease. An image processing algorithm to automate the diagnosis of malaria on thin blood smears is developed. The image classification system is designed to positively identify malaria parasites present in thin blood smears, and differentiate the species of malaria. Images are acquired using a charge-coupled device camera connected to a light microscope. Morphological and novel threshold selection techniques are used to identify erythrocytes (red blood cells) and possible parasites present on microscopic slides. Image features based on colour, texture and the geometry of the cells and parasites are generated, as well as features that make use of a priori knowledge of the classification problem and mimic features used by human technicians. A two-stage tree classifier using backpropogation feedforward neural networks distinguishes between true and false positives, and then diagnoses the species (Plasmodium falciparum, P. vivax, P. ovale or P. malariae) of the infection. Malaria samples obtained from the Department of Clinical Microbiology and Infectious Diseases at the University of the Witwatersrand Medical School are used for training and testing of the system. Infected erythrocytes are positively identified with a sensitivity of 85% and a positive predictive value (PPV) of 81%, which makes the method highly sensitive at diagnosing a complete sample provided many views are analysed. Species were correctly determined for 11 out of 15 samples.

  7. Adolescence and polycystic ovary syndrome: current concepts on diagnosis and treatment.

    Science.gov (United States)

    Spritzer, P M; Motta, A B

    2015-11-01

    Adolescence is a time characterised by changes in reproductive hormones and menstrual patterns, which makes it difficult to diagnose polycystic ovary syndrome (PCOS) in this population. The diagnosis of PCOS has a great physical and psychosocial impact on the young person. Despite the importance of a diagnosis of PCOS at adolescence, data available are limited. This review focuses on analysing markers of PCOS diagnosis and possible treatments in adolescence. Although, during adolescence, diagnosis criteria of PCOS overlap with physiological changes including clinical manifestations of hyperandrogenism (acne and hirsutism), oligo/amenorrhoea, anovulation and ovarian microcysts, there is agreement that irregular menses and hyperandrogenaemia should be used to diagnose PCOS in this population. Moreover, considering that PCOS phenotype could change through the reproductive age and that adolescents display heterogeneous ovarian morphology, it has been proposed that diagnosis of PCOS should be confirmed after the age of 18. The first-line treatment for menstrual irregularity and hirsutism are oral contraceptive pills (OCPs) and for obesity and metabolic abnormalities are lifestyle changes. Insulin-sensitizer drugs, such as metformin, may be added to the treatment in the presence of metabolic alterations. Antiandrogen drugs may also be associated for treating moderate to severe hirsutism. During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include lifestyle changes. Pharmacological treatments comprise OCPs, antiandrogens and metformin, used isolated or combined. During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include

  8. Computer modeling of lung cancer diagnosis-to-treatment process.

    Science.gov (United States)

    Ju, Feng; Lee, Hyo Kyung; Osarogiagbon, Raymond U; Yu, Xinhua; Faris, Nick; Li, Jingshan

    2015-08-01

    We introduce an example of a rigorous, quantitative method for quality improvement in lung cancer care-delivery. Computer process modeling methods are introduced for lung cancer diagnosis, staging and treatment selection process. Two types of process modeling techniques, discrete event simulation (DES) and analytical models, are briefly reviewed. Recent developments in DES are outlined and the necessary data and procedures to develop a DES model for lung cancer diagnosis, leading up to surgical treatment process are summarized. The analytical models include both Markov chain model and closed formulas. The Markov chain models with its application in healthcare are introduced and the approach to derive a lung cancer diagnosis process model is presented. Similarly, the procedure to derive closed formulas evaluating the diagnosis process performance is outlined. Finally, the pros and cons of these methods are discussed.

  9. Automated classification of bone marrow cells in microscopic images for diagnosis of leukemia: a comparison of two classification schemes with respect to the segmentation quality

    Science.gov (United States)

    Krappe, Sebastian; Benz, Michaela; Wittenberg, Thomas; Haferlach, Torsten; Münzenmayer, Christian

    2015-03-01

    The morphological analysis of bone marrow smears is fundamental for the diagnosis of leukemia. Currently, the counting and classification of the different types of bone marrow cells is done manually with the use of bright field microscope. This is a time consuming, partly subjective and tedious process. Furthermore, repeated examinations of a slide yield intra- and inter-observer variances. For this reason an automation of morphological bone marrow analysis is pursued. This analysis comprises several steps: image acquisition and smear detection, cell localization and segmentation, feature extraction and cell classification. The automated classification of bone marrow cells is depending on the automated cell segmentation and the choice of adequate features extracted from different parts of the cell. In this work we focus on the evaluation of support vector machines (SVMs) and random forests (RFs) for the differentiation of bone marrow cells in 16 different classes, including immature and abnormal cell classes. Data sets of different segmentation quality are used to test the two approaches. Automated solutions for the morphological analysis for bone marrow smears could use such a classifier to pre-classify bone marrow cells and thereby shortening the examination duration.

  10. Automatic classification of tissue malignancy for breast carcinoma diagnosis.

    Science.gov (United States)

    Fondón, Irene; Sarmiento, Auxiliadora; García, Ana Isabel; Silvestre, María; Eloy, Catarina; Polónia, António; Aguiar, Paulo

    2018-05-01

    Breast cancer is the second leading cause of cancer death among women. Its early diagnosis is extremely important to prevent avoidable deaths. However, malignancy assessment of tissue biopsies is complex and dependent on observer subjectivity. Moreover, hematoxylin and eosin (H&E)-stained histological images exhibit a highly variable appearance, even within the same malignancy level. In this paper, we propose a computer-aided diagnosis (CAD) tool for automated malignancy assessment of breast tissue samples based on the processing of histological images. We provide four malignancy levels as the output of the system: normal, benign, in situ and invasive. The method is based on the calculation of three sets of features related to nuclei, colour regions and textures considering local characteristics and global image properties. By taking advantage of well-established image processing techniques, we build a feature vector for each image that serves as an input to an SVM (Support Vector Machine) classifier with a quadratic kernel. The method has been rigorously evaluated, first with a 5-fold cross-validation within an initial set of 120 images, second with an external set of 30 different images and third with images with artefacts included. Accuracy levels range from 75.8% when the 5-fold cross-validation was performed to 75% with the external set of new images and 61.11% when the extremely difficult images were added to the classification experiment. The experimental results indicate that the proposed method is capable of distinguishing between four malignancy levels with high accuracy. Our results are close to those obtained with recent deep learning-based methods. Moreover, it performs better than other state-of-the-art methods based on feature extraction, and it can help improve the CAD of breast cancer. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Childhood night terrors and sleepwalking: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Sachin Ratan Gedam

    2017-12-01

    Full Text Available Night terrors and sleepwalking are arousal disorders that occur during the first third of night. Combined existence of sleep disorders are rare phenomenon and found to be associated with behavioural and emotional problems. It becomes difficult to diagnose among sleep disorders and epilepsy is an important differential diagnosis. Management with combined approach of pharmacotherapy and psychological counselling is safe and effective. Here, we present a case of night terrors and sleepwalking to highlight the importance of diagnosis and treatment in this condition. To conclude, all medical professionals need to be aware of different parasomnias and its treatment options.

  12. Diagnosis and treatment of abnormal dental pain

    OpenAIRE

    Fukuda, Ken-ichi

    2016-01-01

    Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, ...

  13. Classification of Diabetic Macular Edema and Its Stages Using Color Fundus Image

    Institute of Scientific and Technical Information of China (English)

    Muhammad Zubair; Shoab A. Khan; Ubaid Ullah Yasin

    2014-01-01

    Diabetic macular edema (DME) is a retinal thickening involving the center of the macula. It is one of the serious eye diseases which affects the central vision and can lead to partial or even complete visual loss. The only cure is timely diagnosis, prevention, and treatment of the disease. This paper presents an automated system for the diagnosis and classification of DME using color fundus image. In the proposed technique, first the optic disc is removed by applying some preprocessing steps. The preprocessed image is then passed through a classifier for segmentation of the image to detect exudates. The classifier uses dynamic thresholding technique by using some input parameters of the image. The stage classification is done on the basis of anearly treatment diabetic retinopathy study (ETDRS) given criteria to assess the severity of disease. The proposed technique gives a sensitivity, specificity, and accuracy of 98.27%, 96.58%, and 96.54%, respectively on publically available database.

  14. Diagnosis of Epilepsy and Related Episodic Disorders.

    Science.gov (United States)

    St Louis, Erik K; Cascino, Gregory D

    2016-02-01

    This review identifies the diverse and variable clinical presentations associated with epilepsy that may create challenges in diagnosis and treatment. Epilepsy has recently been redefined as a disease characterized by one or more seizures with a relatively high recurrence risk (ie, 60% or greater likelihood). The implication of this definition for therapy is that antiepileptic drug therapy may be initiated following a first seizure in certain situations.EEG remains the most commonly used study in the evaluation of people with epilepsy. Routine EEG may assist in diagnosis, classification of seizure type(s), identification of treatment, and monitoring the efficacy of therapy. Video-EEG monitoring permits seizure classification, assessment of psychogenic nonepileptic seizures, and evaluation of candidacy for epilepsy surgery. MRI is pivotal in elucidating the etiology of the seizure disorder and in suggesting the localization of seizure onset. This article reviews the new International League Against Epilepsy practical clinical definition for epilepsy and the differential diagnosis of other physiologic paroxysmal spells, including syncope, parasomnias, transient ischemic attacks, and migraine, as well as psychogenic nonepileptic seizures. The initial investigational approaches to new-onset epilepsy are considered, including neuroimaging and neurophysiologic investigations with interictal and ictal video-EEG. Neurologists should maintain a high index of suspicion for epilepsy when children or adults present with a single paroxysmal spell or recurrent episodic events.

  15. Diagnosis, monitoring and treatment of tuberous sclerosis complex ...

    African Journals Online (AJOL)

    Diagnosis, monitoring and treatment of tuberous sclerosis complex: A South African consensus response to international guidelines. ... inhibitors to treat subependymal giant cell astrocytomas not amenable to surgery and renal angiomyolipomas larger than 3 cm, and as adjunctive treatment for refractory focal seizures.

  16. The molecular classification of hereditary endocrine diseases.

    Science.gov (United States)

    Ye, Lei; Ning, Guang

    2015-12-01

    Hereditary endocrine diseases are an important group of diseases with great heterogeneity. The current classification for hereditary endocrine disease is mostly based upon anatomy, which is helpful for pathophysiological interpretation, but does not address the pathogenic variability associated with different underlying genetic causes. Identification of an endocrinopathy-associated genetic alteration provides evidence for differential diagnosis, discovery of non-classical disease, and the potential for earlier diagnosis and targeted therapy. Molecular diagnosis should be routinely applied when managing patients with suspicion of hereditary disease. To enhance the accurate diagnosis and treatment of patients with hereditary endocrine diseases, we propose categorization of endocrine diseases into three groups based upon the function of the mutant gene: cell differentiation, hormone synthesis and action, and tumorigenesis. Each category was further grouped according to the specific gene function. We believe that this format would facilitate practice of precision medicine in the field of hereditary endocrine diseases.

  17. A Fast SVM-Based Tongue's Colour Classification Aided by k-Means Clustering Identifiers and Colour Attributes as Computer-Assisted Tool for Tongue Diagnosis

    Science.gov (United States)

    Ooi, Chia Yee; Kawanabe, Tadaaki; Odaguchi, Hiroshi; Kobayashi, Fuminori

    2017-01-01

    In tongue diagnosis, colour information of tongue body has kept valuable information regarding the state of disease and its correlation with the internal organs. Qualitatively, practitioners may have difficulty in their judgement due to the instable lighting condition and naked eye's ability to capture the exact colour distribution on the tongue especially the tongue with multicolour substance. To overcome this ambiguity, this paper presents a two-stage tongue's multicolour classification based on a support vector machine (SVM) whose support vectors are reduced by our proposed k-means clustering identifiers and red colour range for precise tongue colour diagnosis. In the first stage, k-means clustering is used to cluster a tongue image into four clusters of image background (black), deep red region, red/light red region, and transitional region. In the second-stage classification, red/light red tongue images are further classified into red tongue or light red tongue based on the red colour range derived in our work. Overall, true rate classification accuracy of the proposed two-stage classification to diagnose red, light red, and deep red tongue colours is 94%. The number of support vectors in SVM is improved by 41.2%, and the execution time for one image is recorded as 48 seconds. PMID:29065640

  18. A Fast SVM-Based Tongue's Colour Classification Aided by k-Means Clustering Identifiers and Colour Attributes as Computer-Assisted Tool for Tongue Diagnosis.

    Science.gov (United States)

    Kamarudin, Nur Diyana; Ooi, Chia Yee; Kawanabe, Tadaaki; Odaguchi, Hiroshi; Kobayashi, Fuminori

    2017-01-01

    In tongue diagnosis, colour information of tongue body has kept valuable information regarding the state of disease and its correlation with the internal organs. Qualitatively, practitioners may have difficulty in their judgement due to the instable lighting condition and naked eye's ability to capture the exact colour distribution on the tongue especially the tongue with multicolour substance. To overcome this ambiguity, this paper presents a two-stage tongue's multicolour classification based on a support vector machine (SVM) whose support vectors are reduced by our proposed k -means clustering identifiers and red colour range for precise tongue colour diagnosis. In the first stage, k -means clustering is used to cluster a tongue image into four clusters of image background (black), deep red region, red/light red region, and transitional region. In the second-stage classification, red/light red tongue images are further classified into red tongue or light red tongue based on the red colour range derived in our work. Overall, true rate classification accuracy of the proposed two-stage classification to diagnose red, light red, and deep red tongue colours is 94%. The number of support vectors in SVM is improved by 41.2%, and the execution time for one image is recorded as 48 seconds.

  19. Comparative analysis of classification based algorithms for diabetes diagnosis using iris images.

    Science.gov (United States)

    Samant, Piyush; Agarwal, Ravinder

    2018-01-01

    Photo-diagnosis is always an intriguing area for the researchers, with the advancement of image processing and computer machine vision techniques it have become more reliable and popular in recent years. The objective of this paper is to study the change in the features of iris, particularly irregularities in the pigmentation of certain areas of the iris with respect to diabetic health of an individual. Apart from the point that iris recognition concentrates on the overall structure of the iris, diagnostic techniques emphasises the local variations in the particular area of iris. Pre-image processing techniques have been applied to extract iris and thereafter, region of interest from the extracted iris have been cropped out. In order to observe the changes in the tissue pigmentation of region of interest, statistical, texture textural and wavelet features have been extracted. At the end, a comparison of accuracies of five different classifiers has been presented to classify two subject groups of diabetic and non-diabetic. Best classification accuracy has been calculated as 89.66% by the random forest classifier. Results have been shown the effectiveness and diagnostic significance of the proposed methodology. Presented piece of work offers a novel systemic perspective of non-invasive and automatic diabetic diagnosis.

  20. Update on the epidemiology, diagnosis, and treatment of leprosy.

    Science.gov (United States)

    Reibel, F; Cambau, E; Aubry, A

    2015-09-01

    Leprosy is an infectious disease that has now been reported for more than 2000 years. The leprosy elimination goal set by the World Health Organization (WHO), i.e. a global prevalence rate Leprosy is a specific infection: (i) it is a chronic infection primarily affecting the skin and peripheral nerves, (ii) Mycobacterium leprae is one of the last bacterial species of medical interest that cannot be cultured in vitro (mainly because of its reductive genome evolution), and (iii) transmission and pathophysiological data is still limited. The various presentations of the disease (Ridley-Jopling and WHO classifications) are correlated with the patient's immune response, bacillary load, and by the delay before diagnosis. Multidrug therapy (dapsone, rifampicin, with or without clofazimine) has been recommended since 1982 as the standard treatment of leprosy; 6 months for patients presenting with paucibacillary leprosy and 12 months for patients presenting with multibacillary leprosy. The worldwide use of leprosy drugs started in the 1980s and their free access since 1995 contributed to the drastic decline in the number of new case patients. Resistant strains are however emerging despite the use of multidrug therapy; identifying and monitoring resistance is still necessary. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. MINIMAL REQUIREMENTS FOR THE DIAGNOSIS, CLASSIFICATION, AND EVALUATION OF THE TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA (ALL) IN THE BFM FAMILY COOPERATIVE GROUP

    NARCIS (Netherlands)

    VANDERDOESVANDENBERG, A; BARTRAM, CR; BASSO, G; BENOIT, YCM; BIONDI, A; DEBATIN, KM; HAAS, OA; HARBOTT, J; KAMPS, WA; KOLLER, U; LAMPERT, F; LUDWIG, WD; NIEMEYER, CM; VANWERING, ER

    1992-01-01

    Minimal requirements and their rationale for the diagnosis and the response to treatment in childhood acute lymphoblastic leukemia (ALL) were defined in the recently instituted "BFM-Family"-Group, in which the German, Austrian, Dutch, Italian, Belgian, French and Hungarian childhood leukemia study

  2. [Diagnosis and treatment of pediatric anismus].

    Science.gov (United States)

    Ding, Shu-qing; Ding, Yi-jiang; Chen, Yong-tian; Ye, Hui

    2006-11-01

    To explore the diagnosis and treatment methods of pediatric anismus. Twenty-nine patients with idiopathic chronic constipation, diagnosed with anismus by colon barium contrast and anorectal manometry from Nov. 2001 to Nov. 2004 in our hospital, were investigated retrospectively. This group consisted of 13 men and 16 women whose mean age was (6.7+/-4.0) years. Hirschsprung diseases were excluded from the patients by colon barium contrast and rectoanal inhibitory reflex (RAIR) examination. Normal RAIR (5-10 ml elicited) was showed on 21 cases while weakened RAIR (15-30 ml elicited) was showed on 8 cases. After the diagnosis, the patients were treated by toilet training, diet regulation and laxative for 1-2 months. 4 cases were recovered, 5 cases were improved and 20 cases were relied on glycerin suppository. Four cases, relied on glycerin suppository, underwent Lynn procedure and had good results after 5-24 months follow-up. Two cases were re-examined by anorectal manometry 3 and 6 months after surgery, the resting pressure and the high pressure zone (HPZ) decreased, but the simulation defecation reflex was still abnormal. The diagnosis of pediatric anismus relies on history of constipation, combined with anorectal manometry and colon barium contrast. Lynn procedure could be chosen for the patients unsatisfied in toilet training and other non-operative treatment.

  3. Ocular Tuberculosis II: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Sumru Önal

    2011-06-01

    Full Text Available Recent studies on the clinical importance of tuberculin skin tests (TST, interferon-gamma release assays (IGRAs, chest computed tomography (CT and polymerase chain reaction have provided a new approach to diagnosing ocular tuberculosis (TBC. However, both TST and IGRAs cannot distinguish between latent TBC infection and active disease. Another corroborative test in the diagnosis of intraocular TBC is the evaluation of the lungs by either chest radiography or CT. Direct evidence for the diagnosis can be obtained by examination of smears and staining for acid-fast organisms, cultures of intraocular tissue/fluid for Mycobacterium tuberculosis, and nucleic acid amplification analysis. In recent years, guidelines have been suggested for the diagnosis of intraocular TBC. The current treatment of intraocular TBC consists of use of four drugs (isoniazid, rifampicin, ethambutol and pyrazinamide taken for a long period of time (total 9-15 months. (Turk J Ophthalmol 2011; 41: 182-90

  4. Case study of physiotherapeutic treatment of patient with diagnosis facial nerve peripheral palsy

    OpenAIRE

    Zahrádková, Tereza

    2015-01-01

    Title of Bachelorʼs thesis: Case study of physiotherapeutic treatment of patient with diagnosis facial nerve peripheral palsy. Aim of thesis: Summary of theoretical findings of patientʼs diagnosis, study metodology of physiotherapeutic care, treatment design, monitoring of treatment, and evaluate the effect of patient with diagnosis facial nerve peripheral palsy. Summary: This thesis comprehensively summarizes the findings of of peripheral facial nerve palsy and it's treatment with physiotera...

  5. EULAR points to consider in the development of classification and diagnostic criteria in systemic vasculitis

    DEFF Research Database (Denmark)

    Basu, Neil; Watts, Richard; Bajema, Ingeborg

    2010-01-01

    The systemic vasculitides are multiorgan diseases where early diagnosis and treatment can significantly improve outcomes. Robust nomenclature reduces diagnostic delay. However, key aspects of current nomenclature are widely perceived to be out of date, these include disease definitions, classific......, classification and diagnostic criteria. Therefore, the aim of the present work was to identify deficiencies and provide contemporary points to consider for the development of future definitions and criteria in systemic vasculitis....

  6. Diagnosis and treatment of radioactive poisoning. Proceedings of the scientific meeting on the diagnosis and treatment of radioactive poisoning

    International Nuclear Information System (INIS)

    1963-01-01

    The increasing use of atomic energy generated by nuclear fission is necessarily accompanied by the production of large quantities of radioactive isotopes. This, together with the growing use of radioactive materials in many fields, has given added importance to practical considerations of how best to deal with accidents - should they occur - involving radioactive contamination of individuals. Such considerations require knowledge of the metabolic behaviour of various radionuclides in man and of methods of increasing their elimination from the body. Information of this type is limited, and it is therefore essential to make maximum use of those data which, are available. Analyses of earlier accidents are one important source of such data; another is experience gained from the medical administration of radioisotopes for therapeutic or diagnostic purposes. The World Health Organization and the International Atomic Energy Agency jointly sponsored a scientific meeting on the Diagnosis and Treatment of Radioactive Poisoning, in Vienna from 15 to 18 October 1962. The aim of the meeting, which followed an earlier one (The Diagnosis and Treatment of Acute Radiation Injury) sponsored by the two organizations in 1960 on another aspect of radiation protection, was to review the present state of knowledge on the diagnosis, evaluation and treatment of persons who have accidentally incorporated radioactive materials. It brought together three groups of persons: those experienced in various methods of diagnosis and treatment of patients who have been exposed (occupationally or accidentally) to radioactive material; those engaged in the clinical administration of radionuclides and the study of their behaviour in man; and those working on related problems with experimental animals. In view of the great interest of many of the topics discussed at the meeting, it was felt desirable that the information presented in the papers and brought out in the ensuing discussions should be

  7. Delay in Presentation, Diagnosis, and Treatment for Breast Cancer Patients in Jordan.

    Science.gov (United States)

    Abu-Helalah, Ahmad Munir; Alshraideh, Hussam Ahmad; Al-Hanaqtah, Mo'tasem; Da'na, Moh'd; Al-Omari, Asim; Mubaidin, Rasmi

    2016-01-01

    Breast cancer is the most common cancer, and one of the leading causes of death for females in Jordan and many countries in the world. Studies have shown that delay in symptoms presentation, diagnosis or treatment would result in poor prognosis. There has been no published study from Jordan on delays in patient presentation, delays in diagnosis, or delays in treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for breast cancer patients in Jordan. This project was a cross-sectional study on female breast cancer patients in Jordan. The total number of participants was 327. The proportion of patients with presentation delay, diagnosis delay, and treatment delay was 32.2%, 49.1%, or 32.4%, respectively. The main reported reasons for delay in presentation were ignorance of the nature of the problem (65.6%), limited/lack of knowledge that symptoms were suggestive of cancer diagnosis (16.7%), and misdiagnosis (16.7%). Predictors of delay and mean time for presentation, diagnosis, and treatment were identified. Our results reveal that breast cancer patients in Jordan are experiencing delays in presentation, diagnosis, and treatment. This could justify the advanced stages at diagnosis and poor outcomes for breast cancer patients in Jordan. We recommend revising the current early detection and down-staging programs in Jordan. © 2015 Wiley Periodicals, Inc.

  8. HIV / AIDS: Symptoms, Diagnosis, Prevention and Treatment

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: Symptoms , Diagnosis, Prevention and Treatment Past Issues / ... Most people who have become recently infected with HIV will not have any symptoms. They may, however, ...

  9. Heart Health - Heart Disease: Symptoms, Diagnosis, Treatment

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Cover Story Heart Health Heart Disease: Symptoms, Diagnosis, Treatment Past Issues / Winter 2009 ... of this page please turn Javascript on. Most heart attacks happen when a clot in the coronary ...

  10. Rough Sets as a Knowledge Discovery and Classification Tool for the Diagnosis of Students with Learning Disabilities

    Directory of Open Access Journals (Sweden)

    Yu-Chi Lin

    2011-02-01

    Full Text Available Due to the implicit characteristics of learning disabilities (LDs, the diagnosis of students with learning disabilities has long been a difficult issue. Artificial intelligence techniques like artificial neural network (ANN and support vector machine (SVM have been applied to the LD diagnosis problem with satisfactory outcomes. However, special education teachers or professionals tend to be skeptical to these kinds of black-box predictors. In this study, we adopt the rough set theory (RST, which can not only perform as a classifier, but may also produce meaningful explanations or rules, to the LD diagnosis application. Our experiments indicate that the RST approach is competitive as a tool for feature selection, and it performs better in term of prediction accuracy than other rulebased algorithms such as decision tree and ripper algorithms. We also propose to mix samples collected from sources with different LD diagnosis procedure and criteria. By pre-processing these mixed samples with simple and readily available clustering algorithms, we are able to improve the quality and support of rules generated by the RST. Overall, our study shows that the rough set approach, as a classification and knowledge discovery tool, may have great potential in playing an essential role in LD diagnosis.

  11. Wolfram Syndrome: Diagnosis, Management, and Treatment.

    Science.gov (United States)

    Urano, Fumihiko

    2016-01-01

    Wolfram syndrome is a rare genetic disorder characterized by juvenile-onset diabetes mellitus, diabetes insipidus, optic nerve atrophy, hearing loss, and neurodegeneration. Although there are currently no effective treatments that can delay or reverse the progression of Wolfram syndrome, the use of careful clinical monitoring and supportive care can help relieve the suffering of patients and improve their quality of life. The prognosis of this syndrome is currently poor, and many patients die prematurely with severe neurological disabilities, raising the urgency for developing novel treatments for Wolfram syndrome. In this article, we describe natural history and etiology, provide recommendations for diagnosis and clinical management, and introduce new treatments for Wolfram syndrome.

  12. Aided diagnosis methods of breast cancer based on machine learning

    Science.gov (United States)

    Zhao, Yue; Wang, Nian; Cui, Xiaoyu

    2017-08-01

    In the field of medicine, quickly and accurately determining whether the patient is malignant or benign is the key to treatment. In this paper, K-Nearest Neighbor, Linear Discriminant Analysis, Logistic Regression were applied to predict the classification of thyroid,Her-2,PR,ER,Ki67,metastasis and lymph nodes in breast cancer, in order to recognize the benign and malignant breast tumors and achieve the purpose of aided diagnosis of breast cancer. The results showed that the highest classification accuracy of LDA was 88.56%, while the classification effect of KNN and Logistic Regression were better than that of LDA, the best accuracy reached 96.30%.

  13. Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo

    Directory of Open Access Journals (Sweden)

    Muhammed Dagkiran

    2015-12-01

    Full Text Available Benign paroxysmal positional vertigo is the cause of peripheral vertigo, which only takes seconds posed by certain head and body position and led to severe attacks of vertigo. Therefore, it is a disturbance that causes a continuous fear of fall and anxiety in some patients. Although benign paroxysmal positional vertigo is the most common cause of peripheral vertigo, it may cause unnecessary tests, treatment costs and the loss of labor due to the result of the delay in the diagnosis and treatment stages. Diagnosis and treatment of this disease is easy. High success rates can be achieved with appropriate repositioning maneuvers after taking a detailed medical history and accurate assessment of accompanying nystagmus. The aim of this paper was to review the updated information about benign paroxysmal positional vertigo. [Archives Medical Review Journal 2015; 24(4.000: 555-564

  14. Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Paat-Ahi, Gerli; Aaviksoo, Ain; Swiderek, Maria

    2014-12-01

    As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England). The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries' DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.

  15. Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

    Directory of Open Access Journals (Sweden)

    Campagnolo, Andrea Maria

    2014-01-01

    Full Text Available Introduction Laryngopharyngeal reflux (LPR is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

  16. The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification.

    Science.gov (United States)

    Travis, William D; Brambilla, Elisabeth; Nicholson, Andrew G; Yatabe, Yasushi; Austin, John H M; Beasley, Mary Beth; Chirieac, Lucian R; Dacic, Sanja; Duhig, Edwina; Flieder, Douglas B; Geisinger, Kim; Hirsch, Fred R; Ishikawa, Yuichi; Kerr, Keith M; Noguchi, Masayuki; Pelosi, Giuseppe; Powell, Charles A; Tsao, Ming Sound; Wistuba, Ignacio

    2015-09-01

    The 2015 World Health Organization (WHO) Classification of Tumors of the Lung, Pleura, Thymus and Heart has just been published with numerous important changes from the 2004 WHO classification. The most significant changes in this edition involve (1) use of immunohistochemistry throughout the classification, (2) a new emphasis on genetic studies, in particular, integration of molecular testing to help personalize treatment strategies for advanced lung cancer patients, (3) a new classification for small biopsies and cytology similar to that proposed in the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (4) a completely different approach to lung adenocarcinoma as proposed by the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (5) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories, (6) reclassifying squamous cell carcinomas into keratinizing, nonkeratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation, (7) grouping of neuroendocrine tumors together in one category, (8) adding NUT carcinoma, (9) changing the term sclerosing hemangioma to sclerosing pneumocytoma, (10) changing the name hamartoma to "pulmonary hamartoma," (11) creating a group of PEComatous tumors that include (a) lymphangioleiomyomatosis, (b) PEComa, benign (with clear cell tumor as a variant) and (c) PEComa, malignant, (12) introducing the entity pulmonary myxoid sarcoma with an EWSR1-CREB1 translocation, (13) adding the entities myoepithelioma and myoepithelial carcinomas, which can show EWSR1 gene rearrangements, (14) recognition of usefulness of WWTR1-CAMTA1 fusions in diagnosis of epithelioid

  17. Evolution in diagnosis and treatment of Legg-Calve-Perthes disease

    Directory of Open Access Journals (Sweden)

    Seyed Mahdi Mazloumi

    2014-06-01

    Full Text Available Legg-Calvé-Perthes disease (LCPD is an idiopathic osteonecrosis of the femoral head with variable complications and resultant deformity of the femoral head and osteoarthritis. Suggested risk factors are acetabular retroversion, obesity, latitude, hyperactivity, and coagulopathy. The most commonly applied classification is based on radiolucency in the lateral pillar of the femoral head, which is strongly correlated with the outcome. In the fragmentation stage of the disease involvement can be classified into three groups. After skeletal maturity, the outcome can be classified using the Stulberg classification based on the sphericity and congruence of the femoral head in relation to the acetabulum. The early goal of treatment is to prevent head deformation by weight transmitted forces during remodeling and ossification stages containment is the widely accepted principle of treatment. Although the Petrie cast still has a role in the short-term treatment of LCPD before and during the reossification stage, available data does not support additional benefits from braces during the course of LCPD.

  18. A Fast SVM-Based Tongue’s Colour Classification Aided by k-Means Clustering Identifiers and Colour Attributes as Computer-Assisted Tool for Tongue Diagnosis

    Directory of Open Access Journals (Sweden)

    Nur Diyana Kamarudin

    2017-01-01

    Full Text Available In tongue diagnosis, colour information of tongue body has kept valuable information regarding the state of disease and its correlation with the internal organs. Qualitatively, practitioners may have difficulty in their judgement due to the instable lighting condition and naked eye’s ability to capture the exact colour distribution on the tongue especially the tongue with multicolour substance. To overcome this ambiguity, this paper presents a two-stage tongue’s multicolour classification based on a support vector machine (SVM whose support vectors are reduced by our proposed k-means clustering identifiers and red colour range for precise tongue colour diagnosis. In the first stage, k-means clustering is used to cluster a tongue image into four clusters of image background (black, deep red region, red/light red region, and transitional region. In the second-stage classification, red/light red tongue images are further classified into red tongue or light red tongue based on the red colour range derived in our work. Overall, true rate classification accuracy of the proposed two-stage classification to diagnose red, light red, and deep red tongue colours is 94%. The number of support vectors in SVM is improved by 41.2%, and the execution time for one image is recorded as 48 seconds.

  19. Radiopharmaceuticals for diagnosis and treatment of arthritis

    International Nuclear Information System (INIS)

    Hosain, F.; Haddon, M.J.; Hosain, H.; Drost, J.K.; Spencer, R.P.

    1990-01-01

    A brief review is given of radiopharmaceuticals for the diagnosis and treatment of arthritis. Topics covered include the pathophysiology of arthritis and the basis for the use of radiotracers, diagnostic procedures and radiotracer applications and therapeutic approaches and radionuclide applications. (UK)

  20. Repeatability of Pulse Diagnosis and Body Constitution Diagnosis in Traditional Indian Ayurveda Medicine

    Science.gov (United States)

    Waagepetersen, Rasmus; Toft, Egon; Prasad, Ramjee; Raturi, Lokesh

    2012-01-01

    In Ayurveda, pulse diagnosis and body constitution diagnosis have a long historical use; still, there is lack of quantitative measure of the reliability of these diagnostic methods. Reliability means consistency of information. Consistent diagnosis leads to consistent treatment and is important for clinical practice, education, and research. The objective of this study is to study the methodology to evaluate the test-retest reliability (repeatability) of pulse diagnosis and body constitution diagnosis. A double-blinded, controlled, clinical trial was conducted in Copenhagen. The same doctor, an expert in Ayurvedic pulse diagnosis, examined the pulse and body constitution of 17 healthy participants twice, in random order without seeing them. A metric on pulse and body constitution variables was developed. Cohen's weighted kappa statistic was used as a measure of intra-rater reliability. Permutation tests were used to test the hypothesis of homogeneous diagnosis (ie, the doctor's diagnosis does not depend on the subject). The hypothesis of homogeneous classification was rejected on the 5% significance level (P values of .02 and .001, respectively, for pulse and body constitution diagnosis). According to the Landis and Koch scale, values of the weighted kappa for pulse diagnosis (P = .42) and body constitution diagnosis (P = .65) correspond to “moderate” and “substantial” agreement, respectively. There was a reasonable level of consistency between 2 pulse and body constitution diagnoses. Further studies are required to quantify inter-subject and intra-subject agreement for greater understanding of reliability of pulse and body constitution diagnosis. PMID:27257530

  1. Genetic Fuzzy System (GFS based wavelet co-occurrence feature selection in mammogram classification for breast cancer diagnosis

    Directory of Open Access Journals (Sweden)

    Meenakshi M. Pawar

    2016-09-01

    Full Text Available Breast cancer is significant health problem diagnosed mostly in women worldwide. Therefore, early detection of breast cancer is performed with the help of digital mammography, which can reduce mortality rate. This paper presents wrapper based feature selection approach for wavelet co-occurrence feature (WCF using Genetic Fuzzy System (GFS in mammogram classification problem. The performance of GFS algorithm is explained using mini-MIAS database. WCF features are obtained from detail wavelet coefficients at each level of decomposition of mammogram image. At first level of decomposition, 18 features are applied to GFS algorithm, which selects 5 features with an average classification success rate of 39.64%. Subsequently, at second level it selects 9 features from 36 features and the classification success rate is improved to 56.75%. For third level, 16 features are selected from 54 features and average success rate is improved to 64.98%. Lastly, at fourth level 72 features are applied to GFS, which selects 16 features and thereby increasing average success rate to 89.47%. Hence, GFS algorithm is the effective way of obtaining optimal set of feature in breast cancer diagnosis.

  2. Diagnosis and treatment of traumatic pancreatic injury

    International Nuclear Information System (INIS)

    Hirakawa, Akihiko; Isayama, Kenji; Nakatani, Toshio

    2011-01-01

    The diagnosis of traumatic pancreatic injury in the acute stage is difficult to establish blood tests and abdominal findings alone. Moreover, to determine treatment strategies, it is important not only that a pancreatic injury is diagnosed but also whether a pancreatic ductal injury can be found. At our center, to diagnose isolated pancreatic injuries, we actively perform endoscopic retrograde pancreatography (ERP) in addition to abdominal CT at the time of admission. For cases with complications such as abdominal and other organ injuries, we perform a laparotomy to ascertain whether a pancreatic duct injury is present. In regard to treatment options, for grade III injuries to the pancreatic body and tail, we basically choose distal pancreatectomy, but we also consider the Bracy method depending on the case. As for grade III injuries to the pancreatic head, we primarily choose pancreaticoduodenectomy, but also apply drainage if the situation calls for it. However, pancreatic injuries are often complicated by injuries of other regions of the body. Thus, diagnosis and treatment of pancreatic injury should be based on a comprehensive decision regarding early prioritization of treatment, taking hemodynamics into consideration after admission, and how to minimize complications such as anastomotic leak and pancreatic fistulas. (author)

  3. Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

    DEFF Research Database (Denmark)

    Louvard, Yves; Thomas, Martyn; Dzavik, Vladimir

    2007-01-01

    by intention to treat, it is necessary to clearly define which vessel is the distal main branch and which is (are) the side branche(s) and give each branch a distinct name. Each segment of the bifurcation has been named following the same pattern as the Medina classification. The classification......, heterogeneity, and inadequate description of techniques implemented. Methods: The aim is to propose a consensus established by the European Bifurcation Club (EBC), on the definition and classification of bifurcation lesions and treatments implemented with the purpose of allowing comparisons between techniques...... in various anatomical and clinical settings. Results: A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch. The simple lesion classification proposed by Medina has been adopted. To analyze the outcomes of different techniques...

  4. [Tardive dyskinesia--diagnosis and treatment].

    Science.gov (United States)

    Kazamatsuri, H

    1993-11-01

    Tardive dyskinesia is defined as a syndrome consisting of abnormal, stereotypical involuntary movements usually of choreoathetoid type, principally affected the mouth, face, limbs and trunk, which occurs relatively late in the course of neuroleptic drug treatment and in the etiology of which the drug treatment is a necessary factor. Presently, the prevalence of tardive dyskinesia in the hospitalized patients in psychiatric hospitals in Japan is estimated to be 20-30%. Epidemiology, possible pathophysiology and symptomatology of tardive dyskinesia are briefly described. Differential diagnosis between this syndrome and other involuntary movements such as psychotic mannerism, senile orofacial dyskinesia, rabbit's syndrome, Pisa syndrome or Meige's syndrome is discussed. Several drugs to suppress involuntary movements of tardive dyskinesia are described. However, there appears to be no consistently reliable therapies for patients who develop the tardive dyskinesia. Treatment for this syndrome, other than neuroleptic withdrawal, are still uncertain.

  5. Diagnosis and treatment of differentiated thyroid cancer (remains, recurrences and metastases) with "1"3"1I

    International Nuclear Information System (INIS)

    Sánchez, V.

    2016-01-01

    Thyroid cancer is the most common endocrine cancer. The incidence worldwide has increased exponentially at the expense of papillary type tumors. In recent years emerged the concept that a patient with low risk of mortality may have a high risk of recurrence of the disease, so the classification according to the risk of recurrence is one of the most important steps to establish what will be the probability that the patient is in remission or present structural disease tracking. The American Joint Committee on Cancer (AJCC) has designated a staging system based on the TNM classification, which allows good mortality risk stratification. It must keep track short and long term patient, being that approximately 30% of all cases have recurrencies. The use of "1"3"1I falls into one of three categories: a) ablation, b) adjuvant and c) therapeutic. The diagnostic body scan provides information on the existence of iodine avid thyroid tissue, although it is not recommended for routine, can be performed in special cases. The postoperative body scan is usually performed to visualize metastasis previously not found. Persistent disease diagnosis is made by imaging studies such as ultrasound or body scan. The preferred treatment management of metastatic distant disease (in order), is surgical excision, iodine therapy, radiotherapy, observation and experimental studies. It is noteworthy that iodine treatment has harmful effects (early and late), so it should be applied only if you will gain a clear benefit for the patient. (author) [es

  6. Lyme disease: clinical diagnosis and treatment

    Science.gov (United States)

    Hatchette, TF; Davis, I; Johnston, BL

    2014-01-01

    Background Lyme disease is an emerging zoonotic infection in Canada. As the Ixodes tick expands its range, more Canadians will be exposed to Borrelia burgdorferi, the bacterium that causes Lyme disease. Objective To review the clinical diagnosis and treatment of Lyme disease for front-line clinicians. Methods A literature search using PubMed and restricted to articles published in English between 1977 and 2014. Results Individuals in Lyme-endemic areas are at greatest risk, but not all tick bites transmit Lyme disease. The diagnosis is predominantly clinical. Patients with Lyme disease may present with early disease that is characterized by a “bull’s eye rash”, fever and myalgias or with early disseminated disease that can manifest with arthralgias, cardiac conduction abnormalities or neurologic symptoms. Late Lyme disease in North America typically manifests with oligoarticular arthritis but can present with a subacute encephalopathy. Antibiotic treatment is effective against Lyme disease and works best when given early in the infection. Prophylaxis with doxycyline may be indicated in certain circumstances. While a minority of patients may have persistent symptoms, evidence does not demonstrate that prolonged courses of antibiotics improve outcome. Conclusion Clinicians need to be aware of the signs and symptoms of Lyme disease. Knowing the regions where Borrelia infection is endemic in North America is important for recognizing patients at risk and informing the need for treatment. PMID:29769842

  7. PLATEAU IRIS--DIAGNOSIS AND TREATMENT.

    Science.gov (United States)

    Stefan, Cornel; Iliescu, Daniela Adriana; Batras, Mehdi; Timaru, Cristina Mihaela; De Simone, Algerino

    2015-01-01

    The objective of our study was to review the current knowledge on the diagnosis and treatment options of plateau iris configuration and syndrome. Relevant publications on plateau iris that were published until 2014. Plateau iris syndrome is a form of primary angle closure glaucoma caused by a large or anteriorly positioned ciliary body that leads to mechanical obstruction of trabecular meshwork. This condition is most often found in younger patients. Plateau iris has been considered an abnormal anatomic variant of the iris that can be diagnosed on ultrasound biomicroscopy or optical coherence tomography of anterior segment. Patients with plateau iris syndrome can be recognized by the lack of response in angle opening after iridotomy. The treatment of choice in these cases is argon laser peripheral iridoplasty.

  8. Describing Peripancreatic Collections According to the Revised Atlanta Classification of Acute Pancreatitis An International Interobserver Agreement Study

    NARCIS (Netherlands)

    Bouwense, Stefan A.; van Brunschot, Sandra; van Santvoort, Hjalmar C.; Besselink, Marc G.; Bollen, Thomas L.; Bakker, Olaf J.; Banks, Peter A.; Boermeester, Marja A.; Cappendijk, Vincent C.; Carter, Ross; Charnley, Richard; van Eijck, Casper H.; Freeny, Patrick C.; Hermans, John J.; Hough, David M.; Johnson, Colin D.; Laméris, Johan S.; Lerch, Markus M.; Mayerle, Julia; Mortele, Koenraad J.; Sarr, Michael G.; Stedman, Brian; Vege, Santhi Swaroop; Werner, Jens; Dijkgraaf, Marcel G.; Gooszen, Hein G.; Horvath, Karen D.; Aghdassi, Ali A.; van Enckevort, Conny C.; de Haas, Robbert J.; Horsthuis, Karin; van der Jagt, Michel F.; Kok, Niels F.; Koopmanschap, Desirée H.; Koppe, Manuel J.; Krak, Nanda C.; Lane, Charlotte E.; Lee, Jean H.; de Lussanet, Q.; Saunders, Michael D.; Swaroop Vege, Santhi; van der Vlugt, Manon; van Wageningen, Bas; Wassenaar, Eelco; van Wely, Bob J.; Wijnhoven, Bas P.

    2017-01-01

    Objectives: Severe acute pancreatitis is associated with peripancreatic morphologic changes as seen on imaging. Uniform communication regarding these morphologic findings is crucial for accurate diagnosis and treatment. For the original 1992 Atlanta classification, interobserver agreement is poor.

  9. Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic.

    Directory of Open Access Journals (Sweden)

    Champica K Bodinayake

    2018-02-01

    Full Text Available Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI. In 2009, the World Health Organization (WHO revised criteria for clinical diagnosis of dengue.The new WHO 2009 classification of dengue divides suspected cases into three categories: dengue without warning signs, dengue with warning signs and severe dengue. We evaluated the WHO 2009 classification vs physicians' subjective clinical diagnosis (gestalt clinical impression in a large cohort of patients presenting to a tertiary care center in southern Sri Lanka hospitalized with acute febrile illness. We confirmed acute dengue in 388 patients (305 adults ≥ 18 years and 83 children, including 103 primary and 245 secondary cases, of 976 patients prospectively enrolled with AFI. At presentation, both adults and children with acute dengue were more likely than those with other AFI to have leukopenia and thrombocytopenia. Additionally, adults were more likely than those with other AFI to have joint pain, higher temperatures, and absence of crackles on examination whereas children with dengue were more likely than others to have sore throat, fatigue, oliguria, and elevated hematocrit and transaminases. Similarly, presence of joint pain, thrombocytopenia, and absence of cough were independently associated with secondary vs primary dengue in adults whereas no variables were different in children. The 2009 WHO dengue classification was more sensitive than physicians' clinical diagnosis for identification of acute dengue (71.5% vs 67.1%, but was less specific. However, despite the absence of on-site diagnostic confirmation of dengue, clinical diagnosis was more sensitive on discharge (75.2%. The 2009 WHO criteria classified almost 75% as having warning signs, even though only 9 (2.3% patients had evidence of plasma leakage and 16 (4.1% had evidence of bleeding.In a large cohort with AFI, we identified features predictive of dengue vs other AFI and secondary vs primary dengue

  10. Mechanism-based classification of pain for physical therapy management in palliative care: A clinical commentary

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification-based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective are explained with recent evidence for physical therapy treatments for each of the mechanisms.

  11. Next Generation Sequencing As an Aid to Diagnosis and Treatment of an Unusual Pediatric Brain Cancer

    Directory of Open Access Journals (Sweden)

    John Glod

    2014-07-01

    Full Text Available Classification of pediatric brain tumors with unusual histologic and clinical features may be a diagnostic challenge to the pathologist. We present a case of a 12-year-old girl with a primary intracranial tumor. The tumor classification was not certain initially, and the site of origin and clinical behavior were unusual. Genomic characterization of the tumor using a Clinical Laboratory Improvement Amendment (CLIA-certified next-generation sequencing assay assisted in the diagnosis and translated into patient benefit, albeit transient. Our case argues that next generation sequencing may play a role in the pathological classification of pediatric brain cancers and guiding targeted therapy, supporting additional studies of genetically targeted therapeutics.

  12. Bipolar Disorder in Adolescence: Diagnosis and Treatment.

    Science.gov (United States)

    Wilkinson, Great Buyck; Taylor, Priscilla; Holt, Jan R.

    2002-01-01

    Due to developmental issues and overlapping symptoms with other disorders, diagnosing bipolar disorder in adolescents is often a confusing and complex process. This article highlights diagnostic criteria, symptoms and behaviors, and the differential diagnosis process. Treatment options are also discussed. (Contains 17 references.) (GCP)

  13. Definition and classification of epilepsy. Classification of epileptic seizures 2016

    Directory of Open Access Journals (Sweden)

    K. Yu. Mukhin

    2017-01-01

    Full Text Available Epilepsy is one of the most common neurological diseases, especially in childhood and adolescence. The incidence varies from 15 to 113 cases per 100 000 population with the maximum among children under 1 year old. The prevalence of epilepsy is high, ranging from 5 to 8 cases (in some regions – 10 cases per 1000 children under 15 years old. Classification of the disease has great importance for diagnosis, treatment and prognosis. The article presents a novel strategy for classification of epileptic seizures, developed in 2016. It contains a number of brand new concepts, including a very important one, saying that some seizures, previously considered as generalized or focal only, can be, in fact, both focal and generalized. They include tonic, atonic, myoclonic seizures and epileptic spasms. The term “secondarily generalized seizure” is replace by the term “bilateral tonic-clonic seizure” (as soon as it is not a separate type of epileptic seizures, and the term reflects the spread of discharge from any area of cerebral cortex and evolution of any types of focal seizures. International League Against Epilepsy recommends to abandon the term “pseudo-epileptic seizures” and replace it by the term “psychogenic non-epileptic seizures”. If a doctor is not sure that seizures have epileptic nature, the term “paroxysmal event” should be used without specifying the disease. The conception of childhood epileptic encephalopathies, developed within this novel classification project, is one of the most significant achievements, since in this case not only the seizures, but even epileptiform activity can induce severe disorders of higher mental functions. In addition to detailed description of the new strategy for classification of epileptic seizures, the article contains a comprehensive review of the existing principles of epilepsy and epileptic seizures classification.

  14. [Costs of appendicitis treatment by diagnosis-related groups in a third-level pediatric hospital].

    Science.gov (United States)

    Tlacuilo-Parra, Alberto; Hernández-Hernández, Araceli; Venegas-Dávalos, Martha; Gutiérrez-Hermosillo, Violeta; Guevara-Gutiérrez, Elizabeth; Ambriz-González, Gabriela

    2014-01-01

    Diagnosis-related groups (DRGs) are widely used in Europe. They allow performing comparisons in hospitals and incurrent hospital payment systems, defining the payment categories. We undertook this study to classify children who underwent appendectomy according to DRGs. Cross-sectional study. Comorbidities, length of hospitalization, histopathologic classification, and DRG classifications were analyzed. We included 313 patients, 62% males, with an average age of 8 ± 3 years; 91% were referred by another hospital and 67% were treated at night. Average length of hospitalization was 4 ± 3 days. There were comorbidities in 8% and surgical complications in 11%. According to histopathology, appendicitis was edematous (11%), suppurative (36%), gangrenous (22%), perforated (29%), and abscessed (2%). At discharge, 97% of the patients were healthy. Total cost for DRG 343 was $10,470,173.00 (Mexican pesos), DRG 342 was $1,227,592.00 and DRG 340 was $511,521.00. The global amount was $12,209,286.00 (Mexican pesos). The unitary cost for treatment of appendectomy for DRG 343 was $37,935.00, for DRG 342 was $49,103.00 and for DRG 340 was $42,626.00 (Mexican pesos). Because 88% of the cases of appendicitis were uncomplicated, this amount of money could be spent to treat these patients in a second-level hospital, using reimbursement 343 without generating additional expenses.

  15. Laser Raman detection of platelets for early and differential diagnosis of Alzheimer’s disease based on an adaptive Gaussian process classification algorithm

    International Nuclear Information System (INIS)

    Luo, Yusheng; Du, Z W; Yang, Y J; Chen, P; Wang, X H; Cheng, Y; Peng, J; Shen, A G; Hu, J M; Tian, Q; Shang, X L; Liu, Z C; Yao, X Q; Wang, J Z

    2013-01-01

    Early and differential diagnosis of Alzheimer’s disease (AD) has puzzled many clinicians. In this work, laser Raman spectroscopy (LRS) was developed to diagnose AD from platelet samples from AD transgenic mice and non-transgenic controls of different ages. An adaptive Gaussian process (GP) classification algorithm was used to re-establish the classification models of early AD, advanced AD and the control group with just two features and the capacity for noise reduction. Compared with the previous multilayer perceptron network method, the GP showed much better classification performance with the same feature set. Besides, spectra of platelets isolated from AD and Parkinson’s disease (PD) mice were also discriminated. Spectral data from 4 month AD (n = 39) and 12 month AD (n = 104) platelets, as well as control data (n = 135), were collected. Prospective application of the algorithm to the data set resulted in a sensitivity of 80%, a specificity of about 100% and a Matthews correlation coefficient of 0.81. Samples from PD (n = 120) platelets were also collected for differentiation from 12 month AD. The results suggest that platelet LRS detection analysis with the GP appears to be an easier and more accurate method than current ones for early and differential diagnosis of AD. (paper)

  16. Diagnosis and treatment of antisperm antibody

    Directory of Open Access Journals (Sweden)

    abolreza Kheirollahi

    2011-08-01

    There are several methods to detect ASA. In the past, the clinical interest in ASA was hampered by the fact that a standardized assay for the detection of ASA was lacking. However, it has to be clarified whether each antibody binding to an antigen, which is identified on the sperm surface, also influences sperm function. Several methods have been reported for treatment of immunoinfertility. Most of the available techniques have side effects, are invasive and expensive, have low efficacy, or provide conflicting results.This review article will help to increase our knowledge about diagnosis and treatment methods of ASA.

  17. Mialgias: Approaches to differential diagnosis, treatment

    Directory of Open Access Journals (Sweden)

    Nadezhda Aleksandrovna Shostak

    2013-01-01

    Full Text Available Differential diagnosis in muscle pains often presents great difficulties so all existing signs of the disease should be carefully considered to make its diagnosis and to prescribe adequate therapy. The paper considers the causes of muscle pains, laboratory and instrumental studies (immunological tests, determination of the level of specific muscular enzymes, primarily creatine phosphokinase – CPK, etc., and the main reasons for enhanced plasma CPK activity. It also describes acute and chronic mialgias associated with enhanced plasma CPK activity, as well as diseases in which mialgias are related to the normal level of CPK, myofascial syndrome (MFS and fibromyalgia (FM in particular. The characteristic features of MFS are given in its diagnostic criteria. It is stated that a differential diagnosis should be made between MFS and major muscle pain-associated abnormalities, such as polymyalgia rheumatica, FM, etc. Diagnosticcriteria for polymyalgia rheumatica are given. A MFS treatment algorithm is presented. Local exposure methods applied to altered musculoligamentous structures in combination with myorelaxants and non-steroidal anti-inflammatory drugs assume paramount importance in MFS.

  18. Improved Correlation of the Neuropathologic Classification According to Adapted World Health Organization Classification and Outcome After Radiotherapy in Patients With Atypical and Anaplastic Meningiomas

    International Nuclear Information System (INIS)

    Combs, Stephanie E.; Schulz-Ertner, Daniela; Debus, Jürgen; Deimling, Andreas von; Hartmann, Christian

    2011-01-01

    published data for future treatment decision-making remains difficult when the histologic diagnosis has not been based on the new improved classification system.

  19. Improved Correlation of the Neuropathologic Classification According to Adapted World Health Organization Classification and Outcome After Radiotherapy in Patients With Atypical and Anaplastic Meningiomas

    Energy Technology Data Exchange (ETDEWEB)

    Combs, Stephanie E., E-mail: Stephanie.Combs@med.uni-heidelberg.de [Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg (Germany); Schulz-Ertner, Daniela [Radiologisches Institut, Markuskrankenhaus Frankfurt, Frankfurt am Main (Germany); Debus, Juergen [Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg (Germany); Deimling, Andreas von; Hartmann, Christian [Department of Neuropathology, Institute for Pathology, University Hospital of Heidelberg, Heidelberg (Germany); Clinical Cooperation Unit Neuropathology, German Cancer Research Center, Heidelberg (Germany)

    2011-12-01

    published data for future treatment decision-making remains difficult when the histologic diagnosis has not been based on the new improved classification system.

  20. [From new genetic and histological classifications to direct treatment].

    Science.gov (United States)

    Compérat, Eva; Furudoï, Adeline; Varinot, Justine; Rioux-Leclerq, Nathalie

    2016-08-01

    The most important criterion for optimal cancer treatment is a correct classification of the tumour. During the last three years, several very important progresses have been made with a better definition of urothelial carcinoma (UC), especially from a molecular point of view. We start having a global understanding of UC, although many details are still not completely understood. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Cholecystectomy and Diagnosis-Related Groups (DRGs: Patient Classification and Hospital Reimbursement in 11 European Countries

    Directory of Open Access Journals (Sweden)

    Gerli Paat-Ahi

    2014-12-01

    Full Text Available Background As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain compared how their Diagnosis-Related Groups (DRG systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. Results European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England. The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Conclusion Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries’ DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.

  2. The Turkish Guideline for the Diagnosis and Management of Urticaria-2016

    Directory of Open Access Journals (Sweden)

    Emek Kocatürk Göncü

    2016-09-01

    Full Text Available Background and Design: Albeit an easily recognized disease, urticaria features many diverse approaches which rationalize the need for an algorithm for the diagnosis, classification, etiopathogenesis, diagnostic evaluation and therapeutic approach. Therefore, authors from Dermatoallergy Working Group of the Turkish Society of Dermatology and the Turkish Dermatoimmunology and Allergy Association aimed to create an urticaria guideline for the diagnosis, treatment and followup of urticaria. Materials and Methods: Each section of the guideline has been written by a different author. The prepared sections were evaluated in part by e-mail correspondence and have taken its final form after revision in the last meeting held by the participation of all authors. Results: The guideline includes the description, classification, pathophysiology as well as diagnosis and treatment of urticaria. Urticaria is classified into two main types: acute urticaria and chronic urticaria while chronic urticaria is further subdivided into spontaneous urticaria and inducible urticaria. The first step of treatment includes standard doses of H1-blockers. In patients who do not respond to the first step, antihistamine dose is increased up to four times; if unsuccessful, another second-generation antihistamine is given in the same dose. In antihistamine-resistant cases, introduction of omalizumab is required. Omalizumab dose may be increased in patients failing to respond to the standard dose. In patients unresponsive to omalizumab, cyclosporine-A may be given. Routine diagnostic tests are not recommended in acute urticaria. In chronic urticaria, erythrocyte sedimentation rate, differential blood count and C-reactive protein testing are the only investigations that are needed routinely. Conclusion: Chronic urticaria is a disease that can be challenging for the physician in terms of treatment and follow-up. Depending on evidence-based data (and individual experiences, this

  3. [Diagnostics and treatment of phenylketonuria].

    Science.gov (United States)

    Bayat, Allan; Møller, Libeth Birk; Lund, Allan Meldgaard

    2015-02-16

    Primary phenylalanine hydroxylase deficiency, also known as phenylketonuria, results in accumulation of phenylalanine in the blood. Early identification and treatment prevents the majority of clinical sequelae to the disease, but psychological and neurodevelopmental problems can occur in some patients. This article reviews the symptoms, diagnosis, classification and strategies of treatment and management of phenylketonuria. Finally we review new pharmacological and non-pharmaco-logical means of treatment.

  4. Plantar fascia: imaging diagnosis and guided treatment.

    Science.gov (United States)

    McNally, Eugene G; Shetty, Shilpa

    2010-09-01

    Plantar fasciopathy is a common cause of heel pain. This article covers the imaging anatomy of the hindfoot, the imaging findings on ultrasound and magnetic resonance imaging (MRI) of plantar fasciopathy, plantar fibromas, trauma, Achilles tendonopathy, neural compression, stress fractures of the os calcis and other heel pad lesions. Thickening of the plantar fascia insertion more than 5 mm either on ultrasound or MRI is suggestive of plantar fasciopathy. Ultrasound is superior to MRI for diagnosis of plantar fibroma as small low signal lesions on MRI are similar to the normal plantar fascia signal. Ultrasound demonstrates low echogenicity compared with the echogenic plantar fascia. Penetrating injuries can appear bizarre due to associated foreign body impaction and infection. Achilles tendonopathy can cause heel pain and should be considered as a possible diagnosis. Treatment options include physical therapy, ECSWT, corticosteroid injection, and dry needling. Percutaneous US guided treatment methods will be described. Thieme Medical Publishers.

  5. Chiari malformations: diagnosis, treatments and failures.

    Science.gov (United States)

    Abd-El-Barr, M M; Strong, C I; Groff, M W

    2014-12-01

    Chiari malformations refer to abnormalities of the hindbrain originally described by the Austrian pathologist Hans Chiari in the early 1890s. These malformations range from herniation of the cerebellar tonsils through the foramen magnum to complete agenesis of the cerebellum. In this review, we review the different classification schemes of Chiari malformations. We discuss the different signs and symptoms that the two most common malformations present with and diagnostic criteria. We next discuss current treatment paradigms, including the new measure of possible in utero surgery to help decrease the incidence of Chiari type II malformations. There is also a small discussion of treatment failures and salvage procedures in these difficult cases. Chiari malformations are a difficult clinical entity to treat. As more is learned about the genetic and environmental factors relating to their characteristics, it will be interesting if we are able to predict which treatments are better suited for different patients. Similarly, with the evolution of in utero techniques especially for Chiari II malformations, it will be interesting to see if the incidence and practice of treating these difficult patients will change.

  6. Exploring new strategies in diagnosis and treatment of hilar cholangiocarcinoma

    NARCIS (Netherlands)

    Mantel, Hendrik Teunis Johannes

    2016-01-01

    Hilar cholangiocarcinoma is a rare form of cancer arising at the confluence of the right and left bile duct. The disease is known for its difficult diagnosis and treatment. The chapters in this thesis describe different aspects of hilar cholangiocarcinoma with the aim to improve diagnosis and

  7. Current concepts in the classification, diagnosis and treatment of vascular anomalies

    International Nuclear Information System (INIS)

    Ernemann, Ulrike; Kramer, Ulrich; Miller, Stephan; Bisdas, Sotirios; Rebmann, Hans; Breuninger, Helmut; Zwick, Christine; Hoffmann, Juergen

    2010-01-01

    Patients with extended vascular anomalies may suffer from significant aesthetic and functional impairment and represent a challenge to therapeutic planning, which is best met by an interdisciplinary concept. In agreement with the International Society for the Study of Vascular Anomalies (ISSVA), vascular lesions are classified into haemangiomas as proliferating endothelial tumours on the one hand and congenital vascular malformations on the other. According to the preponderant vascular channels and hemodynamic characteristics, malformations are subdivided into low flow (venous, lymphatic and capillary) lesions and high-flow malformations. Diagnostic imaging should be targeted at the specific structural and functional informations required for treatment planning. The imaging modality of choice to provide these informations is magnetic resonance imaging (MRI) supplemented by magnetic resonance angiography (MRA) with high spatial and temporal resolution. Treatment indications for haemangiomas depend on the proliferative behaviour of the lesion and comprise β-blockers in order to induce involution as well as cryotherapy, laser and open surgery. Interventional radiological procedures have evolved as an essential element in an interdisciplinary treatment plan for vascular malformations and include percutaneous sclerotherapy with ethanol and OK-432 for venous and lymphatic malformations and transarterial embolization for high-flow lesions.

  8. Current concepts in the classification, diagnosis and treatment of vascular anomalies

    Energy Technology Data Exchange (ETDEWEB)

    Ernemann, Ulrike, E-mail: ulrike.ernemann@med.uni-tuebingen.d [Department of Diagnostic and Interventional Neuroradiology, Radiological Clinic, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Kramer, Ulrich; Miller, Stephan [Department of Diagnostic and Interventional Radiology, Radiological Clinic, University Hospital Tuebingen (Germany); Bisdas, Sotirios [Department of Diagnostic and Interventional Neuroradiology, Radiological Clinic, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Rebmann, Hans [Department of Paediatrics, Children' s Hospital, University Hospital Tuebingen (Germany); Breuninger, Helmut [Department of Dermatology, University Hospital Tuebingen (Germany); Zwick, Christine [Department of Hand, Plastic, Reconstructive and Burns Surgery, BG Trauma Clinic Tuebingen, University Hospital Tuebingen (Germany); Hoffmann, Juergen [Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen (Germany)

    2010-07-15

    Patients with extended vascular anomalies may suffer from significant aesthetic and functional impairment and represent a challenge to therapeutic planning, which is best met by an interdisciplinary concept. In agreement with the International Society for the Study of Vascular Anomalies (ISSVA), vascular lesions are classified into haemangiomas as proliferating endothelial tumours on the one hand and congenital vascular malformations on the other. According to the preponderant vascular channels and hemodynamic characteristics, malformations are subdivided into low flow (venous, lymphatic and capillary) lesions and high-flow malformations. Diagnostic imaging should be targeted at the specific structural and functional informations required for treatment planning. The imaging modality of choice to provide these informations is magnetic resonance imaging (MRI) supplemented by magnetic resonance angiography (MRA) with high spatial and temporal resolution. Treatment indications for haemangiomas depend on the proliferative behaviour of the lesion and comprise {beta}-blockers in order to induce involution as well as cryotherapy, laser and open surgery. Interventional radiological procedures have evolved as an essential element in an interdisciplinary treatment plan for vascular malformations and include percutaneous sclerotherapy with ethanol and OK-432 for venous and lymphatic malformations and transarterial embolization for high-flow lesions.

  9. The Challenge in Diagnosis and Current Treatment of Chronic Thromboembolic Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Anggoro Budi Hartopo

    2017-04-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is currently underdiagnosis and consequently undertreatment in the clinical practice. A deficient in diagnostic modality and treatment availability especially in developing countries makes the CTEPH diagnosis unlikely to confirm. However, high index of clinical suspicion of CTEPH will lead to proper diagnosis and correct treatment  with significant reduction in morbidity and mortality. Left untreated, the mean survival time is 6.8 years and the three year mortality rate may be as high as 90 %. The pathophysiology, diagnosis and treatment of CTEPH are necessary to be shared among internists and primary care physicians, in order to improve the overall outcome of the patients.

  10. Classification and pharmacological treatment of preschool wheezing: changes since 2008

    DEFF Research Database (Denmark)

    Brand, P. L. P.; Caudri, D.; Eber, E.

    2014-01-01

    Since the publication of the European Respiratory Society Task Force report in 2008, significant new evidence has become available on the classification and management of preschool wheezing disorders. In this report, an international consensus group reviews this new evidence and proposes some......, with scheduled close follow-up to monitor treatment effect. The group recommends discontinuing treatment if there is no benefit and taking favourable natural history into account when making decisions about long-term therapy. Oral corticosteroids are not indicated in mild-to-moderate acute wheeze episodes...

  11. Oral lichen planus: A look from diagnosis to treatment.

    Directory of Open Access Journals (Sweden)

    Pablo Córdova

    2014-03-01

    Full Text Available Oral lichen planus (OLP is a chronic mucocutaneous disease of unknown etiology. Its pathogenesis is multifactorial and it may affect the oral mucosa, skin and other mucous membranes. Diagnosis is based on clinic and histopathology; direct immunofluorescence techniques can also be of use. It affects about one to two percent of the population, mainly women between the fifth and sixth decades of life. In the mouth, the most affected area is the buccal mucosa, followed by the gums, tongue and/or palate. Its three most representative clinical forms are reticular, erythematous and erosive; evolution depends on the type it is. Lesion treatment is determined by the clinical form and, since no fully effective treatment has been found yet, it is directed towards controlling the disease. The treatment of choice involves topical or systemic corticosteroids, but other drugs may also be used.The aim of this paper is to gather current and relevant information about oral lichen planus: its pathogenesis, diagnosis, treatment and management.

  12. Prediction of Infertility Treatment Outcomes Using Classification Trees

    Directory of Open Access Journals (Sweden)

    Milewska Anna Justyna

    2016-12-01

    Full Text Available Infertility is currently a common problem with causes that are often unexplained, which complicates treatment. In many cases, the use of ART methods provides the only possibility of getting pregnant. Analysis of this type of data is very complex. More and more often, data mining methods or artificial intelligence techniques are appropriate for solving such problems. In this study, classification trees were used for analysis. This resulted in obtaining a group of patients characterized most likely to get pregnant while using in vitro fertilization.

  13. In vivo subsite classification and diagnosis of oral cancers using Raman spectroscopy

    Directory of Open Access Journals (Sweden)

    Aditi Sahu

    2016-09-01

    Full Text Available Oral cancers suffer from poor disease-free survival rates due to delayed diagnosis. Noninvasive, rapid, objective approaches as adjuncts to visual inspection can help in better management of oral cancers. Raman spectroscopy (RS has shown potential in identification of oral premalignant and malignant conditions and also in the detection of early cancer changes like cancer-field-effects (CFE at buccal mucosa subsite. Anatomic differences between different oral subsites have also been reported using RS. In this study, anatomical differences between subsites and their possible influence on healthy vs pathological classification were evaluated on 85 oral cancer and 72 healthy subjects. Spectra were acquired from buccal mucosa, lip and tongue in healthy, contralateral (internal healthy control, premalignant and cancer conditions using fiber-optic Raman spectrometer. Mean spectra indicate predominance of lipids in healthy buccal mucosa, contribution of both lipids and proteins in lip while major dominance of protein in tongue spectra. From healthy to tumor, changes in protein secondary-structure, DNA and heme-related features were observed. Principal component linear discriminant analysis (PC-LDA followed by leave-one-out-cross-validation (LOOCV was used for data analysis. Findings indicate buccal mucosa and tongue are distinct entities, while lip misclassifies with both these subsites. Additionally, the diagnostic algorithm for individual subsites gave improved classification efficiencies with respect to the pooled subsites model. However, as the pooled subsites model yielded 98% specificity and 100% sensitivity, this model may be more useful for preliminary screening applications. Large-scale validation studies are a pre-requisite before envisaging future clinical applications.

  14. An integrated treatment model for dual diagnosis of psychosis and addiction.

    Science.gov (United States)

    Minkoff, K

    1989-10-01

    A model that integrates the treatment of patients with a dual diagnosis of psychosis and addiction has been developed on a general hospital psychiatric unit. The model emphasizes the parallels between the standard biopsychosocial illness-and-rehabilitation model for treatment of serious psychiatric disorders and the 12-step disease-and-recovery model of Alcoholics Anonymous for treatment of addiction. Dual-diagnosis patients are viewed as having two primary, chronic, biologic mental illnesses, each requiring specific treatment to stabilize acute symptoms and engage the patient in a recovery process. An integrated treatment program is described, as are the steps taken to alleviate psychiatric clinicians' concerns about patient involvement in AA and addiction clinicians' discomfort with patients' use of medication.

  15. Pre-optimization of radiotherapy treatment planning: an artificial neural network classification aided technique

    International Nuclear Information System (INIS)

    Hosseini-Ashrafi, M.E.; Bagherebadian, H.; Yahaqi, E.

    1999-01-01

    A method has been developed which, by using the geometric information from treatment sample cases, selects from a given data set an initial treatment plan as a step for treatment plan optimization. The method uses an artificial neural network (ANN) classification technique to select a best matching plan from the 'optimized' ANN database. Separate back-propagation ANN classifiers were trained using 50, 60 and 77 examples for three groups of treatment case classes (up to 21 examples from each class were used). The performance of the classifiers in selecting the correct treatment class was tested using the leave-one-out method; the networks were optimized with respect their architecture. For the three groups used in this study, successful classification fractions of 0.83, 0.98 and 0.93 were achieved by the optimized ANN classifiers. The automated response of the ANN may be used to arrive at a pre-plan where many treatment parameters may be identified and therefore a significant reduction in the steps required to arrive at the optimum plan may be achieved. Treatment planning 'experience' and also results from lengthy calculations may be used for training the ANN. (author)

  16. Hepatorenal Syndrome: Aetiology, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    G. Low

    2015-01-01

    Full Text Available Acute renal impairment is common in patients with chronic liver disease, occurring in approximately 19% of hospitalised patients with cirrhosis. A variety of types of renal impairment are recognised. The most important of these is the hepatorenal syndrome, a functional renal impairment due to circulatory and neurohormonal abnormalities that underpin cirrhosis. It is one of the most severe complications of cirrhosis with survival often measured in weeks to months. A variety of treatment options exist with early diagnosis and appropriate treatment providing the best hope for cure. This paper provides a comprehensive and up-to-date review of hepatorenal syndrome and lays out the topic according to the following sections: pathophysiology, historical developments, diagnostic criteria and limitations, epidemiology, precipitating factors, predictors, clinical and laboratory findings, prognosis, treatment options, prophylaxis, and conclusion.

  17. Diagnosis and Management of Systemic Sclerosis: A Practical Approach.

    Science.gov (United States)

    Lee, Jason J; Pope, Janet E

    2016-02-01

    Systemic sclerosis is a devastating multisystem rheumatologic condition that is characterized by autoimmunity, tissue fibrosis, obliterative vasculopathy and inflammation. Clinical presentation and course of the condition vary greatly, which complicates both diagnosis and corresponding treatment. In this regard, recent advances in disease understanding, both clinically and biochemically, have led to newer classification criteria for systemic sclerosis that are more inclusive than ever before. Still, significant disease modifying therapies do not yet exist for most patients. Therefore, organ-based management strategies are employed and research has been directed within this paradigm focusing on either the most debilitating symptoms, such as Raynaud's phenomenon, digital ulcers and cutaneous sclerosis, or life-threatening organ involvement such as interstitial lung disease and pulmonary arterial hypertension. The current trends in systemic sclerosis diagnosis, evidence-based treatment recommendations and potential future directions in systemic sclerosis treatment are discussed.

  18. Legionella (Legionnaires' Disease and Pontiac Fever): Treatment and Complications

    Science.gov (United States)

    ... and Trends Fast Facts For Clinicians Disease Specifics Clinical Features Diagnosis, Treatment, & Prevention For Health Departments Surveillance & Reporting Resources Case Definitions CDC Surveillance Classifications How to Report Cases Case ...

  19. [Joint Prosthetic Infection: UpDate Approaches to Diagnosis and Treatment].

    Science.gov (United States)

    Belov, B S; Makarov, S A; Byalik, E I

    2015-01-01

    At present endoprosthetics of the joints is considered as a progressive and ever developing method in the surgical treatment of patients with affection of the locomotor system of any genesis. Hence, increasing of the number of endoprosthetic results in increasing of the number of patients with periprosthetic infection. Polymorphism of the clinical picture and inspecificity of the diagnostic tests often cause a delay in the diagnosis of the joint prosthetic infection (JPI) and consequently the late treatment. The contemporary data on the etiology, epidemiology, clinical picture and diagnosis of JPI are presented. The importance of cooperated treatment of JPI, i.e. combination of the surgical management and etiotropic antibacterial therapy is indicated. The choice of the concrete treatment method is defined by the patient state, comorbid pathology, the infection severity and duration.

  20. [The diagnosis and treatment of myxedema coma].

    Science.gov (United States)

    Aoki, Chie; Kasai, Kikuo

    2012-11-01

    Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to dysfunction in multiple organs. It is very rare disease with high mortality rate. Early recognition and therapy of myxedema coma are essential, and treatment should be begun on the basis of clinical suspection. However, regimen of myxedema is not well established even now, especially about thyroid hormone supplementation. Japan Thyroid Association is drawing up "The diagnostic criteria of myxedema coma (3rd draft) and preliminary guide to treatment of it". According to this criteria and preliminary guide, the clinical presentation, diagnosis, and treatment of myxedema coma will be reviewed here.

  1. Part 1: diagnosis and monitoring

    Directory of Open Access Journals (Sweden)

    Dorota Krasowska

    2017-11-01

    Full Text Available Systemic sclerosis is an immune-mediated disease characterized by a chronic and progressive course. It often leads to multiorgan failure and patient disability, and contributes to significant reduction in the quality of life. Systemic sclerosis affects the skin, subcutaneous tissue, muscles, osteoarticular system and internal organs. The complexity and diversity of clinical presentations require an individual approach and multidisciplinary collaboration both at the stage of diagnosis and treatment. Critical factors in systemic sclerosis include early diagnosis, assessment of internal organ involvement, identification of patients at potential risk of organ complications, assessment of disease dynamics and activity, and implementation of optimal therapy. Part 1 presents current recommendations for the diagnostics and monitoring of patients with systemic sclerosis. Attention is given to classification criteria, clinical forms of systemic sclerosis, assessment of skin thickness and systemic sclerosis microangiopathy, significance of antinuclear antibodies, diagnosis of interstitial lung disease and pulmonary arterial hypertension, renal crisis and cardiac abnormalities, and evaluation of the gastrointestinal tract and osteoarticular and muscular systems.

  2. Clinical Diagnosis of Dental Caries in the 21st Century: Introductory Paper - ORCA Saturday Afternoon Symposium, 2016.

    Science.gov (United States)

    Machiulskiene, Vita; Carvalho, Joana Christina

    2018-03-05

    Classifications employed to measure dental caries should first of all reflect the dynamics of the disease, in order to provide a solid basis for subsequent treatment decisions and for further monitoring of dental health of individual patients and populations. The contemporary philosophy of dental caries management implies that nonoperative treatment of caries lesions should be implemented whenever possible, limiting operative interventions to the severe and irreversible cases. The ORCA Saturday Afternoon Symposium 2016, held back-to-back to the 63rd ORCA Congress in Athens, Greece, was intended to provide an update on general requirements for clinical caries diagnosis and to overview caries diagnostic classifications including their rationale, validation, advantages, and limitations. Clinical caries diagnostic criteria and caries management outcomes are interrelated, and any diagnostic classification disregarding this concept is outdated, according to the current understanding of oral health care. Choosing clinical caries diagnostic classifications that assess the activity status of detected lesions should be a priority for dental professionals since these classifications favor the best clinical practice directed towards nonoperative interventions. The choice of clinical caries diagnostic classifications in research, in clinical practice, and in public health services should be guided by the best available scientific evidence. The clinical caries diagnostic classifications should be universally applicable in all these fields. Policy making in oral health care and the underlying policy analyses should follow the same standards. Any clinical caries diagnostic classification disregarding the universality of its use is of limited or no interest in the context of the clinical caries diagnosis of today. © 2018 S. Karger AG, Basel.

  3. Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia.

    Science.gov (United States)

    Claessens, Yann-Erick; Debray, Marie-Pierre; Tubach, Florence; Brun, Anne-Laure; Rammaert, Blandine; Hausfater, Pierre; Naccache, Jean-Marc; Ray, Patrick; Choquet, Christophe; Carette, Marie-France; Mayaud, Charles; Leport, Catherine; Duval, Xavier

    2015-10-15

    Clinical decision making relative to community-acquired pneumonia (CAP) diagnosis is difficult. Chest radiograph is key in establishing parenchymal lung involvement. However, radiologic performance may lead to misdiagnosis, rendering questionable the use of chest computed tomography (CT) scan in patients with clinically suspected CAP. To assess whether early multidetector chest CT scan affects diagnosis and management of patients visiting the emergency department with suspected CAP. A total of 319 prospectively enrolled patients with clinically suspected CAP underwent multidetector chest CT scan within 4 hours. CAP diagnosis probability (definite, probable, possible, or excluded) and therapeutic plans (antibiotic initiation/discontinuation, hospitalization/discharge) were established by emergency physicians before and after CT scan results. The adjudication committee established the final CAP classification on Day 28. Chest radiograph revealed a parenchymal infiltrate in 188 patients. CAP was initially classified as definite in 143 patients (44.8%), probable or possible in 172 (53.8%), and excluded in 4 (1.2%). CT scan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest radiograph and excluded CAP in 56 (29.8%) of the 188 with parenchymal infiltrate on radiograph. CT scan modified classification in 187 (58.6%; 95% confidence interval, 53.2-64.0), leading to 50.8% definite CAP and 28.8% excluded CAP, and 80% of modifications were in accordance with adjudication committee classification. Because of CT scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalization was decided in 22 and discharge in 23. In CAP-suspected patients visiting the emergency unit, early CT scan findings complementary to chest radiograph markedly affect both diagnosis and clinical management. Clinical trial registered with www.clinicaltrials.gov (NCT 01574066).

  4. Costs of providing tuberculosis diagnosis and treatment services in Viet Nam.

    Science.gov (United States)

    Minh, H V; Mai, V Q; Nhung, N V; Hoi, L V; Giang, K B; Chung, L H; Kien, V D; Duyen, N T; Ngoc, N B; Anh, T T; Phuong, T B; Ngan, T T; Khanh, P H

    2017-09-01

    To estimate the cost of providing tuberculosis (TB) diagnosis and treatment packages at different levels of health facilities in Viet Nam. This was a retrospective costing study from the providers' perspective using a standard costing approach. We included typical services for TB diagnosis and treatment based on standard protocols. The least expensive TB service was the 6-month isoniazid preventive therapy regimen for latent tuberculous infection provided by district health centres (US$7.20-14.30, accounting for 0.3-0.7% of Viet Nam's per capita gross domestic product [GDP] of US$2052.30 in 2014). The cost of diagnosing and treating a patient with drug-susceptible TB (the most common type of TB) ranged between US$51.20 and US$180.70, and represented 2.5-8.8% of Viet Nam's per capita GDP in 2014. The most expensive TB service was the diagnosis and treatment of a multidrug-resistant TB case (US$1568.20-2391.20), accounting for 76.4-116.5% of Viet Nam's per capita GDP in 2014). The cost of TB diagnosis and treatment services in Viet Nam varied according to level of health facility, type of TB, different costing options, and different staff cost scenarios.

  5. Advancements in diagnosis and treatment of meningeal carcinomatosis in solid cancer

    Institute of Scientific and Technical Information of China (English)

    Jun-Zhao Cui; Ze-Yan Zhao; Yuan-Yuan Li; Ming-Ming Zheng; Ya-Juan Liu; Li-Tian Yan; Jun-Ying He; Qing Li; Xiao-Qing Li; Rui-Ping Gao; Hui Bu; Yue-Li Zou; Xiao-Su Guo; Wei-Xin Han

    2017-01-01

    Meningeal carcinomatosis (MC) is a disease that malignant tumor cells cultivate in the cerebrospinal fluid or meninges. With the development of therapy methods and new techniques, survival time of patients with tumor is prolonged, and the incidence of MC is increasing. Diagnosis is based on the evaluation of clinical manifestations, cerebrospinal fluid and neuroimaging findings. Furthermore, in recent years, the diagnostic value of the tumor-derived cell-free DNA in the cerebrospinal fluid (CSF) is promising and may improve the diagnostic yield of CSF analysis. Traditional treatments of MC include surgery, radiation therapy, systemic therapy, and intrathecal therapy. Recently, molecular targeted therapy and immunotherapy have received more and more attention. The authors review the epidemiology, pathogenesis, clinical manifestation, diagnosis and treatment of MC in solid cancer, and discuss the diagnosis and treatment options currently available as well as those under investigation.

  6. Halitosis--a common medical and social problem. A review on pathology, diagnosis and treatment.

    Science.gov (United States)

    Zalewska, A; Zatoński, M; Jabłonka-Strom, A; Paradowska, A; Kawala, B; Litwin, A

    2012-09-01

    Bad breath is a condition that has health and social implications. This paper provides a comprehensive review of the classification of halitosis, it's etiology, it's prevalence, diagnosis and treatment strategies for the condition. Halitosis is affecting about 25-30% of world's population. It includes categories of genuine halitosis, pseudo-halitosis and halitophobia. It is believed that in 80-90% of cases halitosis origins in the oral cavity and the most common causes are: gingival pathologies, caries and poor oral hygiene. Extraoral sources of halitosis are responsible for 10-20% of all cases and are caused by poor diet, alcohol abuse, tobacco smoking, certain drugs and diseases of other parts of digestive tract as well as some systemic conditions. Diagnostics of halitosis includes subjective methods (examiner's sense of smell) and objective methods (instrumental analysis). Simple, subjective examination is considered a "golden standard" in clinical practice. In case of pathological halitosis identifying the direct cause of halitosis is essential. After excluding, or after successful treatment, of all oral pathologies, in case of remaining fetor ex ore identification and treatment of halitosis often requires multidisciplinary approach. Many unknowns remain in causes and mechanisms of halitosis. It can significantly impair quality of life, social interactions, lead directly to depression,low self-esteem or other mood disorders, therefore it is important to properly identify, treat and continue research on halitosis.

  7. Patient casemix classification for medicare psychiatric prospective payment.

    Science.gov (United States)

    Drozd, Edward M; Cromwell, Jerry; Gage, Barbara; Maier, Jan; Greenwald, Leslie M; Goldman, Howard H

    2006-04-01

    For a proposed Medicare prospective payment system for inpatient psychiatric facility treatment, the authors developed a casemix classification to capture differences in patients' real daily resource use. Primary data on patient characteristics and daily time spent in various activities were collected in a survey of 696 patients from 40 inpatient psychiatric facilities. Survey data were combined with Medicare claims data to estimate intensity-adjusted daily cost. Classification and Regression Trees (CART) analysis of average daily routine and ancillary costs yielded several hierarchical classification groupings. Regression analysis was used to control for facility and day-of-stay effects in order to compare hierarchical models with models based on the recently proposed payment system of the Centers for Medicare & Medicaid Services. CART analysis identified a small set of patient characteristics strongly associated with higher daily costs, including age, psychiatric diagnosis, deficits in daily living activities, and detox or ECT use. A parsimonious, 16-group, fully interactive model that used five major DSM-IV categories and stratified by age, illness severity, deficits in daily living activities, dangerousness, and use of ECT explained 40% (out of a possible 76%) of daily cost variation not attributable to idiosyncratic daily changes within patients. A noninteractive model based on diagnosis-related groups, age, and medical comorbidity had explanatory power of only 32%. A regression model with 16 casemix groups restricted to using "appropriate" payment variables (i.e., those with clinical face validity and low administrative burden that are easily validated and provide proper care incentives) produced more efficient and equitable payments than did a noninteractive system based on diagnosis-related groups.

  8. Laboratory testing improves diagnosis and treatment outcomes in primary health care facilities

    Directory of Open Access Journals (Sweden)

    Jane Y. Carter

    2012-10-01

    Setting: Six rural health centres in Kenya. Design: Cross-sectional study to observe change in diagnosis and treatment made by clinical officers after laboratory testing in outpatients attending six rural health centres in Kenya. Subject: The diagnosis and treatment of 1134 patients attending outpatient services in six rural health centres were compared before and after basic laboratory testing. Essential clinical diagnostic equipment and laboratory tests were established at each health centre. Clinical officers and laboratory technicians received on-site refresher training in good diagnostic practices and laboratory procedures before the study began. Results: Laboratory tests were ordered on 704 (62.1% patients. Diagnosis and treatment were changed in 45% of tested patients who returned with laboratory results (21% of all patients attending the clinics. 166 (23.5% patients did not return to the clinician for a final diagnosis and management decision after laboratory testing. Blood slide examination for malaria parasites, wet preparations, urine microscopy and stool microscopy resulted in most changes to diagnosis. There was no significant change in drug costs after laboratory testing. The greatest changes in numbers of recorded diseases following laboratory testing was for intestinal worms (53% and malaria (21%. Conclusion: Effective use of basic laboratory tests at primary health care level significantly improves diagnosis and patient treatment. Use of laboratory testing can be readily incorporated into routine clinical practice. On-site refresher training is an effective means of improving the quality of patient care and communication between clinical and laboratory staff.

  9. Understanding about the classification of pulp inflammation

    Directory of Open Access Journals (Sweden)

    Trijoedani Widodo

    2007-03-01

    Full Text Available Since most authors use the reversible pulpitis and irreversible pulpitis classification, however, many dentists still do not implement these new classifications. Research was made using a descriptive method by proposing questionnaire to dentists from various dental clinics. The numbers of the dentists participating in this research are 22 dentists. All respondents use the diagnosis sheet during their examinations on patients. Nonetheless, it can't be known what diagnosis card used and most of the dentists are still using the old classification. Concerning responses given towards the new classification: a the new classification had been heard, however, it was not clear (36.3%; b the new classification has never been heard at all (63.6%. Then, responses concerning whether a new development is important to be followed-up or not: a there are those who think that information concerning new development is very important (27.2%; b those who feel that it is important to have new information (68.3%; c those who think that new information is not important (8%. It concluded that information concerning the development of classification of pulp inflammation did not reach the dentists.

  10. Automated morphological analysis of bone marrow cells in microscopic images for diagnosis of leukemia: nucleus-plasma separation and cell classification using a hierarchical tree model of hematopoesis

    Science.gov (United States)

    Krappe, Sebastian; Wittenberg, Thomas; Haferlach, Torsten; Münzenmayer, Christian

    2016-03-01

    The morphological differentiation of bone marrow is fundamental for the diagnosis of leukemia. Currently, the counting and classification of the different types of bone marrow cells is done manually under the use of bright field microscopy. This is a time-consuming, subjective, tedious and error-prone process. Furthermore, repeated examinations of a slide may yield intra- and inter-observer variances. For that reason a computer assisted diagnosis system for bone marrow differentiation is pursued. In this work we focus (a) on a new method for the separation of nucleus and plasma parts and (b) on a knowledge-based hierarchical tree classifier for the differentiation of bone marrow cells in 16 different classes. Classification trees are easily interpretable and understandable and provide a classification together with an explanation. Using classification trees, expert knowledge (i.e. knowledge about similar classes and cell lines in the tree model of hematopoiesis) is integrated in the structure of the tree. The proposed segmentation method is evaluated with more than 10,000 manually segmented cells. For the evaluation of the proposed hierarchical classifier more than 140,000 automatically segmented bone marrow cells are used. Future automated solutions for the morphological analysis of bone marrow smears could potentially apply such an approach for the pre-classification of bone marrow cells and thereby shortening the examination time.

  11. Assessment, Diagnosis, and Treatment of Binge Eating Disorder.

    Science.gov (United States)

    Ambrogne, Janet A

    2017-08-01

    Binge eating disorder (BED) is the most prevalent eating disorder in the United States, believed to affect an estimated 2.8 million adults. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, BED was recognized as a separate diagnosis. The purpose of the current article is to provide an overview of BED including assessment, diagnosis, and current pharmacological and nonpharmacological treatment options. Implications for nursing are also addressed. [Journal of Psychosocial Nursing and Mental Health Services, 55(8), 32-38.]. Copyright 2017, SLACK Incorporated.

  12. CLINIC, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF GALACTOSEMIA

    Directory of Open Access Journals (Sweden)

    N.V. Zhurkova

    2008-01-01

    Full Text Available The data of different firms of hereditary galactosemia was analyzed in this article. Clinical and biochemical characteristics and molecular and genetic features of diagnostics of this disease were described. The information about differential diagnosis and problems, related with hereditary galactozemia screening in Russia was given.Key words: children, galactosemia, treatment, screening.

  13. Diagnosis and treatment of radiation-induced burns

    International Nuclear Information System (INIS)

    Portas, Mercedes; Pomerane, Armando; Genovese, Jorge; Perez, Maria R.; Gisone, Pablo

    2002-01-01

    The utilization of radioactive sources in medicine, industry and research is associated with a probability of accidental overexposures to ionizing radiation, among which localized irradiation are the most frequent events. Moreover, between 5 and 8 % of the patients undergoing therapeutical irradiations could exhibit a higher individual radiosensitivity which could account for severe skin reactions. Localized overexposures may damage not only epidermis and dermis but also deeper connective tissue, vessels, muscles and even bones. Within the framework of a cooperation agreement between the Buenos Aires Burn Hospital and the National Board of Nuclear Regulation, a Radio pathology Committee has been established in 1997 with the purpose of carrying out a collaborative project concerning diagnosis and treatment of radiological burns. The present document particularly considers radiological burns form the point of view of their physiopathology, physical and biological dosimetry, diagnosis prognosis and treatment. It also includes basic concepts of radiation biology and radio pathology. It could be an useful tool for training medical practitioners and also a practical guidance for organizing medical response in accidental overexposures. (author)

  14. [Experience of diagnosis and treatment of exogenous high-grade fever].

    Science.gov (United States)

    Xiong, Xing-jiang; Wang, Jie

    2011-06-01

    There is a regular pattern in the diagnosis and treatment of exogenous high-grade fever, of which the key point is formula syndrome identification. Syndrome differentiation of the six channels is appropriate for not only exogenous cold but also various other conditions. The diagnosis and treatment of high-grade fever can also follow the law of syndrome differentiation of the six channels. The theory of epidemic febrile diseases stems from and elaborates on an understanding of exogenous febrile conditions, so many effective formulas used to treat epidemic febrile diseases also have great value in the treatment of high-grade fever. Deteriorated syndrome, which is central to this condition, is very commonly seen in cases of high-grade fever, the key therapeutic principle of which is established according to syndromes. Allowing analysis that does not rigidly adhere to either established modern diagnosis or traditional Chinese syndromes, prominent achievements could be made in treating high-grade fever by summarizing the regular presenting patterns in terms of the constitution and symptoms.

  15. Osteoid Osteoma Mimicking Triangular Fibrocartilage Complex Injury: Diagnosis and Review of Treatment

    Directory of Open Access Journals (Sweden)

    J. M. Lamo-Espinosa

    2012-01-01

    Full Text Available We report the case of osteoid osteoma (OO with ulnar styloid involvement. A review of the literature has been made with the aim of defining the special behaviour of OO when it is near the articular surface. That behaviour can affect the diagnosis, masking the real etiology of the pain, delaying the diagnosis, missing the diagnosis, or what is more serious, conducting an inadequate treatment. We propose a treatment algorithm conducted based on the localization near or far from articular surface and the superficial or deep localization.

  16. Diagnosis and treatment of chronic thromboembolic pulmonary hypertension in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Charles Marinus; Mellemkjær, Søren; Nielsen-Kudsk, Jens Erik

    2016-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is an important differential diagnosis in patients with unexplained dyspnoea. CTEPH is under-recognized and carries a poor prognosis without treatment. Surgical pulmonary endarterectomy is the preferred treatment for the majority of patients...

  17. DIAGNOSIS AND TREATMENT OF CHILDREN ECHINOCOCCOSIS

    Directory of Open Access Journals (Sweden)

    Veliyeva T.A.

    2015-05-01

    Full Text Available The problem of echinococcosis, despite the progress made in its diagnosis and treatment, currently remains poorly understood and highly relevant in pediatric Parasitology. Studies of many authors show that in recent years the number of patients with echinococcosis not only universally recognized endemic foci, but also among people in the European region, including in countries such as Romania, Germany, Austria. However, studies on the prevalence and structure of echinococcosis among children in Ukraine, are not held. Despite the large number of papers devoted to the treatment of echinococcosis, the problem of the treatment of this disease in children is still far from its final decision. Usually offered surgical treatment, which is not possible with multiple lesions of the liver or other organs. All this shows the relevance and importance for practical public health issues for further study of diagnosis and treatment of echinococcosis in children. The purpose of the study. A comparative analysis of the diagnostic efficacy of X-ray and ultrasound method in the diagnosis of echinococcosis in children. Material & methods. This work is based on a survey of 39 children with hepatic echinococcosis, were examined at the Department of Medical Parasitology and Tropical Diseases Kharkiv Medical Academy of Postgraduate Education from 2005 to 2015. Boys was 1.5 times greater (59.5% than girls - 40.5%. Children under five years of age accounted for only 4.0% of all patients, due to their limited contact with the environment when compared with older age. The greatest risk of disease was in the 10- 13 years of age, the number of children in the group reached 40.3% of the patients. The vast majority of patients (89.6% lived in rural areas. In this case, the parents of sick children from the village were engaged in farming, were in personal use livestock, dogs, which probably contributed to the invasion. Very often ill children pas¬tuhov, shepherds. 78% of

  18. Diagnosis and treatment of radiation injuries

    International Nuclear Information System (INIS)

    Dalci, D.; Doerter, G.; Gueclue, I.

    2005-01-01

    This publication is the translation of IAEA Safety Reports Series No.2 ,Diagnosis and Treatment of Radiation Injuries. This report is directed at medical professionals who may be involved in the management of radiation injuries starting from the first few hours or days after an exposure of undefined severity. The principal aim of this publication is to provide guidelines to enable medical professionals to carry out prompt diagnostic measure and to offer emergency treatment. This report provides information in tabulated form on clinical criteria for dose assesment. Additionally, it discusses the appropriate dose-effect relationship in cases of external radiation involving either total body or local exposures, as well as internal contamination

  19. Acute Kidney Injury: Epidemiology, Diagnosis, Prognosis, and Future Directions

    Directory of Open Access Journals (Sweden)

    Joana Briosa Neves

    2015-07-01

    Full Text Available Acute kidney injury (AKI is a common problem highly associated with hospitalisation. AKI is the cause of harmful short-term consequences: longer hospital stays, greater disability after discharge, and greater risk of in-hospital mortality, as well as adverse long-term outcomes, such as progression to chronic kidney disease, development of cardiovascular disease, and increased risk of long-term mortality. The concept of AKI has changed since the introduction of the ‘Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease’ (RIFLE classification. More recently, the ‘Kidney Disease Improving Global Outcomes’ (KDIGO classification appears to have provided increased diagnostic sensitivity and outcome-prediction capability. Novel biomarkers and further research on the role of the immune system in AKI may help improve the diagnosis, severity, outcome evaluation, and treatment of the condition. In this review we describe the epidemiology, diagnosis, and prognosis of AKI, as well as possible future directions for its clinical management.

  20. The Brazilian consensus for the diagnosis and treatment of hyperthyroidism: recommendations by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism.

    Science.gov (United States)

    Maia, Ana Luiza; Scheffel, Rafael S; Meyer, Erika Laurini Souza; Mazeto, Glaucia M F S; Carvalho, Gisah Amaral de; Graf, Hans; Vaisman, Mario; Maciel, Lea M Z; Ramos, Helton E; Tincani, Alfio José; Andrada, Nathalia Carvalho de; Ward, Laura S

    2013-04-01

    Hyperthyroidism is characterized by increased synthesis and release of thyroid hormones by the thyroid gland. Thyrotoxicosis refers to the clinical syndrome resulting from excessive circulating thyroid hormones, secondary to hyperthyroidism or due to other causes. This article describes evidence-based guidelines for the clinical management of thyrotoxicosis. This consensus, developed by Brazilian experts and sponsored by the Department of Thyroid Brazilian Society of Endocrinology and Metabolism, aims to address the management, diagnosis and treatment of patients with thyrotoxicosis, according to the most recent evidence from the literature and appropriate for the clinical reality of Brazil. After structuring clinical questions, search for evidence was made available in the literature, initially in the database MedLine, PubMed and Embase databases and subsequently in SciELO - Lilacs. The strength of evidence was evaluated by Oxford classification system was established from the study design used, considering the best available evidence for each question. We have defined 13 questions about the initial clinical approach for the diagnosis and treatment that resulted in 53 recommendations, including the etiology, treatment with antithyroid drugs, radioactive iodine and surgery. We also addressed hyperthyroidism in children, teenagers or pregnant patients, and management of hyperthyroidism in patients with Graves' ophthalmopathy and various other causes of thyrotoxicosis. The clinical diagnosis of hyperthyroidism usually offers no difficulty and should be made with measurements of serum TSH and thyroid hormones. The treatment can be performed with antithyroid drugs, surgery or administration of radioactive iodine according to the etiology of thyrotoxicosis, local availability of methods and preferences of the attending physician and patient.

  1. SARCOPENIA: DIAGNOSIS, STAGES AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Pasca Luminita Aurelia

    2015-02-01

    Full Text Available Sarcopenia is defined as the age-related loss of skeletal muscle mass and decline of function. The causes of sarcopenia are multi-factorial. The diagnosis of sarcopenia should be considered in all older patients who present with declines in physical function, because of potential consequences for the development of frailty and disability. There are numerous techniques to assess muscle mass, muscle strength and physical performance. Treatment consists of nutritional (macro- and micronutrients and physical activity (resistance exercise regimens adapted to person. There is an emerging role for testosterone and anabolic steroids in severe sarcopenia.

  2. Future strategies in the diagnosis, staging and treatment of bladder cancer.

    NARCIS (Netherlands)

    Heijden, A.G. van der; Witjes, J.A.

    2003-01-01

    PURPOSE OF REVIEW: In this review new modalities in the diagnosis, staging and treatment of superficial and invasive bladder cancer are reviewed. RECENT FINDINGS: Urinary markers still cannot replace cystoscopy in diagnosing bladder cancer. However, DNA micro-array has shown promise for diagnosis.

  3. Lived experiences of breast cancer survivors after diagnosis, treatment and beyond: qualitative study.

    Science.gov (United States)

    Williams, Faustine; Jeanetta, Stephen C

    2016-06-01

    The number of breast cancer survivors has increased since 1990 due to advances in biomedical technology that lead to an increase in early diagnosis and treatment. Research on survivorship has focused on the psychological and treatment aspects of the disease. The goal of this study was focused on exploring the lived experiences of breast cancer survivors from diagnosis, treatment and beyond. To understand the lived experiences of women who are breast cancer survivors. A purposive sampling strategy was used to recruit participants from two Missouri cancer centres. A total of 15 women breast cancer survivors were interviewed. Three major themes emerged that described the lived experiences of the women. These were factors from the diagnosis and treatment management impacting survivorship, relationship and support system and implication of survivorship. Participants noted that coping with the diagnosis and treatment was a stressful journey and required lots of adjustment and changes. Some developed various techniques such as journaling their activities which provided comfort. In addition, support from family was shared as the key which gave them strength and courage through the different stages of treatment. However, they found it difficult to articulate what survivorship meant. Using in-depth interview techniques, this study shed light on the experiences of women who were diagnosed with breast cancer and have completed treatment. They acknowledged frustration with their diagnosis and body changes. Support received from family and friends helped them cope through their treatment. However, they felt abandoned once the treatment phase was over and were uncertain what survivorhood meant to them. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  4. AD/HD: POSSIBLE DIAGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Karl REICHELT

    2008-12-01

    Full Text Available The purpose of this paper is to show that a more exact diagnosis and dietary intervention in AD/HD (Attention Deficit/Hyperactivity Di­sor­der is possible and probable. The clinical symptom based diagnosis we suggest may be supplemented with physiological tests. A ge­netic and environmental inter-action is clearly involved and explainable using phenyl­ke­tonuria as a model.Method: Examining peer reviewed published papers on gut to blood, blood to brain inter­action and effect of interventions in AD/HD and our own studies in the field. The various treatment options are discussed.Results: It can be shown that a gut to brain activity is possible and probable, and dietary intervention is useful and probably safer than drugs. Preliminary data on a small five year follow up of dietary intervention is shown.

  5. Classification and Clinical Diagnosis of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines

    Directory of Open Access Journals (Sweden)

    Mary-Ann Fitzcharles

    2013-01-01

    Full Text Available Objectives. Fibromyalgia syndrome (FMS, characterized by subjective complaints without physical or biomarker abnormality, courts controversy. Recommendations in recent guidelines addressing classification and diagnosis were examined for consistencies or differences. Methods. Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network, and Medline for evidence-based guidelines for the management of FMS were conducted. Results. Three evidence-based interdisciplinary guidelines, independently developed in Canada, Germany, and Israel, recommended that FMS can be clinically diagnosed by a typical cluster of symptoms following a defined evaluation including history, physical examination, and selected laboratory tests, to exclude another somatic disease. Specialist referral is only recommended when some other physical or mental illness is reasonably suspected. The diagnosis can be based on the (modified preliminary American College of Rheumatology (ACR 2010 diagnostic criteria. Discussion. Guidelines from three continents showed remarkable consistency regarding the clinical concept of FMS, acknowledging that FMS is neither a distinct rheumatic nor mental disorder, but rather a cluster of symptoms, not explained by another somatic disease. While FMS remains an integral part of rheumatology, it is not an exclusive rheumatic condition and spans a broad range of medical disciplines.

  6. Pathohistological classification systems in gastric cancer: diagnostic relevance and prognostic value.

    Science.gov (United States)

    Berlth, Felix; Bollschweiler, Elfriede; Drebber, Uta; Hoelscher, Arnulf H; Moenig, Stefan

    2014-05-21

    Several pathohistological classification systems exist for the diagnosis of gastric cancer. Many studies have investigated the correlation between the pathohistological characteristics in gastric cancer and patient characteristics, disease specific criteria and overall outcome. It is still controversial as to which classification system imparts the most reliable information, and therefore, the choice of system may vary in clinical routine. In addition to the most common classification systems, such as the Laurén and the World Health Organization (WHO) classifications, other authors have tried to characterize and classify gastric cancer based on the microscopic morphology and in reference to the clinical outcome of the patients. In more than 50 years of systematic classification of the pathohistological characteristics of gastric cancer, there is no sole classification system that is consistently used worldwide in diagnostics and research. However, several national guidelines for the treatment of gastric cancer refer to the Laurén or the WHO classifications regarding therapeutic decision-making, which underlines the importance of a reliable classification system for gastric cancer. The latest results from gastric cancer studies indicate that it might be useful to integrate DNA- and RNA-based features of gastric cancer into the classification systems to establish prognostic relevance. This article reviews the diagnostic relevance and the prognostic value of different pathohistological classification systems in gastric cancer.

  7. Alzheimer Disease and Behavioral Variant Frontotemporal Dementia: Automatic Classification Based on Cortical Atrophy for Single-Subject Diagnosis.

    Science.gov (United States)

    Möller, Christiane; Pijnenburg, Yolande A L; van der Flier, Wiesje M; Versteeg, Adriaan; Tijms, Betty; de Munck, Jan C; Hafkemeijer, Anne; Rombouts, Serge A R B; van der Grond, Jeroen; van Swieten, John; Dopper, Elise; Scheltens, Philip; Barkhof, Frederik; Vrenken, Hugo; Wink, Alle Meije

    2016-06-01

    Purpose To investigate the diagnostic accuracy of an image-based classifier to distinguish between Alzheimer disease (AD) and behavioral variant frontotemporal dementia (bvFTD) in individual patients by using gray matter (GM) density maps computed from standard T1-weighted structural images obtained with multiple imagers and with independent training and prediction data. Materials and Methods The local institutional review board approved the study. Eighty-four patients with AD, 51 patients with bvFTD, and 94 control subjects were divided into independent training (n = 115) and prediction (n = 114) sets with identical diagnosis and imager type distributions. Training of a support vector machine (SVM) classifier used diagnostic status and GM density maps and produced voxelwise discrimination maps. Discriminant function analysis was used to estimate suitability of the extracted weights for single-subject classification in the prediction set. Receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) were calculated for image-based classifiers and neuropsychological z scores. Results Training accuracy of the SVM was 85% for patients with AD versus control subjects, 72% for patients with bvFTD versus control subjects, and 79% for patients with AD versus patients with bvFTD (P ≤ .029). Single-subject diagnosis in the prediction set when using the discrimination maps yielded accuracies of 88% for patients with AD versus control subjects, 85% for patients with bvFTD versus control subjects, and 82% for patients with AD versus patients with bvFTD, with a good to excellent AUC (range, 0.81-0.95; P ≤ .001). Machine learning-based categorization of AD versus bvFTD based on GM density maps outperforms classification based on neuropsychological test results. Conclusion The SVM can be used in single-subject discrimination and can help the clinician arrive at a diagnosis. The SVM can be used to distinguish disease-specific GM patterns in patients with AD

  8. [Pulmonary hypertension: definition, classification and treatments].

    Science.gov (United States)

    Jutant, Etienne-Marie; Humbert, Marc

    2016-01-01

    Pulmonary hypertension (PH) is a cardio-pulmonary disorder that may involve multiple clinical conditions and can complicate the majority of cardiovascular and respiratory diseases. Its definition is an increase in mean pulmonary artery pressure (mPAP) \\hbox{$\\geqslant $} ⩾ 25 mmHg at rest, leading to right heart failure and ultimately death. The clinical classification of pulmonary hypertension (PH) categorizes PH into groups which share similar pathophysiological and hemodynamic characteristics and treatments. Five groups of disorders that cause PH are identified: pulmonary arterial hypertension (Group 1) which is a pre-capillary PH, defined by a normal pulmonary artery wedge pressure (PAWP) \\hbox{$\\leqslant $} ⩽ 15 mmH, due to remodelling of the small pulmonary arteries (15 mmHg; pulmonary hypertension due to chronic lung disease and/or hypoxia (Group 3); chronic thrombo-embolic pulmonary hypertension (Group 4); and pulmonary hypertension due to unclear and/or multifactorial mechanisms (Group 5). PAH (PH group 1) can be treated with agents targeting three dysfunctional endothelial pathways of PAH: nitric oxide (NO) pathway, endothelin-1 pathway and prostacyclin pathway. Patients at low or intermediate risk can be treated with either initial monotherapy or initial oral combination therapy. In patients at high risk initial combination therapy including intravenous prostacyclin analogues should be considered. Patients with inadequate clinical response to maximum treatment (triple therapy with an intravenous prostacyclin) should be assessed for lung transplantation. Despite progresses, PAH remains a fatal disease with a 3-year survival rate of 58%. Treatment of group 2, group 3 and group 5 PH is the treatment of the causal disease and PAH therapeutics are not recommended. Treatment of group 4 PH is pulmonary endarteriectomy if patients are eligible, otherwise balloon pulmonary angioplasty and/or medical therapy can be considered. © Société de Biologie

  9. Hymenoptera venom allergy : Challenges in diagnosis and treatment

    NARCIS (Netherlands)

    Vos, Byrthe

    2017-01-01

    This thesis gives an overview of some of the main challenges and controversies in the understanding, diagnosis, and treatment of insect allergy and provides a practical guidance for clinical decision-making. A special focus is given to patients with concurrent indolent systemic mastocytosis (ISM)

  10. 2008 International Conference on Ectodermal Dysplasias Classification Conference Report

    Science.gov (United States)

    Salinas, Carlos F.; Jorgenson, Ronald J.; Wright, J. Timothy; DiGiovanna, John J.; Fete, Mary D.

    2009-01-01

    There are many ways to classify ectodermal dysplasia syndromes. Clinicians in practice use a list of syndromes from which to choose a potential diagnosis, paging through a volume, such as Freire-Maia and Pinheiro's corpus, matching their patient's findings to listed syndromes. Medical researchers may want a list of syndromes that share one (monothetic system) or several (polythetic system) traits in order to focus research on a narrowly defined group. Special interest groups may want a list from which they can choose constituencies, and insurance companies and government agencies may want a list to determine for whom to provide (or deny) health care coverage. Furthermore, various molecular biologists are now promoting classification systems based on gene mutation (e.g. TP63 associated syndromes) or common molecular pathways. The challenge will be to balance comprehensiveness within the classification with usability and accessibility so that the benefits truly serve the needs of researchers, health care providers and ultimately the individuals and families directly affected by ectodermal dysplasias. It is also recognized that a new classification approach is an ongoing process and will require periodical reviews or updates. Whatever scheme is developed, however, will have far-reaching application for other groups of disorders for which classification is complicated by the number of interested parties and advances in diagnostic acumen. Consensus among interested parties is necessary for optimizing communication among the diverse groups whether it be for equitable distribution of funds, correctness of diagnosis and treatment, or focusing research efforts. PMID:19681152

  11. [Diagnosis and treatment in general internal medicine. Curriculum selection].

    Science.gov (United States)

    Casal, E R; Vázquez, E N; Husni, C

    1994-01-01

    In our country general internists are the providers of adult medical care in urban areas. In the past twenty years, with the increasing subspecialization within internal medicine and the development of advances in technology, the role of the general internist seems to be endangered. Recently much attention has been focused on this area and Divisions and Programs of General Internal Medicine have been established in most medical schools in the USA. The University of Buenos Aires instituted a Program of General Internal Medicine in its major teaching hospital in 1987. One of its purposes was to offer an educational experience to residents in the field of internal medicine primary care. This paper summarizes how this program was carried out and the subjects proposed in the area of Diagnosis and Treatment. The Program of General Internal Medicine is performed in the Outpatient Division and it is staffed by 3 faculty members and 4 fellows. Residents in Internal Medicine have a three month, full-time block rotation in the Program. A young, city dwelling, lower middle class population participates in the Program, with almost 10000 visits a year. The Program offers an experience that includes supervised patient care, an average of 100 office visits a month, and seminars and/or workshops covering topics of "Diagnosis and Treatment", "Case Presentations", "Clinical Epidemiology", "Prevention", and "Doctor-Patient Interview". In the area of Diagnosis and Treatment, the criteria used were: 1-frequency of diagnosis as determined by previous investigations, 2-relevant clinical conditions absent from the frequency list as determined by a consensus process by faculty members.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. [Diagnosis and treatment of gender identity disorder].

    Science.gov (United States)

    Yamauchi, Toshio

    2004-02-01

    According to DSM-IV criteria, gender identity disorder(GID) is characterized as follows: 1) Strong, persistent cross-gender identification. 2) Persistent discomfort with one's assigned sex or the Sense of inappropriateness in that gender role. 3) Not due to an intersex condition. In this chapter, symptoms, diagnosis and treatment of GID are briefly described. Possible pathogenesis of GID is also discussed.

  13. Headache in military service members with a history of mild traumatic brain injury: A cohort study of diagnosis and classification.

    Science.gov (United States)

    Finkel, Alan G; Yerry, Juanita A; Klaric, John S; Ivins, Brian J; Scher, Ann; Choi, Young S

    2017-05-01

    Introduction Headaches after concussion are highly prevalent, relatively persistent and are being treated like primary headaches, especially migraine. Methods We studied all new patients seen between August 2008 and December 2009 assessed by a civilian headache specialist at the TBI Center at Womack Army Medical Center, Fort Bragg, NC. We report sample demographics, injuries and headache characteristics, including time from injury to headache onset, detailed descriptions and International Classification of Headache Disorders second edition primary headache diagnosis type. Results A total of 95 soldiers reported 166 headaches. The most common injury cited was a blast (53.7%). Most subjects (76.8%) recalled the onset of any headache within 7 days of injury. The most commonly diagnosed headache was a continuous type with migraine features ( n = 31 (18.7%)), followed by chronic migraine (type 1.5.1, n = 14 (8.4%)), migraine with aura (type 1.2.1, n = 10 (6.0%)), hemicrania continua (type 4.7, n = 12 (7.2%)), chronic cluster (type 3.1.2, n = 6 (3.6%)) and headaches not otherwise classifiable (type 14.1, n = 5 (3.0%)) also present. The most clinically important was a continuous headache with migraine features. Conclusion We present a series of patients seen in a military treatment facility for headache diagnosis after concussion in whom we found migraine, as well as uncommon primary headache types, at frequencies that were much higher than expected.

  14. Diagnosis of periodontal diseases using different classification ...

    African Journals Online (AJOL)

    2014-11-29

    Nov 29, 2014 ... Nigerian Journal of Clinical Practice • May-Jun 2015 • Vol 18 • Issue 3 ... Materials and Methods: A total of 150 patients was divided into two groups such as training ... functions from training data and DT learning is one of ... were represented as numerical codings for classification ..... tool within dentistry.

  15. Casemix classification systems.

    Science.gov (United States)

    Fetter, R B

    1999-01-01

    The idea of using casemix classification to manage hospital services is not new, but has been limited by available technology. It was not until after the introduction of Medicare in the United States in 1965 that serious attempts were made to measure hospital production in order to contain spiralling costs. This resulted in a system of casemix classification known as diagnosis related groups (DRGs). This paper traces the development of DRGs and their evolution from the initial version to the All Patient Refined DRGs developed in 1991.

  16. Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment.

    Science.gov (United States)

    Martins, Natália; Ferreira, Isabel C F R; Barros, Lillian; Silva, Sónia; Henriques, Mariana

    2014-06-01

    Candidiasis is the most common opportunistic yeast infection. Candida species and other microorganisms are involved in this complicated fungal infection, but Candida albicans continues to be the most prevalent. In the past two decades, it has been observed an abnormal overgrowth in the gastrointestinal, urinary and respiratory tracts, not only in immunocompromised patients, but also related to nosocomial infections and even in healthy individuals. There is a widely variety of causal factors that contribute to yeast infection which means that candidiasis is a good example of a multifactorial syndrome. Due to rapid increase in the incidence in these infections, this is the subject of numerous studies. Recently, the focus of attention is the treatment and, above all, the prevention of those complications. The diagnosis of candidiasis could become quite complicated. Prevention is the most effective "treatment," much more than eradication of the yeast with antifungal agents. There are several aspects to consider in the daily routine that can provide a strength protection. However, a therapeutic approach is necessary when the infection is established, and therefore, other alternatives should be explored. This review provides an overview on predisposition factors, prevention and diagnosis of candidiasis, highlighting alternative approaches for candidiasis treatment.

  17. A novel relational regularization feature selection method for joint regression and classification in AD diagnosis.

    Science.gov (United States)

    Zhu, Xiaofeng; Suk, Heung-Il; Wang, Li; Lee, Seong-Whan; Shen, Dinggang

    2017-05-01

    In this paper, we focus on joint regression and classification for Alzheimer's disease diagnosis and propose a new feature selection method by embedding the relational information inherent in the observations into a sparse multi-task learning framework. Specifically, the relational information includes three kinds of relationships (such as feature-feature relation, response-response relation, and sample-sample relation), for preserving three kinds of the similarity, such as for the features, the response variables, and the samples, respectively. To conduct feature selection, we first formulate the objective function by imposing these three relational characteristics along with an ℓ 2,1 -norm regularization term, and further propose a computationally efficient algorithm to optimize the proposed objective function. With the dimension-reduced data, we train two support vector regression models to predict the clinical scores of ADAS-Cog and MMSE, respectively, and also a support vector classification model to determine the clinical label. We conducted extensive experiments on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset to validate the effectiveness of the proposed method. Our experimental results showed the efficacy of the proposed method in enhancing the performances of both clinical scores prediction and disease status identification, compared to the state-of-the-art methods. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Granulomatous lobular mastitis: imaging, diagnosis, and treatment.

    Science.gov (United States)

    Hovanessian Larsen, Linda J; Peyvandi, Banafsheh; Klipfel, Nancy; Grant, Edward; Iyengar, Geeta

    2009-08-01

    Granulomatous lobular mastitis is a rare chronic inflammatory disease that has clinical and radiologic findings similar to those of breast cancer. We performed a retrospective analysis of clinical, imaging, and treatment findings in 54 women diagnosed with granulomatous lobular mastitis between January 2000 and April 2008. The imaging findings of granulomatous lobular mastitis overlap with those of malignancy. The most common presentation is a focal asymmetric density on mammography and an irregular hypoechoic mass with tubular extensions on ultrasound. Core biopsy is typically diagnostic. Once the diagnosis is established by tissue sampling, corticosteroids are the first line of treatment.

  19. The new WHO 2016 classification of brain tumors-what neurosurgeons need to know.

    Science.gov (United States)

    Banan, Rouzbeh; Hartmann, Christian

    2017-03-01

    The understanding of molecular alterations of tumors has severely changed the concept of classification in all fields of pathology. The availability of high-throughput technologies such as next-generation sequencing allows for a much more precise definition of tumor entities. Also in the field of brain tumors a dramatic increase of knowledge has occurred over the last years partially calling into question the purely morphologically based concepts that were used as exclusive defining criteria in the WHO 2007 classification. Review of the WHO 2016 classification of brain tumors as well as a search and review of publications in the literature relevant for brain tumor classification from 2007 up to now. The idea of incorporating the molecular features in classifying tumors of the central nervous system led the authors of the new WHO 2016 classification to encounter inevitable conceptual problems, particularly with respect to linking morphology to molecular alterations. As a solution they introduced the concept of a "layered diagnosis" to the classification of brain tumors that still allows at a lower level a purely morphologically based diagnosis while partially forcing the incorporation of molecular characteristics for an "integrated diagnosis" at the highest diagnostic level. In this context the broad availability of molecular assays was debated. On the one hand molecular antibodies specifically targeting mutated proteins should be available in nearly all neuropathological laboratories. On the other hand, different high-throughput assays are accessible only in few first-world neuropathological institutions. As examples oligodendrogliomas are now primarily defined by molecular characteristics since the required assays are generally established, whereas molecular grouping of ependymomas, found to clearly outperform morphologically based tumor interpretation, was rejected from inclusion in the WHO 2016 classification because the required assays are currently only

  20. Clinical diagnosis versus autopsy diagnosis in head trauma

    Directory of Open Access Journals (Sweden)

    Velnic Andreea-Alexandra

    2017-12-01

    Full Text Available The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1 to total discordance (C4 and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis- missing injuries in the autopsy reports and C3 (partial discordance in favor of the necroptic diagnosis- missing injuries in the medical files. Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral

  1. Interocclusal Registration for Diagnosis and Treatment Planning for ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... implant case where multiple posterior teeth are missing and need to be replaced by implant restorations. In the case ... Keywords: Interocclusal Records, Diagnosis and Treatment Plan, Implant. Restorations. Interocclusal ... then removed to leave a window in the acrylic resin. The appliance was finished ...

  2. Food addiction-diagnosis and treatment.

    Science.gov (United States)

    Dimitrijević, Ivan; Popović, Nada; Sabljak, Vera; Škodrić-Trifunović, Vesna; Dimitrijević, Nina

    2015-03-01

    In this article we summarized the recent research of the food addiction, diagnosis, treatment and prevention, which is carried out in this area. The concept of food addiction is new and complex, but proven to be very important for understanding and solving the problem of obesity. First part of this paper emphasizes the neurological studies, whose results indicate the similarity of brain processes that are being activated during drug abuse and during eating certain types of food. In this context, different authors speak of "hyper-palatable", industrial food, saturated with salt, fat and sugar, which favor an addiction. In the section on diagnostic and instruments constructed for assessing the degree of dependence, main diagnostic tool is standardized Yale Food Addiction Scale constructed by Ashley Gearhardt, and her associates. Since 2009, when it was first published, this scale is used in almost all researches in this area and has been translated into several languages. Finally, distinguish between prevention and treatment of food addiction was made. Given that there were similarities with other forms of addictive behavior, the researchers recommend the application of traditional addiction treatment.

  3. Value of the BI-RADS classification in MR-mammography for diagnosis of benign and malignant breast tumors

    International Nuclear Information System (INIS)

    Sohns, Christian; Scherrer, Martin; Staab, Wieland; Obenauer, Silvia

    2011-01-01

    To assess whether the BI-RADS classification in MR-Mammography (MRM) can distinguish between benign and malignant lesions. 207 MRM investigations were categorised according to BI-RADS. The results were compared to histology. All MRM studies were interpreted by two examiners. Statistical significance for the accuracy of MRM was calculated. A significant correlation between specific histology and MRM-tumour-morphology could not be reported. Mass (68%) was significant for malignancy. Significance raised with irregular shape (88%), spiculated margin (97%), rim enhancement (98%), fast initial increase (90%), post initial plateau (65%), and intermediate T2 result (82%). Highly significant for benignity was an oval mass (79%), slow initial increase (94%) and a hyperintense T2 result (77%), also an inconspicuous MRM result (77%) was often seen in benign histology. Symmetry (90%) and further post initial increase (90%) were significant, whereas a regional distribution (74%) was lowly significant for benignity. On basis of the BI-RADS classification an objective comparability and statement of diagnosis could be made highly significant. Due to the fact of false-negative and false-positive MRM-results, histology is necessary. (orig.)

  4. Reliability of Smartphone-Based Instant Messaging Application for Diagnosis, Classification, and Decision-making in Pediatric Orthopedic Trauma.

    Science.gov (United States)

    Stahl, Ido; Katsman, Alexander; Zaidman, Michael; Keshet, Doron; Sigal, Amit; Eidelman, Mark

    2017-07-11

    Smartphones have the ability to capture and send images, and their use has become common in the emergency setting for transmitting radiographic images with the intent to consult an off-site specialist. Our objective was to evaluate the reliability of smartphone-based instant messaging applications for the evaluation of various pediatric limb traumas, as compared with the standard method of viewing images of a workstation-based picture archiving and communication system (PACS). X-ray images of 73 representative cases of pediatric limb trauma were captured and transmitted to 5 pediatric orthopedic surgeons by the Whatsapp instant messaging application on an iPhone 6 smartphone. Evaluators were asked to diagnose, classify, and determine the course of treatment for each case over their personal smartphones. Following a 4-week interval, revaluation was conducted using the PACS. Intraobserver agreement was calculated for overall agreement and per fracture site. The overall results indicate "near perfect agreement" between interpretations of the radiographs on smartphones compared with computer-based PACS, with κ of 0.84, 0.82, and 0.89 for diagnosis, classification, and treatment planning, respectively. Looking at the results per fracture site, we also found substantial to near perfect agreement. Smartphone-based instant messaging applications are reliable for evaluation of a wide range of pediatric limb fractures. This method of obtaining an expert opinion from the off-site specialist is immediately accessible and inexpensive, making smartphones a powerful tool for doctors in the emergency department, primary care clinics, or remote medical centers, enabling timely and appropriate treatment for the injured child. This method is not a substitution for evaluation of the images in the standard method over computer-based PACS, which should be performed before final decision-making.

  5. Diagnosis and Treatment of Hypopituitarism

    Science.gov (United States)

    2015-01-01

    Hypopituitarism is a chronic endocrine illness that caused by varied etiologies. Clinical manifestations of hypopituitarism are variable, often insidious in onset and dependent on the degree and severity of hormone deficiency. However, it is associated with increased mortality and morbidity. Therefore, early diagnosis and prompt treatment is necessary. Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. Knowledge of the use and limitations of these stimulation tests is mandatory for proper interpretation. It is necessary for physicians to inform their patients that they may require lifetime treatment. Hormone replacement therapy should be individualized according to the specific needs of each patient, taking into account possible interactions. Long-term endocrinological follow-up of hypopituitary patients is important to monitor hormonal replacement regimes and avoid under- or overtreatment. PMID:26790380

  6. [Diagnosis and treatment of Pompe disease].

    Science.gov (United States)

    Bravo-Oro, Antonio; de la Fuente-Cortez, Beatriz; Molina-García, Avril; Romero-Díaz, Víktor; Rodríguez-Leyva, Ildefonso; Esmer-Sánchez, María del Carmen

    2013-01-01

    Pompe disease is a rare, progressive and often fatal neuromuscular disorder. It is caused by a deficiency of the lysosomal alpha-glucosidase. Among glycogen storage disorders, it is one of the most common. Its clinical manifestations can start at any moment of life, with a very variable symptomatology. In this article, we show an extended revision of the literature in regards to the main medical aspects of Pompe disease: etiology, psychopathology, epidemiology, clinical variants, pathological diagnosis, and enzyme replacement therapy. With this information, we created a diagnostic and therapeutic guide, which is addressed to specialists and to first-level physicians, in order to let them identify both the classic and the late forms of this disease. We describe as well the best, timely, multidisciplinary treatment in use. Also, we show some suggestions to the proper functioning of health institutions, and routes to diagnosis. We conclude that Pompe disease may be properly diagnosed and treated if health care professionals follow the internationally approved recommendations.

  7. Research Progress of Exosomes in Lung Cancer Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Hongbo ZOU

    2016-11-01

    Full Text Available As the leading cause of morbidity and cancer related-death worldwide, lung cancer has a serious threat to human health. Exosomes are nanoscale lipid membrane vesicles derived from multivesicles, which containing active biomolecules including proteins, lipids, nucleic acids and etc. Exosomes play important roles in lung cancer initiation and progression by promoting the formation of tumor microenvironment, enhancing tumor invasive and metastasis capability, leading to immunosuppression and resistance to chemoradiotherapy, and also have the application value in early diagnosis and treatment. This review summarizes the research progress of exosomes in tumor initiation and progression, and its roles in diagnosis and treatment of lung cancer.

  8. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis.

    Science.gov (United States)

    Di Saverio, Salomone; Birindelli, Arianna; Kelly, Micheal D; Catena, Fausto; Weber, Dieter G; Sartelli, Massimo; Sugrue, Michael; De Moya, Mark; Gomes, Carlos Augusto; Bhangu, Aneel; Agresta, Ferdinando; Moore, Ernest E; Soreide, Kjetil; Griffiths, Ewen; De Castro, Steve; Kashuk, Jeffry; Kluger, Yoram; Leppaniemi, Ari; Ansaloni, Luca; Andersson, Manne; Coccolini, Federico; Coimbra, Raul; Gurusamy, Kurinchi S; Campanile, Fabio Cesare; Biffl, Walter; Chiara, Osvaldo; Moore, Fred; Peitzman, Andrew B; Fraga, Gustavo P; Costa, David; Maier, Ronald V; Rizoli, Sandro; Balogh, Zsolt J; Bendinelli, Cino; Cirocchi, Roberto; Tonini, Valeria; Piccinini, Alice; Tugnoli, Gregorio; Jovine, Elio; Persiani, Roberto; Biondi, Antonio; Scalea, Thomas; Stahel, Philip; Ivatury, Rao; Velmahos, George; Andersson, Roland

    2016-01-01

    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

  9. Modular playware as a playful diagnosis tool for autistic children

    DEFF Research Database (Denmark)

    Lund, Henrik Hautop

    2009-01-01

    children. Using artificial neural networks for automatic classification of the individual construction practices, we may compare this classification with the diagnosis of the children, and possible obtain a supplementary diagnosis tool which is based on the autistic children's free play with the modular...

  10. Urogenital tuberculosis: definition and classification.

    Science.gov (United States)

    Kulchavenya, Ekaterina

    2014-10-01

    To improve the approach to the diagnosis and management of urogenital tuberculosis (UGTB), we need clear and unique classification. UGTB remains an important problem, especially in developing countries, but it is often an overlooked disease. As with any other infection, UGTB should be cured by antibacterial therapy, but because of late diagnosis it may often require surgery. Scientific literature dedicated to this problem was critically analyzed and juxtaposed with the author's own more than 30 years' experience in tuberculosis urology. The conception, terms and definition were consolidated into one system; classification stage by stage as well as complications are presented. Classification of any disease includes dispersion on forms and stages and exact definitions for each stage. Clinical features and symptoms significantly vary between different forms and stages of UGTB. A simple diagnostic algorithm was constructed. UGTB is multivariant disease and a standard unified approach to it is impossible. Clear definition as well as unique classification are necessary for real estimation of epidemiology and the optimization of therapy. The term 'UGTB' has insufficient information in order to estimate therapy, surgery and prognosis, or to evaluate the epidemiology.

  11. [Professor ZHAO Jiping's meridian diagnosis and treatment for primary dysmenorrhea].

    Science.gov (United States)

    Tan, Cheng; Zhang, Chang; Zhang, Jiajia; Wang, Jun

    2016-03-01

    For the treatment of primary dysmenorrhea, professor ZHAO Jiping focuses on meridian diagnosis and inspection, and uses pressing methods to locate the response points along the meridian, including acupoints and aishi points. During the stage of attack, it is essential to press along the spleen meridian, mainly Sanyinjiao (SP 6), Diji (SP 8) and Yinlingquan (SP 9); during the stage of remission, it is essential to press along the bladder meridian and stomach meridian, mainly Ganshu (BL 18), Pishu (BL 20), Weishu (BL 21), Shenshu (BL 23) and Zusanli (ST 36). The differences between deficiency syndrome and excess syndrome lead to the different feelings of doctors and patients. Combined with the results of meridian diagnosis and inspection, the aim of treatment can be achieved by different acupuncture methods. Professor ZHAO pays attention to the treatment of accompanied symptoms and timing of treatment, since the relief of accompanied syndromes and selection of timing are keys to relieving patient's pain.

  12. Hypothyroidism:Symptoms,Diagnosis and Treatment | NIH Medlineplus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Hypothyroidism Hypothyroidism: Symptoms, Diagnosis & Treatment Past Issues / Spring 2012 Table ... of its symptoms are seen in other diseases, hypothyroidism usually cannot be diagnosed based on symptoms alone. ...

  13. Deep vein thrombosis: diagnosis, treatment, and prevention

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, W.P.; Youngswick, F.D.

    Deep vein thrombosis (DVT) is a dangerous complication that may present after elective foot surgery. Because of the frequency with which DVT occurs in the elderly patient, as well as in the podiatric surgical population, the podiatrist should be acquainted with this entity. A review of the diagnosis, treatment, prevention, and the role of podiatry in the management of DVT is discussed in this paper.

  14. Cytauxzoonosis: Diagnosis and treatment of an emerging disease.

    Science.gov (United States)

    Sherrill, Meredith K; Cohn, Leah A

    2015-11-01

    Cytauxzoonosis is a life-threatening hematoprotozoal disease with a rapidly progressive clinical course. Once considered a rare disease only relevant to a small geographic area, it is now recognized in more than about a third of the United States. The geographic range seems likely to increase with expansion of the range of the vector tick. Both disease diagnosis and treatment offer challenges. The acute illness is often recognized by characteristic parasitic cellular inclusions, but illness may occur before parasites can be identified, and parasitic inclusions may persist long after illness has resolved. Also, while infection was once considered nearly uniformly fatal, subclinical infections are now recognized. Disease prognosis has improved for many cats through implementation of new therapies, but some pathogens are resistant to these therapies and death from disease is still common. Currently, prevention strategies are limited to ectoparasite control. Cytauxzoonosis caused by Cytauxzoon felis is limited to the Americas, and is especially problematic in southeastern and south central USA. However, other Cytauxzoon species have been recognized in Europe and Asia. This review is aimed at veterinary practitioners and focuses on the diagnosis and treatment of cytauxzoonosis. Disease management is of crucial importance in endemic regions. Furthermore, the expanding geographic range of infection, and the possibility of parasite identification in chronically infected cats with a travel history, make understanding cytauxzoonosis relevant in non-endemic regions as well. The authors draw on evidence from prospective clinical trials, experimental infections, retrospective clinical studies and case reports, as well as their own personal experience with the diagnosis and treatment of cytauxzoonosis. © The Author(s) 2015.

  15. Guidelines for the diagnosis and monitoring of silicosis.

    Science.gov (United States)

    Fernández Álvarez, Ramón; Martínez González, Cristina; Quero Martínez, Aida; Blanco Pérez, José Jesús; Carazo Fernández, Luis; Prieto Fernández, Amador

    2015-02-01

    Silicosis is one of the occupational respiratory diseases most commonly encountered in our setting. It is caused by inhalation of crystalline silica that triggers a fibrotic response in the lung parenchyma. It presents as diffuse interstitial disease and clinical expression ranges from asymptomatic forms to chronic respiratory failure. Diagnosis is based on clinical history and radiological findings. There is no effective treatment, and once diagnosed, the patient must avoid all sources of occupational exposure. In these guidelines, the clinical, radiological and functional aspects of silicosis are reviewed, and strategies for diagnosis, monitoring and classification of patients are proposed, along with recommendations regarding the occupational implications of this disease. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  16. Dioctophyma renale in a dog: clinical diagnosis and surgical treatment.

    Science.gov (United States)

    Ferreira, Vivian Lindmayer; Medeiros, Fábio Pestana; July, José Roberto; Raso, Tânia Freitas

    2010-02-26

    This study reports a case of parasitism by the giant kidney worm, Dioctophyma renale, diagnosed in the right kidney of a domestic dog. An adult female German Shepherd was attended with clinical history of prostration and hyporexia. The hemogram showed changes compatible with an inflammatory process, for that reason, an abdominal ultrasound was requested. Ultrasound image suggested the presence of D. renale in the right kidney. The diagnosis was confirmed after urinalysis due to the presence of dioctophymas ova in the urinary sediment. Surgical treatment was made and the animal had an excellent recovery after the nephrectomy was performed. Generally, in almost all cases, parasitism by D. renale in domestic dogs is a necropsy finding, nevertheless imaging techniques as sonography and laboratorial exams as urinalysis have been proven to be important tools to achieve diagnosis. The purpose of this study is to report a case of parasitism by D. renale where diagnosis and treatment were made in time to allow the patient's recovery.

  17. 131I-metaiodobenzylguanidine in the treatment of neuroblastoma at diagnosis

    International Nuclear Information System (INIS)

    Mastrangelo, R.; Troncone, L.; Lasorella, A.; Riccardi, R.; Montemaggi, P.; Rufini, V.

    1989-01-01

    Radioactive metaiodobenzylguanidine ( 131 I-MIBG) is taken up specifically by neuroblastoma cells and appears to represent a new treatment modality in patients with advanced neuroblastoma. Taking into account the fact that all patients so far treated were heavily pretreated and resistant to chemotherapy, the results obtained appear encouraging. In order to explore further the potential role of this new drug in untreated patients, we treated with 131 I-MIBG a child with stage III neuroblastoma at diagnosis. We observed the complete disappearance of a large abdominal tumor mass after a relatively low dosage of 131 I-MIBG, with minimal hematologic toxicity. No further treatment was given and, at present, the patient is alive with no evidence of disease 18 months from diagnosis. This child represents, to our knowledge, the only case of neuroblastoma thus far treated at diagnosis and the excellent response obtained suggests the need for further investigations of this therapy in untreated patients

  18. Gene expression profiles reveal key genes for early diagnosis and treatment of adamantinomatous craniopharyngioma.

    Science.gov (United States)

    Yang, Jun; Hou, Ziming; Wang, Changjiang; Wang, Hao; Zhang, Hongbing

    2018-04-23

    Adamantinomatous craniopharyngioma (ACP) is an aggressive brain tumor that occurs predominantly in the pediatric population. Conventional diagnosis method and standard therapy cannot treat ACPs effectively. In this paper, we aimed to identify key genes for ACP early diagnosis and treatment. Datasets GSE94349 and GSE68015 were obtained from Gene Expression Omnibus database. Consensus clustering was applied to discover the gene clusters in the expression data of GSE94349 and functional enrichment analysis was performed on gene set in each cluster. The protein-protein interaction (PPI) network was built by the Search Tool for the Retrieval of Interacting Genes, and hubs were selected. Support vector machine (SVM) model was built based on the signature genes identified from enrichment analysis and PPI network. Dataset GSE94349 was used for training and testing, and GSE68015 was used for validation. Besides, RT-qPCR analysis was performed to analyze the expression of signature genes in ACP samples compared with normal controls. Seven gene clusters were discovered in the differentially expressed genes identified from GSE94349 dataset. Enrichment analysis of each cluster identified 25 pathways that highly associated with ACP. PPI network was built and 46 hubs were determined. Twenty-five pathway-related genes that overlapped with the hubs in PPI network were used as signatures to establish the SVM diagnosis model for ACP. The prediction accuracy of SVM model for training, testing, and validation data were 94, 85, and 74%, respectively. The expression of CDH1, CCL2, ITGA2, COL8A1, COL6A2, and COL6A3 were significantly upregulated in ACP tumor samples, while CAMK2A, RIMS1, NEFL, SYT1, and STX1A were significantly downregulated, which were consistent with the differentially expressed gene analysis. SVM model is a promising classification tool for screening and early diagnosis of ACP. The ACP-related pathways and signature genes will advance our knowledge of ACP pathogenesis

  19. Diagnosis and treatment of hepatocellular carcinoma: An update

    Science.gov (United States)

    Tejeda-Maldonado, Javier; García-Juárez, Ignacio; Aguirre-Valadez, Jonathan; González-Aguirre, Adrián; Vilatobá-Chapa, Mario; Armengol-Alonso, Alejandra; Escobar-Penagos, Francisco; Torre, Aldo; Sánchez-Ávila, Juan Francisco; Carrillo-Pérez, Diego Luis

    2015-01-01

    Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium “washout” in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and loco-regional therapies (alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion’s stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib. PMID:25848464

  20. Diagnosis and treatment of pancreatic cancer. Oncology overview

    International Nuclear Information System (INIS)

    1982-09-01

    Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature related to their research being published by other laboratories throughout the world. Each Oncology Overview represents a survey of the literature associated with a selected area of cancer research. It contains abstracts of articles which have been selected and organized by researchers associated with the field. Contents: Radiological diagnosis of pancreatic cancer; Biopsy and cytology in the diagnosis of pancreatic cancer; Pathology and morphology of pancreatic cancer; Staging and prognosis of pancreatic cancer; Biological and immunological markers in the diagnosis of pancreatic cancer; Surgical treatment of pancreatic cancer; Drug therapy of pancreatic cancer; Radiation therapy of pancreatic cancer; Selected studies on the epidemiology of pancreatic cancer; Clinical correlates and syndromes associated with pancreatic neoplasia

  1. Knee replacement and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Tan, Siok Swan; Chiarello, Pietro; Quentin, Wilm

    2013-11-01

    Researchers from 11 countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their Diagnosis-Related Group (DRG) systems deal with knee replacement cases. The study aims to assist knee surgeons and national authorities to optimize the grouping algorithm of their DRG systems. National or regional databases were used to identify hospital cases treated with a procedure of knee replacement. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97 % of cases. Five standardized case scenarios were defined and quasi-prices according to national DRG-based hospital payment systems ascertained. Grouping algorithms for knee replacement vary widely across countries: they classify cases according to different variables (between one and five classification variables) into diverging numbers of DRGs (between one and five DRGs). Even the most expensive DRGs generally have a cost index below 2.00, implying that grouping algorithms do not adequately account for cases that are more than twice as costly as the index DRG. Quasi-prices for the most complex case vary between euro 4,920 in Estonia and euro 14,081 in Spain. Most European DRG systems were observed to insufficiently consider the most important determinants of resource consumption. Several countries' DRG system might be improved through the introduction of classification variables for revision of knee replacement or for the presence of complications or comorbidities. Ultimately, this would contribute to assuring adequate performance comparisons and fair hospital reimbursement on the basis of DRGs.

  2. FLUORESCENCE DIAGNOSIS AND PHOTODYNAMIC THERAPY IN COMBINED TREATMENT OF CHOLANGIOCARCINOMA

    Directory of Open Access Journals (Sweden)

    A. A. Shiryaev

    2016-01-01

    Full Text Available The results of the pilot study of combined treatment for non-resectable cholangiocarcinoma complicated with obstructive jaundice are represented this paper. Method included percutaneous transhepatic biliary drainage, endoscopic fluorescence diagnosis, photodynamic therapy of tumor stricture, and stenting of bile ducts. Fourteen patients who underwent the treatment in the surgery department clinic of I.M. Sechenov First Moscow State Medical University were enrolled in the study. Fluorescence diagnosis and photodynamic therapy were carried out using photosensitizers photosens (0.5 mg/kg, fotolon (1 mg/kg, and radachlorin (1 mg/kg. The average light dose for one session was 115±5 J/cm2. Fluorescence diagnosis using endoscopic video-fluorescence system for endoscopy and minimally invasive surgery allowed to obtain videoassisted fluorescence image of the tumor and to measure level of photosensitizer fluorescence in tumor in all patients. Malignant tumor was confirmed by morphological study in 12 patients, biopsy of material for morphological study failed in 2 patients with Klatskin tumor. The preliminary results of combined minimally invasive treatment were assessed as promising. The survival time in 4 patients after treatment accounted for 21, 17, 13 and 11 months, respectively. For now 5 patients are under follow-up. Follow-up periods are 13 and 19 months in 2 of them and from 4 to 6 months in 3 of them. Five patients with multiple distant metastases before the treatment died in 3±1 months after therapy. The average lifetime in the treatment group is 9.5 months up to date, however the duration is expected to belonger because 5 of 14 patients are alive.

  3. Scapula Fractures: Interobserver Reliability of Classification and Treatment

    NARCIS (Netherlands)

    Neuhaus, Valentin; Bot, Arjan G. J.; Guitton, Thierry G.; Ring, David C.; Abdel-Ghany, Mahmoud I.; Abrams, Jeffrey; Abzug, Joshua M.; Adolfsson, Lars E.; Balfour, George W.; Bamberger, H. Brent; Barquet, Antonio; Baskies, Michael; Batson, W. Arnold; Baxamusa, Taizoon; Bayne, Grant J.; Begue, Thierry; Behrman, Michael; Beingessner, Daphne; Biert, Jan; Bishop, Julius; Alves, Mateus Borges Oliveira; Boyer, Martin; Brilej, Drago; Brink, Peter R. G.; Brunton, Lance M.; Buckley, Richard; Cagnone, Juan Carlos; Calfee, Ryan P.; Campinhos, Luiz Augusto B.; Cassidy, Charles; Catalano, Louis; Chivers, Karel; Choudhari, Pradeep; Cimerman, Matej; Conflitti, Joseph M.; Costanzo, Ralph M.; Crist, Brett D.; Cross, Brian J.; Dantuluri, Phani; Darowish, Michael; de Bedout, Ramon; DeCoster, Thomas; Dennison, David G.; DeNoble, Peter H.; DeSilva, Gregory; Dienstknecht, Thomas; Duncan, Scott F.; Duralde, Xavier A.; Durchholz, Holger; Egol, Kenneth; Ekholm, Carl; Elias, Nelson; Erickson, John M.; Esparza, J. Daniel Espinosa; Fernandes, C. H.; Fischer, Thomas J.; Fischmeister, Martin; Forigua Jaime, E.; Getz, Charles L.; GIlbert, Richard S.; Giordano, Vincenzo; Glaser, David L.; Gosens, Taco; Grafe, Michael W.; Filho, Jose Eduardo Grandi Ribeiro; Gray, Robert R. L.; Gulotta, Lawrence V.; Gummerson, Nigel William; Hammerberg, Eric Mark; Harvey, Edward; Haverlag, R.; Henry, Patrick D. G.; Hobby, Jonathan L.; Hofmeister, Eric P.; Hughes, Thomas; Itamura, John; Jebson, Peter; Jenkinson, Richard; Jeray, Kyle; Jones, Christopher M.; Jones, Jedediah; Jubel, Axel; Kaar, Scott G.; Kabir, K.; Kaplan, F. Thomas D.; Kennedy, Stephen A.; Kessler, Michael W.; Kimball, Hervey L.; Kloen, Peter; Klostermann, Cyrus; Kohut, Georges; Kraan, G. A.; Kristan, Anze; Loebenberg, Mark I.; Malone, Kevin J.; Marsh, L.; Martineau, Paul A.; McAuliffe, John; McGraw, Iain; Mehta, Samir; Merchant, Milind; Metzger, Charles; Meylaerts, S. A.; Miller, Anna N.; Wolf, Jennifer Moriatis; Murachovsky, Joel; Murthi, Anand; Nancollas, Michael; Nolan, Betsy M.; Omara, Timothy; Omid, Reza; Ortiz, Jose A.; Overbeck, Joachim P.; Castillo, Alberto Pérez; Pesantez, Rodrigo; Polatsch, Daniel; Porcellini, G.; Prayson, Michael; Quell, M.; Ragsdell, Matthew M.; Reid, James G.; Reuver, J. M.; Richard, Marc J.; Richardson, Martin; Rizzo, Marco; Rowinski, Sergio; Rubio, Jorge; Guerrero, Carlos G. Sánchez; Satora, Wojciech; Schandelmaier, Peter; Scheer, Johan H.; Schmidt, Andrew; Schubkegel, Todd A.; Schulte, Leah M.; Schumer, Evan D.; Sears, Benjamin W.; Shafritz, Adam B.; Shortt, Nicholas L.; Siff, Todd; Silva, Dario Mejia; Smith, Raymond Malcolm; Spruijt, Sander; Stein, Jason A.; Pemovska, Emilija Stojkovska; Streubel, Philipp N.; Swigart, Carrie; Swiontkowski, Marc; Thomas, George; Tolo, Eric T.; Turina, Matthias; Tyllianakis, Minos; van den Bekerom, Michel P. J.; van der Heide, Huub; van de Sande, M. A. J.; van Eerten, P. V.; Verbeek, Diederik O. F.; Hoffmann, David Victoria; Vochteloo, A. J. H.; Wagenmakers, Robert; Wall, Christopher J.; Wallensten, Richard; Wascher, Daniel C.; Weiss, Lawrence; Wiater, J. Michael; Wills, Brian P. D.; Wint, Jeffrey; Wright, Thomas; Young, Jason P.; Zalavras, Charalampos; Zura, Robert D.; Zyto, Karol

    2014-01-01

    Objectives:There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to

  4. New insights into the diagnosis of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    van der Zee, Hessel H; Jemec, Gregor B E

    2015-01-01

    Current classifications for hidradenitis suppurativa (HS), such as the Hurley staging system, are not very specific. The absence of rigorous classifications is incongruous with the clinical variability of the condition. There is no pathognomonic sign for HS that leads to a diagnosis...... that is unquestionable. Consequently, diagnosis is made largely through clinical presentation of the condition. The use of several validated tools assists in confirming the diagnosis and the severity of the disease. In future investigations, the identification of phenotypes and clinical subtypes--taking into account...

  5. PLATEAU IRIS – DIAGNOSIS AND TREATMENT

    Science.gov (United States)

    Stefan, Cornel; Iliescu, Daniela Adriana; Batras, Mehdi; Timaru, Cristina Mihaela; De Simone, Algerino

    2015-01-01

    Objectives: The objective of our study was to review the current knowledge on the diagnosis and treatment options of plateau iris configuration and syndrome. Systematic review methodology: Relevant publications on plateau iris that were published until 2014. Conclusions: Plateau iris syndrome is a form of primary angle closure glaucoma caused by a large or anteriorly positioned ciliary body that leads to mechanical obstruction of trabecular meshwork. This condition is most often found in younger patients. Plateau iris has been considered an abnormal anatomic variant of the iris that can be diagnosed on ultrasound biomicroscopy or optical coherence tomography of anterior segment. Patients with plateau iris syndrome can be recognized by the lack of response in angle opening after iridotomy. The treatment of choice in these cases is argon laser peripheral iridoplasty PMID:27373109

  6. Computer-Aided Diagnosis of Micro-Malignant Melanoma Lesions Applying Support Vector Machines

    Directory of Open Access Journals (Sweden)

    Joanna Jaworek-Korjakowska

    2016-01-01

    Full Text Available Background. One of the fatal disorders causing death is malignant melanoma, the deadliest form of skin cancer. The aim of the modern dermatology is the early detection of skin cancer, which usually results in reducing the mortality rate and less extensive treatment. This paper presents a study on classification of melanoma in the early stage of development using SVMs as a useful technique for data classification. Method. In this paper an automatic algorithm for the classification of melanomas in their early stage, with a diameter under 5 mm, has been presented. The system contains the following steps: image enhancement, lesion segmentation, feature calculation and selection, and classification stage using SVMs. Results. The algorithm has been tested on 200 images including 70 melanomas and 130 benign lesions. The SVM classifier achieved sensitivity of 90% and specificity of 96%. The results indicate that the proposed approach captured most of the malignant cases and could provide reliable information for effective skin mole examination. Conclusions. Micro-melanomas due to the small size and low advancement of development create enormous difficulties during the diagnosis even for experts. The use of advanced equipment and sophisticated computer systems can help in the early diagnosis of skin lesions.

  7. Lived experiences of breast cancer survivors after diagnosis, treatment and beyond: qualitative study

    OpenAIRE

    Williams, Faustine; Jeanetta, Stephen C.

    2015-01-01

    Abstract Background The number of breast cancer survivors has increased since 1990 due to advances in biomedical technology that lead to an increase in early diagnosis and treatment. Research on survivorship has focused on the psychological and treatment aspects of the disease. The goal of this study was focused on exploring the lived experiences of breast cancer survivors from diagnosis, treatment and beyond. Objective To understand the lived experiences of women who are breast cancer surviv...

  8. [Application of three-dimensional digital technology in the diagnosis and treatment planning in orthodontics].

    Science.gov (United States)

    Bai, Y X

    2016-06-01

    Three-dimensional(3D)digital technology has been widely used in the field of orthodontics in clinical examination, diagnosis, treatment and curative effect evaluation. 3D digital technology greatly improves the accuracy of diagnosis and treatment, and provides effective means for personalized orthodontic treatment. This review focuses on the application of 3D digital technology in the field of orthodontics.

  9. Food Allergies: Symptoms, Diagnosis, Prevention and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... this page please turn Javascript on. Feature: Food Allergies Food Allergies: Symptoms, Diagnosis, Prevention and Treatment Past Issues / Spring ... treatments only ease the symptoms. Preventing a food allergy reaction There are no drugs or treatments available ...

  10. [Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer].

    Science.gov (United States)

    2018-04-01

    Colorectal cancer is one of the most common malignant tumors in China. In 2012 one million thirty six thousand cases of colorectal cancer were diagnosed all over the world, two hundred fifty three thousand cases were diagnosed in China (accounted for 18.6%). China has the largest number of new cases of colorectal cancer in the world. Colorectal cancer has becoming a serious threat of Chinese residents' health. In 2010, the National Ministry of Health organized colorectal cancer expertise of the Chinese Medical Association to write the "Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer" (2010edition), and publish it publicly. In recent years, the National Health and Family Planning Commission has organized experts to revised the protocol 2 times: the first time in 2015, the second time in 2017. The revised part of "Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer" (2017 edition) involves new progress in the field of imaging examination, pathological evaluation, surgery, chemotherpy and radiotherapy. The 2017 edition of the protocol not only referred to the contents of the international guidelines, but also combined with the specific national conditions and clinical practice in China, and also included many evidence-based clinical data in China recently. The 2017 edition of the protocol would further promote the standardization of diagnosis and treatment of colorectal cancer in China, improve the survival and prognosis of patients, and benefit millions of patients with colorectal cancer and their families.

  11. Diagnosis, treatment and prevention of HIV/AIDS | Lyamuya ...

    African Journals Online (AJOL)

    Diagnosis, treatment and prevention of HIV/AIDS. E Lyamuya. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  12. Optimizing the diagnosis and treatment of bladder cancer using fluorescence cystoscopy and Raman spectroscopy

    NARCIS (Netherlands)

    Draga, R.O.P.

    2013-01-01

    The gold standard for the diagnosis and treatment of bladder cancer is transurethral resection of bladder tumors (TURBT). A relative high recurrence rate and the need for repeated treatments make bladder cancer one the most expensive cancers from diagnosis till death of the patient. The TURBT

  13. Substitutes or Complements? Diagnosis and Treatment with non-Conventional and Conventional Medicine

    Directory of Open Access Journals (Sweden)

    Aida Isabel Tavares

    2015-04-01

    Full Text Available Background Portugal has a strong tradition of conventional western healthcare. So it provides a natural case study for the relationship between Complementary/Alternative Medicine (CAM and Western Medicine (WM. This work aims to test the relationship between CAM and WM users in the diagnosis and treatment stages and to estimate the determinants of CAM choice. Methods The forth Portuguese National Health Survey is employed to estimate two single probit models and obtain the correlation between the consumption of CAM and WM medicines in the diagnosis and treatment stages. Results Firstly, both in the diagnosis and the treatment stage, CAM and WM are seen to be complementary choices for individuals. Secondly, self-medication also shows complementarity with the choice of CAM treatment. Thirdly, education has a non-linear relationship with the choice of CAM. Finally, working status, age, smoking and chronic disease are determinant factors in the decision to use CAM. Conclusion The results of this work are relevant to health policy-makers and for insurance companies. Patients need freedom of choice and, for the sake of safety and efficacy of treatment, WM and CAM healthcare ought to be provided in a joint and integrated health system.

  14. Review of diagnosis and classification of leukemias that occurred in A-bomb survivors (preliminary report)

    Energy Technology Data Exchange (ETDEWEB)

    Matsuo, T; Tomonaga, M; Ichimaru, M; Kamata, N; Kuramoto, A

    1984-11-01

    According to the current knowledge of diagnosis and classification, a review of 157 patients who had developed leukemia before June 30, 1967 was made. The incidence of acute leukemia decreased slightly among A-bomb survivors in Hiroshima; however, the incidence of acute lymphatic leukemia (ALL) increased. The number of chronic myeloid leukemia (CML) was unchanged. The frequency of CML implied that A-bombing damaged stem cells. Among A-bomb survivors in Nagasaki, although the number of acute non-lymphatic leukemia decreased, the number of ALL was unchanged. Adult T-cell leukemia (ATL) was diagnosed in 7 A-bomb survivors, confirming that Nagasaki is an endemic area for ATL. These preliminary results seem to be of importance in elucidating the mechanism of leukemia developing among A-bomb survivors. (Namekawa, K.).

  15. Review of diagnosis and classification of leukemias that occurred in A-bomb survivors (preliminary report)

    International Nuclear Information System (INIS)

    Matsuo, Tatsuki; Tomonaga, Masao; Ichimaru, Michito; Kamata, Nanao; Kuramoto, Atsushi.

    1984-01-01

    According to the current knowledge of diagnosis and classification, a review of 157 patients who had developed leukemia before June 30, 1967 was made. The total number of acute leukemia slightly decreased among A-bomb survivors in Hiroshima; however, the number of acute lymphatic leukemia (ALL) increased. The number of chronic myeloid leukemia (CML) was unchanged. The frequency of CML implied that A-bombing damaged stem cells in a high incidence. Among A-bomb survivors in Nagasaki, although the number of acute non-lymphatic leukemia decreased, the number of ALL was unchanged. Adult T-cell leukemia (ATL) was diagnosed in 7 A-bomb survivors, confirming that Nagasaki is an endemic area for ATL. These preliminary results seem to be of importance in elucidating the mechanism of leukemia developiong among A-bomb survivors. (Namekawa, K.)

  16. Surgeons agree more on treatment recommendations than on classification of proximal humeral fractures

    DEFF Research Database (Denmark)

    Brorson, Stig; Olsen, Bo Sanderhoff; Frich, Lars Henrik

    2012-01-01

    Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations....

  17. Diagnosis and treatment of patients with nonacid gastroesophageal reflux-induced chronic cough

    Directory of Open Access Journals (Sweden)

    Xianghuai Xu

    2015-01-01

    Full Text Available Gastroesophageal reflux (GER is one of the most common causes of chronic cough, and chronic cough due to GER represents a subtype of GER-related diseases. Gastroesophageal reflux-induced chronic cough (GERC can be divided into two subgroups based on the pH of the GER. Nonacid GERC is less common than acid GERC, and its diagnosis and treatment strategy have not been standardized. However, nonacid GERC usually presents with its unique set of characteristics and features upon diagnosis and treatment in the clinic. Although the underlying molecular mechanism of nonacid GERC is not fully understood, it is considered to be associated with reflux theory, reflex theory and airway hypersensitivity. Multi-channel intraluminal impedance combined with pH monitoring is a promising new technique that can detect both acid and nonacid reflux, and our findings as well as those of others have shown its usefulness in diagnosing nonacid GERC. Development of new diagnostic techniques has led to an increased rate of nonacid GERC diagnosis. We summarize our experience in the diagnosis and treatment of nonacid GERC and provide a guide for future therapeutic approaches.

  18. [Improving diagnosis and treatment of tunnel upper limb neuropathies in miners with vibration disease].

    Science.gov (United States)

    Kir'ianov, V A; Zheglova, A V; Aliev, A F; Krylova, I V; Sukhova, A V

    2011-01-01

    The article presents results of research aimed to diagnosis and treatment of tunnel upper limb neuropathies in mining industry workers subjected to vibration factor. The authors specified diagnostic criteria for early diagnosis of tunnel neuropathies affecting median, ulnar and radial nerves, with the severity evaluation for further adequate treatment.

  19. High-Resolution Manometry Improves the Diagnosis of Esophageal Motility Disorders in Patients With Dysphagia: A Randomized Multicenter Study.

    Science.gov (United States)

    Roman, Sabine; Huot, Laure; Zerbib, Frank; Bruley des Varannes, Stanislas; Gourcerol, Guillaume; Coffin, Benoit; Ropert, Alain; Roux, Adeline; Mion, François

    2016-03-01

    High-resolution manometry (HRM) might be superior to conventional manometry (CM) to diagnose esophageal motility disorders. We aimed to compare the diagnosis performed with HRM and CM and confirmed at 6 months in a multicenter randomized trial. Patients with unexplained dysphagia were randomized to undergo either CM or HRM. Motility disorders were diagnosed using the Castell and Spechler classification for CM and the Chicago classification for HRM. Diagnosis confirmation was based on clinical outcome and response to treatment after 6-month follow-up. The initial diagnosis and percentage of confirmed diagnoses were compared between the two arms (CM and HRM). In total, 247 patients were randomized and 245 analyzed: 122 in the CM arm and 123 in the HRM arm. A manometric diagnosis was more frequently initially achieved with HRM than with CM (97% vs. 84%; Pesophageal motility disorders could be identified earlier with HRM than with CM (ClinicalTrial.gov, NCT01284894).

  20. Complex radiological diagnosis and choice of a method of surgical treatment of the lung and the liver hydatidosis

    International Nuclear Information System (INIS)

    Ikramov, A.I.

    2003-01-01

    In dissertation work there were analyzed results of diagnosis and surgical treatment 1.741 patients with lung and liver hydatidosis. The investigations were executed with application of a complex of radiologic methods such X-ray, sonography, CT and MRI tomography. Were analyzed separate and cumulative information of the listed methods on the basis of their sensitivity, specificity and general accuracy. The questions of classification of complicated forms of the lung hydatidosis and criteria to differential diagnosis of spherical lung formations and liver focal formations are discussed. The technique of transthoracic sonography for revealing and differential diagnostics subpleural localization of the hydatidosis and congestions of a liquid in pleural cavity is developed. The indications and contraindications to use transcutaneus fine needle biopsy for diagnostics of the hydatidosis are determined. On the basis of results of complex X-ray diagnostics the original algorithms of a sequence of performance various methods of visualization are developed. The indications to performance pancreatocholangiography are proved at suspicion on ruptured hydatid cysts into biliar tract with mechanical jaundice. The analysis of results of traditional surgical treatment of the hydatidosis, and low invasive transcutaneus procedures, endovisual surgical operations and chemotherapy is carried out. The indications to performance of the listed methods are developed depending on the form and stage of disease, localization of cysts. Were analyzed results of transcutaneus aspiration and drainage of residual cavities after hydatidectomy. The comparative estimation to traditional surgical methods, CT- and US-guided transcutaneus aspirations, drainage is given. Are determined a role and place of complex radiological diagnosis with use sonography, X-ray and CT in early and late postoperative complications after hydatidectomy from the lung and liver (pleural effusion, subdiaphragmal abscess and

  1. Accuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery.

    Science.gov (United States)

    Parnell, Aimee S; Shults, Justine; Gaynor, J William; Leonard, Mary B; Dai, Dingwei; Feudtner, Chris

    2014-02-01

    Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear. We performed a retrospective cohort study of all 14,098 patients 0 to 5 years of age undergoing any of six selected congenital heart operations, ranging in complexity from isolated closure of a ventricular septal defect to single-ventricle palliation, at 40 tertiary-care pediatric centers in the Pediatric Health Information Systems database between 2007 and 2010. Assigned APR-DRGs (cardiac versus noncardiac) were compared using χ2 or Fisher's exact tests between those patients admitted during the first day of life versus later and between those receiving extracorporeal membrane oxygenation support versus those not. Recursive partitioning was used to assess the greatest determinants of APR-DRG type in the model. Every patient admitted on day 1 of life was assigned to a noncardiac APR-DRG (pDRG (pDRG experienced a significantly increased mortality (pDRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Diagnosis as a social determinant: the development of prosocial behaviour before and after an autism spectrum diagnosis.

    Science.gov (United States)

    Russell, Ginny; Kelly, Susan E; Ford, Tamsin; Steer, Colin

    2012-11-01

    Jutel and Nettleton (2011) discuss diagnosis as not only a major classification tool for medicine but also an interactive social process that itself may have ramifications for health. Consideration of diagnosis as a social determinant of health outcomes led to the formulation of our research question: Can we detect a change in the development of prosocial symptoms before and after an Autism Spectrum Disorder (ASD) diagnosis? We examined the developmental trajectory of prosocial skills of children, as impairment in social skills is given as a core symptom for children with ASD. We used a validated scale measuring prosocial behaviour for a sample of 57 children where the measure was repeatedly recorded over ten years. We plotted the developmental trajectory of the prosocial trait in this sample who were enrolled in a longitudinal birth cohort study based in South West England. Multi-factorial fixed effect modelling suggests that the developmental trajectory of this measure of behaviour was not significantly altered by ASD diagnosis, or the consequences of diagnosis, either for better or worse. Further analysis was conducted on a subset of 33 of the children who had both pre-diagnosis and post-diagnosis information, and the same result obtained. The results indicate that prosocial behaviours may be resistant to typical 'treatments': provision of educational and specialist health services triggered by a clinical ASD diagnosis. The implications of this for considering diagnosis as a social determinant are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Diagnosis and classification of Goodpasture's disease (anti-GBM).

    Science.gov (United States)

    Hellmark, Thomas; Segelmark, Mårten

    2014-01-01

    Goodpasture's disease or anti-glomerular basement membrane disease (anti-GBM-disease) is included among immune complex small vessel vasculitides. The definition of anti-GBM disease is a vasculitis affecting glomerular capillaries, pulmonary capillaries, or both, with GBM deposition of anti-GBM autoantibodies. The disease is a prototype of autoimmune disease, where the patients develop autoantibodies that bind to the basement membranes and activate the classical pathway of the complement system, which start a neutrophil dependent inflammation. The diagnosis of anti-GBM disease relies on the detection of anti-GBM antibodies in conjunction with glomerulonephritis and/or alveolitis. Overt clinical symptoms are most prominent in the glomeruli where the inflammation usually results in a severe rapidly progressive glomerulonephritis. Despite modern treatment less than one third of the patients survive with a preserved kidney function after 6 months follow-up. Frequencies vary from 0.5 to 1 cases per million inhabitants per year and there is a strong genetic linkage to HLA-DRB1(∗)1501 and DRB1(∗)1502. Essentially, anti-GBM disease is now a preferred term for what was earlier called Goodpasture's syndrome or Goodpasture's disease; anti-GBM disease is now classified as small vessel vasculitis caused by in situ immune complex formation; the diagnosis relies on the detection of anti-GBM in tissues or circulation in conjunction with alveolar or glomerular disease; therapy is effective only when detected at an early stage, making a high degree of awareness necessary to find these rare cases; 20-35% have anti-GBM and MPO-ANCA simultaneously, which necessitates testing for anti-GBM whenever acute test for ANCA is ordered in patients with renal disease. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Dactylitis in psoriatic arthritis: clinical features, diagnosis, immunopathogenesis, and treatment

    Directory of Open Access Journals (Sweden)

    T. V. Korotaeva

    2018-01-01

    Full Text Available When dactylitis is detected in a patient with psoriatic arthritis (PsA, it is necessary to use active treatment as soon as possible, since in the absence of therapy the disease progresses to joint erosion and  functional disorders. The paper considers the clinical signs and  diagnosis of PsA and notes the importance of differential diagnosis in this sign with other joint inflammatory diseases. It points to the  necessity of elaborating common approaches to an objective  assessment of the severity of dactylitis. Its immunopathogenesis and main treatment areas, including the use of biological agents (BAs,  are detailed. There are data of clinical trials that have evaluated the  efficiency of treatment for dactylitis and established that in most  cases, the use of BAs considerably reduce not only the severity of its clinical signs, but also concomitant bone marrow edema. It is noted  that the development of new pathogenetic treatments targeting a number of currently established biologically active molecules that  play an important role in the pathogenesis of dactylitis will enhance  the efficiency of treatment in patients with PsA.

  5. The diagnosis and treatment of dermatitis herpetiformis

    Directory of Open Access Journals (Sweden)

    Antiga E

    2015-05-01

    Full Text Available Emiliano Antiga, Marzia Caproni Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy Abstract: Dermatitis herpetiformis (DH is an inflammatory cutaneous disease with a chronic relapsing course, pruritic polymorphic lesions, and typical histopathological and immunopathological findings. According to several evidences, DH is considered the specific cutaneous manifestation of celiac disease, and the most recent guidelines of celiac disease have stated that, in celiac patients with a proven DH, a duodenal biopsy is unnecessary for the diagnosis. In this review, the most recent data about the diagnosis and the management of DH have been reported and discussed. In particular, in patients with clinical and/or histopathological findings suggestive for DH, the finding of granular IgA deposits along the dermal–epidermal junction or at the papillary tips by direct immunofluorescence (DIF assay, together with positive results for anti-tissue transglutaminase antibody testing, allows the diagnosis. Thereafter, a gluten-free diet should be started in association with drugs, such as dapsone, that are able to control the skin manifestations during the first phases of the diet. In conclusion, although DH is a rare autoimmune disease with specific immunopathological alterations at the skin level, its importance goes beyond the skin itself and may have a big impact on the general health status and the quality of life of the patients. Keywords: dermatitis herpetiformis, celiac disease, diagnosis, treatment, autoimmune disease, inflammatory cutaneous disease 

  6. [New International Classification of Chronic Pancreatitis (M-ANNHEIM multifactor classification system, 2007): principles, merits, and demerits].

    Science.gov (United States)

    Tsimmerman, Ia S

    2008-01-01

    The new International Classification of Chronic Pancreatitis (designated as M-ANNHEIM) proposed by a group of German specialists in late 2007 is reviewed. All its sections are subjected to analysis (risk group categories, clinical stages and phases, variants of clinical course, diagnostic criteria for "established" and "suspected" pancreatitis, instrumental methods and functional tests used in the diagnosis, evaluation of the severity of the disease using a scoring system, stages of elimination of pain syndrome). The new classification is compared with the earlier classification proposed by the author. Its merits and demerits are discussed.

  7. Heuristic approach to the classification of postpartum endometritis and its forms

    Directory of Open Access Journals (Sweden)

    E. A. Balashova

    2017-01-01

    Full Text Available Тhe work is dedicated to the development of a method of automated medical diagnosis based on the description of biomedical systems using two parameters: energy, reflecting the interaction of its elements, and entropy characterizing the organization of the system. The violations of the energy-entropy cycle of biomedical systems is reflected in the symptoms of the disease. Statistical link between the symptoms of the condition of the body and the nature of excitation of its elements best expressed in the heuristic description of the system state. High accuracy classification of the patient's condition is achieved by using heuristic detection methods. In the proposed approach, allowing to estimate the probability of correct diagnosis increases the accuracy of the classification, and the estimated minimum amount of training samples and the capacity of its constituent signs. Classification technique consists in averaging the characteristic values in the selected classes, the preparation of the complex of symptoms of the most important signs of the disease, to conduct a "rough" diagnostic threshold rules that allow to distinguish severe forms of the disease, then differential diagnosis the severity of the disease. The proposed method was tested for classification of the forms of puerperal endometritis (mild, moderate, severe. The training sample contained 70 case histories. Syndrome to classify the patient's condition was composed of 17 characteristics. Threshold diagnosis has allowed to establish the presence of disease and to separate heavy. Differential diagnosis was used for classification of mild and moderate severity of postpartum endometritis. The accuracy of the classification of forms of postpartum endometritis amounted to 97.1%.

  8. Evaluation of classification method of lung lobe for multi-slice CT images

    International Nuclear Information System (INIS)

    Sakurai, Kousuke; Matsuhiro, Mikio; Saita, Shinsuke

    2010-01-01

    Recently, due to the introduction of multi-slice CT, to obtain a high resolution 3D CT image is possible in a short time. The temporal and spatial resolutions are high, so a highly accurate 3D image analysis is possible. To develop a structure analysis of the lung is needed and to be used as a fundamental technology for early detection of the disease. By separating the lung into lung lobes may provide important information for analysis, diagnosis and treatment of lung diseases. Therefore in this report, we adapt to abnormality example with the classification algorithms using the anatomical information of the bronchus, the pulmonary vein and interlobar fissure information, we evaluate the classification. (author)

  9. Bosniak Classification system

    DEFF Research Database (Denmark)

    Graumann, Ole; Osther, Susanne Sloth; Karstoft, Jens

    2014-01-01

    Background: The Bosniak classification is a diagnostic tool for the differentiation of cystic changes in the kidney. The process of categorizing renal cysts may be challenging, involving a series of decisions that may affect the final diagnosis and clinical outcome such as surgical management....... Purpose: To investigate the inter- and intra-observer agreement among experienced uroradiologists when categorizing complex renal cysts according to the Bosniak classification. Material and Methods: The original categories of 100 cystic renal masses were chosen as “Gold Standard” (GS), established...... to the calculated weighted κ all readers performed “very good” for both inter-observer and intra-observer variation. Most variation was seen in cysts catagorized as Bosniak II, IIF, and III. These results show that radiologists who evaluate complex renal cysts routinely may apply the Bosniak classification...

  10. Diagnosis and treatment of upper limb apraxia

    OpenAIRE

    Dovern, A.; Fink, G. R.; Weiss, P. H.

    2012-01-01

    Upper limb apraxia, a disorder of higher motor cognition, is a common consequence of left-hemispheric stroke. Contrary to common assumption, apraxic deficits not only manifest themselves during clinical testing but also have delirious effects on the patients’ everyday life and rehabilitation. Thus, a reliable diagnosis and efficient treatment of upper limb apraxia is important to improve the patients’ prognosis after stroke. Nevertheless, to date, upper limb apraxia is still an underdiagnosed...

  11. [Gorlin-Goltz Syndrome: Diagnosis and Treatment Options].

    Science.gov (United States)

    Mendes-Abreu, João; Pinto-Gouveia, Miguel; Tavares-Ferreira, Cátia; Brinca, Ana; Vieira, Ricardo

    2017-05-31

    The Gorlin-Goltz syndrome is a rare autosomal dominant hereditary condition, with complete penetrance and variable expressivity. Characterized by the appearance of multiple basaliomas, and often the development of keratocyst, it can also express itself by the presence of palmar/plantar depressions, calcification of brain sickle, and skeletal birth defects, although less frequently. This article presents two cases involving direct relatives, referred after the identification of several basaliomas and jaw cysts. After establishing the diagnosis, given the identification of three major criteria, the treatment consisted in the excision of the lesions followed, in one case, with vismodegib treatment resulting in complete remission. Gorlin-Goltz syndrome is therefore a multidisciplinary challenge, whose variable morbidity and high risk of recurrence make treatment and surveillance critical. However, new molecular targeted therapies have brought a new hope in treating these patients.

  12. Niewydolność serca - definicja, klasyfikacja, epidemiologia, objawy i leczenie = Heart failure - definition, classification, epidemiology, symptoms and treatment

    Directory of Open Access Journals (Sweden)

    Beata Kowalczyk

    2017-02-01

      Streszczenie   W ciągu ostatnich 50 lat pojawiło się wiele określeń niewydolności serca. Dokonał się również znaczący postęp w postrzeganiu i leczeniu tej choroby. Skuteczność leczenia i rehabilitacji przekłada się na redukcję klasy NYHA i poprawę frakcji wyrzutowej lewej komory serca. Istotnie poprawiło się rokowanie chorych z umiarkowaną i ciężką postacią niewydolności. Kluczem do wczesnego rozpoznania niewydolności serca są jej objawy przedmiotowe i podmiotowe. Niestety pomimo ogromnego rozwoju medycyny niewydolność serca jest nadal poważnym problemem klinicznym, społecznym i ekonomicznym. Liczba zachorowań stale rośnie. W kompleksowej opiece nad pacjentem z niewydolnością serca oprócz leczenia farmakologicznego znaczącą rolę odgrywa odpowiednie przygotowanie chorego do życia z niewydolnością serca. Celem artykułu jest podsumowanie zagadnień definicji, klasyfikacji, epidemiologii, objawów i leczenia niewydolności serca.   Słowa kluczowe: niewydolność serca, definicja, klasyfikacja, epidemiologia, leczenie.     Abstract   In the last 50 years there have been many definitions of heart failure. It has been made significant progress in the perception and treatment of the disease. The effectiveness of treatment and rehabilitation translates into a reduction in NYHA class and improve the ejection fraction of the left ventricle. Significantly improved the prognosis in patients with moderate or severe heart failure. The key to early diagnosis of heart failure are its signs and symptoms. Heart failure unfortunately continues despite the enormous development of medicine is serious clinical, social and economic problem. The number of cases continues to grow. In the comprehensive care of patients with heart failure in addition to pharmacological treatment plays an important role adequate preparation of the patient to live with heart failure. Objectives of this article is a summary of issues of definition

  13. Hand eczema classification

    DEFF Research Database (Denmark)

    Diepgen, T L; Andersen, Klaus Ejner; Brandao, F M

    2008-01-01

    of the disease is rarely evidence based, and a classification system for different subdiagnoses of hand eczema is not agreed upon. Randomized controlled trials investigating the treatment of hand eczema are called for. For this, as well as for clinical purposes, a generally accepted classification system...... A classification system for hand eczema is proposed. Conclusions It is suggested that this classification be used in clinical work and in clinical trials....

  14. Reliability of a treatment-based classification system for subgrouping people with low back pain.

    Science.gov (United States)

    Henry, Sharon M; Fritz, Julie M; Trombley, Andrea R; Bunn, Janice Y

    2012-09-01

    Observational, cross-sectional reliability study. To examine the interrater reliability of novice raters in their use of the treatment-based classification (TBC) system for low back pain and to explore the patterns of disagreement in classification errors. Although the interrater reliability of individual test items in the TBC system is moderate to good, some error persists in classification decision making. Understanding which classification errors are common could direct further refinement of the TBC system. Using previously recorded patient data (n = 24), 12 novice raters classified patients according to the TBC schema. These classification results were combined with those of 7 other raters, allowing examination of the overall agreement using the kappa statistic, as well as agreement/disagreement among pairwise comparisons in classification assignments. A chi-square test examined differences in percent agreement between the novice and more experienced raters and differences in classification distributions between these 2 groups of raters. Among 12 novice raters, there was 80.9% agreement in the pairs of classification (κ = 0.62; 95% confidence interval: 0.59, 0.65) and an overall 75.5% agreement (κ = 0.57; 95% confidence interval: 0.55, 0.69) for the combined data set. Raters were least likely to agree on a classification of stabilization (77.5% agreement). The overall percentage of pairwise classification judgments that disagreed was 24.5%, with the most common disagreement being between manipulation and stabilization (11.0%), followed by a mismatch between stabilization and specific exercise (8.2%). Additional refinement is needed to reduce rater disagreement that persists in the TBC decision-making algorithm, particularly in the stabilization category. J Orthop Sports Phys Ther 2012;42(9):797-805, Epub 7 June 2012. doi:10.2519/jospt.2012.4078.

  15. Self-inflicted lesions in dermatology: terminology and classification--a position paper from the European Society for Dermatology and Psychiatry (ESDaP)

    NARCIS (Netherlands)

    Gieler, Uwe; Consoli, Sylvie G.; Tomás-Aragones, Lucía; Linder, Dennis M.; Jemec, Gregor B. E.; Poot, Francoise; Szepietowski, Jacek C.; de Korte, John; Taube, Klaus-Michael; Lvov, Andrey; Consoli, Silla M.

    2013-01-01

    The terminology, classification, diagnosis and treatment of self-inflicted dermatological lesions are subjects of open debate. The present study is the result of various meetings of a task force of dermatologists, psychiatrists and psychologists, all active in the field of psychodermatology, aimed

  16. Mexican Guidelines on the Diagnosis and Treatment of Urticaria

    Directory of Open Access Journals (Sweden)

    Désirée Larenas-Linnemann

    2014-11-01

    Full Text Available Background: Urticaria is a disease that a fth of the population shall suffer once in a lifetime. Recent clinical guidelines have proposed some fundamental changes in the diagnosis and treatment of urticaria, making the development of a national, multidisciplinary guideline, with wide acceptability among different professional groups –both specialists and primary health care workers–, necessary in Mexico. Material and method: Internationally recognized tools for guideline- development were used. An interdisciplinary group of clinical experts (some of them knowledgeable in methodology of guideline develop- ment determined the objectives and scope of the Evidence Based Clinical Practice Guideline with SCOPE. It was decided to adapt and transculturize international guidelines on the diagnosis and treatment of urticaria. With AGREE-II three high-quality guidelines (Zuberbier 2014, Sánchez-Borges 2012, Powell 2007 were selected to function as basic guidelines (BG. A set of Clinical Questions was formulated that lead to recommendations/suggestions, based on these BG, taking into account the cultural and economic background of Mexico, according to GRADE recommendation development. Results: By a formal process of discussion and voting during several working-sessions, experts and rst level healthcare physicians deter- mined the wording of the nal guideline, taking particularly care of developing a document, adjusted to the reality, values and preferences of the Mexican patients. The use of oral second generation, non-sedating antihistamines as rst line treatment is emphasized. Conclusion: This document is an Evidence Based Clinical Practice Guideline for the diagnosis and treatment of acute and chronic urticaria, based on three, high quality, international guidelines. It was developed by a multidisciplinary group. Tables and algorithms make the guideline user-friendly for both, rst line health care physicians and specialists

  17. Delayed diagnosis in pediatric headache: an outpatient Italian survey.

    Science.gov (United States)

    Colombo, Bruno; Dalla Libera, Dacia; De Feo, Donatella; Pavan, Giulia; Annovazzi, Pietro Osvaldo; Comi, Giancarlo

    2011-09-01

    The aim of this prospective study is to assess the time lapse between the onset of recurring headache and the correct diagnosis in a cohort of pediatric patients attending an Italian children's headache center for the first time. One hundred and one patients and parents, referred to the Pediatric Headache Centre of San Raffaele Hospital in Milan, Italy, underwent a semi-structured interview to ascertain features of headache since onset (clinical and family history, presence of childhood periodic syndromes, previously undergone instrumental exams and specialists' examinations before the correct diagnosis, past and current treatment). All patients were evaluated by expert neurologists and their headache was classified according to the International Classification of Headache Disorders II (2004). The median time delay from the onset of the first episode of recurrent headache to definite diagnosis was 20 months (interquartile range 12 to 36 months). A correlation with younger age and a more delayed headache diagnosis was found (r Spearman = 0.25; P = .039). An association between diagnostic delay and positive family history (median 24 months [12 to 48] vs 12 [6 to 24]; P = .014) or female gender (median 18 months [12 to 42] vs. 12 [5 to 30]; P trend = .070) was also evident. Notably, 76 out of 101 patients referred to our Center received an appropriate diagnosis according to International Classification of Headache Disorders II at the time of our visit only. Of note, up to 21% of this group were previously misdiagnosed (for epilepsy 43%, sinusitis 38%, or other diseases 19%), a fact that contributed to a longer time of clinical assessment (median 39 months) before reaching a correct diagnosis. The other group of 80 patients (79%) did not receive a specific diagnosis and treatment, and were not studied until their symptom became chronic and disabling. Pediatric headache is still under-diagnosed and not adequately considered as a health problem in the

  18. Experience in treatment of hyperthyroidism with I-131 diagnosis, patient preparation and therapeutic procedure

    International Nuclear Information System (INIS)

    Zhongyun, Pan

    2003-01-01

    Treatment of hyperthyroidism with I-131 diagnosis is being performed after clinical diagnosis of thyrotoxicosis based on clinical manifestations of hypermetabolic state, serumT3 and T4 determination; medical preparation of patients and therapeutic procedure is obtained for better efficacy, relieve symptoms and prevent aggravation of thyrotoxicosis after I-131 treatment

  19. The impact of the latest classification system of benign vulvar diseases on the management of women with chronic vulvar pruritus

    Directory of Open Access Journals (Sweden)

    Kiymet Handan Kelekci

    2011-01-01

    Full Text Available Background: The management of women with chronic benign vulvar dermatoses has been one of the most difficult and challenging aspects of women′s healthcare for a long time. Aim: Our aim was to compare the ability to approach the specific diagnosis of nonneoplastic and noninfectious vulva diseases, between the new classification system and the old classification system. Methods: One hundred women with chronic vulvar pruritus were included in the study. After detailed examination of the vulva, all visible lesions were biopsied, with normal skin included. All specimens was sent for dermatopathology and examined simultaneously under a binocular microscope by two pathologists. Specific diagnosis if possible and histopathological findings were classified according to both the 1987 and 2006 International Society for the Study of Vulvar Diseases (ISSVD classifications. The ratios that were able to be approached on the specific diagnosis, with the aid the two classification systems, were compared. Results: Specific clinical diagnosis by both pathological and after using clinicopathological correlation was possible in 69 out of 91 patients (75.8% according to the 1987 ISSVD classification, and in 81 out of 91 patients (89.0% according to the ISSVD 2006 classification system. The difference in the clinical diagnosis ratios between the two classification systems was statistically significant ( P < 0.05. In a subgroup of women without specific diagnosis at the time of pathological examination, clinical diagnosis was made in 28 out of 50 women (56% after using the clinicopathological correlation according to the ISSVD 1987 classification, whereas, specific diagnosis was made in 39 out of 49 (79.6% women after using the clinicopathological correlation according to the ISSVD 2006 classification. The difference was statistically significant in terms of the ratio of the ability to achieve a specific diagnosis ( P < 0.01. Conclusion: ISSVD 2006 classification of

  20. Current classification, treatment options, and new perspectives in the management of adipocytic sarcomas

    Directory of Open Access Journals (Sweden)

    De Vita A

    2016-10-01

    Full Text Available Alessandro De Vita,1 Laura Mercatali,1 Federica Recine,1 Federica Pieri,2 Nada Riva,1 Alberto Bongiovanni,1 Chiara Liverani,1 Chiara Spadazzi,1 Giacomo Miserocchi,1 Dino Amadori,1 Toni Ibrahim1 1Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST IRCCS, Meldola, FC, 2Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy Abstract: Sarcomas are a heterogeneous group of mesenchymal tumors arising from soft tissue or bone, with an uncertain etiology and difficult classification. Soft tissue sarcomas (STSs account for around 1% of all adult cancers. Till date, more than 50 histologic subtypes have been identified. Adipocyte sarcoma or liposarcoma (LPS is one of the most common STS subtypes, accounting for 15% of all sarcomas, with an incidence of 24% of all extremity STSs and 45% of all retroperitoneal STSs. The new World Health Organization classification system has divided LPS into four different subgroups: atypical lipomatous tumor/well-differentiated LPS, dedifferentiated LPS, myxoid LPS, and pleomorphic LPS. These lesions can develop at any location and exhibit different aggressive potentials reflecting their morphologic diversity and clinical behavior. Patients affected by LPS should be managed in specialized multidisciplinary cancer centers. Whereas surgical resection is the mainstay of treatment for localized disease, the benefits of adjuvant and neoadjuvant chemotherapy are still unclear. Systemic treatment, particularly chemotherapy, is still limited in metastatic disease. Despite the efforts toward a better understanding of the biology of LPS, the outcome of advanced and metastatic patients remains poor. The advent of targeted therapies may lead to an improvement of treatment options and clinical outcomes. A larger patient enrollment into translational and clinical studies will help increase the knowledge of the biological behavior of LPSs, test new drugs, and introduce new

  1. Neuroendocrine tumors: a review of the clinical aspects, diagnosis and treatment

    International Nuclear Information System (INIS)

    Rodriguez Fernandez, Lisbet; Hernandez Yero, Arturo; Pina Rivera, Yordanka; Yanes Quesada, Marelys

    2008-01-01

    The study of neuroendocrine tumors has been object of interests by medical science. Different methods have been developed for their diagnosis, treatment and prognosis, each of them with its advantages and inconveniences. The published results are based on the experience of other countries, and it would be very useful to apply them in our country to get closer to the real incidence of these tumors in our environment and to have an adequate treatment of the patients affected with this disease. The objective of this paper is to offer a view of the current trends as regards the clinical aspects, the diagnosis and treatment of the neuroendocrine tumors that serves as a working tool for medical practice and for the teaching activity of the physicians related to this topic

  2. Sportsman hernia; the review of current diagnosis and treatment modalities.

    Science.gov (United States)

    Paksoy, Melih; Sekmen, Ümit

    2016-01-01

    Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.

  3. Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective

    Directory of Open Access Journals (Sweden)

    Changbo Zhao

    2015-01-01

    data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification.

  4. A classification tree for the prediction of benign versus malignant disease in patients with small renal masses.

    Science.gov (United States)

    Rendon, Ricardo A; Mason, Ross J; Kirkland, Susan; Lawen, Joseph G; Abdolell, Mohamed

    2014-08-01

    To develop a classification tree for the preoperative prediction of benign versus malignant disease in patients with small renal masses. This is a retrospective study including 395 consecutive patients who underwent surgical treatment for a renal mass classification tree to predict the risk of having a benign renal mass preoperatively was developed using recursive partitioning analysis for repeated measures outcomes. Age, sex, volume on preoperative imaging, tumor location (central/peripheral), degree of endophytic component (1%-100%), and tumor axis position were used as potential predictors to develop the model. Forty-five patients (11.4%) were found to have a benign mass postoperatively. A classification tree has been developed which can predict the risk of benign disease with an accuracy of 88.9% (95% CI: 85.3 to 91.8). The significant prognostic factors in the classification tree are tumor volume, degree of endophytic component and symptoms at diagnosis. As an example of its utilization, a renal mass with a volume of classification tree to predict the risk of benign disease in small renal masses has been developed to aid the clinician when deciding on treatment strategies for small renal masses.

  5. Equilibrium disorders in elderly: diagnostic classification and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Alessandro Castiglione

    2013-04-01

    Full Text Available Background: Balance is primarily related to the proper functioning of three sensory input: vestibular, visual and proprioceptive. The integration of these different afferences contributes to the proper attitude of the body in static and dynamic conditions. Equilibrium disorders are common among elderly patients and are responsible for falls and fractures, leading sometimes to catastrophic outcomes, representing a serious health and social problem. Approximately one third of elderly patients at home and about 50% of institutionalized, over 75 year-old, suffer from this particular condition, with at least one fall a year and almost 50% of these with recurrent episodes. Females are more affected than males. Attempts to ascertain the underlying cause of unbalance should be done, leading then to specific treatment. Nevertheless, many elderly patients do not have a single disease but rather a multitude of medical conditions which may cause dizziness, imbalance and vertigo: effects of ageing, drugs, cardiovascular and neurological disorders, ocular and orthopaedic diseases. Aim of the study: A literature review was carried out with the intention to offer practical and useful notions for the management and treatment of equilibrium disorders. Discussion: In clinical practice, the main challenge is to distinguish between peripheral and central imbalance disorders. The data collected from history and clinical exams should be integrated with the intent to include the patient in one of the following clinical conditions: vertiginous syndrome, pre-syncope and/or syncope, neurological diseases, other conditions.Conclusions: Following the differential diagnosis, treatment mainly consists in drug administration (antiemetic and vestibular suppressor drugs and vestibular rehabilitation (physiotherapy and vestibular exercises.

  6. Experience of diagnosis and treatment of Gitelman syndrome

    Directory of Open Access Journals (Sweden)

    Shuo TIAN

    2017-12-01

    Full Text Available Objective To analyze the clinical characteristics and provide the experiences in diagnosis and treatment of 3 cases of Gitelman syndrome (GitS. Methods Three patients diagnosed as GitS were selected as the objects in Tangshan gongren Hospital from Aug. 2010 to Jan. 2017. Their clinical data were retrospectively analyzed and combined with the related literatures, and the clinical characteristics and treatment experiences of the disease were discussed. Results Of the 3 patients, 2 were teenager onset and another one was adult onset. The blood pressure of the 3 patients was normal, and the clinical features were as paroxysmal weakness, tetany, polyuria and nocturia increased. Laboratory tests revealed low potassium, low sodium, low chlorine, hypomagnesemia, occasionally hypocalcemia, high urinary potassium, metabolic alkalosis, urine Ca/Cr ≤0.2, plasma rennin activity increased significantly and plasma aldosterone was normal. Being eliminated symptoms and phenomena were the potassium intake inadequate, loss of potassium in digestive tract, taking potassium excretion drugs, primary aldosteronism and Cushing syndrome. etc. Patients got symptoms relief and serum potassium level rose to near normal level after receiving the combined potassium and magnesium supplement. Conclusions The clinical characteristics of GitS manifest as fatigue, tetany, normal blood pressure, hypokalemia, hypomagnesemia, metabolic alkalosis, plasma rennin activity increases significantly and plasma aldosterone rises or normal. Treatment with combined potassium and magnesium supplement may lead to a good prognosis, but hypomagnesemia is harder to correct. Kidney damage can be avoided by early diagnosis and treatment. DOI: 10.11855/j.issn.0577-7402.2017.12.13

  7. Heterogeneity of European DRG systems and potentials for a common EuroDRG system: Comment on "Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries"

    OpenAIRE

    Geissler, Alexander; Quentin, Wilm; Busse, Reinhard

    2015-01-01

    Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring...

  8. Diagnosis and treatment of gastroesophageal reflux disease

    Science.gov (United States)

    Badillo, Raul; Francis, Dawn

    2014-01-01

    Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis, peptic stricture, Barrett’s esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification, medical therapy and surgical therapy. Lifestyle modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease. PMID:25133039

  9. Gastric cancer diagnosis and treatment guidelines 2008: Uganda ...

    African Journals Online (AJOL)

    In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the ...

  10. Tuberculous Meningitis: Diagnosis and Treatment Overview

    Directory of Open Access Journals (Sweden)

    Grace E. Marx

    2011-01-01

    Full Text Available Tuberculous meningitis (TBM is the most common form of central nervous system tuberculosis (TB and has very high morbidity and mortality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Characteristic cerebrospinal fluid (CSF findings of TBM include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose. CSF acid-fast smear and culture have relatively low sensitivity but yield is increased with multiple, large volume samples. Nucleic acid amplification of the CSF by PCR is highly specific but suboptimal sensitivity precludes ruling out TBM with a negative test. Treatment for TBM should be initiated as soon as clinical suspicion is supported by initial CSF studies. Empiric treatment should include at least four first-line drugs, preferably isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol; the role of fluoroquinolones remains to be determined. Adjunctive treatment with corticosteroids has been shown to improve mortality with TBM. In HIV-positive individuals with TBM, important treatment considerations include drug interactions, development of immune reconstitution inflammatory syndrome, unclear benefit of adjunctive corticosteroids, and higher rates of drug-resistant TB. Testing the efficacy of second-line and new anti-TB drugs in animal models of experimental TBM is needed to help determine the optimal regimen for drug-resistant TB.

  11. Gorlin-Goltz Syndrome: Diagnosis and Treatment Options

    Directory of Open Access Journals (Sweden)

    João Mendes-Abreu

    2017-05-01

    Full Text Available The Gorlin-Goltz syndrome is a rare autosomal dominant hereditary condition, with complete penetrance and variable expressivity. Characterized by the appearance of multiple basaliomas, and often the development of keratocyst, it can also express itself by the presence of palmar/plantar depressions, calcification of brain sickle, and skeletal birth defects, although less frequently. This article presents two cases involving direct relatives, referred after the identification of several basaliomas and jaw cysts. After establishing the diagnosis, given the identification of three major criteria, the treatment consisted in the excision of the lesions followed, in one case, with vismodegib treatment resulting in complete remission. Gorlin-Goltz syndrome is therefore a multidisciplinary challenge, whose variable morbidity and high risk of recurrence make treatment and surveillance critical. However, new molecular targeted therapies have brought a new hope in treating these patients.

  12. Diagnosis and treatment with endoscopic retrograde cholangiopancreatography

    International Nuclear Information System (INIS)

    Soendenaa, K.; Horn, A.; Viste, A.

    1994-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) was carried out for the first time in 1968. Five years later endoscopic sphincterotomy was performed. Since then both modalities have become established as necessary adjuncts in the diagnosis and treatment of patients with pathology in the bile duct or pancreas. The main indication is common bile duct stone, and as a consequence of this treatment fewer patients are now treated surgically. Patients with malignant bile duct obstruction can be given reasonable palliation of both jaundice and pruritus and therefore improved quality of life. Some reports indicate that endoscopic drainage may be useful for pancreatic stenosis. Complications are few, but vigilance and prompt treatment is necessary to keep morbidity at a minimum. Follow-up after several years shows that sphincterotomy is successful also in the long term. The authors discuss the present diagnostic and therapeutic situation. 31 refs., 2 tabs

  13. - 1 - Stage at diagnosis, clinicopathological and treatment patterns of ...

    African Journals Online (AJOL)

    Abstract: Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer.

  14. Patient misconceptions concerning lumbar spondylosis diagnosis and treatment.

    Science.gov (United States)

    Franz, Eric W; Bentley, J Nicole; Yee, Patricia P S; Chang, Kate W C; Kendall-Thomas, Jennifer; Park, Paul; Yang, Lynda J S

    2015-05-01

    OBJECT Patient outcome measures are becoming increasingly important in the evaluation of health care quality and physician performance. Of the many novel measures currently being explored, patient satisfaction and other subjective measures of patient experience are among the most heavily weighted. However, these subjective measures are strongly influenced by a number of factors, including patient demographics, level of understanding of the disorder and its treatment, and patient expectations. In the present study, patients referred to a neurosurgery clinic for degenerative spinal disorders were surveyed to determine their understanding of lumbar spondylosis diagnosis and treatment. METHODS A multiple-choice, 6-question survey was distributed to all patients referred to a general neurosurgical spine clinic at a tertiary care center over a period of 11 months as a quality improvement initiative to assist the provider with individualized patient counseling. The survey consisted of questions designed to assess patient understanding of the role of radiological imaging in the diagnosis and treatment of low-back and leg pain, and patient perception of the indications for surgical compared with conservative management. Demographic data were also collected. RESULTS A total of 121 surveys were included in the analysis. More than 50% of the patients indicated that they would undergo spine surgery based on abnormalities found on MRI, even without symptoms; more than 40% of patients indicated the same for plain radiographs. Similarly, a large proportion of patients (33%) believed that back surgery was more effective than physical therapy in the treatment of back pain without leg pain. Nearly one-fifth of the survey group (17%) also believed that back injections were riskier than back surgery. There were no significant differences in survey responses among patients with a previous history of spine surgery compared with those without previous spine surgery. CONCLUSIONS These

  15. Reproducibility of the acute rejection diagnosis in human cardiac allografts. The Stanford Classification and the International Grading System

    DEFF Research Database (Denmark)

    Nielsen, H; Sørensen, Flemming Brandt; Nielsen, B

    1993-01-01

    Transplantation has become an accepted treatment of many cardiac end-stage diseases. Acute cellular rejection accounts for 15% to 20% of all graft failures. The first grading system of acute cellular rejection, the Stanford Classification, was introduced in 1979, and since then many other grading...

  16. Evaluation of the Effect of Consultant Characteristics on Telemedicine Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Ann B. Bynum

    2011-01-01

    Full Text Available This study examined teleconsultants' specialty, practice setting, type of employment, years and training in telemedicine to evaluate the effect of these characteristics on diagnoses and treatment. A postuse survey was conducted during 1998–2003 (n=454 consultations in the University of Arkansas for Medical Sciences' Rural Hospital, Telehealth Project. There were 61 consultants who conducted the teleconsultations. The teleconsultants established a diagnosis in 121 consultations and reported a change in diagnoses in 29 consultations. The consultants established a treatment plan in 219 consultations and reported a change in the treatment plan in 100 consultations. Dermatologists were significantly more likely to establish (P<.01 and change (P=.005 the diagnosis and to establish a treatment plan (P=.03, when compared to all other specialties. Teleconsultants who were self-employed were significantly more likely to change the treatment plan (P=.012. The findings suggest that teleconsultants' characteristics can affect diagnoses and treatment in telemedicine.

  17. Mild Cognitive Impairment: Diagnosis, Longitudinal Course, and Emerging Treatments

    Science.gov (United States)

    Vega, Jennifer N.; Newhouse, Paul A.

    2014-01-01

    Mild cognitive impairment (MCI) is widely regarded as the intermediate stage of cognitive impairment between the changes seen in normal cognitive aging and those associated with dementia. Elderly patients with MCI constitute a high-risk population for developing dementia, in particular Alzheimer’s disease (AD). Although the core clinical criteria for MCI have remained largely unchanged, the operational definition of MCI has undergone several revisions over the course of the last decade and remains an evolving diagnosis. Prognostic implications of this diagnosis are becoming clearer with regard to the risk of progressive cognitive deterioration. Although patients with MCI may represent an optimal target population for pharmacological and non-pharmacological interventions, results from clinical trials have been mixed and a definitive effective treatment remains elusive. This article provides a brief overview of the evolution of the concept of MCI and reviews current diagnostic criteria, the longitudinal course of the disorder, and current and emerging treatments for MCI. PMID:25160795

  18. Angelman Syndrome. Part 3 (Differential Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    O.Ye. Abaturov

    2015-10-01

    Full Text Available The article discusses the problem of differential diagnosis and treatment of patients with Angelman syndrome (AS. It provides the most common syndromes with similar to AS phenotypes, the main differences between AS-like syndromes, indicating the causative gene. Much attention is given to the basic directions of treating patients with Angelman syndrome: organization of regime, syndromic treatment, providing psychological, speech therapy, orthopedic services, occupational therapy, activities aimed at social adaptation. This article contains the latest information about modern progressive directions of AS medical management. To optimize the diagnostic and therapeutic process, data about international Angelman syndrome foundations are shown.

  19. [Symptoms, diagnosis and treatment of pancreaticobiliary maljunction associated with congenital cystic dilatation of bile duct].

    Science.gov (United States)

    Funabiki, T; Matsubara, T; Ochiai, M

    1996-08-01

    The concept of congenital biliary dilatation (CBD) was established by Alonso-Lej whose classification has been widely accepted and become a standard. Todani, Komi and several investigators then added additional subclassifications and/or made a proposal of new classification. The trias, abdominal pain, abdominal mass and jaundice, had been characteristically found in these cases, but recently asymptomatic cases are often found. Many reports have shown that the cases with cystic dilation of the biliary duct frequently associated with biliary carcinoma and pancreaticobiliary maljunction (PBM), an anomalous union of pancreatic duct with biliary tree since the Rabbit's first report. Whereas extracorporeal ultrasound and CT scan are minimally invasive diagnostic procedures for these cases, a direct cholangiography, ERCP and PTC are the diagnostic procedures that make a definite diagnosis for the appropriate treatment. Recently, endoscopic ultrasound (EUS), helical CT and magnetic resonance cholangiopan-creatography (MRCP) have drawn an attention since these methods are less invasive than those ever being used. In particular, MRCP will be suitable for the screening of preoperative examination. Whereas cystoduodenostomy used to be performed in the past for these cases, the resection of dilatted bule duct along with the diversion of bile from pancreatic juice should be performed to prevent biliary carcinoma. Cholecystectomy along with the resection of bile duct and the biliary diversion from pancreatic juice should also be performed for cases of PBM without CBD because mutagenicity of bile mixed with pancreatic juice and K-ras point mutation in noncancerous bile duct epithelium in cases of PBM without CBD were demonstrated.

  20. Further substantial improvement of interventional diagnosis and treatment via portal vein system

    International Nuclear Information System (INIS)

    Yang Weizhu; Chen Yongde

    2006-01-01

    Along with the development of interventional appliances and proficiency of operational skills, the interventional diagnosis and treatment via hepatic portal vein system have achieved great progress and improvement. However, in order to further exploit the advantages of interventional diagnosis and treatment, the review of the anatomical structures, normal aberrance of portal venous system were needed. Getting familiar with pathologic condition to discover the new interventional appliances and embolic agents, and then in term of conduct the research on a very tough substantial base in a down-to-earth manner were important. (authors)

  1. Diagnosis and treatments of Prader-Willi syndrome: a review of current consensuses

    Directory of Open Access Journals (Sweden)

    2014-05-01

    Full Text Available We analyzed international consensuses of experts and clinical recommendations on diagnosis and treatment of Prader-Willi syndrome (PWS: PWS consensus diagnostic criteria (1993; US PWS Association (PWSA-USA consensus statements on evaluating of breathing abnormalities (2007, osteoporosis (2008, growth hormone treatment in PWS (2000 and 2009; Endocrine society clinical practice guideline on Prevention and treatment of pediatric obesity (2008; the Second Expert Meeting of the Comprehensive Care of Patients with PWS Consensus published as Recommendations for the diagnosis and management of PWS (2008. Historical analysis and comparison of recommendations are presented in this review article. Absence of Russian clinical practice guidelines on PWS patients management makes necessary the detailed study of listed documents.

  2. Differential diagnosis and treatment of periodontitis-mimicking actinomycosis.

    Science.gov (United States)

    Kim, Nam Ryang; Park, Jun-Beom; Ko, Youngkyung

    2012-12-01

    Actinomycosis is an uncommon chronic granulomatous disease that presents as a slowly progressive, indolent, indurated infiltration with multiple abscesses, fistulas, and sinuses. The purpose of this article is to report on a case of actinomycosis with clinical findings similar to periodontitis. A 46-year-old female presented with recurrent throbbing pain on the right first and second molar of the mandible three weeks after root planing. Exploratory flap surgery was performed, and the bluish-gray tissue fragment found in the interproximal area between the two molars was sent for histopathology. The diagnosis from the biopsy was actinomycosis. The clinical and radiographic manifestations of this case were clinically indistinguishable from periodontitis. The patient did not report any symptoms, and she is scheduled for a follow-up visit. The present study has identified periodontitis-mimicking actinomycosis. Actinomycosis should be included in the differential diagnosis in cases with periodontal pain and inflammation that do not respond to nonsurgical treatment for periodontitis. More routine submissions of tissue removed from the oral cavity for biopsies may be beneficial for differential diagnosis.

  3. Psychological effects of diagnosis and treatment of cervical intraepithelial neoplasia

    DEFF Research Database (Denmark)

    Frederiksen, Maria Eiholm; Njor, Sisse; Lynge, Elsebeth

    2015-01-01

    BACKGROUND: Treatment of cervical intraepithelial neoplasia (CIN) is a common minor surgical procedure to prevent uterine cervical cancer. However, news of an abnormality detected at screening for cancer might cause the woman to worry. OBJECTIVES: To investigate the psychological consequences...... test results, but the impact decreased over time. In several but not all studies, CIN appeared to have similar psychological consequences to abnormal smears. No study showed a difference in psychological outcomes between CIN and cervical cancer diagnosis when these were measured some years after...... psychological outcomes in women with a histological diagnosis or treatment of CIN, and in women having an outcome other than CIN at cervical screening. DATA COLLECTION AND ANALYSIS: We abstracted the data using a pre-specified list of study characteristics and measured outcomes. For studies not reporting...

  4. Diagnosis and management of vascular diseases

    International Nuclear Information System (INIS)

    Fan Xindong; Zheng Lianzhou

    2011-01-01

    Vascular disorders mainly include hemangiomas and vascular malformations, and constitute some of the most difficult diagnostic and therapeutic enigmas that can be encountered in the clinical practice. The clinical presentations are extremely variable and can range from an asymptomatic birthmark to life-threatening congestive heart failure. Attributing any of these extremely varied symptoms that a patients may present with to a vascular malformation may be a challenge to the most experienced clinical. This problem is compounded by the extreme rarity of these vascular lesions. If a clinician meets such a patient once every few years, it will be extremely difficult for the physicians to gain a steep learning curve. In such circumstances, it is difficult to formulate a standard of diagnosis and treatment for these vascular disorders. This paper aims to make a comprehensive and detailed description of the classification and diagnosis of the vascular disorders, the common used embolization agents, the concepts of interventional diagnosis and management and the therapies of various hemangiomas and vascular malformations. (authors)

  5. Computer-Aided Diagnosis Based on Convolutional Neural Network System for Colorectal Polyp Classification: Preliminary Experience.

    Science.gov (United States)

    Komeda, Yoriaki; Handa, Hisashi; Watanabe, Tomohiro; Nomura, Takanobu; Kitahashi, Misaki; Sakurai, Toshiharu; Okamoto, Ayana; Minami, Tomohiro; Kono, Masashi; Arizumi, Tadaaki; Takenaka, Mamoru; Hagiwara, Satoru; Matsui, Shigenaga; Nishida, Naoshi; Kashida, Hiroshi; Kudo, Masatoshi

    2017-01-01

    Computer-aided diagnosis (CAD) is becoming a next-generation tool for the diagnosis of human disease. CAD for colon polyps has been suggested as a particularly useful tool for trainee colonoscopists, as the use of a CAD system avoids the complications associated with endoscopic resections. In addition to conventional CAD, a convolutional neural network (CNN) system utilizing artificial intelligence (AI) has been developing rapidly over the past 5 years. We attempted to generate a unique CNN-CAD system with an AI function that studied endoscopic images extracted from movies obtained with colonoscopes used in routine examinations. Here, we report our preliminary results of this novel CNN-CAD system for the diagnosis of colon polyps. A total of 1,200 images from cases of colonoscopy performed between January 2010 and December 2016 at Kindai University Hospital were used. These images were extracted from the video of actual endoscopic examinations. Additional video images from 10 cases of unlearned processes were retrospectively assessed in a pilot study. They were simply diagnosed as either an adenomatous or nonadenomatous polyp. The number of images used by AI to learn to distinguish adenomatous from nonadenomatous was 1,200:600. These images were extracted from the videos of actual endoscopic examinations. The size of each image was adjusted to 256 × 256 pixels. A 10-hold cross-validation was carried out. The accuracy of the 10-hold cross-validation is 0.751, where the accuracy is the ratio of the number of correct answers over the number of all the answers produced by the CNN. The decisions by the CNN were correct in 7 of 10 cases. A CNN-CAD system using routine colonoscopy might be useful for the rapid diagnosis of colorectal polyp classification. Further prospective studies in an in vivo setting are required to confirm the effectiveness of a CNN-CAD system in routine colonoscopy. © 2017 S. Karger AG, Basel.

  6. Advances in Diagnosis and Treatment of Brain Metastases from the Primary Lung Cancer

    Directory of Open Access Journals (Sweden)

    Yi LIU

    2013-07-01

    Full Text Available Lung cancer with brain metastasis was 23% to 65%, and is the most common type in brain metastasis tumors with the poor prognosis. At present, diagnosis and treatment of brain metastases from lung carcinoma and its molecular mechanism have become one hot spot of amount researches. Here, we made a systematic review of the progress of the clinical features, diagnosis and treatment of brain metastases from lung and its molecular mechanism.

  7. Early diagnosis and treatmente of hydronephrosis in childhood

    Directory of Open Access Journals (Sweden)

    Kokorkin A.D.

    2016-03-01

    Full Text Available Objective: To evaluate early and late results of the diagnosis and treatment of children with congenital hydronephrosis. Materials and methods. Conducted diagnosis and treatment of 47 children with hydronephrosis. Comparing the immediate and long6term outcomes in the two groups: primary (n=22 and control (n=25. In the study group vice diagnosed prenatally was exposed using ultrasound diagnostics and MRI. In the control group exhibited diagnosed after hospital survey for recurrent pyelonephritis. Results and discussion. All children performed surgery on the methodology of Andersen—Hines. Duration of external drainage of the urinary tract in the control group was 14–15 days in core — 7–8 days. In 9% of the children performing morphological situation demanded organo6blowing operation. In the late postoperative period in comparison groups differed significantly in the number of recurrent pyelonephritis background of sustained reductions in dilation of the urinary tract and the growth layer parenchymal kidney operated respectively 88% and 75% of the operated patients. Conclusions. Early verification of congenital hydronephrosis affects the outcomes of vice and to prevent deformation of the kidney function and save it. Late diagnosis on the background of persistent urinary tract infections in 9% of cases leads to organo-blowing operation. Persistent infection of the urinary tract is dependent on the timing of postoperative drainage of the kidney. The optimal duration of drainage 7–8 days. Prenatally diagnosed vice number of recurrences of urinary tract infections in the late postoperative period was 8%, and 87% of renal morphometric parameters were approaching the age norm.

  8. Phenomenology and classification of dystonia: a consensus update.

    Science.gov (United States)

    Albanese, Alberto; Bhatia, Kailash; Bressman, Susan B; Delong, Mahlon R; Fahn, Stanley; Fung, Victor S C; Hallett, Mark; Jankovic, Joseph; Jinnah, Hyder A; Klein, Christine; Lang, Anthony E; Mink, Jonathan W; Teller, Jan K

    2013-06-15

    This report describes the consensus outcome of an international panel consisting of investigators with years of experience in this field that reviewed the definition and classification of dystonia. Agreement was obtained based on a consensus development methodology during 3 in-person meetings and manuscript review by mail. Dystonia is defined as a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonic movements are typically patterned and twisting, and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. Dystonia is classified along 2 axes: clinical characteristics, including age at onset, body distribution, temporal pattern and associated features (additional movement disorders or neurological features); and etiology, which includes nervous system pathology and inheritance. The clinical characteristics fall into several specific dystonia syndromes that help to guide diagnosis and treatment. We provide here a new general definition of dystonia and propose a new classification. We encourage clinicians and researchers to use these innovative definition and classification and test them in the clinical setting on a variety of patients with dystonia. © 2013 Movement Disorder Society. © 2013 Movement Disorder Society.

  9. Records needed for orthodontic diagnosis and treatment planning: a systematic review.

    Directory of Open Access Journals (Sweden)

    Robine J Rischen

    Full Text Available BACKGROUND: Traditionally, dental models, facial and intra-oral photographs and a set of two-dimensional radiographs are used for orthodontic diagnosis and treatment planning. As evidence is lacking, the discussion is ongoing which specific records are needed for the process of making an orthodontic treatment plan. OBJECTIVE: To estimate the contribution and importance of different diagnostic records for making an orthodontic diagnosis and treatment plan. DATA SOURCES: An electronic search in PubMed (1948-July 2012, EMBASE Excerpta Medica (1980-July 2012, CINAHL (1982-July 2012, Web of Science (1945-July 2012, Scopus (1996-July 2012, and Cochrane Library (1993-July 2012 was performed. Additionally, a hand search of the reference lists of included studies was performed to identify potentially eligible studies. There was no language restriction. STUDY SELECTION: The patient, intervention, comparator, outcome (pico question formulated for this study was as follows: for patients who need orthodontic treatment (P, will the use of record set X (I compared with record set Y (C change the treatment plan (O? Only primary publications were included. DATA EXTRACTION: Independent extraction of data and quality assessment was performed by two observers. RESULTS: Of the 1041 publications retrieved, 17 met the inclusion criteria. Of these, 4 studies were of high quality. Because of the limited number of high quality studies and the differences in study designs, patient characteristics, and reference standard or index test, a meta-analysis was not possible. CONCLUSION: Cephalograms are not routinely needed for orthodontic treatment planning in Class II malocclusions, digital models can be used to replace plaster casts, and cone-beam computed tomography radiographs can be indicated for impacted canines. Based on the findings of this review, the minimum record set required for orthodontic diagnosis and treatment planning could not be defined. SYSTEMATIC REVIEW

  10. Hospital of Diagnosis Influences the Probability of Receiving Curative Treatment for Esophageal Cancer.

    Science.gov (United States)

    van Putten, Margreet; Koëter, Marijn; van Laarhoven, Hanneke W M; Lemmens, Valery E P P; Siersema, Peter D; Hulshof, Maarten C C M; Verhoeven, Rob H A; Nieuwenhuijzen, Grard A P

    2018-02-01

    The aim of this article was to study the influence of hospital of diagnosis on the probability of receiving curative treatment and its impact on survival among patients with esophageal cancer (EC). Although EC surgery is centralized in the Netherlands, the disease is often diagnosed in hospitals that do not perform this procedure. Patients with potentially curable esophageal or gastroesophageal junction tumors diagnosed between 2005 and 2013 who were potentially curable (cT1-3,X, any N, M0,X) were selected from the Netherlands Cancer Registry. Multilevel logistic regression was performed to examine the probability to undergo curative treatment (resection with or without neoadjuvant treatment, definitive chemoradiotherapy, or local tumor excision) according to hospital of diagnosis. Effects of variation in probability of undergoing curative treatment among these hospitals on survival were investigated by Cox regression. All 13,017 patients with potentially curable EC, diagnosed in 91 hospitals, were included. The proportion of patients receiving curative treatment ranged from 37% to 83% and from 45% to 86% in the periods 2005-2009 and 2010-2013, respectively, depending on hospital of diagnosis. After adjustment for patient- and hospital-related characteristics these proportions ranged from 41% to 77% and from 50% to 82%, respectively (both P < 0.001). Multivariable survival analyses showed that patients diagnosed in hospitals with a low probability of undergoing curative treatment had a worse overall survival (hazard ratio = 1.13, 95% confidence interval 1.06-1.20; hazard ratio = 1.15, 95% confidence interval 1.07-1.24). The variation in probability of undergoing potentially curative treatment for EC between hospitals of diagnosis and its impact on survival indicates that treatment decision making in EC may be improved.

  11. Ventricular Septal Defect: Peculiarities of Early Neonatal and Postnatal Diagnosis, Clinical Manifestations, Treatment and Prognosis at the Contemporary Stage

    Directory of Open Access Journals (Sweden)

    K.A. Kalashnikova

    2016-05-01

    Full Text Available The article presents the literature data on the incidence, the main clinical manifestations, modern methods for early neonatal and postnatal diagnosis and treatment of ventricular septal defect in children, as well as the prognosis of this disease. According to the International Classification of Diseases, 10th revision, ventricular septal defect is classified as Q21.0 Ventricular septal defect. Incidence. In the overall structure of congenital malformations of the cardiovascular system, ventricular septal defect has about 20 %. Diagnosis. Moderate ventricular septal defect is manifested by shortness of breath, rapid fatigability during feeding, delay in physical development. Significant arterial-venous shunt in the first month of life is accompanied by a transient mild cyanosis when the baby is fed and cries. Infants develop high pulmonary hypertension, circulatory failure, malnutrition. Small noise intensity is typical for newborns in the first weeks or even months of life, which is due to physiologically increased intravascular pulmonary resistance. Systolic murmur is extended to the entire systole with maximum amplitude at the left edge of the sternum at the level of III–IV intercostal spaces. Sclerotic phase of pulmonary hypertension with ventricular septal defect is defined as Eisenmenger reaction. The clinical picture of this disorder depends on the degree of hemodynamic instability caused by the defect parameters, the pressure level in the pulmonary artery, vascular pulmonary resistance, the magnitude and direction of the shunt through the defect. Diagnosis is confirmed by characteristic changes in the electrocardiogram, echocardiography and chest radiograph. Treatment. Small muscular ventricular septal defects often close spontaneously during the first 2 years of life. Drug correction is needed in the development of congestive heart failure. The optimum age for surgery — 5–9 years.

  12. Sigmoid volvulus. Diagnosis and interdisciplinary treatment. Sigmavolvulus, Diagnostik und Moeglichkeit einer interdisziplinaeren Primaertherapie

    Energy Technology Data Exchange (ETDEWEB)

    Schoen, G. (Innsbruck Univ. (Austria). Klinik fuer Radiodiagnostik); Offer, C.; Glaser, K. (Innsbruck Univ. (Austria). Klinik fuer Chirurgie 2)

    1991-02-01

    Sigmoid volvolus is an emergency which requires rapid diagnosis and immediate adequate treatment. Diagnosis is primarily radiological. Emergency laparotomy carries a high mortality and should therefore not be the immediate treatment. In our opinion, detorsion by colonoscopy under radiological control is a promising form of treatment. Selective resection of the sigmoid, thereby removing the cause of the abnormality, should not be forgotten, since this prevents recurrences. For this method, mortality after adequate gut preparation is only 5.4%. An exception to the above is gangrene of the bowel, when an emergency laparotomy cannot be avoided. (orig.).

  13. Fused man-machine classification schemes to enhance diagnosis of breast microcalcifications

    International Nuclear Information System (INIS)

    Andreadis, Ioannis; Sevastianos, Chatzistergos; Konstantina, Nikita; George, Spyrou

    2017-01-01

    Computer aided diagnosis (CAD x ) approaches are developed towards the effective discrimination between benign and malignant clusters of microcalcifications. Different sources of information are exploited, such as features extracted from the image analysis of the region of interest, features related to the location of the cluster inside the breast, age of the patient and descriptors provided by the radiologists while performing their diagnostic task. A series of different CAD x schemes are implemented, each of which uses a different category of features and adopts a variety of machine learning algorithms and alternative image processing techniques. A novel framework is introduced where these independent diagnostic components are properly combined according to features critical to a radiologist in an attempt to identify the most appropriate CAD x schemes for the case under consideration. An open access database (Digital Database of Screening Mammography (DDSM)) has been elaborated to construct a large dataset with cases of varying subtlety, in order to ensure the development of schemes with high generalization ability, as well as extensive evaluation of their performance. The obtained results indicate that the proposed framework succeeds in improving the diagnostic procedure, as the achieved overall classification performance outperforms all the independent single diagnostic components, as well as the radiologists that assessed the same cases, in terms of accuracy, sensitivity, specificity and area under the curve following receiver operating characteristic analysis. (paper)

  14. Fused man-machine classification schemes to enhance diagnosis of breast microcalcifications

    Science.gov (United States)

    Andreadis, Ioannis; Sevastianos, Chatzistergos; George, Spyrou; Konstantina, Nikita

    2017-11-01

    Computer aided diagnosis (CAD x ) approaches are developed towards the effective discrimination between benign and malignant clusters of microcalcifications. Different sources of information are exploited, such as features extracted from the image analysis of the region of interest, features related to the location of the cluster inside the breast, age of the patient and descriptors provided by the radiologists while performing their diagnostic task. A series of different CAD x schemes are implemented, each of which uses a different category of features and adopts a variety of machine learning algorithms and alternative image processing techniques. A novel framework is introduced where these independent diagnostic components are properly combined according to features critical to a radiologist in an attempt to identify the most appropriate CAD x schemes for the case under consideration. An open access database (Digital Database of Screening Mammography (DDSM)) has been elaborated to construct a large dataset with cases of varying subtlety, in order to ensure the development of schemes with high generalization ability, as well as extensive evaluation of their performance. The obtained results indicate that the proposed framework succeeds in improving the diagnostic procedure, as the achieved overall classification performance outperforms all the independent single diagnostic components, as well as the radiologists that assessed the same cases, in terms of accuracy, sensitivity, specificity and area under the curve following receiver operating characteristic analysis.

  15. [Intracranial plasmocytomas: biology, diagnosis, and treatment].

    Science.gov (United States)

    Belov, A I; Gol'bin, D A

    2006-01-01

    Intracranial plasmocytomas are a rare abnormality in a neurosurgeon's practice. The plasmocytomas may originate from the skull bones or soft tissue intracranial structures; they may be solitary or occur as a manifestation of multiple myeloma, this type being typical of most intracranial plasmocytomas. Progression of solitary plasmocytoma to multiple myeloma is observed in a number of cases. Preoperative diagnosis involves computed tomography or magnetic resonance imaging; angiography is desirable. The final diagnosis of plasmocytoma is chiefly based on a morphological study. Special immunohistochemical studies yield very promising results; these are likely to be of high prognostic value. Intracranial plasmocytomas require a differential approach and a meticulous examination since the presence or absence of multiple myeloma radically affects prognosis. There are well-defined predictors; however, it is appropriate that craniobasal plasmocytomas show a worse prognosis than plasmocytomas of the skull vault and more commonly progress to multiple myeloma. Plasmocytomas respond to radiotherapy very well. The gold standard of treatment for plasmocytoma is its total removal and adjuvant radiation therapy; however, there is evidence for good results when it is partially removed and undergoes radiotherapy or after radical surgery without subsequent radiation. The role of chemotherapy has not been defined today.

  16. Classification decision tree in CT imaging: application to the differential diagnosis of solitary pulmonary nodules

    International Nuclear Information System (INIS)

    Ma Hongxia; Guo Yulin; Wang Qiuping; Qiang Yongqian; Liu Min; Guo Xiaojuan; Guo Youmin; Chen Qihang

    2008-01-01

    Objective: To establish classification and regression tree (CART) for differentiating benign from malignant solitary pulmonary nudules (SPN). Methods: One hundred and sixteen consecutive cases with 116 solitary pulmonary nodules, which finally were pathologically proven 54 malignant nodules and 62 benign nodules, were prospectively registered in this research. Twelve clinical presentations and 22 CT findings were collected as predictors. A classification tree was established to distinguish benign SPNs from malignant ones. In the observer test, two groups (one made of junior radiologists and one of senior radiologists) were independently presented with clinical information and CT images without knowing the pathologic and machine-learning results. Performance of observers and CART were compared by receiver operating characteristic analysis. Results: Receiver operating characteristic analysis showed areas under the curve of CART, senior radiologists and junior radiologists respectively were 0.910±0.029, 0.827±0.038, 0.612±0.052. Difference between areas(DBF) between CART and junior radiologists was 0.297(P<0.01). DBF between CART and senior radiologists was 0.083 (P<0.05). DBF between senior and junior radiologists was 0.214 (P<0.01). CART showed a best diagnostic efficiency, followed by junior radiologists, and then senior radiologists. Conclusion: Our data mining techniques using CART prove a high accuracy in differentiating benign from malignant pulmonary nodules based on clinical variables and CT findings. It will be a potentially useful tool in further application of artificial intelligence in the imaging diagnosis. (authors)

  17. Acute Rotavirus-Induced Diarrhea in Children: Clinical Picture, Diagnosis, Treatment

    Directory of Open Access Journals (Sweden)

    S.L. Niankovskyi

    2015-09-01

    Full Text Available The paper considers the current aspects of epidemiology, diagnosis, clinical picture and treatment of acute rotavirus-induced diarrhea in children. There are presented the basic thesis of ESPGHAN consensus (2014 about acute diarrheas. There was analyzed the effectiveness of probiotic Subalin producing interferon for the treatment of acute rotavirus-induced diarrhea. It was demonstrated its effectiveness according to the literature review and own data.

  18. Urolithiasis: Advances in diagnosis and treatment

    International Nuclear Information System (INIS)

    Barbaric, Z.L.; Le Roy, A.J.

    1987-01-01

    This course addresses radiologic aspects of diagnosis and treatment of renal calculi. The combined clinical experience from two institutions (UCLA and Mayo Clinic) of over 3,000 extracorporeal shock wave lithotripsy (ESWL) treatments is presented, as is the new developmental designs and socioeconomic impact. ESWL has radically altered the management of renal and ureteral calculi. An underwater shock wave is concentrated on a calculus, which shatters after being subjected to a number of shocks. Small fragments are usually passed spontaneously, making the patient stone free and eliminating the need for surgery. Radiology plays an important role in this patient population. The presence of radiopaque and radiolucent calculi - their size, number, and location; the anatomic appearance of the kidneys, pelvocalyceal system, and ureter; anatomic variants; and pathologic conditions such as horseshoe kidneys, ureteropelvic junction narrowing, polycystic kidney disease, calyceal diverticuli, infundibular stenosis, ureteral obstruction, and medullary sponge kidney are best imaged with excretory urography and occasionally retrograde pyelography and US. Follow-up examinations usually consist of abdominal radiography and US if obstruction is suspected. The percutaneous approach still plays a major albeit obviously diminished role in treatment and may be used for a number of specific indications, which is discussed

  19. Diabetic polyneuropathy: pathogenesis, classification, clinical presentation, and treatment

    Directory of Open Access Journals (Sweden)

    Marina Valentinovna Nesterova

    2013-01-01

    Full Text Available Diabetes mellitus (DM is a global epidemic followed by late complications as diabetic polyneuropathy (DPN and diabetic foot syndrome, leading to appreciable social and economic consequences. Virtually all patients with DM develop DPN in different periods. There is a clear correlation between the presence and magnitude of painful DPN and the duration of DM and the level of glycosylated hemoglobin and the severity of DPN. In spite of the abundance of theories of the development of DPN, its main identified pathogenetic factor is hyperglycemia. The literature gives no universal classification due to the variability of clinical symptoms. The main goals of treatment are to affect the pathogenesis of the disease and to prescribe symptomatic medications. The pathogenetic treatment of DPN includes compensation for carbohydrate metabolism and use of neurometabolic drugs. Pain from DPN may be controlled with antidepressants, anticonvulsants, local anesthetics and opioid analgesics. Although much evidence for the pathogenesis of peripheral nervous system injury has been recently accumulated, a universal standard for the effective therapy of DPN and the follow-up of these patients has not yet been developed.

  20. [Familial Mediterranean fever - clinical picture, diagnosis and treatment].

    Science.gov (United States)

    Dallos, Tomáš; Ilenčíková, Denisa; Kovács, László

    2014-01-01

    Familial mediterranean fever (FMF) is the most prevalent genetically determined autoinflammatory disease. FMF significantly decreases the quality of life and limits life expectancy due to the development of amyloidosis in affected individuals. Prevalence of FMF is highest in the south-eastern Mediterraneans. In other parts of the world, its occurance is often restricted to high-risk ethnic goups. In Central Europe, experience with FMF is scarse. As for Slovakia, we have reported the first cases of FMF in ethnic Slovaks only recently. Along with their complicated fates, this has lead us to compile a comprehensive overview of the clinical picture, diagnosis and treatment of this elusive disease. Hereby we hope to be able to promote the awareness about this disease and possibly aid the diagnosis in new patients.

  1. Sequential segmental classification of feline congenital heart disease.

    Science.gov (United States)

    Scansen, Brian A; Schneider, Matthias; Bonagura, John D

    2015-12-01

    Feline congenital heart disease is less commonly encountered in veterinary medicine than acquired feline heart diseases such as cardiomyopathy. Understanding the wide spectrum of congenital cardiovascular disease demands a familiarity with a variety of lesions, occurring both in isolation and in combination, along with an appreciation of complex nomenclature and variable classification schemes. This review begins with an overview of congenital heart disease in the cat, including proposed etiologies and prevalence, examination approaches, and principles of therapy. Specific congenital defects are presented and organized by a sequential segmental classification with respect to their morphologic lesions. Highlights of diagnosis, treatment options, and prognosis are offered. It is hoped that this review will provide a framework for approaching congenital heart disease in the cat, and more broadly in other animal species based on the sequential segmental approach, which represents an adaptation of the common methodology used in children and adults with congenital heart disease. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Apples to committee consensus: the challenge of gender identity classification.

    Science.gov (United States)

    Rettew, David C

    2012-01-01

    The debate surrounding the inclusion of gender dysphoria/gender variant behavior (GD/GV) as a psychiatric diagnosis exposes many of the fundamental shortcomings and inconsistencies of our current diagnostic classification system. Proposals raised by the authors of this special issue, including basing diagnosis on cause rather than overt behavior, reclassifying GD/GV behavior as a physical rather than mental condition, and basing diagnosis on impairment or distress, offer some solutions but have limitations themselves given the available database. In contrast to most accepted psychiatric conditions where emphasis is placed on ultimately changing internal thoughts, feelings, and behaviors, consensus treatment for most GD/GV individuals, at least from adolescence onward, focuses on modifying the external body and external environment to maximize positive outcomes. This series of articles illustrating the diversity of opinions on when and if gender incongruence should be considered pathological reflects the relative lack of scientific indicators of disease in this area, similar to many other domains of mental functioning.

  3. Cirrhosis Diagnosis and Liver Fibrosis Staging: Transient Elastometry Versus Cirrhosis Blood Test.

    Science.gov (United States)

    Calès, Paul; Boursier, Jérôme; Oberti, Frédéric; Bardou, Derek; Zarski, Jean-Pierre; de Lédinghen, Victor

    2015-07-01

    Elastometry is more accurate than blood tests for cirrhosis diagnosis. However, blood tests were developed for significant fibrosis, with the exception of CirrhoMeter developed for cirrhosis. We compared the performance of Fibroscan and CirrhoMeter, and classic binary cirrhosis diagnosis versus new fibrosis staging for cirrhosis diagnosis. The diagnostic population included 679 patients with hepatitis C and liver biopsy (Metavir staging and morphometry), Fibroscan, and CirrhoMeter. The prognostic population included 1110 patients with chronic liver disease and both tests. Binary diagnosis: AUROCs for cirrhosis were: Fibroscan: 0.905; CirrhoMeter: 0.857; and P=0.041. Accuracy (Youden cutoff) was: Fibroscan: 85.4%; CirrhoMeter: 79.2%; and PFibrosis classification provided 6 classes (F0/1, F1/2, F2±1, F3±1, F3/4, and F4). Accuracy was: Fibroscan: 88.2%; CirrhoMeter: 88.8%; and P=0.77. A simplified fibrosis classification comprised 3 categories: discrete (F1±1), moderate (F2±1), and severe (F3/4) fibrosis. Using this simplified classification, CirrhoMeter predicted survival better than Fibroscan (respectively, χ=37.9 and 19.7 by log-rank test), but both predicted it well (Ptest). Comparison: binary diagnosis versus fibrosis classification, respectively, overall accuracy: CirrhoMeter: 79.2% versus 88.8% (PFibrosis classification should be preferred over binary diagnosis. A cirrhosis-specific blood test markedly attenuates the accuracy deficit for cirrhosis diagnosis of usual blood tests versus transient elastometry, and may offer better prognostication.

  4. Diagnosis, surgical treatment and follow-up of thyroid cancers

    International Nuclear Information System (INIS)

    Pacini, F.; Pinchera, A.; Vorontsova, T.; Demidchik, E.P.; Delange, F.; Reiners, C.; Schlumberger, M.

    1996-01-01

    This paper reports the activities and the results of the research carried out by the Centers participating to the JSP4 project, within the framework of the EU program on the consequences of the Chernobyl disaster. The project was aimed to develop and to control the application of basic principles for the diagnosis, treatment and follow-up of thyroid carcinoma, with special attention to the peculiar requirement of children and adolescents. To this purpose, training in Western European Centers was offered to a number of scientists from Belarus, Ukraine and Russia. Several official meetings were organized to share views and to discuss the progress of the project. A basic protocol for the diagnosis, treatment and follow-up of thyroid carcinoma has been developed and approved by all participating Centers. Hopefully, it will be applied to the new cases and to those already under monitoring. A large part of the protocol is dedicated to the post-surgical treatment with thyroid hormones for the suppression of TSH and with calcitriol for the management of surgical hypoparathyroidism. A detailed protocol to asses iodine deficiency and, eventually, to introduce a program of iodine supplementation has been proposed. The collection of control cases of childhood thyroid carcinoma in non-radiation exposed European countries has been initiated in Italy, France and Germany. This data will be used as control for the post-Chernobyl childhood thyroid carcinomas. Here is reported a preliminary comparison of the clinical and epidemiological features of almost all (n=368) radiation-exposed Belarus children who developed thyroid carcinoma (age at diagnosis < 16 years), with respect to 90 children of the same age group, who, in the past 20 years, have received treatment for thyroid carcinoma in two centers in Italy (Pisa and Rome). Finally, by molecular biology, genetic mutations of the RET proto-oncogene have been found in several samples of thyroid carcinomas provided by the Belarus

  5. [Tuberculous pneumothorax: Diagnosis and treatment].

    Science.gov (United States)

    Ben Saad, S; Melki, B; Douik El Gharbi, L; Soraya, F; Chaouch, N; Aouina, H; Cherif, J; Hamzaoui, A; Merghli, A; Daghfous, H; Tritar, F

    2018-04-01

    Pneumothorax is a serious complication of cavitary pulmonary tuberculosis. The aim of this study was to describe clinical futures, to highlight challenges of its management. A retrospective multicentric and descriptive study including 65 patients treated for PT (1999-2015) was conducted to figure out clinical futures and its work-up. The mean age was 37.8 years. The sex ratio was 3.6. Smoking history and incarceration were noted respectively in 67.6 and 15.3% of cases. Acute respiratory failure and cachexia were reported in 26.1 and 10.7% of cases. The PT was inaugural in 41.5% of cases. Pyo-pneumothorax was noted in 69.2% of cases. The duration of antituberculous treatment ranged from 6 to 15 months for susceptible TB and was at least 12 months for resistant TB (4 cases). Thoracic drainage was performed in 90.7% patients. Its average length was 47 days. The drain drop was noted in 20% of cases. Bronchopleural fistula was diagnosed in 6 cases and pleural infection in 5 of cases. Surgery treatment was necessary in 6 cases. Mean time to surgery was 171 days. Six patients had pleural decortication associated with pulmonary resection in 4 cases. Persistent chronic PT was noted in 12.6% and chronic respiratory failure in 3% of cases and death in 15.3% of cases. The diagnosis of the PT is often easy. Its treatment encounters multiples difficulties. Duration of thoracic drainage and anti-TB treatment are usually long. Surgery is proposed lately. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. Multi-Modality Cascaded Convolutional Neural Networks for Alzheimer's Disease Diagnosis.

    Science.gov (United States)

    Liu, Manhua; Cheng, Danni; Wang, Kundong; Wang, Yaping

    2018-03-23

    Accurate and early diagnosis of Alzheimer's disease (AD) plays important role for patient care and development of future treatment. Structural and functional neuroimages, such as magnetic resonance images (MRI) and positron emission tomography (PET), are providing powerful imaging modalities to help understand the anatomical and functional neural changes related to AD. In recent years, machine learning methods have been widely studied on analysis of multi-modality neuroimages for quantitative evaluation and computer-aided-diagnosis (CAD) of AD. Most existing methods extract the hand-craft imaging features after image preprocessing such as registration and segmentation, and then train a classifier to distinguish AD subjects from other groups. This paper proposes to construct cascaded convolutional neural networks (CNNs) to learn the multi-level and multimodal features of MRI and PET brain images for AD classification. First, multiple deep 3D-CNNs are constructed on different local image patches to transform the local brain image into more compact high-level features. Then, an upper high-level 2D-CNN followed by softmax layer is cascaded to ensemble the high-level features learned from the multi-modality and generate the latent multimodal correlation features of the corresponding image patches for classification task. Finally, these learned features are combined by a fully connected layer followed by softmax layer for AD classification. The proposed method can automatically learn the generic multi-level and multimodal features from multiple imaging modalities for classification, which are robust to the scale and rotation variations to some extent. No image segmentation and rigid registration are required in pre-processing the brain images. Our method is evaluated on the baseline MRI and PET images of 397 subjects including 93 AD patients, 204 mild cognitive impairment (MCI, 76 pMCI +128 sMCI) and 100 normal controls (NC) from Alzheimer's Disease Neuroimaging

  7. Factors associated with delays in treatment initiation after tuberculosis diagnosis in two districts of India.

    Directory of Open Access Journals (Sweden)

    Durba Paul

    Full Text Available BACKGROUND: Excessive time between diagnosis and initiation of tuberculosis (TB treatment contributes to ongoing TB transmission and should be minimized. In India, Revised National TB Control Programme (RNTCP focuses on indicator start of treatment within 7 days of diagnosis for patients with sputum smear-positive PTB for monitoring DOTS implementation. OBJECTIVES: To determine length of time between diagnosis and initiation of treatment and factors associated with delays of more than 7 days in smear-positive pulmonary TB. METHODS: Using existing programme records such as the TB Register, treatment cards, and the laboratory register, we conducted a retrospective cohort study of all patients with smear-positive pulmonary TB registered from July-September 2010 in two districts in India. A random sample of patients with pulmonary TB who experienced treatment delay of more than 7 days was interviewed using structured questionnaire. RESULTS: 2027 of 3411 patients registered with pulmonary TB were smear-positive. 711(35% patients had >7 days between diagnosis and treatment and 262(13% had delays >15 days. Mean duration between TB diagnosis and treatment initiation was 8 days (range = 0-128 days. Odds of treatment delay >7 days was 1.8 times more likely among those who had been previously treated (95% confidence interval [CI] 1.5-2.3 and 1.6 (95% CI 1.3-1.8 times more likely among those diagnosed in health facilities without microscopy centers. The main factors associated with a delay >7 days were: patient reluctance to start a re-treatment regimen, patients seeking second opinions, delay in transportation of drugs to the DOT centers and delay in initial home visits. To conclude, treatment delay >7 days was associated with a number of factors that included history of previous treatment and absence of TB diagnostic services in the local health facility. Decentralized diagnostic facilities and improved referral procedures may reduce such treatment

  8. Binge-eating disorder: emerging treatments for a new diagnosis.

    Science.gov (United States)

    Tsappis, Michael; Freizinger, Melissa; Forman, Sara F

    2016-08-01

    This review provides an update on the new Diagnostic and Statistical Manual (DSM) diagnosis of binge-eating disorder (BED) by presenting diagnostic criteria, associated risk factors and co-morbidities, and tools for assessment. An update on the currently available evidence-based treatments for adolescent BED is provided to help with the coordination of treatment planning for identified patients with this condition. BED is now officially included in the DSM. Research with youth has begun to show improvement from treatments such as cognitive behavioral therapy, previously shown to be useful in adults. BED is common and often begins during youth. The availability of diagnostic criteria, along with increasing knowledge about the condition and available treatments, is expected to result in improved identification and management in younger patients.

  9. Application of Multimodality Imaging Fusion Technology in Diagnosis and Treatment of Malignant Tumors under the Precision Medicine Plan.

    Science.gov (United States)

    Wang, Shun-Yi; Chen, Xian-Xia; Li, Yi; Zhang, Yu-Ying

    2016-12-20

    The arrival of precision medicine plan brings new opportunities and challenges for patients undergoing precision diagnosis and treatment of malignant tumors. With the development of medical imaging, information on different modality imaging can be integrated and comprehensively analyzed by imaging fusion system. This review aimed to update the application of multimodality imaging fusion technology in the precise diagnosis and treatment of malignant tumors under the precision medicine plan. We introduced several multimodality imaging fusion technologies and their application to the diagnosis and treatment of malignant tumors in clinical practice. The data cited in this review were obtained mainly from the PubMed database from 1996 to 2016, using the keywords of "precision medicine", "fusion imaging", "multimodality", and "tumor diagnosis and treatment". Original articles, clinical practice, reviews, and other relevant literatures published in English were reviewed. Papers focusing on precision medicine, fusion imaging, multimodality, and tumor diagnosis and treatment were selected. Duplicated papers were excluded. Multimodality imaging fusion technology plays an important role in tumor diagnosis and treatment under the precision medicine plan, such as accurate location, qualitative diagnosis, tumor staging, treatment plan design, and real-time intraoperative monitoring. Multimodality imaging fusion systems could provide more imaging information of tumors from different dimensions and angles, thereby offing strong technical support for the implementation of precision oncology. Under the precision medicine plan, personalized treatment of tumors is a distinct possibility. We believe that multimodality imaging fusion technology will find an increasingly wide application in clinical practice.

  10. ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Daniela Benedeto-Stojanov

    2015-06-01

    Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

  11. Celiac disease: Prevalence, diagnosis, pathogenesis and treatment

    Science.gov (United States)

    Gujral, Naiyana; Freeman, Hugh J; Thomson, Alan BR

    2012-01-01

    Celiac disease (CD) is one of the most common diseases, resulting from both environmental (gluten) and genetic factors [human leukocyte antigen (HLA) and non-HLA genes]. The prevalence of CD has been estimated to approximate 0.5%-1% in different parts of the world. However, the population with diabetes, autoimmune disorder or relatives of CD individuals have even higher risk for the development of CD, at least in part, because of shared HLA typing. Gliadin gains access to the basal surface of the epithelium, and interact directly with the immune system, via both trans- and para-cellular routes. From a diagnostic perspective, symptoms may be viewed as either “typical” or “atypical”. In both positive serological screening results suggestive of CD, should lead to small bowel biopsy followed by a favourable clinical and serological response to the gluten-free diet (GFD) to confirm the diagnosis. Positive anti-tissue transglutaminase antibody or anti-endomysial antibody during the clinical course helps to confirm the diagnosis of CD because of their over 99% specificities when small bowel villous atrophy is present on biopsy. Currently, the only treatment available for CD individuals is a strict life-long GFD. A greater understanding of the pathogenesis of CD allows alternative future CD treatments to hydrolyse toxic gliadin peptide, prevent toxic gliadin peptide absorption, blockage of selective deamidation of specific glutamine residues by tissue, restore immune tolerance towards gluten, modulation of immune response to dietary gliadin, and restoration of intestinal architecture. PMID:23155333

  12. Asthma in elite athletes: pathogenesis, diagnosis, differential diagnoses, and treatment

    DEFF Research Database (Denmark)

    Pedersen, Lars; Elers, Jimmi; Backer, Vibeke

    2011-01-01

    Elite athletes have a high prevalence of asthma and exercise-induced bronchoconstriction. Although respiratory symptoms can be suggestive of asthma, the diagnosis of asthma in elite athletes cannot be based solely on the presence or absence of symptoms; diagnosis should be based on objective...... measurements, such as the eucapnic voluntary hyperpnea test or exercise test. When considering that not all respiratory symptoms are due to asthma, other diagnoses should be considered. Certain regulations apply to elite athletes who require asthma medication for asthma. Knowledge of these regulations...... is essential when treating elite athletes. This article is aimed at physicians who diagnose and treat athletes with respiratory symptoms. It focuses on the pathogenesis of asthma and exercise-induced bronchoconstriction in elite athletes and how the diagnosis can be made. Furthermore, treatment of elite...

  13. [Percutaneous tubing and drainage for the diagnosis and treatment of malignant pericardial effusion].

    Science.gov (United States)

    Li, Y; Zhou, J; Zhang, J

    2000-01-01

    To insert a tube into pericardial cavity as an emergent measure of diagnosis and treatment in patients with malignant pericardial effusion. Pericardial puncture was followed by insertion of drainage tube (diameter = 1.8 mm) through the puncture needle. The effusion collected was examined for cancer cells. After drainage, chemotherapeutic agents were administered. Four hours later, drainage was continued for 2 days (drained in 24 hr) and the tube was removed. In 34 cases with malignant pericardial effusion, tube draining was successful to relieve cardiac temponade within 15-60 minutes. Clots were present in 91.2% of the cases and cancer diagnosis was confirmed in all of them. The cytologic diagnosis of effusion was positive in 61.8%, and the cyto-pathologic typing of clots was 81.0%. The difference was statistically significant. When the results of the 2 examinations were put together, the positive rate increased to 94.1%. Tube drainage of malignant pericardial effusion is useful in diagnosis and emergency treatment.

  14. Primary vaginal cancer: role of MRI in diagnosis, staging and treatment

    Science.gov (United States)

    Sunil, J; Klopp, A H; Devine, C E; Sagebiel, T; Viswanathan, C; Bhosale, P R

    2015-01-01

    Primary carcinoma of the vagina is rare, accounting for 1–3% of all gynaecological malignancies. MRI has an increasing role in diagnosis, staging, treatment and assessment of complications in gynaecologic malignancy. In this review, we illustrate the utility of MRI in patients with primary vaginal cancer and highlight key aspects of staging, treatment, recurrence and complications. PMID:25966291

  15. Update on the classification and treatment of localized scleroderma.

    Science.gov (United States)

    Bielsa Marsol, I

    2013-10-01

    Morphea or localized scleroderma is a distinctive inflammatory disease that leads to sclerosis of the skin and subcutaneous tissues. It comprises a number of subtypes differentiated according to their clinical presentation and the structure of the skin and underlying tissues involved in the fibrotic process. However, classification is difficult because the boundaries between the different types of morphea are blurred and different entities frequently overlap. The main subtypes are plaque morphea, linear scleroderma, generalized morphea, and pansclerotic morphea. With certain exceptions, the disorder does not have serious systemic repercussions, but it can cause considerable morbidity. In the case of lesions affecting the head, neurological and ocular complications may occur. There is no really effective and universal treatment so it is important to make a correct assessment of the extent and severity of the disease before deciding on a treatment approach. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

  16. Perspectives on Next Steps in Classification of Orofacial Pain – Part 2: Role of psychosocial factors

    Science.gov (United States)

    Durham, Justin; Raphael, Karen G.; Benoliel, Rafael; Ceusters, Werner; Michelotti, Ambra; Ohrbach, Richard

    2015-01-01

    This paper was initiated by a symposium, in which the present authors contributed, organised by the International RDC/TMD Consortium Network in March 2013. The purpose of the paper is to review the status of biobehavioural research – both quantitative and qualitative – related to orofacial pain with respect to the etiology, pathophysiology, diagnosis and management of orofacial pain conditions, and how this information can optimally be used for developing a structured orofacial pain classification system for research. In particular, we address: representation of psychosocial entities in classification systems, use of qualitative research to identify and understand the full scope of psychosocial entities and their interaction, and the usage of classification system for guiding treatment. We then provide recommendations for addressing these problems, including how ontological principles can inform this process. PMID:26257252

  17. Headache and facial pain: differential diagnosis and treatment.

    Science.gov (United States)

    Bernstein, Jonathan A; Fox, Roger W; Martin, Vincent T; Lockey, Richard F

    2013-01-01

    Headaches affect 90% of the population sometime during their life. Most are benign and fleeting, some are serious and life-threatening, and others require ongoing medical consultation and treatment. A careful history and physical is necessary to establish a differential diagnosis and to guide the choice of testing to make an accurate diagnosis. The most common types of headaches are discussed in this review. They are divided into primary and secondary headache disorders as classified by the International Headache Society. Primary headache disorders include migraine without and with aura, cluster and tension-type headaches. Secondary headaches are those that occur as a result of some other disorder and include brain tumors, rhinosinusitis, diseases of intracranial and extracranial vasculature, and temporomandibular joint disease. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  18. Antenatal Hydronephrosis: Differential Diagnosis, Evaluation, and Treatment Options

    Science.gov (United States)

    Herndon, C.D. Anthony

    2006-01-01

    The diagnosis, evaluation and management of antenatal hydronephrosis has undergone a two stage paradigm shift since the advent of prenatal ultrasonography in the early 1980s. Initially the identification of a large number of asymptomatic infants appeared to afford the surgeon the opportunity for preemptive intervention. However, it has now become apparent that antenatal hydronephrosis (AH) is far more difficult to interpret thanoriginally perceived. The initial enthusiasm for surgery has now been replaced by a much more conservative approach to ureteropelvic junction(UPJ) obstruction, multi-cystic dysplastic kidney(MCDK), vesicoureteral reflux and the non-refluxing megaureter. This review will highlight the postnatal evaluation of AH and include an overview of the Society for Fetal Urology grading system for hydronephrosis. The differential diagnosis and treatment options for UPJ obstruction, vesicoureteral reflux, MCDK, duplication anomalies, megaureter, and posterior urethral valves will be discussed. PMID:17619702

  19. Current status of gastroesophageal reflux disease : diagnosis and treatment.

    Science.gov (United States)

    Chuang, Tang-Wei; Chen, Shou-Chien; Chen, Kow-Tong

    2017-01-01

    The aim of this study was to explore the recent advances in diagnosis and treatment of gastroesophageal reflux disease (GERD). Previous studies were searched using the terms "gastroesophageal reflux disease" and "diagnosis" or "treatment" in Medline and Pubmed. Articles that were not published in the English language, manuscripts without an abstract, reviews, meta-analysis, and opinion articles were excluded from the review. After a preliminary screening, all of the articles were reviewed and synthesized to provide an overview of the contemporary approaches to GERD. GERD has a variety of symptomatic manifestations, which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of other alarming symptoms, these symptoms allow one to make a presumptive diagnosis of GERD and initiate empiric therapy. GERD-associated complications include erosive esophagitis, peptic stricture, Barrett's esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modifications, medical and surgical therapy. Medical therapy involves acid suppression, which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The management of this disease requires a complex approach. Maintenance therapy of GERD after using anti-secretory drugs should be continuously monitored. © Acta Gastro-Enterologica Belgica.

  20. [Recent developments in biopsy diagnosis of early and undefined liver tumors].

    Science.gov (United States)

    Longerich, T; Schirmacher, P

    2009-01-01

    Biopsy diagnosis of early and highly differentiated liver tumors is difficult and complex. Modern pathology has met this challenge by several different means; elaborate morphological algorithms and novel immunohistological markers support the differential diagnosis of highly differentiated HCC and a new, predictive molecular pathological and histological classification of liver cell adenoma was developed. By these new diagnostic tools together with the so-called 'matrix diagnosis' a reliable diagnostic classification is now feasible in the vast majority of these difficult cases.

  1. Nursing dependency, diagnosis-related groups, and length of hospital stay

    OpenAIRE

    Halloran, Edward J.; Kiley, Marylou

    1987-01-01

    Most efforts to modify the diagnosis-related group (DRG) case classification system focus on variables related to medical management. In this study, we investigated the separate but related natures of medicine and nursing by examining 1,288 adult medical and surgical patients in an urban teaching hospital. The complexity of medical treatment was measured by use of the DRG relative cost weight. The nursing indicator was derived from a set of nursing diagnoses. We found that the DRG cost weight...

  2. Treatment of hand eczema, any help from classification?

    NARCIS (Netherlands)

    Schuttelaar, Marie-Louise; Christoffers, Wietske; Boonstra, Marrit; Coenraads, Pieter Jan

    Background: Intervention studies often use unclear definitions of either morphological or aetiological types of hand eczema, or there is no classification at all. These studies are not reproducible or difficult to compare. A generally accepted classification system is essential for clinical trials.

  3. Understanding MIH: definition, epidemiology, differential diagnosis and new treatment guidelines.

    Science.gov (United States)

    Mast, P; Rodrigueztapia, M T; Daeniker, L; Krejci, I

    2013-09-01

    Molar-Incisor Hypomineralisation (MIH) is a congenital disease which increases in prevalence. It affects permanent first molars and, often to a lesser degree, permanent incisors with variable severity. The aetiology is unknown, but different hypotheses have been advanced. Differential diagnosis is mandatory not to confound MIH with other diseases. Treatment consists in a minimally invasive approach by reinforcing and protecting the existing dental structure. In more severe cases, restorative treatment may be indicated.

  4. The combination of disease and Zheng (syndrome on the basic of differentiation of six channels: a new pattern of disease diagnosis and treatment of traditional Chinese medicine

    Directory of Open Access Journals (Sweden)

    Xue Yang

    2017-04-01

    Full Text Available Traditional Chinese medicine (TCM was formed two thousand years ago, and developed in the following centuries. TCM has a unique way of looking at health and illness. Zheng (syndrome is the basic unit and key term in TCM theory. Zheng is the pathological generalization of a certain stage in the development of disease. Treatment based on syndrome differentiation and disease differentiation of TCM is the basic principle to know and treat diseases,and a kind of special method to study diseases in TCM. In Han Dynasty (200 AD, doctor Zhang Zhongjing proposed Liujing Bianzheng (the differential diagnosis in accordance with the theory of six channels to diagnose and treat diseases in Treatise on Febrile and Miscellaneous Diseases. In other words, he divided diseases into six channels diseases based on patient’s Zhengs. Six channels diseases almost include all of the disease according to his classification standards. In addition, there are development rules in the progress of six channels diseases.Therefore, we hypothesized that combination of six channels disease and Zheng on the basic of differentiation of six channels is a new pattern of diagnosis and treatment diseases in TCM, which is beneficial to the understanding of a certain disease and makes disease treatment more convenient, fast and effective.

  5. [Classification and MR imaging of triangular fibrocartilage complex lesions].

    Science.gov (United States)

    Zhan, H L; Liu, Y; Bai, R J; Qian, Z H; Ye, W; Li, Y X; Wu, B D

    2016-06-07

    To explore the MRI characteristics of injuries of triangular fibrocartilage complex (TFCC), and provide imaging basis for the early diagnosis and treatment of the injuries. A total of 10 healthy volunteers without wrist injuries and 200 patients from Beijing Jishuitan Hospital who complained ulnar-sided wrist pain and were highly suspected as the injury of TFCC underwent the wrist magnetic resonance examination. All subjects were in a prone position and underwent examination on coronal T1WI scan and PD-FS on 3 planes respectively. Then the MRI characteristics of 3 healthy volunteers and 67 patients with TFCC injuries that confirmed by operation were analyzed. According to the comparative analysis of normal anatomy and Palmer classification, the injuries were classified and MRI features of different types of injuries were analyzed. At last, imaging findings were compared with surgical results. Three healthy volunteers without injuries showed mainly in low signal intensity on T1WI and PD-FS images. According to Palmer classification, there were 52 traumatic injuries (ⅠA 9, ⅠB 25, ⅠC 3, ⅠD 13, In addition, 1 has central perforation and ulnar avulsion and 1 has ulnar and radial injuries simultaneously) and 15 degenerative injuries (ⅡA 5, ⅡB 1, ⅡC 2 , ⅡD 1 , ⅡE 6) among 67 patients. The central perforation mainly demonstrated as linear high signal perpendicular to the disk, and run in a sagittal line. The ulnar, distal, and radial avulsion mainly showed the injuries were irregular, the structures were ambiguous, and there was high signal intensity in the injured structures on PD-FS. Degenerative injuries demonstrated the irregularity of TFC and heterogeneous signals on PD-FS. There were mixed intermediate-high signals and changes in the articular cartilage of lunate and ulna, high signal in the lunotriquetral ligament and ulnocarpal or radioulnar arthritis. MRI can demonstrate the anatomy of TFCC accurately, evaluate and make the general classification

  6. Radiologic fallopian tube catheterization for diagnosis and treatment of proximal tubal obstruction

    International Nuclear Information System (INIS)

    Thurmond, A.S.; Rosch, J.

    1988-01-01

    Seventy-five infertile women in whom proximal fallopian tube obstruction had been demonstrated by conventional hysterosalpingography were managed by means of fluoroscopic transcervical fallopian tube catheterization techniques. The procedure helped avoid surgery for diagnosis and/or treatment of proximal tubal obstruction in 71 women (95%). In 32 patients who had patent tube(s) following the procedure, 15 pregnancies have occurred, 14 intrauterine and one tubal (follow-up, 6 months). Fifteen patients had follow-up studies after recanalization, and 19 of 23 tubes remained patent (83%). Fluoroscopic fallopian tube catheterization improves diagnosis of fallopian tube disease and is a low-cost, nonsurgical treatment for infertility caused by proximal fallopian tube obstruction

  7. [Haemangiomas and congenital vascular malformations: their classification and diagnosis

    NARCIS (Netherlands)

    Zweep, H.P.; Rieu, P.N.M.A.; Die, C.E. van; Boll, A.P.M.; Steijlen, P.M.; Spauwen, P.H.M.

    2002-01-01

    Mulliken and Glowacki's classification of peripheral blood- and lymph-vessel abnormalities is based on their clinical course and cellular characteristics, and is therefore clear to and readily usable by the practising physician. In order to make the diagnostic process more accessible, the

  8. International Classification of Headache Disorders 3rd edition beta-based field testing of vestibular migraine in China: Demographic, clinical characteristics, audiometric findings and diagnosis statues.

    Science.gov (United States)

    Zhang, Yixin; Kong, Qingtao; Chen, Jinjin; Li, Lunxi; Wang, Dayan; Zhou, Jiying

    2016-03-01

    This study explored the clinical characteristics of vestibular migraine in Chinese subjects and performed a field test of the criteria of the International Classification of Headache Disorders 3rd edition beta version. Consecutive patients with vestibular migraine were surveyed and registered in a headache clinic during the study period. The diagnosis of vestibular migraine was made according to International Classification of Headache Disorders 3rd edition beta version. Assessments included standardized neuro-otology bedside examination, pure-tone audiogram, bithermal caloric testing, neurological imaging, cervical X-ray or magnetic resonance imaging, Doppler ultrasound of cerebral arteries and laboratory tests. A total of 67 patients (62 female/five male, 47.8 ± 10.3 years old) were enrolled in this study. The mean ages of migraine and vertigo onset were 32.2 ± 11.5 and 37.9 ± 10.1 years, respectively. The most common migraine subtype was migraine without aura (79%), followed by migraine with aura (12%) and chronic migraine (9%). The duration of vertigo attacks varied from seconds to days and 25% of patients had attacks that lasted less than 5 minutes. Among the patients with short-lasting attacks, 75% of these patients had ≥5 attacks per day within 72 hours. Auditory symptoms were reported in 36% of the patients. Migraine prophylactic treatments were effective in 77% of the patients. Our study showed that the clinical features of vestibular migraine in China were similar to those of Western studies. The definition of vertigo episodes and migraine subtypes of vestibular migraine in International Classification of Headache Disorders 3rd edition beta version might be modified further. More than five vertigo attacks per day within 72 hours might be helpful as far as identifying vestibular migraine patients with short-lasting attacks. © International Headache Society 2015.

  9. European audit of current practice in diagnosis and treatment of childhood growth hormone deficiency

    DEFF Research Database (Denmark)

    Juul, Anders; Bernasconi, Sergio; Clayton, Peter E

    2002-01-01

    The present survey among members of the ESPE on current practice in diagnosis and treatment of growth hormone (GH) deficiency (GHD) is of great clinical relevance and importance in the light of the recently published guidelines for diagnosis and treatment of GHD by the Growth Hormone Research...... Society. We have found much conformity but also numerous discrepancies between the recommendations of the Growth Hormone Research Society and the current practice in Europe....

  10. [Diagnosis and treatment of STDs].

    Science.gov (United States)

    Latif, A

    1995-07-01

    Even though laboratory tests can easily diagnose sexually transmitted diseases (STDs), they require expensive, sophisticated equipment, which is lacking in many countries, and they take several days to obtain the results. In most cases, these tests require a sample for culture or the patient must be transferred to a hospital or an STD treatment center. Often patients do not want to return for test results or for treatment or they refuse to be transferred to another health facility. Thus, the STD goes untreated. The syndromic approach addresses these obstacles to STD diagnosis and treatment at the primary health care level. Nurses, midwives, health assistants, and clinical personnel undergo training in order to be able to diagnose and treat STDs during the first visit, at a reasonable cost, and without lab tests. They identify principal groups of signs and symptoms (i.e., syndromes) common to certain STDs. Prescribed drugs must be effective, cause no side effects, be available at the same center as the first consultation, and, preferably, be administered orally or by one dose. STD control programs need to identify the most prevalent syndromes and etiologic agents in the area and determine the most effective antibiotics for those syndromes. Donovanosis, syphilis, and soft chancre are responsible for genital ulcers in India and in Papua New Guinea; only syphilis and soft chancre are in other areas. Thus, it is important to provide treatment for all three causes in India and Papua New Guinea. It is easier to diagnose and treat penal discharge and genital ulcers in men and women than vaginal discharge and/or symptoms of pelvic inflammation in women. Thus, health workers need to ask a series of questions on risk factors for gonorrhea and chlamydia.

  11. [The importance of classifications in psychiatry].

    Science.gov (United States)

    Lempérière, T

    1995-12-01

    The classifications currently used in psychiatry have different aims: to facilitate communication between researchers and clinicians at national and international levels through the use of a common language, or at least a clearly and precisely defined nomenclature; to provide a nosographical reference system which can be used in practice (diagnosis, prognosis, treatment); to optimize research by ensuring that sample cases are as homogeneous as possible; to facilitate statistical records for public health institutions. A classification is of practical interest only if it is reliable, valid and acceptable to all potential users. In recent decades, there has been a considerable systematic and coordinated effort to improve the methodological approach to classification and categorization in the field of psychiatry, including attempts to create operational definitions, field trials of inter-assessor reliability, attempts to validate the selected nosological categories by analysis of correlation between progression, treatment response, family history and additional examinations. The introduction of glossaries, and particularly of diagnostic criteria, marked a decisive step in this new approach. The key problem remains that of the validity of diagnostic criteria. Ideally, these should be based on demonstrable etiologic or pathogenic data, but such information is rarely available in psychiatry. Current classifications rely on the use of extremely diverse elements in differing degrees: descriptive criteria, evolutive criteria, etiopathogenic criteria, psychopathogenic criteria, etc. Certain syndrome-based classifications such as DSM III and its successors aim to be atheoretical and pragmatic. Others, such as ICD-10, while more eclectic than the different versions of DSM, follow suit by abandoning the terms "disease" and "illness" in favor of the more consensual "disorder". The legitimacy of classifications in the field of psychiatry has been fiercely contested, being

  12. An international survey of classification and treatment choices for group D retinoblastoma

    Directory of Open Access Journals (Sweden)

    Jasmine H Francis

    2017-06-01

    Full Text Available AIM: To determine which IIRC scheme was used by retinoblastoma centers worldwide and the percentage of D eyes treated primarily with enucleation versus globe salvaging therapies as well as to correlate trends in treatment choice to IIRC version used and geographic region. METHODS: An anonymized electronic survey was offered to 115 physicians at 39 retinoblastoma centers worldwide asking about IIRC classification schemes and treatment patterns used between 2008 and 2012. Participants were asked to record which version of the IIRC was used for classification, how many group D eyes were diagnosed, and how many eyes were treated with enucleation versus globe salvaging therapies. Averages of eyes per treatment modality were calculated and stratified by both IIRC version and geographic region. Statistical significance was determined by Chi-square, ANOVA and Kruskal-Wallis tests using Prism. RESULTS: The survey was completed by 29% of physicians invited to participate. Totally 1807 D eyes were diagnosed. Regarding IIRC system, 27% of centers used the Children’s Hospital of Los Angeles (CHLA version, 33% used the Children’s Oncology Group (COG version, 23% used the Philadelphia version, and 17% were unsure. The rate for primary enucleation varied between 0 and 100% and the mean was 29%. By IIRC version, primary enucleation rates were: Philadelphia, 8%; COG, 34%; and CHLA, 37%. By geographic region, primary enucleation rates were: Latin America, 57%; Asia, 40%; Europe, 36%; Africa, 10%, US, 8%; and Middle East, 8%. However, systemic chemoreduction was used more often than enucleation in all regions except Latin America with a mean of 57% per center (P<0.0001. CONCLUSION: Worldwide there is no consensus on which IIRC version is used, systemic chemoreduction was the most frequently used initial treatment during the study period followed by enucleation and primary treatment modality, especially enucleation, varied greatly with regards to IIRC version

  13. Classification methods to detect sleep apnea in adults based on respiratory and oximetry signals: a systematic review.

    Science.gov (United States)

    Uddin, M B; Chow, C M; Su, S W

    2018-03-26

    Sleep apnea (SA), a common sleep disorder, can significantly decrease the quality of life, and is closely associated with major health risks such as cardiovascular disease, sudden death, depression, and hypertension. The normal diagnostic process of SA using polysomnography is costly and time consuming. In addition, the accuracy of different classification methods to detect SA varies with the use of different physiological signals. If an effective, reliable, and accurate classification method is developed, then the diagnosis of SA and its associated treatment will be time-efficient and economical. This study aims to systematically review the literature and present an overview of classification methods to detect SA using respiratory and oximetry signals and address the automated detection approach. Sixty-two included studies revealed the application of single and multiple signals (respiratory and oximetry) for the diagnosis of SA. Both airflow and oxygen saturation signals alone were effective in detecting SA in the case of binary decision-making, whereas multiple signals were good for multi-class detection. In addition, some machine learning methods were superior to the other classification methods for SA detection using respiratory and oximetry signals. To deal with the respiratory and oximetry signals, a good choice of classification method as well as the consideration of associated factors would result in high accuracy in the detection of SA. An accurate classification method should provide a high detection rate with an automated (independent of human action) analysis of respiratory and oximetry signals. Future high-quality automated studies using large samples of data from multiple patient groups or record batches are recommended.

  14. Childbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Bellanger, Martine M; Quentin, Wilm; Tan, Siok Swan

    2013-05-01

    The study compares how Diagnosis-Related Group (DRG) based hospital payment systems in eleven European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) deal with women giving birth in hospitals. It aims to assist gynaecologists and national authorities in optimizing their DRG systems. National or regional databases were used to identify childbirth cases. DRG grouping algorithms and indicators of resource consumption were compared for those DRGs which account for at least 1% of all childbirth cases in the respective database. Five standardized case vignettes were defined and quasi prices (i.e. administrative prices or tariffs) of hospital deliveries according to national DRG-based hospital payment systems were ascertained. European DRG systems classify childbirth cases according to different sets of variables (between one and eight variables) into diverging numbers of DRGs (between three and eight DRGs). The most complex DRG is valued 3.5 times more resource intensive than an index case in Ireland but only 1.1 times more resource intensive than an index case in The Netherlands. Comparisons of quasi prices for the vignettes show that hypothetical payments for the most complex case amount to only € 479 in Poland but to € 5532 in Ireland. Differences in the classification of hospital childbirth cases into DRGs raise concerns whether European systems rely on the most appropriate classification variables. Physicians, hospitals and national DRG authorities should consider how other countries' DRG systems classify cases to optimize their system and to ensure fair and appropriate reimbursement. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Diagnosis and treatment of polycystic ovary syndrome (PCOS): an interview with Richard Legro.

    Science.gov (United States)

    Legro, Richard

    2015-03-27

    In this podcast, we talk to Professor Richard Legro about the recommendations for the diagnosis and treatment of polycystic ovary syndrome (PCOS) based on clinical practice guidelines and discuss the challenges of diagnosis PCOS at specific age groups. The controversies associated with treatment of PCOS, including therapies for infertility as this is a problem commonly observed in PCOS subjects, are highlighted together with future directions on the topic. The podcast for this interview is available at. http://www.biomedcentral.com/content/supplementary/s12916-015-0299-2-s1.mp3.

  16. [Clinical practice guideline. Diagnosis and treatment of dyslipidemia.

    Science.gov (United States)

    Canalizo-Miranda, Elvia; Favela-Pérez, Eddie Alberto; Salas-Anaya, Javier Alejandro; Gómez-Díaz, Rita; Jara-Espino, Ricardo; Del Pilar Torres-Arreola, Laura; Viniegra-Osorio, Arturo

    2013-01-01

    Non-communicable diseases are a public health problem in México. Coronary heart disease and diabetes mellitus are the first and second cause of death in the country, followed by thrombotic cerebrovascular events. Cardiovascular diseases are the leading cause of death; one primary risk factor is hypercholesterolemia. The detection and treatment of lipid abnormalities is the key to the prevention and management of chronic non-communicable diseases. Two nationally representative surveys have shown that lipid abnormalities are the most common risk factors in Mexican adults. The purpose of this guide is to provide a basis for identifying dyslipidemia in a timely manner, and to systematize the criteria for diagnosis and treatment in the first and second level of care.

  17. Classification across gene expression microarray studies

    Directory of Open Access Journals (Sweden)

    Kuner Ruprecht

    2009-12-01

    Full Text Available Abstract Background The increasing number of gene expression microarray studies represents an important resource in biomedical research. As a result, gene expression based diagnosis has entered clinical practice for patient stratification in breast cancer. However, the integration and combined analysis of microarray studies remains still a challenge. We assessed the potential benefit of data integration on the classification accuracy and systematically evaluated the generalization performance of selected methods on four breast cancer studies comprising almost 1000 independent samples. To this end, we introduced an evaluation framework which aims to establish good statistical practice and a graphical way to monitor differences. The classification goal was to correctly predict estrogen receptor status (negative/positive and histological grade (low/high of each tumor sample in an independent study which was not used for the training. For the classification we chose support vector machines (SVM, predictive analysis of microarrays (PAM, random forest (RF and k-top scoring pairs (kTSP. Guided by considerations relevant for classification across studies we developed a generalization of kTSP which we evaluated in addition. Our derived version (DV aims to improve the robustness of the intrinsic invariance of kTSP with respect to technologies and preprocessing. Results For each individual study the generalization error was benchmarked via complete cross-validation and was found to be similar for all classification methods. The misclassification rates were substantially higher in classification across studies, when each single study was used as an independent test set while all remaining studies were combined for the training of the classifier. However, with increasing number of independent microarray studies used in the training, the overall classification performance improved. DV performed better than the average and showed slightly less variance. In

  18. Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

    Science.gov (United States)

    Min, Seung-Kee; Kim, Young Hwan; Joh, Jin Hyun; Kang, Jin Mo; Park, Ui Jun; Kim, Hyung-Kee; Chang, Jeong-Hwan; Park, Sang Jun; Kim, Jang Yong; Bae, Jae Ik; Choi, Sun Young; Kim, Chang Won; Park, Sung Il; Yim, Nam Yeol; Jeon, Yong Sun; Yoon, Hyun-Ki; Park, Ki Hyuk

    2016-01-01

    Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care. PMID:27699156

  19. Tissue classifications in Monte Carlo simulations of patient dose for photon beam tumor treatments

    Science.gov (United States)

    Lin, Mu-Han; Chao, Tsi-Chian; Lee, Chung-Chi; Tung-Chieh Chang, Joseph; Tung, Chuan-Jong

    2010-07-01

    The purpose of this work was to study the calculated dose uncertainties induced by the material classification that determined the interaction cross-sections and the water-to-material stopping-power ratios. Calculations were made for a head- and neck-cancer patient treated with five intensity-modulated radiotherapy fields using 6 MV photon beams. The patient's CT images were reconstructed into two voxelized patient phantoms based on different CT-to-material classification schemes. Comparisons of the depth-dose curve of the anterior-to-posterior field and the dose-volume-histogram of the treatment plan were used to evaluate the dose uncertainties from such schemes. The results indicated that any misassignment of tissue materials could lead to a substantial dose difference, which would affect the treatment outcome. To assure an appropriate material assignment, it is desirable to have different conversion tables for various parts of the body. The assignment of stopping-power ratio should be based on the chemical composition and the density of the material.

  20. Tissue classifications in Monte Carlo simulations of patient dose for photon beam tumor treatments

    International Nuclear Information System (INIS)

    Lin, Mu-Han; Chao, Tsi-Chian; Lee, Chung-Chi; Tung-Chieh Chang, Joseph; Tung, Chuan-Jong

    2010-01-01

    The purpose of this work was to study the calculated dose uncertainties induced by the material classification that determined the interaction cross-sections and the water-to-material stopping-power ratios. Calculations were made for a head- and neck-cancer patient treated with five intensity-modulated radiotherapy fields using 6 MV photon beams. The patient's CT images were reconstructed into two voxelized patient phantoms based on different CT-to-material classification schemes. Comparisons of the depth-dose curve of the anterior-to-posterior field and the dose-volume-histogram of the treatment plan were used to evaluate the dose uncertainties from such schemes. The results indicated that any misassignment of tissue materials could lead to a substantial dose difference, which would affect the treatment outcome. To assure an appropriate material assignment, it is desirable to have different conversion tables for various parts of the body. The assignment of stopping-power ratio should be based on the chemical composition and the density of the material.

  1. Unraveling Executive Functioning in Dual Diagnosis.

    Science.gov (United States)

    Duijkers, Judith C L M; Vissers, Constance Th W M; Egger, Jos I M

    2016-01-01

    In mental health, the term dual-diagnosis is used for the co-occurrence of Substance Use Disorder (SUD) with another mental disorder. These co-occurring disorders can have a shared cause, and can cause/intensify each other's expression. Forming a threat to health and society, dual-diagnosis is associated with relapses in addiction-related behavior and a destructive lifestyle. This is due to a persistent failure to control impulses and the maintaining of inadequate self-regulatory behavior in daily life. Thus, several aspects of executive functioning like inhibitory, shifting and updating processes seem impaired in dual-diagnosis. Executive (dys-)function is currently even seen as a shared underlying key component of most mental disorders. However, the number of studies on diverse aspects of executive functioning in dual-diagnosis is limited. In the present review, a systematic overview of various aspects of executive functioning in dual-diagnosis is presented, striving for a prototypical profile of patients with dual-diagnosis. Looking at empirical results, inhibitory and shifting processes appear to be impaired for SUD combined with schizophrenia, bipolar disorder or cluster B personality disorders. Studies involving updating process tasks for dual-diagnosis were limited. More research that zooms in to the full diversity of these executive functions is needed in order to strengthen these findings. Detailed insight in the profile of strengths and weaknesses that underlies one's behavior and is related to diagnostic classifications, can lead to tailor-made assessment and indications for treatment, pointing out which aspects need attention and/or training in one's self-regulative abilities.

  2. Diagnosis and treatment of superficial esophageal cancer.

    Science.gov (United States)

    Barret, Maximilien; Prat, Frédéric

    2018-01-01

    Endoscopy allows for the screening, early diagnosis, treatment and follow up of superficial esophageal cancer. Endoscopic submucosal dissection has become the gold standard for the resection of superficial squamous cell neoplasia. Combinations of endoscopic mucosal resection and radiofrequency ablation are the mainstay of the management of Barrett's associated neoplasia. However, protruded, non-lifting or large lesions may be better managed by endoscopic submucosal dissection. Novel ablation tools, such as argon plasma coagulation with submucosal lifting and cryoablation balloons, are being developed for the treatment of residual Barrett's esophagus, since iatrogenic strictures still hamper the development of extensive circumferential resections in the esophagus. Optimal surveillance modalities after endoscopic resection are still to be determined. The assessment of the risk of lymph-node metastases, as well as of the need for additional treatments based on qualitative and quantitative histological criteria, balanced to the patient's condition, requires a dedicated multidisciplinary team decision process. The need for trained endoscopists, expert pathologists and surgeons, and specialized multidisciplinary meetings underlines the role of expert centers in the management of superficial esophageal cancer.

  3. Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer

    DEFF Research Database (Denmark)

    Iachina, Maria; Jakobsen, Erik; Fallesen, Anne Kudsk

    2017-01-01

    with treatment facilities during the care pathway. We wanted to investigate whether this organizational set-up influenced the time that patients wait for the diagnosis and treatment. Therefore, the objective of this study was to uncover the impact of transfer between hospitals on the delay in the diagnosis......BACKGROUND: Lung cancer is the second most frequent cancer diagnosis in Denmark. Although improved during the last decade, the prognosis of lung cancer is still poor with an overall 5-year survival rate of approximately 12%. Delay in diagnosis and treatment of lung cancer has been suggested...... and incomplete data on the dates of referral, diagnosis and treatment were excluded. RESULTS: A total of 11 273 patients were included for further analyses. Transfer patients waited longer for treatment after the diagnosis, (Hazard ratio (HR) 0.81 (0.68-0.96)) and in total time from referral to treatment (HR 0...

  4. Prostate Cancer: Symptoms, Diagnosis and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Prostate Cancer Prostate Cancer: Symptoms, Diagnosis and Treatment Past Issues / Winter 2010 Table of Contents Symptoms Prostate cancer has no symptoms in its early stages. They ...

  5. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines.

    Science.gov (United States)

    Nishida, Toshirou; Blay, Jean-Yves; Hirota, Seiichi; Kitagawa, Yuko; Kang, Yoon-Koo

    2016-01-01

    Although gastrointestinal stromal tumors (GISTs) are a rare type of cancer, they are the commonest sarcoma in the gastrointestinal tract. Molecularly targeted therapy, such as imatinib therapy, has revolutionized the treatment of advanced GIST and facilitates scientific research on GIST. Nevertheless, surgery remains a mainstay of treatment to obtain a permanent cure for GIST even in the era of targeted therapy. Many GIST guidelines have been published to guide the diagnosis and treatment of the disease. We review current versions of GIST guidelines published by the National Comprehensive Cancer Network, by the European Society for Medical Oncology, and in Japan. All clinical practice guidelines for GIST include recommendations based on evidence as well as on expert consensus. Most of the content is very similar, as represented by the following examples: GIST is a heterogeneous disease that may have mutations in KIT, PDGFRA, HRAS, NRAS, BRAF, NF1, or the succinate dehydrogenase complex, and these subsets of tumors have several distinctive features. Although there are some minor differences among the guidelines--for example, in the dose of imatinib recommended for exon 9-mutated GIST or the efficacy of antigen retrieval via immunohistochemistry--their common objectives regarding diagnosis and treatment are not only to improve the diagnosis of GIST and the prognosis of patients but also to control medical costs. This review describes the current standard diagnosis, treatment, and follow-up of GISTs based on the recommendations of several guidelines and expert consensus.

  6. Diagnosis of prostate cancer with needle biopsy: should all cases be biopsied before treatment?

    Science.gov (United States)

    Oranusi, C K; Ugezu, A I; Nwofor, Ame

    2012-01-01

    The triad of digital rectal examination (DRE), serum prostate specific antigen, and transrectal ultrasound-guided prostate biopsy is used in the detection of prostate cancer (PCa). It is recommended that all cases of PCa should be diagnosed with needle biopsy before treatment. The exclusion criteria for those that may not be suitable have not yet been defined. We reviewed all the patients diagnosed with PCa at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast, Nigeria, from January 2007 to December 2010. Relevant biodata and method of diagnosis of PCa before treatment were reviewed. A total of 133 patients had bilateral orchidectomy over the period. 120 (90.2%) had their diagnosis confirmed by needle biopsy before bilateral orchidectomy (category 1), while 13 (9.8%) had bilateral orchidectomy before diagnosis was confirmed. The method of diagnosis for category 1 patients was with lower urinary tract symptoms (LUTS), abnormal DRE findings, elevated prostate-specific antigen (PSA), and transrectal needle biopsy. For category 11 patients, diagnosis of PCa was suspected based on LUTS, abnormal DRE findings, and elevated PSA. Of this number, 11 (84.6%) had, in addition, sudden onset paraplegia at presentation, while 2 (15.4%) had severe uncontrolled hematuria at presentation. All the patients in both categories had needle biopsy confirmation of their disease. The sensitivity of PSA was 99.2%. Needle biopsy of the prostate is the preferred method for the diagnosis of PCa in most cases before treatment is undertaken. There are valid reasons why all PCas will not be diagnosed in this fashion. Elevated PSA when combined with an abnormal DRE finding increases the predictive value for cancer. In areas where pathologists are lacking, abnormal DRE and elevated PSA results can be a guide to proceed to treatment especially, where there is severe compromise of patients' quality of life due to symptoms of advanced PCa while awaiting confirmation.

  7. Clinical application of electron beam computed tomography in diagnosis of truncus arteriosus

    International Nuclear Information System (INIS)

    Zhang Gejun; Dai Ruping; Cao Cheng; Qi Xiaoou; Bai Hua; Ma Zhanhong; Chen Yao; Mu Feng; Ren Li

    2005-01-01

    Objective: To evaluate value of electron beam computed tomography (EBCT) in diagnosis of truncus arteriosus (TA). Methods: Ten cases of TA with age ranging from 2-month to 24 years were studied. All cases were examined and diagnosed with Imatron C-150 scanner using contrastmedia. The results of EBCT were analyzed and compared with the results of echocardiography (in 10 cases), cardiovascular angiography (in 3 cases) and surgery findings (in 1 case ). Results: EBCT yielded qualitative diagnosis and classification in all 10 cases. Echocardiography revealed qualitative diagnosis in 9 cases, however its classification was accordant to EBCT just in 5 cases. The concomitant abnormalities of TA were found more with EBCT than that with echocardiography. Cardiovascular angiography was performed in 3 cases, yielding inaccurate classification 2 cases. One case of TA was operated just based on the results of echocardiography, EBCT and catheterization. Conclusion: As a noninvasive method, EBCT could yield qualitative diagnosis of TA as well as classification. The results of EBCT examination combining echocardiography and catheterization could guide the operations. (authors)

  8. Multi-centre retrospective analysis of clinical diagnosis and treatment for chronic cough

    Directory of Open Access Journals (Sweden)

    Xiao-ming CHENG

    2011-02-01

    Full Text Available Objective To explore the clinical characteristics and the present status of diagnosis and treatment of chronic cough.Methods The clinical data of 238 in-patients and out-patients of Departments of Respiratory Diseases from 4 teaching hospitals of Chongqing Municipality were collected from Oct.2008 to Dec.2009,and their clinical characteristics,diagnosis and therapeutic effects were retrospectively analyzed.Results A total of 238 patients were enrolled,most of them complained of dry cough and night cough.Throat symptoms were most common,including itching or foreign body sensation,throat discomfort and gastro-oesophageal reflux.Congestion of pharynx and cobblestone like changes in posterior pharyngeal wall were the most common signs in patients with chronic cough.Among all the supplementary examinations,bronchial provocation test resulted in highest positive rate.Etiological diagnosis was done in a total of 254 case-times for diseases leading to chronic cough,among them upper airway cough syndrome(UACS was suspected in 115 case-times.cough variant asthma(CVA in 42 case-times,and cough due to gastroesophageal reflux(GERC in 53 case-times.After the specific treatment targeting UACS,CVA and GERC,in 152 case-times improvement was found after follow-up,including 56,27 and 21 case-times,respectively,with an effective rate of 68.4%(104/152.The final diagnosis for the other 44 case-times with chronic cough was chronic tonsillitis,chronic bronchitis,eosinophilic bronchitis and angiotensin converting enzyme inhibitor(ACEI induced cough.A definite diagnosis was finally made in 148 out of a total of 254 casses,with a diagnostic rate of 58.3%(148/254.Conclusion The final diagnostic rate in etiology of chronic cough is still poor nowadays in our country,and empirical treatment is still the main practice for chronic cough.

  9. Application of Digital Diagnosis and Treatment Technique in Benign Mandibular Diseases.

    Science.gov (United States)

    Ju, Rui; Zeng, Wei; Lian, Xiaotian; Chen, Gang; Yin, Huaqiang; Tang, Wei

    2018-02-06

    To explore the feasibility of preoperative planning for treatment of benign mandibular lesions (BML) using digital technologies such as three-dimensional (3D) reconstruction, measurement, visualization as well as image contrast and design of neural positioning protection template (NPPT) in combination with 3D printing technology in the BML diagnosis and treatment. The 3D models of BML and inferior alveolar nerves (IAN) of 10 BML patients were reconstructed based on their digital imaging and communications in medicine (DICOM) data using MIMICS16.0 software. The models were used to visualize lesions and nerve contrast measurement and guide design of personalized NPPT and osteotomy after operation modality was determined in order to achieve accurate, minimally invasive operation with shortened intraoperative time. Intraoperative NPPT application could accurately locate lesions and their scope and assist osteotomy. The measurement results were consistent with those of preoperative reconstruction and measurement. The BML were curetted completely without damage IAN. The 10 BML patients had no numbness and other discomforts in the lower lip and mandibular teeth after operation. The digital diagnosis and treatment technology is an effective method for functional treatment of BML patients and its application could achieve personalized, minimally invasive and precise treatment and save intraoperation time.

  10. Myxedema coma: diagnosis and treatment.

    Science.gov (United States)

    Wall, C R

    2000-12-01

    Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. Patients with hypothyroidism may exhibit a number of physiologic alterations to compensate for the lack of thyroid hormone. If these homeostatic mechanisms are overwhelmed by factors such as infection, the patient may decompensate into myxedema coma. Patients with hypothyroidism typically have a history of fatigue, weight gain, constipation and cold intolerance. Physicians should include hypothyroidism in the differential diagnosis of every patient with hyponatremia. Patients with suspected myxedema coma should be admitted to an intensive care unit for vigorous pulmonary and cardiovascular support. Most authorities recommend treatment with intravenous levothyroxine (T4) as opposed to intravenous liothyronine (T3). Hydrocortisone should be administered until coexisting adrenal insufficiency is ruled out. Family physicians are in an important position to prevent myxedema coma by maintaining a high level of suspicion for hypothyroidism.

  11. Molecular Classification of Lobular Carcinoma of the Breast

    Science.gov (United States)

    Fu, Denggang; Zuo, Qi; Huang, Qi; Su, Li; Ring, Huijun Z.; Ring, Brian Z.

    2017-01-01

    The morphology of breast tumors is complicated and diagnosis can be difficult. We present here a novel diagnostic model which we validate on both array-based and RNA sequencing platforms which reliably distinguishes this tumor type across multiple cohorts. We also examine how this molecular classification predicts sensitivity to common chemotherapeutics in cell-line based assays. A total of 1845 invasive breast cancer cases in six cohorts were collected, split into discovery and validation cohorts, and a classifier was created and compared to pathological diagnosis, grade and survival. In the validation cohorts the concordance of predicted diagnosis with a pathological diagnosis was 92%, and 97% when inconclusively classified cases were excluded. Tumor-derived cell lines were classified with the model as having predominantly ductal or lobular-like molecular physiologies, and sensitivity of these lines to relevant compounds was analyzed. A diagnostic tool can be created that reliably distinguishes lobular from ductal carcinoma and allows the classification of cell lines on the basis of molecular profiles associated with these tumor types. This tool may assist in improved diagnosis and aid in explorations of the response of lobular type breast tumor models to different compounds. PMID:28303886

  12. MRI-based treatment plan simulation and adaptation for ion radiotherapy using a classification-based approach

    International Nuclear Information System (INIS)

    Rank, Christopher M; Tremmel, Christoph; Hünemohr, Nora; Nagel, Armin M; Jäkel, Oliver; Greilich, Steffen

    2013-01-01

    In order to benefit from the highly conformal irradiation of tumors in ion radiotherapy, sophisticated treatment planning and simulation are required. The purpose of this study was to investigate the potential of MRI for ion radiotherapy treatment plan simulation and adaptation using a classification-based approach. Firstly, a voxelwise tissue classification was applied to derive pseudo CT numbers from MR images using up to 8 contrasts. Appropriate MR sequences and parameters were evaluated in cross-validation studies of three phantoms. Secondly, ion radiotherapy treatment plans were optimized using both MRI-based pseudo CT and reference CT and recalculated on reference CT. Finally, a target shift was simulated and a treatment plan adapted to the shift was optimized on a pseudo CT and compared to reference CT optimizations without plan adaptation. The derivation of pseudo CT values led to mean absolute errors in the range of 81 - 95 HU. Most significant deviations appeared at borders between air and different tissue classes and originated from partial volume effects. Simulations of ion radiotherapy treatment plans using pseudo CT for optimization revealed only small underdosages in distal regions of a target volume with deviations of the mean dose of PTV between 1.4 - 3.1% compared to reference CT optimizations. A plan adapted to the target volume shift and optimized on the pseudo CT exhibited a comparable target dose coverage as a non-adapted plan optimized on a reference CT. We were able to show that a MRI-based derivation of pseudo CT values using a purely statistical classification approach is feasible although no physical relationship exists. Large errors appeared at compact bone classes and came from an imperfect distinction of bones and other tissue types in MRI. In simulations of treatment plans, it was demonstrated that these deviations are comparable to uncertainties of a target volume shift of 2 mm in two directions indicating that especially

  13. The selective angiographic diagnosis and endovascular embolization treatment of severe epistaxis

    International Nuclear Information System (INIS)

    Zhang Xiquan; Lu Yonghong; Sun Jinghua; Guo Deqiang; Li Yuzhen; Wei Aihua

    2002-01-01

    Objective: To evaluate selective angiographic diagnosis and embolization of severe epistaxis in 57 cases. Methods: 41 cases with spontaneous haemorrhage, 11 cases with traumatic haemorrhage, 3 cases with haemorrhage of nasopharyngeal fibroangioma, and 2 case with haemorrhage of nasopharyngeal carcinoma were included in the study. Selective angiographic diagnosis and embolization of epistaxis were performed with absorbable gelatin sponge or balloon or spring coil by using Seldinger's method. Results: 59 procedure of angiographic diagnosis and embolization were performed in 57 cases. Both maxillaris internal artery embolization was performed in 6 cases. After embolization, satisfactory results were achieved immediately in 55 cases. After 6 months to 2 years' follow-up, no haemorrhage recurred. In 4 cases with traumatic haemorrhage in the face, simple maxillaris internal artery embolization was performed in 2 cases. Conclusion: Selective angiographic diagnosis and embolization are safe, effective, and successful method of choices in the treatment of severe epistaxis

  14. Noninvasive differential diagnosis of dental periapical lesions in cone-beam CT scans

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Kazunori, E-mail: kazokada@sfsu.edu [Department of Computer Science, San Francisco State University, San Francisco, California 94132 (United States); Rysavy, Steven [Biomedical and Health Informatics Program, University of Washington, Seattle, Washington 98195 (United States); Flores, Arturo [Computer Science and Engineering, University of California, San Diego, California 92093 (United States); Linguraru, Marius George [Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010 and Departments of Radiology and Pediatrics, George Washington University, Washington, DC 20037 (United States)

    2015-04-15

    Purpose: This paper proposes a novel application of computer-aided diagnosis (CAD) to an everyday clinical dental challenge: the noninvasive differential diagnosis of periapical lesions between periapical cysts and granulomas. A histological biopsy is the most reliable method currently available for this differential diagnosis; however, this invasive procedure prevents the lesions from healing noninvasively despite a report that they may heal without surgical treatment. A CAD using cone-beam computed tomography (CBCT) offers an alternative noninvasive diagnostic tool which helps to avoid potentially unnecessary surgery and to investigate the unknown healing process and rate for the lesions. Methods: The proposed semiautomatic solution combines graph-based random walks segmentation with machine learning-based boosted classifiers and offers a robust clinical tool with minimal user interaction. As part of this CAD framework, the authors provide two novel technical contributions: (1) probabilistic extension of the random walks segmentation with likelihood ratio test and (2) LDA-AdaBoost: a new integration of weighted linear discriminant analysis to AdaBoost. Results: A dataset of 28 CBCT scans is used to validate the approach and compare it with other popular segmentation and classification methods. The results show the effectiveness of the proposed method with 94.1% correct classification rate and an improvement of the performance by comparison with the Simon’s state-of-the-art method by 17.6%. The authors also compare classification performances with two independent ground-truth sets from the histopathology and CBCT diagnoses provided by endodontic experts. Conclusions: Experimental results of the authors show that the proposed CAD system behaves in clearer agreement with the CBCT ground-truth than with histopathology, supporting the Simon’s conjecture that CBCT diagnosis can be as accurate as histopathology for differentiating the periapical lesions.

  15. Noninvasive differential diagnosis of dental periapical lesions in cone-beam CT scans

    International Nuclear Information System (INIS)

    Okada, Kazunori; Rysavy, Steven; Flores, Arturo; Linguraru, Marius George

    2015-01-01

    Purpose: This paper proposes a novel application of computer-aided diagnosis (CAD) to an everyday clinical dental challenge: the noninvasive differential diagnosis of periapical lesions between periapical cysts and granulomas. A histological biopsy is the most reliable method currently available for this differential diagnosis; however, this invasive procedure prevents the lesions from healing noninvasively despite a report that they may heal without surgical treatment. A CAD using cone-beam computed tomography (CBCT) offers an alternative noninvasive diagnostic tool which helps to avoid potentially unnecessary surgery and to investigate the unknown healing process and rate for the lesions. Methods: The proposed semiautomatic solution combines graph-based random walks segmentation with machine learning-based boosted classifiers and offers a robust clinical tool with minimal user interaction. As part of this CAD framework, the authors provide two novel technical contributions: (1) probabilistic extension of the random walks segmentation with likelihood ratio test and (2) LDA-AdaBoost: a new integration of weighted linear discriminant analysis to AdaBoost. Results: A dataset of 28 CBCT scans is used to validate the approach and compare it with other popular segmentation and classification methods. The results show the effectiveness of the proposed method with 94.1% correct classification rate and an improvement of the performance by comparison with the Simon’s state-of-the-art method by 17.6%. The authors also compare classification performances with two independent ground-truth sets from the histopathology and CBCT diagnoses provided by endodontic experts. Conclusions: Experimental results of the authors show that the proposed CAD system behaves in clearer agreement with the CBCT ground-truth than with histopathology, supporting the Simon’s conjecture that CBCT diagnosis can be as accurate as histopathology for differentiating the periapical lesions

  16. Noninvasive differential diagnosis of dental periapical lesions in cone-beam CT scans.

    Science.gov (United States)

    Okada, Kazunori; Rysavy, Steven; Flores, Arturo; Linguraru, Marius George

    2015-04-01

    This paper proposes a novel application of computer-aided diagnosis (CAD) to an everyday clinical dental challenge: the noninvasive differential diagnosis of periapical lesions between periapical cysts and granulomas. A histological biopsy is the most reliable method currently available for this differential diagnosis; however, this invasive procedure prevents the lesions from healing noninvasively despite a report that they may heal without surgical treatment. A CAD using cone-beam computed tomography (CBCT) offers an alternative noninvasive diagnostic tool which helps to avoid potentially unnecessary surgery and to investigate the unknown healing process and rate for the lesions. The proposed semiautomatic solution combines graph-based random walks segmentation with machine learning-based boosted classifiers and offers a robust clinical tool with minimal user interaction. As part of this CAD framework, the authors provide two novel technical contributions: (1) probabilistic extension of the random walks segmentation with likelihood ratio test and (2) LDA-AdaBoost: a new integration of weighted linear discriminant analysis to AdaBoost. A dataset of 28 CBCT scans is used to validate the approach and compare it with other popular segmentation and classification methods. The results show the effectiveness of the proposed method with 94.1% correct classification rate and an improvement of the performance by comparison with the Simon's state-of-the-art method by 17.6%. The authors also compare classification performances with two independent ground-truth sets from the histopathology and CBCT diagnoses provided by endodontic experts. Experimental results of the authors show that the proposed CAD system behaves in clearer agreement with the CBCT ground-truth than with histopathology, supporting the Simon's conjecture that CBCT diagnosis can be as accurate as histopathology for differentiating the periapical lesions.

  17. Update on diagnosis and treatment of idiopathic pulmonary fibrosis

    Science.gov (United States)

    Baddini-Martinez, José; Baldi, Bruno Guedes; da Costa, Cláudia Henrique; Jezler, Sérgio; Lima, Mariana Silva; Rufino, Rogério

    2015-01-01

    Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation. PMID:26578138

  18. Update on diagnosis and treatment of idiopathic pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    José Baddini-Martinez

    2015-10-01

    Full Text Available Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation.

  19. Distant metastases in differentiated thyroid carcinoma: diagnosis and treatment

    International Nuclear Information System (INIS)

    Schmidt, A.; Cross, G.; Pitoia, F.

    2017-01-01

    Distant metastases occur in less than 10% of patients with differentiated thyroid carcinoma. In these patients, overall survival at 10 years is considerably reduced. Whereas cure is the initial goal of treatment, stabilisation of the disease and management of symptoms have become the primary objective in many patients with persistent radio-iodine refractory progressive disease. In the last decade, several targeted therapies have shown encouraging results in patients with advanced disease. The objective of this review is to describe the characteristics, diagnosis, overall survival, and the local and systemic available treatments for patients with distant metastases from differentiated thyroid cancer. (authors) [es

  20. Advances in the Diagnosis and Treatment of PCOS.

    Science.gov (United States)

    Carmina, Enrico; Guastella, Ettore; Longo, Rosa Alba

    2016-01-01

    While the Rotterdam criteria look simple and easy to follow, in clinical practice diagnosis of PCOS may be problematic because of the use of inaccurate commercial androgen assays. Progresses in ovarian ultrasound and in AMH measurement have modified the way to make the diagnosis of PCOS and an update of Rotterdam criteria may be necessary. In classic severe form of PCOS, ovarian follicle count is a very reliable diagnostic criterion but AMH measurement may also present high diagnostic specificity and sensitivity. This finding is particularly important when no clinical signs of androgen excess are present and only commercial assays for androgen measurement are available. At the contrary, in mild PCOS phenotypes, sensitivity of AMH measurement is too low whileFNPO count maintains a high diagnostic sensitivity. However, at least in ovulatory hyperandrogenic PCOS phenotype, increased AMH values in association with enlarged ovarian size permit the diagnosis of ovulatory PCOS in 85% of these patients. Treatment of PCOS women has to be directed to get fertility or in patients not seeking fertility to solve or attenuate the psychological implications of androgen excess and of irregular menses and the risk of endometrial hyperplasia. The therapeutic protocols that are used in our department are presented.

  1. Seasonal Allergies: Symptoms, Diagnosis, and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... this page please turn Javascript on. Feature: Managing Allergies Seasonal Allergies: Symptoms, Diagnosis, and Treatment Past Issues / Summer 2011 ... of Contents Is It a Cold or an Allergy? Symptoms Cold Airborne Allergy Cough Common Sometimes General ...

  2. Classification in Medical Imaging

    DEFF Research Database (Denmark)

    Chen, Chen

    Classification is extensively used in the context of medical image analysis for the purpose of diagnosis or prognosis. In order to classify image content correctly, one needs to extract efficient features with discriminative properties and build classifiers based on these features. In addition...... on characterizing human faces and emphysema disease in lung CT images....

  3. Applications of nanotechnology for melanoma treatment, diagnosis, and theranostics

    Directory of Open Access Journals (Sweden)

    Chen J

    2013-07-01

    Full Text Available Jiezhong Chen,1,2 Renfu Shao,3 Xu Dong Zhang,4 Chen Chen1 1School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia; 2Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia; 3GeneCology Research Centre, School of Science, Education and Engineering, University of the Sunshine Coast, Maroochydore, QLD, Australia; 4School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Abstract: Melanoma is the most aggressive type of skin cancer and has very high rates of mortality. An early stage melanoma can be surgically removed, with a survival rate of 99%. However, metastasized melanoma is difficult to cure. The 5-year survival rates for patients with metastasized melanoma are still below 20%. Metastasized melanoma is currently treated by chemotherapy, targeted therapy, immunotherapy and radiotherapy. The outcome of most of the current therapies is far from optimistic. Although melanoma patients with a mutation in the oncogene v-Raf murine sarcoma viral oncogene homolog B1 (BRAF have an initially higher positive response rate to targeted therapy, the majority develop acquired drug resistance after 6 months of the therapy. To increase treatment efficacy, early diagnosis, more potent pharmacological agents, and more effective delivery systems are urgently needed. Nanotechnology has been extensively studied for melanoma treatment and diagnosis, to decrease drug resistance, increase therapeutic efficacy, and reduce side effects. In this review, we summarize the recent progress on the development of various nanoparticles for melanoma treatment and diagnosis. Several common nanoparticles, including liposome, polymersomes, dendrimers, carbon-based nanoparticles, and human albumin, have been used to deliver chemotherapeutic agents, and small interfering ribonucleic acids (siRNAs against signaling molecules have also been tested for the treatment of melanoma. Indeed

  4. To Know or Not to Know: Ethical Issues Related to Early Diagnosis of Alzheimer's Disease

    Directory of Open Access Journals (Sweden)

    Niklas Mattsson

    2010-01-01

    Full Text Available In Alzheimer's disease (AD, pathological processes start in the brain long before clinical dementia. Biomarkers reflecting brain alterations may therefore indicate disease at an early stage, enabling early diagnosis. This raises several ethical questions and the potential benefits of early diagnosis must be weighted against possible disadvantages. Currently, there are few strong arguments favouring early diagnosis, due to the lack of disease modifying therapy. Also, available diagnostic methods risk erroneous classifications, with potentially grave consequences. However, a possible benefit of early diagnosis even without disease modifying therapy is that it may enable early decision making when patients still have full decision competence, avoiding problems of hypothetical consents. It may also help identifying patients with cognitive dysfunction secondary to other diseases that may be responsive to treatment already today.

  5. Anorexia nervosa: the diagnosis. A postmodern ethics contribution to the bioethics debate on involuntary treatment for anorexia nervosa.

    Science.gov (United States)

    Kendall, Sacha

    2014-03-01

    This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter "AN: the diagnosis") several ethical issues are revealed. Firstly, "AN: the diagnosis" influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, "AN: the diagnosis" impacts on how treatment and treatment efficacy are defined and the ethical justifiability of paternalism. Thirdly, "AN: the diagnosis" can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. "AN: the diagnosis" can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty.

  6. Advances in research on and diagnosis and treatment of achondroplasia in China

    Science.gov (United States)

    Wang, Yao; Liu, Zeying; Liu, Zhenxing; Zhao, Heng; Zhou, Xiaoyan; Cui, Yazhou; Han, Jinxiang

    2013-01-01

    Summary Achondroplasia is a rare autosomal dominant genetic disease. Research on achondroplasia in China, however, has received little emphasis. Around 80–90% of cases of neonatal achondroplasia result from mutations in fibroblast growth factor receptor 3 (FGFR3) according to polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). Recently, genetic research on achondroplasia in China made a major breakthrough by revealing two novel mutations located on the FGFR3 gene, thus helping to complete the pathological molecular map of achondroplasia. There are still, however, unknown aspects of the diagnosis and treatment of achondroplasia. This review will summarize advances in research on and the clinical diagnosis and treatment of achondroplasia in China. PMID:25343101

  7. Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race

    Directory of Open Access Journals (Sweden)

    Yu Xue

    2009-10-01

    Full Text Available Abstract Background Previous studies have documented lower breast cancer survival among women with lower socioeconomic status (SES in the United States. In this study, I examined the extent to which socioeconomic disparity in breast cancer survival was explained by stage at diagnosis, treatment, race and rural/urban residence using the Surveillance, Epidemiology, and End Results (SEER data. Methods Women diagnosed with breast cancer during 1998-2002 in the 13 SEER cancer registry areas were followed-up to the end of 2005. The association between an area-based measure of SES and cause-specific five-year survival was estimated using Cox regression models. Six models were used to assess the extent to which SES differences in survival were explained by clinical and demographical factors. The base model estimated the hazard ratio (HR by SES only and then additional adjustments were made sequentially for: 1 age and year of diagnosis; 2 stage at diagnosis; 3 first course treatment; 4 race; and 5 rural/urban residence. Results An inverse association was found between SES and risk of dying from breast cancer (p Conclusion Stage at diagnosis, first course treatment and race explained most of the socioeconomic disparity in breast cancer survival. Targeted interventions to increase breast cancer screening and treatment coverage in patients with lower SES could reduce much of socioeconomic disparity.

  8. UTIs in small animal patients: part 2: diagnosis, treatment, and complications.

    Science.gov (United States)

    Smee, Nicole; Loyd, Kimberly; Grauer, Gregory F

    2013-01-01

    There are multiple considerations when making a treatment plan for patients with urinary tract infections (UTIs). In part 2 of this review the authors discuss the clinical signs, diagnosis, treatment, and complications associated with bacterial UTIs in dogs and cats. Part 1 of this review summarized etiology and pathogenesis (see the Jan/Feb 2013 issue of the Journal of the American Animal Hospital Association).

  9. Diagnosis and treatment of spinal tuberculosis after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Peng-Cheng Gu; Rong-Huan Wu; Xiang-Jin Lin

    2009-01-01

    BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of spinal tuberculosis after organ transplantation. METHOD: Two cases were diagnosed as spinal tuberculosis after liver transplantation and were treated with socarboxazide, rifampicin, streptomycin and ethambutol for more than one year. RESULTS: After treatment with anti-tuberculosis drugs for several months, the symptoms of both patients clearly improved. Back pain disappeared, and erythrocyte sedimentation and body temperature returned to normal. CONCLUSIONS: We should highly suspect spinal tuberculosis if notalgia and night sweats are present after organ transplantation. Anti-tuberculosis therapy is an effective treatment for spinal tuberculosis after organ transplantation.

  10. Neural attractor network for application in visual field data classification

    International Nuclear Information System (INIS)

    Fink, Wolfgang

    2004-01-01

    The purpose was to introduce a novel method for computer-based classification of visual field data derived from perimetric examination, that may act as a ' counsellor', providing an independent 'second opinion' to the diagnosing physician. The classification system consists of a Hopfield-type neural attractor network that obtains its input data from perimetric examination results. An iterative relaxation process determines the states of the neurons dynamically. Therefore, even 'noisy' perimetric output, e.g., early stages of a disease, may eventually be classified correctly according to the predefined idealized visual field defect (scotoma) patterns, stored as attractors of the network, that are found with diseases of the eye, optic nerve and the central nervous system. Preliminary tests of the classification system on real visual field data derived from perimetric examinations have shown a classification success of over 80%. Some of the main advantages of the Hopfield-attractor-network-based approach over feed-forward type neural networks are: (1) network architecture is defined by the classification problem; (2) no training is required to determine the neural coupling strengths; (3) assignment of an auto-diagnosis confidence level is possible by means of an overlap parameter and the Hamming distance. In conclusion, the novel method for computer-based classification of visual field data, presented here, furnishes a valuable first overview and an independent 'second opinion' in judging perimetric examination results, pointing towards a final diagnosis by a physician. It should not be considered a substitute for the diagnosing physician. Thanks to the worldwide accessibility of the Internet, the classification system offers a promising perspective towards modern computer-assisted diagnosis in both medicine and tele-medicine, for example and in particular, with respect to non-ophthalmic clinics or in communities where perimetric expertise is not readily available

  11. THE INFECTIVE ENDOCARDITIS (PREVENTION, DIAGNOSIS CRITERIA AND TREATMENT: KEY POINTS 2010

    Directory of Open Access Journals (Sweden)

    A. A. Demin

    2010-01-01

    Full Text Available Key positions of Guidelines on the prevention, diagnosis, and treatment of infective endocarditis issued by the Task Force of ESC in 2009 are explained in the comments. Recent opinions on these items are presented.

  12. Challenges in the diagnosis and treatment of pulmonary arterial hypertension.

    LENUS (Irish Health Repository)

    2012-12-01

    Advances in the diagnosis and management of pulmonary arterial hypertension (PAH) have resulted in significant improvements in outcomes for patients with this devastating and progressive disease. However, because of the non-specific nature of its symptoms, and the low level of suspicion among clinicians, prompt and accurate diagnosis of PAH as a rare disease remains a challenge. This article explains some of the issues that need to be addressed when faced with a patient with suspected PAH and describes how noninvasive and invasive techniques can be used effectively to ensure an accurate diagnosis. The availability of PAH-specific therapy means that once diagnosed, patients have a much greater chance of survival than they would have had in the past. However, despite improved survival, mortality is still high and, therefore, there is still room for improvement. It is currently recommended that patients with an inadequate clinical response to treatment receive sequential combination therapy; however, supportive data are still scarce. Although there is no clear explanation, these findings may be explained by the design and end-points chosen in clinical trials, the changing population of PAH and a need to improve the management strategy in this disease. Indeed, there is a clear need for randomised controlled studies that investigate whether adopting individualised treatment strategies, including upfront combination therapy, could help to optimise long-term management of patients with PAH.

  13. Pain in Fabry Disease: Practical Recommendations for Diagnosis and Treatment.

    Science.gov (United States)

    Politei, Juan M; Bouhassira, Didier; Germain, Dominique P; Goizet, Cyril; Guerrero-Sola, Antonio; Hilz, Max J; Hutton, Elspeth J; Karaa, Amel; Liguori, Rocco; Üçeyler, Nurcan; Zeltzer, Lonnie K; Burlina, Alessandro

    2016-07-01

    Patients with Fabry disease (FD) characteristically develop peripheral neuropathy at an early age, with pain being a crucial symptom of underlying pathology. However, the diagnosis of pain is challenging due to the heterogeneous and nonspecific symptoms. Practical guidance on the diagnosis and management of pain in FD is needed. In 2014, experts met to discuss recent advances on this topic and update clinical guidance. Emerging disease-specific tools, including FabryScan, Fabry-specific Pediatric Health and Pain Questionnaire, and Würzburg Fabry Pain Questionnaire, and more general tools like the Total Symptom Score can aid diagnosis, characterization, and monitoring of pain in patients with FD. These tools can be complemented by more objective and quantifiable sensory testing. In male and female patients of any age, pain related to FD can be an early indication to start disease-specific enzyme replacement therapy before potentially irreversible organ damage to the kidneys, heart, or brain occurs. To improve treatment outcomes, pain should be diagnosed early in unrecognized or newly identified FD patients. Treatment should include: (a) enzyme replacement therapy controlling the progression of underlying pathology; (b) adjunctive, symptomatic pain management with analgesics for chronic neuropathic and acute nociceptive, and inflammatory or mixed pain; and (c) lifestyle modifications. © 2016 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.

  14. Cancer classification in the genomic era: five contemporary problems.

    Science.gov (United States)

    Song, Qingxuan; Merajver, Sofia D; Li, Jun Z

    2015-10-19

    Classification is an everyday instinct as well as a full-fledged scientific discipline. Throughout the history of medicine, disease classification is central to how we develop knowledge, make diagnosis, and assign treatment. Here, we discuss the classification of cancer and the process of categorizing cancer subtypes based on their observed clinical and biological features. Traditionally, cancer nomenclature is primarily based on organ location, e.g., "lung cancer" designates a tumor originating in lung structures. Within each organ-specific major type, finer subgroups can be defined based on patient age, cell type, histological grades, and sometimes molecular markers, e.g., hormonal receptor status in breast cancer or microsatellite instability in colorectal cancer. In the past 15+ years, high-throughput technologies have generated rich new data regarding somatic variations in DNA, RNA, protein, or epigenomic features for many cancers. These data, collected for increasingly large tumor cohorts, have provided not only new insights into the biological diversity of human cancers but also exciting opportunities to discover previously unrecognized cancer subtypes. Meanwhile, the unprecedented volume and complexity of these data pose significant challenges for biostatisticians, cancer biologists, and clinicians alike. Here, we review five related issues that represent contemporary problems in cancer taxonomy and interpretation. (1) How many cancer subtypes are there? (2) How can we evaluate the robustness of a new classification system? (3) How are classification systems affected by intratumor heterogeneity and tumor evolution? (4) How should we interpret cancer subtypes? (5) Can multiple classification systems co-exist? While related issues have existed for a long time, we will focus on those aspects that have been magnified by the recent influx of complex multi-omics data. Exploration of these problems is essential for data-driven refinement of cancer classification

  15. Possible effects of an early diagnosis and treatment in patients with growth hormone deficiency: the state of art.

    Science.gov (United States)

    Stagi, Stefano; Scalini, Perla; Farello, Giovanni; Verrotti, Alberto

    2017-09-16

    Growth hormone deficiency (GHD) is a relatively uncommon and heterogeneous endocrine disorder presenting in childhood with short stature. However, during the neonatal period, the metabolic effects of GHD may to require prompt replacement therapy to avoid possible life-threatening complications. An increasing amount of data suggests the importance of an early diagnosis and treatment of GHD because of its auxological, metabolic, and neurodevelopmental features with respect to the patients diagnosed and treated later in life.The available results show favourable auxological outcomes for patients with GHD diagnosed and treated with r-hGH early in life compared with those from patients with GHD who do not receive this early diagnosis and treatment. Because delayed referral for GHD diagnosis and treatment is still frequent, these results highlight the need for more attention in the diagnosis and treatment of GHD.Despite these very encouraging data regarding metabolic and neurodevelopmental features, further studies are needed to better characterize these findings. Overall, the importance of early diagnosis and treatment of GHD needs to be addressed.

  16. YouTube provides irrelevant information for the diagnosis and treatment of hip arthritis.

    Science.gov (United States)

    Koller, Ulrich; Waldstein, Wenzel; Schatz, Klaus-Dieter; Windhager, Reinhard

    2016-10-01

    YouTube is increasingly becoming a key source for people to satisfy the need for additional information concerning their medical condition. This study analyses the completeness of accurate information found on YouTube pertaining to hip arthritis. The present study analyzed 133 YouTube videos using the search terms: hip arthritis, hip arthritis symptoms, hip arthritis diagnosis, hip arthritis treatment and hip replacement. Two quality assessment checklists with a scale of 0 to 12 points were developed to evaluate available video content for the diagnosis and the treatment of hip arthritis. Videos were grouped into poor quality (grade 0-3), moderate quality (grade 4-7) and excellent quality (grade 8-12), respectively. Three independent observers assessed all videos using the new grading system and independently scored all videos. Discrepancies regarding the categories were clarified by consensus discussion. For intra-observer reliabilities, grading was performed at two occasions separated by four weeks. Eighty-four percent (n = 112) had a poor diagnostic information quality, 14% (n = 19) a moderate quality and only 2% (n = 2) an excellent quality, respectively. In 86% (n = 114), videos provided poor treatment information quality. Eleven percent (n = 15) of videos had a moderate quality and only 3% (n = 4) an excellent quality, respectively. The present study demonstrates that YouTube is a poor source for accurate information pertaining to the diagnosis and treatment of hip arthritis. These finding are of high relevance for clinicians as videos are going to become the primary source of information for patients. Therefore, high quality educational videos are needed to further guide patients on the way from the diagnosis of hip arthritis to its proper treatment.

  17. Fetal tachycardia : diagnosis and treatment

    NARCIS (Netherlands)

    Oudijk, Martijn Alexander

    2003-01-01

    Part I: Fetal tachyarrhythmias Diagnosis Fetal tachycardia is a serious condition warranting specialized evaluation. In chapter 2, methods of diagnosis of fetal tachycardia are described, including doppler and M-mode echocardiography and fetal magnetocardiography. The study presented in chapter 3

  18. Intra- and interobserver reliability of the Eaton classification for trapeziometacarpal arthritis: a systematic review.

    Science.gov (United States)

    Berger, Aaron J; Momeni, Arash; Ladd, Amy L

    2014-04-01

    Trapeziometacarpal, or thumb carpometacarpal (CMC), arthritis is a common problem with a variety of treatment options. Although widely used, the Eaton radiographic staging system for CMC arthritis is of questionable clinical utility, as disease severity does not predictably correlate with symptoms or treatment recommendations. A possible reason for this is that the classification itself may not be reliable, but the literature on this has not, to our knowledge, been systematically reviewed. We therefore performed a systematic review to determine the intra- and interobserver reliability of the Eaton staging system. We systematically reviewed English-language studies published between 1973 and 2013 to assess the degree of intra- and interobserver reliability of the Eaton classification for determining the stage of trapeziometacarpal joint arthritis and pantrapezial arthritis based on plain radiographic imaging. Search engines included: PubMed, Scopus(®), and CINAHL. Four studies, which included a total of 163 patients, met our inclusion criteria and were evaluated. The level of evidence of the studies included in this analysis was determined using the Oxford Centre for Evidence Based Medicine Levels of Evidence Classification by two independent observers. A limited number of studies have been performed to assess intra- and interobserver reliability of the Eaton classification system. The four studies included were determined to be Level 3b. These studies collectively indicate that the Eaton classification demonstrates poor to fair interobserver reliability (kappa values: 0.11-0.56) and fair to moderate intraobserver reliability (kappa values: 0.54-0.657). Review of the literature demonstrates that radiographs assist in the assessment of CMC joint disease, but there is not a reliable system for classification of disease severity. Currently, diagnosis and treatment of thumb CMC arthritis are based on the surgeon's qualitative assessment combining history, physical

  19. Classic galactosemia: features of diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    N.O. Pichkur

    2018-02-01

    Full Text Available Background. Galactosemia type I, or classic galactosemia (CG, is the most severe form of hereditary disorders of carbohydrate metabolism, in particular, galactose. Galactosemia is not included in the program of massive neonatal screening in Ukraine. The CG is characterized by the non-specific onset symptoms and leads to high mortality among infants in the neonatal period. The problem of early diagnosis and treatment of infants with CG in the absence of a program for massive neonatal screening in Ukraine requires solution. The purpose was to analyse the clinical and laboratory, molecular genetic features of patients with CG; to define a set of clinical symptoms and to form selective groups of patients for administration of diet therapy and laboratory diagnosis; to develop schemes-stages of effective early diagnosis and treatment of patients with CG in the absence of mass neonatal screening in order to reduce infant mortality and prevent the disability of patients with this pathology. Materials and methods. In 2014–2017, 317 patients with a diagnosis of hepatitis of uncertain origin were examined. The age of patients ranged from 3 days to 16 years; 145 (45 % of them were males, 172 (55 % — females. In all patients, a polysyndromic clinical picture with predominant lesion in the liver function was observed. All patients were examined for the activity of galactose-1-phosphate uridylyltransferase (GALT enzyme in the red blood cells and underwent DNA diagnosis for the detection of major mutations in the GALT gene. All patients were examined for viral hepatitis, underwent biochemical blood tests for hepatic transaminases, alkaline phosphatase, bilirubin levels, and coagulopathy. Tandem mass spectrometry was also performed to exclude or confirm the metabolic imbalance of amino acids, organic acids, and mitochondrial beta-oxi­dation of fatty acids. Five patients with suspected glycogenosis have been subjected to a quantitative glycogen test in the

  20. Trialling diagnosis-related groups classification in the Iranian health system: a case study examining the feasibility of introducing casemix.

    Science.gov (United States)

    Ghaffari, S; Doran, C; Wilson, A; Aisbett, C

    2010-05-01

    This paper examines the quality of routinely collected information in an Iranian hospital in a trial of casemix classification. Australian Refined Diagnosis Related Groups (AR-DRG) were used to classify patient episodes. There were 327 DRGs identified, of which 20% had only 1 case. The grouper program identified invalid records for 4% of total separations. Approximately 4.5% of cases were classified into error DRGs and 3.4% were ungroupable. No complication and comorbidity effects were identified with 93% of total cases. R2 (variance in length of stay explained) was 44% for untrimmed cases, increasing to 63%, 57% and 58% after trimming by L3H3, IQR and 10th-95th percentile methods respectively.