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Sample records for boy differential diagnosis

  1. Differential diagnosis diphtheria adults

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    Yu. I. Liashenko

    2010-01-01

    Full Text Available A total of 1,824 human cases of diphtheria, treated at the Clinical Infectious Diseases Hospital SP Botkin (St. Petersburg during 1993, as well as 19 deaths in 1994. It is known that early diagnosis of infectious diseases, especially diphtheria, contributes to the favorable outcome of the disease. The diagnosis of diphtheria at the prehospital stage is always difficult. Presented in detail the differential diagnosis of the disease, clinically similar to diphtheria: Lacunal angina, angina Simanovsky, infectious mononucleosis, angina Ludwig’s angina Dugue, syphilis, non-infectious with clinical «masks» of diphtheria and other. Diphtheria epidemic of 1993–1994 in Russia and, in particular, in St. Petersburg, showed that the late admission of patients with diphtheria infection in hospitals, usually associated with irregular differential diagnosis of this dangerous disease.

  2. Differential diagnosis of hyponatraemia.

    LENUS (Irish Health Repository)

    Thompson, Chris

    2012-03-01

    The appropriate management of hyponatraemia is reliant on the accurate identification of the underlying cause of the hyponatraemia. In the light of evidence which has shown that the use of a clinical algorithm appears to improve accuracy in the differential diagnosis of hyponatraemia, the European Hyponatraemia Network considered the use of two algorithms. One was developed from a nephrologist\\'s view of hyponatraemia, while the other reflected the approach of an endocrinologist. Both of these algorithms concurred on the importance of assessing effective blood volume status and the measurement of urine sodium concentration in the diagnostic process. To demonstrate the importance of accurate diagnosis to the correct treatment of hyponatraemia, special consideration was given to hyponatraemia in neurosurgical patients. The differentiation between the syndrome of inappropriate antidiuretic hormone secretion (SIADH), acute adrenocorticotropic hormone (ACTH) deficiency, fluid overload and cerebral salt-wasting syndrome was discussed. In patients with SIADH, fluid restriction has been the mainstay of treatment despite the absence of an evidence base for its use. An approach to using fluid restriction to raise serum tonicity in patients with SIADH and to identify patients who are likely to be recalcitrant to fluid restriction was also suggested.

  3. [Communication disorders: differential diagnosis].

    Science.gov (United States)

    Campos-Castelló, J; Briceño-Cuadros, S

    To evaluate components of clinical semiology in the differential diagnosis of communication disorders (TC) and their possible biological markers. We consider two groups, according to the communication disorders themselves and their effects on social interaction. In the first case both aspects are affected in parallel and in the second it is predominantly social interaction which is affected. In the first groups we studied dyslalias, dyrhrythmias, acquired aphasias, TC relation to epilepsy, types of seizures and EEG discharges. The dysphasia of development and epilepsy may be associated by chance, as a result of the same cause or the epilepsy be responsible for the TC, either because of seizures or continuously (acquired epileptic aphasia, SLK). Based on personal data and the literature we studied the semiology, possible biological markers and differential diagnosis. We consider disorders of neurone migration and metabolic alterations of initial neuropsychological semiology and cerebellar anomalies involved in cognitive functions. In the second group we assessed autism, generalized disorders of development and particular syndromes with semantic pragmatic TC. The development of language cannot be separated from other aspects of neurological maturation. One cannot affirm that there is a direct relationship between epilepsy and TC, although this does occur in some cases. We accept the hypothesis that SLK, POCSL and atypical EPB are clinical forms of the same syndrome of epilepsy. Recognition of the cognitive affective cerebellar syndrome by its involvement in social executive function, language and personality characterizes certain conditions (Williams, Asperger, fragile X, autism). A progressive rational battery of complementary studies on clinical data is essential to determine biological markers in syndromes which still lack them.

  4. JUVENILE ARTHRITIS: CLINICAL MANIFESTATIONS AND DIFFERENTIAL DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS

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    Алексей Николаевич Кожевников

    2014-12-01

    Full Text Available The diagnosis and treatment of inflammatory joint diseases is the pressing problem of pediatric rheumatology and orthopedics. Juvenile arthritis is the most frequent chronic inflammatory disease of the musculoskeletal system in children and adolescents. Still juvenile arthritis is often misdiagnosed. The article provides current knowledge on juvenile arthritis, its clinical manifestations, as well as diagnostic and treatment strategies, and differential diagnosis.

  5. Neurofibromatoses: part 1 ? diagnosis and differential diagnosis

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    Luiz Oswaldo Carneiro Rodrigues

    2014-03-01

    Full Text Available Neurofibromatoses (NF are a group of genetic multiple tumor growing predisposition diseases: neurofibromatosis type 1 (NF1, neurofibromatosis type 2 (NF2 and schwannomatosis (SCH, which have in common the neural origin of tumors and cutaneous signs. They affect nearly 80 thousand of Brazilians. In recent years, the increased scientific knowledge on NF has allowed better clinical management and reduced complication morbidity, resulting in higher quality of life for NF patients. In most cases, neurology, psychiatry, dermatology, clinical geneticists, oncology and internal medicine specialists are able to make the differential diagnosis between NF and other diseases and to identify major NF complications. Nevertheless, due to its great variability in phenotype expression, progressive course, multiple organs involvement and unpredictable natural evolution, NF often requires the support of neurofibromatoses specialists for proper treatment and genetic counseling. This Part 1 offers step-by-step guidelines for NF differential diagnosis. Part 2 will present the NF clinical management.

  6. [Differential diagnosis of proteinuria].

    Science.gov (United States)

    Rupprecht, H D

    2004-10-21

    Normally, protein secretion in the urine is less than 150 mg/day or less than 100 mg/g creatinine. Orthostatic proteinuria, proteinuria in the presence of fever, and effort proteinuria are benign forms. In cases of persistent proteinuria, prerenal or overflow proteinuria are distinguished from renal and post-renal proteinuria. Renal forms can be differentiated into glomerular and tubular as well as mixed forms. The urine dipstick is of only low sensitivity, and is therefore unsuitable as a screening test for diabetic microalbuminuria. In addition, it cannot detect immunoglobulin light chains in Bence Jones proteinuria. For the differentiation between glomerular and tubular forms of proteinuria, the determination of marker proteins in the urine, for example, alpha1 microglobulin, albumin and IgG, has proven utility.

  7. [Diagnosis and differential diagnosis of Cushing's syndrome].

    Science.gov (United States)

    Santos, Silvia; Santos, Estefanía; Gaztambide, Sonia; Salvador, Javier

    2009-02-01

    Because of the variability in the clinical expression of Cushing's syndrome, different biochemical tests and imaging techniques must be used for effective diagnosis and treatment. The clinical history is important to assess the general impact of hypercortisolism on organs and systems, as well as to guide suspicion toward more aggressive entities such as overt ectopic ACTH syndrome or to detect an iatrogenic etiology of Cushing's syndrome. The screening phase relies on tests that are sensitive but not specific, such as urinary free cortisol, nocturnal salivary cortisol and 1 mg dexamethasone suppression, which still require established assessment criteria. Confirmation can be obtained by repeating urinary cortisol, 2 mg/day dexamethasone suppression, both alone and combined with corticotropin releasing hormone (CRH), to exclude pseudoCushing states. ACTH dependency can be easily explored by ACTH measurements, but the differential diagnosis between pituitary and ectopic Cushing's disease is difficult and may require invasive procedures such as inferior petrosal sinus sampling. Sophisticated imaging and isotopic techniques play a significant role in locating the source of ACTH in ectopic syndromes but are not always effective. In general, biochemical and imaging tests should be combined in order to assess different mechanisms and perspectives of the syndrome. Rigorous methodology is essential to obtain accurate results, allowing a correct diagnosis and improving therapeutic performance in this devastating disease.

  8. DIFFERENTIAL DIAGNOSIS OF HYPERTROPHIC CARDIOMYOPATHY

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    I. V. Leontyeva

    2017-01-01

    Full Text Available Hypertrophic cardiomyopathy is the most common form of cardiomyopathy, occurring in childhood, occurring when a gene is mutated that encodes proteins of sarcomeric and non-sarcomeric complexes. The diagnosis of the disease is based on the data of echocardiography, revealing structural changes in the heart muscle according to the type of hypertrophy, while the genesis of these changes remains unclear. The causes of hypertrophic cardiomyopathy in childhood are diverse. Of great importance is the early diagnosis of metabolic forms of hypertrophic cardiomyopathy, so in some cases regress of hypertrophy is possible against the background of enzyme-substitution or other drug therapy. The article presents a clinical (cardiac and extracardiac symptoms and laboratory markers of hypertrophic cardiomyopathy with mutations of genes of proteins of the sarcomeric complex, congenital metabolic disorders (glycogenoses, lysosomal pathology, fatty acid metabolism disorders, and mitochondrial diseases, genetic syndromes (Noonan, LEOPARD, Costello, cardio-fascial-cutaneous, neuromuscular diseases. The criteria for differential diagnosis of genetic forms of hypertrophic cardiomyopathy and myocardial hypertrophy in athletes are presented. 

  9. Factors Influencing the Probability of a Diagnosis of Autism Spectrum Disorder in Girls versus Boys

    Science.gov (United States)

    Duvekot, Jorieke; van der Ende, Jan; Verhulst, Frank C.; Slappendel, Geerte; van Daalen, Emma; Maras, Athanasios; Greaves-Lord, Kirstin

    2017-01-01

    In order to shed more light on why referred girls are less likely to be diagnosed with autism spectrum disorder than boys, this study examined whether behavioral characteristics influence the probability of an autism spectrum disorder diagnosis differently in girls versus boys derived from a multicenter sample of consecutively referred children…

  10. Problem Oriented Differential Diagnosis of Tropical Diseases

    Science.gov (United States)

    1989-09-01

    animal attacks, loneliness, and excessive concern about minor injuries. 5. Renal lithiasis precipitated by dehydration. The following infectious...are at higher risk for developing renal lithiasis . Clinicians must be prepared to expand their differential diagnosis of genitourinary diseases to

  11. Differential diagnosis of disseminated periventricular calcifications

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    Rieger, P.; Piepgras, U.

    1986-08-01

    Juvenile disseminated periventricular calcifications may occur in tuberous sclerosis, toxoplasmosis, cytomegaly, and in tuberculous meningitis. Cysticercosis, by contrast, does not result in corresponding intracerebral foci until an older age. Differential diagnosis is no problem if clinical findings are typical (tuberous sclerosis) or if serological verification is positive. However, any unclear clinical diagnosis can often be secured by CT.

  12. POLYMYOSITIS/DERMATOMIOSITIS: DIFFERENTIAL DIAGNOSIS

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    O. A. Antelava

    2016-01-01

    Full Text Available The lecture considers the problem of rare systemic connective tissue diseases, such as idiopathic inflammatory myopathies (IIMs. It underlines the clinical and immunological heterogeneity of their subtypes, which defines therapeutic tactics and prognosis. The diagnostic criteria for IIMs are given. A differential diagnostic algorithm based on the exclusion of phenotypically similar forms of myopathies of different genesis is proposed. 

  13. [The differential diagnosis of neck masses].

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    Pérusse, R

    1989-09-01

    This article on the differential diagnosis of cervical masses is a review of the main causes of the masses that an extra-oral exam can detect. Some of these masses are of particular interest to the dentist; they are notably cellulitis of dental origin, salivary pathologies and cervical adenopathies. There is no need to stress the major importance of the role played by the cervical adenopathies in the diagnosis of leukaemias, lymphomas and disorders linked to the HIV virus. The first part of this article focuses mainly on the differential diagnosis of cervical adenopathies, while the non-ganglionic masses will be discussed in another article.

  14. Differential diagnosis of infantile hemangiomas.

    Science.gov (United States)

    Perman, Marissa J; Castelo-Soccio, Leslie; Jen, Melinda

    2012-08-01

    1.Compare and contrast infantile hemangiomas with other vascular anomalies that may be confused clinically.2.Describe the vascular anomalies classification system according to the International Society for the Study of Vascular Anomalies (ISSVA), highlighting the differences between vascular tumors, such as infantile hemangiomas, and vascular malformations.3.Briefly review associated signs or syndromes found in the context of certain vascular anomalies.Infantile hemangiomas are the most common benign vascular tumor in infancy but may mimic many other types of vascular anomalies. In many cases, the appearance, time of onset, growth pattern, and consistency of infantile hemangiomas make the diagnosis straightforward (see "Pathogenesis of Infantile Hemangiomas" on p. 321). However, many other vascular lesions can appear quite similar to infantile hemangiomas, especially early in life, and at times this makes the correct diagnosis challenging. Copyright 2012, SLACK Incorporated.

  15. [Diagnosis and differential diagnosis of acute hepatic prophyrias (author's transl)].

    Science.gov (United States)

    Doss, M

    1979-11-16

    Diagnosis of porphyria is a clinical and biochemical procedure. Acute hepatic porphyrias are molecular regulation diseases which are characterized by a relative enzyme deficiency of the ferro-chelatase chain and an induction of hepatic delta-aminoacid synthase. There are indistinct clinical and pathobiochemical transitions between the three acute hepatic types of porphyria: acute intermittent porphyria, hereditary coproporphyria and porphyria variegata. They develop a similar acute clinical syndrome. The differential diagnosis is made possible by a differentiation of porphyrins and porphyrin precursers in the urine and the porphyrines in the stool and by the determination of uroporphyrinogen synthase activity in the erythrocytes.

  16. [Differential diagnosis between dissociative disorders and schizophrenia].

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    Shibayama, Masatoshi

    2011-01-01

    The differential diagnosis of dissociative disorders includes many psychiatric disorders, such as schizophrenia, bipolar disorders (especially bipolar II disorder), depressive disorder (especially atypical depression), epilepsy, Asperger syndrome, and borderline personality disorder. The theme of this paper is the differential diagnosis between dissociative disorders and schizophrenia. Schneiderian first-rank symptoms in schizophrenia are common in dissociative disorders, especially in dissociative identity disorder (DID). Many DID patients have been misdiagnosed as schizophrenics and treated with neuroleptics. We compared and examined Schneiderian symptoms of schizophrenia and those of dissociative disorders from a structural viewpoint. In dissociative disorders, delusional perception and somatic passivity are not seen. "Lateness" and "Precedence of the Other" originated from the concept of "Pattern Reversal" (H. Yasunaga)" is characteristic of schizophrenia. It is important to check these basic structure of schizophrenia in subjective experiences in differential diagnosis between dissociative disorders and schizophrenia.

  17. DIFFERENTIAL DIAGNOSIS OF NORMOCALCEMIC HYPERPARATHYROIDISM

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    N. A. Kravchun

    2015-01-01

    Full Text Available Objective: to describe a case of normocalcemic hyperparathyroidism.Materials and methods. A female patient aged 51 years sought medical advice for complaints of spinal column and bone pains, periodic dizziness, and hand numbness. The patient underwent clinical and biochemical blood tests, determination of the blood levels of calcium, phosphorus, parathyroid hormone, concentrations of total vitamin D, calciuria, electrocardiography, thyroid ultrasonography, and neck computed tomography.Results. Based on her complaints, examination evidence, evaluation of the clinical presentations of the disease, and objective and instrumental examination findings, the patient was diagnosed with left parathyroid adenoma and primary hyperparathyroidism; stage II hypertensive disease, grade I, a moderate risk; retinal angiopathy of both eyes; stage I dyscirculatory encephalopathy with liquor and venous dyscirculation and moderate vestibular ataxia; urolithiasis; kidney stones; and spondylosis mainly involving the lumbar spine. The diagnostic determinants for verifying the diagnosis were the results of neck computed tomography, namely: the signs of space-occupying lesion in the projection of the left parathyroid gland; the blood level of parathyroid hormone 118.6 pg/ml (normal value (N 9.5–75.0 pg/ml; total vitamin D 21.64 nmol/l (N 75–250 nmol/l; and calcium 2.48 mmol/l (N 2.15–2.50 mmol/l. The history of urolithiasis, repeated lithotripsy, as well as spondylosis with lumboischalgia was an absolute indication for surgical treatment.Conclusion. The practical interest in this case is due to the complexity of diagnosing normocalcemic hyperparathyroidism after vitamin D deficiency. The early stages of primary hyperparathyroidism are asymptomatic and frequently give rise to irreversible renal complications, causing renal failure and, as a consequence, disability. This clinical case demonstrates the importance of routinely determining vitamin D concentrations

  18. Differential diagnosis of myelitis; Differenzialdiagnostik der Myelitis

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    Langner, Soenke [Universitaetsmedizin Greifswald (Germany). Inst. fuer Diagnostische Radiologie und Neuroradiologie

    2016-09-15

    Acute transverse Myelitis is an inflammatory myelopathy characterized by rapid onset of bilateral neurological symptoms. There is a vast array of differential diagnoses and the underlying pathology often cannot be identified on clinical examination alone. Therefore neuroimaging has a central role in narrowing the differential diagnosis. This review aims to provide a summary of common causes of non-traumatic myelopathies, many of which may have similar radiological appearance.

  19. CLINIC, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF GALACTOSEMIA

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    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.

  20. Pyknodysostosis: Oral findings and differential diagnosis

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    Soares L

    2008-05-01

    Full Text Available Pyknodysostosis is a rare, genetic, autosomal recessive condition characterized by short stature, generalized bone sclerosis, and oral manifestations such as maxillary atresia and an increase of the mandibular angle. The main purpose of this article was to report a case of pyknodysostosis, describing the characteristic orofacial findings of the disease and discussing the differential diagnosis.

  1. Diagnosis and Differential Diagnosis in Behcet’s Disease

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    Osman Köse

    2009-12-01

    Full Text Available The diagnosis of Behcet’s disease is made on the basis of the criteria proposed by the International Study group for Behcet’s disease in 1990. According to the criteria, recurrent oral ulceration must be present as well as at least two of the following: Recurrent genital ulceration, eye lesions, skin lesions and a positive pathergy test. Acute/chronic oral ulcers and genital ulcers should be regarded in the differential diagnosis of Behcet’s disease. We discussed the details of different dermatologic diseases especially of prominent with oral and genital ulcers in this article.

  2. Diagnosis and Differential Diagnosis in Behcet’s Disease

    OpenAIRE

    Osman Köse

    2009-01-01

    The diagnosis of Behcet’s disease is made on the basis of the criteria proposed by the International Study group for Behcet’s disease in 1990. According to the criteria, recurrent oral ulceration must be present as well as at least two of the following: Recurrent genital ulceration, eye lesions, skin lesions and a positive pathergy test. Acute/chronic oral ulcers and genital ulcers should be regarded in the differential diagnosis of Behcet’s disease. We discussed the details of different derm...

  3. Differential diagnosis of chronic cough in children.

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    Weinberger, Miles; Fischer, Anthony

    2014-01-01

    A cough is considered chronic when it lasts >4 weeks. Chronic cough can be from a variety of causes. This article provides a structured approach to evaluating the child with chronic cough. Beginning with the disturbing cough that is absent once asleep, consistent with the habit cough syndrome, the diagnostic criteria for 10 causes of chronic cough are discussed. Using a structured approach to the differential diagnosis, common and uncommon causes can be identified. Well-established causes of chronic cough, such as asthma, are likely to be well known to the reader, whereas more recently identified etiologies, such as protracted bacterial bronchitis, are presented in more detail. The differential value of flexible and rigid bronchoscopy and bronchoalveolar lavage for aiding in the differential diagnosis is included for those entities where their use is essential.

  4. [Differential diagnosis of parkinsonian syndromes using MRI].

    Science.gov (United States)

    Mahlknecht, P; Schocke, M; Seppi, K

    2010-10-01

    The differential diagnosis of parkinsonian syndromes is considered one of the most challenging in clinical neurology. Despite published consensus operational criteria for the diagnosis of Parkinson's disease (PD) and the various atypical parkinsonian disorders (APD), such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal degeneration (CBD), the clinical separation of APDs from PD carries a high rate of misdiagnosis. However, the early differentiation between APD and PD, each characterized by a very different natural history, is crucial for determining the prognosis and choosing a treatment strategy. Despite limitations the various modern magnetic resonance imaging (MRI) techniques have undoubtedly added to the differential diagnosis of neurodegenerative parkinsonism. In clinical practice conventional MRI with visual assessment of T2 and T1-weighted imaging is a well established method for the exclusion of symptomatic parkinsonism due to other pathologies and may also point to the diagnosis of APD. Furthermore, advances in MRI techniques, such as diffusion-weighted imaging (DWI), have enabled abnormalities in the basal ganglia and infratentorial brain structures in APD to be quantitatively illustrated.

  5. [Differential diagnosis of Graves' orbitopathy. Case report].

    Science.gov (United States)

    Erdei, Annamária; Steiber, Zita; Gazdag, Annamária; Bodor, Miklós; Berta, Eszter; Szász, Róbert; Szántó, Antónia; Ujhelyi, Bernadett; Barna, Sándor; Berényi, Ervin; Nagy, V Endre

    2016-02-21

    Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures.

  6. Labaratory capacity of differential anemia diagnosis

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    L. M. Meshсheryakova

    2015-06-01

    Full Text Available The paper presents the laboratory values by which modern differential diagnosis of anemias can be performed. This takes into account a widerange of laboratory tests, including: serum ferritin, erythrocyte ferritin, serum iron, total serum iron binding capacity, iron transferrin saturation,transferrin, transferrin receptor, serum vitamin B12, erythrocyte vitamin B12, serum folate, erythrocyte folate, hepsidin, HIF-1 (hypoxiainducible factor-1, immunoglobulins on erythrocytes end others. The combination of these studies helps to accurate diagnosis and appropriate therapy.

  7. The differential diagnosis of spastic diplegia.

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    Huntsman, Richard; Lemire, Edmond; Norton, Jonathon; Dzus, Anne; Blakley, Patricia; Hasal, Simona

    2015-05-01

    Spastic diplegia is the most common form of cerebral palsy worldwide. Many disorders mimic spastic diplegia, which can result in misdiagnosis for the child with resultant negative treatment and family counselling implications. In this paper, the authors provide a brief review of spastic diplegia and the various disorders in the differential diagnosis. We also provide a diagnostic algorithm to assist physicians in making the correct diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Differential Diagnosis in Neuroendocrine Neoplasms of the Larynx

    NARCIS (Netherlands)

    Hunt, Jennifer L; Ferlito, Alfio; Hellquist, Henrik; Rinaldo, Alessandra; Skálová, Alena; Slootweg, Pieter J; Willems, Stefan M; Cardesa, Antonio

    2017-01-01

    The differential diagnosis of neuroendocrine neoplasms of the larynx is broad and includes lesions of epithelial, mesenchymal, and neuroectodermal origin. These lesions have overlapping clinical and pathologic aspects and must be carefully considered in the differential diagnosis of laryngeal

  9. Mialgias: Approaches to differential diagnosis, treatment

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    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.

  10. [MRI diagnosis of cardiac myxomas: sequence evaluation and differential diagnosis].

    Science.gov (United States)

    Sommer, T; Vahlhaus, C; Hofer, U; von Smekal, A; Wardelmann, E; Bierhoff, E; Pauleit, D; Wilhelm, K; Textor, J; Schild, H

    1999-02-01

    To evaluate native and contrast enhanced T1-weighted spin (T1-SE), cine gradient echo (Cine-GE), and T2-weighted turbo spin (T2-TSE) sequences in the diagnosis and differential diagnosis of cardiac myxomas. 15 patients with echocardiographically suspected cardiac atrial myxomas underwent 0.5 T-MR imaging of the heart with native T1-SE, contrast-enhanced T1-SE, Cine-GE, and T2-TSE sequences. MR images were evaluated for signal intensity (SI) and lesion's conspicuity. Results were confirmed histologically (14 x) or by follow-up (1 x). MRI revealed myxomas in 9 patients, sarcomas in three patients, and thrombi in three patients. Lesion conspicuity was better in Cine-GE and T2-TSE compared with native and contrast-enhanced T1-SE sequences. Myxomas were characterized by an intermediate SI similar to myocardium in T1-SE, high SI similar to water in T2-TSE, and low to moderately high enhancement (range 19-75%, mean 48%). Distinct SI characteristics together with anatomical-topographical features (attachment to the interatrial septum, no infiltration of myocardium and vessels) are diagnostic for cardiac myxomas. Cine-GE and T2-TSE sequences are the sequences of choice for detection of myxomas and other atrial masses. T2-TSE and contrast-enhanced T1-weighted sequences are most useful for mass characterisation and differentiation between myxomas, malignant tumors, and thrombi.

  11. Inter-hemispheric Intrinsic Connectivity as a Neuromarker for the Diagnosis of Boys with Tourette Syndrome.

    Science.gov (United States)

    Liao, Wei; Yu, Yang; Miao, Huan-Huan; Feng, Yi-Xuan; Ji, Gong-Jun; Feng, Jian-Hua

    2017-05-01

    Tourette syndrome (TS) is associated with gross morphological changes in the corpus callosum, suggesting deficits in inter-hemispheric coordination. The present study sought to identify changes in inter-hemispheric functional and anatomical connectivity in boys with "pure" TS as well as their potential value for clinical diagnosis. TS boys without comorbidity (pure TS, n = 24) were selected from a large dataset and compared to age- and education-matched controls (n = 32). Intrinsic functional connectivity (iFC) between bilateral homotopic voxels was computed and compared between groups. Abnormal iFC was found in the bilateral prefronto-striatum-midbrain networks as well as bilateral sensorimotor and temporal cortices. The iFC between the bilateral anterior cingulate cortex (ACC) was negatively correlated with symptom severity. Anatomical connectivity strengths between functionally abnormal regions were estimated by diffusion probabilistic tractography, but no significant between-group difference was found. To test the clinical applicability of these neuroimaging findings, multivariate pattern analysis was used to develop a classification model in half of the total sample. The classification model exhibited excellent classification power for discriminating TS patients from controls in the other half samples. In summary, our findings emphasize the role of inter-hemispheric communication deficits in the pathophysiology of TS and suggest that iFC is a potential quantitative neuromarker for clinical diagnosis.

  12. Psoriasis: epidemiology, natural history, and differential diagnosis

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    Basko-Plluska JL

    2012-09-01

    Full Text Available Juliana L Basko-Plluska, Vesna Petronic-RosicDepartment of Medicine, Section of Dermatology, University of Chicago, Chicago, IL, USAAbstract: Psoriasis is a chronic, immune-mediated, inflammatory disease which affects primarily the skin and joints. It occurs worldwide, but its prevalence varies considerably between different regions of the world. Genetic susceptibility as well as environmental factors play an important role in determining the development and prognosis of psoriasis. Genome-wide association studies have identified many genetic loci as potential psoriasis susceptibility regions, including PSORS1 through PSORS7. Histocompatibility antigen (HLA studies have also identified several HLA antigens, with HLA-Cw6 being the most frequently associated antigen. Epidemiological studies identified several modifiable risk factors that may predispose individuals to developing psoriasis or exacerbate pre-existing disease. These include smoking, obesity, alcohol consumption, diet, infections, medications and stressful life events. The exact mechanism by which they trigger psoriasis remains to be elucidated; however, existing data suggest that they are linked through Th1-mediated immunological pathways. The natural history of psoriasis varies depending on the clinical subtype as well as special circumstances, including pregnancy and HIV infection. In general, psoriasis is a chronic disease with intermittent remissions and exacerbations. The differential diagnosis is vast and includes many other immune-mediated, inflammatory disorders.Keywords: psoriasis, epidemiology, natural history, differential diagnosis

  13. Gender-Differentiated parenting revisited : Meta-analysis reveals very few differences in parental control of boys and girls

    National Research Council Canada - National Science Library

    Endendijk, Joyce J; Groeneveld, Marleen G; Bakermans-Kranenburg, Marian J; Mesman, Judi

    2016-01-01

    Although various theories describe mechanisms leading to differential parenting of boys and girls, there is no consensus about the extent to which parents do treat their sons and daughters differently...

  14. Optic neuritis, its differential diagnosis and management.

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    Hoorbakht, Hedieh; Bagherkashi, Farid

    2012-01-01

    The aim of this review is to summarize the latest information about optic neuritis, its differential diagnosis and management. Optic Neuritis (ON) is defined as inflammation of the optic nerve, which is mostly idiopathic. However it can be associated with variable causes (demyelinating lesions, autoimmune disorders, infectious and inflammatory conditions). Out of these, multiple sclerosis (MS) is the most common cause of demyelinating ON. ON occurs due to inflammatory processes which lead to activation of T-cells that can cross the blood brain barrier and cause hypersensitivity reaction to neuronal structures. For unknown reasons, ON mostly occurs in adult women and people who live in high latitude. The clinical diagnosis of ON consists of the classic triad of visual loss, periocular pain and dyschromatopsia which requires careful ophthalmic, neurologic and systemic examinations to distinguish between typical and atypical ON. ON in neuromyelitis optica (NMO) is initially misdiagnosed as ON in MS or other conditions such as Anterior Ischemic Optic Neuropathy (AION) and Leber's disease. Therefore, differential diagnosis is necessary to make a proper treatment plan. According to Optic Neuritis Treatment Trial (ONTT) the first line of treatment is intravenous methylprednisolone with faster recovery and less chance of recurrence of ON and conversion to MS. However oral prednisolone alone is contraindicated due to increased risk of a second episode. Controlled High-Risk Subjects Avonex(®) Multiple Sclerosis Prevention Study "CHAMPS", Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment "BENEFIT" and Early Treatment of MS study "ETOMS" have reported that treatment with interferon β-1a,b results in reduced risk of MS and MRI characteristics of ON. Contrast sensitivity, color vision and visual field are the parameters which remain impaired mostly even after good recovery of visual acuity.

  15. Optic Neuritis, its Differential Diagnosis and Management

    Science.gov (United States)

    Hoorbakht, Hedieh; Bagherkashi, Farid

    2012-01-01

    The aim of this review is to summarize the latest information about optic neuritis, its differential diagnosis and management. Optic Neuritis (ON) is defined as inflammation of the optic nerve, which is mostly idiopathic. However it can be associated with variable causes (demyelinating lesions, autoimmune disorders, infectious and inflammatory conditions). Out of these, multiple sclerosis (MS) is the most common cause of demyelinating ON. ON occurs due to inflammatory processes which lead to activation of T-cells that can cross the blood brain barrier and cause hypersensitivity reaction to neuronal structures. For unknown reasons, ON mostly occurs in adult women and people who live in high latitude. The clinical diagnosis of ON consists of the classic triad of visual loss, periocular pain and dyschromatopsia which requires careful ophthalmic, neurologic and systemic examinations to distinguish between typical and atypical ON. ON in neuromyelitis optica (NMO) is initially misdiagnosed as ON in MS or other conditions such as Anterior Ischemic Optic Neuropathy (AION) and Leber’s disease. Therefore, differential diagnosis is necessary to make a proper treatment plan. According to Optic Neuritis Treatment Trial (ONTT) the first line of treatment is intravenous methylprednisolone with faster recovery and less chance of recurrence of ON and conversion to MS. However oral prednisolone alone is contraindicated due to increased risk of a second episode. Controlled High-Risk Subjects Avonex® Multiple Sclerosis Prevention Study “CHAMPS”, Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment “BENEFIT” and Early Treatment of MS study “ETOMS” have reported that treatment with interferon β-1a,b results in reduced risk of MS and MRI characteristics of ON. Contrast sensitivity, color vision and visual field are the parameters which remain impaired mostly even after good recovery of visual acuity. PMID:22888383

  16. Lymphangioleiomyomatosis: differential diagnosis and optimal management

    Directory of Open Access Journals (Sweden)

    Xu KF

    2014-08-01

    Full Text Available Kai-Feng Xu,1 Bee Hong Lo2 1Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, People's Republic of China; 2Developmental Pediatrician, PECAT, Children's Hospital Westmead, Sydney, NSW, Australia Abstract: Lymphangioleiomyomatosis (LAM is an uncommon disease presented as diffuse thin-walled cystic changes in the lung. The main differential diagnoses include pulmonary Langerhans' histiocytosis (PLCH, Birt-Hogg-Dubé syndrome (BHD, lymphoid interstitial pneumonia (LIP, and amyloidosis. A combination of clinical, radiological, and pathological approaches as well as genetic testing will clarify the diagnosis in most cases. LAM is a disease almost exclusively in women. Dyspnea, pneumothorax, and hemoptysis are common presentations in LAM patients. LAM is also a lymphatic disorder affecting lymphatic vessels and lymph nodes. Chylothorax, chylous ascites, and lymphangiomyomas are frequently seen. LAM can present sporadically as a single entity or as part of tuberous sclerosis complex (TSC. Angiomyolipoma (AML is a characteristic extra-pulmonary lesion, either found in association with sporadic or TSC-related LAM. High-risk populations should be screened for LAM, including adult women with TSC and female patients with spontaneous pneumothorax, AMLs in the kidney, and diffuse cystic lung diseases. Definitive diagnosis of LAM is based on a high level of clinical suspicion on presentation supported by pathological findings or by a distinct feature, such as a history of TSC, AMLs in the kidney, chylothorax, or chylous ascites. Vascular endothelial growth factor-D (VEGF-D in serum is a noninvasive and reliable diagnostic biomarker. In experienced centers, trans-bronchial lung biopsy (TBLB provides a convenient and safe way to obtain lung specimens for diagnostic purposes. An effective treatment for LAM is now available, namely using a mechanistic target of rapamycin (mTOR inhibitor such as sirolimus. Efficacy of sirolimus has

  17. Diagnosis, Differential Diagnosis, and Epidemiology of Primary Sclerosing Cholangitis.

    Science.gov (United States)

    Ponsioen, Cyriel Y

    2015-01-01

    According to recent guidelines, primary sclerosing cholangitis (PSC) is diagnosed when a patient has a cholestatic liver enzyme profile, characteristic bile duct changes on imaging, and when secondary causes of sclerosing cholangitis are excluded. In patients with a clinical suspicion but normal cholangiography, a liver biopsy is indicated to establish a diagnosis of small duct PSC. Several other disease entities such as IgG4-associated cholangitis (IAC), cholangiocarcinoma (CCA), and secondary causes of sclerosing cholangitis such as choledocholithiasis, AIDS-cholangiopathy, ischemia, surgical bile duct trauma, or mast cell cholangiopathy can mimic PSC. IAC can be differentiated from PSC by applying the HISORt criteria including the serum IgG4 level. In cases where serum IgG4 is less than 2 × ULN, the ratio of IgG4/IgG1 >0.24 is indicative for IAC. Choledocholithiasis with recurrent cholangitis as a cause of sclerosing cholangitis can pose a conundrum, since PSC itself is associated with an increased prevalence of gallstones. The epidemiology of PSC worldwide has been poorly described. Incidence and prevalence rates vary from 0-1.3 and 0-16.2 per 100,000 inhabitants respectively. However, these figures are not based on population-based cohorts. A recent large population-based cohort from the Netherlands reported an incidence of 0.5 and a prevalence of 6/100,000. Approximately 10% fulfil the criteria for small duct PSC. At diagnosis of PSC, concurrent inflammatory bowel disease (IBD), primarily ulcerative colitis or Crohn's colitis is present in 50%, but increasing to 80%, 10 years or more after diagnosis. Conversely, 3% of IBD patients will develop PSC. PSC predisposes to malignancy. The estimated cumulative risk of developing CCA after 30 years is 20%. For colorectal carcinoma in PSC/colitis patients, the estimated cumulative risk at 30 years is 13%. © 2015 S. Karger AG, Basel.

  18. [Differential diagnosis of post-concussive syndrome].

    Science.gov (United States)

    Pelegrín-Valero, C; Fernández-Guinea, S; Tirapu-Ustarroz, J; Múñoz-Céspedes, J M

    Posconcussional syndrome is characterized by a heterogeneous group of somatic, cognitive and psychosocial symptoms, which occur in patients with head trauma, generally of mild severity. It is the neuropsychiatric postraumatic disorder more prevalent in the field of forensic medicine. Classical authors (Lishamn and Barraquer, for example) focused on controversial aspects of this syndrome, such as conceptual problems and etiology (organic versus functional). The objective of this report is to review the posconcussional literature in search of relevant aspects in forensic neuropsychology: conceptual aspects, epidemiology, etiology, clinical features, methodology for assessment, and its differential diagnosis with other postraumatic disorders, such as postraumatic stress disorder, adjustment disorder, anxiety disorder, mood disorders (major depressive disorder), substancerelated disorders, dementia due to head trauma, amnesic disorder, somatoform disorders, factitious disorder, malingering, chronic pain and chronic whiplash syndrome.

  19. [Difficulties in the differential diagnosis of splenomegaly].

    Science.gov (United States)

    Seĭsembekov, T Z; Umbetalina, N S; Iungbliut, A A; Musataeva, M M; Shilova, V N; Bekk, V G; Batpaeva, N I

    1991-01-01

    The authors discuss diagnostic difficulties that may occur in the interpretation of splenomegaly. In some cases, other tumorous formations, palpable in the left hypochondrium (renal tumor and retroperitoneal fibroma in cases demonstrated) may be taken for splenomegaly. In other cases, diagnostic difficulties may be related to establishing the cause of genuine splenomegaly. Out of 10 patients with genuine splenomegaly, the cause of which could not be ascertained at the prehospital stage, the enlargement of the spleen in 2 was due to liver cirrhosis, in 3, to subleukemic myelosis, in 1, to splenic tuberculosis, in 2, to multiple capillary angiomas of the spleen, in 1, to chronic monocytic leukemia, and in 1 patient, to splenic echinococcosis. In 3 patients out of the 10, the diagnosis was verified by surgery followed by histological examination of the spleen. The conclusion is made about the necessity of the use of clinical and laboratory examinations, of patients with obscure "splenomegaly" together with the use of x-ray and ultrasonography of the spleen, kidneys, gastrointestinal tract, puncture of the bone marrow and spleen. In some cases, splenectomy may be performed along with histological examination of the spleen as the final stage of differential diagnosis of splenomegalies.

  20. Diabetes insipidus: Differential diagnosis and management.

    Science.gov (United States)

    Robertson, Gary L

    2016-03-01

    Diabetes insipidus (DI) is a syndrome characterized by the excretion of abnormally large volumes of dilute urine. It can be caused by any of 4 fundamentally different defects that must be distinguished for safe and effective management. They are: (1) pituitary DI, due to inadequate production and secretion of antidiuretic hormone, arginine-vasopressin (AVP); (2) gestational DI due to degradation of AVP by an enzyme made in placenta; (3) primary polydipsia, due to suppression of AVP secretion by excessive fluid intake; and (4) nephrogenic DI due to renal insensitivity to the antidiuretic effect of AVP. This review describes several methods of differential diagnosis, indicates the advantages and disadvantages of each and presents a new approach that is simpler and less costly but just as reliable as the best of the older methods. The various treatments for the different types of DI and recent findings on the genetic basis of the familial forms of DI are also discussed with emphasis on their contributions to improved diagnosis and management. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. [Differential diagnosis of unilateral necrotic tonsillitis].

    Science.gov (United States)

    Gebhardt, B; Herrmann, K; Roessner, A; Vorwerk, U

    2010-05-01

    The best known clinical picture of a one-sided necrotisising, infectious tonsillitis is the by Plaut and Vincent (1894) described angina Plaut-Vincent. In addition to this fusospirochetosis it is in case of necrotisising inflammations in the oropharynx differential-diagnostically important to consider also the anaerobic type Prevotella, especially Prevotella disiens as a potential trigger . Because the clinical course forms of a necrotisising oropharyngeal inflammations can be very different and complicate so a suitable diagnosis, it is very important to get a complete and perfect cause proof. For getting this proof a correct test production, transport and cultivation are of extreme importance . The type Prevotella consists of different species gram-negative, obligate anaerobic strains. They are regarded as a cause of suppurating inflammations and abscesses of the genital tract and are components of the aerobic anaerobic mixed flora in case of gingival infections. The sole proof in the microbiological culture as a smear test result of a one-sided necrotisising tonsillitis has to be seen as a first description by reason of missing literature . As triggers for one-sided necrotisising tonsillitis are considered different causes. Next a carcinoma of the tonsil, Lues, Angina Plaut-Vincent have to be excluded. An infection with Prevotella disiens is an extremely rare variation in contrast. However, the transmission is possible by insufficient hygiene, lack phenomena and sexual intercourse and to consider therefore as an exclusion diagnosis.

  2. The Differential Diagnosis of Thrombocytopenia in Pregnancy.

    Science.gov (United States)

    Bergmann, Frauke; Rath, Werner

    2015-11-20

    Thrombocytopenia is, after anemia, the second most common abnormality of the complete blood count in pregnancy, with a reported frequency of 6.6% to 11.2%. It has many causes. Thrombocytopenia should be diagnostically evaluated as early as possible in pregnancy, so that the obstetrical management can be accordingly planned to minimize harm to the mother and child. As the various underlying diseases share clinical features and laboratory findings, the differential diagnosis is often a difficult interdisciplinary challenge. In this article, we review pertinent literature (2000-January 2015) retrieved by a selective search in PubMed. Gestational thrombocytopenia is the most common type, accounting for 75% of cases, followed by severe pre-eclampsia/HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) in 15-22% and autoimmune thrombocytopenia (ITP) in 1-4%. Gestational thrombocytopenia and ITP differ in the bleeding history, the severity of thrombocytopenia, the frequency of neo - natal thrombocytopenia, and the rate of normalization of the platelet count after delivery. The HELLP syndrome and rarer microangiopathic hemolytic anemias (e.g., thrombotic thrombocytopenic purpura) can be differentiated on the basis of their main clinical features, such as hypertension/proteinuria and upper abdominal pain, the severity of hemolysis and thrombocytopenia, the degree of transaminase elevation, and the rapidity of postpartum remission of the clinical and laboratory findings. A stepwise diagnostic procedure should be followed to distinguish further causes, e.g., to differentiate thrombocytopenia due to infection, autoimmune disease, or drugs from thrombocytopenia due to a rare hereditary disease. The early interdisciplinary evaluation of thrombocytopenia in pregnancy is a prerequisite for the optimal care of the mother and child. The development of evidence-based recommendations for interdisciplinary management should be a goal for the near future.

  3. Baseline inhibin B and anti-Mullerian hormone measurements for diagnosis of hypogonadotropic hypogonadism (HH) in boys with delayed puberty.

    Science.gov (United States)

    Coutant, Régis; Biette-Demeneix, Estelle; Bouvattier, Claire; Bouhours-Nouet, Natacha; Gatelais, Frédérique; Dufresne, Sylvie; Rouleau, Stéphanie; Lahlou, Najiba

    2010-12-01

    The diagnosis of isolated hypogonadotropic hypogonadism (IHH) in boys with delayed puberty is challenging, as may be the diagnosis of hypogonadotropic hypogonadism (HH) in boys with combined pituitary hormone deficiency (CPHD). Yet, the therapeutic choices for puberty induction depend on accurate diagnosis and may influence future fertility. The aim was to assess the utility of baseline inhibin B (INHB) and anti-Mullerian hormone (AMH) measurements to discriminate HH from constitutional delay of puberty (CDP). Both hormones are produced by Sertoli cells upon FSH stimulation. Moreover, prepubertal AMH levels are high as a reflection of Sertoli cell integrity. We studied 82 boys aged 14 to 18 yr with pubertal delay: 16 had IHH, 15 congenital HH within CPHD, and 51 CDP, as confirmed by follow-up. Subjects were genital stage 1 (testis volumeHH. In IHH and CPHD boys with genital stage 1, sensitivity and specificity were 100% for INHB concentration of 35 pg/ml or less. In IHH and CPHD boys with genital stage 2, sensitivities were 86 and 80%, whereas specificities were 92% and 88%, respectively, for an INHB concentration of 65 pg/ml or less. The performance of testosterone, AMH, FSH, and LH measurements was lower. No combination or ratio of hormones performed better than INHB alone. Discrimination of HH from CDP with baseline INHB measurement was excellent in subjects with genital stage 1 and fair in subjects with genital stage 2.

  4. The Diagnosis and Treatment of Multiple Factitious Oral Ulcers in a 6-Year-Old Boy

    Directory of Open Access Journals (Sweden)

    Priscilla Santana Pinto Gonçalves

    2017-01-01

    Full Text Available Factitious ulcers are characterized by self-inflicted lesions with multifactorial origin. These lesions are frequently found in head, neck, and hands. This report shows a 6-year-old boy diagnosed with factitious oral ulcers that occurred after the self-biting of buccal vestibule and nail-scratching of gingival tissue. Clinically, a significant swelling was observed, hard on palpation, located at the right lower third of the face, next to the posterior area of the mandible. In the intraoral examination, ulcers at different healing stages were noted on the swelling area. During the anamnesis, the father reported a change in his familial structure that triggers psychological stress, providing the clues to the presumptive diagnosis of factitious oral ulcers. We prescribed the topical use of Gingilone® three times a day to control the local pain and inflammation. At 7-day follow-up, we noticed the reduction of extraoral swelling and the initial healing of the ulcers. The presumptive diagnosis was confirmed at 30-day follow-up, with the lasting remission of oral lesions. The treatments of factitious oral ulcers should be individually tailored for each patient, focused on a multidisciplinary approach, including psychotherapy and periodic clinical control. To the best of our knowledge, gaps of evidence lead to the lack of standardized clinical protocols on this issue.

  5. True vocal fold nodules: the role of differential diagnosis.

    Science.gov (United States)

    Kunduk, Melda; McWhorter, Andrew J

    2009-12-01

    The present article aims to discuss the current reviews and the literature published regarding the differential diagnosis of vocal fold nodules with emphasis on diagnosis and nomenclature. Benign lesions of the vocal folds, including nodules, continue to challenge practitioners in nomenclature uniformity and even histologic diagnosis. Utilization of molecular techniques is helping to better understand Reinke's space and to better differentiate these lesions. This more accurate diagnosis may help guide appropriate treatment indicating behavioral versus surgical therapy. Further study with the application of new technology in the laboratory and clinic will continue to refine our differential diagnosis and understanding of vocal fold nodules.

  6. Gender-Differentiated Parenting Revisited: Meta-Analysis Reveals Very Few Differences in Parental Control of Boys and Girls.

    Science.gov (United States)

    Endendijk, Joyce J; Groeneveld, Marleen G; Bakermans-Kranenburg, Marian J; Mesman, Judi

    2016-01-01

    Although various theories describe mechanisms leading to differential parenting of boys and girls, there is no consensus about the extent to which parents do treat their sons and daughters differently. The last meta-analyses on the subject were conducted more than fifteen years ago, and changes in gender-specific child rearing in the past decade are quite plausible. In the current set of meta-analyses, based on 126 observational studies (15,034 families), we examined mothers' and fathers' differential use of autonomy-supportive and controlling strategies with boys and girls, and the role of moderators related to the decade in which the study was conducted, the observational context, and sample characteristics. Databases of Web of Science, ERIC, PsychInfo, Online Contents, Picarta, and Proquest were searched for studies examining differences in observed parental control of boys and girls between the ages of 0 and 18 years. Few differences were found in parents' use of control with boys and girls. Parents were slightly more controlling with boys than with girls, but the effect size was negligible (d = 0.08). The effect was larger, but still small, in normative groups and in samples with younger children. No overall effect for gender-differentiated autonomy-supportive strategies was found (d = 0.03). A significant effect of time emerged: studies published in the 1970s and 1980s reported more autonomy-supportive strategies with boys than toward girls, but from 1990 onwards parents showed somewhat more autonomy-supportive strategies with girls than toward boys. Taking into account parents' gender stereotypes might uncover subgroups of families where gender-differentiated control is salient, but based on our systematic review of the currently available large data base we conclude that in general the differences between parenting of boys versus girls are minimal.

  7. Gender-Differentiated Parenting Revisited: Meta-Analysis Reveals Very Few Differences in Parental Control of Boys and Girls.

    Directory of Open Access Journals (Sweden)

    Joyce J Endendijk

    Full Text Available Although various theories describe mechanisms leading to differential parenting of boys and girls, there is no consensus about the extent to which parents do treat their sons and daughters differently. The last meta-analyses on the subject were conducted more than fifteen years ago, and changes in gender-specific child rearing in the past decade are quite plausible. In the current set of meta-analyses, based on 126 observational studies (15,034 families, we examined mothers' and fathers' differential use of autonomy-supportive and controlling strategies with boys and girls, and the role of moderators related to the decade in which the study was conducted, the observational context, and sample characteristics. Databases of Web of Science, ERIC, PsychInfo, Online Contents, Picarta, and Proquest were searched for studies examining differences in observed parental control of boys and girls between the ages of 0 and 18 years. Few differences were found in parents' use of control with boys and girls. Parents were slightly more controlling with boys than with girls, but the effect size was negligible (d = 0.08. The effect was larger, but still small, in normative groups and in samples with younger children. No overall effect for gender-differentiated autonomy-supportive strategies was found (d = 0.03. A significant effect of time emerged: studies published in the 1970s and 1980s reported more autonomy-supportive strategies with boys than toward girls, but from 1990 onwards parents showed somewhat more autonomy-supportive strategies with girls than toward boys. Taking into account parents' gender stereotypes might uncover subgroups of families where gender-differentiated control is salient, but based on our systematic review of the currently available large data base we conclude that in general the differences between parenting of boys versus girls are minimal.

  8. Hepcidin: from discovery to differential diagnosis.

    Science.gov (United States)

    Kemna, Erwin H J M; Tjalsma, Harold; Willems, Hans L; Swinkels, Dorine W

    2008-01-01

    Although iron is essential for living organisms to survive, its reactive properties require strict regulation in order to prevent toxic effects. Hepcidin, a liver produced peptide hormone, is thought to be the central regulator of body iron metabolism. Its production is mainly controlled by the erythropoietic activity of the bone-marrow, the amount of circulating and stored body iron, and inflammation. Recent reports, however, provide new hypotheses on how hepcidin might exert its regulatory function. Although hepcidin was first discovered in human urine and serum, most of our understanding of hepcidin regulation and action comes from in vitro and mice studies that often use hepcidin mRNA expression as a read out. The difficulties in carrying out studies in humans have mostly been due to the lack of suitable hepcidin assay. The recent development of assays to measure hepcidin in serum and urine has offered new opportunities to study hepcidin regulation in humans. However, for the moment, only a small number of laboratories are able to perform these assays. The aim of this review is to discuss insights into hepcidin regulation obtained from recent clinical studies in the light of findings from in vitro and mice studies. Ongoing studies in humans should provide us with more information on the etiology of iron metabolism disorders in order to create new therapeutic strategies and improve differential diagnosis protocols for these diseases.

  9. DIFFERENTIAL DIAGNOSIS OF ORGANIC ACIDEMIA: CLINICAL AND NEUROIMAGING FINDINGS

    OpenAIRE

    Mahmoud Reza ASHRAFI; Alireza TAVASOLI

    2012-01-01

    Clinical differential DiagnosisThe organic acidemias are important in the differential diagnosis of metabolic and neurologic derangement in the neonate and of new-onset neurologic signs in the older child.A-Organic aciduriaSeveral disorders, not classified as primary disorders of organic acid metabolism, have a characteristic urinary organic acid profile that suggests the appropriate diagnosis.• Mevalonicaciduria, a disorder of cholesterol biosynthesis, shows mevalonic acid in the urine.• Glu...

  10. Gender-Differentiated parenting revisited : Meta-analysis reveals very few differences in parental control of boys and girls

    National Research Council Canada - National Science Library

    Endendijk, Joyce J; Groeneveld, Marleen G; Bakermans-Kranenburg, Marian J; Mesman, Judi

    2016-01-01

    ...-analyses to examine whether parents use different control strategies with boys than with girls. We focused on observed parental control, to minimize social desirable responding by parents and because differential parenting occurs mostly at an unconscious level and is therefore more likely to be captured using observation methods than with self-...

  11. Gender-Differentiated parenting revisited : Meta-analysis reveals very few differences in parental control of boys and girls

    NARCIS (Netherlands)

    Endendijk, Joyce J.|info:eu-repo/dai/nl/330190865; Groeneveld, Marleen G.; Bakermans-Kranenburg, Marian J.; Mesman, Judi

    2016-01-01

    Although various theories describe mechanisms leading to differential parenting of boys and girls, there is no consensus about the extent to which parents do treat their sons and daughters differently. The last meta-analyses on the subject were conducted more than fifteen years ago, and changes in

  12. Endomyocardial fibrosis. Problems in differential diagnosis.

    Science.gov (United States)

    Falase, A O; Kolawole, T M; Lagundoye, S B

    1976-04-01

    The clinical and angiographic findings in 5 consecutive patients with congestive cardiac failure are presented to illustrate the pitfalls in the clinical diagnosis of endomyocardial fibrosis. In one patient the clinical diagnosis was confirmed at angiography while another patient who had angiographic evidence of early right ventricular endomyocardial fibrosis was diagnosed clinically as mitral stenosis. In 2 patients the clinical diagnosis was erroneous, there being no evidence of endomyocardial fibrosis on angiography. The fifth patient, who had angiographic evidence of idiopathic cardiomegaly, was diagnosed clinically as either idiopathic cardiomegaly or advanced left ventricular endomyocardial fibrosis. In tropical countries, where endomyocardial fibrosis, rheumatic heart disease, and idiopathic cardiomegaly are common, accurate clinical diagnosis of endomyocardial fibrosis is often difficult and angiographic studies are essential for confirmation.

  13. Familial Case of Cherubism from South India: Differential Diagnosis and Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Varun Muthuraman

    2014-01-01

    Full Text Available Cherubism is a rare familial multilocular cystic lesion of the jaws. The condition clinically appears as a bilateral symmetric swelling of the cheeks in children and is the primary reason for referral. It is a rare lesion of the jaws that has a dominant pattern of inheritance. We report two cases of cherubism, that of a boy and his mother suggestive of a strong familial incidence. A variety of lesions of the jaw mimic this condition and hence the differential diagnosis has been emphasised.

  14. Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management.

    Science.gov (United States)

    Handler, Marc Z; Patel, Parimal A; Kapila, Rajendra; Al-Qubati, Yasin; Schwartz, Robert A

    2015-12-01

    The diagnosis of leishmaniasis can be challenging because it mimics both infectious and malignant conditions. A misdiagnosis may lead to an unfavorable outcome. Using culture, histologic, and/or polymerase chain reaction study results, a diagnosis of leishmaniasis can be established and treatment initiated. Appropriate management requires an accurate diagnosis, which often includes identification of the specific etiologic species. Different endemic areas have varying sensitivities to the same medication, even within individual species. Species identification may be of practical value, because infections with select species have a substantial risk of visceral involvement. In addition, HIV and otherwise immunocompromised patients with leishmaniasis have a propensity for diffuse cutaneous leishmaniasis. For most New World Leishmania species, parenteral antimonial drugs remain the first line of therapy, while Old World species are easily treated with physical modalities. Historically, live organism vaccination has been used and is effective in preventing leishmaniasis, but results in an inoculation scar and an incubation period that may last for years. A more effective method of vaccination would be welcome. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Tuberculous and brucellosis meningitis differential diagnosis

    DEFF Research Database (Denmark)

    Erdem, Hakan; Senbayrak, Seniha; Gencer, Serap

    2015-01-01

    BACKGROUND: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the dif......BACKGROUND: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included...

  16. Epidemiology, diagnosis and differential diagnosis in Parkinson's disease tremor.

    Science.gov (United States)

    Baumann, Christian R

    2012-01-01

    The epidemiology of tremor in Parkinson's disease is not well examined. The prevalence of Parkinson's disease is about 100-300 per 100,000, and the majority (70-100%) of these patients may develop tremor during the course of the disorder. The expression of tremor is also influenced by the genetic background of selected patients. On the other hand, Parkinson patients with a predominant tremor phenotype may have a more favourable prognosis in terms of mortality and the development of motor and non-motor complications. The diagnosis of Parkinson tremor is based on a clinical diagnosis of both underlying Parkinson's disease and on the tremor itself. Tremor is a rhythmical, involuntary oscillatory movement of a body part, and includes resting tremor, action tremor including postural and kinetic tremor. The classical type is resting tremor, but other phenotypes may also occur. Misdiagnoses between Parkinson tremor and essential tremor are relatively common. Electrophysiological and functional imaging examinations can be useful in the distinction of the two, but both approaches suffer from some limitations. In general, essential tremor and other tremor forms can be distinguished from Parkinson tremor by their frequency and their expression with different activation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Differential diagnosis of focal pancreatitis and pancreatic cancer

    NARCIS (Netherlands)

    van Gulik, T. M.; Moojen, T. M.; van Geenen, R.; Rauws, E. A.; Obertop, H.; Gouma, D. J.

    1999-01-01

    The differentiation of focal, chronic pancreatitis (CP) and pancreatic cancer (PAC) poses a diagnostic dilemma. Both conditions may present with the same symptoms and signs. The complexity of differential diagnosis is enhanced because PAC is frequently associated with secondary inflammatory changes

  18. Surface primary bone tumors: Systematic approach and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Mendez Diaz, Cristina; Soler Fernandez, Rafaela; Rodriguez Garcia, Esther; Fernandez Armendariz, Pablo; Diaz Angulo, Carolina [Complejo Hospitalario Universitario A Coruna, Department of Radiology, A Coruna (Spain)

    2015-09-15

    Surface primary bone tumors may appear similar to their intramedullary counterpart, but because they are rare, they may pose diagnostic challenges when showing different characteristics compared to their intramedullary counterpart. It is important for radiologists to recognize the imaging findings for various uncommon surface primary bone tumors, which may help to reduce the differential diagnosis or to lead to a specific diagnosis. Radiography is typically used for first-line imaging. If necessary, it is followed by CT or MRI for evaluation and characterization of surface bone tumors. The aim of this article is to review the imaging findings and differential diagnosis for surface primary bone tumors. (orig.)

  19. Nuclear magnetic tomography in the differential diagnosis of liver disease

    Energy Technology Data Exchange (ETDEWEB)

    Roedl, W.

    1985-05-01

    In evaluating nuclear magnetic tomography for the diagnosis of liver disease, one must differentiate between circumscribed and diffuse lesions. Nuclear magnetic tomography provides additional information for lesions which are echogenic on ultrasound and can differentiate between metastases, haemangiomas and hamartomas. In diffuse parenchymal disease measurement of relaxation time can differentiate between fatty liver, cirrhosis (alcoholic, primary biliary), haemochromatosis (cirrhotic transformation) and hepatoma. NMR spectroscopy is a method for the future.

  20. Differential diagnosis of small bowel occlusions

    Directory of Open Access Journals (Sweden)

    Paolo Ghiringhelli

    2009-06-01

    Full Text Available Hereditary nonpolyposis colorectal cancer (HNPCC, also known as Lynch syndrome, is a common autosomal dominant syndrome characterized by early age at onset, and microsatellite instability (MSI. Patients with Lynch syndrome have a markedly increased risk of colorectal cancer. We report a case of a 28-year-old male with Lynch syndrome; the case allows to describe clinical manifestations and diagnostic criteria of this syndrome, and to underline the importance of genetics in the diagnosis of this disease.

  1. [Differential diagnosis of chronic myeloic leucemia in infancy (author's transl)].

    Science.gov (United States)

    Binder, C; Pichler, E; Radaskiewicz, T; Scheibenreiter, S

    1976-01-01

    A 3 months old girl presented with significant enlargement of liver, spleen and lymphnodes, with moderate anemia, thrombopenia and leucocytosis. In the differential count there was a shift to the left and an increase of monocyte-like cells (35%). Differential diagnosis included leucemoid reaction, infectious mononucleosis, myelo-proliferative disorder with a missing C chromosome and chronic myeloid leucemia. Clinical symptoms, cytochemistry and caryotype of bone marrow cells suggested infantile chronic myeloic leucemia and normal ALP index and possibly normal HbF. Treatment with 6-mercaptopurine was followed by partial remission. The therapeutic consequences of exact differential diagnosis are discussed.

  2. Specific phobias in older adults: characteristics and differential diagnosis.

    Science.gov (United States)

    Coelho, Carlos M; Gonçalves, Daniela C; Purkis, Helena; Pocinho, Margarida; Pachana, Nancy A; Byrne, Gerard J

    2010-08-01

    Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis, but also recognition of idiosyncratic factors associated with this population. Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post-traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging. A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used. Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia. First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.

  3. [Meningocele, glioma and optic nerve meningioma: differential diagnosis and treatment].

    Science.gov (United States)

    Genol, I; Troyano, J; Ariño, M; Iglesias, I; Arriola, P; García-Sánchez, J

    2009-11-01

    After studying 3 clinical cases, we have reviewed the clinical and radiological characteristics of meningocele, meningioma and optic nerve glioma. The differential diagnosis and therapeutic management are also discussed. Review of three clinical reports of three patients seen in our unit and a bibliographic search concerning the diagnosis and therapeutic management of these three entities at the present time. Differential diagnosis has to be based on a wide range of parameters: epidemiologic (age, race, sex, prevalence of the tumors), clinical (visual acuity, perimetry, Hertel exophthalmometry and funduscopy) and radiologic (computed tomography and magnetic resonance). Anatomopathologic study is required only rarely. The therapeutic options are: observation, surgery and radiotherapy. A correct differential diagnosis is mandatory to be able to individualize the treatment for each entity (Arch Soc Esp Oftalmol 2009; 84: 563-568).

  4. Socio-economic differentiation of the growth and the dietary intake of Polish boys aged 7-16 years.

    Science.gov (United States)

    Suliga, Edyta

    2009-01-01

    The period of the constitutional transformation, apart from many advantages, has generated a number of serious problems that may affect the biological state of children and adolescents in Poland. The study documented socio-economic differentiation of growth and dietary intake of boys. The research involved 523 boys aged 7-16; 54.4% of subjects came from Kielce (a city with a population of over 200 000) and 45.6% came from rural areas - from a region underprivileged in terms of economic development, with a majority of its inhabitants living off the land. Height and weight measurements of the subjects were taken, which allowed for computation of BMI. Dietary intake was assessed using the interview method for 24 h dietary recall. A multifactor variance analysis for unequal numbers in subclasses was applied to estimate the influence of socio-economic factors such as place of residence, mother's education and number of children in the family on somatic traits and on nutrient intake. Urban boys whose mothers had experienced higher education were characterized by the greatest height (peducation. The greatest amount of minerals and vitamins was found in the diets of boys whose mothers had higher education and lived in a city. Diets of boys with the greatest body height were also characterized by a greater content of mineral components and vitamins, and a greater percentage of energy derived from protein. The relative body mass of the investigated subjects was probably more influenced by factors other than nutrition, i.e. mostly physical activity.

  5. Developing a semantic web model for medical differential diagnosis recommendation.

    Science.gov (United States)

    Mohammed, Osama; Benlamri, Rachid

    2014-10-01

    In this paper we describe a novel model for differential diagnosis designed to make recommendations by utilizing semantic web technologies. The model is a response to a number of requirements, ranging from incorporating essential clinical diagnostic semantics to the integration of data mining for the process of identifying candidate diseases that best explain a set of clinical features. We introduce two major components, which we find essential to the construction of an integral differential diagnosis recommendation model: the evidence-based recommender component and the proximity-based recommender component. Both approaches are driven by disease diagnosis ontologies designed specifically to enable the process of generating diagnostic recommendations. These ontologies are the disease symptom ontology and the patient ontology. The evidence-based diagnosis process develops dynamic rules based on standardized clinical pathways. The proximity-based component employs data mining to provide clinicians with diagnosis predictions, as well as generates new diagnosis rules from provided training datasets. This article describes the integration between these two components along with the developed diagnosis ontologies to form a novel medical differential diagnosis recommendation model. This article also provides test cases from the implementation of the overall model, which shows quite promising diagnostic recommendation results.

  6. Differential diagnosis of anemia in pregnant women

    Directory of Open Access Journals (Sweden)

    T. S. Prokhorenko

    2017-01-01

    Full Text Available The review is dedicated to the diagnostics of hypochromic microcytic anemia among pregnant women with carbohydrate metabolism disorders by means of existing laboratory algorithm of examination. We give some data on the anemic syndrome in women with diabetes mellitus type 1. These data demonstrate an equal occurrence of anemia of chronic disorder and iron-deficiency anemia in this group of patients. Special attention is paid to the role of hepcidin in iron metabolism as well as to the mechanisms of regulation of hepcidin production under normal and pathological conditions. The review cites researches, which demonstrate the effectiveness of hepcidin measurement for differential diagnostics of anemic syndrome. We also touch upon the problem concerning treatment of anemia of chronic disorder.

  7. Differential diagnosis of recurrent bronchitis in children

    Directory of Open Access Journals (Sweden)

    I. I. Zakirov

    2016-01-01

    Full Text Available The interest of the doctors — pediatricians to recurrent bronchitis is caused by its high specific weight in the structure of bronchopulmonary pathology in children, the complexity and the need to search the differential selection of an individual regimen and prevention. Recurrent bronchitis with bronchoobstructive syndromes patient is regarded as a predictor of asthma, however, erroneously consider these nosological forms as the stages of a single pathophysiological chain as congenital and acquired diseases of respiratory system, pathology of gastro-intestinal tract, cardio-vascular system can masquerade as recurrent bronchitis. The aim of this work — to analyze the current medical literature on the problem of differential search causes leading recurrent respiratory syndrome in children. Materials and methods. The review publications domestic and foreign authors studied data from clinical and epidemiological studies. Results and its discussion. Anatomical physiological characteristics of the respiratory tract, complicated premorbid background, the re-infection of the child respiratory infection contribute to the recurrent course of bronchitis. The most common recurrent bronchitis is transient, recurrent bronchitis episodes completely stoped with the age of the child. Recurrent respiratory infections can fix bronchial hyperreactivity and with the presence of aggravated allergic history lead to the development of asthma. Severe bronchitis, resistance to standard scheme of therapy, the frequent recurrence of respiratory syndrome dictate the need to expand the diagnostic research to clarify the leading cause of recurrent bronchitis. Conclusion. Recurrent bronchitis is considered as a separate nosological form. At the same time, by repeated episodes of respiratory infection may be masked by malformations, hereditary diseases of respiratory system, bronchus foreign body microaspiration syndrome, pathology of the cardio-vascular system. 

  8. The differential diagnosis of hearing loss.

    Science.gov (United States)

    Zahnert, Thomas

    2011-06-01

    According to the World Health Organization, hearing loss is one of the six leading contributors to the global burden of disease. It is becoming an ever more important problem in society at large, not just because the population is aging, but also because young people increasingly spend their leisure time in activities that expose them to excessive noise. On the other hand, the treatment of hearing loss is improving, as the result of technical developments in otological surgery, hearing aids, and cochlear implants. For nearly every type of hearing loss, there is now some type of rehabilitative treatment. The prerequisite to effective care is timely and accurate diagnosis. Review of the pertinent literature and national guidelines. The available epidemiological data on hearing loss in Germany are inadequate. It is roughly estimated that 13 to 14 million people in Germany are in need of treatment for hearing loss. The most common types of permanent hearing loss are those associated with old age, chronic otitis media, and acoustic trauma. Transient hearing loss is particularly common in childhood as a result of inadequate ventilation of the middle ear. The further technical development of cochlear implants has now widened their indications to include severe congenital deafness and presbycusis.

  9. Orbital inflammatory disease: Pictorial review and differential diagnosis

    Science.gov (United States)

    Pakdaman, Michael N; Sepahdari, Ali R; Elkhamary, Sahar M

    2014-01-01

    Orbital inflammatory disease (OID) represents a collection of inflammatory conditions affecting the orbit. OID is a diagnosis of exclusion, with the differential diagnosis including infection, systemic inflammatory conditions, and neoplasms, among other conditions. Inflammatory conditions in OID include dacryoadenitis, myositis, cellulitis, optic perineuritis, periscleritis, orbital apicitis, and a focal mass. Sclerosing orbital inflammation is a rare condition with a chronic, indolent course involving dense fibrosis and lymphocytic infiltrate. Previously thought to be along the spectrum of OID, it is now considered a distinct pathologic entity. Imaging plays an important role in elucidating any underlying etiology behind orbital inflammation and is critical for ruling out other conditions prior to a definitive diagnosis of OID. In this review, we will explore the common sites of involvement by OID and discuss differential diagnosis by site and key imaging findings for each condition. PMID:24778772

  10. Successful diagnosis and treatment 50 years after exposure: is mucocutaneous leishmaniasis still a neglected differential diagnosis?

    Science.gov (United States)

    Schleucher, Regina D; Zanger, Philipp; Gaessler, Michael; Knobloch, Juergen

    2008-01-01

    We present a case of a long-term history of imported mucocutaneous leishmaniasis, illustrating the importance of this differential diagnosis even decades after exposure. Diagnostic pitfalls and the role of primary subspecies differentiation are demonstrated. Chemotherapy avoiding antimonials was successful and remarkably well tolerated by an elderly patient.

  11. Diagnosis and differential diagnosis of hydrocephalus in adults; Diagnostik und Differenzialdiagnostik des Hydrozephalus beim Erwachsenen

    Energy Technology Data Exchange (ETDEWEB)

    Langner, Soenke; Mensel, Birger; Kuehn, Jens Peter; Kirsch, Michael [Univ. Medicine Greifswald (Germany). Inst. for Diagnostic Radiology and Neuroradiology; Fleck, Steffen; Baldauf, Joerg [Univ. Medicine Greifswald (Germany). Dept. of Neurosurgery

    2017-08-15

    Hydrocephalus is caused by an imbalance of production and absorption of cerebrospinal fluid (CSF) or obstruction of its pathways, resulting in ventricular dilatation and increased intracranial pressure. Imaging plays a crucial role in the diagnosis, differential diagnosis and planning of treatment. This review article presents the different types of hydrocephalus und their typical imaging appearance, describes imaging techniques, and discusses differential diagnoses of the different forms of hydrocephalus. Imaging plays a central role in the diagnosis of hydrocephalus. While magnetic resonance (MR) imaging is the first-line imaging modality, computed tomography (CT) is often the first-line imaging test in emergency patients.

  12. [Differential diagnosis of neuromyelitis optica spectrum disorders].

    Science.gov (United States)

    Tanaka, Keiko; Tanaka, Masami

    2010-09-01

    Neuromyelitis optica (NMO) is a demyelinating disease of the central nervous system that preferentially affects the optic nerves and spinal cord. NMO-IgG/anti-aquaporin 4 antibody (AQP4-Ab) is considered as a specific diagnostic marker for NMO. A previous study using animal models passively transferred with AQP4-Ab has partially proven that NMO-IgG/AQP4-Ab has an effector function in the pathogenesis of NMO, exemplifying the diagnostic significance of this antibody. Further, this marker can be used to differentiate the limited forms of NMO, such as recurrent myelitis or optic neuritis or NMO with isolated cerebral/brainstem lesions during the early course of the disease, from other diseases with a different etiology. NMO spectrum disorders (NMOSD) comprise these clinically heterogeneous conditions, all of which are positive for AQP4-Ab. However, few patients show clinical characteristic features of NMO, without AQP4-Ab positivity. We should be careful to introduce interferon beta for the prevention of relapse to these seronegative but suspicious for NMO patients. A few NMOSD patients have also been diagnosed with systemic lupus erythematosus (SLE) or Sjogren syndrome (SjS). However, there have been no reported cases of patients with SLE/SjS who do not exhibit any neurological symptoms and AQP4-Ab-positivity, and it is likely that these 2 autoimmune diseases incidentally overlap. NMO might follow myasthenia gravis (MG), after thymectomy for the treatment of MG. Taken together,as in the case of other systemic autoimmune diseases,an antibody-mediated pathomechanism of NMO is suggested.

  13. Diffuse cystic lung diseases: differential diagnosis.

    Science.gov (United States)

    Baldi, Bruno Guedes; Carvalho, Carlos Roberto Ribeiro; Dias, Olívia Meira; Marchiori, Edson; Hochhegger, Bruno

    2017-01-01

    Diffuse cystic lung diseases are characterized by cysts in more than one lung lobe, the cysts originating from various mechanisms, including the expansion of the distal airspaces due to airway obstruction, necrosis of the airway walls, and parenchymal destruction. The progression of these diseases is variable. One essential tool in the evaluation of these diseases is HRCT, because it improves the characterization of pulmonary cysts (including their distribution, size, and length) and the evaluation of the regularity of the cyst wall, as well as the identification of associated pulmonary and extrapulmonary lesions. When combined with clinical and laboratory findings, HRCT is often sufficient for the etiological definition of diffuse lung cysts, avoiding the need for lung biopsy. The differential diagnoses of diffuse cystic lung diseases are myriad, including neoplastic, inflammatory, and infectious etiologies. Pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis, lymphocytic interstitial pneumonia, and follicular bronchiolitis are the most common diseases that produce this CT pattern. However, new diseases have been included as potential determinants of this pattern. RESUMO As doenças pulmonares císticas difusas se caracterizam pela presença de cistos envolvendo mais de um lobo pulmonar, que se originam por diversos mecanismos, incluindo dilatação dos espaços aéreos distais por obstrução, necrose das paredes das vias aéreas e destruição do parênquima. Essas doenças apresentam evolução variável. A TCAR é fundamental na avaliação dessas doenças uma vez que permite uma melhor caracterização dos cistos pulmonares, incluindo sua distribuição, tamanho, extensão e regularidade das paredes, assim como a determinação de outras lesões pulmonares e extrapulmonares associadas. Frequentemente a TCAR é suficiente para a definição etiológica dos cistos pulmonares difusos, associada a achados clínicos e laboratoriais, sem a necessidade

  14. MRI diagnosis of infantile Alexander disease in a 14 month old African boy.

    Science.gov (United States)

    Dlamini, Nondumiso; du Plessis, Vicci

    2016-10-01

    Alexander disease, also known as fibrinoid leukodystrophy, is a rare leukoencephalopathy which occurs due to a mutation in the glial fibrillary acid protein (GFAP) gene. Magnetic resonance imaging (MRI) has proven to be highly sensitive in making the diagnosis. Typical MRI findings, in combination with positive genetic blood analysis, confirm the diagnosis.

  15. Dementia and Depression: A Process Model for Differential Diagnosis.

    Science.gov (United States)

    Hill, Carrie L.; Spengler, Paul M.

    1997-01-01

    Delineates a process model for mental-health counselors to follow in formulating a differential diagnosis of dementia and depression in adults 65 years and older. The model is derived from empirical, theoretical, and clinical sources of evidence. Explores components of the clinical interview, of hypothesis formation, and of hypothesis testing.…

  16. Differential Diagnosis of Acute Stroke and Viral Encephalitis

    Directory of Open Access Journals (Sweden)

    I.V. Bogadelnikov

    2012-04-01

    Full Text Available At the present time, there has been an increase in the frequency of ischemic and hemorrhagic stroke in children. The clinical picture of the disease has similar features to the one of viral encephalitis. Differential diagnosis is necessary to choose correct treatment tactics.

  17. Delayed puberty and hypogonadotropic hypogonadism. Differential diagnosis and treatment

    NARCIS (Netherlands)

    Snoep, Marinus Cornelis

    1978-01-01

    This thesis describes a method enabling a prospecrive differential diagnosis to be made berween delayed puberty (DP) and hypogonadotropic hypogonadism (HH). The influence of androgen administration on the gonadal feedback sysrem of patients with delayed puberty was also studied. ... Zie: Summary

  18. Isolated femoral hypoplasia: an intrauterine differential diagnosis to campomelia

    Energy Technology Data Exchange (ETDEWEB)

    Koerber, Friederike; Benz-Bohm, Gabriele [University of Cologne, Department of Paediatric Radiology, Cologne (Germany); Schoenau, Eckard [University of Cologne, Department of Paediatrics, Cologne (Germany); Horwitz, A.Eldad [Klinikum Krefeld, Department of Paediatric Radiology, Krefeld (Germany)

    2005-06-01

    The isolated form of femoral bowing is an important differential diagnosis of campomelia. Therefore, knowledge of isolated anomalies is fundamental for prenatal diagnosis, especially for the differential diagnosis from severe syndromes. Four cases are presented to discuss the differential diagnosis of femoral bowing including a review of the literature. We report four newborn babies with unilateral bowing and shortening of the femur. Three had no further anomaly; one child had additional abnormalities due to coumarin embryopathy. The radiological findings were shortened femora with bowing and varus deformity and cortical thickening on the concave side. All other parts showed normal bone structure. The aetiology of femoral bowing is unknown. Early damage of the cartilaginous model followed by remodelling with thickening on the concave side of the bone similar to the healing of malaligned fractures is suspected. The isolated form of femoral bowing without any other anomalies has to be differentiated from complex and more often severe congenital syndromes such as campomelia. Postpartum radiological examination should be reduced to a single exposure of the affected limb and follow-up should be done by clinical examination. (orig.)

  19. DIFFERENTIAL DIAGNOSIS OF CUTANEOUS LEISHMANIAS IS AND PARACOCCIDIOIDOMYCOSIS: CASE REPORT

    Directory of Open Access Journals (Sweden)

    Thaísa da Silva Vieira

    2017-01-01

    Full Text Available The polymorphism of the clinical presentation of paracoccidioidomycosis allows it to be included in the differential diagnosis of various clinical conditions, including cutaneous leishmaniasis. This study aims to discuss the difficulty of establishing the differential diagnosis between paracoccidioidomycosis and american cutaneous leishmaniasis in the case of patients from rural areas with chronic ulcerative lesion in the oral and nasal mucosa. This is a case report of an adult patient, coming from rural Itagi, Bahia, admitted to the public Hospital Prado Valadares (HGPV, in Jequié-BA. Thus, the case report aims to contribute to the medical and scientific community in the description of the clinical aspects of the lesions for the early diagnosis and prevention of the impacts of disabilities and injuries

  20. [Differential diagnosis of oral mucosal erosions and ulcers in children].

    Science.gov (United States)

    Benoit, S; Hamm, H

    2015-04-01

    Oral ulcers and erosions are of great clinical importance because they are common in childhood and adolescence and generally painful. They can be related to harmless conditions, such as recurrent aphthous stomatitis. On the other hand, they can be associated with severe systemic diseases making an early diagnosis and initiation of treatment necessary. We herein focus on the systematic presentation of differential diagnoses of oral ulcers and erosions in pediatric patients and present clues in the history and clinical features that are helpful to establish the diagnosis. Patient's age at the beginning of the symptoms, differentiation between acute and chronic course, distribution of mucosal lesions, additional involvement of the skin, extracutaneous symptoms, general condition of the patient, comorbidities and medication may be determining factors of the correct diagnosis. In children and adolescents aphthous stomatitis, infections and trauma are the most frequent causes of oral ulcerations or erosions of the mucous membranes.

  1. Differential Effects of Male and Female Reading Tutors Based on Boys' Gendered Views of Reading

    Science.gov (United States)

    Sokal, Laura; Thiem, Cassandra; Crampton, Amanda; Katz, Herb

    2009-01-01

    This study examined the effects of the gender of reading tutors on 173 third and fourth grade mainly inner-city boys identified as struggling readers. Reading achievement ("Alberta Diagnostic Reading Program") and reader self-perceptions ("Readers' Self-Perception Scale") were monitored over a 22-week reading intervention.…

  2. "Racialised Facilitative Capital" and the Paving of Differential Paths to Achievement of Afro-Trinidadian Boys

    Science.gov (United States)

    Rampersad, Ravi

    2014-01-01

    Bourdieu describes capital as the political building blocks of social order that give meaning to social accumulation and consumption. Through a combination of Bourdieu's sociology and critical race theory, this sojourn into Afro-Trinidadian boys' achievement seeks to elucidate an approach to understanding capital as inherently raced. This is…

  3. The Performance-Verbal IQ Discrepancy in Differentiated Subgroups of Delinquent Adolescent Boys.

    Science.gov (United States)

    Hecht, Ira H.; Jurkovic, Gregory J.

    1978-01-01

    The validity of Wechsler's Performance--Verbal IQ sign was examined for psychopathic, neurotic, and subcultural delinquent boys. The psychopathic group scored significantly higher on the performance scale than on the verbal scale, and lower on the comprehension subtest than the other groups. Findings were related to characteristics common to…

  4. Thoracic splenosis as a differential diagnosis of juxtapleural nodules

    Directory of Open Access Journals (Sweden)

    B. Lopes

    2014-01-01

    Full Text Available Thoracic splenosis is rare and consists of ectopic implantation of splenic tissue into the chest after concomitant thoracic and abdominal trauma with diaphragm injury. It occurs in about 18% of cases of splenic ruptures. In almost all cases, diagnosis is given incidentally once patients are usually asymptomatic. Thoracic splenosis should be considered as a differential diagnosis in all patients with history of trauma presenting with juxtapleural nodules in chest computed tomography. However, malignant conditions should be ruled out firstly. Biopsy is not essential for the diagnosis once nuclear medicine can confirm splenosis in patients with pertinent history of trauma and suggestive tomographic image. We present a typical case of thoracic splenosis whose diagnosis was made by nuclear medicine and no invasive procedures were required.

  5. [Sturge-Weber syndrome: differential diagnosis of neurocysticercosis].

    Science.gov (United States)

    Stokes, A C; Hernández-Cossio, O; Hernández-Fustes, O J; Munhoz, R P; Hernández-Fustes, O J; Francisco, A N

    The Sturge-Weber syndrome is characterized by facial cutaneous angioma associated with leptomeningeal and cerebral angioma, typically ipsilateral to the facial lesion, which is accompanied by convulsions, mental retardation, contralateral hemiparesia, hemiatrophy, homonymous hemianopsia and glaucoma. Most of the patients with radiographic evidence of intracranial angioma develop convulsive crises, but only half have severe mental retardation. The image of calcification on cranial tomography often leads to confusion in diagnosis, especially with neurocysticercosis, particularly in places where this is endemic and the patients present with minimal skin lesions or these are at atypical sites. We present the case of a 13 year-old boy hospitalized with status epilepticus who, since the age of 1 year and 3 months, had had convulsive seizures which were of generalized tonic-clonic type and partially complex with secondary generalization, treated with carbamazepine at a dose of 400 mg per day. Neurocysticercosis was diagnosed on a tomogram showing calcification of the left parieto-occipital gyrus. Following physical examination and complementary tests the diagnosis of Sturge-Weber syndrome was made. We emphasize the importance of the diagnosis of Sturge-Weber syndrome, its clinical picture and treatment.

  6. Fetal Testosterone Predicts Sexually Differentiated Childhood Behavior in Girls and in Boys

    Science.gov (United States)

    Auyeung, Bonnie; Baron-Cohen, Simon; Ashwin, Emma; Knickmeyer, Rebecca; Taylor, Kevin; Hackett, Gerald; Hines, Melissa

    2009-01-01

    Mammals, including humans, show sex differences in juvenile play behavior. In rodents and nonhuman primates, these behavioral sex differences result, in part, from sex differences in androgens during early development. Girls exposed to high levels of androgen prenatally, because of the genetic disorder congenital adrenal hyperplasia, show increased male-typical play, suggesting similar hormonal influences on human development, at least in females. Here, we report that fetal testosterone measured from amniotic fluid relates positively to male-typical scores on a standardized questionnaire measure of sex-typical play in both boys and girls. These results show, for the first time, a link between fetal testosterone and the development of sex-typical play in children from the general population, and are the first data linking high levels of prenatal testosterone to increased male-typical play behavior in boys. PMID:19175758

  7. [DIFFERENTIAL DIAGNOSIS OF TUMOROID-LIKE ABSCESS AND LUNG CANCER].

    Science.gov (United States)

    Churylin, R

    2015-01-01

    The purpose of work is development and clarification of roentgenology displays of tumoroidea variant of abscess of lungs for differential diagnostics him with the cancer of lungs. Practically in most cases abscess of lungs there is a necessity of leadthrough of differential diagnostics with in a number of nosology forms, including with the cavernous form of peripheral cancer of lungs. The features of flow of roentgenologic picture of tumoroidea variant are resulted, alike symptoms, differ ences and signs which allow to set a correct diagnosis, are resulted, the value of follow-up of roent genologic research and use of computed tomography is underlined.

  8. Oral angioleiomyoma: a case report and considerations on differential diagnosis

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Galvão Barboza

    2013-12-01

    Full Text Available Angioleiomyomas are benign mesenchymal tumors derived from smooth muscle, which rarely occur in the oral cavity. We report a case of an angioleiomyoma occurring in the maxillary gingiva. The lesion was painless, with a lobulated surface, fibrous in consistency, and firm upon palpation. Microscopic examination showed an encapsulated tumor mass composed of large vascular channels of varying calibers, surrounded by thick walls of irregularly arranged, spindle-shaped cells, which were immunopositive for smooth-muscle actin. It is sometimes difficult to differentiate an angioleiomyoma from other spindle-cell tumors, thus we emphasize its histological differential diagnosis.

  9. Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years After Initial Diagnosis.

    Science.gov (United States)

    Gillberg, I Carina; Helles, Adam; Billstedt, Eva; Gillberg, Christopher

    2016-01-01

    We examined comorbid psychiatric and neurodevelopmental disorders in fifty adult males (mean age 30 years) with Asperger syndrome (AS) diagnosed in childhood and followed up prospectively for almost two decades (13-26 years). Only three of the 50 men had never met criteria for an additional psychiatric/neurodevelopmental diagnosis and more than half had ongoing comorbidity (most commonly either ADHD or depression or both). Any psychiatric comorbidity increased the risk of poorer outcome. The minority of the AS group who no longer met criteria for a full diagnosis of an autism spectrum disorder were usually free of current psychiatric comorbidity. The high rate of psychiatric/neurodevelopmental comorbidities underscores the need for a full psychiatric/neurodevelopmental assessment at follow-up of males with AS.

  10. Diagnosis and Treatment of Odontogenic Cutaneous Sinus Tracts in an 11-Year-Old Boy

    OpenAIRE

    Chen, Ke; Liang, Yun; Xiong, Huacui

    2016-01-01

    Abstract Odontogenic cutaneous sinus tracts (OCSTs) are generally primarily misdiagnosed and inappropriately treated by virtue of their rarity and the absence of dental symptoms. Accurate diagnosis and treatment and the elimination of the source of infection can reduce the incidence of complications and relieve the pain of the patient. In this case report, we present the case of an 11-year-old patient with an apparent abscess but an unobvious draining sinus tract in his left cheek. Intraorall...

  11. Infective endocarditis: the specific features of its course, the criteria for diagnosis, differential diagnosis (part II

    Directory of Open Access Journals (Sweden)

    B S Belov

    2008-01-01

    Full Text Available Infective endocarditis (IE is today characterized by polyetiology due to a wide range of pathogens. The paper describes the specific features of the clinical picture of the disease in relation to the etiological agent, which have, in some cases, a crucial role in the choice of empiric antibiotic therapy. Significant clinical polymorphism, obscure symptoms, and monosyndromic onset as guises all enhance the importance of the differential diagnosis of IE, at its early stages in particular. Basic approaches to differentiating IE from the diseases in which differentially diagnostic problems arise to the utmost are outlined.

  12. Pathology and differential diagnosis of chronic, noninfectious gastritis.

    Science.gov (United States)

    Polydorides, Alexandros D

    2014-03-01

    The histologic finding of chronic inflammation in an endoscopic mucosal biopsy of the stomach (chronic gastritis) is very common and usually reflects the presence of Helicobacter pylori infection. However, infectious organisms are not always present in biopsy material, and some cases of chronic gastritis do not result from H. pylori infection. Thus, the differential diagnosis of this finding is an important one for pathologists to keep in mind. This review presents the three most common and clinically significant causes of chronic, noninfectious gastritis, namely, autoimmune atrophic gastritis, lymphocytic gastritis, and gastric involvement in the setting of inflammatory bowel disease, especially Crohn disease. For each entity, a brief discussion of its etiology and pathogenesis, a review of the clinical and endoscopic features, and a description of the microscopic findings are presented in the context of the differential diagnosis of chronic gastritis with emphasis on helpful histopathologic hints and long-term sequelae. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Clinical predictors and differential diagnosis of posterior reversible encephalopathy syndrome

    OpenAIRE

    della Faille, Laetitia; Fieuws, Steffen; Van Paesschen, W.

    2017-01-01

    The aim of our study is to determine the clinical predictors and the differential diagnosis of posterior reversible encephalopathy syndrome (PRES) in patients presenting with acute neurological symptoms and risk factors for PRES. Using the diagnostic algorithm for PRES from Fugate and Rabinstein (Lancet Neurol 14(9):914-925, 1), we carried out a retrospective study on 220 patients, presenting with acute neurological symptoms such as seizures, encephalopathy, headache, visual disturbances or o...

  14. Clinical predictors and differential diagnosis of posterior reversible encephalopathy syndrome

    OpenAIRE

    Faille, Laetitia della; Fieuws, S.; Van Paesschen, W.

    2017-01-01

    The aim of our study is to determine the clinical predictors and the differential diagnosis of posterior reversible encephalopathy syndrome (PRES) in patients presenting with acute neurological symptoms and risk factors for PRES. Using the diagnostic algorithm for PRES from Fugate and Rabinstein (Lancet Neurol 14(9):914?925, 1), we carried out a retrospective study on 220 patients, presenting with acute neurological symptoms such as seizures, encephalopathy, headache, visual disturbances or o...

  15. Significance of MRI in diagnosis and differential diagnosis of Parkinson's disease.

    Science.gov (United States)

    Mahlknecht, Philipp; Hotter, Anna; Hussl, Anna; Esterhammer, Regina; Schocke, Michael; Seppi, Klaus

    2010-01-01

    The differential diagnosis of parkinsonian syndromes is considered one of the most challenging in neurology, even for movement disorder specialists. Despite published consensus operational criteria for the diagnosis of Parkinson's disease (PD) and the various atypical parkinsonian disorders (APDs) such as progressive supranuclear palsy, multiple system atrophy, and corticobasal syndrome, the clinical separation of APDs from PD carries a high rate of misdiagnosis. However, an early differentiation between APD and PD, each characterized by a largely different natural history, is crucial for determining the prognosis and choosing a treatment strategy. Despite limitations, the different modern magnetic resonance (MR) techniques have undoubtedly added to the differential diagnosis of neurodegenerative parkinsonism. Conventional MRI with visual assessment of T(2)- and T(1)-weighted imaging as well as various advanced MRI techniques offer objective measures and may therefore be useful tools in the diagnostic workup of PD and APDs. In clinical practice, conventional MRI is a well-established method for the exclusion of symptomatic parkinsonism due to other pathologies such as tumors, cerebral ischemia or inflammatory diseases. Furthermore, over the past two decades, advances in MR techniques have enabled to quantitatively illustrate abnormalities in the basal ganglia and infratentorial structures in APDs by methods such as magnetic resonance volumetry, diffusion-weighted imaging, magnetization transfer imaging and proton magnetic resonance spectroscopy. This article aims to review research findings on the value of MRI techniques in the differential diagnosis of neurodegenerative parkinsonian disorders. Copyright 2010 S. Karger AG, Basel.

  16. Nasal rhinosporidiosis: differential diagnosis of fungal sinusitis and inverted papilloma

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    Crosara, Paulo Fernando Tormin Borges

    2009-03-01

    Full Text Available Introduction: Clinical case report of rhinosporidiosis, a rare and chronic granulomatous disease, caused by Rhinosporidium seeberi. Objective: To include this disease in the differential diagnoses of polypoid lesions of the nasal mass. Report: A male patient from the North of Brazil evolved a three-year papilomatous polypoid lesion of the left nasal cavity. He was submitted to sinusectomy with resection of the entire lesion, located in ethmoid bulla and uncinated process. Inverted papilloma or fungal sinusitis were differential diagnoses. The histopathological examination revealed a strong infestation by numerous fungal structures with sporangia shape full of sporangiospores. The microorganisms were positive for colorations of Grocott, PAS and Mayer's Mucicarmin; opposite from Coccidioides immitis, which presents no contrast by the mucicarmin. We didn't choose complimentary treatment and after one year of follow-up he presents with no sign of recurrence. Final Comments: Rhinosporidiosis must be considered to be a nasal polypoid lesion differential diagnosis. In the intranasal lesions diagnosis we should keep in mind the patient's origin. The anatomopathological study is mandatory to set the diagnosis. In the rhinosporidiosis, the surgical exeresis can be a curative treatment.

  17. Differential diagnosis of granulomatous lung disease: clues and pitfalls

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    Shinichiro Ohshimo

    2017-09-01

    Full Text Available Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis. Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis.

  18. Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

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    Michelle Nigri Levitan

    2013-12-01

    Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

  19. Diagnosis and Treatment of Odontogenic Cutaneous Sinus Tracts in an 11-Year-Old Boy

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    Chen, Ke; Liang, Yun; Xiong, Huacui

    2016-01-01

    Abstract Odontogenic cutaneous sinus tracts (OCSTs) are generally primarily misdiagnosed and inappropriately treated by virtue of their rarity and the absence of dental symptoms. Accurate diagnosis and treatment and the elimination of the source of infection can reduce the incidence of complications and relieve the pain of the patient. In this case report, we present the case of an 11-year-old patient with an apparent abscess but an unobvious draining sinus tract in his left cheek. Intraorally, a glass-ionomer-cement filling on the occlusal surface of the left mandibular first molar (tooth 36) was noted. Radiographic examination revealed a radiopaque mass inside the crown and pulp chamber and an irregular, radiolucent periapical lesion surrounding the distal root apex. He was diagnosed with an OCTS secondary to a periapical abscess of tooth 36. Precise root canal therapy (RCT) and chronic granuloma debridement was performed; 6 months later, the abscess and sinus had healed completely, and the periapical lesion had resolved. Odontogenic cutaneous sinus tracts are uncommon in the clinic. This case report reminds us of the significance of OCSTs and provides some implications for their diagnosis and treatment. PMID:27196471

  20. Differential diagnosis of middle ear inflammatory diseases by MRI findings

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    Muneta, Yuki; Yamamoto, Etsuo; Ohmura, Masaki; Mizukami, Chikashi; Oiki, Hiroyuki; Tsuji, Jun; Tanabe, Makito; Funabiki, Kazuo; Saiwai, Shigeo (Kobe City General Hospital (Japan))

    1992-09-01

    Although computed tomography can reveal a soft tissue mass in middle ear diseases as an area of increased density, it cannot differentiate cholesteatoma from other inflammatory tissue. We prospectively studied 30 patients with various middle ear inflammatory diseases, including inflammatory granulation tissue, cholesteatoma and cholesterin granuloma with magnetic resonance imaging (MRI) with or without Gd-DTPA enhancement. Cholesteatoma and inflammatory granulation tissue showed intensity ranging from low to high on T1-weighted images and from high to very high on T2-weighted images. However, cholesteatoma showed either no enhancement or ring enhancement on MR imagings with Gd-DTPA, and it could be differentiated from the Gd-DTPA-enhanced inflammatory granulation tissue. Cholesterin granuloma showed very high intensity on both T1 and T2-weighted images. Therefore, MRI with Gd-DTPA is considered to be useful in the differential diagnosis of these middle ear diseases. (auhtor).

  1. The investigation and differential diagnosis of Asperger syndrome in adults.

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    Lehnhardt, Fritz-Georg; Gawronski, Astrid; Pfeiffer, Kathleen; Kockler, Hanna; Schilbach, Leonhard; Vogeley, Kai

    2013-11-08

    As a result of the increased public interest in autism spectrum disorders (ASD), certain core manifestations of ASD--impaired social interaction and communication, bizarre interests--are now commonly recognized as being typical of autism, not only in children, but in adults as well. More often than before, general practitioners, neurologists, and psychiatrists find themselves being asked whether a patient is suffering from previously unrecognized Asperger syndrome (AS). The prevalence of ASD is estimated at 1%, and the ratio of diagnosed to undiagnosed cases at about 3:2. Little is known about the diagnostic evaluation of AS in adulthood. We selectively searched the Medline database for pertinent literature, paying special attention to diagnostic manuals and to the guideline of the United Kingdom's National Institute for Health and Care Excellence (NICE). Centrally important aspects of the diagnosis of AS include an assessment of the patient's ability to assume the emotional perspectives of others, non-verbal modes of expression, repetitive behavior patterns, and childhood social behavioral history. The autism quotient (AQ) is now established as a simple but nonspecific screening test. Up to 70% of all affected adults have comorbid disturbances, most often depression and anxiety disorders. The differential diagnosis includes personality disorders, anxiety disorders, obsessive-compulsive disorder, and attention deficit-hyperactivity disorder. The diagnostic assessment should proceed in stepwise fashion, starting from simple screening in primary care and then moving on to evaluation of the suspected diagnosis by a mental health care specialist, followed by extensive further investigation in an outpatient clinic specifically devoted to patients with autism spectrum disorders. The diagnostic assessment of autism in adults requires knowledge of the core and accompanying manifestations of autism and of their differential diagnoses. More research is needed for the

  2. Liver biopsy interpretation in the differential diagnosis of autoimmune liver disease in children

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    Clara Gerosa

    2013-06-01

    Full Text Available Autoimmune liver disease  (AILD represents a group of complex inflammatory liver diseases, all characterized by an aberrant autoreactivity against hepatocytes and/or biliary structures. AILD may be subclassified into four major diseases: autoimmune hepatitis (AIH, primary biliary cirrhosis (PBC, primary sclerosing cholangitis (PSC, and autoimmune cholangitis (AIC. Recently a new entity frequently associated with autoimmune pancreatitis and defined IgG4-related cholangitis (IgG4-RC,  has been added to the spectrum of AILD. The most frequent autoimmune liver diseases  of the AILD spectrum occurring in children and in young adults are  AIH  and PSC, overlap syndrome between AIH and PSC, also defined as autoimmune sclerosing cholangitis (ASC, representing a frequent finding in pediatric patients. Here,  the morphological findings that may help liver pathologists in the differential diagnosis of AILD in pediatric patients are reviewed, underlying the frequency in liver biopsy interpretation of complex cases in which a precise diagnosis may remain controversial, due to overlap of hepatocytic and bile duct cell lesions. Among the multiple morphological changes typical of AILD,  the detection of an high number of plasma cell clusters in the portal and periportal regions is generally considered one of the main clue for the diagnosis of AIH. The recent report in a 13-year old  boy of IgG4-associated cholangitis, induces  pathologists when detecting a huge number of plasmacells, to consider the differential diagnosis between AIH and IgG4-RC.Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research

  3. Meckel Syndrome: Genetics, Perinatal Findings, and Differential Diagnosis

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    Chih-Ping Chen

    2007-03-01

    Full Text Available Meckel syndrome (MKS is a lethal, autosomal recessive disorder characterized by occipital encephalocele, bilateral renal cystic dysplasia, hepatic ductal proliferation, fibrosis and cysts, and polydactyly. Genetic heterogeneity of MKS has been established by three reported MKS loci, i.e., MKS1 on 17q23, MKS2 on 11q13, and MKS3 on 8q21.13-q22.1. MKS1 encodes a component of flagellar apparatus basal body proteome, which is associated with ciliary function. MKS3 encodes a seven-transmembrane receptor protein, meckelin. The identification of the MKS3 gene as well as the MKS1 gene enables molecular genetic testing for at-risk families, and allows accurate genetic counseling, carrier testing, and prenatal diagnosis. Pregnancies with MKS fetuses may be associated with an elevated maternal serum α-fetoprotein level and an abnormal screening result in the second-trimester maternal serum screening test. The classic MKS triad of occipital encephalocele, postaxial polydactyly, and bilateral enlarged multicystic kidneys can be diagnosed before the 14th gestational weeks by ultrasonography. However, later in pregnancy, severe oligohydramnios may make the diagnosis of polydactyly and encephalocele difficult. Differential diagnosis for MKS includes autosomal recessive polycystic kidney disease, trisomy 13, Smith-Lemli-Opitz syndrome, hydrolethalus syndrome, Senior-Loken syndrome, Joubert syndrome, Bardet-Biedl syndrome, and oral-facial-digital syndrome type 1. This article provides an overview of genetics, perinatal findings, and differential diagnosis of MKS. The ciliopathy underlies the pathogenesis of MKS. Prenatal diagnosis of bilateral enlarged multicystic kidneys should alert MKS and prompt a thorough investigation of central nervous system malformations and polydactyly.

  4. The reversed halo sign: update and differential diagnosis

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    Godoy, M C B; Viswanathan, C; Marchiori, E; Truong, M T; Benveniste, M F; Rossi, S; Marom, E M

    2012-01-01

    The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air–space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population. PMID:22553298

  5. Allergic rhinoconjunctivitis and differential diagnosis of the red eye.

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    Granet, David

    2008-01-01

    Red eye is a common presentation in clinical practice with conjunctivitis being the most common cause of red eye. Most commonly, conjunctivitis is infective (bacterial and viral) or allergic in origin although other forms of conjunctivitis including toxic and irritative conjunctivitis and conjunctivitis related to systemic conditions or dry eye are prevalent enough to warrant consideration in diagnosis. This article aims to provide a guide for generalists and allergists in the differential diagnosis of conjunctivitis allowing the inclusion of eye treatment into their current practice. With a discussion of important aspects to include in the patient history as well as a systematic guide to examination of the eye for generalists and allergists, this article provides a "plan of action" in the examination protocol for red eye patients. A differential diagnosis table and flowchart are provided as a useful chair-side reference for practitioners. With a particular focus on the more prevalent types of conjunctivitis, typical features, signs, and symptoms of each type are detailed. A general discussion of prognosis and treatment options and conditions that require ophthalmologic referral is included.

  6. Prenatal Diagnosis, Fetal Surgery, Recurrence Risk and Differential Diagnosis of Neural Tube Defects

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    Chih-Ping Chen

    2008-09-01

    Full Text Available Prenatal screening with α-fetoprotein (AFP and ultrasonography have allowed the prenatal diagnosis of neural tube defects (NTDs in current obstetric care, and open spina bifida has been considered a potential candidate for in utero treatment in modern pediatric surgery. This article provides an overview of maternal serum AFP screening, amniotic fluid AFP assays, amniotic fluid acetylcholinesterase immunoassays and level II ultrasound for NTDs, prenatal repair of fetal myelomeningocele, recurrence risk of NTDs, and differential diagnosis of NTDs on prenatal ultrasound.

  7. Boys Will Be Boys.

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    Broude, Gwen J.

    1999-01-01

    Many psychologists assert that boys are in dire straits in U.S. society, but in fact, there is no evidence of an emotional or behavioral epidemic for either sex. If there is any truth to the claim that boys are in trouble, it results from practices that foster aggression. It is a mistake to regard either gender as "fragile." (SLD)

  8. Differential Diagnosis of Parotid Lipoma in a Breast Ca Patient

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    Melda Misirlioglu

    2017-01-01

    Full Text Available Lipomas are common benign tumors usually detected on the torso, neck, upper thighs, and upper arms. However, they are rarely found in the parotid gland region. Because of their rarity at this site, they are not often considered in the differential diagnosis of parotid tumors. This report describes a rare case of a lipoma in the superficial lobe of parotid gland. A 71-year-old female patient admitted to our department complaining about swelling and pain in the posterior area of the left mandibular region since one month. Her medical history included mastectomy after breast CA fifteen years ago. Clinical examination revealed a smooth-surfaced, soft, and painful mass, with well-defined margins in the left mandibular region. Differential diagnosis of metastasis, inflammatory neck swellings, and benign salivary gland tumors were considered for the patient. Advanced imaging methods such as ultrasonography and contrast tomography revealed that the lesion was a lipoma of parotid gland. A surgical intervention under general anesthesia was planned for the removal of the mass; however patient refused the surgical treatment. Patient was placed on six-month periodic recall. This article reviews the radiographic appearance and differential diagnoses of lipoma in this rare location.

  9. RLS, PLM, and their differential diagnosis--a video guide.

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    Högl, Birgit; Zucconi, Marco; Provini, Federica

    2007-01-01

    This video guide has been designed as an introduction to the full spectrum of nocturnal presentations of restless legs syndrome (RLS) and periodic limb movements (PLM), and to their differential diagnoses. The DVD consists of four sections: In the first part, clinical presentations of RLS are covered (videos 1-3). In the second part, the variety of typical and less frequent presentations of PLM are demonstrated (videos 4-14). The third part shows the clinical presentation of augmentation (videos 15-19). The last section is dedicated to the differential diagnosis of RLS and PLM and demonstrates nocturnal manifestations of other motor disorders during sleep, which must be distinguished: Epilepsy, parasomnias, and other movement disorders (of sleep) (videos 20-33). After viewing this DVD, the reader should be able to: (1) appreciate the spectrum of voluntary and unvoluntary movements seen in patients with RLS during wakefulness; (2) recognize typical PLM during sleep in subjects with RLS, and appreciate the enormous variability of clinical presentations of PLM; (3) describe specific and distinct aspects of motor activity in augmentation in patients with RLS; and (4) be aware of the most important differential diagnosis of RLS/PLM from a video or nocturnal motor activity point of view, namely, nocturnal epilepsy, parasomnias, and others.

  10. Automatic Differential Diagnosis of Melanocytic Skin Tumors Using Ultrasound Data.

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    Andrėkutė, Kristina; Linkevičiūtė, Gintarė; Raišutis, Renaldas; Valiukevičienė, Skaidra; Makštienė, Jurgita

    2016-12-01

    We describe a novel automatic diagnostic system based on quantitative analysis of ultrasound data for differential diagnosis of melanocytic skin tumors. The proposed method has been tested on 160 ultrasound data sets (80 of malignant melanoma and 80 of benign melanocytic nevi). Acoustical, textural and shape features have been evaluated for each segmented lesion. Using parameters selected according to Mahalanobis distance and linear support vector machine classifier, we are able to differentiate malignant melanoma from benign melanocytic skin tumors with 82.4% accuracy (sensitivity = 85.8%, specificity = 79.6%). The results indicate that high-frequency ultrasound has the potential to be used for differential diagnosis of melanocytic skin tumors and to provide supplementary information on lesion penetration depth. The proposed system can be used as an additional tool for clinical decision support to improve the early-stage detection of malignant melanoma. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  11. Metabolic connectivity for differential diagnosis of dementing disorders.

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    Titov, Dmitry; Diehl-Schmid, Janine; Shi, Kuangyu; Perneczky, Robert; Zou, Na; Grimmer, Timo; Li, Jing; Drzezga, Alexander; Yakushev, Igor

    2017-01-01

    Presently, visual and quantitative approaches for image-supported diagnosis of dementing disorders rely on regional intensity rather than on connectivity measurements. Here, we test metabolic connectivity for differentiation between Alzheimer's disease and frontotemporal lobar degeneration. Positron emission tomography with 18F-fluorodeoxyglucose was conducted in 47 patients with mild Alzheimer's disease, 52 patients with mild frontotemporal lobar degeneration, and 45 healthy elderly subjects. Sparse inverse covariance estimation and selection were used to identify patterns of metabolic, inter-subject covariance on the basis of 60 regional values. Relative to healthy subjects, significantly more pathological within-lobe connections were found in the parietal lobe of patients with Alzheimer's disease, and in the frontal and temporal lobes of subjects with frontotemporal lobar degeneration. Relative to the frontotemporal lobar degeneration group, more pathological connections between the parietal and temporal lobe were found in the Alzheimer's disease group. The obtained connectivity patterns differentiated between two patients groups with an overall accuracy of 83%. Linear discriminant analysis and univariate methods provided an accuracy of 74% and 69%, respectively. There are characteristic patterns of abnormal metabolic connectivity in mild Alzheimer's disease and frontotemporal lobar degeneration. Such patterns can be utilized for single-subject analyses and might be more accurate in the differential diagnosis of dementing disorders than traditional intensity-based analyses. © The Author(s) 2015.

  12. Antenatal Hydronephrosis: Differential Diagnosis, Evaluation, and Treatment Options

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    C.D. Anthony Herndon

    2006-01-01

    Full Text Available 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.

  13. Gastric schwannoma as a rare differential diagnosis of pleural effusion.

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    Janowitz, P; Meier, F; Reisig, J

    2002-11-01

    We report a case of solitary gastric schwannoma that initially manifested with recurrent left pleural effusion caused by an inflammatory reaction. A 75-year-old female was primarily admitted with progressive dyspnoea and left sided effusion. History as well as clinical examination, gastroscopy, computed tomography (CT) and transabdominal ultrasound of the abdomen suggested the diagnosis of a benign tumour of the stomach. The tumour was resected and a fundectomy with a security distance of 3-5 cm performed. Histological assessment revealed a large intramural schwannoma of the gastric wall, arising from the submucosal layer. There was no evidence of malignancy. During a three year follow-up the patient has not shown any evidence of relapse or pleural effusion. This is a very rare manifestation of this benign tumour, representing a rare differential diagnosis in a case of left sided pleural effusion.

  14. Differential diagnosis of dental fluorosis made by undergraduate dental students.

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    Rigo, Lilian; Lodi, Leodinei; Garbin, Raíssa Rigo

    2015-01-01

    To check knowledge of undergraduate dental students to make diagnosis of dental fluorosis with varying degrees of severity and choose its appropriate treatment. Data were collected using a semi-structured questionnaire addressing knowledge of undergraduates based on ten images of mouths presenting enamel changes. Only three images were correctly diagnosed by most undergraduates; the major difficulty was in establishing dental fluorosis severity degree. Despite much information about fluorosis conveyed during the Dentistry training, as defined in the course syllabus, a significant part of the students was not able to differentiate it from other lesions; they did not demonstrate expertise as to defining severity of fluorosis and indications for treatment, and could not make the correct diagnosis of enamel surface changes.

  15. Arteriovenous malformations in the differential diagnosis of palatal swellings

    Science.gov (United States)

    Ozden, Bora; Bas, Burcu; Duran, Hatice; Celenk, Peruze; Gunhan, Omer

    2016-01-01

    An arteriovenous malformation (AVM) is composed of abnormal communications between arteries and veins without the normal intervening capillary bed. AVM of the head and neck is a rare vascular anomaly. We present here an unusual case of AVM with the size of 4x3 cm at the left posterior palatal area. Incisionel biopsy revealed AVM. Resection of the lesion following angiography was suggested to the patient however, he refused the treatment. The patient was considered to be under control. AVM should always be kept in mind in the differential diagnosis of palatal swellings. PMID:28955556

  16. Costal chondrosarcoma requiring differential diagnosis from metastatic tumor.

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    Matsuoka, Katsunari; Ueda, Mitsuhiro; Miyamoto, Yoshihiro

    2017-02-01

    Although chondrosarcoma is a common malignant bone tumor, cases arising in the rib are relatively rare. We experienced a case of chondrosarcoma arising in the right 10th rib during follow-up after lung cancer surgery. Although the finding of an osteolytic mass suggested a metastatic bone tumor, 18F-fluorodeoxyglucose positron-emission tomography demonstrated low fluorodeoxyglucose uptake, and a primary bone tumor was suspected. The bone tumor was resected and diagnosed as chondrosarcoma. Four years after resection, there has been no recurrence or metastasis. Positron-emission tomography was useful for differential diagnosis between a chondrosarcoma and a metastatic bone tumor.

  17. [Diagnosis and differential diagnosis of cerebro-vascular malformations by CT (author's transl)].

    Science.gov (United States)

    Schumacher, M; Stoeter, P; Voigt, K

    1980-03-01

    In 38 patients, the diagnosis of a cerebrovascular malformation (17 arteriovenous agniomas including one low-flow- and two venous angiomas; 10 aneurysms; 4 arteriovenous fistulae of the cavernous sinus, the tentorium and one of the Great Vein of Galen; 6 megadolical basilar arteries) was initially made by computertomographic (CT) examination, including contrast enhancement. The characteristic and pathognomonic CT findings are described and compared with those of cerebral angiography also done in these cases. The problems of differential diagnosis and the reasons for a false CT diagnosis in 5 other patients with a cerebro-vascular malformation are investigated; and the diagnostic value of cerebral angiography and CT is discussed and their complementary functions are being pointed out.

  18. Multivariable Discriminant Analysis for the Differential Diagnosis of Microcytic Anemia

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    Eloísa Urrechaga

    2013-01-01

    Full Text Available Introduction. Iron deficiency anemia and thalassemia are the most common causes of microcytic anemia. Powerful statistical computer programming enables sensitive discriminant analyses to aid in the diagnosis. We aimed at investigating the performance of the multiple discriminant analysis (MDA to the differential diagnosis of microcytic anemia. Methods. The training group was composed of 200 β-thalassemia carriers, 65 α-thalassemia carriers, 170 iron deficiency anemia (IDA, and 45 mixed cases of thalassemia and acute phase response or iron deficiency. A set of potential predictor parameters that could detect differences among groups were selected: Red Blood Cells (RBC, hemoglobin (Hb, mean cell volume (MCV, mean cell hemoglobin (MCH, and RBC distribution width (RDW. The functions obtained with MDA analysis were applied to a set of 628 consecutive patients with microcytic anemia. Results. For classifying patients into two groups (genetic anemia and acquired anemia, only one function was needed; 87.9% β-thalassemia carriers, and 83.3% α-thalassemia carriers, and 72.1% in the mixed group were correctly classified. Conclusion. Linear discriminant functions based on hemogram data can aid in differentiating between IDA and thalassemia, so samples can be efficiently selected for further analysis to confirm the presence of genetic anemia.

  19. Clinical presentation of inappropriate sinus tachycardia and differential diagnosis.

    Science.gov (United States)

    Peyrol, Michael; Lévy, Samuel

    2016-06-01

    Inappropriate sinus tachycardia (IST) is a syndrome characterized by a sinus tachycardia not related to a medical condition, to a physiological response, or to medication or drugs and associated with symptoms, often invalidating and altering the quality of life of affected patients. It occurs predominantly in adolescents and young adults, and in the female sex. The diagnosis requires a complete work-up in order to exclude other causes of sinus tachycardia and one or several additional tests: 24-h ECG ambulatory recordings, echocardiogram, exercise testing, and autonomous nervous system assessment. It should be differentiated from the postural orthostatic tachycardia syndrome, with which it shares a number of symptoms, and other supraventricular tachycardias originating in the high right atrium. An electrophysiological study should be considered in selected cases in order to differentiate IST from other supraventricular tachycardias. The mechanism is still unclear, and possible etiologies may include intrinsic abnormality of the sinus node, autonomic dysfunction, hypersensitivity of the sinus node to catecholamines, blunted vagal system, or a combination of the above. The authors emphasize the wide spectrum of clinical presentations and the need to better define the IST and the criteria required to ascertain its diagnosis.

  20. Differential diagnosis of malignant ovarian tumors on CT findings

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    Kim, Young Chae; Yoon, Myung Hwan; Yang, Dal Mo; Chung, Hyo Sun; Kim, Hyung Sik; Song, Ik Hyun; Chung, Yoon Ho; Lee, Young Suk [Chungang Gil Hospital, Inchon (Korea, Republic of)

    1996-07-01

    To assess the value of CT for the differential diagnosis of malignant ovarian tumors. We reviewed CT scans of 31 patients with surgically confirmed 46 malignant ovarian tumors. (29 epithelial tumors, 9 Krukenberg tumors, 6 germ cell tumors, and 2 sex cord-stromal tumors.) CT scans were evaluated for the mass (bilaterality, size, internal component, and margin), peritoneal spread pattern, ascites, invasion of adjacent organ, and lymphadenopathy. Bilateral masses were seen in epithelial or Krukenberg tumor in 61.1%(11/18) and 80%(4/5) respectively. Epithelial tumors showed predominantly cystic mass(37.9%, 11/29), irregular margin(82.8%, 24/29) of mass, and accompanying peritoneal and omental spread (66.7%, 12/18), while Krukenberg tumor showed predominantly solid mass(55.5%, 5/9), smooth margin of mass(100%, 5/5), and no peritoneal and omental spread. All cases with germ cell tumor or sex cord-stromal tumor showed unilateral mass. Relatively young aged, unilateral solid (66.7%, 4/6) tumors were germ cell tumor. Of these cases, septa within solid portion of mass were prominent in all dysgerminoma. (3/3) CT may be a valuable tool for the differential diagnosis of malignant ovarian tumors.

  1. Differential diagnosis of vertigo and dizziness in the emergency department.

    Science.gov (United States)

    Ozono, Yoshiyuki; Kitahara, Tadashi; Fukushima, Munehisa; Michiba, Takahiro; Imai, Ryusuke; Tomiyama, Youichirou; Nishiike, Suetaka; Inohara, Hidenori; Morita, Hisaki

    2014-02-01

    To establish a system of differential diagnosis for vertigo/dizziness at the Emergency Department (ED), careful history-taking of complications and examinations of nystagmus should be helpful and therefore prepared by ED staff. Vertigo/dizziness could come from various kinds of organs for equilibrium, sometimes resulting in an emergency due to the central origin. In the present study, we checked patients' background data at the ED in advance of a definitive diagnosis at the Department of Otolaryngology and examined the significance of the correlation between the data and the diagnosis. We studied a series of 120 patients with vertigo/dizziness, who visited the Departments of Emergency and Otolaryngology between April 2011 and March 2012. At the ED, we first checked patients' backgrounds and carried out neurologic and neuro-otologic examinations. At the Department of Otolaryngology, we finally diagnosed all the patients according to the criteria and classified the origins of vertigo/dizziness into central and non-central diseases. The ratio of patients with disease of central origin was 12.5% and that for non-central origin was 87.5%. The risk factors for cerebrovascular disease such as hypertension, heart disease, and diabetes were also the risk factors for central vertigo/dizziness by the chi-squared test. To predict a central origin for vertigo/dizziness, only gaze nystagmus was the significant factor by multivariate regression analysis.

  2. Neuropsychological differential diagnosis of mild traumatic brain injury.

    Science.gov (United States)

    Larrabee, Glenn J; Rohling, Martin L

    2013-01-01

    The diagnosis and evaluation of mild traumatic brain injury (mTBI) is reviewed from the perspective of meta-analyses of neuropsychological outcome, showing full recovery from a single, uncomplicated mTBI by 90 days post-trauma. Persons with history of complicated mTBI characterized by day-of-injury computed tomography or magnetic resonance imaging abnormalities, and those who have suffered prior mTBIs may or may not show evidence of complete recovery similar to that experienced by persons suffering a single, uncomplicated mTBI. Persistent post-concussion syndrome (PCS) is considered as a somatoform presentation, influenced by the non-specificity of PCS symptoms which commonly occur in non-TBI samples and co-vary as a function of general life stress, and psychological factors including symptom expectation, depression and anxiety. A model is presented for forensic evaluation of the individual mTBI case, which involves open-ended interview, followed by structured interview, record review, and detailed neuropsychological testing. Differential diagnosis includes consideration of other neurologic and psychiatric disorders, symptom expectation, diagnosis threat, developmental disorders, and malingering. Copyright © 2013 John Wiley & Sons, Ltd.

  3. Clinical predictors and differential diagnosis of posterior reversible encephalopathy syndrome.

    Science.gov (United States)

    Faille, Laetitia Della; Fieuws, S; Van Paesschen, W

    2017-06-01

    The aim of our study is to determine the clinical predictors and the differential diagnosis of posterior reversible encephalopathy syndrome (PRES) in patients presenting with acute neurological symptoms and risk factors for PRES. Using the diagnostic algorithm for PRES from Fugate and Rabinstein (Lancet Neurol 14(9):914-925, 1), we carried out a retrospective study on 220 patients, presenting with acute neurological symptoms such as seizures, encephalopathy, headache, visual disturbances or other focal neurological signs that appear in the clinical setting of risk factors such as hypertension/blood pressure fluctuations, chemotherapy, renal failure, autoimmune disorders, or eclampsia, in whom imaging of the brain was performed to exclude PRES. Seventeen percent of patients had a radiologically confirmed diagnosis of PRES. Univariable logistic regression showed a significant association between PRES and epileptic seizures, encephalopathy, hypertension, chemotherapy and renal failure. Multivariable logistic regression of acute neurological symptoms and risk factors showed a significant association of epileptic seizures, encephalopathy, visual disturbances, hypertension and chemotherapy with PRES. Using these variables to predict PRES yielded a discriminative ability (AUC) equal to 0.793. Diagnoses when PRES was not confirmed included primary or secondary headaches (26%), toxic-metabolic encephalopathy (21%), vascular pathology (12%) and other less frequent disorders. Epileptic seizures, encephalopathy, visual disturbances, hypertension, renal failure and chemotherapy were the best clinical predictors of PRES, while headache, immune suppression and autoimmune disease were not useful for the clinical diagnosis of PRES in our study.

  4. Digital imaging in differential diagnosis of small choroidal melanoma.

    Science.gov (United States)

    Saari, Jukka M; Kivelä, Tero; Summanen, Paula; Nummelin, Kari; Saari, K Matti

    2006-12-01

    To assess the role of digital imaging and a new subtraction method for differential diagnosis of choroidal nevus and small choroidal melanoma. Of 241 consecutive patients referred to a tertiary referral center for suspected choroidal melanoma, 110 who underwent digital imaging of the ocular fundus were eligible for this study. Digital color, red-free and red light retinal images were evaluated in a randomized and masked manner and by the subtraction method for diagnosis of the fundus lesion. The reference standard was based on the combined results of ophthalmological examination, including mydriatic ophthalmoscopy, B scan ultrasonography, digital imaging and fluorescein angiography of the ocular fundus. Comparative use of digital color, red-free and red light imaging had 85.7% (95%CI 42.1-99.6) sensitivity, 99.0% (95%CI 94.7-99.9) specificity and 98.2% (95%CI 93.6-99.8) exact agreement versus reference standard in differentiation of small choroidal melanoma from pseudomelanoma. Direct comparison between use of digital images and the reference standard showed excellent agreement in detecting small choroidal melanoma from suspected choroidal lesions (K 0.847; 95%CI 0.639-1.0). The subtraction method was useful to show growth in four of 94 melanocytic choroidal tumors. The mean annual incidence of choroidal melanoma in Southwest Finland was 0.80 per 100.000 population. The most frequent choroidal pseudomelanomas were choroidal melanotic and amelanotic nevi, disciform lesions, congenital hypertrophy of the retinal pigment epithelium, and circumscribed choroidal hemangioma. Combined use of digital color, red-free and red light imaging was a suitable adjunct in differentiation of small choroidal melanoma from different pseudomelanomas. The subtraction method may reveal early growth of the melanotic choroidal tumors.

  5. The sedimentation sign for differential diagnosis of lumbar spinal stenosis.

    Science.gov (United States)

    Macedo, Luciana Gazzi; Wang, Yue; Battié, Michele C

    2013-05-01

    Cross-sectional cohort study. To evaluate the diagnostic value of the sedimentation sign further by assessing its performance on the differential diagnosis of patients with lumbar spinal stenosis (LSS) and other lumbar conditions with similar clinical presentations. Recently, a new test using MR imaging, the sedimentation sign, was introduced to aid in the diagnosis of LSS. The initial testing demonstrated that the sign was positive in 100% of patients with LSS with decreased walking ability and dural sac cross-sectional areas (CSA) less than 80 mm, and negative in 94% of patients with nonspecific low back pain, no leg pain or claudication and dural sac CSA greater than 120 mm. Fifty patients with central or combined LSS, 22 with lateral stenosis only and 43 with posterolateral disc herniation with unilateral radiculopathy were included. Using axial MR images of the lumbar spine, the sedimentation sign was assessed by 2 observers independently, without knowledge of participant clinical history or diagnosis. Frequencies of a positive sign in each patient group were calculated. The sedimentation sign was positive in 2% of patients with disc herniation, 23% with lateral stenosis, and 54% with central or combined stenosis. When the analysis included only patients with LSS with dural sac CSA less than 80 mm and walking limitations similar to the original study introducing the sedimentation sign (n = 17), the proportion of patients presenting with a positive sign increased to 82%. The sedimentation sign is more prevalent in patients with the clinical diagnosis of central or combined LSS than in patients with lateral stenosis only or posterolateral disc herniation. Yet, whether it enhances current diagnostic practices remains undetermined.

  6. Screening for Differentially Expressed Proteins Relevant to the Differential Diagnosis of Sarcoidosis and Tuberculosis.

    Directory of Open Access Journals (Sweden)

    Shan-Shan Du

    Full Text Available In this study, we sought to identify differentially expressed proteins in the serum of patients with sarcoidosis or tuberculosis and to evaluate these proteins as markers for the differential diagnosis of sarcoidosis and sputum-negative tuberculosis.Using protein microarrays, we identified 3 proteins exhibiting differential expression between patients with sarcoidosis and tuberculosis. Elevated expression of these proteins was verified using the enzyme-linked immunosorbent assay (ELISA and was further confirmed by immunohistochemistry. Receiver operating characteristic (ROC curve, logistic regression analysis, parallel, and serial tests were used to evaluate the diagnostic efficacy of the proteins.Intercellular Adhesion Molecule 1(ICAM-1 and leptin were screened for differentially expressed proteins relevant to sarcoidosis and tuberculosis. Using ROC curves, we found that ICAM-1 (cutoff value: 57740 pg/mL had an area under the curve (AUC, sensitivity, and specificity of 0.718, 62.3%, and 79.5% respectively, while leptin (cutoff value: 1193.186 pg/mL had an AUC, sensitivity, and specificity of 0.763, 88.3%, and 65.8%, respectively. Logistic regression analysis revealed that the AUC, sensitivity, and specificity of combined leptin and ICAM-1 were 0.787, 89.6%, and 65.8%, respectively, while those of combined leptin, ICAM-1, and body mass index (BMI were 0.837, 90.9%, and 64.4%, respectively, which had the greatest diagnostic value. Parallel and serial tests indicated that the BMI-leptin parallel with the ICAM-1 serial was the best diagnostic method, achieving a sensitivity and specificity of 86.5% and 73.1%, respectively. Thus, our results identified elevated expression of ICAM-1 and leptin in serum and granulomas of sarcoidosis patients.ICAM-1 and leptin were found to be potential markers for the diagnosis of sarcoidosis and differential diagnosis of sarcoidosis and sputum-negative tuberculosis.

  7. [The "athlete's heart": structure, function and differential diagnosis].

    Science.gov (United States)

    Carro, Amelia; Carro, Fernando; del Valle, Miguel Enrique

    2011-10-22

    Long-term, intense sport activity induces morphologic and functional adaptations on cardiovascular system. The magnitude of these changes is determined by various factors, creating a specific condition: the "Athlete's Heart" (AH). It is important to distinguish this entity from other cardiomyopathies, taking into account that the differential diagnosis can be challenging. There has been an increase in the number of people practicing sports, which goes in parallel with the increase in the prevalence of AH. However, the proportion of asymptomatic subjects affected by cardiovascular diseases taking part on competitive sports, is also growing. We revise the main characteristics of AH, as well as the key points to distinguish AH from pathologic conditions. A delicate characterization as AH or cardiomyopathy would help to settle appropriate measures to lower the risk of sports-related sudden cardiac death. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  8. [Tuberculosis in the otorhinolaryngologic area. A still current differential diagnosis].

    Science.gov (United States)

    Schneider, W; Wolf, S R; Solbach, W

    1993-12-01

    Between 1986 and 1992 18 cases of tuberculosis of the cervical lymph nodes, the larynx, the middle ear, or the paranasal sinuses were diagnosed at the ENT clinic of the University of Erlangen-Nuremberg. A rare case of tuberculous infection of both the maxillary and ethmoidal sinuses and the pharyngeal tonsil is presented. All patients with involvement of the upper respiratory tract had concomitant productive pulmonary tuberculosis, whereas in tuberculous cervical lymphadenitis and otitis media the disease was regularly limited to the neck and the ear respectively. Preoperative microbiological testing pointed to a tuberculous origin in only 3 of the 18 patients, so that histological and microbiological examination of excision biopsy specimens was the most reliable test. As there was no apparent decrease in incidence over the 7 years, we conclude that tuberculosis remains an important differential diagnosis in ENT.

  9. Differential diagnosis and management of liver tumors in infants

    Science.gov (United States)

    Fernandez-Pineda, Israel; Cabello-Laureano, Rosa

    2014-01-01

    During the first year of life, most of the liver neoplasms are benign in origin, but some of these histologically benign lesions may be challenging in their management. Although most hepatic hemangiomas can be safely observed until involution is documented, some patients will need treatment due to progressive hepatomegaly, hypothyroidism and/or cardiac failure. Large mesenchymal hamartomas may require extensive hepatic resection and an appropriate surgical plan is critical to obtain good results. For malignant neoplasms such as hepatoblastoma, complete surgical resection is the mainstay of curative therapy. The decision about whether to perform an upfront or delayed resection of a primary liver malignant tumor is based on many considerations, including the ease of resection, surgical expertise, tumor histology and stage, and the likely chemosensitivity of the tumor. This article reviews the initial management of the more common hepatic tumors of infancy, focusing on the differential diagnosis and treatment options. PMID:25068000

  10. Mixed periapical lesion: differential diagnosis of a case.

    Science.gov (United States)

    Krithika, C; Kota, S; Gopal, K S; Koteeswaran, D

    2011-03-01

    A radicular cyst associated with carious teeth is a very common odontogenic lesion in the oral cavity, but calcifications in residual radicular cysts are quite rare. We report one such case where a routine pre-implant radiographic assessment revealed a mixed periapical radiopaque radiolucent lesion in the right maxillary central incisor region. Histological and radiographic studies show that there is a slow increase in the mineralized deposits within the cyst lumen with time. This becomes prominent histochemically in cysts more than 8 years old and radiographically 6 years later, as seen in our case. In this paper we would like to highlight the importance of a residual radicular cyst with calcifications in the differential diagnosis of a mixed periapical radiopaque radiolucent lesion.

  11. Olfactory Reference Syndrome: Diagnostic Criteria and Differential Diagnosis

    Directory of Open Access Journals (Sweden)

    Lochner C

    2003-01-01

    Full Text Available Olfactory reference syndrome (ORS has been defined as a psychiatric condition characterized by persistent preoccupation about body odour accompanied by shame, embarrassment, significant distress, avoidance behaviour and social isolation. ORS has however not been included in the Diagnostic and Statistical Manual of Mental Disorders (4th edition (DSM-IV and, given that its primary symptoms may be found in various other disorders, differential diagnosis can be problematic. Using an illustrative case of ORS, we propose diagnostic criteria for ORS. We also argue that ORS represents a unique cluster of symptoms that can be delineated as a separate diagnostic entity, and that ORS falls on a spectrum of social anxiety disorders that includes social anxiety disorder, taijin kyofusho, and body dysmorphic disorder.

  12. Persistent severe hypokalemia: Gitelman syndrome and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Christine Zomer Dal Molin

    Full Text Available Abstract The main causes of hypokalemia are usually evident in the clinical history of patients, with previous episodes of vomiting, diarrhea or diuretic use. However, in some patients the cause of hypokalemia can become a challenge. In such cases, two major components of the investigation must be performed: assessment of urinary excretion potassium and the acid-base status. This article presents a case report of a patient with severe persistent hypokalemia, complementary laboratory tests indicated that's it was hypomagnesaemia and hypocalciuria associated with metabolic alkalosis, and increase of thyroid hormones. Thyrotoxic periodic paralysis was included in the differential diagnosis, but evolved into euthyroid state, persisting with severe hypokalemia, which led to be diagnosed as Gitelman syndrome.

  13. Radiological diagnosis and differential diagnosis of headache; Radiologische Diagnostik und Differenzialdiagnostik bei Kopfschmerzen im Erwachsenenalter

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    Langner, S.; Kirsch, M. [University Medicine Greifswald (Germany). Inst. for Diagnostic Radiology and Neuroradiology

    2015-10-15

    Headache is very common and affects almost everyone at some point. It is one of the most common disorders that leads patients to see their physician. All different forms have the nociception via trigeminal nerve fibers in common. Beside the clinical course headaches are classified as either primary or secondary, with the latter having an identifiable structural or biochemical cause. Imaging has a low diagnostic yield in primary headache but play an important role in the differential diagnosis of secondary forms. An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome.

  14. Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

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    Henninger, B.; Glodny, B.; Rudisch, A.; Trieb, T.; Loizides, A.; Judmaier, W.; Schocke, M.F. [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Putzer, D. [Innsbruck Medical University, Department of Nuclear Medicine, Innsbruck (Austria)

    2013-08-15

    To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis. We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test. The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis. A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis. (orig.)

  15. [Differential diagnosis of Dandy-Walker syndrome different presentations].

    Science.gov (United States)

    Tobías-González, Pablo; Gil Mira, Mar; Valero de Bernabé, Javier; Zapardiel, Ignacio

    2012-08-01

    Dandy-Walker syndrome is a set of abnormalities of the posterior fossa including three modalities: classic Dandy-Walker malformation, Dandy-Walker variant and mega-cisterna magna. Our objective is clarify the differential diagnosis among these entities. Descriptive and retrospective study of Dandy-Walker cases diagnosed at our Department during the last five years plus a review of the related Medical literature. Three cases of Dandy-Walker modalities are reported: one case of classic Dandy-Walker malformation, one case of Dandy-Walker variant, and one case of false Dandy-Walker. In the first two cases the patients underwent legal abortion, whereas in the last one a healthy male newborn was delivered in the week 38 of gestation. Malformations in the posterior fossa, including Dandy-Walker syndrome, are still a challenge in prenatal diagnosis. Technical developments in imaging, such as in three-dimensional sonography and magnetic resonance, allow higher resolution and multiplanar images for an easier diagnose. There is a high rate of false positive, particularly before the 18th week of gestation. It is advisable not to establish a final diagnose before that week.

  16. [Camptocormia in the differential diagnosis of hyperkyphosis and ankylosing spondylitis].

    Science.gov (United States)

    Sarholz, M; Vorgerd, M; Braun, J

    2012-09-01

    An 83-year-old patient with Parkinson's disease was referred because of pain in the thoracolumbar spine, increasing kyphosis and gait disturbance. Clinically, the main anomaly was a marked hyperkyphosis of the spine during standing and sitting which regressed while recumbent. Radiologically, spondylosis, osteochondrosis, and facet joint arthrosis demonstrated marked degeneration of the spine (diffuse skeletal hyperostosis, DISH). But the postural disorder could not adequately be explained by these pathological changes. The sacroiliac joints were age-appropriate, syndesmophytes or ankylosis typically of AS were not detectable. A diagnosis of camptocormia in connection with the known Parkinson's disease was made together with the neurologist. Intensive physio- and balneotherapy, the administration of non-steroidal anti-inflammatory drugs (NSAIDs) and an intensification of the Parkinson medication led to a slight improvement of gait disturbance and pain, but not of the tendency to hyperkyphosis. In the differential diagnosis of postural disorders in spinal diseases, especially in case of hyperkyphosis, camptocormia is of importance as a rare manifestation of different diseases, such as Parkinson's disease. The treatment of camptocormia is difficult and usually not satisfactory. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Restless legs syndrome: differential diagnosis and management with rotigotine

    Directory of Open Access Journals (Sweden)

    Giovanni Merlino

    2009-01-01

    Full Text Available Giovanni Merlino1,3, Anna Serafini1, Francesca Robiony2, Mariarosaria Valente1,3, Gian Luigi Gigli1,31Sleep Disorder Center, Neurology and Clinical Neurophysiology; 2Pharmacy Unit, Santa Maria della Misericordia University Hospital, Udine, Italy; 3DPMSC, University of Udine, ItalyAbstract: RLS is a common sleep disorder with distinctive clinical features. The prevalence of RLS in Caucasians and North Americans ranges from 5% to 10%. However, only some of these subjects (almost the 3% of the general population report being affected by a frequent and severe form of the sleep disorder. RLS is diagnosed clinically by means of four internationally recognized criteria that summarize the main characteristics of the sleep disorder. Besides the essential criteria, supportive and associated features of RLS have been established by experts in order to help physicians treat patients with doubtful symptoms. Several clinical conditions may mimic this sleep disorder. In order to increase the sensibility and specificity of RLS diagnosis, doctors should perform a meticulous patient history and then an accurate physical and neurological examination. Dopamine agonists are recognized as the preferred first-line treatment for RLS. Rotigotine is a non-ergoline dopamine agonist with selectivity for D1, D2 and D3 receptors. The drug is administered via transdermal patches which release rotigotine for 24 hours. Four clinical trials demonstrated that this compound is able to improve RLS symptomatology with few and moderate adverse events. Head to head trials are required to compare the efficacy and tolerability of rotigotine with other dopamine agonists administered via oral intake. Rotigotine has been approved by the FDA and EMEA for Parkinson’s disease. For the treatment of moderate to severe idiopathic RLS, rotigotine has been recommended for approval by the EMEA and is under review by the FDA.Keywords: restless legs syndrome, diagnosis, differential diagnosis

  18. Differential diagnosis of breast lesions using ultrasound elastography

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    Ioana Andreea Gheonea

    2011-01-01

    Full Text Available Context: The recent introduction of elastography has increased the specificity of USG and enabled early diagnosis of breast cancer. Quantitative elastography, especially with strain ratio (SR index, improves diagnostic accuracy and decreased number of biopsies. Aims: The purpose of this study was to assess the role of USG elastography in the differential diagnosis of breast lesions. Settings and Design: This prospective study was conducted in the University of Medicine and Pharmacy Research Centre of Craiova. Materials and Methods: Fifty-eight patients diagnosed with breast lesions between January 2009 and January 2010 were included in this prospective study. All the patients were examined in the supine position, and the B-mode USG image was displayed alongside the elastography strain image. For obtaining the elastography images we used a EUS Hitachi EUB 8500 ultrasound system with a 6.5-MHz linear probe. The elastography strain images were scored according to the Tsukuba elasticity score. Statistical Analysis: We performed receiver operator characteristic (ROC analysis for assessment of the role of USG elastography in the diagnosis of breast lesions. Results: We obtained a sensitivity of 86.7% and a specificity of 92.9% for elasticity score and a sensitivity of 93.3% and a specificity of 92.9% for SR (when a cutoff point of 3.67 was used. There was very good correlation between SR and elasticity score (Spearman coefficient of 0.911. Conclusions: Elastography is a fast, simple method that can complement conventional USG examination. This method has the lowest cost/efficiency ratio and it is also the most noninvasive and accessible imaging method, with an accuracy comparable to MRI.

  19. Gender stereotype endorsement differentially predicts girls' and boys' trait-state discrepancy in math anxiety.

    Science.gov (United States)

    Bieg, Madeleine; Goetz, Thomas; Wolter, Ilka; Hall, Nathan C

    2015-01-01

    Mathematics is associated with anxiety for many students; an emotion linked to lower well-being and poorer learning outcomes. While findings typically show females to report higher trait math anxiety than males, no gender differences have to date been found in state (i.e., momentary) math anxiety. The present diary study aimed to replicate previous findings in investigating whether levels of academic self-concept was related to this discrepancy in trait vs. state anxiety measures. Additionally, mathematics-related gender stereotype endorsement (mathematics is a male domain) was investigated as an additional predictor of the trait-state discrepancy. The sample included 755 German 9th and 10th graders who completed self-report measures of trait math anxiety, math self-concept, and gender stereotype endorsement, in addition to state measures of anxiety after math classes by use of a standardized diary for 2-3 weeks (N within = 6207). As expected, females reported higher trait math anxiety but no gender differences were found for state math anxiety. Also in line with our assumptions, multilevel analyses showed the discrepancy between trait and state anxiety to be negatively related to students' self-concept (i.e., a lower discrepancy for students with higher self-concepts). Furthermore, gender stereotype endorsement differentially predicted the trait-state discrepancy: When controlling for self-concept in mathematics, females who endorsed the gender stereotype of math being a male domain more strongly overestimated their trait math anxiety as compared to their state anxiety whereas this effect was not significant for males. The present findings suggest that gender stereotype endorsement plays an important role in explaining gender differences in math anxiety above and beyond academic self-concept. Implications for future research and educational practice are discussed.

  20. Gender stereotype endorsement differentially predicts girls' and boys' trait-state discrepancy in math anxiety

    Directory of Open Access Journals (Sweden)

    Madeleine eBieg

    2015-09-01

    Full Text Available Mathematics is associated with anxiety for many students; an emotion linked to lower well-being and poorer learning outcomes. While findings typically show females to report higher trait math anxiety than males, no gender differences have to date been found in state (i.e., momentary math anxiety. The present diary study aimed to replicate previous findings in investigating whether levels of academic self-concept was related to this discrepancy in trait versus state anxiety measures. Additionally, mathematics-related gender stereotype endorsement (mathematics is a male domain was investigated as an additional predictor of the trait-state discrepancy. The sample included 755 German 9th and 10th graders who completed self-report measures of trait math anxiety, math self-concept, and gender stereotype endorsement, in addition to state measures of anxiety after math classes by use of a standardized diary for 2-3 weeks (Nwithin = 6207. As expected, females reported higher trait math anxiety but no gender differences were found for state math anxiety. Also in line with our assumptions, multilevel analyses showed the discrepancy between trait and state anxiety to be negatively related to students’ self-concept (i.e., a lower discrepancy for students with higher self-concepts. Furthermore, gender stereotype endorsement differentially predicted the trait-state discrepancy: When controlling for self-concept in mathematics, females who endorsed the gender stereotype of math being a male domain more strongly overestimated their trait math anxiety as compared to their state anxiety whereas this effect was not significant for males. The present findings suggest that gender stereotype endorsement plays an important role in explaining gender differences in math anxiety above and beyond academic self-concept. Implications for future research and educational practice are discussed.

  1. Gender stereotype endorsement differentially predicts girls' and boys' trait-state discrepancy in math anxiety

    Science.gov (United States)

    Bieg, Madeleine; Goetz, Thomas; Wolter, Ilka; Hall, Nathan C.

    2015-01-01

    Mathematics is associated with anxiety for many students; an emotion linked to lower well-being and poorer learning outcomes. While findings typically show females to report higher trait math anxiety than males, no gender differences have to date been found in state (i.e., momentary) math anxiety. The present diary study aimed to replicate previous findings in investigating whether levels of academic self-concept was related to this discrepancy in trait vs. state anxiety measures. Additionally, mathematics-related gender stereotype endorsement (mathematics is a male domain) was investigated as an additional predictor of the trait-state discrepancy. The sample included 755 German 9th and 10th graders who completed self-report measures of trait math anxiety, math self-concept, and gender stereotype endorsement, in addition to state measures of anxiety after math classes by use of a standardized diary for 2–3 weeks (Nwithin = 6207). As expected, females reported higher trait math anxiety but no gender differences were found for state math anxiety. Also in line with our assumptions, multilevel analyses showed the discrepancy between trait and state anxiety to be negatively related to students' self-concept (i.e., a lower discrepancy for students with higher self-concepts). Furthermore, gender stereotype endorsement differentially predicted the trait-state discrepancy: When controlling for self-concept in mathematics, females who endorsed the gender stereotype of math being a male domain more strongly overestimated their trait math anxiety as compared to their state anxiety whereas this effect was not significant for males. The present findings suggest that gender stereotype endorsement plays an important role in explaining gender differences in math anxiety above and beyond academic self-concept. Implications for future research and educational practice are discussed. PMID:26441778

  2. Differential diagnosis of pleural mesothelioma using Logic Learning Machine.

    Science.gov (United States)

    Parodi, Stefano; Filiberti, Rosa; Marroni, Paola; Libener, Roberta; Ivaldi, Giovanni Paolo; Mussap, Michele; Ferrari, Enrico; Manneschi, Chiara; Montani, Erika; Muselli, Marco

    2015-01-01

    Tumour markers are standard tools for the differential diagnosis of cancer. However, the occurrence of nonspecific symptoms and different malignancies involving the same cancer site may lead to a high proportion of misclassifications. Classification accuracy can be improved by combining information from different markers using standard data mining techniques, like Decision Tree (DT), Artificial Neural Network (ANN), and k-Nearest Neighbour (KNN) classifier. Unfortunately, each method suffers from some unavoidable limitations. DT, in general, tends to show a low classification performance, whereas ANN and KNN produce a "black-box" classification that does not provide biological information useful for clinical purposes. Logic Learning Machine (LLM) is an innovative method of supervised data analysis capable of building classifiers described by a set of intelligible rules including simple conditions in their antecedent part. It is essentially an efficient implementation of the Switching Neural Network model and reaches excellent classification accuracy while keeping low the computational demand. LLM was applied to data from a consecutive cohort of 169 patients admitted for diagnosis to two pulmonary departments in Northern Italy from 2009 to 2011. Patients included 52 malignant pleural mesotheliomas (MPM), 62 pleural metastases (MTX) from other tumours and 55 benign diseases (BD) associated with pleurisies. Concentration of three tumour markers (CEA, CYFRA 21-1 and SMRP) was measured in the pleural fluid of each patient and a cytological examination was also carried out. The performance of LLM and that of three competing methods (DT, KNN and ANN) was assessed by leave-one-out cross-validation. LLM outperformed all other considered methods. Global accuracy was 77.5% for LLM, 72.8% for DT, 54.4% for KNN, and 63.9% for ANN, respectively. In more details, LLM correctly classified 79% of MPM, 66% of MTX and 89% of BD. The corresponding figures for DT were: MPM = 83%, MTX

  3. Prenatal Diagnosis of Cloacal Exstrophy: A Case Report and Differential Diagnosis with a Simple Omphalocele

    Directory of Open Access Journals (Sweden)

    Ching-Yu Chou

    2015-03-01

    Full Text Available Cloacal exstrophy is a rare congenital disorder that may lead to mortality and morbidity. Although the prenatal diagnosis of cloacal exstrophy can be made by a midtrimester ultrasound, it is difficult to differentiate it from a simple omphalocele that can be corrected completely by surgery without morbidity. We reported a case with cloacal exstrophy and reviewed previous literature on differentiating it from an omphalocele. A 33-year-old, pregnant female visited our outpatient center for prenatal care at the 22nd gestational week. The midtrimester ultrasound showed fetal anomalies including a protruding mass from umbilicus, absence of bladder, ambiguous genitalia, and bilateral renal hydronephrosis. The parents received prenatal genetic counseling and decided to continue the pregnancy. A female baby was delivered at the 37th gestational week via vaginal delivery, and cloacal exstrophy without omphalocele was diagnosed. Cloacal exstrophy is a complicated congenital disorder that should be differentiated from a simple omphalocele. Prenatal counseling and postnatal care in a tertiary medical center are important for parents and the fetus, respectively.

  4. Elastofibroma dorsi – differential diagnosis in chest wall tumours

    Directory of Open Access Journals (Sweden)

    Steinau Hans-Ulrich

    2007-02-01

    Full Text Available Abstract Background Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue. Methods We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months. Results The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse. Conclusion In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients.

  5. Chronic Lyme Disease and Co-infections: Differential Diagnosis

    Science.gov (United States)

    Berghoff, Walter

    2012-01-01

    In Lyme disease concurrent infections frequently occur. The clinical and pathological impact of co-infections was first recognized in the 1990th, i.e. approximately ten years after the discovery of Lyme disease. Their pathological synergism can exacerbate Lyme disease or induce similar disease manifestations. Co-infecting agents can be transmitted together with Borrelia burgdorferi by tick bite resulting in multiple infections but a fraction of co-infections occur independently of tick bite. Clinically relevant co-infections are caused by Bartonella species, Yersinia enterocolitica, Chlamydophila pneumoniae, Chlamydia trachomatis, and Mycoplasma pneumoniae. In contrast to the USA, human granulocytic anaplasmosis (HGA) and babesiosis are not of major importance in Europe. Infections caused by these pathogens in patients not infected by Borrelia burgdorferi can result in clinical symptoms similar to those occurring in Lyme disease. This applies particularly to infections caused by Bartonella henselae, Yersinia enterocolitica, and Mycoplasma pneumoniae. Chlamydia trachomatis primarily causes polyarthritis. Chlamydophila pneumoniae not only causes arthritis but also affects the nervous system and the heart, which renders the differential diagnosis difficult. The diagnosis is even more complex when co-infections occur in association with Lyme disease. Treatment recommendations are based on individual expert opinions. In antibiotic therapy, the use of third generation cephalosporins should only be considered in cases of Lyme disease. The same applies to carbapenems, which however are used occasionally in infections caused by Yersinia enterocolitica. For the remaining infections predominantly tetracyclines and macrolides are used. Quinolones are for alternative treatment, particularly gemifloxacin. For Bartonella henselae, Chlamydia trachomatis, and Chlamydophila pneumoniae the combination with rifampicin is recommended. Erythromycin is the drug of choice for

  6. Fabry disease - underestimated in the differential diagnosis of multiple sclerosis?

    Science.gov (United States)

    Böttcher, Tobias; Rolfs, Arndt; Tanislav, Christian; Bitsch, Andreas; Köhler, Wolfgang; Gaedeke, Jens; Giese, Anne-Katrin; Kolodny, Edwin H; Duning, Thomas

    2013-01-01

    Fabry disease is a rare X-linked inherited lysosomal storage disorder affecting multiple organ systems. It includes central nervous system involvement via micro- and macroangiopathic cerebral changes. Due to its clinical symptoms and frequent MRI lesions, Fabry disease is commonly misdiagnosed as multiple sclerosis. We present an overview of cases from Fabry centres in Germany initially misdiagnosed with multiple sclerosis and report the clinical, MR-tomographical, and laboratory findings. Eleven Fabry patients (one male, ten females) initially diagnosed with multiple sclerosis were identified from 187 patient records (5.9%) and analyzed for presenting symptoms, results of the initial diagnostic workup, and the clinical course of the disease. Four patients were identified as having a "possible" history of MS, and 7 patients as "definite" cases of multiple sclerosis (revised McDonald criteria). On average, Fabry disease was diagnosed 8.2 years (±9.8 years) after the MS diagnosis, and 12.8 years after onset of first symptoms (±10.3 years). All patients revealed white matter lesions on MRI. The lesion pattern and results of cerebrospinal fluid examination were inconsistent and non-specific. White matter lesion volumes ranged from 8.9 mL to 34.8 mL (mean 17.8 mL±11.4 mL). There was no association between extra-neurological manifestations or enzyme activity and lesion load. There are several anamnestic and clinical hints indicating when Fabry disease should be considered a relevant differential diagnosis of multiple sclerosis, e.g. female patients with asymmetric, confluent white matter lesions on MRI, normal spinal MR imaging, ectatic vertebrobasilar arteries, proteinuria, or lack of intrathecally derived immunoglobulin synthesis.

  7. Fabry disease - underestimated in the differential diagnosis of multiple sclerosis?

    Directory of Open Access Journals (Sweden)

    Tobias Böttcher

    Full Text Available OBJECTIVE: Fabry disease is a rare X-linked inherited lysosomal storage disorder affecting multiple organ systems. It includes central nervous system involvement via micro- and macroangiopathic cerebral changes. Due to its clinical symptoms and frequent MRI lesions, Fabry disease is commonly misdiagnosed as multiple sclerosis. We present an overview of cases from Fabry centres in Germany initially misdiagnosed with multiple sclerosis and report the clinical, MR-tomographical, and laboratory findings. METHODS: Eleven Fabry patients (one male, ten females initially diagnosed with multiple sclerosis were identified from 187 patient records (5.9% and analyzed for presenting symptoms, results of the initial diagnostic workup, and the clinical course of the disease. RESULTS: Four patients were identified as having a "possible" history of MS, and 7 patients as "definite" cases of multiple sclerosis (revised McDonald criteria. On average, Fabry disease was diagnosed 8.2 years (±9.8 years after the MS diagnosis, and 12.8 years after onset of first symptoms (±10.3 years. All patients revealed white matter lesions on MRI. The lesion pattern and results of cerebrospinal fluid examination were inconsistent and non-specific. White matter lesion volumes ranged from 8.9 mL to 34.8 mL (mean 17.8 mL±11.4 mL. There was no association between extra-neurological manifestations or enzyme activity and lesion load. CONCLUSION: There are several anamnestic and clinical hints indicating when Fabry disease should be considered a relevant differential diagnosis of multiple sclerosis, e.g. female patients with asymmetric, confluent white matter lesions on MRI, normal spinal MR imaging, ectatic vertebrobasilar arteries, proteinuria, or lack of intrathecally derived immunoglobulin synthesis.

  8. Restless legs syndrome: differential diagnosis and management with pramipexole

    Directory of Open Access Journals (Sweden)

    Francesca Brindani

    2009-06-01

    Full Text Available Francesca Brindani, Francesca Vitetta, Franco GemignaniDepartment of Neurosciences, University of Parma, ItalyAbstract: Restless legs syndrome (RLS is a condition characterized by discomfort at rest and urge to move focused on the legs. RLS may occur as an idiopathic, often hereditary condition (primary RLS, or in association with medical conditions (secondary RLS including iron deficiency, uremia, and polyneuropathy. Current understanding of the pathophysiology of RLS points to the involvement of three interrelated components: dopaminergic dysfunction, impaired iron homeostasis, and genetic mechanisms. The diagnosis of RLS is made according to the consensus criteria by a National Institutes of Health panel: 1 an urge to move the legs, usually accompanied by uncomfortable sensations; 2 beginning or worsening during rest; 3 relieved by movement; and 4 worse, or only occurring, in the evening or at night. The differential diagnosis of RLS aims to: 1 distinguish RLS from other disorders with RLS-like symptoms and 2 identify secondary forms, with investigation of underlying diseases. The treatment of RLS demands a clinical evaluation to rule out and cure causes of secondary RLS, including iron supplementation when deficient, and to eliminate the triggering factors. The presence of neuropathy should be especially investigated in nonhereditary, late-onset RLS, in view of a possible treatment of the underlying disease. The first line treatment for idiopathic RLS is represented by dopamine agonists, in particular nonergot-derived ropinirole and pramipexole, whereas ergot dopamine agonists (cabergoline and pergolide are no longer in first-line use given the risks of cardiac valvulopathy. Although no comparative trials have been published, a meta-analysis of pramipexole versus ropinirole suggests differences in efficacy and tolerability favoring pramipexole.Keywords: restless legs syndrome, pramipexole, dopamine, agonists, small fiber neuropathy

  9. Differential diagnosis of bipolar disorder and major depressive disorder.

    Science.gov (United States)

    Hirschfeld, R M

    2014-12-01

    Patients with bipolar disorder spend approximately half of their lives symptomatic and the majority of that time suffering from symptoms of depression, which complicates the accurate diagnosis of bipolar disorder. Challenges in the differential diagnosis of bipolar disorder and major depressive disorder are reviewed, and the clinical utility of several screening instruments is evaluated. The estimated lifetime prevalence of major depressive disorder (i.e., unipolar depression) is over 3 and one-half times that of bipolar spectrum disorders. The clinical presentation of a major depressive episode in a bipolar disorder patient does not differ substantially from that of a patient with major depressive disorder (unipolar depression). Therefore, it is not surprising that without proper screening and comprehensive evaluation many patients with bipolar disorder may be misdiagnosed with major depressive disorder (unipolar depression). In general, antidepressants have demonstrated little or no efficacy for depressive episodes associated with bipolar disorder, and treatment guidelines recommend using antidepressants only as an adjunct to mood stabilizers for patients with bipolar disorder. Thus, correct identification of bipolar disorder among patients who present with depression is critical for providing appropriate treatment and improving patient outcomes. Clinical characteristics indicative of bipolar disorder versus major depressive disorder identified in this review are based on group differences and may not apply to each individual patient. The overview of demographic and clinical characteristics provided by this review may help medical professionals distinguish between major depressive disorder and bipolar disorder. Several validated, easily administered screening instruments are available and can greatly improve the recognition of bipolar disorder in patients with depression. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. The differential diagnosis of anxiety. Psychiatric and medical disorders.

    Science.gov (United States)

    Cameron, O G

    1985-03-01

    This article has reviewed clinical and demographic features of the primary anxiety disorders and other psychiatric and medical disorders that often are associated with anxiety symptoms, highlighting differential diagnosis. In summary, phobic disorders (exogenous anxiety) are characterized by anxiety reliably elicited by specific environmental stimuli; the stimuli involved determine which type of phobia is diagnosed. In contrast, panic attacks and generalized anxiety (endogenous anxiety) involve symptoms of anxiety not associated only with specific eliciting stimuli. Panic disorder is differentiated from generalized anxiety disorder by the presence of discrete attacks; both disorders usually have some level of persistent anxiety. Obsessive-compulsive disorder is characterized by recurrent unwanted but irresistible thoughts and the ritualized repetitive acts resulting from these obsessions, in the absence of preexisting psychosis or depression. Finally, posttraumatic stress disorder involves various anxiety (and other) symptoms as a direct result of an obvious stressor. Depressive symptoms are frequently associated with anxiety. It is sometimes impossible to determine which is the primary disorder. Overlap of syndromes probably also occurs with other primary psychiatric disorders, especially somatoform disorders, adjustment disorder with anxious mood, and several personality disorders. Finally, primary anxiety can be confused with several medical syndromes, especially when the medical disorder has not been recognized. Nevertheless, research with patients with pheochromocytoma suggests that medical causes of anxiety may be qualitatively different from primary anxiety disorders, especially the psychic anxiety component. Attention to the clinical and demographic features listed in Table 4, as well as the use of newly-developed structured diagnostic interviews should usually lead to a correct diagnosis, as illustrated by the following examples. The onset of a fear of

  11. [The Gitelman syndrome--a differential diagnosis of Bartter syndrome].

    Science.gov (United States)

    Zimmermann, J; Reincke, M; Schramm, L; Harlos, J; Allolio, B

    1994-12-15

    Hypokalemia due to renal potassium wasting in the absence of hypertension, moderate metabolic alkalosis, hyperreninism and hyperaldosteronism suggest the presence of Bartter's syndrome. The underlying cause is an inherited defect of sodium chloride reabsorption in the thick ascending limb of Henle. A differential diagnosis of Bartter's syndrome is Gitelman's syndrome, another hypokalemia-hypomagnesemia syndrome, which is thought to be caused by a transport defect in the distal tube. We report 3 patients presenting with signs primarily suggestive of Bartter's syndrome, who turned out to have Gitelman's syndrome after determining the excretion of calcium in the urine. Two women, 36- and 55-year old, suffered from paresthesias in the hands and feet and from tetanic convulsions. The brother of the 36-year old woman presented in our hospital because of an accidentally discovered hypokalemia without any clinical symptoms. In all patients the outstanding biochemical features were hypokalemia, hypomagnesemia and moderate metabolic alcalosis. The renin and aldosterone values were inappropriately high. The most characteristic finding in the urine, besides the presence of hyperkaliuria was the diminution of calcium excretion, despite normocalcemia. The association between sodium and calcium reabsorption in the loop of Henle predicts hypercalciuria in patients with a defect in salt reabsorption in this segment, as in Bartter's syndrome. In Gitelman's syndrome the laboratory features resemble the findings in Bartter's syndrome, except for the presence of hypocalciuria. Since hypocalciuria follows also the administration of thiazide diuretics, which act in the early part of distal tube, a transport defect in this part of the tube is thought to be responsible for the electrolyte disturbances in Gitelman's syndrome. The measurement of the urinary calcium excretion in patients with an unclear hypokalemia-hypomagnesemia-syndrome allows easily the differentiation between Bartter

  12. Using milk leukocyte differentials for diagnosis of subclinical bovine mastitis.

    Science.gov (United States)

    Gonçalves, Juliano Leonel; Lyman, Roberta L; Hockett, Mitchell; Rodriguez, Rudy; Dos Santos, Marcos Veiga; Anderson, Kevin L

    2017-08-01

    This research study aimed to evaluate the use of the milk leukocyte differential (MLD) to: (a) identify quarter milks that are culture-positive; and (b) characterize the milk leukocyte responses to specific groups of pathogens causing subclinical mastitis. The MLD measures the absolute number and relative percentage of inflammatory cells in milk samples. Using the MLD in two dairy herds (170 and 172 lactating cows, respectively), we studied all lactating cows with a most recent monthly Dairy Herd Improvement Association somatic cell count (SCC) >200 × 103 cells/ml. Quarter milk samples from 78 cows meeting study criteria were analysed by MLD and aseptically collected milk samples were subjected to microbiological culture (MC). Based upon automated instrument evaluation of the number and percentage of inflammatory cells in milk, samples were designated as either MLD-positive or - negative for subclinicial mastitis. Positive MC were obtained from 102/156 (65·4%) of MLD-positive milk samples, and 28/135 (20·7%) of MLD-negative milk samples were MC-positive. When MC was considered the gold standard for mastitis diagnosis, the calculated diagnostic Se of the MLD was 65·4% (IC95% = 57·4 to 72·8%) and the Sp was 79·3% (IC95% = 71·4 to 85·7%). Quarter milks positive on MC had higher absolute numbers of neutrophils, lymphocytes and macrophages, with higher neutrophils% and lymphocytes% but lower macrophages%. The Log10 (N/L) ratios were the most useful ratio to differentiate specific subclinical mastitis quarters from healthy quarters. Use of the MLD on cows with monthly composite SCC > 200 × 103 cells/ml for screening at quarter level identified quarters more likely to be culture-positive. In conclusion, the MLD can provide an analysis of mammary quarter status more detailed than provided by SCC alone; however, the MLD response to subclinical mastitis was not found useful to specifically identify the causative pathogen.

  13. Differential Fairness Decisions and Brain Responses after Expressed Emotions of Others in Boys with Autism Spectrum Disorders

    Science.gov (United States)

    Klapwijk, Eduard T.; Aghajani, Moji; Lelieveld, Gert-Jan; van Lang, Natasja D. J.; Popma, Arne; van der Wee, Nic J. A.; Colins, Olivier F.; Vermeiren, Robert R. J. M.

    2017-01-01

    Little is known about how emotions expressed by others influence social decisions and associated brain responses in autism spectrum disorders (ASD). We investigated the neural mechanisms underlying fairness decisions in response to explicitly expressed emotions of others in boys with ASD and typically developing (TD) boys. Participants with ASD…

  14. IMPORTANCE OF LIVER FUNCTION TESTS IN DIFFERENTIAL DIAGNOSIS OF JAUNDICE

    Directory of Open Access Journals (Sweden)

    Sandeep

    2015-11-01

    marked elevation in serum direct bilirubin along with marked elevated levels of Serum alkaline phosphatase. CONCLUSION: Liver function tests are used as a primary tool by the clinicians in differential diagnosis of a case of jaundice as they definitely give us a clue to reach to the root cause of jaundice.

  15. Mesenteric ischemia: the importance of differential diagnosis for the surgeon

    Science.gov (United States)

    2013-01-01

    Background Intestinal ischemia is an abdominal emergency that accounts for approximately 2% of gastrointestinal illnesses. It represents a complex of diseases caused by impaired blood perfusion to the small and/or large bowel including acute arterial mesenteric ischemia (AAMI), acute venous mesenteric ischemia (AVMI), non occlusive mesenteric ischemia (NOMI), ischemia/reperfusion injury (I/R), ischemic colitis (IC). In this study different study methods (US, CT) will be correlated in the detection of mesenteric ischemia imaging findings due to various etiologies. Methods Basing on our institutions experience, 163 cases of mesenteric ischemia/infarction from various cases, investigated with CT and undergone surgical treatment were retrospectively evaluated, in particular trought the following findings: presence/absence of arterial/venous obstruction, bowel wall thickness and enhancement, presence/absence of spastic reflex ileus, hypotonic reflex ileus or paralitic ileus, mural and/or portal/mesenteric pneumatosis, abdominal free fluid, parenchymal ischemia/infarction (liver, kidney, spleen). Results To make an early diagnosis useful to ensure a correct therapeutic approach, it is very important to differentiate between occlusive (arterial, venous) and non occlusive causes (NOMI). The typical findings of each forms of mesenteric ischemia are explained in the text. Conclusion The radiological findings of mesenteric ischemia have different course in case of different etiology. In venous etiology the progression of damage results faster than arterial even if the symptomatology is less acute; bowel wall thickening is an early finding and easy to detect, simplifying the diagnosis. In arterial etiology the damage progression is slower than in venous ischemia, bowel wall thinning is typical but difficult to recognize so diagnosis may be hard. In the NOMI before/without reperfusion the ischemic damage is similar to AAMI with additional involvement of large bowel

  16. Differential diagnosis of cervical malignant lymphadenopathy among Iranian patients.

    Science.gov (United States)

    Naeimi, Mohammad; Sharifi, Amin; Erfanian, Youssef; Velayati, Arash; Izadian, Shahla; Golparvar, Sadegh

    2009-03-01

    To investigate the differential diagnosis in cases referred with neck lumps suspicious to malignant nodal masses and its relation to demographic variants. Individuals who entered in this cross-sectional study conducted at the Department of Otolaryngology, Ghaem Medical Center, Mashdad, Iran from May 1995 to April 2005 were re-evaluated by history taking, physical examination and imaging studies. Fine needle aspiration was applied to obtain tissue sampling. Among the patients, 232 cases had malignant disease confirmed by pathology reports. Cases with unknown primary tumor underwent investigations including pan-endoscopy, and further imaging studies were carried out to determine the primary tumor site. Demographic data as gender, age, location, size, and pathology of tumor were considered. The results of this study showed that 50% of patients which were referred with neck masses had malignant neoplasm. The most common pathology in patients younger than 40 years were lymphoma (55%) and thyroid cancer (26%), whereas, in patients older than 40 years squamous cell carcinoma (67%) was more common. The most involved lymph nodes were jugulodigastric chain. Larynx and hypopharynx are the most common sources of aerodigestive tract metastatic. According to high incidence malignancy (50%) among neck lesions, an asymmetrical neck mass in adults should be considered malignant until proven otherwise. It seems that age is an important predictor of tumor pathology, and determination of further diagnostic investigations would be helpful.

  17. Hidradenitis suppurativa and perianal Crohn disease: differential diagnosis.

    Science.gov (United States)

    Bassas-Vila, J; González Lama, Y

    2016-09-01

    The first description of perianal fistulas and complications in Crohn disease was made 75 years ago by Penner and Crohn. Published studies have subsequently confirmed that perianal fistulas are the most common manifestations of fistulising Crohn disease. Hidradenitis suppurativa was described in 1854 by a French surgeon, Aristide Verneuil. It is a chronic, inflammatory, recurrent and debilitating disease of the pilosebaceous follicle, that usually manifests after puberty with deep, painful and inflamed lesions in the areas of the body with apocrine glands, usually the axillary, inguinal and anogenital regions. The differential diagnosis between hidradenitis suppurativa and Crohn disease can be challenging, especially when the disease is primarily perianal. When they occur simultaneously, hidradenitis suppurativa and Crohn disease show severe phenotypes and patients can respond to anti-tumour necrosis factor therapy, although adalimumab is currently the only treatment with demonstrated efficacy in hidradenitis suppurativa and Crohn disease. In addition, there is sometimes a need for different complementary surgical procedures. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  18. Serum Fragments of Tau for the Differential Diagnosis of Alzheimer's Disease

    DEFF Research Database (Denmark)

    Inekci, Dilek; Henriksen, K.; Linemann, T.

    2015-01-01

    Differential diagnosis of AD is still a challenge due to overlapping features with other types of dementia. Biomarkers for the differential diagnosis of AD can improve the diagnostic value of the disease and ensure an appropriate treatment of patients. The aim of this study was to evaluate...

  19. Understanding the Prcess of Differential Diagnosis: Prerequisite to the Training of Medical and Veterinary Medical Practitioners.

    Science.gov (United States)

    Wagner, Roy M. K.

    The paper describes an auto-tutorial methodology for training veterinary medical practitioners to perform differential diagnoses. It describes in detail the three phases of differential diagnosis: sensory pick-up, a combination of cognition and memory; categorization, the process by which diagnosticians group symptoms and signs prior to diagnosis;…

  20. Differential Relationships of Anxiety and Autism Symptoms on Social Skills in Young Boys With Fragile X Syndrome.

    Science.gov (United States)

    Reisinger, Debra L; Roberts, Jane E

    2017-09-01

    Social skills are critical for academic, social, and psychological success of children with both typical and atypical development. Boys with fragile X syndrome (FXS) are at high risk for social skill impairments, given intellectual impairments and secondary conditions. The present study examines the impact of adaptive behavior, autism symptoms, and anxiety symptoms to social skills at the composite and subdomain level in boys with FXS across age. This cross-sectional study included boys with FXS (3-14 years) contrasted to age-matched typical control boys. Results revealed that social skills are generally within developmental expectations, with adaptive behavior as the primary predictor. Anxiety and autism symptoms emerged as additive risk factors, particularly in the areas of responsibility and self-control.

  1. Differential diagnosis of myelodysplastic syndrome and aplastic anemia using MRI

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Eun; Park, Jung Mi; Lee, Jae Mun; Kim, Ki Tae; Kim, Dong Wook; Kim, Chun Choo; Kim, Chun Yul; Shinn, Kyung Sub [Catholic University Medical College, Seoul (Korea, Republic of)

    1995-04-15

    To assess the patterns of myelodysplastic syndrome (MDS) and aplastic anemia (AA) on MRI of the spinal bone marrow and to find the differential points between the two groups. Fourteen patients with MDS (n=7) and AA (n=7) were studied using magnetic resonance imaging. Sagittal images from the lower thoracic and lumbar vertebral marrow were evaluated on T1-weighted and STIR images. Five distinct patterns of signal intensity of the T1-weighted and STIR images were classified. T1 and T2 relaxation times and T1 marrow/fat signal intensity ratio were measured and analyzed (t-test). The cellularity of bone marrow was evaluated on histologic slides. MDS showed homogeneously low signal intensity on T1WI and high signal intensity on STIR image, indicating hypercellular marrow, whereas AA showed relative high signal intensity on T1WI and low signal intensity on STIR image, representing fatty marrow. T1 and T2 relaxation time (T1 for MDS=750.26 msec {+-} 177.50, T1 for AA=413.21 msec {+-} 167.39 ({rho} < 0.000), T2 for MDS=91.86 msec {+-} 14.16, T2 for AA=81.44 msec {+-} 15.31 ({rho} < 0.001) and T1 marrow/fat signal intensity ratio (0.22 {+-} 0.048 in MDS, 0.30 {+-} 0.083 in AA ({rho} < 0.000) revealed statistically significant difference between the two groups. Although the marrow aspiration and needle biopsy are mandatory in hematologic disease for diagnosis, there are limited in assessing the change of total marrow mass. Therefore MRI of bone marrow might be useful in distinguishing MDS from AA because of its ability of representation of total marrow mass.

  2. Differential diagnosis between odontogenic keratocyst and ameloblastoma by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Eun, Sang A; Kim, Kee Deog; Park, Chang Seo [Yonsei University College of Dentistry, Seoul (Korea, Republic of)

    2002-06-15

    The objective of this study is to find the differentiating characteristics of ameloblastomas and odontogenic keratocysts of the jaw by analyzing computed tomography (CT) images of the lesions, clarify radiological characteristics associated with jaw lesions, and to make a diagnosis based on these findings. Test subjects were chosen among the patients who were diagnosed as having an odontogenic keratocyst or ameloblastoma at the Yonsei University Dental Hospital from January 1996 to December 2000 and had CT scans taken preoperatively. The subject pool was comprised of 51 cases of odontogenic keratocyst and 37 cases of ameloblastoma. The following measures were used for image analysis of the lesion : the anatomic location, CT pattern, mesiodistal width, buccolingual width, the ratios between mesiodistal width and buccolingual width, height, CT number, homogeneity of radiodensity, the appearance of a sclerotic rim, continuity of adjacent cortical bone, and displacement and resorption of adjacent teeth. Comparing the CT patten, mesiodistal width, buccolingual width, height, CT number, homogeneity, appearance of sclerotic rim, continuity of adjacent cortical bone, there were statistically significant differences between ameloblastoma and odontogenic keratocyst test subjects (p<0.05). Comparing the ratios between mesiodistal width and buccolingual width, displacement and resorption of adjacent teeth, there were no statistically significant differences (p>0.05). We compared odontogenic keratocysts and ameloblastomas in CT scans. They occurred most frequently in the posterior to the ramus of the mandible. The findings of patterns of the CT images showed that size and border of lesions were more aggressive in ameloblastomas than in odontogenic keratocysts. The internal contents represented an increased attenuation area (IAA) in odontopenic keratocyst. Odontogenic keratocysts were shown to have higher CT numbers than ameloblastomas.

  3. [Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

    Science.gov (United States)

    Deĭkina, O N; Mishin, V Iu; Demikhova, O V

    2007-01-01

    The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

  4. [MRI diagnosis in longitudinal stress fractures: differential diagnosis of Ewing sarcoma].

    Science.gov (United States)

    Pauleit, D; Sommer, T; Textor, J; Flacke, S; Hasan, C; Steuer, K; Emous, D; Schild, H

    1999-01-01

    To compare MR imaging features of stress fractures, simulating malignancies, and Ewing sarcomas. MR imaging studies of 4 patients with longitudinal stress fractures of the tibia (n = 2) and the femur (n = 2) simulating malignancy were retrospectively compared with the MRI scans of 10 patients with histologically proven Ewing sarcoma (femur n = 5; tibia n = 3, fibula n = 1, humerus n = 1). The diagnosis of stress fractures was confirmed by follow-up examinations. An additional biopsy was performed in two patients. Despite negative x-ray examinations, MRI showed the fracture line in all patients with stress fractures. In these cases marrow edema was irregular and there was no well defined margin towards normal fatty marrow. In contrast Ewing sarcomas were sharply demarcated in 9/10 cases. Extraosseous enhancing soft tissue was found in Ewing sarcomas as well as in stress fractures. In stress fractures the enhancing mass was repair tissue. Areas of necrosis within the enhancing mass was seen in (8/10) Ewing sarcomas, only. In follow-up studies we observed a decrease of the marrow edema in patients with stress fractures. Occurrence of low signal areas in T1- and T2-weighted sequences within the initial enhanced extraosseous tissue corresponded to bony callus on x-rays films. Repair tissue in stress fractures can imitate malignancy. The irregularity of the marrow edema without well defined margins, the lack of necrosis in the small enhancing tissue and the proof of the fracture line in the MRI are criteria to differentiate stress fractures from Ewing sarcomas. Short-term follow up studies are helpful to underline the diagnosis.

  5. Using Neuropsychometric Measurements in the Differential Diagnosis of Specific Learning Disability.

    Science.gov (United States)

    Turgut Turan, Sevil; Erdoğan Bakar, Emel; Erden, Gülsen; Karakaş, Sirel

    2016-06-01

    The aim of this study was to develop a neuropsychometric battery for the differential diagnosis of specific learning disability (SLD), with specific respect to attention deficit hyperactivity disorder (ADHD), and to help resolve the conflicting results in the literature by an integrative utilization of scores on both the Bannatyne categories and neuropsychological tests. The sample included 168 primary school boys who were assigned to SLD (n=21), ADHD (n=45), SLD and ADHD (n=57), and control groups (n=45). The exclusion criteria were a neurological or psychiatric comorbidity other than ADHD, a level of anxiety and/or depression above the cutoff score, medication affecting cognitive processes, visual and/or auditory disorders, and an intelligence level outside the IQ range of 85-129. Psychometric scores were obtained from the SLD Battery and Wechsler Intelligence Scale for Children-Revised in the form of Bannatyne category scores. Neuropsychological scores were from the Visual-Aural Digit Span Test-Form B, Serial Digit Learning Test, Judgment of Line Orientation, and Mangina Test. The battery was called the Integrative Battery of SLD. The correctness of estimation for classifying cases into the diagnostic dyads (SLD/ADHD, SLD/SLD+ADHD, and SLD+ADHD/ADHD) by an integrative utilization of both the Bannatyne category scores (n=4) and scores from the four neuropsychological tests (n=10) was 92.4%, 81.4%, and 71.8%, respectively. These proportions were generally higher than those obtained using the Bannatyne category scores alone (86.4%, 75.5%, and 73.1%, respectively). The same trend was seen in the classification of children into diagnostic and control groups. However, the proportion of the correctness of estimation was higher than that obtained for the diagnostic dyads. When conducted using appropriately chosen research designs and statistical techniques and if confounding variables are sufficiently controlled, a neuropsychometric battery that includes capacities that

  6. The ultrasonographic features of endometriomas: morphologic analysis and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Sung; Park, Chan Sup; Song, Soon Young; Lee, Eun Ja; Park, No Hyuck [College of Medicine, Kwandong Univ., Koyang (Korea, Republic of); Park, Cheol Min [College of Medicine, Korea Univ., Seoul (Korea, Republic of); Kim, Bo Hyun; Kim, Chan Kyo [College of Medicine, Sungkyunkwan Univ., Seoul (Korea, Republic of)

    2003-12-01

    To analyze the sonographic, morphologic, and internal echo patterns of endometriomas, and thus determine which ultrasonographic (US) findings assist diagnosis. One hundred and forty-seven eases of pathologically proven adnexal masses in 130 women were divided into three groups: group I, in which endometriomas were diagnosed at both preoperative US and surgery (true positive) (n=97); group II, in which endometriomas were misdiagnosed at preoperative US, and were confirmed after surgery to be other pathologic entities (false positive) (n=10); group III, in which other adnexal masses were misdiagnosed at preoperative US, but were proven after surgery to be endometriomas (false negative) (n=40). The US findings in these cases were retrospectively reviewed in terms of (a) morphologic type: unilocular, multiseptated, multilobulated, solid and cystic, or mixed; (b) internal echo pattern: homogeneous fine, anechoic, fine septation, or complex; (c) size; (d) wall thickness; (e) the presence or absence of septation; (f) wall nodularity; (g) echogenic wall foci; and (h) a solid area. In group I, the most common morphological type was unilocular cyst (n=63; 65%). In lesions most commonly emitted homogeneous fine echoes (n=76; 78%). In this group, most masses (86%) were less than 10 cm in diameter and the wall thickness in 65% of cases was less than 3 mm. Additionally, internal septation, wall nodularity, focal echogenic wall foci, and a solid area were observed at US. Group II, cases were pathologically confirmed as mucinous cystadenoma (n=3), mucinous cystadenoma with borderline malignancy, hemorrhagic cyst, functional cyst, endometrioid carcinoma, and hematoma. In group III, cases were misdiagnosed as cystadenoma (n=15), hemorrhagic cyst, teratoma, ovarian cancer, functional cyst and ectopic pregnancy at preoperative US. There were no significant differences in size or wall thickness between groups II and III, and group I. At US, groups II and III also showed internal

  7. Decision support for the differential diagnosis of jaundice

    NARCIS (Netherlands)

    R.W. Segaar (Robert)

    1991-01-01

    textabstractMaking a diagnosis is always a challenge for the clinician who faces a jaundiced patient. A diagnosis provides a basis for prognosis, and guides therapeutic action. Modeling of the diagnostic process provides an understanding of the contributing elements. In addition, diagnostic

  8. ON DIFFERENTIAL DIAGNOSIS BETWEEN AUTISTIC DISORDER AND ASPERGER’S SYNDROME

    Directory of Open Access Journals (Sweden)

    Stefan Todorov

    2012-11-01

    Full Text Available The differential diagnosis between Autistic disorder (AD and Asperger’s syndrome (AS in most cases is quite difficult since most of the symptoms are clinically undistinguished. Several factors complicate the diagnosis of AS- an autism spectrum disorder (ASD. It is considered by some authors to be simply a milder version of autistic disorder. Problems in diagnosis include disagreement among diagnostic criteria, controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome, and over- and under-diagnosis. Our paper is based on the diagnostic and differential diagnostic criteria of DSM-IV, ICD-10 and our clinical experience.In the process of diagnosis and differential diagnosis we, naturally, illustrate and discuss the similarities and differences between the two disorders.

  9. Infectious diseases of the brain: imaging and differential diagnosis; Infektioese Hirnerkrankungen: Bildgebung und differenzialdiagnostische Aspekte

    Energy Technology Data Exchange (ETDEWEB)

    Haehnel, S.; Seitz, A. [Abt. Neuroradiologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany); Storch-Hagenlocher, B. [Abt. Neurologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany)

    2006-09-15

    Infectious diseases of the central nervous system have to be considered in differential diagnosis particularly in immunocompromised persons. Neuro-imaging, specifically advanced techniques such as diffusion weighted MRI and perfusion MRI contribute much to the differentiation of brain infections and for differentiating brain infections from other, for instance, neoplastic diseases. In this review we present the imaging criteria of the most important brains infections in adults and in pediatric patients and discuss differential diagnostic aspects in detail. (orig.)

  10. Differential diagnosis of neurodegenerative diseases using structural MRI data

    Directory of Open Access Journals (Sweden)

    Juha Koikkalainen

    2016-01-01

    The results prove that automatic quantification methods and computerized decision support methods are feasible for clinical practice and provide comprehensive information that may help clinicians in the diagnosis making.

  11. Differential Relationships of Anxiety and Autism Symptoms on Social Skills in Young Boys with Fragile X Syndrome

    Science.gov (United States)

    Reisinger, Debra L.; Roberts, Jane E.

    2017-01-01

    Social skills are critical for academic, social, and psychological success of children with both typical and atypical development. Boys with fragile X syndrome (FXS) are at high risk for social skill impairments, given intellectual impairments and secondary conditions. The present study examines the impact of adaptive behavior, autism symptoms,…

  12. Molybdenum cofactor deficiency mimics cerebral palsy: differentiating factors for diagnosis.

    Science.gov (United States)

    Kikuchi, Kenjiro; Hamano, Shin-ichiro; Mochizuki, Hiroshi; Ichida, Kimiyoshi; Ida, Hiroyuki

    2012-08-01

    We describe an infant with molybdenum cofactor deficiency, initially diagnosed as cerebral palsy. Clinical features of molybdenum cofactor deficiency, e.g., neonatal seizures, hypertonus/hypotonus, and feeding and respiratory difficulties, resemble those of neonatal hypoxic-ischemic encephalopathy. Our patient, a 2-year-old boy, presented with spastic quadriplegia and mental retardation. He manifested intractable neonatal seizures and diffuse cerebral atrophy. When admitted with bronchitis at age 18 months, his uric acid levels in blood and urine were undetectable. A urinary sulfite test revealed positive results. Further tests revealed elevated urinary levels of xanthine, hypoxanthine, and S-sulfocystein. Sequencing of the MOCS2A gene revealed heterozygosity for c.[265T>C] + [266A>G], diagnosed as molybdenum cofactor deficiency type B. Neonatal seizures, progressive cerebral atrophy, and low serum levels of uric acid may provide diagnostic clues in patients with cerebral palsy of undetermined cause. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Clinicoradiologic Differential Diagnosis of Odontogenic Keratocyst and Ameloblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Ho Gul; Lee, Jang Yeol; Kim, Kee Deog; Park, Chang Seo [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Yensei University, Seoul (Korea, Republic of)

    2000-12-15

    To clarify the clinical and radiologic parameters that can be used to differentiate odontogenic keratocyst and ameloblastoma. The records of 46 patients of ameloblstoma and 48 patients of odontogenic keratocyst at the Yonsei University Dental Hospital during the period of 1979 to 1995 were retrospectively reviewed. As a possible means for differentiating between the odontogenic keratocyst and ameloblastoma, the clinical parameters and the radiologic parameters were evaluated. In the clinical parameters, there was no significant deference in age, sex, and sign and symptoms (p>0.05).In the radiologic parameters, there was significant difference in site, shape of the lesion, and external root resorption of adjacent teeth (p<0.05). The site, shape of the lesion, and external root resorption of adjacent teeth can be the parameters to differentiate odontogenic keratocyst and ameloblastoma, but a definite differentiation of these two lesions needs a more specialized imaging modality.

  14. Imaging and differential diagnosis of pediatric spinal tuberculosis

    Directory of Open Access Journals (Sweden)

    Xiao-ying Xing

    2015-03-01

    Conclusion: Pediatric spinal tuberculosis often occurs in the cervical and thoracic vertebrae with typical imaging findings. The cases with atypical manifestations should be differentiated from other diseases such as Langerhans cell histiocytosis and metastatic neoplasm.

  15. DNA restriction fragment length polymorphisms in differential diagnosis of genetic disease: application in neuromuscular diseases

    NARCIS (Netherlands)

    Defesche, J. C.; de Vissar, M.; Bakker, E.; Bouwsma, G.; de Vijlder, J. J.; Bolhuis, P. A.

    1989-01-01

    Three families, in which several male individuals suffer from a hereditary neuromuscular disease, were examined by analysis of naturally occurring restriction fragment length polymorphisms (RFLPs) and by screening for deletions. Originally, differential diagnosis included spinal muscular atrophy

  16. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions : A pooled analysis

    NARCIS (Netherlands)

    van der Waaij, LA; van Dullemen, HM; Porte, RJ

    Background: Pancreatic cystic tumors commonly include serous cystadenoma (SCA), mucinous cystadenoma (MCA), and mucinous cystadenocarcinoma (MCAC). A differential diagnosis with pseudocysts (PC) can be difficult. Radiologic criteria are not reliable. The objective of the study is to investigate the

  17. The Floating-Harbor syndrome: report of another patient and differential diagnosis with Shprintzen syndrome.

    Science.gov (United States)

    Smeets, E; Fryns, J P; Van den Berghe, H

    1996-01-01

    In this report we describe the typical clinical signs and symptoms in a young female child with Floating-Harbor syndrome. A review of the literature is presented and the differential diagnosis with Shprintzen syndrome is discussed.

  18. DIFFERENTIAL DIAGNOSIS OF ROSACEA AND SKIN TUBERCULOSIS AS AN EXAMPLE OF A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    M. L. Aripova

    2014-01-01

    Full Text Available In this paper for a clinical observation of a patient with rosacea, and patients with a flat form of lupus tuberculosis presented a differential clinical diagnosis of tuberculosis of the skin.

  19. Usefulness of immunohistochemical indicators for diagnosis and prognosis of poorly differentiated tumours

    OpenAIRE

    Kandefer-Gola Małgorzata; Nowak Marcin; Ciaputa Rafał; Madej Janusz A.

    2016-01-01

    Immunohistochemical studies have become an indispensable element of establishing the correct histopathological diagnosis of poorly differentiated lesions, proving particularly suitable, and occasionally indispensable, for diagnosis of poorly differentiated neoplastic tumours. Knowledge of the mechanism of action and normal reaction of individual proteins is required in selection of the antibody pattern for a given tissue and in evaluation of the obtained results. This paper aims to promote th...

  20. Asthma in elite athletes: pathogenesis, diagnosis, differential diagnoses, and treatment

    DEFF Research Database (Denmark)

    Pedersen, Lars; Elers, Jimmi; Backer, Vibeke

    2011-01-01

    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......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...

  1. Differential diagnosis of acute abdominal pain – acute intermittent porphyria

    Directory of Open Access Journals (Sweden)

    Mislav Klobučić

    2011-08-01

    Full Text Available Acute intermittent porphyria (AIP is a rare autosomal dominant disorder of heme biosynthesis in liver due to deficiency of porphobilinogen deaminase enzyme. Clinically, AIP is dominatedby a colicky type pain, which does not subside after taking usual analgesics. Additional frequent symptoms are vomiting, hypertension, peripheral neuropathy, seizures, depression, delirium and coma. This paper reported a case of a twenty-fi- ve-year-old female patient, who had undergone a period of six days between the first presentationto the medical department and the diagnosis confirmation. It has accentuated possible mistakes in symptomatic therapy administration as well as dangers of a delayed diagnosis.

  2. The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia.

    Science.gov (United States)

    Sousa, Pedro A; Pereira, Salomé; Candeias, Rui; de Jesus, Ilídio

    2014-03-01

    Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin, it is the 12-lead surface electrocardiogram that usually enables this differentiation. Since 1978, various electrocardiographic criteria have been proposed for the differential diagnosis of wide complex tachycardias, particularly the presence of atrioventricular dissociation, and the axis, duration and morphology of QRS complexes. Despite the wide variety of criteria, diagnosis is still often difficult, and errors can have serious consequences. To reduce such errors, several differential diagnosis algorithms have been proposed since 1991. However, in a small percentage of wide QRS tachycardias the diagnosis remains uncertain and in these the wisest decision is to treat them as ventricular tachycardias. The authors' objective was to review the main electrocardiographic criteria and differential diagnosis algorithms of wide QRS tachycardia. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. Differential diagnosis between ameloblastoma and odontogenic keratocyst using computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kawazu, Toshiyuki; Yoshiura, Kazunori; Yuasa, Kenji; Kanda, Shigenobu; Ohzeki, Satoru; Shinohara, Masanori [Kyushu Univ., Fukuoka (Japan). Faculty of Dentistry; Araki, Kazuyuki; Higuchi, Yoshinori

    1997-09-01

    Radiographic features of ameloblastoma and odontogenic keratocyst are similar although their biological behaviors are different. Therefore, it is very important to differentiate these lesions before treatment. The aim of this study was to differentiate between the two lesions based on characteristic CT findings. Fifty-three patients diagnosed histopathologically as having ameloblastoma (29 cases) or odontogenic keratocyst (24 cases) and who underwent CT were evaluated radiologically, and some characteristic radiological features to differentiate both lesions were assessed. Ameloblastomas tended to be more than 40 mm in long diameter and 0.5 short/long diameter ratio, whereas odontogenic keratocysts were less than 40 mm and 0.5, respectively (P<0.05: Chi-square test). Buccal expansion of the cortex was seen more often in ameloblastomas than in odontogenic keratocysts (P<0.05: Chi-square test). Together with these features and internal high density structure, which was only seen in odontogenic keratocysts, differential diagnostic criteria between ameloblastomas and odontogenic keratocysts were proposed. Diagnostic accuracy based on these criteria was 84.9%. These results that our criteria to differentiate ameloblastomas from odontogenic keratocysts using CT are clinically useful prior to treatment. (author)

  4. Diagnosis and treatment of mandibular extraoral sinus of periodontal origin in a 9-year-old boy: A case report

    Directory of Open Access Journals (Sweden)

    Ozdemir A

    2008-10-01

    Full Text Available Cutaneous sinus tract of dental origin is the commonest of the many types of sinus tracts that are formed on the face and neck. Cutaneous sinus tracts may originate from local chronic osteomyelitis (Garre′s osteomyelitis. Although the etiological factor is usually periapical infection, they are seldom of periodontal origin. Conventional periapical and panoramic roentgenograms are generally insufficient for diagnosis and treatment planning of cutaneous sinus tracts of periodontal origin. In the present case, computed tomography was used for diagnosis, and osteomyelitis was managed by periodontal treatment.

  5. [Desmoplastic fibroma. Differential diagnosis of a periapical lesion from endodontic failure].

    Science.gov (United States)

    Zabalegui, B; Gil, J; Zabalegui, I

    1989-01-01

    Treatment of endodontically involved teeth requires accurate diagnosis of the clinical pulpal condition to determine the primary cause of pathosis. The case presented shows the differential diagnosis between a desmoplastic fibroma and a failure of a misdiagnosed endodontic treatment. The initial direction of treatment should had never been the endodontic therapy but local surgical curettage of the lesion.

  6. Differential Diagnosis of Epileptic versus Pseudoepileptic Seizures in Developmentally Disabled Persons.

    Science.gov (United States)

    Neill, John C.; Alvarez, Norberto

    1986-01-01

    Differential diagnosis of epilepsy versus pseudoepileptic seizures in the developmentally disabled by use of an eight-channel radiotelemetered electroencephalograph-video recording system suggested that traditional diagnosis on the basis of clinical description, interictal electroencephalogram, and medical history may be inaccurate. (Author/DB)

  7. Clinical features and differential diagnosis of type 2 diabetes mellitus in children

    OpenAIRE

    T. L. Kuraeva; I A Dubinina

    2009-01-01

    This review was designed to evaluate prevalence, specific clinical features, and differential diagnosis of type 2 diabetes mellitus (DM2) in children and adolescents. Special emphasis is laid on the importance of immunological and molecular-genetic studies for the verification of diagnosis and active case detection in h groups.

  8. Cracked and broken teeth--definitions, differential diagnosis and treatment.

    Science.gov (United States)

    Paul, R A; Tamse, A; Rosenberg, E

    2007-04-01

    Cracked and broken teeth present a diagnostic dilemma to the dentist and the sooner a correct diagnosis is made the greater are the chances to save the tooth. As the location, direction and size of the crack or fracture dictates the choice of treatment, it is important to first define the types of cracks and fractures in the coronal and radicular tooth structure. Cracks and fractures can be classified as follows: 1. craze lines 2. fractured cusps 3. cracked teeth 4. split teeth 5. vertical root fractures. The vertical root fracture has been described recently in two articles in this publication, and therefore will not be discussed here. Diagnosis of a cracked tooth is not always initially obvious. The patient's response to clinical testing is the primary diagnostic tool along with the dental history provided by the patient. Radiographs are secondary in making a diagnosis. Clinical aids for reproducing the patient's symptoms such as occlusal bite devices, observing occlusal wear facets and the application of cold water to one tooth at a time may isolate the offending tooth. In situations where an irreversible pulpitis is diagnosed, endodontic treatment is indicated. In the case of a questionable diagnosis, or one in which a potential reversible pulpitis is made, a provisional restoration can be placed for an unspecified time as a diagnostic aid. If endodontic therapy were indicated, consultation with the patient as to the compromised prognosis and the alternatives to endodontic treatment is essential.

  9. [Parinaud's oculoglandular syndrome. A rare differential diagnosis of "red eye"].

    Science.gov (United States)

    Jäckel, M C; Glock, T; Künster, A

    2006-01-01

    Two cases of Parinaud's oculoglandular syndrome, which represents an ocular manifestation of cat-scratch disease, are reported. The symptoms are subacute and include unilateral conjunctivitis and pre-auricular lymphadenopathy. Diagnosis primarily relies on the recognition of suggestive clinical signs in conjunction with positive serologic testing. In most cases, therapy is not necessary.

  10. MRI findings and differential diagnosis in children with cerebral paragonimiasis

    Directory of Open Access Journals (Sweden)

    Zhen Zeng

    2016-06-01

    Conclusions: The clinical manifestations of cerebral paragonimiasis are nonspecific in children while the MRI findings of cerebral paragonimiasis are characteristic, including irregular hemorrhage, ring-like enhancement and disproportionately large areas of surrounding edema. Brain MRI plays an important role in the diagnosis of cerebral paragonimiasis in children.

  11. Differential diagnosis of suspected multiple sclerosis: a consensus approach

    NARCIS (Netherlands)

    Miller, D. H.; Weinshenker, B.G.; Filippi, M.; Banwell, B.L.; Cohen, J.A.; Freedman, M.S.; Galetta, S.L.; Hutchinson, M.; Johnson, R.T.; Kappos, L.; Kira, J.; Lublin, F.D.; McFarland, H.F.; Montalban, X.; Panitch, H.; Richert, J.R.; Reingold, S.C.; Polman, C.H.

    2008-01-01

    Background and objectives: Diagnosis of multiple sclerosis (MS) requires exclusion of diseases that could better explain the clinical and paraclinical findings. A systematic process for exclusion of alternative diagnoses has not been defined. An International Panel of MS experts developed consensus

  12. Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years after Initial Diagnosis

    Science.gov (United States)

    Gillberg, I. Carina; Helles, Adam; Billstedt, Eva; Gillberg, Christopher

    2016-01-01

    We examined comorbid psychiatric and neurodevelopmental disorders in fifty adult males (mean age 30 years) with Asperger syndrome (AS) diagnosed in childhood and followed up prospectively for almost two decades (13-26 years). Only three of the 50 men had "never" met criteria for an additional psychiatric/neurodevelopmental diagnosis and…

  13. Differential Diagnosis of Severe Speech Disorders Using Speech Gestures

    Science.gov (United States)

    Bahr, Ruth Huntley

    2005-01-01

    The differentiation of childhood apraxia of speech from severe phonological disorder is a common clinical problem. This article reports on an attempt to describe speech errors in children with childhood apraxia of speech on the basis of gesture use and acoustic analyses of articulatory gestures. The focus was on the movement of articulators and…

  14. Differential Diagnosis of Children with Suspected Childhood Apraxia of Speech

    Science.gov (United States)

    Murray, Elizabeth; McCabe, Patricia; Heard, Robert; Ballard, Kirrie J.

    2015-01-01

    Purpose: The gold standard for diagnosing childhood apraxia of speech (CAS) is expert judgment of perceptual features. The aim of this study was to identify a set of objective measures that differentiate CAS from other speech disorders. Method: Seventy-two children (4-12 years of age) diagnosed with suspected CAS by community speech-language…

  15. Serum beta-2-microglobulin in the differential diagnosis ...

    African Journals Online (AJOL)

    tiating MM from MGUS was determined using a classification rule. Despite lacking specificity, serum 82m measurement was useful in differentiating MM from MGUS, and was the best second choice variable in relation to serum albumin and haemoglobin in patients with normal renal function. S Air Med J 1991; 79: 650-653.

  16. DIFFERENTIAL DIAGNOSIS OF PRIMARY AND METASTATIC OVARIAN TUMORS IN PATIENTS WITH COLONIC CANCER

    Directory of Open Access Journals (Sweden)

    I. G. Komarov

    2013-01-01

    Full Text Available This report summarizes existing data on differential diagnosis between primary and metastatic ovarian cancer in patients with colorectal cancer (CRC. The results obtained in N.N. Blokhin Russian Cancer Research Center on the management of this malignancy are also presented. The evidence in favour of the need of genetic counseling and monitoring of the patients with aggravated familial history for early diagnosis of synchronous and metachronous ovarian cancer in patients with CRC is produced. A number of clinical, laboratory and diagnostic methods in addition to immunohistology and molecular genetics should be used for differential diagnosis of primary and metastatic ovarian cancer in patients with CRC.

  17. Differential diagnosis of bilateral thalamic lesions; Differenzialdiagnose bilateral Thalamuslaesionen

    Energy Technology Data Exchange (ETDEWEB)

    Linn, J.; Brueckmann, H. [Universitaetsklinikum Muenchen (Germany). Abt. fuer Neuroradiologie; Hoffmann, L.A. [Universitaetsklinikum Muenchen (Germany). Inst. fuer Klinische Neuroimmunologie; Danek, A. [Universitaetsklinikum Muenchen (Germany). Klinik und Poliklinik fuer Neurologie

    2007-03-15

    A multitude of different diseases can result in bilateral thalamic lesions. These include vascular pathologies requiring prompt therapeutic intervention, such as basilar thrombosis or thrombosis of the internal cerebral veins, as well as tumors, infectious or demyelinating diseases, and toxic-metabolic lesions. Therefore, detailed knowledge of the typical radiological findings for the various diseases is essential for determining the correct diagnosis. This review provides a synopsis of the radiological findings for the most important bithalamic lesions and an overview of the literature.

  18. [Rectal tonometry in the differential diagnosis of constipation in pediatrics].

    Science.gov (United States)

    Licastro, R; Ciocca, M; Guastavino, E

    1979-01-01

    Based on the difficulties regarding the clinical, radiological, and histological diagnosis of colonic aganglionosis, we resorted the motility studies. Sixty-two children (15 days-10 years of age) were studied by means of rectal motility without knowing the results of the other auxilary methods. We obtained a clear difference between aganglionic and other group formed by constipated functional or psicogenic. We conclude that rectal motility studies have the advantage of being rapid and non-aggressive, besides avoiding rectal biopsy.

  19. [How I explore ... differential diagnosis of a red eye].

    Science.gov (United States)

    Huvelle, H; Duchesne, B; Rakic, J-M

    2013-11-01

    As a common reason for consultation, red eye can be a symptom of benign diseases, such as conjunctivitis, subconjunctival hemorrhage, dry eye syndrome,..., which can be managed by the general practitioner or internist. Conversely, more serious pathologies require a ophthalmologist management: these are keratitis, uveitis, acute glaucoma attack, or endophtalmitis. This article is intended to help practitioner to guide diagnosis when he's faced with a red eye.

  20. Loin to groin pain: The importance of a differential diagnosis

    Directory of Open Access Journals (Sweden)

    Alexander E.P. Smith

    2015-01-01

    Conclusion: Assessment of patients with loin pain requires a systematic approach. PVCS is a rare cause of lumbar back and loin pain but one that should be considered, particularly in active young males. Early diagnosis is key to prevent the potential sequalae of untreated rhabdomyolysis. There is currently no consensus on management option for PVCS with only a few cases being reported in the literature. We describe successful management with supportive non operative treatment.

  1. Differential diagnosis of dental fluorosis made by undergraduate dental students

    OpenAIRE

    Rigo,Lilian; Lodi,Leodinei; Garbin,Raíssa Rigo

    2015-01-01

    ABSTRACT Objective To check knowledge of undergraduate dental students to make diagnosis of dental fluorosis with varying degrees of severity and choose its appropriate treatment. Methods Data were collected using a semi-structured questionnaire addressing knowledge of undergraduates based on ten images of mouths presenting enamel changes. Results Only three images were correctly diagnosed by most undergraduates; the major difficulty was in establishing dental fluorosis severity degree....

  2. Somatostatinoma syndrome: a challenging differential diagnosis among pancreatic tumors

    Directory of Open Access Journals (Sweden)

    Paula Martinez Vianna

    2013-03-01

    Full Text Available Among the neuroendocrine neoplasia, the pancreatic somatostatin-producing tumors are very rare. Usually functional, these tumors produce the somatostatinoma syndrome, which encompasses diabetes mellitus, diarrhea/steatorrhoea, and cholelithiasis. Other symptoms may include dyspepsia, weight loss, anemia, and hypochlorhydria. All theses symptoms are explained by the inhibitory actions of the somatostatin released by tumoral cells originated from pancreatic delta cells or endocrine cells of the digestive tract. The diagnosis is easy to overlook since these symptoms are commonly observed in other more common syndromes. Besides the clinical features, diagnosis is based on serum determination of somatostatin, and imaging exams, such as ultrasound, computer tomography and positron emission tomography. Pathologic examination is characterized by the positivity of immunohistochemical reaction for synaptophysin, chromogranin, and somatostatin. These tumors can be classified according to tumor size, mitotic index, neural or vascular invasion, and distant metastases. The authors describe the case of a 61-year-old female patient who sought medical care because of a 6-month history of watery diarrhea, weight loss, and depression. She was diagnosed with diabetes mellitus 3 years ago. Imaging examination revealed a tumoral mass of 4 cm in its longest axis in the topography of the head of the pancreas and calculous cholecistopathy. The patient’s clinical status was unfavorable for a surgical approach. She died after 20 days of hospitalization. The definitive diagnosis was achieved with the autopsy findings, which disclosed a pancreatic somatostatinoma.

  3. Usefulness of Thallium Scan for Differential Diagnosis of Breast Mass

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Sang Kyun; Yum, Ha Yong; Lee, Chung Han; Choi, Kyung Hyun [Kosin University College of Medicine, Pusan (Korea, Republic of)

    1994-07-15

    The purpose of this study is to evaluate thallium scanning as a potential test in differentiating malignant from benign lesions of breast. Thirty-one female patients underwent thallium scan of the breast. After intravenous injection of 74-111 MBq(2-3 mCi)of thallium-201, anterior and lateral images were obtained. We compared thallium scans with pathological results. Of 11 patients with breast cancers, 10 cases (90.9%) were detected using thallium scan. Thallium scan obtained in one patient who had breast cancer but received several cycles of chemotherapy did not show thallium uptake. The smallest detectable cancer was 1.5 cm in diameter. In contrast, there is no thallium accumulation in breasts of 17 of 20 patients with benign disease (85%), Three cases of 13 fibrocystic disease show thallium uptake in their breast. In conclusion, thallium scan is an effective test in differentiating benign from malignant lesion.

  4. Hypertrophic pachymeningitis: Current criteria for diagnosis and differentiation (Clinical case and review of literature

    Directory of Open Access Journals (Sweden)

    E. G. Mendelevich

    2015-01-01

    Full Text Available The paper describes a 44-year-old male patient with an about 6-year history of hypertrophic pachymeningitis. The major clinical symptoms were characterized by headache, exophthalmos, and blindness in one eye. The data for differential diagnosis of the disease are given. The current literature on the clinical manifestations of hypertrophic pachymeningitis, its differential diagnosis, and the results of magnetic resonance imaging (MRI is reviewed. Diagnostic difficulties at the stage of a clinical observation are due to the nonspecificity of neurological manifestations and the need for a comprehensive examination to detect a somatic disease. MRI can diagnose the disease-specific phenomenon of damage to the meninges, which calls for further careful differentiation. Clinicians must be familiar with alternative differential diagnosis, as a rapid specific therapeutic approach will help avoid long-term or irreversible neurological complications.

  5. Salmonella osteomyelitis. An important differential diagnosis of granulomatous osteomyelitis.

    Science.gov (United States)

    Wu, P C; Khin, M M; Pang, S W

    1985-07-01

    A case of septicemia owing to Salmonella choleraesuis with localization in the lumbar spine and left knee is described. The spinal lesion is dominated by tuberculoid granulomas with or without central necrosis. The necrotic foci within some granulomas show heavy polymorph infiltration, whereas in others they simulate caseous necrosis and are indistinguishable histologically from tuberculosis, brucellosis, and fungal infections. As Salmonella osteomyelitis has a strong tendency to chronicity if antimicrobial treatment is delayed, inappropriate, or inadequate, this diagnosis should be considered in all cases of granulomatous osteomyelitis, especially when the patient is immunosuppressed or has hemoglobinopathy.

  6. Differential diagnosis of dementia: intra- and interdiscipline agreement.

    Science.gov (United States)

    Plugge, L A; Verhey, F R; van Everdingen, J J; Jolles, J

    1991-01-01

    Ninety clinicians from six disciplines diagnosed ten case descriptions of patients, judged by a multidisciplinary expert committee to suffer from dementia. Five cases were diagnosed before and five after a consensus meeting on the diagnosis of dementia. A significant change in the level of agreement between the disciplines could not be established. The analysis did show a significant difference between the disciplines in the use of etiologic diagnoses. The results indicated that, in order to avoid possible bias caused by medical specialization, a multidisciplinary approach for this type of patient is recommended.

  7. Renal Adenomas: Pathological Differential Diagnosis with Malignant Tumors

    Directory of Open Access Journals (Sweden)

    F. Algaba

    2008-01-01

    Full Text Available The renal adenomas can be confused by imaging diagnosis with malignant renal tumors, but there are also real biological dilemmas to determine their behavior. The consensus decisions are the following. (1 The adenoma of clear cells is not accepted, instead it is considered that all the clear-cell tumors are carcinomas, with greater or lesser aggressiveness. (2 Among the papillary neoplasms the WHO 2004 renal cell tumors classification are considered as papillary adenomas tumors with a maximum diameter of 5 mm and may represent a continuum biological process to papillary renal cell carcinoma. The papillary adenomas associated with End-kidney and/or acquired cystic disease may have a different pathogenesis. (3 To consider a tumor as an oncocytoma the size is not important, only the cytological features, microscopic, ultrastructural, and immunohistochemically can help, but some chromosomal observations introduce some questions about its relation with the chromophobe renal cell carcinoma. (4 Finally, the metanephric adenoma, a tumor with some morphological similarity with the nephroblastoma must be considered in the renal adenomas diagnosis.

  8. Pemphigus foliaceus as a differential diagnosis in vesicobullous lesions.

    Science.gov (United States)

    Fonseca, Louise de Almeida Ferreira; Alves, Célia Antônia Xavier de Moraes; Aprahamian, Ivan; Pinto, Clóvis Antônio Lopes

    2017-01-01

    Given the challenge of clinical diagnosis of bullous skin lesions, this report aimed to discuss the histological changes, the presentation and clinical reasoning for diagnosis of these lesions. At the same time, the importance of the pathology was reviewed to identify these clinical scenarios. In this case report, we highlighted the clinical progression of a case of pemphigus foliaceus. RESUMO Considerando o desafio do diagnóstico clínico de lesões cutâneas de apresentação bolhosa, o presente trabalho procurou discutir as alterações histológicas, a apresentação e o raciocínio clínico para o diagnóstico de tais lesões. Paralelamente, a importância da patologia foi revisada na identificação destes quadros. Neste relato de caso, destaca-se a evolução clínica de um quadro de pênfigo foliáceo.

  9. Antrochoanal polyps in children: CT findings and differential diagnosis

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    Pruna, X.; Serres, X.; Garriga, V.; Barber, I. [Dept. of Radiology, Hospital General de Granollers, Barcelona (Spain); Ibanez, J.M. [Dept. of Otorhinolaryngology, Hospital General de Granollers, Barcelona (Spain); Vera, J. [Dept. of Radiology, Univ. of Barcelona (Spain)

    2000-05-01

    Antrochoanal polyp (Killian polyp) is an infrequent, usually solitary, benign, slowly growing lesion that arises from the maxillary antrum and reaches the choana. These polyps have a discrete male predominance and are diagnosed usually between the third and the fifth decades of life. This report is based on three cases of antrochoanal polyp, occurring in the pediatric group, and the objective is to demonstrate their different CT characteristics, principal differential diagnoses, and potential complications. We emphasize that in all three cases of our series the growth of the polyp to the choana is through the accessory ostium. (orig.)

  10. Diagnosis and Treatment of Odontogenic Cutaneous Sinus Tracts in an 11-Year-Old Boy: A Case Report.

    Science.gov (United States)

    Chen, Ke; Liang, Yun; Xiong, Huacui

    2016-05-01

    Odontogenic cutaneous sinus tracts (OCSTs) are generally primarily misdiagnosed and inappropriately treated by virtue of their rarity and the absence of dental symptoms. Accurate diagnosis and treatment and the elimination of the source of infection can reduce the incidence of complications and relieve the pain of the patient.In this case report, we present the case of an 11-year-old patient with an apparent abscess but an unobvious draining sinus tract in his left cheek. Intraorally, a glass-ionomer-cement filling on the occlusal surface of the left mandibular first molar (tooth 36) was noted. Radiographic examination revealed a radiopaque mass inside the crown and pulp chamber and an irregular, radiolucent periapical lesion surrounding the distal root apex. He was diagnosed with an OCTS secondary to a periapical abscess of tooth 36. Precise root canal therapy (RCT) and chronic granuloma debridement was performed; 6 months later, the abscess and sinus had healed completely, and the periapical lesion had resolved.Odontogenic cutaneous sinus tracts are uncommon in the clinic. This case report reminds us of the significance of OCSTs and provides some implications for their diagnosis and treatment.

  11. The Differential Diagnosis of Acute Colitis: Clues to a Specific Diagnosis.

    Science.gov (United States)

    Jessurun, Jose

    2017-12-01

    This review describes a systematic approach to the interpretation of colonic biopsy specimens of patients with acute colitis. Five main histologic patterns are discussed: acute colitis, focal active colitis, pseudomembranous colitis, hemorrhagic colitis, and ischemic colitis. For each pattern, the most common etiologic associations and their differential diagnoses are presented. Strategies based on histologic analysis and clinical considerations to differentiate acute from chronic colitides are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Isolated Cataplexy in the Differential Diagnosis of Drop Attacks: A Case of Successful Clinical Diagnosis and Treatment

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    Robert T. Egel

    2012-01-01

    Full Text Available Drop attacks are sudden spontaneous falls that are not accompanied by alteration of consciousness and are followed by immediate recovery. Cataplexy, which is usually associated with narcolepsy, is one of the causes of drop attacks. We report a patient with the rare condition of cataplexy without associated narcolepsy (isolated cataplexy. Isolated cataplexy should be included in the differential diagnosis when a patient presents with recurrent drop attacks and normal diagnostic test results.

  13. Differential diagnosis of the epileptogenic supratentorial brain tumors in children

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    V. S. Khalilov

    2015-01-01

    Full Text Available Fifty-six out of 79 pediatric patients with supratentorial brain tumors were noted to have symptomatic epilepsy. Dysembryoplastic neuroepithelial tumors (DNET, diffuse astrocytomas (DA, and gangliogliomas (GG were the most epileptogenic tumors. Seizures were new-onset in all our noted cases of DNET and in 4 patients with GG and the only clinical tumor sign in 6 of 8 cases of DNET. The neuroimaging features of the MRI pattern of DNET, DA, and GG were an iso/hypointense signal on Tl-weighted magnetic resonance images and a signal, the intensity of which varied from heterogeneous to cerebrospinal fluid, on T2-weighted FLAIR images. Cases of DNET and GG displayed no mass effect or perifocal edema, a trend towards location in the temporoinsular regions, and a frequent concurrence with local gray-white matter differentiation disorders and atrophy. The FLAIR images clearly showed the so-called foam-like (multicystic structure with pericystic changes. No significant change in the dimensions of the identified DNET and GG was observed during the follow up period. In low-grade DA, tumor growth was reduced and it is difficult to differentiate minimal perifocal edema from tumor-like tissue. The sensitivity of these tumors to contrast enhancement is ambiguous. Along with DNET (that was epileptogenic in 100% of cases, DA (91,7% and GG (80% were the most common epileptogenic brain tumors.

  14. Patient exposure in the basic science classroom enhances differential diagnosis formation and clinical decision-making

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    Justin G. Peacock

    2015-02-01

    Full Text Available Purpose. The authors proposed that introducing real patients into a pathology classroom early in medical education would help integrate fundamental principles and disease pathology with clinical presentation and medical history.Methods. Three patients with different pathologies described their history and presentation without revealing their diagnosis. Students were required to submit a differential diagnosis in writing, and then were able to ask questions to arrive at the correct diagnosis. Students were surveyed on the efficacy of patient-based learning.Results. Average student scores on the differential diagnosis assignments significantly improved 32% during the course. From the survey, 72% of students felt that patient encounters should be included in the pathology course next year. Seventy-four percent felt that the differential diagnosis assignments helped them develop clinical decision-making skills. Seventy-three percent felt that the experience helped them know what questions to ask patients. Eighty-six percent felt that they obtained a better understanding of patients’ social and emotional challenges.Discussion. Having students work through the process of differential diagnosis formulation when encountering a real patient and their clinical presentation improved clinical decision-making skills and integrated fundamental concepts with disease pathology during a basic science pathology course.

  15. Spectrophotometric intracutaneous analysis for differential diagnosis of pigmented skin lesions

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    Е. V. Filonenko

    2013-01-01

    Full Text Available The non-invasive diagnosis of pigmented skin lesions by spectrophotometric intracutaneous analysis (SIA-scopy using device for dermatoscopy (SIAscope V by Astron Clinica, Ltd was approved in P.A.Herzen Moscow Cancer Research Institute. The method is based on analysis of light interaction with wavelength of 440–960 nm anf human skin, which is recorded by change of image on scan. The comparative analysis of SIA-scopy and histological data in 327 pigmented skin lesions in 147 patients showed, that SIA had high diagnostic efficiency for cutaneous melanoma: the sensitivity was 96%, specifity – 94%, diagnostic accuracy – 94%. For study of malignant potential of pigmented lesions by SIA-scopy the most informative capacity was obtained for assessment of melanin in papillary dermis, status of blood vessels and collagen fibres (SIA-scans 3, 4, 5.

  16. Idiopathic pulmonary hemorrhage: morphology and differential diagnosis. Case report

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    Eduardo Cambruzzi

    2013-06-01

    Full Text Available Idiopathic pulmonary hemorrhage (IPH is a rare cause of alveolar hemorrhage (AH with unknown etiology that primarily affects children. The process has a variable clinical progression, and its diagnosis is established after excluding all causes of AH. Herein, the authors report a case of IPH in an adult male patient referring cough and hemoptysis. The conventional radiography computed tomography imaging identified zones of consolidation and areas of ground-glass attenuation in the lower lobes and lingula. Forced spirometry, bronchoscopy, and laboratorial tests yielded normal results. Several alveolar hemosiderin-laden macrophages were identified on bronchoalveolar lavage and lung biopsy. Thus, the histopathological findings associated with clinical data were compatible with IPH.

  17. Differential diagnosis of neurodegenerative diseases using structural MRI data

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    Koikkalainen, Juha; Rhodius-Meester, Hanneke; Tolonen, Antti

    2016-01-01

    in structural magnetic resonance imaging (MRI) scans could best distinguish four types of dementia, Alzheimer's disease, frontotemporal dementia, vascular dementia, and dementia with Lewy bodies, and control subjects. We extracted an extensive set of features quantifying volumetric and morphometric...... of differential diagnostics. Most studies compare patients and controls, or Alzheimer's disease with one other type of dementia. Such a bilateral comparison does not resemble clinical practice, where a clinician is faced with a number of different possible types of dementia. Here we studied which features...... individuals was used for evaluation. The cross-validated classification accuracy was 70.6% and balanced accuracy was 69.1% for the five disease groups using only automatically determined MRI features. Vascular dementia patients could be detected with high sensitivity (96%) using features from FLAIR images...

  18. Skin signs in child abuse and differential diagnosis.

    Science.gov (United States)

    Oranje, A; Bilo, R A

    2011-08-01

    Child abuse has been recognized as a serious problem, of which the awareness in medical discipline but also in the general public has been increased since many years. The reporting of child abuse has therefore been increased during the last years. Also in politics it has been noted that the current situation around child abuse is alarming and the caring approach has many short-comings in early recognition and treatment. The skin is the most accessible organ of the human being. It is also the most frequently injured organ in child abuse. Skin abnormalities are visible to everyone. Therefore you need specific skills to correctly diagnose skin findings . The diagnosis of skin abnormalities in suspected child abuse is the work of experienced and dedicated specialists, e.g. pediatric dermatologists who are able to read the skin. Diagnostic errors can be prevented through close cooperation between forensic pediatrics, pediatric dermatology and pediatric radiology, but also other specialists should be consulted in difficult problematic clinical cases. Several skin disorders may mimic child abuse. Suspicion of child abuse must be approached just like every other medical problem in a child, namely based on expertise and multi-disciplinary cooperation and always supported by second opinion. In this review article skin signs of child abuse are stressed and the most common confusing dermatological disorders are illustrated.

  19. The lung in systemic vasculitis: radiological patterns and differential diagnosis

    Science.gov (United States)

    Mantini, Cesare; Sperandeo, Marco; Galluzzo, Michele; Belcaro, Giovanni; Tartaro, Armando; Cotroneo, Antonio R

    2016-01-01

    The respiratory system may be involved in all systemic vasculitides, although with a variable frequency. The aim of our review is to describe radiographic and high-resolution CT (HRCT) findings of pulmonary vasculitides and to correlate radiological findings with pathological results. Lung disease is a common feature of antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitides, including granulomatosis with polyangiitis (Wegener's), eosinophilic granulomatosis with polyangiitis (Churg–Strauss) and microscopic polyangiitis. Pulmonary involvement is less frequent in immune-complex-mediated small-vessel vasculitides, such as Behçet's disease and Goodpasture's syndrome. Pulmonary involvement associated to large-vessel (gigantocellular arteritis and Takayasu's disease) or medium-vessel (nodose polyarteritis and Kawasaki's disease) vasculitides is extremely rare. The present review describes the main clinical and radiological features of pulmonary vasculitides with major purpose to correlate HRCT findings (solitary or multiple nodules, cavitary lesions, micronodules with centrilobular or peribronchial distribution, airspace consolidations, “crazy paving”, tracheobronchial involvement, interstitial disease) with pathological results paying particular attention to the description of acute life-threatening manifestations. A thorough medical history, careful clinical examination and the knowledge of radiological patterns are mandatory for a correct and early diagnosis. PMID:26876879

  20. SAPHO syndrome in the differential diagnosis of metastasis.

    Science.gov (United States)

    Berenguer Francés, Miguel Ángel; Lafaurie Acevedo, Alejandro; Tormo Ferrero, Vicente; Cardenal Macia, Rafael; Andreu Martínez, Francisco José

    2016-01-01

    SAPHO syndrome was proposed in the late 80s in order to group different osteoarticular manifestations with specific radiological findings such as the hyperostosis of the front part of the chest wall. Prevalence, etiology and pathogenesis of the disease are unknown, while diagnosis is made both clinically and by the specific gammagraphic image of «bull horn» in the sternoclavicular joint. The following case of a 64-year-old woman diagnosed with infiltrating ductal carcinoma of the right breast pT1N0Mx is reported. When studying the extent of the disease, a gammagraphic image of diffuse blast injury in the sterna manubrium was evidenced, which allowed the suspicion of Paget's disease or metastatic injury. Study was completed with a chest CT in which manubrium sclerosis was evidenced, suggesting metástasis. Res ults of the studies pointed out SAPHO syndrome as the most likely diagnostic option. The low tumor stage of the patient prompted the idea of possible alternative diagnoses. A deeper knowledge of this clinical condition may be crucial to avoid mistakes when classifying a subject in more advanced tumor stages, and consequently, to prevent the use of more aggressive chemotherapy and radiotherapy treatments. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  1. Respiratory Epithelium Lined Cyst of the Maxilla: Differential Diagnosis

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    C. P. Martinelli-Kläy

    2017-01-01

    Full Text Available Maxillary cysts, including the cysts lined by respiratory epithelium, can present a diagnostic challenge. We report an unusual case of a maxillary cyst on an endodontically treated tooth #16, in which the cavity was totally lined by a respiratory epithelium. The patient, a 35-year-old male, presented with a generalized chronic periodontitis and complained of a pain in the tooth #16 region. A periodontal pocket extending to the root apices with pus coming out from the gingival was found. A combined endodontic periodontal was observed on a panoramic radiography. CBCT-scan revealed a well-circumscribed radiolucent lesion at the apices of the distobuccal root of the 16. A communication with the right maxillary sinus cavity and a maxillary and ethmoidal sinusitis were also observed. The lesion was removed and histological examination revealed a cyst lined exclusively by respiratory epithelium. Ciliated and rare mucous cells were also observed. The diagnosis could evoke a surgical ciliated cyst mimicking the radicular cyst but the patient has no previous history of trauma or surgery in the maxillofacial region. It could also be an unusual radicular cyst in which the stratified squamous epithelium was destroyed by inflammation and replaced by a respiratory epithelium of the maxillary sinus.

  2. Respiratory Epithelium Lined Cyst of the Maxilla: Differential Diagnosis

    Science.gov (United States)

    Chatelain, S.; Salvado, F.

    2017-01-01

    Maxillary cysts, including the cysts lined by respiratory epithelium, can present a diagnostic challenge. We report an unusual case of a maxillary cyst on an endodontically treated tooth #16, in which the cavity was totally lined by a respiratory epithelium. The patient, a 35-year-old male, presented with a generalized chronic periodontitis and complained of a pain in the tooth #16 region. A periodontal pocket extending to the root apices with pus coming out from the gingival was found. A combined endodontic periodontal was observed on a panoramic radiography. CBCT-scan revealed a well-circumscribed radiolucent lesion at the apices of the distobuccal root of the 16. A communication with the right maxillary sinus cavity and a maxillary and ethmoidal sinusitis were also observed. The lesion was removed and histological examination revealed a cyst lined exclusively by respiratory epithelium. Ciliated and rare mucous cells were also observed. The diagnosis could evoke a surgical ciliated cyst mimicking the radicular cyst but the patient has no previous history of trauma or surgery in the maxillofacial region. It could also be an unusual radicular cyst in which the stratified squamous epithelium was destroyed by inflammation and replaced by a respiratory epithelium of the maxillary sinus. PMID:29093979

  3. Overactive bladder, differential diagnosis, and clinical utility of fesoterodine

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    Wyndaele J-J

    2012-11-01

    Full Text Available Jean-Jacques WyndaeleDepartment of Urology, Antwerp University, Antwerp, BelgiumAbstract: Overactive bladder is a symptom syndrome with urgency, frequency and, in many cases, nocturia. Urge incontinence is not present in all. There is no direct correlation with detrusor overactivity, an objective finding during urodynamic testing where involuntary contractions can be noticed. In the pathophysiology, much more attention has been given to the afferent/sensory arm of the micturition reflex in the last decade. Anatomical and infectious causes have to be diagnosed or ruled out. Diagnosis of overactive bladder is made mostly by history-taking, but other tests can be necessary in specific patients. Treatment consists of behavioral measures, a good explanation of the condition, training, and pelvic floor physiotherapy. Drugs are often used. Until recently, antimuscarinic drugs have been the mainstay of pharmacological therapy. Fesoterodine is a newer antimuscarinic agent which is more pharmacodynamically stable then tolterodine. Fesoterodine has been extensively researched using different dosages and compared with placebo and tolterodine, in different age groups, and under different conditions. Fesoterodine is superior to placebo and to tolterodine in the short term and long term. Its safety is very acceptable.Keywords: overactive bladder, fesoterodine, incontinence, urgency, lower urinary tract

  4. Balloon Cell Urethral Melanoma: Differential Diagnosis and Management

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    M. McComiskey

    2015-01-01

    Full Text Available Introduction. Primary malignant melanoma of the urethra is a rare tumour (0.2% of all melanomas that most commonly affects the meatus and distal urethra and is three times more common in women than men. Case. A 76-year-old lady presented with vaginal pain and discharge. On examination, a 4 cm mass was noted in the vagina and biopsy confirmed melanoma of a balloon type. Preoperative CT showed no distant metastases and an MRI scan of the pelvis demonstrated no associated lymphadenopathy. She underwent anterior exenterative surgery and vaginectomy also. Histology confirmed a urethral nodular malignant melanoma. Discussion. First-line treatment of melanoma is often surgical. Adjuvant treatment including chemotherapy, radiotherapy, or immunotherapy has also been reported. Even with aggressive management, malignant melanoma of the urogenital tract generally has a poor prognosis. Recurrence rates are high and the mean period between diagnosis and recurrence is 12.5 months. A 5-year survival rate of less than 20% has been reported in balloon cell melanomas along with nearly 20% developing local recurrence. Conclusion. To the best of our knowledge, this case is the first report of balloon cell melanoma arising in the urethra. The presentation and surgical management has been described and a literature review provided.

  5. Restless legs syndrome: differential diagnosis and management with rotigotine.

    Science.gov (United States)

    Merlino, Giovanni; Serafini, Anna; Robiony, Francesca; Valente, Mariarosaria; Gigli, Gian Luigi

    2009-01-01

    RLS is a common sleep disorder with distinctive clinical features. The prevalence of RLS in Caucasians and North Americans ranges from 5% to 10%. However, only some of these subjects (almost the 3% of the general population) report being affected by a frequent and severe form of the sleep disorder. RLS is diagnosed clinically by means of four internationally recognized criteria that summarize the main characteristics of the sleep disorder. Besides the essential criteria, supportive and associated features of RLS have been established by experts in order to help physicians treat patients with doubtful symptoms. Several clinical conditions may mimic this sleep disorder. In order to increase the sensibility and specificity of RLS diagnosis, doctors should perform a meticulous patient history and then an accurate physical and neurological examination. Dopamine agonists are recognized as the preferred first-line treatment for RLS. Rotigotine is a non-ergoline dopamine agonist with selectivity for D1, D2 and D3 receptors. The drug is administered via transdermal patches which release rotigotine for 24 hours. Four clinical trials demonstrated that this compound is able to improve RLS symptomatology with few and moderate adverse events. Head to head trials are required to compare the efficacy and tolerability of rotigotine with other dopamine agonists administered via oral intake. Rotigotine has been approved by the FDA and EMEA for Parkinson's disease. For the treatment of moderate to severe idiopathic RLS, rotigotine has been recommended for approval by the EMEA and is under review by the FDA.

  6. Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis

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    Ana Rita Garcia

    2017-10-01

    Full Text Available Hemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-computed tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis.

  7. The role of cognitive-developmental tests in differential diagnosis of borderline and schizophrenic patients

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    Vulević Gordana

    2012-01-01

    Full Text Available The aim of our research was to find out whether cognitive-developmental tests such as Nominal Realism Test and Vygotsky Concept Formation Test could contribute to the process of diagnosing borderline and schizophrenic patients. The specific aim of this study was to assess the diagnostic power of subtests (such as Vocabulary, Comprehension, Similarities and Picture Arrangement Test on Wechsler Adult Intelligence Scale (VITI in the differential diagnosis of the two groups of patients. The study included 90 subjects, 30 of whom were diagnosed with borderline personality disorder (BPD, 30 had the diagnosis of schizophrenic psychosis (SCH, while 30, who had no psychiatric diagnosis, represented the control group. The findings indicate that the patients with BPD, and particularly those diagnosed with SCH, had both quantitative and qualitative cognitive impairment. The findings show that cognitive developmental tests represent valuable tools in the differential diagnosis of borderline personality disorder and schizophrenia.

  8. Differential diagnosis between apraxia and dysarthria based on acoustic analysis.

    Science.gov (United States)

    Melle, Natalia; Gallego, Carlos

    2012-07-01

    Acoustic analysis provides objective quantitative measures of speech that enable a comprehensive and accurate understanding of motor disorders and complement the traditional measures. This paper aims to distinguish between normal and pathological speech, more specifically between apraxia of speech and spastic dysarthria in native Spanish speaking patients using acoustic parameters. Participants (4 aphasic with apraxia of speech, 4 with spastic dysarthria, and 15 without speech disorders) performed three different tasks: repeating the syllable sequence [pa-ta-ka], repeating the isolated syllable [pa] and repeating the vowel sequence [i-u]. The results showed that the normative values of motor control, in general, coincide with those obtained in previous research on native English speakers. They also show that damage to motor control processes results in a decrease in the rate of alternating and sequential movements and an increase in the inter-syllabic time for both types of movements. A subset of the acoustic parameters analyzed, those that measure motor planning processes, enable differentiation between normal population and apraxic and dysarthric patients, and between the latter. The differences between the pathological groups support the distinction between motor planning and motor programming as described by van der Merwe's model of sensorimotor processing (1997).

  9. Feline acromegaly: an essential differential diagnosis for the difficult diabetic.

    Science.gov (United States)

    Niessen, Stijn J M

    2010-01-01

    Clinicians who deal with diabetic cats can have mixed experiences. Some patients are 'textbook cases', responding very well to insulin administration; others prove to be more challenging. Recent studies have shown a significant proportion of problem diabetic cats to have underlying acromegaly (hypersomatotropism). Recognising this syndrome in these cats will be key to successfully managing the concurrent diabetes. Just like the 'normal' (non-acromegalic) diabetic cat, the acromegalic diabetic cat tends to be a middle-aged to older male neutered domestic short hair. However, with increasing case experience, this signalment may change. Most patients are insulin resistant, although this may not be the initial presenting sign. No breed predispositions have been recognised to date. There is no single diagnostic test for feline acromegaly - a confident diagnosis relies on a combination of clinical signs, feline growth hormone and insulin-like growth factor 1 levels, and intracranial imaging. Additionally, the ideal treatment protocol has yet to be established. Currently, radiotherapy is considered by many to be the best treatment; however, costs, the need for multiple anaesthetics, and the often delayed and unpredictable treatment response represent serious limitations of this modality. Previously, medical treatment has proven unsuccessful. Recent studies provide some evidence in favour of, and some against, the use of newer long-acting somatostatin analogue preparations in a proportion of acromegalic cats. Two recent studies have revealed a relatively high prevalence of acromegaly among diabetic cats. One also specifically assessed the value of hormonal tests, computed tomography and magnetic resonance imaging during the diagnostic process. Copyright 2009 ESFM and AAFP. Published by Elsevier Ltd. All rights reserved.

  10. Differential diagnosis of mastoid hypocellularity in human skeletal remains.

    Science.gov (United States)

    Flohr, Stefan; Kierdorf, Uwe; Schultz, Michael

    2009-11-01

    Mastoid hypocellularity is frequently used as an indicator of chronic otits media in paleopathological investigations. The condition can be caused by a poor development of air cells during infancy and early childhood (primary hypocellularity) or by obliteration of air cells with bone during later life (secondary hypocellularity). We performed a macroscopic, radiographic, and microscopic study of pneumatization patterns in 151 mastoid processes of individuals from an early-medieval cemetery in Germany, with emphasis on the architecture of the nonpneumatized portion of hypocellular mastoid processes. Two types of primary mastoid hypocellularity were distinguished. The first was characterized by a poorly defined boundary between the pneumatized portion and the nonpneumatized portion and a trabecular thickening in the spongy bone of the latter. The second showed a well-defined boundary between the pneumatized portion and the nonpneumatized portion and normal spongy bone architecture in the latter. The key feature for the diagnosis of secondary hypocellularity was the recognition of the walls of former air cells. Our observations closely match the histopathological findings by Wittmaack (Wittmaack: Uber die normale und die pathologische Pneumatisation des Schläfenbeins. Jena: Gustav Fischer [1918]), who developed a concept of the normal pneumatization process of the temporal bone and the pathogenesis of aberrant pneumatization. We agree with Wittmaack's view that two types of primary mastoid hypocellularity can be distinguished morphologically. Regarding the pathogenesis of these types, we, however, conclude that Wittmaack's concept needs to be revised and updated. Further studies are required to establish the relationship between morphological findings in cases of mastoid hypocellularity and the health status of individuals.

  11. Toward a Differential Diagnosis of Hidden Hearing Loss in Humans.

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    M Charles Liberman

    Full Text Available Recent work suggests that hair cells are not the most vulnerable elements in the inner ear; rather, it is the synapses between hair cells and cochlear nerve terminals that degenerate first in the aging or noise-exposed ear. This primary neural degeneration does not affect hearing thresholds, but likely contributes to problems understanding speech in difficult listening environments, and may be important in the generation of tinnitus and/or hyperacusis. To look for signs of cochlear synaptopathy in humans, we recruited college students and divided them into low-risk and high-risk groups based on self-report of noise exposure and use of hearing protection. Cochlear function was assessed by otoacoustic emissions and click-evoked electrocochleography; hearing was assessed by behavioral audiometry and word recognition with or without noise or time compression and reverberation. Both groups had normal thresholds at standard audiometric frequencies, however, the high-risk group showed significant threshold elevation at high frequencies (10-16 kHz, consistent with early stages of noise damage. Electrocochleography showed a significant difference in the ratio between the waveform peaks generated by hair cells (Summating Potential; SP vs. cochlear neurons (Action Potential; AP, i.e. the SP/AP ratio, consistent with selective neural loss. The high-risk group also showed significantly poorer performance on word recognition in noise or with time compression and reverberation, and reported heightened reactions to sound consistent with hyperacusis. These results suggest that the SP/AP ratio may be useful in the diagnosis of "hidden hearing loss" and that, as suggested by animal models, the noise-induced loss of cochlear nerve synapses leads to deficits in hearing abilities in difficult listening situations, despite the presence of normal thresholds at standard audiometric frequencies.

  12. Neurocognitive differential diagnosis of dementing diseases: Alzheimer's Dementia, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder.

    Science.gov (United States)

    Braaten, Alyssa J; Parsons, Thomas D; McCue, Robert; Sellers, Alfred; Burns, William J

    2006-11-01

    Similarities in presentation of Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder, pose differential diagnosis challenges. The current study identifies specific neuropsychological patterns of scores for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. Neuropsychological domains directly assessed in the study included: immediate memory, delayed memory, confrontational naming, verbal fluency, attention, concentration, and executive functioning. The results reveal specific neuropsychological comparative profiles for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. The identification of these profiles will assist in the differential diagnosis of these disorders and aid in patient treatment.

  13. [Restless legs syndrome and nocturnal leg pain : Differential diagnosis and treatment].

    Science.gov (United States)

    Hornyak, M; Stiasny-Kolster, K; Evers, S; Happe, S

    2011-09-01

    Pain in the legs belongs to the five most frequent regional pain symptoms. Restless legs syndrome (RLS) presents a particular differential diagnosis for pain in the legs, which is characterized by a nocturnal urge to move the legs often associated with painful sensations in the legs. It is one of the most common neurological disorders and probably the leading cause of nocturnal pain in the legs. In this overview, the diagnosis and therapy of RLS as well as aspects of pain therapy of the disorder are presented. In addition, the differential diagnoses for exclusion of other specific causes of nocturnal pain in the legs are discussed.

  14. Enhancement of multiple cranial and spinal nerves in vanishing white matter: expanding the differential diagnosis.

    Science.gov (United States)

    Eluvathingal Muttikkal, Thomas Jose; Montealegre, Denia Ramirez; Matsumoto, Julie Ann

    2017-10-12

    Abnormal cranial or spinal nerve contrast enhancement on MRI in cases of suspected pediatric leukodystrophy is recognized as an important clue to the diagnosis of either metachromatic leukodystrophy or globoid cell leukodystrophy (Krabbe disease). We report a case of genetically confirmed childhood vanishing white matter with enhancement of multiple cranial and spinal nerves in addition to the more typical intracranial findings. This case expands the limited differential diagnosis of cranial nerve or spinal nerve enhancement in cases of suspected leukodystrophy and may aid in more efficient work-up and earlier diagnosis of vanishing white matter.

  15. Magnetic resonance imaging and bone scintigraphy in the differential diagnosis of unclassified arthritis

    DEFF Research Database (Denmark)

    Duer, Anne; Østergaard, M; Hørslev-Petersen, K

    2008-01-01

    OBJECTIVES: To investigate the value in clinical practice of hand magnetic resonance imaging (MRI) and whole body bone scintigraphy in the differential diagnosis of patients with unclassified arthritis. METHODS: 41 patients with arthritis (> or = 2 swollen joints, > 6 months' duration) which...... joints of the most symptomatic hand and whole body bone scintigraphy were performed. Two rheumatologists agreed on the most likely diagnosis and the patients were treated accordingly. A final diagnosis was made by another specialist review 2 years later. RESULTS: Tentative diagnoses after MRI and bone...

  16. CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Macari, M.; Faust, M.; Liang, H.; Pachter, H.L

    2007-01-15

    Aim: To describe the imaging findings of jejunal diverticulitis as depicted at contrast-enhanced computed tomography (CT) and review the differential diagnosis and clinical management. Materials and Methods: CT and pathology databases were searched for the diagnosis of jejunal diverticulitis. Three cases were identified and the imaging and clinical findings correlated. Results: Jejunal diverticulitis presents as a focal inflammatory mass involving the proximal small bowel. A trial of medical management with antibiotics may be attempted. Surgical resection may be required if medical management is unsuccessful. Conclusion: The imaging findings at MDCT may allow a specific diagnosis of jejunal diverticulitis to be considered and may affect the clinical management of the patient.

  17. Case for diagnosis. Infective dermatitis associated with HTLV-1: differential diagnosis of atopic dermatitis.

    Science.gov (United States)

    Oliveira, Lorena Maria Lima de; Souza, Marcos Vilela de; Guedes, Antonio Carlos Martins; Araújo, Marcelo Grossi

    2017-01-01

    Infective dermatitis associated with HTLV-1 (IDH) is the main cutaneous marker of HTLV-1 infection. This disease occurs primarily in children and should be differentiated from other eczemas, especially from atopic dermatitis. The largest series of IDH are from Jamaica and Brazil. There are an estimated 15 to 20 million infected people in the world, and Brazil is one of the endemic regions. Studies suggest that IDH in children may be a marker for the development of T-cell leukemia/lymphoma (ATL) or myelopathy associated with HTLV-1/tropical spastic paraparesis (HAM / TSP) in adulthood.

  18. Differential diagnosis of stroke in a setting of high HIV prevalence in ...

    African Journals Online (AJOL)

    Background and Purpose: The differential diagnosis of stroke in Africa in areas with high HIV prevalence includes brain infections. We studied causes of stroke in Blantyre, Malawi, where HIV prevalence among medical in-patients is 70%. Methods: In a descriptive study of 8 month duration, all patients presenting at Queen ...

  19. MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis.

    Science.gov (United States)

    Treglia, Giorgio; Cason, Ernesto; Stefanelli, Antonella; Cocciolillo, Fabrizio; Di Giuda, Daniela; Fagioli, Giorgio; Giordano, Alessandro

    2012-02-01

    Differential diagnosis between Parkinson's disease (PD) and other Parkinsonism using clinical criteria or imaging methods is often difficult. The purpose of this study is to systematically review and meta-analyze published data about the diagnostic performance of myocardial innervation imaging using (123)I-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between PD and other Parkinsonism. A comprehensive computer literature search of studies published through March 2011 regarding MIBG scintigraphy in patients with PD and other Parkinsonism was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between PD and other Parkinsonism were selected. Pooled sensitivity, pooled specificity and area under the ROC curve were calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between PD and other Parkinsonism. Nineteen studies comprising 1,972 patients (1,076 patients with PD, 117 patients with other Lewy body diseases and 779 patients with other diseases) were included in this meta-analysis. The pooled sensitivity of MIBG scintigraphy in detecting PD was 88% (95% CI 86-90%); the pooled specificity of MIBG scintigraphy in discriminating between PD and other Parkinsonism was 85% (95% CI 81-88%). The area under the ROC curve was 0.93. In patients with clinically suspected PD, myocardial innervation imaging demonstrated high sensitivity and specificity. MIBG scintigraphy is an accurate test in this setting. Nevertheless, possible causes of false-negative and false-positive results should be kept in mind when interpreting the scintigraphic results.

  20. In regard to the question of macroscopic differential diagnosis of alcoholic and dilated cardiomyopathy

    Directory of Open Access Journals (Sweden)

    O. V. Sokolova

    2014-01-01

    Full Text Available The differential diagnosis of alcoholic and dilated cardiomyopathy according to the macroscopic data is represented in the article. The identity of macroscopic changes of heart, related to alcoholic and dilated cardiomyopathy, cannot diagnose these diseases based on the macroscopic characteristics; especially if there are no other visceral manifestations typical for chronic alcoholism.

  1. Differential diagnosis of stroke. in a setting of high HIV prevalence in ...

    African Journals Online (AJOL)

    4Parasitology, Leiden University Medical Centre, Leiden, the Netherlands. Background and Purpose: The differential diagnosis of stroke in Africa in areas with high. HIV prevalence includes brain infections. We studied causes of stroke in Blantyre, Malawi, Where HIV prevalence among med ical in-patients is 70%. Methods:.

  2. COMPUTED-TOMOGRAPHY IN DIFFERENTIAL-DIAGNOSIS OF TEMPOROMANDIBULAR-JOINT DISORDERS

    NARCIS (Netherlands)

    DEBONT, LGM; VANDERKUIJL, B; STEGENGA, B; VENCKEN, LM; BOERING, G

    Computed tomography (CT) has great potential for imaging intra- and extracapsular hard-tissue abnormality of the temporomandibular joint (TMJ). CT is not the best method of imaging disk position and form. For differential diagnosis of TMJ disorders, CT is especially successful in bony lesions. The

  3. Neutrophil-to-lymphocyte ratio in the differential diagnosis of acute bacterial meningitis.

    Science.gov (United States)

    Mentis, A-F A; Kyprianou, M A; Xirogianni, A; Kesanopoulos, K; Tzanakaki, G

    2016-03-01

    The differential diagnosis of acute community-acquired meningitis is of paramount importance in both therapeutic and healthcare-related economic terms. Despite the routinely used markers, novel, easily calculated, and rapidly available biomarkers are needed particularly in resource-poor settings. A promising, exponentially studied inflammatory marker is the neutrophil-to-lymphocyte ratio (NLR), albeit not assessed in meningitis. The aim of this study was to investigate the utility of the NLR in the differential diagnosis of acute meningitis. Data on cerebrospinal fluid (CSF) and blood leukocyte parameters from more than 4,000 patients diagnosed with either bacterial or viral meningitis in Greece during the period 2006-2013 were retrospectively examined. The diagnostic accuracy of the NLR and neutrophil counts in CSF and blood were evaluated by receiver operating characteristic curves. The discrimination ability of both the NLR and neutrophil counts was significantly higher in CSF than in blood. The optimal cutoff values of the NLR and neutrophil counts were 2 in CSF vs 8 in blood, and 287 cells in CSF vs 12,100 cells in blood, respectively. For these values, sensitivity, negative predictive value, and odds ratio were statistically significantly higher in CSF than blood for both markers. Logistic regression analysis showed that the CSF NLR carries independent and additive information to neutrophil counts in the differential diagnosis of acute meningitis. This study is the first one to assess NLR in acute meningitis, providing promising results for its differential diagnosis.

  4. Estimation of Fractal Dimension in Differential Diagnosis of Pigmented Skin Lesions

    Science.gov (United States)

    Aralica, Gorana; Milošević, Danko; Konjevoda, Paško; Seiwerth, Sven; Štambuk, Nikola

    Medical differential diagnosis is a method of identifying the presence of a particular entity (disease) within a set of multiple possible alternatives. The significant problem in dermatology and pathology is the differential diagnosis of malignant melanoma and other pigmented skin lesions, especially of dysplastic nevi. Malignant melanoma is the most malignant skin neoplasma, with increasing incidence in various parts of the world. It is hoped that the methods of quantitative pathology, i.e. morphometry, can help objectification of the diagnostic process, since early discovery of melanoma results in 10-year survival rate of 90%. The aim of the study was to use fractal dimension calculated from the perimeter-area relation of the cell nuclei as a tool for the differential diagnosis of pigmented skin lesions. We analyzed hemalaun-eosin stained pathohistological slides of pigmented skin lesions: intradermal naevi (n = 45), dysplastic naevi (n = 47), and malignant melanoma (n = 50). It was found that fractal dimension of malignant melanoma cell nuclei differs significantly from the intradermal and dysplastic naevi (p ≤ 0. 001, Steel-Dwass Multiple Comparison Test). Additionaly, ROC analysis confirmed the value of fractal dimension based evaluation. It is suggested that the estimation of fractal dimension from the perimeter-area relation of the cell nuclei may be a potentially useful morphometric parameter in the medical differential diagnosis of pigmented skin lesions.

  5. [Utility of skin ultrasound in the differential diagnosis of blue lesions, hydrocysts].

    Science.gov (United States)

    Perez-Lopez, Israel; Garrido-Colmenero, Cristina; Blasco-Morente, Gonzalo; Aneiros-Fernandez, Jose; Arias-Santiago, Salvador

    2015-04-16

    Many skin diseases may present as blue papules and nodules; the differential diagnosis includes such different entities such as metastatic melanoma, angioma, lipoma, epidermoid cyst, pilomatrixoma, blue nevus, glomus tumor, or hidrocystoma. Cutaneous ultrasound can be a complementary diagnostic technique of great value in these cases.

  6. Student Physical Therapists' Competence and Self-Confidence in Basic Clinical Assessment and Musculoskeletal Differential Diagnosis.

    Science.gov (United States)

    Alexander, Kathleen M; Olsen, Janette; Seiger, Cindy; Peterson, Teri S

    2016-01-01

    Student physical therapists are expected to learn and confidently perform technical skills while integrating nontechnical behavioral and cognitive skills in their examinations and interventions. The purpose of this study was to compare the self-confidence of entry-level doctoral student physical therapists during foundational assessment and musculoskeletal differential diagnosis courses and the students' competencies based on skills examinations. Methods using qualitative and quantitative procedures. Student physical therapists (n=27) participated in a basic assessment course followed by a musculoskeletal differential diagnosis course. The students completed confidence surveys prior to skills examinations in both courses. A random sample of students participated in focus groups, led by a researcher outside the physical therapy department. Student confidence did not correlate with competency scores. At the end of the basic clinical assessment course and the beginning of the differential diagnosis course, students' confidence was significantly below baseline. However, by the end of the differential diagnosis course, student confidence had returned to original baseline levels. Over three semesters, the students lost confidence and then regained confidence in their abilities. Additional experience and practice influenced perceived confidence. However, increased competence may have been associated with poor self-appraisal skills instead of increased competency.

  7. Differential diagnosis in computerized tomography. 2. rev. and enl. ed.; Differenzialdiagnosen in der Computertomografie

    Energy Technology Data Exchange (ETDEWEB)

    Burgener, Francis A.; Meyers, Steven P. [Rochester Univ., NY (United States). Dept. of Imaging Sciences; Herzog, Christopher [Rotkreuzklinikum Muenchen (Germany); Zaunbauer, Wolfgang [Kantonsspital St. Gallen (Switzerland). Inst. fuer Radiologie

    2013-02-01

    The book on differential diagnosis in computerized tomography is aimed to support radiologists and physicians with experience concerning the interpretation of computerized tomography images by detailed descriptions of CT diagnoses. The book covers the following topics: intracranial indications, head and neck, spinal cord, muscle-skeleton system, thorax, abdomen and pelvis.

  8. Ulno-volar bayonet hand: Its differential diagnosis from Madelung's deformity

    Energy Technology Data Exchange (ETDEWEB)

    Christ, F.

    1981-04-01

    The ulno-volar bayonet hand related to the mostly hereditary multiple exostoses is compared to Madelung's forearm deformity under clinical and roentgenological view in differential diagnosis. The ulno-volar bayonet hand is considerably more seldom, basing upon dysplasia of the lower part of the ulna, less inconvenient in function, and hardly tending to the development of early arthrosis.

  9. Forensic Case Reports Presenting Immersion Pulmonary Edema as a Differential Diagnosis in Fatal Diving Accidents

    DEFF Research Database (Denmark)

    Vinkel, Julie; Bak, Peter; Juel Thiis Knudsen, Peter

    2018-01-01

    deaths, and through a thorough analysis of each case, including both diving physiology and forensic pathology, we present IPE as a differential diagnosis to drowning in four cases. Our findings propose that; absence of watery content in the stomach and conducting airways, and liquid filled lungs without...

  10. Differential diagnosis in inflammatory bowel disease colitis: State of the art and future perspectives

    Science.gov (United States)

    Tontini, Gian Eugenio; Vecchi, Maurizio; Pastorelli, Luca; Neurath, Markus F; Neumann, Helmut

    2015-01-01

    Distinction between Crohn’s disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis cannot be reached in up to 10% of patients presenting with IBD colitis. This topic is receiving emerging attention, as medical therapies, surgical approaches and leading prognostic outcomes require more and more disease-specific strategies in IBD patients. The optimization of standard diagnostic approaches based on clinical features, biomarkers, radiology, endoscopy and histopathology appears to provide only marginal benefits. Conversely, emerging diagnostic techniques in the field of gastrointestinal endoscopy, molecular pathology, genetics, epigenetics, metabolomics and proteomics have already shown promising results. Novel advanced endoscopic imaging techniques and biomarkers can shed new light for the differential diagnosis of IBD, better reflecting diverse disease behaviors based on specific pathogenic pathways. PMID:25574078

  11. Granulomatosis with polyangiitis (Wegener granulomatosis) as a differential diagnosis of sternal osteomyelitis: the challenges in diagnosis.

    Science.gov (United States)

    Kim, Sang-Dong; Kim, Gun-Woo; Kim, Tae-Eun; Nam, Eun-Jung; Han, Seung-Woo

    2013-12-01

    Although granulomatosis with polyangiitis (GPA) can affect a large number of organ systems and produce a broad spectrum of clinical symptoms, skeletal involvement is very rare, with the exception of facial bone involvement associated with destructive nasal and sinus inflammation. We describe here a 54-year-old man with sternal osteomyelitis and destructive arthritis around the sternoclavicular joint. Despite antibiotics and conventional immunosuppressive treatment, his symptoms deteriorated, and a new mass-like lung lesion was developed. A histopathologic analysis of the lung mass revealed chronic granulomatous inflammation with fibrinoid necrosis, and he was diagnosed with GPA. When a patient with a destructive inflammatory lesion has negative culture results and no response to conventional therapy, we propose that an aggressive approach is necessary for a pathologic diagnosis to exclude the possibility of GPA.

  12. Clinical presentation and differential diagnosis of dementia with Lewy bodies: a review.

    Science.gov (United States)

    Morra, L F; Donovick, P J

    2014-06-01

    Dementia with Lewy bodies is one of the most prevalent dementia diagnoses. However, differential diagnosis between dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia can still be very difficult given the overlap in neuropathology, clinical presentation, cognitive, and neuroanatomical changes. A literature review of dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia was conducted using PubMed. Accurate diagnosis of dementia with Lewy bodies is crucial in order to more accurately predict the progression of the disease and negative side effects from pharmacological treatment. The differences and similarities between dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia are highlighted in order to aid clinicians in differential diagnosis. Copyright © 2013 John Wiley & Sons, Ltd.

  13. Epiglottic masses identified on CT imaging: A case report and review of the broad differential diagnosis

    Science.gov (United States)

    Saraf-Lavi, Efrat; Kryvenko, Oleksandr; Sargi, Zoukaa

    2015-01-01

    Epiglottic masses may be cystic, granulomatous, infectious, benign or malignant neoplastic, or manifestations of a systemic disease. When large in size, the airway may become obstructed, and when accompanied by suspicious features such as cartilaginous invasion, extension to the pre-epiglottic or para-glottic spaces, or lymphadenopathy, the radiologist must consider malignancy as a primary differential diagnosis. However, when only benign features are identified, the differential diagnosis is broad. We present a 65-year-old female with an incidental 1 cm exophytic, pedunculated, papillomatous lesion on the laryngeal surface of the epiglottis discovered upon endoscopic evaluation for dyspepsia and heartburn. Because of her risk factors for malignancy, CT scan was requested and revealed only benign features. Subsequent excisional biopsy revealed a benign squamous papilloma; however, multiple additional differential considerations were entertained preoperatively. PMID:26246108

  14. [Comorbid psychiatric disorders and differential diagnosis of patients with autism spectrum disorder without intellectual disability].

    Science.gov (United States)

    Strunz, Sandra; Dziobek, Isabel; Roepke, Stefan

    2014-06-01

    Autism spectrum conditions (ASC) without intellectual disability are often diagnosed late in life. Little is known about co-occurring psychiatric disorders and differential diagnosis of ASC in adulthood, particularly with regard to personality disorders. What kind of comorbid psychiatric disorders occur in ASC? Which are the most prevalent differential diagnoses in a sample of patients who seek autism specific clinical diagnostics? 118 adults who were referred with a presumed diagnosis of autistic disorder, were diagnosed with autism specific instruments and the prevalence of further psychiatric disorders was investigated. 59 (50%) fulfilled the criteria of ASC. 36% of the individuals with ASC fulfilled also criteria for a DSM-IV axis-I psychiatric disorder. Affective disorders (24%) and social phobia (14%) were the most prevalent comorbid disorders. The most frequent differential diagnoses were depression, social phobia, paranoid, avoidant and narcissistic personality disorder. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Contrast-enhanced ultrasonography in differential diagnosis of benign and malignant ovarian tumors.

    Directory of Open Access Journals (Sweden)

    Jing-Jing Qiao

    Full Text Available To evaluate the accuracy of contrast-enhanced ultrasonography (CEUS in differential diagnosis of benign and malignant ovarian tumors.The scientific literature databases PubMed, Cochrane Library and CNKI were comprehensively searched for studies relevant to the use of CEUS technique for differential diagnosis of benign and malignant ovarian cancer. Pooled summary statistics for specificity (Spe, sensitivity (Sen, positive and negative likelihood ratios (LR+/LR-, and diagnostic odds ratio (DOR and their 95%CIs were calculated. Software for statistical analysis included STATA version 12.0 (Stata Corp, College Station, TX, USA and Meta-Disc version 1.4 (Universidad Complutense, Madrid, Spain.Following a stringent selection process, seven high quality clinical trials were found suitable for inclusion in the present meta-analysis. The 7 studies contained a combined total of 375 ovarian cancer patients (198 malignant and 177 benign. Statistical analysis revealed that CEUS was associated with the following performance measures in differential diagnosis of ovarian tumors: pooled Sen was 0.96 (95%CI = 0.92∼0.98; the summary Spe was 0.91 (95%CI = 0.86∼0.94; the pooled LR+ was 10.63 (95%CI = 6.59∼17.17; the pooled LR- was 0.04 (95%CI = 0.02∼0.09; and the pooled DOR was 241.04 (95% CI = 92.61∼627.37. The area under the SROC curve was 0.98 (95% CI = 0.20∼1.00. Lastly, publication bias was not detected (t = -0.52, P = 0.626 in the meta-analysis.Our results revealed the high clinical value of CEUS in differential diagnosis of benign and malignant ovarian tumors. Further, CEUS may also prove to be useful in differential diagnosis at early stages of this disease.

  16. "Daddy's Gone to War": Father Absence and Its Differential Effects on America's Homefront Girls and Boys during the Second World War--and After.

    Science.gov (United States)

    Tuttle, William M., Jr.

    The absence of fathers during World War II had differing effects on the development of identity in boys and girls. Articles and research of the era discussed boys' separation from their fathers but largely failed to address daughters' loss of paternal influence. Evidence suggests that for both boys and girls, the problem was not primarily the…

  17. Boye, TE

    African Journals Online (AJOL)

    Boye, TE. Vol 1, No 4 (2012) - Articles Sociological Variables Influencing the Nigeria Premier League Abstract PDF. ISSN: 2006-5442. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact AJOL ...

  18. differential diagnosis

    African Journals Online (AJOL)

    tion and pervasive developmental disorders (autism, Asperger's syndrome, Rett's disorder and childhood disintegrative disorder) often have additional psychiatric and behavioural problems. These include hyperactivity, aggression, inattention, self injury, stereotyping, impaired social interaction and poor peer relation-.

  19. CT diagnosis and differential diagnosis of otodystrophic lesions of the temporal bone

    Energy Technology Data Exchange (ETDEWEB)

    D' Archambeau, O.; Parizel, P.M.; Schepper, A.M. De (Antwerp University Hospital (Belgium). Department of Radiology); Koekelkoren, E.; Van De Heyning, P. (Antwerp University Hospital (Belgium). Department of E.N.T.)

    The purpose of this study was to assess the diagnostic and differential diagnostic value of high-resolution computed tomography in the evaluation of temporal-bone dystrophies. The study group included 55 patients with osseous abnormalities of the temporal bone in general, and the labyrinthine capsule in particular. In 27 patients the CT scan revealed evidence of otodystrophic lesions. The CT findings in patients with otosclerosis (21 patients), osteogenesis imperfecta (two patients), fibrous dysplasia (one patient). Paget's disease (one patient) and osteoporosis (two patients) are described. The CT scans of 17 patients revealed secondary osseous lesions due to metastasis (five patients), post-inflammatory changes (10 patients) or labyrinthitis ossificans (two patients). Normal variants and congenital mineralization defects were diagnosed in nine patients, Down's syndrome in two. Our results indicate the importance of high-resolution computed tomography as the primary imaging modality in evaluating osseous lesions of the temporal bone and labyrinth. (author). 14 refs.; 13 figs; 2 tabs.

  20. The Potential of Gait Analysis to Contribute to Differential Diagnosis of Early Stage Dementia: Current Research and Future Directions

    Science.gov (United States)

    Morgan, Debra; Funk, Melanie; Crossley, Margaret; Basran, Jenny; Kirk, Andrew; Bello-Haas, Vanina Dal

    2007-01-01

    Early differential diagnosis of dementia is becoming increasingly important as new pharmacologic therapies are developed, as these treatments are not equally effective for all types of dementia. Early detection and differential diagnosis also facilitates informed family decision making and timely access to appropriate services. Information about…

  1. Compilation of a preliminary checklist for the differential diagnosis of neurogenic stuttering

    Directory of Open Access Journals (Sweden)

    Mariska Lundie

    2014-06-01

    Full Text Available Background: Neurogenic stuttering (NS is the most frequently occurring acquired form of stuttering in children and adults. This form of stuttering is primarily caused by neurological incidents. Owing to controversies with regard to similarities between developmental stuttering (DS and NS symptomatology, differential diagnosis is problematic. Differential diagnosis will guide the appropriate management of persons who stutter (PWS.Objectives: The aim of this study was to describe and highlight the characteristics of NS in order to compile a preliminary checklist for accurate diagnosis and intervention.Method: An explorative, applied mixed method, multiple case study research design was followed. Purposive sampling was used to select four participants. A comprehensive assessment battery was compiled for data collection.Results: The results revealed a distinct pattern of core stuttering behaviours in NS, although discrepancies existed regarding stuttering severity and frequency. It was also found that DS and NS can co-occur. The case history and the core stuttering pattern are important considerations during differential diagnosis, as these are the only consistent characteristics in people with NS.Conclusion: It is unlikely that all the symptoms of NS are present in an individual. The researchers scrutinised the findings of this study and the findings of previous literature to compile a potentially workable checklist.

  2. [A modified Calgary syncope syndrome score in the differential diagnosis between cardiac syncope and vasovagal syncope].

    Science.gov (United States)

    Jin, Hong-fang; Yang, Jin-yan; Li, Xue-ying; Zhu, Lu-lu; Han, Ling; Zhang, Feng-wen; Chen, Li; Du, Jun-bao; Zhang, Qing-you

    2012-02-01

    This study aimed at analyzing the usefulness of a modified Calgary Syncope Syndrome Score in the differential diagnosis between cardiac syncope (CS) and vasovagal syncope (VVS) in children through a large sample clinical study. Totally 189 children [112 males, 77 females, aged 2 - 18 yrs, mean age (12.4 ± 3.1) yrs] with CS and VVS who were at the syncope clinic or admitted to the Department of Pediatrics, Peking University First Hospital from August 2002 to April 2011 were included in the study. The diagnosis was analyzed by a modified Calgary Syncope Syndrome Score and receiver operating characteristic (ROC) curve was used to explore the predictive value of different Calgary Syncope Syndrome Scores in differential diagnosis between CS and VVS. There were significant differences in the score between CS [-5.00(-7, 1)] and VVS [1(-4, 6)] (P Syndrome Score was integer number, CS should be considered when the score was less than -3. The modified Calgary Syncope Syndrome Score might be used as an initial diagnostic method in differential diagnosis between CS and VVS, based on the history of the patients.

  3. Compilation of a preliminary checklist for the differential diagnosis of neurogenic stuttering.

    Science.gov (United States)

    Lundie, Mariska; Erasmus, Zandria; Zsilavecz, Ursula; Van der Linde, Jeannie

    2014-06-27

    Neurogenic stuttering (NS) is the most frequently occurring acquired form of stuttering in children and adults. This form of stuttering is primarily caused by neurological incidents. Owing to controversies with regard to similarities between developmental stuttering (DS) and NS symptomatology, differential diagnosis is problematic. Differential diagnosis will guide the appropriate management of persons who stutter (PWS). The aim of this study was to describe and highlight the characteristics of NS in order to compile a preliminary checklist for accurate diagnosis and intervention. An explorative, applied mixed method, multiple case study research design was followed. Purposive sampling was used to select four participants. A comprehensive assessment battery was compiled for data collection. The results revealed a distinct pattern of core stuttering behaviours in NS, although discrepancies existed regarding stuttering severity and frequency. It was also found that DS and NS can co-occur. The case history and the core stuttering pattern are important considerations during differential diagnosis, as these are the only consistent characteristics in people with NS. It is unlikely that all the symptoms of NS are present in an individual. The researchers scrutinised the findings of this study and the findings of previous literature to compile a potentially workable checklist.

  4. Diagnosis and differential diagnosis of Graves' orbitopathy in MRI; Diagnose und Differenzialdiagnose der endokrinen Orbitopathie in der MRT

    Energy Technology Data Exchange (ETDEWEB)

    Daubner, D.; Spieth, S.; Engellandt, K.; Kummer, R. von [Universitaetsklinikum Carl Gustav Carus, Technische Universitaet Dresden, Abteilung Neuroradiologie, Institut und Poliklinik fuer Radiologische Diagnostik, Dresden (Germany)

    2012-06-15

    Imaging of Graves' orbitopathy (GO) includes radiological and nuclear medicine procedures. Depending on the method used they provide information about the distribution and activity of the disease. Magnetic resonance imaging (MRI) is not only a helpful tool for making the diagnosis it also enables differentiation of the active and inactive forms of GO due to intramuscular edema. The modality is therefore appropriate to evaluate the disease activity and the course of therapy. The disease leads to the typical enlargement of the muscle bodies of the extraocular muscles. The inferior rectus, medial rectus and levator palpebrae muscles are mostly involved. Signal changes of the intraconal and extraconal fat tissue are possible and a bilateral manifestation is common. The differential diagnosis includes inflammatory diseases and tumors, of which orbital pseudotumor (idiopathic, unspecific orbital inflammation), ocular myositis and orbital lymphoma are the most important. The specific patterns (localization, involvement of orbital structures and signal changes) can be differentiated by MRI. (orig.) [German] Die Bildgebung der endokrinen Orbitopathie (EO) umfasst radiologische und nuklearmedizinische Verfahren, die je nach Methode Aussagen zur Verteilung und Aktivitaet der Erkrankung liefern. Die Magnetresonanztomographie (MRT) ist nicht nur zur Diagnosestellung hilfreich, sondern auch in der Lage, die aktive von der inaktiven Form anhand des intramuskulaeren Oedems zu unterscheiden. Das Verfahren eignet sich deshalb auch zur Aktivitaetsbeurteilung und zur Bewertung einer Therapie im Verlauf. Die Erkrankung fuehrt zu einer typischen Verdickung des Muskelbauchs der extraokulaeren Augenmuskeln, wobei die Mm. rectus inferior, rectus medialis und levator palpebrae am haeufigsten betroffen sind. Signalveraenderungen des intra- und extrakonalen Fettgewebes sind moeglich, und eine bilaterale Manifestation ist haeufig. Die Differenzialdiagnose umfasst neben anderen

  5. Fault detection and diagnosis in nonlinear systems a differential and algebraic viewpoint

    CERN Document Server

    Martinez-Guerra, Rafael

    2014-01-01

    The high reliability required in industrial processes has created the necessity of detecting abnormal conditions, called faults, while processes are operating. The term fault generically refers to any type of process degradation, or degradation in equipment performance because of changes in the process's physical characteristics, process inputs or environmental conditions. This book is about the fundamentals of fault detection and diagnosis in a variety of nonlinear systems which are represented by ordinary differential equations. The fault detection problem is approached from a differential algebraic viewpoint, using residual generators based upon high-gain nonlinear auxiliary systems (‘observers’). A prominent role is played by the type of mathematical tools that will be used, requiring knowledge of differential algebra and differential equations. Specific theorems tailored to the needs of the problem-solving procedures are developed and proved. Applications to real-world problems, both with constant an...

  6. Plasmodium species differentiation by non-expert on-line volunteers for remote malaria field diagnosis.

    Science.gov (United States)

    Ortiz-Ruiz, Alejandra; Postigo, María; Gil-Casanova, Sara; Cuadrado, Daniel; Bautista, José M; Rubio, José Miguel; Luengo-Oroz, Miguel; Linares, María

    2018-01-30

    Routine field diagnosis of malaria is a considerable challenge in rural and low resources endemic areas mainly due to lack of personnel, training and sample processing capacity. In addition, differential diagnosis of Plasmodium species has a high level of misdiagnosis. Real time remote microscopical diagnosis through on-line crowdsourcing platforms could be converted into an agile network to support diagnosis-based treatment and malaria control in low resources areas. This study explores whether accurate Plasmodium species identification-a critical step during the diagnosis protocol in order to choose the appropriate medication-is possible through the information provided by non-trained on-line volunteers. 88 volunteers have performed a series of questionnaires over 110 images to differentiate species (Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae, Plasmodium knowlesi) and parasite staging from thin blood smear images digitalized with a smartphone camera adapted to the ocular of a conventional light microscope. Visual cues evaluated in the surveys include texture and colour, parasite shape and red blood size. On-line volunteers are able to discriminate Plasmodium species (P. falciparum, P. malariae, P. vivax, P. ovale, P. knowlesi) and stages in thin-blood smears according to visual cues observed on digitalized images of parasitized red blood cells. Friendly textual descriptions of the visual cues and specialized malaria terminology is key for volunteers learning and efficiency. On-line volunteers with short-training are able to differentiate malaria parasite species and parasite stages from digitalized thin smears based on simple visual cues (shape, size, texture and colour). While the accuracy of a single on-line expert is far from perfect, a single parasite classification obtained by combining the opinions of multiple on-line volunteers over the same smear, could improve accuracy and reliability of Plasmodium species

  7. A case report of an intermuscular lipoma: presentation, pathophysiology, differential diagnosis.

    Science.gov (United States)

    Kaeser, Martha A; Smith, Linda W; Kettner, Norman W

    2010-09-01

    The purpose of this report is to present the case of a 54-year-old female patient with a pathologically confirmed diagnosis of soft tissue lipoma. The clinical presentation, pathophysiology, differential diagnosis, and treatment options for lipoma are described. The patient presented to a chiropractic clinic with painful swelling in the right anterior thigh. Physical examination revealed a palpable mobile mass with minimal tenderness. The initial consultation was with the primary care physician, and it resulted in a sonographic examination as the initial imaging modality to rule out deep venous thrombosis. The result of this examination was negative. Following a delay by additional incorrect diagnoses and treatments, a diagnosis of an intermuscular lipoma was established by magnetic resonance imaging and confirmed on biopsy as a soft tissue lipoma. The patient underwent complete excision of the mass. Lipomas are common benign soft tissue masses and should be considered in the differential diagnosis of a thigh mass. Magnetic resonance imaging with contrast depicts the lipomatous mass as having a characteristic high-intensity fat signal without enhancement. It is important for clinicians to have an increased awareness in recognizing the clinical and imaging manifestations of a soft tissue lipoma to optimize an initial diagnosis and treatment. Copyright © 2010 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  8. Differential diagnosis between schizophrenia, pervasive development disorders and obsessive-compulsive disorder in childhood

    OpenAIRE

    Almeida, Marcelo Machado de; Silva, Ana Raquel Correa e; Lauar,Hélio; Carvalho, Luciana de

    2003-01-01

    As dificuldades no diagnóstico dos transtornos mentais na infância criam dilemas e escassez de literatura específica. Neste estudo de caso discutimos o diagnóstico diferencial entre esquizofrenia, transtornos invasivos do desenvolvimento e transtorno obsessivo-compulsivo em uma garota de 7 anos. Difficulties of diagnosis of mental disorders in children lead us to dilemmas due to a lack of specific literature. In this case study we discuss the differential diagnosis between schizophrenia, p...

  9. A Case of Relapsing-Remitting Neuroborreliosis Challenges in the Differential Diagnosis of Recurrent Myelitis

    Directory of Open Access Journals (Sweden)

    P. Albrecht

    2012-03-01

    Full Text Available We report the case of a 31-year-old woman with 4 episodes of myelitis with pleocytosis, a positive Borrelia burgdorferi serology with positive antibody indices, and full recovery each time after antibiotic and steroid treatment, suggesting neuroborreliosis. We nevertheless believe that recurrent neuroborreliosis is improbable based on the levels of the chemokine CXCL13 in cerebrospinal fluid and favor the diagnosis of post-infectious autoimmune-mediated transverse myelitis possibly triggered by an initial neuroborreliosis as the cause of the relapses observed in our patient. We demonstrate the diagnostic steps and procedures which were important in the differential diagnosis of this unusual and challenging case.

  10. Infantile myofibroma or lymphatic malformation: differential diagnosis of neonatal cystic cervicofacial lesions.

    Science.gov (United States)

    Merrell, Stephen C; Rahbar, Reza; Alomari, Ahmad I; Padua, Horacio M; Vargas, Sara O; Neufeld, Ellis J; Dearden, Jennifer L; Mulliken, John B; Greene, Arin K

    2010-03-01

    A 5-day-old male neonate was referred to our vascular anomalies center with a large cystic submandibular mass. History and physical examination and ultrasonographic results indicated the diagnosis to be macrocystic lymphatic malformation. Consequently, the child was treated with sclerotherapy and subtotal excision. The histopathological examination result showed that the lesion was infantile myofibroma. This diagnostic error was attributed to atypical features of infantile myofibroma in this child: unusually large cysts, rapid enlargement, and coagulopathy. This report expands the clinical spectrum of infantile myofibromatosis and suggests its consideration in the differential diagnosis of neonatal cystic cervicofacial lesions.

  11. Tuberculosis of the glans penis: an important differential diagnosis of genital ulcer disease.

    Science.gov (United States)

    Singal, Archana; Pandhi, Deepika; Kataria, Vandana; Arora, Vinod K

    2017-12-01

    We report a 45-year-old, apparently healthy sero-negative man, presenting with multiple ulcers on the glans penis for a duration of three months. There was no significant inguinal lymphadenopathy. He showed no improvement on systemic antibiotics and acyclovir. Histopathology revealed the diagnosis of genital tuberculosis (TB), and polymerase chain reaction for Mycobacterium tuberculosis tested positive. The patient responded well to category I anti-tubercular treatment with complete resolution of lesions in six months. It is important to consider a differential diagnosis of penile TB in patients with non-healing genital ulcers.

  12. Sporothrix schenckii Sensu Lato identification in fragments of skin lesion cultured in NNN medium for differential diagnosis of cutaneous leishmaniasis.

    Science.gov (United States)

    Antonio, Liliane de Fátima; Pimentel, Maria Inês Fernandes; Lyra, Marcelo Rosandiski; Madeira, Maria de Fátima; Miranda, Luciana de Freitas Campos; Paes, Rodrigo Almeida; Brito-Santos, Fábio; Carvalho, Maria Helena Galdino Figueredo; Schubach, Armando de Oliveira

    2017-02-01

    Eighty-nine patients with clinical suspicion of leishmaniasis were referred for differential diagnosis. Sporothrix schenckii sensu lato was isolated in Novy-MacNeal-Nicolle + Schneider media in 98% of 64 patients with final diagnosis of sporotrichosis. This medium may be suitable for diagnosis of sporotrichosis in areas where cutaneous leishmaniasis is also endemic. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Computer tomographic differential diagnosis of benign and malignant lipoid masses in the mediastinum and their spread

    Energy Technology Data Exchange (ETDEWEB)

    Sinner, W.N.

    1980-06-01

    Details of the tissues in the mediastinum can nowadays be demonstrated by computer tomography (CT) pictorially and quantitative measurements of their density coefficient carried out. The diagnosis of a fat-containing tumour or of benign lipomatosis of the mediastinum and their differentiation from malignant lesions is important for treatment and prognosis. In the past this could only be done by surgery. CT permits this differentiation pre-operatively and by a non-invasive method. The extent of malignant tumours and their relationship to other mediastinal structures and their spread beyond the mediastinum can be determined.

  14. Common recessive limb girdle muscular dystrophies differential diagnosis: why and how?

    Directory of Open Access Journals (Sweden)

    Ana Cotta

    2014-09-01

    Full Text Available Limb girdle muscular dystrophies are heterogeneous autosomal hereditary neuromuscular disorders. They produce dystrophic changes on muscle biopsy and they are associated with mutations in several genes involved in muscular structure and function. Detailed clinical, laboratorial, imaging, diagnostic flowchart, photographs, tables, and illustrated diagrams are presented for the differential diagnosis of common autosomal recessive limb girdle muscular dystrophy subtypes diagnosed nowadays at one reference center in Brazil. Preoperative image studies guide muscle biopsy site selection. Muscle involvement image pattern differs depending on the limb girdle muscular dystrophy subtype. Muscle involvement is conspicuous at the posterior thigh in calpainopathy and fukutin-related proteinopathy; anterior thigh in sarcoglycanopathy; whole thigh in dysferlinopathy, and telethoninopathy. The precise differential diagnosis of limb girdle muscular dystrophies is important for genetic counseling, prognostic orientation, cardiac and respiratory management. Besides that, it may probably, in the future, provide specific genetic therapies for each subtype.

  15. [Identification and application of marker genes for differential diagnosis of chronic fatigue syndrome].

    Science.gov (United States)

    Kawai, Tomoko; Rokutan, Kazuhito

    2007-06-01

    Chronic fatigue syndrome (CFS) is a complex disease and has no laboratory biomarkers, which makes diagnosis of CFS difficult. Several research groups challenged to identify genes specific for CFS; however, there are no overlaps between studies. The U.S. Centers for Disease Control and Prevention reported remarkable gene expression profiles of a large scale cohort study recruited 227 people. Reported genes were mostly different from the previously reported genes, again featuring the complexity of CFS. Separately, we identified 9 genes that were significantly and differentially expressed between CFS patients and healthy subjects using an original microarray. The changes in expression of 9 genes were confirmed by quantitative PCR. We also demonstrated the usefulness of 9 genes for differential diagnosis of CFS.

  16. Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment.

    Science.gov (United States)

    Brewer, Rachel Biber; Gregory, Andrew J M

    2012-03-01

    Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse. PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment. Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary. Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians.

  17. Meniere′s disease: Still a mystery disease with difficult differential diagnosis

    Directory of Open Access Journals (Sweden)

    Vassiliou A

    2011-01-01

    Full Text Available One hundred and forty-six years after its first description, the differential diagnosis of Meniere′s disease remains very challenging. The aim of the present study is to review the current knowledge on the advantages and disadvantages of the new diagnostic methods for Meniere′s disease. The importance of accurate diagnosis for primary healthcare systems is also discussed. An extensive search of the literature was performed in Medline and other available database sources. Information from electronic links and related books were also included. Controlled clinical studies, prospective cohort studies, retrospective cohort studies, cross-sectional studies, case reports, written guidelines, systematic reviews, and books were selected. The typical clinical triad of symptoms from the vestibular and cochlear systems (recurrent vertigo, fluctuating sensorineural hearing loss and tinnitus is usually the key for clinical diagnosis. Glycerol dehydration test and electrocochleography are the main diagnostic tests in current practice, while vestibular evoked myogenic potentials may be used in disease staging. Imagine techniques are not specific enough to set alone the diagnosis of Meniere′s disease, although they may be necessary to exclude other pathologies. Recently developed 3D MRI protocols can delineate the perilymphatic/endolymphatic spaces of the inner ear and aid diagnosis. Meniere′s disease is a continuous problem for the patients and affects their quality of life. Taking into account the frequent nature of the disease in certain countries, efforts for reliable diagnosis, prompt referral, and successful management are undoubtedly cost-effective for healthcare systems.

  18. Brain MR Contribution to the Differential Diagnosis of Parkinsonian Syndromes: An Update

    Directory of Open Access Journals (Sweden)

    Giovanni Rizzo

    2016-01-01

    Full Text Available Brain magnetic resonance (MR represents a useful and feasible tool for the differential diagnosis of Parkinson’s disease. Conventional MR may reveal secondary forms of parkinsonism and may show peculiar brain alterations of atypical parkinsonian syndromes. Furthermore, advanced MR techniques, such as morphometric-volumetric analyses, diffusion-weighted imaging, diffusion tensor imaging, tractography, proton MR spectroscopy, and iron-content sensitive imaging, have been used to obtain quantitative parameters useful to increase the diagnostic accuracy. Currently, many MR studies have provided both qualitative and quantitative findings, reflecting the underlying neuropathological pattern of the different degenerative parkinsonian syndromes. Although the variability in the methods and results across the studies limits the conclusion about which technique is the best, specific radiologic phenotypes may be identified. Qualitative/quantitative MR changes in the substantia nigra do not discriminate between different parkinsonisms. In the absence of extranigral abnormalities, the diagnosis of PD is more probable, whereas basal ganglia changes (mainly in the putamen suggest the diagnosis of an atypical parkinsonian syndrome. In this context, changes in pons, middle cerebellar peduncles, and cerebellum suggest the diagnosis of MSA, in midbrain and superior cerebellar peduncles the diagnosis of PSP, and in whole cerebral hemispheres (mainly in frontoparietal cortex with asymmetric distribution the diagnosis of Corticobasal Syndrome.

  19. Efficient Targeted Next Generation Sequencing-Based Workflow for Differential Diagnosis of Alport-Related Disorders

    OpenAIRE

    Gábor Kovács; Tibor Kalmár; Emőke Endreffy; Zoltán Ondrik; Béla Iványi; Csaba Rikker; Ibolya Haszon; Sándor Túri; Mária Sinkó; Csaba Bereczki; Zoltán Maróti

    2016-01-01

    Alport syndrome (AS) is an inherited type IV collagen nephropathies characterized by microscopic hematuria during early childhood, the development of proteinuria and progression to end-stage renal disease. Since choosing the right therapy, even before the onset of proteinuria, can delay the onset of end-stage renal failure and improve life expectancy, the earliest possible differential diagnosis is desired. Practically, this means the identification of mutation(s) in COL4A3-A4-A5 genes. We us...

  20. Late-onset childhood occipital epilepsy. An unusual case in adolescence and differential diagnosis with migraine

    OpenAIRE

    Liberalesso, Paulo Breno Noronha; Silva, Izabella Celidônio Bertoldo da; Klagenberg, Karlin Fabianne; Jurkiewicz, Ari Leon; Zeigelboim, Bianca Simone

    2009-01-01

    INTRODUCTION: The new proposed classification of ILAE Task Force (2001) proposes that the occipital epilepsies should be split into two subtypes: an early-onset benign childhood occipital epilepsy (or Panayiotopoulos type) and late-onset childhood occipital epilepsy (or Gastaut type). Migraine with visual aura must be considered as a differential diagnosis in childhood and adolescents with occipital epilepsy without motor phenomena. OBJECTIVE: The goal of our paper is to report the case a 16-...

  1. Ureteral polyp: a difficult case to make a differential diagnosis with ureteral tumor

    OpenAIRE

    本多, 正人; 中村, 正広

    1992-01-01

    We report a case of primary fibroepithelial polyp of the left ureter. The patient was a 34-year-old-man, complaining of left flank pain. An excretory urogram and retrograde pyelogram revealed left hydronephrosis and filling defect of the middle third of ureter. It was difficult to make a differential diagnosis with ureteral tumor. A frozen section revealed no malignancy and we performed partial ureterectomy and end-to-end anastomosis. We discussed the clinical features of adult primary ureter...

  2. Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

    OpenAIRE

    Yoon, William; Paulson, Kari; Mazzara, Paul; Nagori, Sweety; Barawi, Mohammed; Berri, Richard

    2012-01-01

    Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should i...

  3. Differential diagnosis of infections in a patient with Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Paolo Ghiringhelli

    2008-01-01

    We describe a case of a 65-years-old patient with Chronic Obstructive Pulmonary Disease (COPD), receiving oxygen therapy and resistant to antibiotic therapy. He was admitted with high fever, productive cough, marked leukocytosis, and chest X-ray findings of infiltration and fluid levels within lung cysts. A differential diagnosis was essential to start an adequate treatment and avoid the rapid worsening of patients respiratory status. In patients with chronic pulmonary diseases under immunoth...

  4. How Different Are Girls and Boys above and below the Diagnostic Threshold for Autism Spectrum Disorders?

    Science.gov (United States)

    Dworzynski, Katharina; Ronald, Angelica; Bolton, Patrick; Happe, Francesca

    2012-01-01

    Objective: This study aimed to explore sex differences in autistic traits in relation to diagnosis, to elucidate factors that might differentially impact whether girls versus boys meet diagnostic criteria for autism or a related autism spectrum disorder (ASD). Method: Data from a large population-based sample of children were examined. Girls and…

  5. Rapid Differential Diagnosis of Breast Microcalcification Using Targeted Near-Infrared Fluorophores.

    Science.gov (United States)

    Park, Min Ho; Lim, Wonbong; Jo, Danbi; Jung, Jin Seok; Kim, Subin; Kim, Jangho; Lim, Hyo Soon; Lee, Ji Shin; Min, Jung-Joon; Hyun, Hoon

    2017-12-06

    Early detection and differential diagnosis of breast microcalcifications are of significant importance in effective treatment of early breast cancer, because mineral composition of breast calcification is directly associated with different pathological states. However, applying image-based modalities for component identification in breast calcification remains challenging, because no calcification-specific contrast agent is available to distinguish between benign and malignant (type I and type II, respectively) calcifications of breast lesions. In this study, real-time near-infrared (NIR) fluorescence imaging of breast microcalcifications using targeted NIR fluorophores in combination with dual-channel NIR fluorescence imaging system is reported. This strategy can be used to solve major problem in mammography and ultrasonography methods for the differentiation of benign and malignant microcalcifications. Thus, this novel technology shows significant potential for breast cancer diagnosis and image-guided surgery performed with increased precision and efficiency by providing differential diagnosis of breast microcalcifications. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  6. Biotechnological advances in the diagnosis, species differentiation and phylogenetic analysis of Schistosoma spp.

    Science.gov (United States)

    Zhao, Guang-Hui; Li, Juan; Blair, David; Li, Xiao-Yan; Elsheikha, Hany M; Lin, Rui-Qing; Zou, Feng-Cai; Zhu, Xing-Quan

    2012-01-01

    Schistosomiasis is a serious parasitic disease caused by blood-dwelling flukes of the genus Schistosoma. Throughout the world, schistosomiasis is associated with high rates of morbidity and mortality, with close to 800 million people at risk of infection. Precise methods for identification of Schistosoma species and diagnosis of schistosomiasis are crucial for an enhanced understanding of parasite epidemiology that informs effective antiparasitic treatment and preventive measures. Traditional approaches for the diagnosis of schistosomiasis include etiological, immunological and imaging techniques. Diagnosis of schistosomiasis has been revolutionized by the advent of new molecular technologies to amplify parasite nucleic acids. Among these, polymerase chain reaction-based methods have been useful in the analysis of genetic variation among Schistosoma spp. Mass spectrometry is now extending the range of biological molecules that can be detected. In this review, we summarize traditional, non-DNA-based diagnostic methods and then describe and discuss the current and developing molecular techniques for the diagnosis, species differentiation and phylogenetic analysis of Schistosoma spp. These exciting techniques provide foundations for further development of more effective and precise approaches to differentiate schistosomes and diagnose schistosomiasis in the clinic, and also have important implication for exploring novel measures to control schistosomiasis in the near future. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Differential Diagnosis of Nongap Metabolic Acidosis: Value of a Systematic Approach

    Science.gov (United States)

    Madias, Nicolaos E.

    2012-01-01

    Summary Nongap metabolic acidosis is a common form of both acute and chronic metabolic acidosis. Because derangements in renal acid-base regulation are a common cause of nongap metabolic acidosis, studies to evaluate renal acidification often serve as the mainstay of differential diagnosis. However, in many cases, information obtained from the history and physical examination, evaluation of the electrolyte pattern (to determine if a nongap acidosis alone or a combined nongap and high anion gap metabolic acidosis is present), and examination of the serum potassium concentration (to characterize the disorder as hyperkalemic or hypokalemic in nature) is sufficient to make a presumptive diagnosis without more sophisticated studies. If this information proves insufficient, indirect estimates or direct measurement of urinary NH4+ concentration, measurement of urine pH, and assessment of urinary HCO3− excretion can help in establishing the diagnosis. This review summarizes current information concerning the pathophysiology of this electrolyte pattern and the value and limitations of all of the diagnostic studies available. It also provides a systematic and cost-effective approach to the differential diagnosis of nongap metabolic acidosis. PMID:22403272

  8. Differential diagnosis of rheumatic illnesses. 4. compl. rev. and enl. ed.; Differenzialdiagnose rheumatischer Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Zeidler, Henning [Rheumatologikum Hannover (Germany); Michel, Beat [UniversitaetsSpital Zuerich, Zurich (Switzerland). Rheumaklinik und Inst. fuer Physikalische Medizin

    2009-07-01

    The number of the possible differential diagnosis of rheumatic illnesses is extraordinarily high. This circumstance makes the diagnostics a difficult field with numerous pitfalls. The correct and complete diagnosis however is a condition for the correct therapy. This book facilitates this way from the symptom to the diagnosis for the reader: A detailed representation of the fundamentals (anamnesis, investigation findings, laboratory diagnostics and imaging) a detailed description of all important differential diagnosis follows. The meanwhile fourth edition of this standard work was completely revised and updated. An indispensable guide book for all persons which treat patients with rheumatic illnesses. [German] Die Zahl der moeglichen Differenzialdiagnosen rheumatischer Erkrankungen ist ausserordentlich hoch. Dieser Umstand macht die Diagnostik zu einem schwierigen Feld mit zahlreichen Fallstricken. Die korrekte und vollstaendige Diagnose ist aber Voraussetzung fuer die richtige Therapie. Dieses Buch erleichtert dem Leser diesen Weg vom Symptom zur Diagnose: Einer ausfuehrlichen Darstellung der Grundlagen (Anamnese, Untersuchungsbefund, Labordiagnostik und Bildgebung) folgt eine detaillierte Beschreibung aller wichtigen Differenzialdiagnosen. Die mittlerweile vierte Auflage dieses Standardwerks wurde komplett ueberarbeitet und aktualisiert. Ein unverzichtbarer Ratgeber fuer alle, die Patienten mit Erkrankungen aus dem rheumatologischen Formenkreis behandeln. (orig.)

  9. The Differential Diagnosis of Desquamative Gingivitis: Review of the Literature and Clinical Guide for Dental Undergraduates.

    Science.gov (United States)

    Al-Abeedi, Faris; Aldahish, Yaser; Almotawa, Zaid; Kujan, Omar

    2015-01-01

    Desquamative gingivitis is an elucidating term used to demonstrate epithelial desquamation, erythema, erosions, and/or vesiculobullous lesions of the gingiva. Detection and differentiation between conditions that manifest desquamative gingivitis have been almost a continuing problem for dental undergraduates. Several studies have described the association between desquamative gingivitis and other relevant conditions. This study aimed to review the current literature on desquamative gingivitis and to formulate a clinical guide for the differential diagnosis of desquamative gingivitis designated as a teaching aid tool for dental undergraduates. A search strategy based on the key words "desquamative gingivitis, guidelines, diagnosis, undergraduate, teaching" was performed in Medline and Google Scholar. Papers published between 1932 and December 2014 were scrutinized. Only articles that describe the terminology and classification of DG-associated disorders or the diagnostic procedures of DG were selected, then obtained in full text and analyzed. 47 studies were included and reviewed narratively. The clinical signs and symptoms of desquamative gingivitis are insufficient to make a definitive diagnosis. We proposed a clinical flowchart aimed to help dental undergraduates achieving their goal in making an accurate and easy diagnosis. However, this guideline needs further evaluation.

  10. Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

    Directory of Open Access Journals (Sweden)

    William Yoon

    2012-01-01

    Full Text Available Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

  11. Gastric schwannoma: a rare but important differential diagnosis of a gastric submucosal mass.

    Science.gov (United States)

    Yoon, William; Paulson, Kari; Mazzara, Paul; Nagori, Sweety; Barawi, Mohammed; Berri, Richard

    2012-01-01

    Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60-70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10-30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

  12. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis

    Directory of Open Access Journals (Sweden)

    Sinem Iliaz

    2014-01-01

    Full Text Available Introduction: The differential diagnosis of sarcoidosis creates a challange due to tuberculosis also having lung and lymph node involvement. Because both diseases show granulomatous inflammation, it may not be possible to distinguish tuberculosis and sarcoidosis in pathological specimens. As a result of the complexity in the differential diagnosis of sarcoidosis and tuberculosis, new markers for differentiation are being investigated. Objective: The aim of our study is to investigate the value of neutrophil/lymphocyte ratio (NLR as a possible marker in differentiating sarcoidosis and tuberculosis. Materials and Methods: In our study, 51 acid-fast bacilli (AFB positive and/or culture-positive patients with pulmonary tuberculosis, ​​40 patients with biopsy-proven sarcoidosis and a control group consisting of 43 patients were included. In our study, information was collected retrospectively based on hospital records. Results: Leukocyte and neutrophil counts, NLR, erythrocyte sedimentation rate (ESR, C-reactive protein (CRP were significantly higher, and albumin was significantly lower in the tuberculosis group compared with sarcoidosis (for all parameters P < 0.001. The most appropriate cut-off value of NLR to distinguish tuberculosis from sarcoidosis was determined as 2.55. For this cut-off value of NLR there was 79% sensitivity, 69% specificity, 73% positive predictive value (PPV, 75% negative predictive value (NPV, and area under the curve (AUC was 0.788. For differentiation of sarcoidosis from tuberculosis, accuracy of the NLR test according to this cut-off value was found as 76%. Conclusion: NLR as a little known marker in respiratory medicine was found to be supportive in differentiation of tuberculosis and sarcoidosis. More studies on this issue is needed.

  13. 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.

  14. Immunoglobulin light and heavy chain amyloidosis AL/AH: renal pathology and differential diagnosis.

    Science.gov (United States)

    Picken, Maria M

    2007-01-01

    Among the varied and biochemically diverse group of protein folding disorders that are collectively known as the amyloidoses, AL-amyloidosis where deposits are derived from the immunoglobulin light chain fragments, is the most prevalent systemic form of the disease found in the western world. In contrast, AH-amyloidosis, resulting from the deposition of immunoglobulin heavy chains, is a rare disease with very few cases thus far reported. Both diseases primarily affect older individuals and are always associated with some form of plasma cell/B cell lymphoproliferative process. The overwhelming majority of monoclonal light chains are nephrotoxic leading to frequent renal involvement, although a wide variety of other organ systems may be involved. The most common clinical presentation is proteinuria and the disease is often diagnosed by renal biopsy. The kidneys are the most frequent site of amyloid fibril deposition in AL and light microscopic examination of Congo red stained sections is the prime means of detection. Electron microscopy may be helpful in the detection of small deposits and in the differentiation of amyloid from other types of renal fibrillar deposits. Current treatment of systemic amyloidoses depends upon the type of amyloid deposits; thus, accurate typing, using a panel of antibodies, is of paramount importance. While the differential diagnosis of amyloidoses continues to expand with increased awareness of hereditary types, currently, the main challenge is diagnosis of AL/AH with confidence. Future goals include the development of more precise and sensitive diagnostic tools. This chapter presents the pathology of AL/AH, current standards of diagnosis and the differential diagnosis. Whenever possible, the most recent references, considered as being particularly useful to clinicians and pathologists serving patients with renal amyloidosis, have been selected.

  15. High-resolution ultrasonography assists the differential diagnosis of blue naevi and cutaneous metastases of melanoma.

    Science.gov (United States)

    Samimi, M; Perrinaud, A; Naouri, M; Maruani, A; Perrodeau, E; Vaillant, L; Machet, L

    2010-09-01

    Metastases of cutaneous melanoma may simulate benign blue naevi clinically. To investigate the value of ultrasonography in the differential diagnosis of lesions that look similar clinically, i.e. blue naevi and cutaneous metastases of melanoma. Participants were invited for inclusion in the study if they had a cutaneous blue lesion clinically suggestive of a blue naevus or cutaneous metastasis of melanoma. After obtaining signed consent, the lesion was photographed and studied using dermoscopy and high-resolution ultrasonography before being removed for histological examination. Clinical, dermoscopic and ultrasonographic images were reviewed anonymously by four dermatologists to assign the diagnosis of blue naevus or metastasis of melanoma. The diagnostic performance of clinical examination, dermoscopy and sonography was assessed for the ability of each to differentiate between metastases of melanoma and blue naevi with reference to the histological diagnosis. Moreover, experts undertook a semeiological description of each ultrasonographic image according to seven items: location of the lesion, echogenicity, homogeneity, shape of the lesion, definition of margins, posterior acoustic shadow and increased posterior echogenicity.   Twenty-eight patients were included with a total of 39 blue skin lesions, and 17 of the 28 patients had a previous history of melanoma. Interobserver agreement in the semeiological description of the sonographic images was good (κ≥0·6) for five of seven items. Sonography was more specific (94%) than clinical examination (77%) and dermoscopy (74%). The sonographic features contributing to the differential diagnosis were: location of the lesion (P=0·027), shape of the lesion (Pmelanoma. A blue naevus is a homogeneous, hypoechoic, 'dish-shaped' lesion, located in the superficial dermis, whereas metastases of melanoma are 'potato-shaped', hypoechoic, heterogeneous lesions, located in the hypodermis. © 2010 The Authors. Journal

  16. A Quest for Awareness: Gender-Differentiated English Language Arts Resources and Instructional Techniques to Acknowledge the Needs and Passions of Fourth and Fifth Grade Boys

    Science.gov (United States)

    Feltman, Todd Jason

    2013-01-01

    A major educational crisis has been transpiring among fourth and fifth grade boys over the last twenty years (Eliot, 2009; Whitmire, 2010). On average, fourth and fifth grade boys, regardless of racial background or socioeconomic class, are performing below girls, both academically in reading and writing. The Center on Educational Policy reports…

  17. The role of immunophenotyping in differential diagnosis of chronic lymphocytic leukemia

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    Dragović-Ivančević Tijana

    2014-01-01

    Full Text Available Introduction. Accurate diagnosis of chronic lymphocytic leukemia (CLL acquires immunophenotyping by flow cytometry in order to facilitate differential diagnosis between CLL and other mature B-cell neoplasms (MBCN. Objective. The aim of this study was to define immunological profile of CLL cells. Methods. Immunophenotyping by flow cytometry was performed on peripheral blood specimens at diagnosis in the group of 211 patients with de novo MBCN. Results. Absolute count of B-cells was significantly increased in all MBCN patients comparing to healthy control group (p<0.05. B-cell monoclonality was detected in 96% of all MBCN patients, by using surface immunoglobulin (sIg light chain restriction. B-cell antigens, CD19, CD20, CD22, were expressed with very high frequency in CLL and other MBCN. In comparison with other MBCN, in CLL group, the frequency of expression was higher for CD5 and CD23 (p<0.0001, though lower for FMC7 antigen (p<0.0001. CLL patients were characterized by lower expression patterns of CD20, CD22, CD79b, and sIg (p<0.0001 as well as higher expression pattern of CD5 antigen (p<0.05. Correlation between the final diagnosis of MBCN and values of CLL scoring system showed that the majority of CLL patients (97% had higher values (5 or 4 whereas the majority of other MBCN patients (96% had lower score values (0-3. Conclusion. Our results have shown that characteristic immunophenotype which differentiates CLL from other MBCN is defined by following marker combination - CD19+ CD20+low CD22+low CD5+high CD23+ FMC7- CD79b+low sIg+low. CLL score values of 5 or 4 points are highly suggestive for diagnosis of CLL.

  18. Importance of complex diagnostic approach in differential diagnosis of alveolar echinococcosis

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    Szilágyiová M.

    2015-12-01

    Full Text Available Alveolar and cystic echinococcosis, serious parasitic diseases caused by larval stages of Echinococcus multilocularis and E. granulosus has been diagnosed in Slovakia for a long time. Study presents case of 49-years old patient with accidentally diagnosed one big (60 mm and multiple small (2 - 24 mm hypoechogenic structures localised in right liver lobe. According to positive serology to E. granulosus antigen and results of imaging examinations the patient was classifi ed as possible case of cystic echinococcosis and treated with mebendazole. Later, due to the worsening of clinical, laboratory and CT fi ndings surgical biopsy was performed and surgical biopsy and subsequent PCR examination of liver tissue confi rmed the diagnosis of alveolar echinococosis. Clinical picture of disease imitating cystic echinococcosis in presented case report, together with results of serological tests confi rmed importance of accurate differential diagnosis of echinococcosis. Each aspect of clinical and laboratory results should be considered responsibly, however, sometimes only molecular techniques can solve the problem of differential diagnosis.

  19. Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury

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    Lauren Surdyke

    2017-01-01

    Full Text Available Locked-in syndrome (LIS is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

  20. History of the infantile hepatic hemangioma: From imaging to generating a differential diagnosis.

    Science.gov (United States)

    Gnarra, Maria; Behr, Gerald; Kitajewski, Alison; Wu, June K; Anupindi, Sudha A; Shawber, Carrie J; Zavras, Nick; Schizas, Dimitrios; Salakos, Chris; Economopoulos, Konstantinos P

    2016-08-08

    We aim to provide an up-to-date summary of infantile hepatic hemangioma (IHH) and its misnomers and to dialectically present the differential diagnosis of these rare entities of the liver. Eligible peer-reviewed articles on hepatic infantile hemangiomas, published between 2000 and 2015, were reviewed for this study. IHH is the most common hepatic vascular tumor in children. Once a liver mass is identified in an infant, the differential diagnosis ranges from vascular malformations to benign and malignant tumors including mesenchymal hamartoma, hepatoblastoma, metastatic neuroblastoma, so careful physical examination, imaging studies, and, if indicated, tumor markers and biopsy, are of pivotal importance to ascertain the correct diagnosis. Despite the benign nature of IHHs, some of these lesions may demand medical and/or surgical intervention, especially for multiple and diffuse IHH. Complications can include hepatomegaly, hypothyroidism and cardiac failure. Therefore, a close follow-up is required until complete involution of the lesions. We propose an algorithm to guide the physicians towards the proper management of hepatic lesions.

  1. Novel biochemical marker for differential diagnosis of seizure: ischemia-modified albumin.

    Science.gov (United States)

    Uzel, Muzeyyen; Oray, Nese Colak; Bayram, Basak; Kume, Tuncay; Girgin, Mehmet Can; Doylan, Ozgur; Saritabak, Ercument; Yanturali, Sedat

    2014-09-01

    Differential diagnosis of seizure is critical in patients presented to emergency department (ED) with altered mental status or loss of consciousness. Although electroencephalogram is important for the diagnosis of seizures, its use in EDs is limited. The level of ischemia-modified albumin (IMA) increases in conditions of ischemic distress such as acute coronary syndrome, pulmonary embolism, and mesenteric ischemia. No studies exist in literature regarding the increase of IMA levels parallel to increased seizure activity in adults. The aim of the study was to investigate the diagnostic value of IMA in adult patients presented to ED with seizures. Forty patients presented to ED with seizure, and 40 control patients of similar age and sex as the study group were enrolled in this study. Initial and fourth-hour levels of IMA and albumin were measured. Groups were compared in terms of sociodemographic data and details regarding their seizures as well as initial and fourth-hour levels of IMA. Mean levels of IMA were 61.5 IU/mL and 18.5 IU/mL (P seizures. Ischemia-modified albumin may be considered as a useful biomarker in the differential diagnosis of seizure. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis.

    Science.gov (United States)

    Park, Hyun Jeong; Choi, Byung Ihn; Lee, Eun Sun; Park, Sung Bin; Lee, Jong Beum

    2017-06-01

    Rapid advances in liver imaging have improved the evaluation of hepatocarcinogenesis and early diagnosis and treatment of hepatocellular carcinoma (HCC). In this situation, detection of early-stage HCC in its development is important for the improvement of patient survival and optimal treatment strategies. Because early HCCs are considered precursors of progressed HCC, precise differentiation between a dysplastic nodule (DN), especially a high-grade DN, and early HCC is important. In clinical practice, these nodules are frequently called "borderline hepatic nodules." This article discusses radiological and pathological characteristics of these borderline hepatic nodules and offers an understanding of multistep hepatocarcinogenesis by focusing on the descriptions of the imaging changes in the progression of DN and early HCC. Detection and accurate diagnosis of borderline hepatic nodules are still a challenge with contrast enhanced ultrasonography, CT, and MRI with extracellular contrast agents. However, gadoxetic acid-enhanced MRI may be useful for improving the diagnosis of these borderline nodules. Since there is a net effect of incomplete neoangiogenesis and decreased portal venous flow in the early stage of hepatocarcinogenesis, borderline hepatic nodules commonly show iso- or hypovascularity. Therefore, precise differentiation of these nodules remains a challenging issue. In MRI using hepatobiliary contrast agents, signal intensity of HCCs on hepatobiliary phase (HBP) is regarded as a potential imaging biomarker. Borderline hepatic nodules are seen as nonhypervascular and hypointense nodules on the HBP, which is important for predicting tumor behavior and determining appropriate therapeutic strategies.

  3. Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn's disease: a pilot study.

    Science.gov (United States)

    Tontini, Gian Eugenio; Mudter, Jonas; Vieth, Michael; Atreya, Raja; Günther, Claudia; Zopf, Yurdagül; Wildner, Dane; Kiesslich, Ralf; Vecchi, Maurizio; Neurath, Markus F; Neumann, Helmut

    2015-05-01

    The differential diagnosis of ulcerative colitis from Crohn's disease is of pivotal importance for the management of inflammatory bowel diseases, as both entities involve specific therapeutic management strategies. Confocal laser endomicroscopy (CLE) allows on-demand, in vivo characterization of architectural and cellular details during endoscopy. The aim of this study was to assess the efficacy of CLE to differentiate between ulcerative colitis and Crohn's disease. This was a prospective study involving consecutive patients with a well-established diagnosis of ulcerative colitis or Crohn's disease who underwent colonoscopy with fluorescein-aided confocal imaging. Overall, 79 patients were included (40 Crohn's disease, 39 ulcerative colitis). CLE findings in patients with Crohn's disease, showed significantly more discontinuous inflammation (87.5 % vs. 5.1 %), focal cryptitis (75.0 % vs. 12.8 %), and discontinuous crypt architectural abnormality (87.5 % vs. 10.3 %) than in ulcerative colitis (P Crohn's disease), decreased crypt density (79.5 % vs. 22.5 %), and frankly irregular surface (89.7 % vs. 17.5 %; P Crohn's disease. However, because of the limited penetration depth of CLE, submucosal details or granulomas were not visible. The new scoring system may allow in vivo diagnosis of ulcerative colitis or Crohn's disease. Trial registered at ClinicalTrials.gov: NCT 02238665. © Georg Thieme Verlag KG Stuttgart · New York.

  4. [Differential diagnosis between Schizotypal Personality Disorder and Autism Spectrum Disorders: a case report].

    Science.gov (United States)

    Ünver, Buket; Öner, Özgür; Yurtbaşı, Pınar

    2015-01-01

    Schizotypal personality disorder is characterized by social and interpersonal deficits marked by discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. Inappropriate or constricted affect, reduced capacity for relationships, lack of close friends and reduced capacity for social life are the symptoms that overlap both schizotypal personality disorder and autism spectrum disorders. The making of differential diagnosis may be difficult since several symptoms are similar between these disorders. In this study, we discussed the differential diagnosis issues on the basis of an adolescent case. Odd appearance, magical thoughts, reference thoughts suggests Schizotypal Personality Disorder whereas lack of eye contact at 2 years old, a preference to be isolated and play alone and referral to a child psychiatrist at 4 years old suggest Autism Spectrum Disorders. Based on the results of psychological assessment, Wechsler Intelligence Scale for Children-Revised (WISC-R) profile is compatible with autistic children's profiles. Based on Schizotypal Personality Questionnaire, the patient's anxiety, lack of close friends, constricted affect symptoms which take place in the category of interpersonal schizotypy seems to overlap with lack of communication of Autism Spectrum Disorders. This case report indicates that, separation of autism and schizophrenia, a very important historical breakthrough in autism research, may be blurred in cases with less typical clinical pictures representing autistic and schizophrenic "spectrum" diagnosis.

  5. Urticarial lesions: if not urticaria, what else? The differential diagnosis of urticaria: part II. Systemic diseases.

    Science.gov (United States)

    Peroni, Anna; Colato, Chiara; Zanoni, Giovanna; Girolomoni, Giampiero

    2010-04-01

    There are a number of systemic disorders that can manifest with urticarial skin lesions, including urticarial vasculitis, connective tissue diseases, hematologic diseases, and autoinflammatory syndromes. All of these conditions may enter into the differential diagnosis of ordinary urticaria. In contrast to urticaria, urticarial syndromes may manifest with skin lesions other than wheals, such as papules, necrosis, vesicles, and hemorrhages. Lesions may have a bilateral and symmetrical distribution; individual lesions have a long duration, and their resolution frequently leaves marks, such as hyperpigmentation or bruising. Moreover, systemic symptoms, such as fever, asthenia, and arthralgia, may be present. The most important differential diagnosis in this group is urticarial vasculitis, which is a small-vessel vasculitis with predominant cutaneous involvement. Systemic involvement in urticarial vasculitis affects multiple organs (mainly joints, the lungs, and the kidneys) and is more frequent and more severe in patients with hypocomplementemia. Clinicopathologic correlation is essential to establishing a correct diagnosis. After completing the learning activity, participants should be able to distinguish urticarial lesions suggesting diagnoses other than common urticaria; assess patients with urticarial lesions, and suspect systemic diseases presenting with urticarial skin lesions. Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  6. HE4 in the Differential Diagnosis of a Pelvic Mass: A Case Report

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    Luigi Frati

    2011-01-01

    Full Text Available Neoplasms of the ovary present an increasing challenge to the physician. Neoplastic ovarian cysts can resemble endometriomas in ultrasound imaging and need to be carefully considered in the differential diagnosis. We report the case of a woman with a strong family history of hereditary breast and ovarian cancer, who presented with a pelvic mass. The young girl refused oncogenetic counseling and genetic testing, even though she had a 50% a priori probability of being a BRCA1 mutation carrier. Pelvic magnetic resonance imaging (MRI and a comparative analysis of the serum concentration of HE-4 and CA125 biomarkers provided accuracy and sensitivity in the diagnosis of a benign ovarian pathology. Based on this experience, we propose that the sensitivity of a screening program based on a HE4 and CA125 assay and MRI in high risk patients with mutations in the BRCA1 and BRCA2 genes may be considered a useful pre-operative tool for the differential diagnosis of pelvic masses.

  7. Takotsubo cardiomyopathy: Pathophysiology and role of cardiac biomarkers in differential diagnosis.

    Science.gov (United States)

    Gopalakrishnan, Prabhakaran; Zaidi, Ramsha; Sardar, Muhammad Rizwan

    2017-09-26

    Takotsubo cardiomyopathy (TC) is characterized by reversible ventricular dysfunction, not limited to the distribution of an epicardial coronary artery. A disease primarily afflicting post-menopausal women, it is frequently mistaken for acute anterior wall myocardial infarction. Alternatively called Stress Cardiomyopathy, physical or emotional triggers are identified in only three fourths of TC patients. Long considered a benign condition, recent findings suggest poor short term prognosis similar to acute coronary syndrome (ACS). Despite the widely recognized pathophysiological role of catecholamine excess, its diagnostic role is uncertain. TC is suspected based on typical wall motion abnormalities in ventriculogram or echocardiogram. Several additional electrocardiographic, laboratory and imaging parameters have been studied with the goal of clinical diagnosis of TC. While several clinical clues differentiate it from ACS, a clinical diagnosis is often elusive leading to avoidable cardiac catheterizations. Natriuretic peptides (NPs), a family of peptide hormones released primarily in response to myocardial stretch, play a significant role in pathophysiology, diagnosis as well as treatment of congestive heart failure. TC with its prominent ventricular dysfunction is associated with a significant elevation of NPs. NPs are elevated in ACS as well but the degree of elevation is typically lesser than in TC. Markers of myocardial injury such as troponin are usually elevated to a higher degree in ACS than in TC. This differential elevation of NPs and markers of myocardial injury may play a role in early clinical recognition of TC.

  8. Role of neuropsychological assessment in the differential diagnosis of Alzheimer's disease and vascular dementia

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    Érica Maria Lima Pimentel

    Full Text Available Abstract The prevalence of dementia increases significantly from the age of 65 years, doubling every five years thereafter. Alzheimer's disease (AD and vascular dementia (VaD constitute the two main dementia types. Differentiating them encompasses anamnesis, neurological examination, laboratory and neuroimaging exams and neuropsychological assessment. Neuropsychological assessment produces different findings for each dementia type, and reveals those areas most impaired as well as those most preserved. The aim of the present article was to describe the role of neuropsychology in diagnosing dementia and achieving a differential diagnosis between AD and VaD. A general overview follows of the most widely known instruments used to assess cognitive function in dementia, and the cognitive changes seen in AD and VaD. The conclusion drawn was that there is significant overlap in cognitive changes between both these dementia types, while each type has its own specific characteristics which are identifiable and quantifiable on neuropsychological assessments and provide the basis for reaching a differential diagnosis.

  9. Using the Disease State Fingerprint Tool for Differential Diagnosis of Frontotemporal Dementia and Alzheimer's Disease

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    Miguel Ángel Muñoz-Ruiz

    2016-07-01

    Full Text Available Background: Disease State Index (DSI and its visualization, Disease State Fingerprint (DSF, form a computer-assisted clinical decision making tool that combines patient data and compares them with cases with known outcomes. Aims: To investigate the ability of the DSI to diagnose frontotemporal dementia (FTD and Alzheimer's disease (AD. Methods: The study cohort consisted of 38 patients with FTD, 57 with AD and 22 controls. Autopsy verification of FTD with TDP-43 positive pathology was available for 14 and AD pathology for 12 cases. We utilized data from neuropsychological tests, volumetric magnetic resonance imaging, single-photon emission tomography, cerebrospinal fluid biomarkers and the APOE genotype. The DSI classification results were calculated with a combination of leave-one-out cross-validation and bootstrapping. A DSF visualization of a FTD patient is presented as an example. Results: The DSI distinguishes controls from FTD (area under the receiver-operator curve, AUC = 0.99 and AD (AUC = 1.00 very well and achieves a good differential diagnosis between AD and FTD (AUC = 0.89. In subsamples of autopsy-confirmed cases (AUC = 0.97 and clinically diagnosed cases (AUC = 0.94, differential diagnosis of AD and FTD performs very well. Conclusions: DSI is a promising computer-assisted biomarker approach for aiding in the diagnostic process of dementing diseases. Here, DSI separates controls from dementia and differentiates between AD and FTD.

  10. Assessing impact of differential symptom functioning on post-traumatic stress disorder (PTSD) diagnosis.

    Science.gov (United States)

    He, Qiwei; Glas, Cees A W; Veldkamp, Bernard P

    2014-06-01

    This article explores the generalizability of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for post-traumatic stress disorder (PTSD) to various subpopulations. Besides identifying the differential symptom functioning (also referred to as differential item functioning [DIF]) related to various background variables such as gender, marital status and educational level, this study emphasizes the importance of evaluating the impact of DIF on population inferences as made in health surveys and clinical trials, and on the diagnosis of individual patients. Using a sample from the National Comorbidity Study-Replication (NCS-R), four symptoms for gender, one symptom for marital status, and three symptoms for educational level were significantly flagged as DIF, but their impact on diagnosis was fairly small. We conclude that the DSM-IV diagnostic criteria for PTSD do not produce substantially biased results in the investigated subpopulations, and there should be few reservations regarding their use. Further, although the impact of DIF (i.e. the influence of differential symptom functioning on diagnostic results) was found to be quite small in the current study, we recommend that diagnosticians always perform a DIF analysis of various subpopulations using the methodology presented here to ensure the diagnostic criteria is valid in their own studies. Copyright © 2014 John Wiley & Sons, Ltd.

  11. Screening and differential diagnosis of renal light chain-associated diseases.

    Science.gov (United States)

    Gerth, Jens; Sachse, Anja; Busch, Martin; Illner, Nico; Muegge, Lars-Olof; Gröne, Hermann-Josef; Wolf, Gunter

    2012-01-01

    Renal involvement in the light chain-associated diseases multiple myeloma (MM), amyloidosis (AL) and monoclonal immune position disease (MIDD) is common and differential diagnosis usually requires renal biopsy. The aim of this study was to investigate if noninvasive methods are viable to identify and differentiate between the various types of kidney diseases. All patients with a light chain-associated disease admitted to our center from 1996 to 2008 were retrospectively evaluated. Renal biopsy data were correlated with proteinuria findings. Only the ratio of free κ/λ light chains showed a good sensitivity for myeloma cast nephropathy (MCN), AL and MIDD. The λ light chain was characteristic for AL, the κ light chain dominated in MIDD. Renal function at the time of diagnosis was worst in MIDD. MCN presented with a proteinuria of > 3.5 g/g creatinine. In contrast, a higher proteinuria was found in AL or MIDD. Whereas the κ/λ ratio in the urine was pathological for all three diseases, extremely high or low ratios indicated the presence of MCN. However, in AL or MIDD, the ratio was only moderately elevated. A noninvasive differentiation between MCN and other forms of renal light chain disease is possible. Copyright © 2011 S. Karger AG, Basel.

  12. Differential diagnosis between traumatic and nontraumatic rupture of the intracranial vertebral artery in medicolegal autopsy.

    Science.gov (United States)

    Ro, Ayako; Kageyama, Norimasa; Takatsu, Akihiro; Fukunaga, Tatsushige

    2009-04-01

    We attempted to establish histopathological identification between traumatic rupture and nontraumatic arterial dissection of the intracranial vertebral artery (IVA) resulting in subarachnoid hemorrhage (SAH). Step-serial observations of ruptured IVAs among four traumatic and 44 nontraumatic SAH patients were investigated. We found that the most specific characteristic for differentiation was the shape of the ruptured adventitia. Extension of the adventitia was clearly observed in nontraumatic cases. In contrast, traumatic cases showed transmural ruptures. Other specific characteristics were also detected. For traumatic cases, small incomplete tears of intima and media were frequently found; they formed oblique tears without adventitial extension. Fragmentized internal elastic lamina was also observed in traumatic cases. In contrast, previous arterial dissections were frequently confirmed in nontraumatic cases. Medial degenerations or defects were detected in all nontraumatic cases. In these cases, the peripheral lesion of the rupture was appeared as intimal tears at recessed vascular wall caused by medial defects. This suggested a relationship between medial lesions and pathogenesis of arterial dissections. These additional features were found in both ruptured and non-ruptured intracranial arteries. We concluded that histopathological investigation is a reliable method for differential diagnosis between traumatic and nontraumatic rupture of the IVA resulting in fatal SAH. These morphological differentiations could be valuable for medicolegal diagnosis.

  13. Differential Diagnosis of the pancreatic disease : significance of perivascular changes at celiac trunk and superior mesenteric artery on CT

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    Kwon, Ryang; Kim, Ki Whang; Yu, Jeong Sik; Kim, Ji Hyung; Kim, Dong Guk; Lee, Sung Il; Ahn, Chang Soo; Oh, Sei Jung [Yonsei Univ., Seoul (Korea, Republic of). Coll. of Medicine; Kim, Young Hwan [Sanggye Paik Hospital, Seoul (Korea, Republic of)

    1998-03-01

    The purpose of this paper is to classify perivascular change in the celiac trunk and SMA occurring in pancreatic disease and to evaluate its significance in differential diagnosis. In 73 patients with pancreatic disease (42, acute pancreatitis; 14, chronic pancreatitis; 17, pancreatic cancer) abdominal CT findings were retrospectively reviewed. We defined infiltration as linear or irregular density and thickening as presence of a soft tissue mantle surrounding the vessel, and statistically evaluated the usefulness of these factors for the differential diagnosis of pancreatic diseases. Thickening of the celiac trunk and SMA is a valuable finding in the differential diagnosis of pancreatic inflammatory disease and pancreatic cancer. When applied to the differential diagnosis of pancreatic disease, perivascular change should be classified as either infiltration or thickening. (author). 10 refs., 1 tab., 2 figs.

  14. Teaching differential diagnosis in primary care using an inverted classroom approach: student satisfaction and gain in skills and knowledge

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    B?sner, Stefan; Pickert, Julia; Stibane, Tina

    2015-01-01

    Background Differential diagnosis is a crucial skill for primary care physicians. General practice plays an increasing important role in undergraduate medical education. Via general practice, students may be presented with an overview of the whole spectrum of differential diagnosis in regard to common symptoms encountered in primary care. This project evaluated the impact of a blended learning program (using the inverted classroom approach) on student satisfaction and development of skills an...

  15. [Rett's syndrome--differential diagnosis of autism in a case report].

    Science.gov (United States)

    Bujas-Petković, Z; Matijasić, R; Divcić, B

    1989-12-01

    In this paper, a rare neurological disorder seen exclusively in girls is described. According to its progress and clinical behaviour, a syndrome resembles autism. The disease was reported in 1966 by A. Rett from Vienna. The syndrome often remains unrecognized because of its low incidence or is mistaken for autism, mental retardation and cerebral paralysis. The table of differential diagnosis of this disease in relation to autism is given. We report on a 5-year-old girl from Zrenjanin who was admitted to the Division for Autism, Psychiatric Hospital Jankomir, Zagreb. The diagnosis of Rett's syndrome was established in this patient whose initial description documented autism. The medications have shown to be without effect, except anticonvulsive drugs and ketogenic diet. Physical, occupational and musical therapy as well as hydrotherapy were applied.

  16. Paracoccidioidomicose e tuberculose: diagnóstico diferencial Paracoccidioidomycosis and tuberculosis: differential diagnosis

    Directory of Open Access Journals (Sweden)

    Thâmara Aline Bertoni

    2010-02-01

    Full Text Available É relatado o caso de um paciente portador de paracoccidioidomicose (PCM, supostamente há 15 anos, que, apesar de a baciloscopia sempre ser negativa, foi tratado empiricamente para tuberculose, por duas vezes sem melhora clínica. O diagnóstico de PCM após longo tempo, por meio de metodologia simples, chama atenção para a importância da investigação paralela de tuberculose e paracoccidioidomicose como diagnóstico diferencial em respiradores sintomáticos crônicos.This study reports the case of a patient who allegedly had paracoccidioidomycosis (PCM for fifteen years. Despite the fact that his baciloscopy result had always been negative, he was empirically treated for tuberculosis twice without clinical improvement. PCM diagnosis through simple methodology draws attention to the importance of parallel investigation into tuberculosis and paracoccidioidomycosis as differential diagnosis in chronic symptomatic patients.

  17. Sclerosing cholangitis: Clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis

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    Seo, Ni Eun [Dept. of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, So Yeon; Lee, Seung Soo; Byun, Jae Ho; Kim, Hyoung Jung; Kim, Jin Hee; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2016-02-15

    Sclerosing cholangitis is a spectrum of chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts, which can be classified as primary and secondary sclerosing cholangitis. Primary sclerosing cholangitis is a chronic progressive liver disease of unknown cause. On the other hand, secondary sclerosing cholangitis has identifiable causes that include immunoglobulin G4-related sclerosing disease, recurrent pyogenic cholangitis, ischemic cholangitis, acquired immunodeficiency syndrome-related cholangitis, and eosinophilic cholangitis. In this review, we suggest a systemic approach to the differential diagnosis of sclerosing cholangitis based on the clinical and laboratory findings, as well as the typical imaging features on computed tomography and magnetic resonance (MR) imaging with MR cholangiography. Familiarity with various etiologies of sclerosing cholangitis and awareness of their typical clinical and imaging findings are essential for an accurate diagnosis and appropriate management.

  18. Compilation of a preliminary checklist for the differential diagnosis of neurogenic stuttering

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    Mariska Lundie

    2014-06-01

    Objectives: The aim of this study was to describe and highlight the characteristics of NS in order to compile a preliminary checklist for accurate diagnosis and intervention. Method: An explorative, applied mixed method, multiple case study research design was followed. Purposive sampling was used to select four participants. A comprehensive assessment battery was compiled for data collection. Results: The results revealed a distinct pattern of core stuttering behaviours in NS, although discrepancies existed regarding stuttering severity and frequency. It was also found that DS and NS can co-occur. The case history and the core stuttering pattern are important considerations during differential diagnosis, as these are the only consistent characteristics in people with NS. Conclusion: It is unlikely that all the symptoms of NS are present in an individual. The researchers scrutinised the findings of this study and the findings of previous literature to compile a potentially workable checklist.

  19. Differential diagnosis in paradoxical vocal fold movement (PVFM): an interdisciplinary task.

    Science.gov (United States)

    Franca, Maria Claudia

    2014-12-01

    The objective of this study was to contribute to the discussion of differential diagnosis in paradoxical vocal fold movement (PVFM), a disorder frequently associated with episodes of breathing difficulty and stridor. Because of analogous respiratory symptoms, PVFM is often misdiagnosed as asthma. Additional evidence suggests the association of factors such as respiratory struggle during physical exertion, digestive reflux, and respiratory allergies with PVFM, particularly in athletes and young females. Interdisciplinary attention is warranted to avoid unnecessary utilization of medical resources and potential delay in the application of proper treatment. A description of critical points in PVFM differential diagnosis is proposed, featuring the assessment of a seven-year-old female with a history of behaviors considered to exacerbate voice fatigue symptoms. Noticeably, the child has consistently demonstrated tiredness and respiratory difficulties during physical education classes. Past use of oral steroids to reduce respiratory problems was applied with no improvement; short-acting beta 2-agonists have been also tried with mild improvement. Indications of instability and effort associated with respiratory-phonatory functions were demonstrated. Furthermore, there was evidence of GERD and seasonal allergies. The literature suggests an association of factors such as respiratory struggle during physical exertion, unwanted vocal effort, GERD, and respiratory allergies in individuals with PVFM, particularly in young females. A diagnosis of PVFM was suggested, in association with paradoxical vocal folds motion caused by respiratory difficulties verified by laryngeal examination. In PVFM, the vocal folds adduct during inhalation, thereby restricting the airway opening. Inconsistent vocal folds movement during phonation may also lead to PVFM symptoms. Acute bronchospasm/asthma-like symptoms, as well as additional morbidity may impact accuracy of diagnosis, leading to

  20. Differential diagnosis of infections in a patient with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Paolo Ghiringhelli

    2008-12-01

    Full Text Available We describe a case of a 65-years-old patient with Chronic Obstructive Pulmonary Disease (COPD, receiving oxygen therapy and resistant to antibiotic therapy. He was admitted with high fever, productive cough, marked leukocytosis, and chest X-ray findings of infiltration and fluid levels within lung cysts. A differential diagnosis was essential to start an adequate treatment and avoid the rapid worsening of patients respiratory status. In patients with chronic pulmonary diseases under immunotherapy, micotic infections should be considered. Aspergillus fumigatus was cultured from bronchial washing fluid and we diagnosed chronic necrotizing pulmonary aspergillosis (CNPA. Oral itraconazole was started and his symptoms and laboratory data markedly improved.

  1. IMAGING TECHNIQUES IN THE DIFFERENTIAL DIAGNOSIS OF PARASITIC LUNG DISEASES AND LUNG CANCER

    Directory of Open Access Journals (Sweden)

    P. M. Kotlyarov

    2016-01-01

    Full Text Available We analyzed imaging findings of 18 patients with atypical manifestations of parasitic diseases of the lung, who were admitted to the hospital with suspected lung cancer or metastatic lung cancer. The common CT, MRT and US findings of parasitic lung disease are fluid-containing lesions, septal structures (echinococcosis, alveolar echinococcosis, cisticercosis, no evidence of bronchial involvement and the absence of contrast agent accumulation in the affected area (paragonimiasis, shistosomiasis, toxoplasmosis, pneumocystis. Realtime monitoring with dynamic CT is often critical for differential diagnosis between atypical manifestations of parasitic lung disease and cancer or secondary lung tumor. 

  2. Constructing a Computer-Aided Differential Diagnosis Engine from Open-Source APIs.

    Science.gov (United States)

    Morrison, James J; Hostetter, Jason M; Aggarwal, Abhi; Filice, Ross W

    2016-12-01

    This paper describes the design and implementation of an application that parses and analyzes radiology report text to provide a radiologic differential diagnosis. The system was constructed using a combination of freely available web-based APIs and originally developed during the Society for Imaging Informatics in Medicine (SIIM) 2014 Hackathon. Continued development has refined and increased the accuracy of the algorithm. This project demonstrates the power and possibilities of combining existing technologies to solve unique problems as well as the stimulus of the hackathon setting to spur innovation.

  3. Difficulties in the differential diagnosis of erythema nodosum: Primary myelofibrosis as an etiological factor

    Directory of Open Access Journals (Sweden)

    D. I. Abdulganieva

    2017-01-01

    Full Text Available Erythema nodosum (EN is the most common form of panniculitis that is a reactive process caused by a wide variety of etiological factors. The problems with the differential diagnosis of this abnormality have not lost its relevance. The paper deals with a clinical case of recurrent EN concurrent with an immunological phenomenon (positivity for rheumatoid factor and antimitochondrial antibodies, long-lasting asymptomatic splenomegaly, and subsequently developed primary myelofibrosis. To ascertain the cause of secondary EN often causes difficulties in real clinical practice. 

  4. [Morpheiform sarcoidosis as atypical manifestation of sarcoidosis. Review of the literature and differential diagnosis].

    Science.gov (United States)

    Castellanos-González, María; Picazo Talavera, María Remedios

    2016-09-16

    Sarcoidosis is an idiopathic multisystem granulomatous disease that commonly involves the skin in 25% of affected patients. Because lesions assume a vast array of morphologies, a classification dividing them into specific (with presence of typical granulomas in the biopsy) or nonspecific (not containing granulomas) has been proposed. In the first group the variant morpheaform is considered exceptional. We review the cases reported in the literature and describe the possible differential diagnosis. We highlight the importance of recognizing the very atypical presentation of sarcoidosis and its ability to mimic morpheaform or sclerosis diseases in our patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  5. Cerebral vascular malformations: Applications of magnetic resonance imaging to differential diagnosis

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    Imakita, S.; Nishimura, T.; Yamada, N.; Naito, H.; Takamiya, M.; Yamada, Y.; Kikuchi, H.; Yonekawa, Y.; Sawada, T.; Yamaguchi, T.

    1989-09-01

    Twelve patients with cerebral vascular malformations (5 cavernous angiomas, 1 thrombosed arteriovenous malformation, and 6 venous angiomas) were studied with magnetic resonance (MR) imaging. All lesions were clearly depicted. Characteristic MR findings were obtained mainly on T2-weighted images: A markedly low intensity area was always seen. The margins of arteriovenous malformation (AVM) and venous angioma were irregular while those of cavernous angioma were smooth in all planes on T2-weighted images. Gradient-echo (GrE) pulse sequence were more sensitive than T2-weighted spin echo (SE) in AVM detection. MR imaging could play an important role in the differential diagnosis of cerebral vascular malformations. (orig.).

  6. Wound healing and treating wounds: Differential diagnosis and evaluation of chronic wounds.

    Science.gov (United States)

    Morton, Laurel M; Phillips, Tania J

    2016-04-01

    Wounds are an excellent example of how the field of dermatology represents a cross-section of many medical disciplines. For instance, wounds may be caused by trauma, vascular insufficiency, and underlying medical conditions, such as diabetes, hypertension, and rheumatologic and inflammatory disease. This continuing medical education article provides an overview of wound healing and the pathophysiology of chronic wounds and reviews the broad differential diagnosis of chronic wounds. It also describes the initial steps necessary in evaluating a chronic wound and determining its underlying etiology. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  7. Features of the differential diagnosis of persons with gender identity disorders

    Directory of Open Access Journals (Sweden)

    Z.D. Novikova

    2013-10-01

    Full Text Available We presented a study of the features of gender identity in people undergoing gender, psychological and psychiatric examination to address the issue of gender reassignment. We analyze the specifics of gender identity, levels of masculinity and femininity, the similarities and differentiation within four nosological groups, which include persons with gender identity disorders (GID with transsexualism, personality disorders, diseases of the schizophrenia spectrum, and with organic mental disorders. We address the question of the differential diagnosis in the process of psychological screening of people with transsexualism and other types of GID. The analytical description of the four algorithms and their comparison are psychologically specific, qualitative research, almost impossible using statistical method of data processing. The data presented may be useful to specialists involved in the study of persons with gender identity disorders

  8. Is CRX protein a useful marker in differential diagnosis of tumors of the pineal region?

    Science.gov (United States)

    Manila, Antonelli; Mariangela, Novello; Libero, Lauriola; Francesca, Gianno; Romana, Buttarelli Francesca; Felice, Giangaspero

    2014-01-01

    The cone-rod homeobox (CRX) is a gene that belongs to the member of the orthodenticle homeobox (Otx) family, with important function in development and differentiation of retinal and pineal cells. Moreover, CRX appears to be specifically expressed in pineal tumors and retinoblastomas. We performed an immunohistochemical study on 91 pediatric and adult central nervous system tumors, plus 2 normal brain samples. Our results demonstrated that CRX is expressed not only in pineal parenchymal tumors and retinoblastoma, but also in a some medulloblastomas and supratentorial primitive neuroectodermal tumors. None of the glial tumors screened were positive for CRX. In conclusion, CRX could be useful in surgical neuropathology for the differential diagnosis of pineal region tumors, in particular to discriminate pineal tumors from glial tumors.

  9. [The spectrum of cystic kidney disease in adulthood: differential diagnosis and complications].

    Science.gov (United States)

    Peces, R; Costero, O

    2003-01-01

    Simple renal cysts are the most common renal masses, accounting for roughly 65 to 70% of cases. They most often occur in patients over the age of 50 as determined from post-mortem examination or renal ultrasonography. The major concern with simple renal cysts is differentiating them from more serious disorders, such as polycystic kidney disease and solid masses such as a renal carcinoma or abscess. Renal arteriovenous malformations may present with ultrasound picture mimicking simple parapelvic cyst. Ultrasound, doppler ultrasound, computed tomography and magnetic resonance imaging are effective in documenting the underlying lesions non-invasively. Arteriography may be useful to characterise vascular lesion. We report here the spectrum of cystic kidney disease in adulthood in a group of patient with different disorders. The differential diagnosis, complications and associated process are discussed.

  10. Clear cell odontogenic carcinoma: A rare case report with emphasis on differential diagnosis.

    Science.gov (United States)

    Datar, Uma Vasant; Kamat, Mamata Sharad; Kanitkar, Sampada Shriram; Byakodi, Sanjay Satappa

    2017-01-01

    Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic malignancy with a female predilection, typically presenting as swelling in anterior region of mandible. CCOC was classified as a malignant neoplasm of odontogenic origin by the WHO in 2005 as it exhibits an aggressive growth pattern, local recurrence, and tendency of distant metastasis. Histologically, CCOC is characterized by sheets and islands of vacuolated/clear cells. Since clear cells are present in few odontogenic tumors, salivary gland neoplasms, and metastatic tumors to the jaws; presence of clear cells in a lesion of head and neck area poses a diagnostic challenge. Knowledge about the clinical course, histopathologic pattern, and immunoprofile of CCOC aids in differentiating it from other clear cell tumors. Herein, we present a case of CCOC in anterior mandibular region of 60-year-old female patient with an emphasis on its differential diagnosis from other clear cell lesions of the jaws.

  11. Clear cell odontogenic carcinoma: A rare case report with emphasis on differential diagnosis

    Directory of Open Access Journals (Sweden)

    Uma Vasant Datar

    2017-01-01

    Full Text Available Clear cell odontogenic carcinoma (CCOC is a rare odontogenic malignancy with a female predilection, typically presenting as swelling in anterior region of mandible. CCOC was classified as a malignant neoplasm of odontogenic origin by the WHO in 2005 as it exhibits an aggressive growth pattern, local recurrence, and tendency of distant metastasis. Histologically, CCOC is characterized by sheets and islands of vacuolated/clear cells. Since clear cells are present in few odontogenic tumors, salivary gland neoplasms, and metastatic tumors to the jaws; presence of clear cells in a lesion of head and neck area poses a diagnostic challenge. Knowledge about the clinical course, histopathologic pattern, and immunoprofile of CCOC aids in differentiating it from other clear cell tumors. Herein, we present a case of CCOC in anterior mandibular region of 60-year-old female patient with an emphasis on its differential diagnosis from other clear cell lesions of the jaws.

  12. The functional role of microRNA in acute lymphoblastic leukemia: relevance for diagnosis, differential diagnosis, prognosis, and therapy

    Directory of Open Access Journals (Sweden)

    Luan CX

    2015-10-01

    Full Text Available Chengxin Luan,1,* Zixue Yang,2,* Baoan Chen1 1Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, 2State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, People’s Republic of China *These authors contributed equally to this work Abstract: MicroRNAs (miRNAs, a new class of noncoding RNAs, which can hybridize to target messenger RNAs and regulate their expression posttranscriptionally, express differentially in distinct stages of lymphopoiesis and influence the direction of lymphoid precursor maturation. Hence, there is aberrant expression of miRNAs involved in malignant lymphopoiesis, and these aberrations can be used as signatures of acute lymphoblastic leukemia (ALL with different subtypes. In addition, changes in the expression of several miRNAs may have functional relevance with leukemogenesis or drug resistance. As a result, the reversal of the expression of these miRNAs may alleviate the disease to some extent and improve clinical outcomes. However, among the studies of miRNAs, there are still some problems that need to be solved to understand the function of miRNAs in ALL more thoroughly. Keywords: ALL, microRNA, lymphopoiesis, molecular diagnosis, lymphoid malignant, molecular therapy

  13. Differential diagnosis of pancreatic cancer from other solid tumours arising from the periampullary area on MDCT

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    Jang, Suk Ki [Bundang Jesaeng General Hospital, Departments of Radiology, Daejin Medical Center, Seognam-si, Gyeonggi-do (Korea, Republic of); Kim, Jung Hoon; Joo, Ijin; Jeon, Ju Hyun; Han, Joon Koo; Choi, Byung Ihn [Seoul National University College of Medicine, Department of Radiology and Institute of Radiation Medicine, Chongno-gu, Seoul (Korea, Republic of); Shin, Kyung Sook [Chungnam National University School of Medicine, Department of Radiology, 266 Munhwa-ro, Jung-gu, Daejeon (Korea, Republic of)

    2015-10-15

    To investigate CT features and differential diagnosis of pancreatic adenocarcinoma compared to other solid tumours arising in the periampullary area. One hundred and ninety-five patients with pathologically proven, solid periampullary tumours, including pancreatic adenocarcinoma (n = 98), neuroendocrine tumours (n = 52), gastrointestinal stromal tumours (n = 31), and solid pseudopapillary neoplasms (n = 14), underwent preoperative CT. Two radiologists reviewed CT features and rated the possibility of pancreatic adenocarcinoma. Statistically common findings for pancreatic adenocarcinoma included: patient age >50 years; ill-defined margin; completely solid mass; homogeneous enhancement; hypoenhancement on arterial and venous phases; atrophy; and duct dilatation. Statistically common findings for GIST included: heterogeneous enhancement; hyperenhancement on arterial and venous phases; rim enhancement; and prominent feeding arteries. The hyperenhancement on arterial and venous phases is statistically common in NET, and heterogeneous enhancement, hypoenhancement on the arterial and venous phases are statistically common in SPN. Diagnostic performance of CT for differentiating pancreatic adenocarcinomas from other solid periampullary tumours was 0.962 and 0.977 with excellent interobserver agreement (κ = 0.824). CT is useful not only for differentiating pancreatic adenocarcinoma form other solid tumours but also for differentiating between other solid tumours, including NET, SPN, and GIST, arising in the periampullary area. (orig.)

  14. Foreign Body Granuloma: A Diagnosis Not to Forget

    Directory of Open Access Journals (Sweden)

    I. El Bouchti

    2012-01-01

    The differential diagnosis for bony reaction to an unrecognised organic foreign body includes osteoid osteoma, chronic and acute osteomyelitis, tuberculosis granuloma, bone cyst, aneurysmal bone cyst, cortical fibrous defect, and neoplasm. We report the case of a boy suffering from a thorn inducing a lytic lesion of the fifth metatarsal that demonstrates the diagnosis difficulties of foreign body granuloma.

  15. The differential diagnosis of children with joint hypermobility: a review of the literature

    Directory of Open Access Journals (Sweden)

    Elliott Elizabeth J

    2009-01-01

    Full Text Available Abstract Background In this study we aimed to identify and review publications relating to the diagnosis of joint hypermobility and instability and develop an evidence based approach to the diagnosis of children presenting with joint hypermobility and related symptoms. Methods We searched Medline for papers with an emphasis on the diagnosis of joint hypermobility, including Heritable Disorders of Connective Tissue (HDCT. Results 3330 papers were identified: 1534 pertained to instability of a particular joint; 1666 related to the diagnosis of Ehlers Danlos syndromes and 330 related to joint hypermobility. There are inconsistencies in the literature on joint hypermobility and how it relates to and overlaps with milder forms of HDCT. There is no reliable method of differentiating between Joint Hypermobility Syndrome, familial articular hypermobility and Ehlers-Danlos syndrome (hypermobile type, suggesting these three disorders may be different manifestations of the same spectrum of disorders. We describe our approach to children presenting with joint hypermobility and the published evidence and expert opinion on which this is based. Conclusion There is value in identifying both the underlying genetic cause of joint hypermobility in an individual child and those hypermobile children who have symptoms such as pain and fatigue and might benefit from multidisciplinary rehabilitation management. Every effort should be made to diagnose the underlying disorder responsible for joint hypermobility which may only become apparent over time. We recommend that the term "Joint Hypermobility Syndrome" is used for children with symptomatic joint hypermobility resulting from any underlying HDCT and that these children are best described using both the term Joint Hypermobility Syndrome and their HDCT diagnosis.

  16. Differential diagnosis between Parkinson's disease and essential tremor using the smartphone's accelerometer.

    Directory of Open Access Journals (Sweden)

    Sergi Barrantes

    Full Text Available The differential diagnosis between patients with essential tremor (ET and those with Parkinson's disease (PD whose main manifestation is tremor may be difficult unless using complex neuroimaging techniques such as 123I-FP-CIT SPECT. We considered that using smartphone's accelerometer to stablish a diagnostic test based on time-frequency differences between PD an ET could support the clinical diagnosis.The study was carried out in 17 patients with PD, 16 patients with ET, 12 healthy volunteers and 7 patients with tremor of undecided diagnosis (TUD, who were re-evaluated one year after the first visit to reach the definite diagnosis. The smartphone was placed over the hand dorsum to record epochs of 30 s at rest and 30 s during arm stretching. We generated frequency power spectra and calculated receiver operating characteristics curves (ROC curves of total spectral power, to establish a threshold to separate subjects with and without tremor. In patients with PD and ET, we found that the ROC curve of relative energy was the feature discriminating better between the two groups. This threshold was then used to classify the TUD patients.We could correctly classify 49 out of 52 subjects in the category with/without tremor (97.96% sensitivity and 83.3% specificity and 27 out of 32 patients in the category PD/ET (84.38% discrimination accuracy. Among TUD patients, 2 of 2 PD and 2 of 4 ET were correctly classified, and one patient having PD plus ET was classified as PD.Based on the analysis of smartphone accelerometer recordings, we found several kinematic features in the analysis of tremor that distinguished first between healthy subjects and patients and, ultimately, between PD and ET patients. The proposed method can give immediate results for the clinician to gain valuable information for the diagnosis of tremor. This can be useful in environments where more sophisticated diagnostic techniques are unavailable.

  17. Automated Differential Diagnosis of Early Parkinsonism Using Metabolic Brain Networks: A Validation Study.

    Science.gov (United States)

    Tripathi, Madhavi; Tang, Chris C; Feigin, Andrew; De Lucia, Ivana; Nazem, Amir; Dhawan, Vijay; Eidelberg, David

    2016-01-01

    The differentiation of idiopathic Parkinson disease (IPD) from multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), the most common atypical parkinsonian look-alike syndromes (APS), can be clinically challenging. In these disorders, diagnostic inaccuracy is more frequent early in the clinical course when signs and symptoms are mild. Diagnostic inaccuracy may be particularly relevant in trials of potential disease-modifying agents, which typically involve participants with early clinical manifestations. In an initial study, we developed a probabilistic algorithm to classify subjects with clinical parkinsonism but uncertain diagnosis based on the expression of metabolic covariance patterns for IPD, MSA, and PSP. Classifications based on this algorithm agreed closely with final clinical diagnosis. Nonetheless, blinded prospective validation is required before routine use of the algorithm can be considered. We used metabolic imaging to study an independent cohort of 129 parkinsonian subjects with uncertain diagnosis; 77 (60%) had symptoms for 2 y or less at the time of imaging. After imaging, subjects were followed by blinded movement disorders specialists for an average of 2.2 y before final diagnosis was made. When the algorithm was applied to the individual scan data, the probabilities of IPD, MSA, and PSP were computed and used to classify each of the subjects. The resulting image-based classifications were then compared with the final clinical diagnosis. IPD subjects were distinguished from APS with 94% specificity and 96% positive predictive value (PPV) using the original 2-level logistic classification algorithm. The algorithm achieved 90% specificity and 85% PPV for MSA and 94% specificity and 94% PPV for PSP. The diagnostic accuracy was similarly high (specificity and PPV > 90%) for parkinsonian subjects with short symptom duration. In addition, 25 subjects were classified as level I indeterminate parkinsonism and 4 more subjects as level II

  18. Targeted next-generation sequencing for differential diagnosis of neurofibromatosis type 2, schwannomatosis, and meningiomatosis.

    Science.gov (United States)

    Louvrier, Camille; Pasmant, Eric; Briand-Suleau, Audrey; Cohen, Joëlle; Nitschké, Patrick; Nectoux, Juliette; Orhant, Lucie; Zordan, Cécile; Goizet, Cyril; Goutagny, Stéphane; Lallemand, Dominique; Vidaud, Michel; Vidaud, Dominique; Kalamarides, Michel; Parfait, Béatrice

    2018-02-02

    Clinical overlap between neurofibromatosis type 2 (NF2), schwannomatosis, and meningiomatosis can make clinical diagnosis difficult. Hence, molecular investigation of germline and tumor tissues may improve the diagnosis. We present the targeted next generation sequencing (NGS) of NF2, SMARCB1, LZTR1, SMARCE1, and SUFU tumor suppressor genes, using an amplicon-based approach. We analyzed blood DNA from a cohort of 196 patients, including patients with: NF2 (N=79), schwannomatosis (N=40), meningiomatosis (N=12), and no clearly established diagnosis (N=65). Matched tumor DNA was analyzed when available. Forty-seven NF2-/SMARCB1-negative schwannomatosis patients and 27 NF2-negative meningiomatosis patients were also evaluated. A NF2 variant was found in 41/79(52%) of NF2 patients. SMARCB1 or LZTR1 variants were identified in 5/40(12.5%) and 13/40(32%) patients in the schwannomatosis cohort. Potentially pathogenic variants were found in 12/65 (18,5%) patients with no clearly established diagnosis. A LZTR1 variant was identified in 16/47(34%) of NF2/SMARCB1-negative schwannomatosis patients. A SMARCE1 variant was found in 3/39(8%) of meningiomatosis patients. No SUFU variant was found in the cohort. NGS was an effective and sensitive method to detect mutant alleles in blood or tumor DNA of mosaic NF2 patients. Interestingly, we identified a four-hit mechanism resulting in the complete NF2 loss-of-function combined with SMARCB1 and LZTR1 haploinsufficiency in two-thirds of tumors from NF2 patients. Simultaneous investigation of NF2, SMARCB1, LZTR1, and SMARCE1 is a key element in the differential diagnosis of NF2, schwannomatosis, and meningiomatosis. The targeted NGS strategy is suitable for the identification of NF2 mosaicism in blood and for the investigation of tumors from these patients.

  19. Differential diagnosis and treatment of panic disorder: a medical model perspective.

    Science.gov (United States)

    Vittone, B J; Uhde, T W

    1985-12-01

    The authors present a review of existing literature along with new data regarding the phenomenology, differential diagnosis, course and treatment of panic disorder and agoraphobia. Panic attacks are viewed as central to the development of these disorders, and individual cognitive frameworks contribute to the manner in which a patient's symptoms evolve. An apparent though unclear relation to depressive states is described. Substance abuse may also be a consequence of recurrent panic attacks. A scheme towards differential diagnosis of panic disorder from other psychiatric and medical disorders is proposed. Personality characteristics of these patients vary considerably, but certain factors, such as dependency, are common. Family relations are often strained and assume importance in treatment. Data on the longitudinal course of illness is presented implying a relationship of panic disorder to both depression and stressful life events in many patients. Treatments that thus far seem most effective are pharmacological and behavioural approaches. Imipramine, MAO inhibitors, and alprazolam currently appear to be the most useful medications employed, although other agents may at times be useful alternatives. Dietary interventions, family therapy, and group and individual psychotherapy are also reviewed and discussed as adjunctive therapies in the treatment of panic disorder.

  20. Neuroimaging in Parkinsonism: a study with magnetic resonance and spectroscopy as tools in the differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Vasconcellos, Luiz Felipe Rocha [1Hospital dos Servidores do Estado, Rio de Janeiro RJ (Brazil)], e-mail: luizneurol@terra.com.br; Novis, Sergio A. Pereira; Rosso, Ana Lucia Z. [Hospital Universitario Clementino Fraga Filho (HUCFF), Rio de Janeiro, RJ (Brazil); Moreira, Denise Madeira [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Inst. de Neurologia Deolindo Couto; Leite, Ana Claudia C.B. [Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ (Brazil)

    2009-03-15

    The differential diagnosis of Parkinsonism based on clinical features, sometimes may be difficult. Diagnostic tests in these cases might be useful, especially magnetic resonance imaging, a noninvasive exam, not as expensive as positron emission tomography, and provides a good basis for anatomical analysis. The magnetic resonance spectroscopy analyzes cerebral metabolism, yielding inconsistent results in parkinsonian disorders. We selected 40 individuals for magnetic resonance imaging and spectroscopy analysis, 12 with Parkinson's disease, 11 with progressive supranuclear palsy, 7 with multiple system atrophy (parkinsonian type), and 10 individuals without any psychiatric or neurological disorders (controls). Clinical scales included Hoenh and Yahr, unified Parkinson's disease rating scale and mini mental status examination. The results showed that patients with Parkinson's disease and controls presented the same aspects on neuroimaging, with few or absence of abnormalities, and supranuclear progressive palsy and multiple system atrophy showed abnormalities, some of which statistically significant. Thus, magnetic resonance imaging and spectroscopy could be useful as a tool in differential diagnosis of Parkinsonism. (author)

  1. Differential diagnosis of groove pancreatic carcinomas vs. groove pancreatitis: Usefulness of the portal venous phase

    Energy Technology Data Exchange (ETDEWEB)

    Ishigami, Kousei, E-mail: Ishigamikousei@aol.co [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 (Japan); Tajima, Tsuyoshi; Nishie, Akihiro; Kakihara, Daisuke [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 (Japan); Fujita, Nobuhiro [Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Asayama, Yoshiki; Ushijima, Yasuhiro; Irie, Hiroyuki [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 (Japan); Nakamura, Masafumi; Takahata, Shunichi [Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Ito, Tetsuhide [Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 (Japan)

    2010-06-15

    Purpose: To clarify if the portal venous phase is helpful for the differential diagnosis of groove pancreatic carcinomas and groove pancreatitis. Materials and methods: MDCT and MRI of groove pancreatic carcinomas (n = 7) and groove pancreatitis (n = 15) were retrospectively reviewed by two radiologists independently. The signal intensity on T2-weighted images was subjectively assessed. The presence or absence of common bile duct (CBD) and main pancreatic duct (MPD) strictures, calcifications, and cystic lesions was evaluated. Additionally, the appearance of groove pancreatic carcinoma and that of groove pancreatitis in the portal venous phase on dynamic MDCT and MRI were compared. Results: There were no significant differences in the signal intensity on T2-weighted images and in the presence or absence of CBD and MPD strictures, calcifications, and cystic lesions between groove pancreatic carcinomas and groove pancreatitis. However, patchy focal enhancement in the portal venous phase was more commonly observed in groove pancreatitis than groove pancreatic carcinoma (Reviewers 1 and 2: 14/15 [93.3%] vs. 1/7 [14.3%], P < 0.0001). In addition, peripheral enhancement was only seen in groove pancreatic carcinomas (Reviewer 1: 4/7 [57.1%] vs. 0/15 [0%], P < 0.005, and Reviewer 2: 3/7 [42.9%] vs. 0/15 [0%], P < 0.05). Conclusion: The portal venous phase may be helpful for the differential diagnosis of groove pancreatic carcinomas and groove pancreatitis.

  2. Application of high-resolution genomic profiling in the differential diagnosis of liposarcoma.

    Science.gov (United States)

    Koczkowska, Magdalena; Lipska-Ziętkiewicz, Beata Stefania; Iliszko, Mariola; Ryś, Janusz; Miettinen, Markku; Lasota, Jerzy; Biernat, Wojciech; Harazin-Lechowska, Agnieszka; Kruczak, Anna; Limon, Janusz

    2017-01-01

    Rarity and heterogeneity of liposarcomas (LPS) make their diagnosis difficult even for sarcoma-experts pathologists. The molecular mechanism underlying the development and progression of liposarcomas (LPS) remains only partially known. In order to identify and compare the genomic profiles, we analyzed array-based comparative genomic hybridization (array-CGH) profiles of 66 liposarcomas, including well-differentiated (WDLPS), dedifferentiated (DDLPS) and myxoid (MLPS) subtypes. Copy number aberrations (CNAs) were identified in 98% of WDLPS and DDLPS and in 95% of MLPS cases. The minimal common region of amplification at 12q14.1q21.1 was observed in 96% of WDLPS and DDLPS cases. Four regions of CNAs, including losses of chromosome 6, 11 and 13 and gains of chromosome 14 were classified as recurrent in DDLPS; at least one was identified in 74% of DDLPS tumors. The DDLPS-associated losses were much more common in tumors with increased genomic complexity. In MLPS, the most frequent CNAs were losses of chromosome 6 (40%) and gains of chromosome 1 (30%), with the minimal overlapping regions 6q14.1q22.31 and 1q25.1q32.2, respectively. Our findings show that the application of array-CGH allows to delineate clearly the genomic profiles of WDLPS, DDLPS and MLPS that reflect biological differences between these tumors. Although CNAs varied widely, the subtypes of tumors have characteristic genomic profiles that could facilitate the differential diagnosis of LPS subtypes, especially between WDLPS and DDLPS.

  3. Physical therapist screening and differential diagnosis for traumatic-onset elbow pain: A case report.

    Science.gov (United States)

    VanWye, William R; Hoover, Donald L; Willgruber, Sean

    2016-10-01

    Elbow pain can originate from many sources yet have similar signs and symptoms, thereby presenting differential diagnostic challenges. The elbow is commonly injured, thus requiring all clinicians to possess excellent diagnostic skills. A 24-year-old woman slipped and fell on her outstretched left hand, experiencing immediate elbow pain. The same day radiographs were deemed negative by her orthopedist, who referred her to physical therapy with the diagnoses of elbow sprain and contusion. Immediately after examining the patient, the physical therapist consulted with the referring orthopedist. The decision to consult was based on: the mechanism of injury, pain severity out of proportion to the referred diagnoses, significantly limited ROM, abnormal joint end feels, exquisite pain with tactile and tuning fork bony palpation, and positive elbow extension test. The treating physical therapist shared the above-noted findings with the orthopedist, who overruled and recommended continuing the original prescription of non-steroidal anti-inflammatory medication and physical therapist treatment for four weeks. The physical therapist's updated plan of care at four weeks noted the patient's continued reports of pain, functional limitations, and disability. A magnetic resonance image (MRI) was then ordered, revealing a radial head fracture. A thorough history and examination by the physical therapist led to clustering of signs and symptoms, allowing for the development of a differential diagnosis list which included occult radial head fracture. All clinicians should be prepared to screen for complex conditions. Timely diagnosis and improved outcomes for clinically complex patients are increasingly necessary in contemporary healthcare reimbursement models.

  4. SOLITARY PULMONARY NODULES: EFFECTIVENESS OF DYNAMIC CT IN THE DIFFERENTIAL DIAGNOSIS

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    N. K. Silanteva

    2017-01-01

    Full Text Available The differential diagnosis of solitary pulmonary nodules remains a challenge in oncology. Dynamic contrastenhanced CT is a potentially valuable tool capable of detecting malignancy. The purpose of the study was to evaluate the value of dynamic CT in the differential diagnosis of solitary pulmonary nodules. Material and methods. Fifty two patients with solitary pulmonary nodules underwent CT examination using a GE Optima CT660. The CT protocol included: 1 scan volume from the jugular notch to the end of the diaphragmatic dome; 2 location of the nodule in the lung; 3 scanning time for 30 sec, 1 min, 2 min, 4 min and 6 min following contrast agent injection. The image processing was carried out on an Advantage Workstation for Windows (AW4.5, GE Healthcare. The CT findings were verified by histology after CT-guided transthoracic biopsy of lung lesions and lung surgeries. Results. The sensitivity, specificity and accuracy of dynamic contract-enhanced CT were higher than those without dynamic CT (85, 95 and 92 % versus 71, 95 and 88 %, respectively.

  5. Best practices in the differential diagnosis and reporting of acute transfusion reactions

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    Hillis CM

    2016-01-01

    Full Text Available Christopher M Hillis,1–3,* Andrew W Shih,1,3,* Nancy M Heddle1,3,4 1Department of Medicine, 2Department of Oncology, 3McMaster Transfusion Research Program, McMaster University, Hamilton, 4Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada  *These authors contributed equally to this work Abstract: An acute transfusion reaction (ATR is any reaction to blood, blood components, or plasma derivatives that occurs within 24 hours of a transfusion. The frequencies of ATRs and the associated symptoms, reported by the sentinel sites of the Ontario Transfusion Transmitted Injuries Surveillance System from 2008 to 2012, illustrate an overlap in presenting symptoms. Despite this complexity, the differential diagnosis of an ATR can be determined by considering predominant signs or symptoms, such as fever, dyspnea, rash, and/or hypotension, as these signs and symptoms guide further investigations and management. Reporting of ATRs locally and to hemovigilance systems enhances the safety of the blood supply. Challenges to the development of an international transfusion reaction reporting system are discussed, including the issue of jurisdiction and issues of standardization for definitions, investigations, and reporting requirements. This review discusses a symptom-guided approach to the differential diagnosis of ATRs, the evolution of hemovigilance systems, an overview of the current Canadian system, and proposes a best practice model for hemovigilance based on a World Health Organization patient safety framework. Keywords: blood transfusion, blood components, hemovigilance

  6. Functional brain imaging in the dementias: role in early detection, differential diagnosis, and longitudinal studies

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    Devous, M.D. Sr. [Nuclear Medicine Center and Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX (United States)

    2002-12-01

    This review considers the role of functional brain imaging techniques in the dementias. The substantial assistance that especially single-photon emission tomography and positron emission tomography can play in the initial diagnosis of dementia and in the differential diagnosis of the specific dementing disorder is discussed. These techniques alone essentially match the sensitivity and specificity of clinical diagnoses in distinguishing Alzheimer's dementia (AD) from age-matched controls, from frontal lobe dementia and vascular dementia, and even from Lewy body dementia. Newer analytic techniques such as voxel-based correlational analyses and discriminant function analyses enhance the power of such differential diagnoses. Functional brain imaging techniques can also significantly assist in patient screening for clinical trials. The correlation of the observed deficits with specific patterns of cognitive abnormalities permits enhanced patient management and treatment planning and improved longitudinal assessment of outcome. It is also noteworthy that the classic abnormalities of temporoparietal and posterior cingulate hypoperfusion or hypometabolism appear to be present prior to symptom onset. These abnormalities predict progression to AD in the presence of the earliest of symptoms, and are present even in cognitively normal but at-risk subjects, with a severity proportional to the risk status. Even greater predictive ability for progression to AD is obtained by combining measures of perfusion or metabolism with risk factors, tau protein levels, hippocampal N-Acetyl aspartate concentrations, or hippocampal volume measures. (orig.)

  7. KatG protein: A novel marker for differential diagnosis of Myobacterium avium complex infection

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    Gupta K

    2010-01-01

    Full Text Available Purpose: Biochemical or nucleic acid based diagnostic techniques for MAC infection are unsatisfactory. This study aims to identify and evaluate M. avium secretory protein(s of diagnostic potential, so as to develop a rapid and simple method for diagnosis of MAC infection. Material and Methods: Initially, a specific protein band of ~80-85 kDa was recognised by differential immunoblotting; which was subjected to anion exchange column chromatography for purification of proteins. After fractionisation using SDS-PAGE and electroelution, blast search was carried out. Further immunoreactivity studies were done with M. avium and Mtb infected mice sera. Clinical utilisation of separated protein was evaluated by conducting indirect ELISA with serum samples from mycobacterial infected patients. Results: A specific 81.6 kDa protein, shown to be catalase-peroxidase protein (KatG by blast search was separated. Immunoreactivity studies of purified KatG proteins with mice sera confirmed it to be specific for M. avium infection. Indirect ELISA with patient samples further confirmed it to be M. avium infection specific. Conclusion: KatG protein is specifically recognised by MAC patients and can be used as a marker for simple and rapid ELISA based tests for differential diagnosis of M. avium infection.

  8. Modern representations about differential diagnosis of schizophrenia-like psychosis disorders due to psychoactive substance use

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    V. V. Chugunov

    2014-08-01

    Full Text Available In recent years in the world there is a tendency of quantity of persons who use drugs increase. Free availability of drugs of different groups for population is the main cause. Another trend associated with the consumption of drugs. All these factors led to the increased frequency of psychosis occurrence among consumers of psychoactive substances. In structure of such psychosis there are a variety of symptoms and syndromes. And since the number of drug users is quite broad in its structure - there are also persons with mental illness. This gives number of diagnostic difficulties. In this regard, the aim of the study was to trace the modern ideas of differential diagnosis of schizophrenia-like psychosis disorders due to the drug use. Materials and methods of research. In this work the content analysis of the modern representations of differential diagnosis of schizophrenia-like psychosis disorders as a result of the use of psychoactive substances was made. The problem of determination of primary and secondary nature of drug addiction in patients with psychotic disorders was indicated. Etiology and psychopathogenesis hypotheses of the addiction from psychoactive substances in the context of their correlation with endogenous mental pathology were defined. In the literature there is no clear diagnostic criteria that would allow distinguishing psychosis due to the use of drugs and endogenous psychosis, which is combined with the admission medicines. However, the attention of clinicians should be concentrated on the premorbid condition: the presence of hereditary family history, pathological behavior in childhood and adolescence. It was found that the majority of substances may cause one or more syndromes - delirium, dementia, and amnestic syndrome, delusional syndrome, hallucinatory syndrome, depressive syndrome, anxiety, and personality disorder, such disorders as schizophrenia-like psychosis disorders are not rare. Special attention was paid to the

  9. DIFFERENTIAL DIAGNOSIS OF DEEP GLUTEAL PAIN IN A FEMALE RUNNER WITH PELVIC INVOLVEMENT: A CASE REPORT

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    Podschun, Laura; Kolber, Morey J.; Garcia, Ashley; Rothschild, Carey E.

    2013-01-01

    Background: Gluteal injuries, proximal hamstring injuries, and pelvic floor disorders have been reported in the literature among runners. Some suggest that hip, pelvis, and/or groin injuries occur in 3.3% to 11.5% of long distance runners. The purpose of this case report is to describe the differential diagnosis and treatment approach for a patient presenting with combined hip and pelvic pain. Case description: A 45-year-old female distance runner was referred to physical therapy for proximal hamstring pain that had been present for several months. This pain limited her ability to tolerate sitting and caused her to cease running. Examination of the patient's lumbar spine, pelvis, and lower extremity led to the initial differential diagnosis of hamstring syndrome and ischiogluteal bursitis. The patient's primary symptoms improved during the initial four visits, which focused on education, pain management, trunk stabilization and gluteus maximus strengthening, however pelvic pain persisted. Further examination led to a secondary diagnosis of pelvic floor hypertonic disorder. Interventions to address the pelvic floor led to resolution of symptoms and return to running. Outcomes: Pain level on the Visual Analog Scale decreased from 7/10 to 1/10 over the course of treatment. The patient was able to return to full sport activity and improved sitting tolerance to greater then two hours without significant discomfort. Discussion: This case suggests the interdependence of lumbopelvic and lower extremity kinematics in complaints of hamstring, posterior thigh and pelvic floor disorders. This case highlights the importance of a thorough examination as well as the need to consider a regional interdependence of the pelvic floor and lower quarter when treating individuals with proximal hamstring pain. Level of Evidence: Level 4 PMID:24175132

  10. Primary seminal vesicle carcinoma. The usefulness of PAX8 immunohistochemical expression for the differential diagnosis.

    Science.gov (United States)

    Posenato, Ilaria; Caliò, Anna; Segala, Diego; Sgroi, Salvatore; Polara, Andrea; Brunelli, Matteo; Martignoni, Guido

    2017-11-01

    Primary seminal vesicle carcinoma is a rare entity whose diagnosis can be achieved by ruling out the main carcinomas that commonly invade the seminal vesicles. Although a panel of immunohistochemical markers (cancer antigen 125, cytokeratin [CK] 7, CK20, prostate-specific antigen, and prostate-specific acid phosphatase) has been proposed as unique for primary seminal vesicle carcinoma, a reliable positive marker is lacking. In this article, we report a case of primary seminal vesicle carcinoma in a 57-year-old man. The tumor was localized to the left seminal vesicle and histologically characterized by papillae lined by broad eosinophilic cells with pleomorphic nuclei. The neoplastic cells expressed cancer antigen 125 and CK7, whereas CK20, prostate-specific antigen, and prostate-specific acid phosphatase were negative. A strong and diffuse nuclear labeling for PAX8 was detected. Because carcinomas of the colon, bladder, and prostate, the main differential diagnosis in this setting, have been reported consistently to be PAX8 negative, this marker may be very useful for a prompt diagnosis of seminal vesicle carcinoma. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Evaluation of bone scintigraphy in differential diagnosis of benign bone tumors

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    Okuyama, Takeo; Suzuki, Hitoshi; Nakamoto, Kazuya; Suzuki, Soji (Tokyo Medical and Dental Univ. (Japan). School of Medicine)

    1982-12-01

    Bone scintigrachy with sup(99m)Tc-phosphate compounds was evaluated from the analysis of 71 consecutive cases of various benign bone tumors whether the scintigrams could be helpful in their differential diagnosis. The characteristics of the scintigraphic image at the site of bone lesions were noticed as being marked (++), moderate (+) and poor or minimal (-), according to the degree of accumulation of the radioactivity. Fibrous dysplasia (8 among 9 cases) as well as aneurysmal bone cyst (3 among 4 cases) had strong tendency of marked accumulation. Poor or minimal accumulation was observed in almost all of the lesions of nonossifying fibroma including fibrous cortical defect (6 all cases), solitary bone cyst (4 among 6 cases) and enchondroma (3 among 4 cases). Moderate accumulation was said to be non-specific, since it could be encountered in any type of benign bone tumors. But it was noticed that the majority of the bone lesions of eosinophilic granuloma (7 among 9 cases) showed moderate accumulation and the scintigraphic evidence of the skeletal disease appeared to be less extensive than the roentgenogram. These scintigraphic characteristics realized in some benign bone tumors occasionally played an important role in clinical diagnosis, especially in the cases atypical on roentgenographic findings. Several instructive cases whose final diagnosis was strongly linked to the scintigraphic information were demonstrated.

  12. Role of anti-GQ1B antibody in differential diagnosis of acute ophthalmoparesis

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    E Ece Boylu

    2010-04-01

    Full Text Available E Ece Boylu, R Erdem Togrol, Mehmet Güney Şenol, M Fatih Özdag, Mehmet SaraçogluGATA Hadarpaşa Educational and Research Hospital, Department of Neurology, Istanbul, TurkeyAbstract: Miller Fisher syndrome (MFS is a triad of total external ophthalmoplegia, ataxia, and areflexia, while botulism has the usual clinical presentation of involvement of cranial muscles and palsies with blurred vision, diplopia, ptosis, dilated pupils, and facial paralysis, caused by a bacterial neurotoxin which attacks proteins involved in presynaptic vesicle release. In this report, we needed to make the differential diagnosis between MFS and botulism in a patient who presented with acute ophthalmoparesis and a history of diarrhea three days before, which started two days after consuming tinned food. Routine laboratory, neurophysiologic, and imaging investigations were normal. A clinical diagnosis of Miller Fisher syndrome was reached by anti-ganglioside GQ1B and GM1 Ig G and M antibody investigations which proved positive. The patient was treated with intravenous immunoglobulin two weeks after (in the late period the symptoms started and he has recovered completely. Systemic autoimmune diseases should be considered in patients with bilateral ophthalmoparesis. As in the present patient, the evaluation of specific antibodies helps in the diagnosis and thus early effective treatment is possible.Keywords: anti-ganglioside antibody, botulism, Miller Fisher syndrome, ophthalmoparesis

  13. Differential diagnosis of usual interstitial pneumonia: when is it truly idiopathic?

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    Wim A. Wuyts

    2014-09-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF, the most common and lethal of the idiopathic interstitial pneumonias, is defined by a radiological and/or pathological pattern of usual interstitial pneumonia (UIP. However, UIP is not synonymous with IPF as other clinical conditions may be associated with UIP, including chronic hypersensitivity pneumonitis, collagen vascular disease, drug toxicity, asbestosis, familial IPF and Hermansky–Pudlak syndrome. Differentiating IPF (“idiopathic UIP” from conditions that mimic IPF (“secondary UIP” has substantial therapeutic and prognostic implications. A number of radiological and histological clues may help distinguish IPF from other conditions with a UIP pattern of fibrosis, but their appreciation requires extensive expertise in interstitial lung disease as well as an integrated multidisciplinary approach involving pulmonologists, radiologists and pathologists. In addition, multidisciplinary discussions may decrease the time to initial IPF diagnosis and, thus, enable more timely management. This concept was strongly emphasised by the 2011 ATS/ERS/JRS/ALAT guidelines. This article highlights, with the aid of a clinical case, the difficulties in making a diagnosis of IPF in clinical practice. Yet, an accurate diagnosis is critical, particularly given the availability of drugs that may reduce the pace of functional decline and disease progression in IPF.

  14. MRT diagnosis of cardiac myxomas: sequence evaluation and differential diagnosis; MRT-Diagnostik kardialer Myxome: Sequenzevaluierung und Differentialdiagnose

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    Sommer, T.; Hofer, U.; Pauleit, D.; Wilhelm, K.; Textor, J.; Schild, H. [Bonn Univ. (Germany). Radiologische Klinik; Vahlhaus, C. [Bonn Univ. (Germany). Medizinische Poliklinik; Smekal, A. v. [UniversitaetsSpital Zuerich, Zurich (Switzerland). Inst. fuer Diagnostische Radiologie; Wardelmann, E.; Bierhoff, E. [Bonn Univ. (Germany). Pathologisches Inst.

    1999-02-01

    Purpose: To evaluate native and contrast enhanced T{sub 1}-weighted spin (T{sub 1}-SE), cine gradient echo (Cine-GE), and T{sub 2}-weighted turbo spin (T{sub 2}-TSE) sequences in the diagnosis and differential diagnosis of cardiac myxomas. Methods: 15 patients with echocardiographically suspected cardiac arterial myxomas underwent 0,5 T-MR imaging of the heart with native T{sub 1}-SE, contrast-enhanced T{sub 1}-SE, Cine-GE, and T{sub 2}-TSE sequences. MR images were evaluated for signal intensity (SI) and lesion`s conspicuity. Results were confirmed histologically (14x) or by follow-up (1x). Results: MRI revealed myxomas in 9 patients, sarcomas in three patients, and thrombi in three patients. Lesion conspicuity was better in Cine-GE and T{sub 2}-TSE compared with native and contrast-enhanced T{sub 1}-SE sequences. Myxomas were characterized by an intermediate SI similar to myocardium in T{sub 1}-SE, high SI similar to water in T{sub 2}-TSE, and low to moderately high enhancement (range 19-75%, mean 48%). Conclusion: Distinct SI characteristics together with anatomical-topographical features (attachment to the interatrial septum, no infiltration of myocardium and vessels) are diagnostic for cardiac myxomas. Cine-GE and T{sub 2}-TSE sequences are the sequences of choice for detection of myxomas and other atrial masses. T{sub 2}-TSE and contrast-enhanced T{sub 1}-weighted sequences are most useful for mass characterisation and differentiation between myxomas, malignant tumors, and thrombi. (orig.) [Deutsch] Ziel: Evaluierung nativer und kontrastverstaerkter T{sub 1}-gesichteter Spin-Echo-Sequenzen (T{sub 1}-SE), Cine-Gradienten-Echo-Sequenzen (GE) sowie T{sub 2}-gewichteter Turbo-Spin-Echo-Sequenzen (T{sub 2}-TSE) in Diagnostik und Differentialdiagnose kardialer Myxome. Methode: 15 Patienten mit echokardiographischem Verdacht auf ein Vorhofmyxom erhielten eine MRT-Untersuchung des Herzens (0,5 Tesla, EKG-getriggerte T{sub 1}-SE nativ-, T{sub 1}-SE KM-, GE-, T{sub 2

  15. Combining SPECT and Quantitative EEG Analysis for the Automated Differential Diagnosis of Disorders with Amnestic Symptoms

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    Yvonne Höller

    2017-09-01

    Full Text Available Single photon emission computed tomography (SPECT and Electroencephalography (EEG have become established tools in routine diagnostics of dementia. We aimed to increase the diagnostic power by combining quantitative markers from SPECT and EEG for differential diagnosis of disorders with amnestic symptoms. We hypothesize that the combination of SPECT with measures of interaction (connectivity in the EEG yields higher diagnostic accuracy than the single modalities. We examined 39 patients with Alzheimer's dementia (AD, 69 patients with depressive cognitive impairment (DCI, 71 patients with amnestic mild cognitive impairment (aMCI, and 41 patients with amnestic subjective cognitive complaints (aSCC. We calculated 14 measures of interaction from a standard clinical EEG-recording and derived graph-theoretic network measures. From regional brain perfusion measured by 99mTc-hexamethyl-propylene-aminoxime (HMPAO-SPECT in 46 regions, we calculated relative cerebral perfusion in these patients. Patient groups were classified pairwise with a linear support vector machine. Classification was conducted separately for each biomarker, and then again for each EEG- biomarker combined with SPECT. Combination of SPECT with EEG-biomarkers outperformed single use of SPECT or EEG when classifying aSCC vs. AD (90%, aMCI vs. AD (70%, and AD vs. DCI (100%, while a selection of EEG measures performed best when classifying aSCC vs. aMCI (82% and aMCI vs. DCI (90%. Only the contrast between aSCC and DCI did not result in above-chance classification accuracy (60%. In general, accuracies were higher when measures of interaction (i.e., connectivity measures were applied directly than when graph-theoretical measures were derived. We suggest that quantitative analysis of EEG and machine-learning techniques can support differentiating AD, aMCI, aSCC, and DCC, especially when being combined with imaging methods such as SPECT. Quantitative analysis of EEG connectivity could become

  16. Value of apparent diffusion coefficient calculation in the differential diagnosis of parotid gland tumors.

    Science.gov (United States)

    Yerli, H; Agildere, A M; Aydin, E; Geyik, E; Haberal, N; Kaskati, T; Oguz, D; Ozluoglu, L N

    2007-11-01

    The differential diagnosis of parotid gland tumors is often difficult with conventional magnetic resonance imaging. To determine whether the calculation of the apparent diffusion coefficient (ADC) is valuable for making the differential diagnosis of parotid tumors. Thirty parotid masses in 28 patients and 24 healthy parotid glands in 12 controls were examined in this prospective study. Diffusion-weighted magnetic resonance imaging with echo-planar spin-echo sequences was used to evaluate each subject. The ADC of each tumor and each healthy parotid gland was calculated. Tumor diagnoses were confirmed by the results of histopathologic analysis. The following types of masses were identified: 11 Warthin tumors, nine pleomorphic adenomas, seven malignant tumors, one basal cell adenoma, and two benign cysts. The mean ADC value for the Warthin tumors was 0.97+/-0.16 x 10(-3) mm(2)/s, for the pleomorphic adenomas was 1.74+/-0.37 x 10(-3) mm(2)/s, for the malignant tumors was 1.04+/-0.35 x 10(-3) mm(2)/s, and for the normal parotid glands was 0.34+/-0.20 x 10(-3) mm(2)/s. The respective ADC value for the single basal cell adenoma was 1.40 x 10(-3) mm(2)/s. Statistically significant differences were identified between the subjects with pleomorphic adenoma and those with another type of parotid tumor, and between subjects with healthy parotid glands and those with a tumor. Calculating the ADC appears to be useful in differentiating pleomorphic adenomas from other types of parotid gland tumors.

  17. Comparison of multiplex-PCR and antigen detection for differential diagnosis of Entamoeba histolytica

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    Helena Lúcia Carneiro Santos

    Full Text Available Amebiasis is an infection caused by Entamoeba histolytica. However, differentiation between E. histolytica and Entamoeba dispar, which are morphologically identical species, is essential for treatment decision, precaution of the invasive disease and public health. The purpose of the present study was to evaluate a Multiplex -PCR for detection and differentiation of E. histolytica from E. dispar from fresh stool samples in comparison with the coproantigen commercial ELISA. Microscopic examination of stools using the Coprotest method, detection of stool antigen by enzyme-linked immunosorbent assay kit and a home made Multiplex-PCR, were used for the diagnosis of amoebiasis infection. Analysis of the 127 stools samples by microscopy examination demonstrated that only 27 (21% samples were positive for E. histolytica/E. dispar complex. Among these stool samples, 11 were positive by Multiplex-PCR, with nine presenting the diagnostic fragment characteristic of E. dispar (96 bp and two presenting diagnostic fragment of E. histolytica (132 bp. Among negative samples detected by microscopic examination, three positive samples for E. dispar and one positive for E. histolytica by Multiplex-PCR was observed. This denotes a low sensibility of microscopic examination when a single stool sample is analyzed. Assay for detection of E. histolytica antigen was concordant with multiplex-PCR in relation to E. histolytica. Statistical analysis comparing the sensibility tests was not done because of the low number of E. histolytica cases. The results demonstrate the importance of the specific techniques use for the differentiation between E. histolytica and E. dispar.

  18. Rapid differential diagnosis of diabetes insipidus in a 7-month-old infant: The copeptin approach.

    Science.gov (United States)

    Vergier, J; Fromonot, J; Alvares De Azevedo Macedo, A; Godefroy, A; Marquant, E; Guieu, R; Tsimaratos, M; Reynaud, R

    2018-01-01

    Diabetes insipidus is characterized by hypoosmotic polyuria related to deficiency of arginine-vasopressin (AVP) secretion (central diabetes insipidus, CDI) or renal insensitivity to AVP (nephrogenic diabetes insipidus, NDI). The water deprivation test with assessment of AVP activity is currently the gold standard for differential diagnosis in patients presenting polyuria-polydipsia syndrome. Nevertheless, it can be dangerous without proper surveillance and its interpretation may be challenging. Other markers have been suggested. Direct quantification of circulating AVP is not sufficient for diagnosis: vasopressin is unstable, analysis is complex. AVP comes from prohormone preprovasopressin with concomitant release of copeptin (C-terminal moiety) in the equimolar ratio. Copeptin is stable in vitro, with easy and rapid measurement (copeptin versus AVP to discriminate etiologies of polyuria in adults, but its value has not been demonstrated in infants yet. A 7-month-old infant presented polyuria-polydipsia syndrome with poor weight gain. Laboratory tests pointed out hypernatremia (170mmol/L) and blood hyperosmolarity (330mOsm/L) with inappropriate urinary hypoosmolarity (168mOsm/L). Plasmatic copeptin measurement was found at a very high level, 303pmol/L (1-14pmol/L). DdAVP administration did not improve the polyuria, confirming the final diagnosis of NDI. Hyperhydration with a hypoosmolar diet normalized the hydration status and circulating levels of copeptin within 1 week. Copeptin, a stable peptide reflecting AVP secretion, could be a safer and faster biomarker for etiological diagnosis of polyuria-polydipsia syndrome in children. Before regularization of hydration status, a single baseline measurement may be enough to discriminate NDI from other etiologies without the water deprivation test. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Uvemaster: A Mobile App-Based Decision Support System for the Differential Diagnosis of Uveitis.

    Science.gov (United States)

    Gegundez-Fernandez, Jose A; Fernandez-Vigo, Jose I; Diaz-Valle, David; Mendez-Fernandez, Rosalia; Cuiña-Sardiña, Ricardo; Santos-Bueso, Enrique; Benitez-Del-Castillo, Jose M

    2017-08-01

    To examine the diagnostic accuracy and performance of Uvemaster, a mobile application (app) or diagnostic decision support system (DDSS) for uveitis. The app contains a large database of knowledge including 88 uveitis syndromes each with 76 clinical items, both ocular and systemic (total 6688) and their respective prevalences, and displays a differential diagnoses list (DDL) ordered by sensitivity, specificity, or positive predictive value (PPV). In this retrospective case-series study, diagnostic accuracy (percentage of cases for which a correct diagnosis was obtained) and performance (percentage of cases for which a specific diagnosis was obtained) were determined in reported series of patients originally diagnosed by a uveitis specialist with specific uveitis (N = 88) and idiopathic uveitis (N = 71), respectively. Diagnostic accuracy was 96.6% (95% confidence interval [CI], 93.2-100). By sensitivity, the original diagnosis appeared among the top three in the DDL in 90.9% (95% CI, 84.1-96.6) and was the first in 73.9% (95% CI, 63.6-83.0). By PPV, the original diagnosis was among the top DDL three in 62.5% (95% CI, 51.1-71.6) and the first in 29.5% (95% CI, 20.5-38.6; P uveitis, 19 new diagnoses were made reducing this series to 52 (22.8%) and improving by 8.3% the new rate of diagnosed specific uveitis cases (performance = 77.2%; 95% CI, 71.1-82.9). Uvemaster proved accurate and based on the same clinical data was able to detect more cases of specific uveitis than the original clinician only-based method.

  20. Hyperechogenicity of substantia nigra for differential diagnosis of Parkinson's disease: A meta-analysis.

    Science.gov (United States)

    Shafieesabet, Azin; Fereshtehnejad, Seyed-Mohammad; Shafieesabet, Azadeh; Delbari, Ahmad; Baradaran, Hamid Reza; Postuma, Ronald B; Lökk, Johan

    2017-09-01

    Studies have suggested that the majority of patients with Parkinson's disease have abnormal ultrasound hyperechogenicity of the substantia nigra, and that this may be useful in diagnosis. We performed a systematic review and meta-analysis to evaluate diagnostic value of substantia nigra ultrasound to differentiate Parkinson's disease from atypical parkinsonism and from essential tremor. We systematically searched PubMed and EMBASE for relevant studies published until November 2016. Eligible articles were screened, data were extracted and study quality was scored by two independent reviewers. We applied random effect models to calculate pooled estimates for the prevalence of hyperechogenicity in each condition. For final meta-analysis, 71 articles with a total number of 5730 participants (idiopathic Parkinson's disease: 4494, atypical parkinsonism: 594, essential tremor: 642) were included. The pooled prevalence rate of hyperechogenicity was 84% (95 %CI 80-87%) in idiopathic Parkinson's disease, 28% (95% CI 20-36%) in atypical parkinsonism and 15% (95% CI 7-23%) in essential tremor. Based on our meta-analysis, substantia nigra hyperechogenecity has 75% (95% CI: 60-86%) sensitivity and 70% (95% CI: 55-81%) specificity to differentiate idiopathic Parkinson's disease from atypical parkinsonism. Sensitivity and specificity to distinguish idiopathic Parkinson's disease from essential tremor was calculated as 78% (95% CI: 69-85%) and 85% (95% CI: 77-91%), respectively. Findings from our meta-analysis showed that transcranial sonography can provide useful information to differentiate idiopathic Parkinson's disease from mimicking movement disorders, although sensitivity and specificity are suboptimal, particularly for differentiating from atypical parkinsonism. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Do not overlook Weismann-Netter syndrome in differential diagnosis of skeletal dysplasias.

    Science.gov (United States)

    Caksen, H; Kurtoğlu, S

    2004-01-01

    Weismann-Netter syndrome (WNS), a rare condition, is characterized by an anterior curvature of the bones of the lower limbs, usually bilateral and symmetrical. It was first described in 1954 by Weismann-Netter and Stuhl. We report a 2-year-old girl with typical findings of WNS who was misdiagnosed as having rickets. Our purpose is to draw attention to the WNS in the differential diagnosis of skeletal dysplasias. We think that the true incidence of WNS is probably higher than previously reported; therefore, we would like to emphasize that WNS should be considered in patients who have bowed lower extremities and have been diagnosed as having syphilis or healed rickets.

  2. Cognitive-style characteristics as criteria for differential diagnosis of delirium

    Directory of Open Access Journals (Sweden)

    I.V. Kuznetsov

    2014-08-01

    Full Text Available We present a psychological study of the relationship of cognitive styles with the development of delusional formations, overvalued ideas and simulative products in order to develop criteria of delirium differential diagnosis. We examined 118 men, ordered at forensic psychological and psychiatric examination, among them delusional symptoms were found in 68 people, and overvalued ideas in 26 people, 24 people simulated delirium. As a method of research, we used pathopsychological experiment and projective techniques and methods that identify particular cognitive style (TAT, Rorschach, Torrance. We found that delusional patients, unlike those simulating a mental disorder, show field independence cognitive style combined with the rigidity that is characteristic also for patients with endogenous overvalued ideas. In personality disorders, we found combination of field independence with the flexibility or with rigidity.

  3. Myelographic differential diagnosis of spinal arachnoiditis with an emphasis on Tbc arachnoiditis

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yo Won; Yun, Ku Sub; Han, Moon Hee; Chang, Kee Hyun [Seoul University College of Medicine, Seoul (Korea, Republic of)

    1988-10-15

    Spinal arachnoiditis is a rare condition. The arachnoiditis of various causes, leptomeningeal meatasis, leptomeningeal lymphoma, hypertrophic polyneuritis, etc. are known to have a similar radiologic manifestations. The authors reviewed myelographic findings of 20 patients with spinal arachnoiditis retrospectively to discovery any specific findings helpful to make a differential diagnosis. The causes of spinal arachnoiditis were tuberculous origin in 9 cases, pyogenic in 2, postoperative in one, lymphoma in 3 and leptomeningeal metastasis in 5. Myelographic findings of tuberculous spinal arachnoiditis were block of CSF (89%), especially at the conus medullar is level, multiple fine and/or coarse nodular filling defects (78%), nerve root thickening (56%), focal irregular adhesive filling defects (44%) and irregular or indistinct thecal sac margin (44%). Irregular adhesive band like filling defects and/or multiple fine nodular filling defects seem to be characteristics of the arachnoiditis. Myelographic findings showing coarse nodular filling defects without fine ones are suggestive of leptomeningeal metastasis.

  4. Recurrent eccrine hidradenoma of the breast in a male patient: problems in differential diagnosis

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    Maria Orsaria

    2013-04-01

    Full Text Available Introduction: Hidradenoma is an uncommon usually benign tumor of the skin that grows slowly.Case presentation: We describe a case of a 39 patient with a breast mass. Physical examination revealed a solitary, well-circumscribed tumor, measuring 1 cm by 0.7 cm. No other skin abnormalities were found. A total surgical excision was performed and histologic examination concluded to an eccrine hidradenoma with clear cells.Conclusion: Here we discuss problems in the differentiate this tumor, mainly in this not common location, from a breast primary (ductal carcinoma or adenomyoepitelioma, from a metastatic clear cell carcinoma and from other types of skin tumors. Moreover, this patient presented with a recurrence of the tumor in the same location, suggesting a locally aggressive form of this neoplasia; few reports in the literature are described as at low malignant potential, but definite criteria for this diagnosis are not well defined.

  5. Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: Imaging features

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    Kivrak, Ali Sami [Selcuk University, Meram Medical Faculty, Department of Radiology, 42080 Konya (Turkey)], E-mail: alisamikivrak@hotmail.com; Koc, Osman; Emlik, Dilek; Kiresi, Demet; Odev, Kemal [Selcuk University, Meram Medical Faculty, Department of Radiology, 42080 Konya (Turkey); Kalkan, Erdal [Selcuk University, Meram Medical Faculty, Department of Neurosurgery, Konya (Turkey)

    2009-07-15

    Computed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening.

  6. The impact of high-resolution ultrasound in the differential diagnosis of non-hemolytic jaundice.

    Science.gov (United States)

    Rauh, Peter; Neye, Holger; Mönkemüller, Klaus; Malfertheiner, Peter; Rickes, Steffen

    2010-12-01

    Because jaundice is a common reason for hospital admission. A fast and correct differential diagnosis is very important to increase treatment efficacy. The aim of our study was to evaluate the impact of the high-resolution ultrasound in this kind of clinical setting. In a prospective study we included 30 patients and we divided them in patients with extrahepatic jaundice and patients with intrahepatic jaundice. We observed a high accuracy of the high-resolution sonography, with a sensitivity of 95% and a specificity of 100% for extrahepatic jaundice, and a sensitivity of 100% and a specificity of 95% for intrahepatic jaundice. We conclude that the high-resolution ultrasound should be used in the very beginning of the diagnostic algorithm for the evaluation of patients with unclear jaundice.

  7. A medical diagnosis support system based on automatic knowledge extraction from databases through differential evolution.

    Science.gov (United States)

    De Falco, Ivanoe

    2013-01-01

    An intelligent system for supporting medical diagnosis is presented in this paper. The system automatically extracts knowledge from databases as sets of IF-THEN rules. The approach chosen to fulfil this task is based on the differential evolution (DE) algorithm and its implementation results in a tool called DEREx. This tool is aimed at supporting clinicians in their decision making in the diagnostic process, by providing them with clear explanations on the reasons why each item is assigned to a given class. Performance of the tool has been evaluated over seven medical databases and compared against that of fifteen well-known classification tools. Numerical results in terms of classification accuracy and their statistical analysis, have evidenced the effectiveness of the proposed approach, so DEREx is preferable because of its added value, i.e. the knowledge extracted automatically and provided to users in an easily comprehensible form.

  8. Intranodal palisaded myofibroblastoma: A case report and an update on etiopathogenesis and differential diagnosis

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    Nandyala Hariharanadha Sarma

    2013-01-01

    Full Text Available Intra-nodal palisaded myofibroblastoma (IPM is a rare benign lymph node mesenchymal tumor. It presents as a slow growing, painless nodular mass confined mostly to the inguinal area. Histologically, it shows palisading spindle cells, hemorrhages, hemosiderin laden macrophages, and amianthoid fibers, almost totally replacing the lymph node. Recent genetic evidence supports viral etiology. A case of IPM occurring in a 25-year-old woman is presented and the differential diagnosis of this lesion is discussed. IPM occurs between 4 th and 6 th decade of life, male to female ratio is 2:1 and the inguinal region is the commonest location. Origin of this tumor is from myofibroblasts or smooth muscle fibers. Though benign, morphologically it can be confused with malignant tumors like Kaposi′s sarcoma, melanoma, and leiomyosarcoma. Prognosis is excellent and surgical excision is the only needed treatment. There are no reports of malignant transformation though an occasional case has recurred.

  9. A rare differential diagnosis to occupational neck pain: bilateral stylohyoid syndrome

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    Vogel Tobias

    2006-06-01

    Full Text Available Abstract Chronic neck pain is widely prevalent and a common source of disability in the working-age population. Etiology of chronic neck pain includes neck sprain, mechanical or muscular neck pain, myofascial pain syndrome, postural neck pain as well as pain due to degenerative changes. We report the case of a 42 year old secretary, complaining about a longer history of neck pain and limited movement of the cervical spine. Surprisingly, the adequate radiologic examination revealed a bilateral ossification of the stylohyoid ligament complex. Her symptoms remained intractable from conservative treatment consisting of anti-inflammatory medication as well as physical therapy. Hence the patient was admitted to surgical resection of the ossified stylohyoid ligament complex. Afterwards she was free of any complaints and went back to work. Therefore, ossification of the stylohyoid ligament complex causing severe neck pain and movement disorder should be regarded as a rare differential diagnosis of occupational related neck pain.

  10. Differential diagnosis of Mendelian and mitochondrial disorders in patients with suspected multiple sclerosis

    Science.gov (United States)

    Katz Sand, Ilana B.; Honce, Justin M.; Lublin, Fred D.

    2015-01-01

    Several single gene disorders share clinical and radiologic characteristics with multiple sclerosis and have the potential to be overlooked in the differential diagnostic evaluation of both adult and paediatric patients with multiple sclerosis. This group includes lysosomal storage disorders, various mitochondrial diseases, other neurometabolic disorders, and several other miscellaneous disorders. Recognition of a single-gene disorder as causal for a patient’s ‘multiple sclerosis-like’ phenotype is critically important for accurate direction of patient management, and evokes broader genetic counselling implications for affected families. Here we review single gene disorders that have the potential to mimic multiple sclerosis, provide an overview of clinical and investigational characteristics of each disorder, and present guidelines for when clinicians should suspect an underlying heritable disorder that requires diagnostic confirmation in a patient with a definite or probable diagnosis of multiple sclerosis. PMID:25636970

  11. The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms.

    Science.gov (United States)

    Yaltho, Toby C; Jankovic, Joseph

    2011-08-01

    Hemifacial spasm is defined as unilateral, involuntary, irregular clonic or tonic movement of muscles innervated by the seventh cranial nerve. Most frequently attributed to vascular loop compression at the root exit zone of the facial nerve, there are many other etiologies of unilateral facial movements that must be considered in the differential diagnosis of hemifacial spasm. The primary purpose of this review is to draw attention to the marked heterogeneity of unilateral facial spasms and to focus on clinical characteristics of mimickers of hemifacial spasm and on atypical presentations of nonvascular cases. In addition to a comprehensive review of the literature on hemifacial spasm, medical records and videos of consecutive patients referred to the Movement Disorders Clinic at Baylor College of Medicine for hemifacial spasm between 2000 and 2010 were reviewed, and videos of illustrative cases were edited. Among 215 patients referred for evaluation of hemifacial spasm, 133 (62%) were classified as primary or idiopathic hemifacial spasm (presumably caused by vascular compression of the ipsilateral facial nerve), and 4 (2%) had hereditary hemifacial spasm. Secondary causes were found in 40 patients (19%) and included Bell's palsy (n=23, 11%), facial nerve injury (n=13, 6%), demyelination (n=2), and brain vascular insults (n=2). There were an additional 38 patients (18%) with hemifacial spasm mimickers classified as psychogenic, tics, dystonia, myoclonus, and hemimasticatory spasm. We concluded that although most cases of hemifacial spasm are idiopathic and probably caused by vascular compression of the facial nerve, other etiologies should be considered in the differential diagnosis, particularly if there are atypical features. Copyright © 2011 Movement Disorder Society.

  12. Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates.

    Science.gov (United States)

    Zhang, Yanhong; Kleer, Celina G

    2016-07-01

    -Phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm with risks of local recurrence and uncommon metastases. The classification proposed by the World Health Organization for PTs into benign, borderline, and malignant is based on a combination of several histologic features. The differential diagnosis between PT and fibroadenoma and the histologic grading of PT remain challenging. In addition, the molecular pathogenesis of PT is largely unknown. -To provide an updated overview of pathologic features, diagnostic terminology, and molecular alterations of PT. -Current English literature related to PT of the breast. -Phyllodes tumor shows a wide spectrum of morphology. There are no clearly distinct boundaries between PT and fibroadenoma. Strict histologic assessment of a combination of histologic features with classification can help to achieve the correct diagnosis and provide useful clinical information. The genomic landscapes of PT generated from genomic sequencing provide insights into the molecular pathogenesis of PT and help to improve diagnostic accuracy and identify potential drug targets in malignant PT.

  13. Radiological differential diagnosis of rheumatoid arthritis; Radiologische Differenzialdiagnose der rheumatoiden Arthritis

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    Wick, M.C.; Klauser, A.S. [Medizinische Universitaet Innsbruck, Department Radiologie, Innsbruck (Austria)

    2012-02-15

    Establishing an early and reliable diagnosis of rheumatoid arthritis (RA) is of major importance but can be a great clinical challenge leading to direct therapeutic consequences. No single epidemiological, genetic, clinical, serological or radiological test exists which can exclusively diagnose RA. In general diagnosis of RA includes a case history, clinical signs, laboratory abnormalities and radiological examinations, viz. conventional radiography of the joints of the hands and feet. This review summarizes the most important radiological features of RA and the radiological findings of its closest differential diagnoses. (orig.) [German] Eine fruehe Diagnosestellung bei rheumatoider Arthritis (RA) stellt eine grosse klinische Herausforderung dar, da sich daraus unmittelbare therapeutische Konsequenzen ableiten. Es gibt keinen epidemiologischen, genetischen, klinischen, serologischen oder radiologischen Test, mit dessen alleiniger Anwendung die Diagnose der RA definitiv gestellt werden kann. Die Diagnose der RA erfolgt durch die Kombination von Patientenanamnese, klinischen Zeichen und serologischen Biomarkern in Zusammenschau mit der radiologischen Diagnostik, allen voran der Anwendung konventioneller Roentgenbilder der Haende und Fuesse. In diesem Uebersichtsartikel werden die wichtigsten radiologischen Merkmale zur Diagnose der RA und der diagnostisch haeufigsten Differenzialerkrankungen dargestellt. (orig.)

  14. Cystic pyeloureteritis: review of 34 cases. Radiologic aspects and differential diagnosis.

    Science.gov (United States)

    Menéndez, V; Sala, X; Alvarez-Vijande, R; Solé, M; Rodriguez, A; Carretero, P

    1997-07-01

    To refine the clinical and radiologic description of an unusual benign disease, cystic pyeloureteritis (CPU), consisting of the appearance of suburothelial cysts that raise the mucosa layer of the urothelium. We also studied its relationship with various types of inflammation, including chronic infection, that may be the stimulus for the appearance of CPU. We compiled 34 cases of CPU covering the period 1976 to 1994, analyzing the clinical manifestations, diagnostic procedures, differential diagnosis, and evolution. There are no specific symptoms associated with the presence of cysts. The average age of the patients was 59 years (range 30 to 77). Urinary tract infection was detected in 18 (53%). The pyeloureteritis was unilateral in 27 (79%) and bilateral in 7 (21%) of the patients. The location of the cysts was as follows: 1 pyelic (3%); 6 pyeloureteral (18%); and 27 (79%) ureteral. Resolution of the radiologic alterations depends on the resolution of the associated pathology: infections, lithiasis, and obstruction. We conclude that CPU is a benign pathology with indolent evolution and variable duration; it is not associated with sequelae. Diagnosis is made on the basis of radiologic findings, mainly intravenous urography; in view of the minor entity of the pathology, biopsy is not advisable if the radiologic findings are conclusive.

  15. Neurocysticercosis, familial cerebral cavernomas and intracranial calcifications: differential diagnosis for adequate management

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    Emerson Leandro Gasparetto

    2016-06-01

    Full Text Available ABSTRACT Neurocysticercosis (NCC is an endemic disease and important public health problem in some areas of the World and epilepsy is the most common neurological manifestation. Multiple intracranial lesions, commonly calcified, are seen on cranial computed tomography (CT in the chronic phase of the disease and considered one of the diagnostic criteria of the diagnosis. Magnetic resonance imaging (MRI is the test that better depicts the different stages of the intracranial cysts but does not show clearly calcified lesions. Cerebral cavernous malformations (CCM, also known as cerebral cavernomas, are frequent vascular malformations of the brain, better demonstrated by MRI and have also epilepsy as the main form of clinical presentation. When occurring in the familial form, cerebral cavernomas typically present with multiple lesions throughout the brain and, very often, with foci of calcifications in the lesions when submitted to the CT imaging. In the countries, and geographic areas, where NCC is established as an endemic health problem and neuroimaging screening is done by CT scan, it will be important to consider the differential diagnosis between the two diseases due to the differences in adequate management.

  16. Strongyloides colitis is a lethal mimic of ulcerative colitis: the key morphologic differential diagnosis.

    Science.gov (United States)

    Qu, Zhenhong; Kundu, Uma R; Abadeer, Rania A; Wanger, Audrey

    2009-04-01

    Strongyloides stercoralis colitis is a severe, but easily curable, form of strongyloidiasis that carries a high mortality rate if untreated. Autoinfection characteristic of Strongyloides stercoralis frequently makes the infection a life-long disease unless it is effectively treated. Our experience with 4 cases of Strongyloides colitis prompted us to assess the clinical outcome of the disease by literature review. In this case series, the misdiagnosis and resultant mortality rates of Strongyloides colitis are 52% and 39.1%, respectively. A low index of suspicion and morphologic resemblance to ulcerative colitis were the main sources of diagnostic error. Ulcerative colitis alone accounted for 38.5% of the erroneous diagnoses. Features of Strongyloides colitis that contrast with those of ulcerative colitis include (1) skip pattern of the inflammation, (2) distal attenuation of the disease, (3) eosinophil-rich infiltrates, (4) relative intact crypt architecture, and (5) frequent involvement of submucosa. We also found that history of steroid therapy, chronic colitis refractory to conventional immune-modifying management, and endoscopic finding of distal attenuation of the colitis are helpful clues. It is also our experience that if Strongyloides colitis is included in the differential diagnosis, the correct diagnosis can usually be made. Current therapy with ivermectin or albendazole is very effective at a cure rate greater than 98%. We believe that the misdiagnosis and mortality rates of this curable, but often, unnecessarily deadly, infectious disease are alarming and warrant efforts to increase the awareness of the disease.

  17. Primary peripancreatic lymph node tuberculosis as a differential diagnosis of pancreatic neoplasia.

    Science.gov (United States)

    García Del Olmo, Nuria; Boscà Robledo, Andrea; Penalba Palmí, Rafael; Añón Iranzo, Elena; Aguiló Lucía, Javier

    2017-07-01

    Primary peripancreatic lymph node tuberculosis is an exceptional entity in immunocompetent patients, but its incidence is increasing in developed countries in recent years due to increasing immigration. It usually presents as a pancreatic mass and is misdiagnosed as pancreatic neoplasia in most cases, with the diagnosis of tuberculosis occurring after surgery. We report the case of a 38 year old Pakistani man with abdominal pain of several months duration, who was initially diagnosed with a pancreatic neoplasm after detecting a mass in the pancreatic isthmus by computed tomography (CT) and abdominal magnetic resonance imaging (MRI). However, after performing an endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB), the patient was diagnosed with peripancreatic lymph node tuberculosis. After receiving anti-tuberculous treatment, the patient presented clinical improvement, despite a small reduction in the lesion size. In conclusion, peripancreatic lymph node tuberculosis is part of the differential diagnosis of pancreatic neoplasia. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) represents a valuable and useful diagnostic tool for detecting this pathology, avoiding surgeries with a high morbidity and mortality.

  18. Efficient Targeted Next Generation Sequencing-Based Workflow for Differential Diagnosis of Alport-Related Disorders.

    Science.gov (United States)

    Kovács, Gábor; Kalmár, Tibor; Endreffy, Emőke; Ondrik, Zoltán; Iványi, Béla; Rikker, Csaba; Haszon, Ibolya; Túri, Sándor; Sinkó, Mária; Bereczki, Csaba; Maróti, Zoltán

    2016-01-01

    Alport syndrome (AS) is an inherited type IV collagen nephropathies characterized by microscopic hematuria during early childhood, the development of proteinuria and progression to end-stage renal disease. Since choosing the right therapy, even before the onset of proteinuria, can delay the onset of end-stage renal failure and improve life expectancy, the earliest possible differential diagnosis is desired. Practically, this means the identification of mutation(s) in COL4A3-A4-A5 genes. We used an efficient, next generation sequencing based workflow for simultaneous analysis of all three COL4A genes in three individuals and fourteen families involved by AS or showing different level of Alport-related symptoms. We successfully identified mutations in all investigated cases, including 14 unpublished mutations in our Hungarian cohort. We present an easy to use unified clinical/diagnostic terminology and workflow not only for X-linked but for autosomal AS, but also for Alport-related diseases. In families where a diagnosis has been established by molecular genetic analysis, the renal biopsy may be rendered unnecessary.

  19. Primary peripancreatic lymph node tuberculosis as a differential diagnosis of pancreatic neoplasia

    Directory of Open Access Journals (Sweden)

    Nuria García-del-Olmo

    Full Text Available Primary peripancreatic lymph node tuberculosis is an exceptional entity in immunocompetent patients, but its incidence is increasing in developed countries in recent years due to increasing immigration. It usually presents as a pancreatic mass and is misdiagnosed as pancreatic neoplasia in most cases, with the diagnosis of tuberculosis occurring after surgery. We report the case of a 38 year old Pakistani man with abdominal pain of several months duration, who was initially diagnosed with a pancreatic neoplasm after detecting a mass in the pancreatic isthmus by computed tomography (CT and abdominal magnetic resonance imaging (MRI. However, after performing an endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB, the patient was diagnosed with peripancreatic lymph node tuberculosis. After receiving anti-tuberculous treatment, the patient presented clinical improvement, despite a small reduction in the lesion size. In conclusion, peripancreatic lymph node tuberculosis is part of the differential diagnosis of pancreatic neoplasia. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB represents a valuable and useful diagnostic tool for detecting this pathology, avoiding surgeries with a high morbidity and mortality.

  20. Metastatic Renal Cell Carcinoma Presenting as a Paranasal Sinus Mass: The Importance of Differential Diagnosis

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    Massimo Ralli

    2017-01-01

    Full Text Available Metastases in the paranasal sinuses are rare; renal cell carcinoma is the most common cancer that metastasizes to this region. We present the case of a patient with a 4-month history of a rapidly growing mass of the nasal pyramid following a nasal trauma, associated with spontaneous epistaxis and multiple episodes of hematuria. Cranial CT scan and MRI showed an ethmoid mass extending to the choanal region, the right orbit, and the right frontal sinus with an initial intracranial extension. Patient underwent surgery with a trans-sinusal frontal approach using a bicoronal incision combined with an anterior midfacial degloving; histological exam was compatible with a metastasis of clear cell renal cell carcinoma. Following histological findings, a total body CT scan showed a solitary 6 cm mass in the upper posterior pole of the left kidney identified as the primary tumor. Although rare, metastatic renal cell carcinoma should always be suspected in patients with nasal or paranasal masses, especially if associated with symptoms suggestive of a systemic involvement such as hematuria. A correct early-stage diagnosis of metastatic RCC can considerably improve survival rate in these patients; preoperative differential diagnosis with contrast-enhanced imaging is fundamental for the correct treatment and follow-up strategy.

  1. Tendinitis of the Temporalis muscle: Differential diagnosis and treatment. A Case Report.

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    Veronica Iturriaga.

    2016-03-01

    Full Text Available Introduction: The temporalis muscle plays an essential role in mastication and is actively involved in the mandibular closing movement. It is covered by a fibroelastic fascia that forms its tendon. Tendinitis is a degenerative and inflammatory process, which originates in the tendon-bone junction. Signs and symptoms such as swelling, pain, tenderness on palpation, limitation of movement and mouth opening are frequently associated with other temporomandibular disorders and not with tendinitis as a causal factor. Objective: To describe a clinical case identifying the diagnostic process and management of tendinitis of the temporalis muscle. Case report: A 30-year old male patient who sought treatment after continuous squeezing pain in the zygomatic and bilateral temporal regions with increased pain during mouth opening and mandibular function. The patient referred pain in the insertion region of the tendon of the temporalis muscle. Pain was removed after using anesthesia, consequently confirming the diagnosis of tendinitis of the temporalis muscle. Primary management measures were performed and then peritendinous corticosteroids were administered. The patient did not refer spontaneous or functional pain during check-up. Conclusion: Tendinitis of the temporalis muscle is a common condition, although frequently underdiagnosed. A good differential diagnosis must be performed to avoid confusion with other common conditions such as odontogenic pain, sinusitis, arthralgia, myofascial pain and migraine. Management depends on the type of tendinitis. It usually occurs in conjunction with other types of TMD or facial pain, so it is important to know the different clinical characteristics of pathologies with similar manifestations.

  2. Differential diagnosis of white matter diseases in the tropics: An overview

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    Pandit Lekha

    2009-01-01

    Full Text Available In hospitals in the tropics, the availability of magnetic resonance imaging (MRI facilities in urban areas and especially in teaching institutions have resulted in white matter diseases being frequently reported in a variety of clinical settings. Unlike the west where multiple sclerosis (MS is the commonest white matter disease encountered, in the tropics, there are myriad causes for the same. Infectious and post infectious disorders probably account for the vast majority of these diseases. Human immunodeficiency virus (HIV infection tops the list of infective conditions. Central nervous system (CNS tuberculosis occasionally presents with patchy parenchymal lesions unaccompanied by meningeal involvement. Human T cell leukemia virus (HTLV infection and cystic inflammatory lesions such as neurocysticercosis are important causes to be considered in the differential diagnosis. Diagnosing post infectious demyelinating disorders is equally challenging since more than a third of cases seen in the tropics do not present with history of past infection or vaccinations. Metabolic and deficiency disorders such as Wernicke′s encephalopathy, osmotic demyelinating syndrome associated with extra pontine lesions and Vitamin B12 deficiency states can occassionaly cause confusion in diagnosis. This review considers a few important disorders which manifest with white matter changes on MRI and create diagnostic difficulties in a population in the tropics.

  3. A Review on Fat Necrosis of the Breast: The Dilemma of Differential Diagnosis with Cancer

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    Toktam Beheshtian

    2015-05-01

    Full Text Available Fat necrosis is a benign inflammatory process which can involve adipose tissue anywhere in the body. A previous history of trauma or surgery may or may not be present. Information about the clinical and radiological appearance of this lesion is very important because it can mimic breast cancer.In this article, we review the features of fat necrosis in different imaging modalities including mammography, ultrasound, and magnetic resonance imaging (MRI, and compare them with histopathologic findings; then, we try to provide a logical approach for fat necrosis management.The appearance of fat necrosis at imaging is variable from definitely benign type to highly suspicious for malignancy. The specificity of mammography is higher than that of ultrasonography; therefore, for a definite diagnosis of fat necrosis, emphasis should be mainly based on mammography rather than ultrasonography.Finally, fat necrosis is not a common disease; however, regarding unusual and atypical findings in different imaging modalities, differentiation from a cancer may be difficult, especially in patients with a previous history of malignancy. Therefore, a multimodality approach is required for a definite diagnosis.

  4. Efficient Targeted Next Generation Sequencing-Based Workflow for Differential Diagnosis of Alport-Related Disorders.

    Directory of Open Access Journals (Sweden)

    Gábor Kovács

    Full Text Available Alport syndrome (AS is an inherited type IV collagen nephropathies characterized by microscopic hematuria during early childhood, the development of proteinuria and progression to end-stage renal disease. Since choosing the right therapy, even before the onset of proteinuria, can delay the onset of end-stage renal failure and improve life expectancy, the earliest possible differential diagnosis is desired. Practically, this means the identification of mutation(s in COL4A3-A4-A5 genes. We used an efficient, next generation sequencing based workflow for simultaneous analysis of all three COL4A genes in three individuals and fourteen families involved by AS or showing different level of Alport-related symptoms. We successfully identified mutations in all investigated cases, including 14 unpublished mutations in our Hungarian cohort. We present an easy to use unified clinical/diagnostic terminology and workflow not only for X-linked but for autosomal AS, but also for Alport-related diseases. In families where a diagnosis has been established by molecular genetic analysis, the renal biopsy may be rendered unnecessary.

  5. ADHD and autism: differential diagnosis or overlapping traits? A selective review.

    Science.gov (United States)

    Taurines, Regina; Schwenck, Christina; Westerwald, Eva; Sachse, Michael; Siniatchkin, Michael; Freitag, Christine

    2012-09-01

    According to DSM-IV TR and ICD-10, a diagnosis of autism or Asperger Syndrome precludes a diagnosis of attention-deficit/hyperactivity disorder (ADHD). However, despite the different conceptualization, population-based twin studies reported symptom overlap, and a recent epidemiologically based study reported a high rate of ADHD in autism and autism spectrum disorders (ASD). In the planned revision of the DSM-IV TR, dsm5 (www.dsm5.org), the diagnoses of autistic disorder and ADHD will not be mutually exclusive any longer. This provides the basis of more differentiated studies on overlap and distinction between both disorders. This review presents data on comorbidity rates and symptom overlap and discusses common and disorder-specific risk factors, including recent proteomic studies. Neuropsychological findings in the areas of attention, reward processing, and social cognition are then compared between both disorders, as these cognitive abilities show overlapping as well as specific impairment for one of both disorders. In addition, selective brain imaging findings are reported. Therapeutic options are summarized, and new approaches are discussed. The review concludes with a prospectus on open questions for research and clinical practice.

  6. Lymph Node Thyroglobulin Measurement in Diagnosis of Neck Metastases of Differentiated Thyroid Carcinoma

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    Luca Giovanella

    2011-01-01

    Full Text Available Aim. Enlarged cervical lymph nodes (LNs in patients with thyroid cancer are usually assessed by fine-needle aspiration cytology (FNAC. Thyroglobulin (Tg is frequently elevated in malignant FNAC needle wash specimens (FNAC-Tg. The objectives of the study were to (1 determine an appropriate diagnostic cut-off for FNAC-Tg levels (2 compare FNAC and FNAC-Tg results in a group of 108 patients affected by differentiated thyroid carcinoma (DTC. Methods. A total of 126 consecutive FNACs were performed on enlarged LNs and the final diagnosis was confirmed by surgical pathology examination or clinical follow-up. The best FNAC-Tg cut-off level was selected by receiver operating curve analysis, and diagnostic performances of FNAC and FNAC-Tg were compared. Results. The rate of FNAC samples adequate for cytological examination was 77% in contrast FNAC-Tg available in 100% of aspirates (<.01. The sensitivity, specificity, and accuracy of FNAC were 71%, 80%, 74%, 100%, 80%, and 94%, respectively. The most appropriate cut-off value for the diagnosis of thyroid cancer metastatic LN was 1.1 ng/mL (sensitivity 100%, specificity 100%. Conclusions. The diagnostic performance of needle washout FNAC-Tg measurement with a cut-off of 1.1 ng/mL compared favorably with cytology in detecting DTC node metastases.

  7. Differential diagnosis of human ascites: inhibitors of the contact system and total proteins.

    Science.gov (United States)

    Buø, L; Karlsrud, T S; Dyrhaug, G; Jacobsen, M B; Bell, H; Johansen, H T; Aasen, A O

    1993-09-01

    To assess their accuracies as markers for malignancy, we assayed alpha 2-macroglobulin, C1-inhibitor, alpha 1-protease inhibitor, and total proteins in ascites and plasma from patients with gastrointestinal cancer (n = 15) and non-malignant liver disease (n = 13), using functional and immunologic assays. For all inhibitors and total proteins determined in ascites, the values in the cancer group were significantly higher than the corresponding values in the group with non-malignant liver disease. The diagnostic accuracy for differentiating malignancy-related from non-malignant ascites was 93% for a alpha 1-protease inhibitor value > or = 50% of the pool plasma value and 90% for alpha 2-macroglobulin > or = 16%, C1-inhibitor > or = 40% (all functional assays), and total proteins > or = 20 g/l (biuret). In conclusion, functional assays for alpha 2-macroglobulin, C1-inhibitor, and alpha 1-protease inhibitor and determination of total proteins in ascites appeared to be very informative tests for the differential diagnosis of ascites. The test for alpha 1-protease inhibitor gave higher specificity (92% versus 77%) and likelihood ratio for a positive test (12 versus 4) compared with the other tests.

  8. Importance of neutrophil gelatinase-associated lipocalin in differential diagnosis of acute and chronic renal failure.

    Science.gov (United States)

    Ozkan, Seda; Durukan, Polat; Kavalci, Cemil; Duman, Ali; Sayhan, Mustafa Burak; Salt, Omer; Ipekci, Afsin

    2014-08-01

    Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury. NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury. Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease. In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure. This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study. Blood pH, HCO3(-), BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls. Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P 0.05). Median creatinine values were 2.84 ± 2.95 in ARF group and 4.78 ± 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRF groups (P renal injury and differentiate ARF and CRF.

  9. Preoperative differential diagnosis between intrahepatic biliary cystadenoma and cystadenocarcinoma: A single-center experience

    Science.gov (United States)

    Zhang, Fu-Bo; Zhang, Ai-Min; Zhang, Zhi-Bin; Huang, Xin; Wang, Xi-Tao; Dong, Jia-Hong

    2014-01-01

    AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma. METHODS: A retrospective analysis of patient data was performed, which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003 and April 2013 at the General Hospital of PLA. Potential patients were excluded whose diagnoses were not confirmed pathologically. Basic information (including patient age and gender), clinical manifestation, duration of symptoms, serum assay results (including tumor markers and the results of liver function tests), radiological features and pathological results were collected. All patients were followed up. RESULTS: Preoperative levels of cancer antigen 125 (12.51 ± 9.31 vs 23.20 ± 21.86, P cystadenoma subgroup. There were no statistically significant differences in age or gender between the two groups, or in pre- or post-operative levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBIL), and direct bilirubin (DBIL) between the two groups. However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL. There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications. CONCLUSION: Preoperative differential diagnosis relies on the integration of information, including clinical symptoms, laboratory findings and imaging results. PMID:25253963

  10. Cerebrospinal fluid metabolomic profiling in tuberculous and viral meningitis: Screening potential markers for differential diagnosis.

    Science.gov (United States)

    Li, Zihui; Du, Boping; Li, Jing; Zhang, Jinli; Zheng, Xiaojing; Jia, Hongyan; Xing, Aiying; Sun, Qi; Liu, Fei; Zhang, Zongde

    2017-03-01

    Tuberculous meningitis (TBM) is the most severe and frequent form of central nervous system tuberculosis. The current lack of efficient diagnostic tests makes it difficult to differentiate TBM from other common types of meningitis, especially viral meningitis (VM). Metabolomics is an important tool to identify disease-specific biomarkers. However, little metabolomic information is available on adult TBM. We used (1)H nuclear magnetic resonance-based metabolomics to investigate the metabolic features of the CSF from 18 TBM and 20 VM patients. Principal component analysis and orthogonal signal correction-partial least squares-discriminant analysis (OSC-PLS-DA) were applied to analyze profiling data. Metabolites were identified using the Human Metabolome Database and pathway analysis was performed with MetaboAnalyst 3.0. The OSC-PLS-DA model could distinguish TBM from VM with high reliability. A total of 25 key metabolites that contributed to their discrimination were identified, including some, such as betaine and cyclohexane, rarely reported before in TBM. Pathway analysis indicated that amino acid and energy metabolism was significantly different in the CSF of TBM compared with VM. Twenty-five key metabolites identified in our study may be potential biomarkers for TBM differential diagnosis and are worthy of further investigation. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. [Rare differential diagnosis of acute kidney injury--Case 09/2009].

    Science.gov (United States)

    Seizer, Peter; Prayon, Berenike; Gröne, Elisabeth; Müssig, Karsten

    2009-10-01

    A 44-year-old male and his 40-year-old wife, both previously in good health, were admitted for abdominal pain, diarrhea, vomiting, severe headache, and oliguria after ingestion of wild mushrooms two weeks earlier. Physical examination revealed costo-vertebral-angular tenderness in the husband and abdominal tenderness in both patients. Laboratory showed acute renal injury with markedly increased serum concentrations of creatine and urea. On abdominal ultrasound, the kidneys were slightly increased in size with echogenic parenchyma and prominent medullary pyramids. Signs of an immunological or infectious etiology were missing. Histological investigation of the renal biopsy showed acute interstitial nephritis with marked tubular damage in both cases. History and histological findings were consistent with Orellanus syndrome following ingestion of mushrooms of the Cortinarius species. In both patients, haemodialysis was initiated. In the husband, dialysis was discontinued on day 8 and a follow-up visit after one month revealed stage 5 chronic kidney disease. In the wife, continuation of haemodialysis in an ambulatory setting required implantation of a temporary vascular catheter. In cases of acute renal injury of unknown origin, ingestion of mushrooms of the Cortinarius species should be included in the differential diagnoses. In particular, initial gastrointestinal complaints may point to this rare differential diagnosis.

  12. Differential Diagnosis of Cystic Lymphangioma of the Pancreas Based on Imaging Features

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    Ting-Kai Leung

    2006-01-01

    Full Text Available Lymphangioma is a benign tumor, which is a consequence of lymphatic malformation with blockage of lymphatic flow. Most lymphangiomas occur in the neck and axillary region, and < 1% occur in the mesentery or retroperitoneum. Lymphangiomas arising from the pancreas are extremely rare. We report the case of a 34-year-old woman with cystic lymphangioma of the pancreas without major symptoms or signs. A 6 × 6 cm intra-abdominal cystic mass was incidentally revealed by sonography during a health examination. It is always a challenge to differentiate the lesion from other possible cystic-like pancreatic neoplasms. Differential diagnosis of cystic lymphangioma from other cystic-like tumors of the pancreas can be performed based on their imaging characteristics, including presence of septa, cystic or wall calcification, soft tissue, wall thickness, single or multiple loculation, and dilatation of the pancreatic duct. Post-gadolinium magnetic resonance imaging is excellent in defining the origin of intra-abdominal cystic mass and intracystic septa.

  13. Hematological Indices for Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia

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    Aysel Vehapoglu

    2014-01-01

    Full Text Available Background. The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT and iron deficiency anemia (IDA. We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and β-TT in the same patient groups. Methods. A total of 290 carefully selected children aged 1.1–16 years were evaluated. We calculated 12 discrimination indices in all patients with hemoglobin (Hb values of 8.7–11.4 g/dL. None of the subjects had a combined case of IDA and β-TT. All children with IDA received oral iron for 16 weeks, and HbA2 screening was performed after iron therapy. The patient groups were evaluated according to red blood cell (RBC count; red blood distribution width index; the Mentzer, Shine and Lal, England and Fraser, Srivastava and Bevington, Green and King, Ricerca, Sirdah, and Ehsani indices; mean density of hemoglobin/liter of blood; and mean cell density of hemoglobin. Results. The Mentzer index was the most reliable index, as it had the highest sensitivity (98.7%, specificity (82.3%, and Youden’s index (81% for detecting β-TT; this was followed by the Ehsani index (94.8%, 73.5%, and 68.3%, resp. and RBC count (94.8%, 70.5%, and 65.3%. Conclusion. The Mentzer index provided the highest reliabilities for differentiating β-TT from IDA.

  14. The role of echocardiography in the differential diagnosis between training induced myocardial hypertrophy versus cardiomyopathy.

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    Venckunas, Tomas; Mazutaitiene, Birute

    2007-01-01

    technique applied to distinguish athlete's heart from the cardiomyopathy.Conventional echocardiographic criteria such as left ventricular chamber size and diastolic function parameters are to be regarded first when making differential diagnosis between substantially increased wall thickness in athlete's heart (i.e. physiological adaptation) versus a disease (usually hypertrophic cardiomyopathy).When conventional echocardiographic parameters fail to diagnose the nature of myocardial hypertrophy, other differentiation criteria such as aerobic fitness, cardiac performance in response to physical exertion, and changes in echocardiographic parameters due to detraining, must be taken into consideration.Tissue Doppler, contrast and three-dimensional imaging are state-of-the-art echocardiographic techniques which have recently appeared in the differential diagnostics.

  15. Differential diagnosis algorithm of endogenous catatonia, catatonia-morphic and catatonia-mimicking states

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    D. N. Safonov

    2017-08-01

    Full Text Available Subject relevance. The process of mental pathology pathomorphosis leads to the polymorphism of its clinical manifestations and, as a consequence – to difficulties in identification and differential diagnosis. The solution to this problem is in the adaption of diagnostic methodology to clinical realities by including into their structure instruments formed basing on pathomorphosis factors and trends. In this perspective, the most prominent example is endogenous catatonia, which in the academic tradition is conventionally affiliated with the form of schizophrenia with the same name. According to the classical understanding, endogenous catatonia, or, in the narrow sense – catatonic syndrome, is a group of intermittent motor disorders, arranged with polymorphic shell constellation of neuropsychiatric manifestations. The aim is to develop pathomorphosis adapted clinical algorithm of endogenous catatonia differential diagnostics. Materials and methods: 236 patients of Zaporizhzhia Regional Psychiatric Clinic were examined. Patients were divided into groups due to their mental disorders: – core group: patients with elements of endogenous catatonia in the structure of different clinical forms of schizophrenia (there were 144 patients in this group; – comparison group #1: 69 patients with late neurotropic effects of neuroleptic therapy (LNENT; – comparison group #2: 103 patients with catatonia-morphic dissociative disorders (CDD; – comparison group #3: 90 patients with organic catatonic disorder (OrCD; Results. Using Bush-Francis Catatonia Rating scale as an instrument of clinical analysis and statistical research of results with A. Wald’s sequential analysis (modificated by E. V. Gubler an algorithm of differential diagnostics of endogenus catatonia which includes 3 steps of Recognition Scale for Endogenous Catatonia is developed. Conclusion. Designed scales have a number of categorical differences from existing analogues, foremost by

  16. Differential diagnosis of Parkinsonism using dual phase F 18 FP CIT PET imaging

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    Jin, So Young; Oh, Min Young; Ok, Seung Jun; Oh, Jung Su; Lee, Sang Ju; Chung, Sun Ju; Lee, Chong Sik; Kim, Jae Seung [Univ. of Ulsan, Seoul (Korea, Republic of)

    2012-03-15

    Dopamine transporter (DAT) imaging can demonstrate presynaptic dopaminergic neuronal loss in Parkinson's disease (PD). However, differentiating atypical parkinsonism (APD) from PD is often difficult. We investigated the usefulness of dual phase F 18 FP CIT positron emission tomography (PET) imaging in the differential diagnosis of parkinsonism. Ninety eight subjects [five normal, seven drug induced parkinsonism (DIP), five essential tremor (ET), 24 PD, 20 multiple system atrophy parkinson type (MSA-P), 13 multiple system atrophy cerebellar type (MSA-C), 13 progressive supranuclear palsy (PSP), and 11 dementia with Lewy bodies(DLB)] underwent F 18 FP CIT PET. PET images were acquired at 5 min (early phase) and 3 h (late phase) after F 18 FP CIT administration (185MBq). Regional uptake pattern of cerebral and cerebellar hemispheres was assessed on early phase images, using visual, quantitative, and statistical parametric mapping (SPM) analyses. Striatal DAT binding was normal in normal, ET, DIP, and MSA C groups, but abnormal in PD, MSA P PSP, and DLB groups. No difference was found in regional uptake on early phase images among normal DAT binding groups, except in the MSA C group. Abnormal DAT binding groups showed different regional uptake pattern on early phase images compared with PD in SPM analysis (FDR<0.05). When discriminating APD from PD, visual interpretation of the early phase image showed high diagnostic sensitivity and specificity (75.4% and 100%, respectively). Regarding the ability to distinguish specific APD, sensitivities were 81% for MSA P, 77% for MSA C, 23% for PSP, and 54.5% for DLB. Dual phase F 18 FP CIT PET imaging is useful in demonstrating striatal DAT loss in neurodegenerative parkinsonism, and also in differentiating APD, particularly MSA, from PD.

  17. MR imaging findings of pineal germinoma: focus on differential diagnosis from other germ cell tumors

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    Kim, Hyun Jin; Lee, Ho Kyu; Kim, Jae Kyun; Shin, Ji Hoon; Choi, Choong Gon; Lee, Myung Jun; Ham, Soo Youn; Lee, Jong Hwa; Suh, Dae Chul [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-10-01

    To determine the characteristic MR imaging findings of pineal germinoma, and differential diagnosis from other germ cell tumors. MR images of patients with histopathologically proven pineal germinoma(n=3D14) and other pineal germ cell tumors(n=3D10) were retrospectively analyzed with regard to size, signal intensity and homogeneity, enhancing features, cyst formation, and multiplicity of lesions. Other pineal germ cell tumors were the mixed germ cell tumors (n=3D4), malignant teratomas (n=3D3), choriocarcinoma(n=3D1), embryonal carcinoma(n=3D1), and endodermal sinus tumor(n=3D1). Tumor markers were evaluated. On T1-weighted images, germinomas showed homogeneous(86%) or iso signal intensity (93%), while other germ cell tumors showed inhomogeneous(70%) or iso signal intensity(70%). On T2-weighted images, germinomas showed homogeneous(64%) or iso signal intensity(57%), while other germ cell tumors showed inhomogeneous(70%) or high signal intensity(80%). On Gd-DTPA enhanced images, germinomas showed homogeneous (93%) or strong enhancement (64%), while other germ cell tumors showed homogeneous(60%) or strong enhancement (70%). Cyst formation was noted in ten Patients (71%) with germinoma and in six (60%) with other germ cell tumors. Invasion on surrounding structures was seen in 11 patients (79%) with germinoma and in five (50%) with other germ cell tumors. Lesions were multiple in three patients(21%) with germinoma. Thirteen of 14 patients with germinoma had normal serum {alpha}-FP(tetoprotein) and {beta}-HCG(human chononic gonafotrophin) levels. Two of four patients with mixed germ cell tumors had elevated serum {beta}-FP and {alpha}-HCG levels; in the ther two, elevated serum {alpha}-FP or {beta}-HCG levels were noted. In the malignant teratoma and embryonal carcinoma patients, serum {alpha}-FP and {beta}-HCG levels were normal. The patient with choriocarcinoma had an elevated serum {beta}-HCG level. On T1W1, the only significant differential point (p<0.01) between

  18. Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: a nursing approach.

    Science.gov (United States)

    Lopes, Maria Helena Baena de Moraes; Ortega, Neli Regina Siqueira; Silveira, Paulo Sérgio Panse; Massad, Eduardo; Higa, Rosângela; Marin, Heimar de Fátima

    2013-03-01

    To develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I). A fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. The model was implemented in Microsoft Visual C++(®) Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). The sensitivity and specificity of the model were calculated considering the expert's opinion as a gold standard. In order to compute the Kappa's values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different. The overestimation of the accordance showed an excellent agreement (kappa=0.92, p<0.0001); and the underestimation provided a moderate agreement (kappa=0.42, p<0.0001). In general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42). The decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view. In spite of

  19. Gilbert’s syndrome: clinical features, diagnostics, differential diagnosis and treatment (part 2

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    T.V. Sorokman

    2017-02-01

    discoloration of the skin (“teinte bilieuse”, especially on the face, hands, and feet without a distinct scleral icterus. Sometimes the development of repeatedly intermittent episodes of jaundice with high bilirubinemia (indirect bilirubin without the evidence of hemolysis (differential diagnostic feature is observed. 2. A tendency to development of pigmented and vascular nevi and xanthelasma of the eyelids, and hyperpigmentation around the eyes; to bradycardia, hypothermia, migraine, postural, intermittent albuminuria or to alimentary glycosuria. 3. An increased tendency to pigmentation under the influence of light, heat, and also chemical and mechanical stimuli. 4. A neuromuscular hyperexcitability. 5. Increased sensitivity to cold. 6. Dyspeptic complaints (pain, nausea, abdominal bloa­ting, diarrhea or constipation. 7. No signs of increased hemolysis (differential diagnostic feature with increasing content in, bilirubin (differential diagnostic feature. 8. The majority of patients have normal liver function tests (differential diagnostic feature also normal bromsulphalein test is also normal (differential diagnostic feature. 9. The biochemical abnormality is not detected by histological methods (differential diagnostic feature .10. Frequently, a family disease of the liver is observed. The differential diagnosis of GS is conducted with all types of hyperbilirubinemias, hemolytic anemias, congenital hepatic cirrhosis, hepatitis, cholecystopathy, atresia of biliary ducts or the small intestine. Medications are used only in severe hyperbilirubinemias and as concomitant therapy in the presence of symptoms of vitamin deficiencies, violations of a motor-evacuation function of the upper digestive tract in the clinical picture and to prevent complications (cholelithiasis.

  20. Peak systolic velocity of superior thyroid artery for the differential diagnosis of thyrotoxicosis.

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    Xiaolong Zhao

    Full Text Available AIM: The differentiation of destruction-induced thyrotoxicosis and Graves' disease (GD is of great importance for selection of proper therapy. Radioactive iodine uptake (RAIU is the gold standard for differentiating these two conditions but its application has remained somewhat limited. Thyroid color Doppler flow sonography (CDFS is a potential alternative of RAIU but more supporting evidence is warranted. In the present study, a standard operative procedure was developed to measure the mean peak systolic velocity of superior thyroid artery (STA-PSV and evaluate its role in the differential diagnosis of thyrotoxicosis. METHODS: A total of 135 patients with untreated thyrotoxicosis were enrolled into one retrospective study (GD, n = 103; thyroiditis, n = 32 and another prospective study recruited 169 patients (GD, n = 118; thyroiditis, n = 51. Thirty normal controls were also enrolled. Thyroid function, anti-TSH-receptor antibody (TRAb, RAIU, CFDS of thyroid and STA-PSV were performed for each patient. Receiver operator curve (ROC was used to evaluate the diagnostic value of STA-PSV in a retrospective study so as to seek the optimal cutoff point. Then the cutoff point value was used to validate its diagnostic value in a prospective study and in another thyrotoxicosis population. RESULTS: STA-PSV of GD was significantly higher than that of thyroiditis in both retrospective and prospective studies. The area under the ROC curve of mean STA-PSV was 0.8799 and 0.9447 in the retrospective and prospective studies respectively. If a mean STA-PSV cutoff point of 50.5 cm/s was set from the retrospective analysis for the prospective study, the sensitivity and specificity in distinguishing GD from thyroiditis were 81.04% and 96.08% respectively. Mean STA-PSV and TRAb had similar area under ROC. The coefficients of variation in STA-PSV measurement were lower than 10% for the euthyroid, thyroiditis and GD groups. CONCLUSIONS: STA-PSV is a feasible supplement

  1. Herlyn-werner-wunderlich syndrome: MRI findings, radiological guide (two cases and literature review, and differential diagnosis

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    Del Vescovo Riccardo

    2012-03-01

    Full Text Available Abstract Background Herlyn-Werner-Wunderlich (HWW syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures, and it is characterized by the triad of didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis. It generally occurs at puberty and exhibits non-specific and variable symptoms with acute or pelvic pain shortly following menarche, causing a delay in the diagnosis. Moreover, the diagnosis is complicated by the infrequency of this syndrome, because Müllerian duct anomalies (MDA are infrequently encountered in a routine clinical setting. Cases presentation two cases of HWW syndrome in adolescents and a differential diagnosis for one case of a different MDA, and the impact of magnetic resonance (MR imaging technology to achieve the correct diagnosis. Conclusions MR imaging is a very suitable diagnostic tool in order to perform the correct diagnosis of HWW syndrome.

  2. Herlyn-Werner-Wunderlich syndrome: MRI findings, radiological guide (two cases and literature review), and differential diagnosis.

    Science.gov (United States)

    Del Vescovo, Riccardo; Battisti, Sofia; Di Paola, Valerio; Piccolo, Claudia L; Cazzato, Roberto L; Sansoni, Ilaria; Grasso, Rosario F; Zobel, Bruno Beomonte

    2012-03-09

    Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures, and it is characterized by the triad of didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis. It generally occurs at puberty and exhibits non-specific and variable symptoms with acute or pelvic pain shortly following menarche, causing a delay in the diagnosis. Moreover, the diagnosis is complicated by the infrequency of this syndrome, because Müllerian duct anomalies (MDA) are infrequently encountered in a routine clinical setting. two cases of HWW syndrome in adolescents and a differential diagnosis for one case of a different MDA, and the impact of magnetic resonance (MR) imaging technology to achieve the correct diagnosis. MR imaging is a very suitable diagnostic tool in order to perform the correct diagnosis of HWW syndrome.

  3. Omental infarction in an obese 10-year-old boy

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    Katerina Kambouri

    2011-09-01

    Full Text Available Primary omental infarction (POI has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intraoperative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.

  4. The radiological and histopathological differential diagnosis of chordoid neoplasms in skull base

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    PAN Bin-cai

    2013-07-01

    Full Text Available Background Chordoid neoplasms refer to tumors appearing to have histological features of embryonic notochord, which is characterized by cords and lobules of neoplastic cells arranged within myxoid matrix. Because of radiological and histological similarities with myxoid matrix and overlapping immunohistochemical profile, chordoma, chordoid meningioma, chordoid glioma, and rare extraskeletal myxoid chondrosarcoma enter in the radiological and histological differential diagnosis at the site of skull base. However, there is always a great challenge for histopathologists to make an accurate diagnosis when encountering a chordoid neoplasm within or near the central nervous system. The aim of this study is to investigate and summarize the radiological, histological features and immunohistochemical profiles of chordoid neoplasms in skull base, and to find a judicious panel of immunostains to unquestionably help in diagnostically challenging cases. Methods A total of 23 cases of chordoid neoplasms in skull base, including 10 chordomas, 5 chordoid meningiomas, 3 chordoid gliomas and 5 extraskeletal myxoid chondrosarcomas, were collected from the First Affiliated Hospital, Sun Yat-sen University and Guangdong Tongjiang Hospital. MRI examination was performed on the patients before surgical treatment. Microscopical examination and immunohistochemical staining study using vimentin (Vim, pan-cytokeratin (PCK, epithelial membrane antigen (EMA, S?100 protein (S-100, glial fibrillary acidic protein (GFAP, D2-40, Galectin-3, CD3, CD20, Ki-67 were performed on the samples of cases. The clinicopathological data of the patients was also analyzed retrospectively. Results Most of chordomas were localized in the clivus with heterogeneous hyperintensity on T2WI scanning. The breakage of clivus was observed in most cases. Histologically, the tumor cells of chordoma exhibited bland nuclear features and some contained abundant vacuolated cytoplasm (the so

  5. Efficacy and safety of breast radiothermometry in the differential diagnosis of breast lesions.

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    Caferova, Sahnaz; Uysal, Fatma; Balcı, Pınar; Saydam, Serdar; Canda, Tülay

    2014-01-01

    The aim of this study is to research the contribution of radiothermometry (RTM) to the characterization of breast masses, the differentiation of malignant-benign masses and diagnosis of early stage breast cancer. This prospective study comprised 182 cases of patients diagnosed with a breast mass and a control group of 55 cases: a total of 237. When histopathology is accepted as the gold standard among diagnostic methods, the sensitivity, specificity, and positive-negative predictive value for RTM were 90.9%, 20.8%, 61.2% and 62.5%, respectively. Consistency was 0.129. When compared with mammography the same values for RTM examination are 87%, 81.4%, 58% and 95.5%. Consistency was 0.582. Evaluating with respect to size of the mass accepting mammography as the gold standard, RTM examination had sensitivity, specificity, positive and negative predictive values for masses 2 cm and above of 88.9%, 83.3%, 88.9% and 83.3%. Consistency was 0.722. The consistency of RTM for lesion diagnosis in BI-RADS II breast structure is higher than the consistency of mammography. Identification of lesions in the breast and presence of microcalcification by RTM shows that it is more trustworthy compared to mammography. When compared with mammography the validity results for RTM show there is a good level of conformity between the two methods. When evaluated based on the area below the ROC cure and compared to mammography, RTM is sufficiently successful at evaluating positive and negative cases.

  6. 18F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment.

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    Meyer, Philipp T; Frings, Lars; Rücker, Gerta; Hellwig, Sabine

    2017-12-01

    Accurate differential diagnosis of parkinsonism is of paramount therapeutic and prognostic importance. In addition, with the development of invasive therapies and novel disease-specific therapies, strategies for patient enrichment in trial populations are of growing importance. Imaging disease-specific patterns of regional glucose metabolism with PET and 18F-FDG allows for a highly accurate distinction between Parkinson disease (PD) and atypical parkinsonian syndromes, including multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. On the basis of a preliminary metaanalysis of currently available studies with inclusion of multiple disease groups, we estimated that the diagnostic sensitivity and specificity for visual PET readings supported by voxel-based statistical analyses for diagnosis of atypical parkinsonian syndromes are 91.4% and 90.6%, respectively. The diagnostic specificity of 18F-FDG PET for diagnosing multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration was consistently shown to be high (>90%), whereas sensitivity was more variable (>75%). It is increasingly acknowledged that cognitive impairment represents a major challenge in PD, with mild cognitive impairment being a prodromal stage of PD with dementia (PDD). In line with clinical and neuropsychologic studies, recent PET studies demonstrated that posterior cortical dysfunction in nondemented PD patients precedes cognitive decline and the development of PDD by several years. Taken together, the current literature underscores the utility of 18F-FDG PET for diagnostic evaluation of parkinsonism and the promising role of 18F-FDG PET for assessment and risk stratification of cognitive impairment in PD. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

  7. Elderly onset rheumatoid arthritis: differential diagnosis and choice of first-line and subsequent therapy.

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    Villa-Blanco, Juan Ignacio; Calvo-Alén, Jaime

    2009-01-01

    Elderly onset rheumatoid arthritis (EORA) has been considered a benign form of rheumatoid arthritis (RA). However, it most probably encompasses different subsets of patients with distinct outcomes. According to data reported in the most recent studies directly comparing older and younger RA patients, it seems that, overall, the prognosis of EORA patients is not very different from that of other patients with this disease. However, some cases with negative rheumatoid factor and polymyalgia-like symptoms appear to be a distinct subset with a different genetic basis and a more benign course. The differential diagnosis of EORA from other rheumatological disorders that are prevalent in this stratum of the population, such as polymyalgia rheumatica, crystal-induced arthritis or osteoarthritis, may be complicated because these disorders can present with signs and symptoms similar to those of RA in some circumstances. A prompt diagnosis of true RA is important because early treatment should be implemented. It is recommended that therapy of EORA be tailored according to disease activity, with the aim of achieving clinical remission or the lowest possible level of disease activity in order to minimize potential functional sequelae. Co-morbidities and drug toxicity profiles are major considerations when choosing the most suitable therapy for EORA patients. Prudent use and careful follow-up of all treatments are also required because of the increased risk of adverse events in elderly patients. However, no special contraindications to the use of disease-modifying antirheumatic drugs in this age group apply, and use of biological therapies currently used in younger RA patients has also been described in these patients. Therefore, a therapeutic strategy for first-line and subsequent treatment that is in accordance with the disease activity of patients with EORA is suggested.

  8. [Differential diagnosis of imported filariasis by molecular techniques (2006-2009)].

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    Jiménez, Maribel; González, Luis Miguel; Bailo, Begoña; Blanco, Alejandra; García, Luz; Pérez-González, Francisco; Fuentes, Isabel; Gárate, Teresa

    2011-11-01

    The last few years has seen an increase in the number of immigrants and travellers from endemic areas where filariasis are mainly caused by Loa loa (L. loa), Mansonella perstans (M. perstans) and Wuchereria bancrofti (W. bancrofti) species. These demographic changes has led to the need for better filariae species-specific molecular diagnostic tests to solve problems, as alternatives to the more time consuming classic parasitology methods. Thus, the objective of the present work was the implementation of optimised molecular protocols (nested-PCR and ITS1-RFLP) developed in our laboratory, for the differential diagnosis of filarial parasites. The results obtained were compared with those obtained using the conventional parasitological methods. A total of 523 samples (517 peripheral blood, 5 adult worms and one vitreous body) were sent to Parasitology Department of the National Microbiology Centre, Carlos II Research Institute (ISCIII), from 47 Health Centres in the Autonomous Regions of Spain, from 2006 to 2009. The samples were studied by the Knott technique, nested-PCR and ITS1-RFLP. The molecular techniques applied on blood samples showed to be more sensitive that Knott's concentration technique in the diagnosis of both L. loa (n=12 versus n=4) and M. perstans (n=57 versus n=25) infections. The nested-PCR and ITS1-RFLP are potential diagnostic tools for daily routine laboratory species-specific and sensitive detection of L. loa and M. perstans filarial species in immigrant population and travellers from endemic areas where these filarial species are co-endemic. Knott's concentration technique was less sensitive than molecular methods and should be carried out as a complementary diagnostic assay. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  9. Epidemiological Aspects and Differential Diagnosis of the Cutaneous Round Cell Tumors in Dogs

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    Roxana CORA

    2017-05-01

    Full Text Available Round cell neoplasms (RCNs are frequent cutaneous lesions in dogs, with high percentages among skin tumors. In this category are included histiocytoma, mast cell tumor, plasmacytoma, lymphoma and transmissible venereal tumor. The aim of the study was to perform an epidemiological study with reference to the cutaneous round cell tumors in a period of 10 years in the Department of Pathology (Faculty of Veterinary Medicine, Cluj-Napoca, Romania. Additionally, in the recorded cases with round cell tumors (mast cell tumor, histiocytoma and lymphoma we described the main histological and cytological features. The epidemiological data were collected from the records of Pathology Department between 2005-2014. The investigation included dogs diagnosed with cutaneous round cell neoplasms, following necropsy analysis or assessment of biopsies or cytological samples. All collected specimens were analyzed by histopathological and/or cytological techniques. The staining used for histological investigation were Hematoxylin-eosin, Masson’s trichrome and Toluidine blue, whereas Diff Quik and Wright methods were utilized in cytological specimens. The distribution of the cutaneous round cell tumors in relation to age, breed and sex was also assessed. The most frequent round cell tumor type was the mast cell tumor (19.54% followed by histiocytoma (11.33% and lymphoma (1.98%. The round cell tumors recorded were equally distributed in both males and females. Concerning the distribution of cutaneous RCNs by age (average age, histiocytoma occurred in 5 years old subjects, mast cell tumor in 11.9 years old subjects, and lymphoma in 6 years old subjects. Mast cell tumor was more frequent in stray dogs and Boxer breed, while histiocytoma occurred more commonly in stray dogs. Histological and cytological analysis was mandatory to perform the differential diagnosis between RCNs. Microscopic details concerning cytoplasm and nucleus of tumoral cells, together with the

  10. Differential diagnosis of truly suprasellar space-occupying masses: synopsis of clinical findings, CT, and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Reul, J. [Dept. of Neuroradiology, Technical Univ., Aachen (Germany); Weis, J. [Dept. of Neuropathology, Technical Univ., Aachen (Germany); Spetzger, U. [Dept. of Neurosurgery, Technical Univ., Aachen (Germany); Isensee, C. [Dept. of Neurology, Technical Univ., Aachen (Germany); Thron, A. [Dept. of Neuroradiology, Technical Univ., Aachen (Germany)

    1995-11-01

    This review demonstrates the features of truly suprasellar masses in modern imaging based on the clinical, CT, and MRI findings of 42 patients with suprasellar masses in correlation to the histologic findings. The radiologic examinations were evaluated retrospectively to determine if diagnosis can be made based on specific imaging patterns. The most frequent clinical findings of space-occupying suprasellar masses were visual disturbances, diabetes insipidus, and symptoms and signs of occlusive hydrocephalus. There were no clinical features specific for any of the observed masses. Craniopharyngiomas were the most frequent tumors. They appeared in two different forms, as cystic and as solid enhancing masses. The cystic tumors could not be differentiated from cystic hamartomas or cystic gliomas by CT or MRI. The solid craniopharyngiomas were similar to meningiomas and hamartomas. In craniopharyngiomas of adults calcifications were not common. In CT and especially in MRI gliomas were characterized by the diffuse infiltration of the adjacent brain tissue or optic nerve. Except for meningiomas, all lesions were highly variable in appearance, making a reliable characterization by CT and MRI difficult in many cases. However, administration of contrast media in some cases resulted in a better tumor delineation. Compared with unenhanced MRI the enhanced scans did not increase diagnostic efficacy for neoplasms, but were helpful in the differentiation from inflammatory diseases. The MRI technique was superior to CT in demonstrating the anatomic relationships, thus facilitating evaluation of origin and extent of the lesions. The CT technique, of course, was more reliable in the detection of calcifications. Both CT and MRI are not tissue-specific, however, and suprasellar tumors as well as many other neoplasms cannot be classified using only one of these imaging techniques. (orig.)

  11. Differential diagnosis of idiopathic granulomatous mastitis and breast cancer using acoustic radiation force impulse imaging.

    Science.gov (United States)

    Teke, Memik; Teke, Fatma; Alan, Bircan; Türkoğlu, Ahmet; Hamidi, Cihad; Göya, Cemil; Hattapoğlu, Salih; Gumus, Metehan

    2017-01-01

    Differentiation of idiopathic granulomatous mastitis (IGM) from carcinoma with routine imaging methods, such as ultrasonography (US) and mammography, is difficult. Therefore, we evaluated the value of a newly developed noninvasive technique called acoustic radiation force impulse imaging in differentiating IGM versus malignant lesions in the breast. Four hundred and eighty-six patients, who were referred to us with a presumptive diagnosis of a mass, underwent Virtual Touch tissue imaging (VTI; Siemens) and Virtual Touch tissue quantification (VTQ; Siemens) after conventional gray-scale US. US-guided percutaneous needle biopsy was then performed on 276 lesions with clinically and radiologically suspicious features. Malignant lesions (n = 122) and IGM (n = 48) were included in the final study group. There was a statistically significant difference in shear wave velocity marginal and internal values between the IGM and malignant lesions. The median marginal velocity for IGM and malignant lesions was 3.19 m/s (minimum-maximum 2.49-5.82) and 5.05 m/s (minimum-maximum 2.09-8.46), respectively (p < 0.001). The median internal velocity for IGM and malignant lesions was 2.76 m/s (minimum-maximum 1.14-4.12) and 4.79 m/s (minimum-maximum 2.12-8.02), respectively (p < 0.001). The combination of VTI and VTQ as a complement to conventional US provides viscoelastic properties of tissues, and thus has the potential to increase the specificity of US.

  12. Radiographic differential diagnosis between ameloblastoma and odontogenic keratocyst: with emphasis on CT

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    Soh, Byung Chun; Heo, Min Suk; An, Chang Hyeon; Lee, Sam Sun; Choi, Soon Chul; Park, Tae Won [College of Dentistry, Seoul National University, Seoul (Korea, Republic of); Choi, Mi [College of Dentistry, Kyungpook National University, Daegu (Korea, Republic of)

    2002-09-15

    To evaluate clinical and radiographic differential diagnosis between ameloblastoma and odontogenic keratocyst (OKC) using clinical data, plain radiographs, and CT. 25 cases of ameloblastoma and 44 cases of OKC diagnosed in biopsy, were selected from the files stored in Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital from 1999 to 2001, and evaluated using following criteria: sex and age, location, shape, border to normal bone tissue, effect to adjacent tissues, homogeneity in the lumen of the lesion, response of the cortical bone, long-to-short length (L/S) ratio of the lesion, and expansion angle of the cortex. Ameloblastoma and OKC were seen most frequently in third decades and no statistical significance was noted between both sexes. Ameloblastoma occurred most frequently in mandibular angle and ramus area (68%) and OKC at the maxillary molar (34.1%), and mandibular angle and ramus area (43.2%). The root resorption of the adjacent teeth, mandibular canal displacement, and the impaction of teeth were seen more frequently in ameloblastoma than in OKC. The L/S ratio measured in CT was largest in maxillary OKC cases, followed by mandibular ameloblastoma, and mandibular OKC (1.2, 1.8 and 2.4 respectively). The expansion angle of the cortex shows a statistically significant difference between ameloblastoma (48.8 .deg. C) and OKC (31.5 .deg. C). The numeric morphology (L/S ratio) and expansion angle of the cortical bone of the lesion measured in computed tomography can be used to differentiate the ameloblastoma and odontogenic keratocyst.

  13. Attenuation mechanism of Brucella melitensis M5-10, implications for vaccine development and differential diagnosis

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    Yuanqiang ZHENG,Yanchun SHI,Chang AN,Ruisheng LI,Dongjun LIU,Yuehua KE,Kairong MAO,Mingjuan YANG,Zeliang CHEN,Shorgan BOU

    2014-12-01

    Full Text Available Brucellosis is a worldwide zoonosis. Vaccination is the most efficient means to prevent and control brucellosis. The current licensed attenuated vaccines for animal use were developed by sequential passage in non-natural hosts that decreased virulence in its original hosts. The attenuation mechanism of these strains remains largely unknown. In the present study, we sequenced the genome of Brucella melitensis vaccine strain M5-10. Sequence analysis showed that a large number of genetic changes occurred in the vaccine strains. A total of 2854 genetic polymorphic sites, including 2548 SNP, 241 INDEL and 65 MNV were identified. Of the 2074 SNPs in coding regions, 1310 (63.2% were non-synonymous SNPs. Gene number, percent and N/S ratios were disproportionally distributed among the cog categories. Genetic polymorphic sites were identified in genes of the virB operon, flagella synthesis, and virulence regulating systems. These data indicate that changes in some cog categories and virulence genes might result in the attenuation. These attenuation mechanisms also have implications for screening and development of new vaccine strains. The genetic changes in the genome represent candidate sites for differential diagnosis between these vaccine strains and other virulence ones. Transcription analysis of virulence genes showed that expression of dnaK, vjbR were reduced in M5-10 strain when compared with that in 16M. A duplex PCR targeting virB6 and dnaK was successfully used to differentiate between M5-10 and the virulent 16M strain. The genome re-sequencing technique represents a strong strategy not only for evaluation of vaccines, but also for development of new vaccines.

  14. Apparent diffusion coefficient measurements with diffusion-weighted imaging for differential diagnosis of soft-tissue tumor

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    Yu Zou

    2016-01-01

    Conclusion: Our results provide strong evidence that patients diagnosed with malignant soft-tissue tumors have low ADC values of DWI compared to those with benign soft-tissue tumors. Therefore, ADC measurements with DWI may be reliable in differential diagnosis of soft-tissue tumors.

  15. Contribution of routine brain MRI to the differential diagnosis of parkinsonism: a 3-year prospective follow-up study.

    NARCIS (Netherlands)

    Meijer, F.J.A.; Aerts, M.B.; Abdo, W.F.; Prokop, M.; Borm, G.F.; Esselink, R.A.J.; Goraj, B.M.; Bloem, B.R.

    2012-01-01

    Various signs on routine brain MRI can help differentiate between Parkinson's disease (PD) and the various forms of atypical parkinsonism (AP). Here, we evaluate what routine brain MRI contributes to the clinical diagnosis, in both early and advanced disease stages. We performed a prospective

  16. CONDENSING OSTEITIS OF THE CLAVICLE - MAGNETIC-RESONANCE-IMAGING AS AN ADJUNCT METHOD FOR DIFFERENTIAL-DIAGNOSIS

    NARCIS (Netherlands)

    VIERBOOM, MAC; STEINBERG, JDJ; MOOYAART, EL; VANRIJSWIJK, MH

    Condensing osteitis of the clavicle is a benign disorder leading to osteosclerosis of the medial end of the clavicle. The differential diagnosis between condensing osteitis of the clavicle and ischaemic necrosis of the medial clavicular epiphysis (Friedrich's disease), osteoid osteoma, and low grade

  17. Determining level of endogenous serum erythropoietin for differential diagnosis of polycythemia vera and symptomatic polycythemia

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    Kostyukevych O.M.

    2013-06-01

    Full Text Available The article deals with determining possibility of the assessment of the level of endogenous serum erythropoietin (EPO for differential diagnosis of polycythemia vera (PV and secondary erythrocytosis (SE. The determination of subnormal level of this cytokine for the diagnosis of PV has been detected. The relation between the level of endogenous erythropoietin and iron metabolism also has been analyzed. The study involved 88 patients with PV and 119 patients with SE. Statistically significant decrease in EPO concentration level has been detected in PV patients. The mean EPO level was equal to 6.38 ± 0.84 mIU/mL and 17.98 ±2.48 mIU/mL in PV and SE patients respectively. In control group of individuals EPO concentration was equal to 9,81 ±0,58 mIU/mL, the significant difference was found between all studied groups (р<0.01. According to our data, EPO was increased in 28 SE patients (23.53%, it was not observed in control group and in group of PV patients (φ*emp = 4.355, р<0.01. The decrease of EPO level in PV patients has been detected more often than in SE patients (84.09% versus 11.76% , φ*emp = 5.218, р<0.01, it has not been observed in control group. Only 14 (15.91% PV patients had normal EPO level, in contrast 77 (64.71% SE patients demonstrated normal EPO level (φ*emp = 4.578, р<0.01. The average level of ferritin was equal to 57.41 ± 9.74 ng/mL in PV patients and 199.77 ± 14.32 ng/mL in SE patients (р<0.01. Significantly more patients with PV demonstrated decrease of ferritin level (31.81% versus 7.56%, φ*emp = 4.438, р<0.01. Patients with SE more often had raised level of EPO than PV patients (15.12% versus 4.54%, φ*emp = 2.453, р<0.01. The sensitivity of test with detecting of the reduced level of EPO for the diagnosis of PV was 84.1%, specificity - 87.4%, positive predictive value - 83.1%, negative predictive value - 88.1%. Normal range of EPO significantly (rs = 0,5494 correlated with decreased levels of serum ferritin in

  18. 123I-FP-CIT SPECT in the differential diagnosis between dementia with Lewy bodies and other dementias.

    Science.gov (United States)

    Brigo, Francesco; Turri, Giulia; Tinazzi, Michele

    2015-12-15

    To systematically review the utility of dopamine system imaging using 123I-FP-CIT SPECT in the differential diagnosis between dementia with Lewy bodies (DLB) and other dementia syndromes. We searched MEDLINE, CENTRAL and ClinicalTrials.gov to identify studies reporting enough data to determine accuracy measure of 123I-FP-CIT SPECT in differentiating between DLB and other dementia syndromes. Studies including patients with Parkinson's disease or other parkinsonisms associated with abnormal DAT imaging were excluded. The methodological quality of studies was evaluated with QUADAS-2. Eight studies were included. Studies adopting a clinical diagnosis as a reference standard showed sensitivity and specificity values of DaTSCAN in differentiating between DLB and non-DLB dementia syndromes (all subtypes, AD and FTD) consistently higher than 80%, both considering a visual and a semiquantitative analysis. The meta-analyses from the three studies using a neuropathological reference standard yielded sensitivity and specificity values higher than those adopting a clinical diagnostic reference. 123I-FP-CIT SPECT can represent an accurate method to differentiate between DLB and other dementia syndromes. However, most data in the literature derive from studies adopting the clinical diagnosis as the reference diagnostic standard and which are therefore intrinsically unable to demonstrate an accuracy of DAT imaging above that of careful clinical diagnosis alone. The very few studies providing information on the neuropathologic correlation for the DaTSCAN findings show however high sensitivity and specificity values, suggesting that SPECT scan is more accurate than clinical diagnosis and may prove useful in supporting the clinical diagnosis of DLB. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Differential diagnosis and prognosis of T1-weighted post-gadolinium intralabyrinthine hyperintensities

    Energy Technology Data Exchange (ETDEWEB)

    Dubrulle, F.; Puech, P.; Ernst, O. [University Nord of France, Department of Radiology, CHU Lille, Huriez Hospital INSERM, Lille (France); Kohler, R. [CHU Lille, Huriez Hospital, Department of Radiology, Lille (France); Vincent, C. [CHU Lille, Department of Otology and Oto-neurosurgery, Lille (France)

    2010-11-15

    The aim of this longitudinal study is to describe the different intralabyrinthine lesions yielding high signal intensity on T1-weighted (T1W) images after intravenous gadolinium and then to analyze the follow-up of these patients. Thirty-seven patients were included and followed clinically and radiologically. A precise analysis of MR labyrinthine signals allowed exact depiction of the different lesions. Special interest is focused on the intralabyrinthine fluid signal on 3D high-resolution T2W images. The enhanced T1W labyrinthine hyperintensities correspond to two different categories: intralabyrinthine enhancement (15 intralabyrinthine schwannomas, 13 labyrinthitis, 1 inflammatory granuloma) and spontaneous T1W hyperintensities (8 intralabyrinthine hemorrhages). Hemorrhagic lesions show a substantial decrease of the intralabyrinthine fluid signal on the 3D HRT2 that evolves to ossification. In labyrinthitis, the importance of the initial labyrinthine fluid signal decrease on the 3D HRT2 is well correlated with the hearing prognosis. A meticulous analysis of inner ear lesions allows various intralabyrinthine lesions, in particular schwannomas, to be differentiated from labyrinthitis. T1W imaging without gadolinium is essential for the correct diagnosis of rapidly evolving hearing loss. In labyrinthitis and intralabyrinthine hemorrhage, 3D HRT2 brings an interesting prognostic factor for the chance of hearing recovery. (orig.)

  20. Mendeliome sequencing enables differential diagnosis and treatment of neonatal lactic acidosis.

    Science.gov (United States)

    Fazeli, Walid; Karakaya, Mert; Herkenrath, Peter; Vierzig, Anne; Dötsch, Jörg; von Kleist-Retzow, Jürgen-Christoph; Cirak, Sebahattin

    2016-12-01

    Neonatal lactic acidosis can be associated to severe inborn errors of metabolism. Rapid identification of the underlying disorder may improve the clinical management through reliable counseling of the parents and adaptation of the treatment. We present the case of a term newborn with persistent hypoglycemia on postnatal day 1, who developed severe lactic acidosis, aggravating under intravenous glucose administration. Routine metabolic investigations revealed elevated pyruvate and lactate levels in urine, and magnetic resonance spectroscopy showed a lactic acid peak and decreased N-acetylaspartate levels. Mitochondrial disorders, e.g., pyruvate dehydrogenase (PDH) deficiency, were the major differential diagnoses. However, both hypoglycemia and the elevated lactate to pyruvate ratio in serum (=55.2) were not typical for PDH deficiency. We used "Mendeliome sequencing", a next-generation sequencing approach targeting all genes which have been previously linked to single-gene disorders, to obtain the correct diagnosis. On day 27 of life, we identified a homozygous stop mutation in the PDHX gene, causing pyruvate dehydrogenase E3-binding protein deficiency. After starting the ketogenic diet, the infant recovered and is showing delayed but progressive development. Mendeliome sequencing was successfully used to disentangle the underlying cause of severe neonatal lactic acidosis. Indeed, it is one of several targeted sequencing approaches that allow rapid and reliable counseling of the parents, adaptation of the clinical management, and renunciation of unnecessary, potentially invasive and often costly diagnostic measures.

  1. Temple syndrome as a differential diagnosis to Prader-Willi syndrome: Identifying three new patients.

    Science.gov (United States)

    Lande, Asgeir; Kroken, Mette; Rabben, Kai; Retterstøl, Lars

    2018-01-01

    The two imprinting syndromes Temple syndrome (TS14) and Prader-Willi syndrome (PWS) share many features in infancy and childhood. TS14 is an important, yet often neglected, differential diagnosis to PWS. We wanted to assess the frequency of TS14 among patients tested for PWS. In all samples submitted to our lab for genetic PWS testing during 2014 and 2015, we consecutively conducted additional analyses for TS14. A total of 143 samples were included. The most frequent indications for testing were developmental delay, overweight, and hypotonia. For TS14 testing, we performed a methylation-sensitive MLPA-kit detecting deletions and methylation aberrations in chromosomal region 14q32. TS14 was confirmed in 3 out of 143 patients (2.1%). In comparison, PWS was also confirmed in three patients. Brief clinical descriptions of the TS14 patients are presented. Temple syndrome is presumably underdiagnosed, and should be considered when testing children for PWS. © 2017 Wiley Periodicals, Inc.

  2. Isolated flexor pollicis longus nerve fascicle lesion – a rare differential diagnosis of thumb flexion deficiency

    Directory of Open Access Journals (Sweden)

    Glauser, Eva

    2016-12-01

    Full Text Available A rare differential diagnosis of thumb flexion deficiency is an isolated flexor pollicis longus (FPL nerve fascicle lesion. We present a 42-year-old otherwise healthy female patient who developed a weak thumb-to-index pinch and deficient right thumb flexion following the removal of osteosynthesis plates after a forearm fracture. Clinically,the flexor pollicis longus function was absent, yet index flexion and sensibility were unimpaired. Tendon rupture was excluded using a tenodesis test and the electro-physiological result of isolated interosseus nerve fascicle lesion was confirmed intraoperatively by inspection and electrostimulation. Tendon transfer using the extensor carpi radialis longus reconstruct strong thumb flexion during pinch. In summary, due to its specific location and anatomy, the FPL branch is more prone to isolated neuropathy, e.g. by injections or operations, than to other fascicles of the anterior interosseus nerve. When confronted with sudden and isolated thumb flexion deficiency, specialists should be aware of this rare phenomenon.

  3. Dynamic automated synovial imaging (DASI) for differential diagnosis of rheumatoid arthritis

    Science.gov (United States)

    Grisan, E.; Raffeiner, B.; Coran, A.; Rizzo, G.; Ciprian, L.; Stramare, R.

    2014-03-01

    Inflammatory rheumatic diseases are leading causes of disability and constitute a frequent medical disorder, leading to inability to work, high comorbidity and increased mortality. The gold-standard for diagnosing and differentiating arthritis is based on patient conditions and radiographic findings, as joint erosions or decalcification. However, early signs of arthritis are joint effusion, hypervascularization and synovial hypertrophy. In particular, vascularization has been shown to correlate with arthritis' destructive behavior, more than clinical assessment. Contrast Enhanced Ultrasound (CEUS) examination of the small joints is emerging as a sensitive tool for assessing vascularization and disease activity. The evaluation of perfusion pattern rely on subjective semiquantitative scales, that are able to capture the macroscopic degree of vascularization, but are unable to detect the subtler differences in kinetics perfusion parameters that might lead to a deeper understanding of disease progression and a better management of patients. We show that after a kinetic analysis of contrast agent appearance, providing the quantitative features characterizing the perfusion pattern of the joint, it is possible to accurately discriminate RA from PSA by building a random forest classifier on the computed features. We compare its accuracy with the assessment performed by expert radiologist blinded of the diagnosis.

  4. [Differential diagnosis and management of intramuscular myxomas: A review of our experience].

    Science.gov (United States)

    Granel-Villach, Laura; Alcalde-Sánchez, Miguel; Salvador-Marín, Manuel; García-Calvo, Rafael; Santonja-López, Nuria; Salvador-Sanchís, José Luis

    Intramuscular myxoma is a rare benign soft tissue tumour of mesenchymal origin, which appears as a painless mass of slow growth. Early diagnosis is important in order to differentiate it from other entities, especially soft tissue sarcoma. Two cases, both women with a mean age of 52.5 years (range 40-65) are presented. The first was seen due to growth of a gluteal mass, and the second by coccydynia. Computed tomography and nuclear magnetic resonance were the diagnostic tests of choice. In one case, where there was a single but large lesion, radical extirpation of the gluteal muscle was chosen. In the other case, in which the lesions were multiple, individualised excision of cysts was performed. Postoperative functional limitation was low in both types of surgery, with good oncological results being obtained. Intramuscular myxomas are benign lesions. There are no cases of malignancy or recurrence due to incomplete resection. It has to be determined whether they are single or multiple, since in the latter case, they could be due to syndromes such as Mazabraud syndrome, which is associated with bone fibrous dysplasia, or Albright syndrome that is also associated with pigmented skin spots. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  5. Primary Synovial Sarcoma of Kidney: A Rare Differential Diagnosis of Renomegaly

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    Gaurang Modi

    2014-01-01

    Full Text Available Synovial sarcomas (SS are classified as subgroup of soft tissue sarcomas affecting mainly extremities of young adults. Primary SS of kidney are very rare tumours with poor prognosis. Though they have characteristic histology and immunohistochemistry (IHC due to rarity of incidence it is difficult to diagnose them. Sometimes chromosomal rearrangement studies are required to confirm the diagnosis. We are presenting a case of 41-year-old male who was referred to our cancer centre for evaluation of left renal mass. CT scan of abdomen revealed a large left renal mass encasing the aorta. Biopsy of renal mass revealed poorly differentiated sarcoma and IHC was positive for vimentin, CD99, and BCL2 and negative for AE1, epithelial membrane antigen, and leukocyte common antigen. The patient was clinically inoperable as renal mass was encasing the aorta. So he was subsequently offered palliative chemotherapy in form of ifosfamide and adriamycin. CT abdomen shows partial response after 3 cycles of chemotherapy according to RECIST criteria.

  6. The disfluent speech of bilingual spanish-english children: considerations for differential diagnosis of stuttering.

    Science.gov (United States)

    Byrd, Courtney T; Bedore, Lisa M; Ramos, Daniel

    2015-01-01

    The primary purpose of this study was to describe the frequency and types of speech disfluencies that are produced by bilingual Spanish-English (SE) speaking children who do not stutter. The secondary purpose was to determine whether their disfluent speech is mediated by language dominance and/or language produced. Spanish and English narratives (a retell and a tell in each language) were elicited and analyzed relative to the frequency and types of speech disfluencies produced. These data were compared with the monolingual English-speaking guidelines for differential diagnosis of stuttering. The mean frequency of stuttering-like speech behaviors in the bilingual SE participants ranged from 3% to 22%, exceeding the monolingual English standard of 3 per 100 words. There was no significant frequency difference in stuttering-like or non-stuttering-like speech disfluency produced relative to the child's language dominance. There was a significant difference relative to the language the child was speaking; all children produced significantly more stuttering-like speech disfluencies in Spanish than in English. Results demonstrate that the disfluent speech of bilingual SE children should be carefully considered relative to the complex nature of bilingualism.

  7. Penile myiasis as a differential diagnosis for genital ulcer: a case report

    Directory of Open Access Journals (Sweden)

    Mauro R.L. Passos

    Full Text Available The genital localized myiasis is a rare zooparasitic dermatosis. This case reported to a penile myiasis by Dermatobia hominis larvae in a 62 year-old man, who is a retired military official from São Gonçalo city, Rio de Janeiro state, Brazil. This patient was guided to the sexually transmitted diseases (STD clinic from Universidade Federal Fluminense (UFF by professionals from a urology outpatient clinic of a public hospital from Rio de Janeiro state. The exam showed a 2 cm diameter nodular lesion with a hyperemic area in the glands penis that had arisen 20 days before the exam. It evolved in a favorable way after larvae removal, through previous local anesthesia and slight pressure in lesion's base with the extraction of the larvae. Penile myiasis is not a very frequent situation, although it must be considered as an option in differential diagnosis of genital infectious diseases, even among people of low economical level, as in the case presented.

  8. Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation.

    Science.gov (United States)

    Dighe, Manjiri; Bae, Unmin; Richardson, Michael L; Dubinsky, Theodore J; Minoshima, Satoshi; Kim, Yongmin

    2008-08-01

    To explore the sensitivity and specificity of ultrasonographic (US) elastography using carotid arterial pulsation as the compression source for differential diagnosis of thyroid nodules. This HIPAA-compliant study was approved by the ethics committee of the institution, and all patients provided written informed consent. Fifty-eight patients (13 men and 45 women [mean age, 51 years; range, 20-76 years]) were enrolled. A short US examination and elastography with pulsation of the carotid artery used as the thyroid compression source were performed before fine-needle aspiration. Baseband US data were downloaded for off-line analysis. Elastographic maps and the thyroid stiffness index were calculated. The Kruskal-Wallis nonparametric rank sum test was used to assess equality of population medians among the different types of thyroid nodules; the R software environment was used for statistical computing and graphics (http://www.r-project.org/). Thyroid stiffness index calculated with elastography using carotid arterial pulsation as the compression source was effective in helping distinguish between papillary carcinomas (n = 10) and other lesions (n = 43) because papillary carcinomas were stiffer than other lesions (P < .0039). It is possible to distinguish between papillary carcinomas and other lesions with the thyroid stiffness index calculated from US elastography using carotid arterial pulsation.

  9. Analysis of the Serum Bile Acid Composition for Differential Diagnosis in Patients with Liver Disease

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    Tomonori Sugita

    2015-01-01

    Full Text Available Objectives. We determined the serum bile acid (BA composition in patients with liver diseases and healthy volunteers to investigate the relationship between the etiologies of liver disease and BA metabolism. Material and Methods. Sera from 150 patients with liver diseases and 46 healthy volunteers were obtained. The serum concentrations of the 16 different BAs were determined according to the LC-MS/MS method and were compared between the different liver diseases. Results. A total of 150 subjects, including patients with hepatitis C virus (HCV (n=44, hepatitis B virus (HBV (n=23, alcoholic liver disease (ALD (n=21, biliary tract disease (n=20, nonalcoholic fatty liver disease (NAFLD (n=13, and other liver diseases (n=29, were recruited. The levels of UDCA and GUDCA were significantly higher in the ALD group, and the levels of DCA and UDCA were significantly lower in the biliary tract diseases group than in viral hepatitis group. In the UDCA therapy (− subgroup, a significantly lower level of TLCA was observed in the ALD group, with lower levels of CDCA, DCA, and GLCA noted in biliary tract diseases group compared to viral hepatitis group. Conclusions. Analysis of the BA composition may be useful for differential diagnosis in liver disease.

  10. Analysis of the serum bile Acid composition for differential diagnosis in patients with liver disease.

    Science.gov (United States)

    Sugita, Tomonori; Amano, Katsushi; Nakano, Masanori; Masubuchi, Noriko; Sugihara, Masahiro; Matsuura, Tomokazu

    2015-01-01

    Objectives. We determined the serum bile acid (BA) composition in patients with liver diseases and healthy volunteers to investigate the relationship between the etiologies of liver disease and BA metabolism. Material and Methods. Sera from 150 patients with liver diseases and 46 healthy volunteers were obtained. The serum concentrations of the 16 different BAs were determined according to the LC-MS/MS method and were compared between the different liver diseases. Results. A total of 150 subjects, including patients with hepatitis C virus (HCV) (n = 44), hepatitis B virus (HBV) (n = 23), alcoholic liver disease (ALD) (n = 21), biliary tract disease (n = 20), nonalcoholic fatty liver disease (NAFLD) (n = 13), and other liver diseases (n = 29), were recruited. The levels of UDCA and GUDCA were significantly higher in the ALD group, and the levels of DCA and UDCA were significantly lower in the biliary tract diseases group than in viral hepatitis group. In the UDCA therapy (-) subgroup, a significantly lower level of TLCA was observed in the ALD group, with lower levels of CDCA, DCA, and GLCA noted in biliary tract diseases group compared to viral hepatitis group. Conclusions. Analysis of the BA composition may be useful for differential diagnosis in liver disease.

  11. Chronic pulmonary embolism - radiological imaging and differential diagnosis; Chronische Lungenembolie - Radiologische Bildmorphologie und Differenzialdiagnose

    Energy Technology Data Exchange (ETDEWEB)

    Coppenrath, E.; Herzog, P.; Attenberger, U.; Reiser, M. [Klinikum Innenstadt der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2007-08-15

    In chronic pulmonary embolism branches of the pulmonary arterial tree remain partially or totally occluded. This may lead to pulmonary hypertension with the development of right ventricular hypertrophy as well as structural changes of pulmonary arteries. Imaging of chronic pulmonary embolism should prove vessel occlusions (pulmonary angiography, MSCT, MRI) and reduction of regional lung perfusion (lung scanning, MSCT, MRI). According to current guidelines ventilation-perfusion lung scanning and pulmonary angiography are still recommended as the methods of choice. MSCT and MRI provide technical alternatives which are helpful in differential diagnosis versus other types of pulmonary hypertension. In spite of medical and surgical measures (in rare cases pulmonary thromboendarterectomy) the prognosis of chronic pulmonary embolism remains unfavourable. (orig.) [German] Bei der chronischen Lungenembolie sind Abschnitte der arteriellen Lungenstrombahn dauerhaft verschlossen. Dies kann zu einer Erhoehung des pulmonal-arteriellen Drucks mit den Folgen einer Rechtsherzbelastung und strukturellen Veraenderungen der Pulmonalarterien fuehren. Bildmorphologisch nachzuweisen sind Gefaessverschluesse (Pulmonalisangiographie, MSCT, MRT) und die Minderperfusion des Lungenparenchyms (Szintigraphie, MSCT, MRT). Nach den bisherigen Empfehlungen gelten fuer die Diagnostik der chronischen Lungenembolie die Lungenszintigraphie (Ventilation/Perfusion) und die Pulmonalisangiographie als Methoden der ersten Wahl. Die MSCT und MRT (Angiographie/Perfusion) stellen technische Alternativen dar. Differenzialdiagnostisch sind andere Formen der pulmonalen Hypertonie abzugrenzen. Trotz medikamentoeser und chirurgischer Therapiemassnahmen (z. B. pulmonale Thrombendarterektomie) bleibt die Prognose der chronischen Lungenembolie unguenstig. (orig.)

  12. Evaluation of the Sensitivity and Specificity of Immunohistochemical Markers in the Differential Diagnosis of Effusion Cytology

    Directory of Open Access Journals (Sweden)

    Zahraa Mohammed Yahya

    2013-11-01

    Full Text Available Objective: To evaluate the sensitivity and specificity of Calretinin and Carcinoembryonic antigen as immunocytochemical markers in distinguishing mesothelial cells from metastatic adenocarcinoma cells in effusion cytology.Methods: This study included 50 patients who presented with effusions (26 pleural and 24 peritoneal, at Al-Kadhimya Teaching Hospital who were selected according to their preliminary diagnosis from 1st December 2010 to 30th June 2011. Effusion fluids were aspirated and processed for both conventional cytological methods using Papanicolaou-stain and immunocytochemical staining with anti Calretinin and Carcinoembryonic antigen.Results: The sensitivity of cytology for detection of malignant cells was 77%, with 100% specificity and 86% accuracy. Calretinin was observed to be a specific (100% and sensitive (90% marker for mesothelial cells (of benign etiology. Carcinoembryonic antigen exhibited 70% sensitivity and 100% specificity for adenocarcinoma cells. When the results of both cytology and immunocytochemistry were considered in conjunction, the sensitivity for the detection of malignancy increased to 97%, with 100% specificity and 98% accuracy.Conclusion: Calretinin and Carcinoembryonic antigen were found to be useful markers for differentiating reactive mesothelial cells from metastatic adenocarcinoma cells in smears prepared from body fluids. Also, the combination of both cytology and immunocytochemical studies using the two markers can greatly enhance the diagnostic accuracy, sensitivity and specificity in malignant effusions.

  13. [Hyperventilation syndrome and bronchial asthma: role of verbal dyspnea characteristics in differential diagnosis].

    Science.gov (United States)

    2012-01-01

    To investigate verbal dyspnea characteristics in patients with bronchial asthma (BA) and hyperventilation syndrome (HVS). The trial covered 52 patients with BA, 10 patients with BA combination with HVS and 18 patients with HVS. Verbal dyspnea characteristics were studied with PM. Simon questionnaire. The examination of the patients was made using scale HADS. Naimigen questionnaire, body plethysmography, bronchodilation test, capnography with spontaneous hyperventilation test, analysis of arterial blood gas composition. Most commonly BA patients characterized dyspnea with such words as "I am breathless" (n = 8, 33.3%), "I breathe with effort" (n = 6, 25%) and "I feel suffocation" (n = 6, 25%). HVS patients characterized their dyspnea most often as "air shortage" (n = 14, 77.8%), "I can't take a deep breath" (n = 10, 55.6%), "breathing needs concentration" (n = 6, 33.3%) and "I have to grasp air with mouth" (n = 5, 17.9%). The latter description correlated with capnometric markers of HVS and responses to Naimigen questionnaire. The description "I feel suffocation" directly correlated with BA stage by GINA and bronchial obstruction severity. Verbal dyspnea characteristics differ in BA and HVS patients and this can be used in differential diagnosis of these conditions.

  14. Musculoskeletal pain: a new algorithm for differential diagnosis of a cardinal symptom in pediatrics.

    Science.gov (United States)

    Tallen, G; Bielack, S; Henze, G; Horneff, G; Korinthenberg, R; Lawrenz, B; Niehues, T; Peitz, J; Placzek, R; Schmittenbecher, P; Schönau, E; Wessel, L; Wirth, T; Mentzel, H-J; Creutzig, U

    2014-04-01

    Musculoskeletal pain (MSP) is a common childhood complaint associated with multiple differential diagnoses, including cancer. Considering the expanding spectrum of diagnostics, evaluat-ing a young patient with MSP is a challenge today, particularly for non-specialists in a primary care setting. Since childhood cancer is rare and most cardinal symptoms mimic rather non-serious diseases, misdiagnosis is not uncommon, but of significant prognostic relevance. To build the appropriate bridge between primary and secon-dary care for a child presenting with MSP, thereby preventing treatment delay and longterm sequelae, initial evaluation should follow a comprehensive, multidisciplinary, systematic and stepwise approach, which unites the patient's individual anamnestic, psychosocial, and clinical charac-teristics. After a systematic review of the literature, we generated multidisciplinarily quality-assured recommendations for efficient, rational and cost-effective primary care assessment of pediatric MSP. The algorithm promotes the identification and structured interpretation of the patient's individual clinical clues. It should serve the primary care physician to recognize when further intervention, rather than reassurance and follow-up, is needed using the minimum amount of testing to make an appropriate, prompt diagnosis in the clinical situation "child presenting with MSP". A German version of this algorithm has been published in the Guideline-Portal of The Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF) in November 2013. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Utility Serum Marker HE4 for the Differential Diagnosis Between Endometriosis and Adnexal Malignancy.

    Science.gov (United States)

    Zapardiel, Ignacio; Gorostidi, Mikel; Ravaggi, Antonella; Allende, Maria T; Silveira, Margarida; Abehsera, Daniel; Macuks, Ronalds

    2016-01-01

    The aim of the study was to assess the utility of serum human epididymal secretory protein E4 (HE4) biomarker in the differential diagnosis of endometriosis and adnexal malignancies. Multicentric prospective observational study between January 2010 and December 2011 in 4 European centers (Italy, Portugal, Latvia, and Spain) was carried out. We collected 981 healthy patients diagnosed with adnexal patology and selected 65 patients diagnosed with endometriosis and analyzed their serum markers CA125, HE4, and Risk of Ovarian Malignancy Algorithm (ROMA) index. We also analyzed all cases of malignant histology and divided them according to CA125 levels (negative, ≤35 U/mL; intermediate, >35-150 U/mL; and highly positive, >150 U/mL). HE4 was positive only in 1.5% of cases, CA125 in 64.6%, and ROMA index in 14.1%. In the subgroup intermediate CA125 values, positive HE4 is very specific (91.2%) correctly classifying patients with benign disease, but with lower sensibility (66.1%); however, ROMA index showed a high sensibility (89.3%), with a false-positive rate of 42.8%. HE4 can be a very useful biomarker to exclude malignant disease in patients with endometriosis.

  16. Most frequent causes, complications and differential diagnosis of neonatal respiratory distress in chest X-ray

    Energy Technology Data Exchange (ETDEWEB)

    Ponhold, W. (Vienna Univ. (Austria). Kinderklinik)

    1982-01-01

    The radiologic changes of the chest X-ray of 270 newborns with respiratory distress were analyzed. In cases of Hyaline Membranes the chest X-Ray showed finely granular evenly disseminated structures combined with signs of hypoventilation. Localized, patchy, streaky, homogenous and reticulonodular shadows were found in cases of pneumonia and hemorrhage. Hyperinflation were an additional sign for an inflammatory disease. This symptom was also demonstrated in pulmonary bleeding, but was less common. The bilateral interstitial augmentation of the pulmonary structure in combination with cardiomegaly was mainly a symptom for cardial insufficiency and transient tachypnea. The differentiation between fine granular and reticulo-nodular structures should create no problem if the chest X-ray is of good quality. Extrapulmonary air collections were found in a high percentage in the course of artificial ventilation as a consequence of the 'baro-trauma'. The radiologic diagnosis of BPD was no problem. The value of the chest X-ray lies in the demonstration of a pulmonary cause for the respiratory distress, in the demonstration of complications and in the radiological observation of the disease.

  17. Residual Salivary Secretion Ability May Be a Useful Marker for Differential Diagnosis in Autoimmune Diseases

    Directory of Open Access Journals (Sweden)

    Etsuko Maeshima

    2014-01-01

    Full Text Available Background. We have elucidated decreased resting salivary flow in approximately 60% of patients with autoimmune diseases not complicated by Sjögren syndrome (SjS. In this study, salivary stimulation tests using capsaicin were performed to examine residual salivary secretion ability in patients with autoimmune diseases. Materials and Methods. Fifty-eight patients were divided into three groups: patients with primary or secondary SjS (SjS group, patients with systemic sclerosis not complicated by SjS (SSc group, and patients with other autoimmune diseases (non-SjS/non-SSc group. Simple filter paper and filter paper containing capsaicin were used to evaluate salivary flow rates. Results. Resting salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group but did not differ significantly between the SjS and SSc groups. Capsaicin-stimulated salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group, but not significantly different between the SjS and SSc groups. In the non-SjS/non-SSc group, salivary flow rates increased after capsaicin stimulation to the threshold level for determination of salivary gland dysfunction, whereas no improvement was observed in the SjS and SSc groups. Conclusion. Residual salivary secretion ability may be a useful marker for differential diagnosis in autoimmune diseases.

  18. MR Imaging Findings of Ovarian Cystadenofibroma and Cystadenocarcinofibroma: Clues for the Differential Diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Dae Chul; Kim, Sun Ho; Kim, Seung Hyup [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2006-09-15

    We wanted to assess the MR imaging findings of ovarian cystadenofibroma and cystadenocarcinofibroma, and we wanted to find clues for making the differential diagnosis between them. The MR images of 12 pathologically proven cystadenofibromas and two cystadenocarcinofibromas were reviewed, with a focus on the internal architecture, signal intensity and enhancement. All the tumors appeared as multilocular cysts, except for a single unilocular cystic mass and a single solid mass. The previously reported characteristic MR findings of cystadenofibroma (a multilocular cystic mass with a T2- dark-signal-intensity solid component containing small cystic locules) were found in only 43% of the tumors (6/14). Diffuse or partial thickening of the cyst wall with T2-dark signal intensity without a definite solid component was as common as the previous reported findings (6/14). Two cystadenocarcinofibromas showed more prominent solid portions with higher T2-signal intensities and stronger enhancement than did the cystadenofibromas. Diffuse or partial thickening of the cyst wall with dark-signal-intensity in multilocular cystic masses may suggest ovarian cystadenofibroma, and this type of appearance may be as common as the previously reported characteristic appearance. A prominent solid component with a higher T2-signal intensity and strong enhancement are the typical findings of cystadenocarcinofibroma.

  19. [Clinical findings and differential diagnosis in ketosis and hypocalcemia in sheep].

    Science.gov (United States)

    Bickhardt, K; Henze, P; Ganter, M

    1998-11-01

    Clinical and laboratory examinations were carried out in a prospective study from 1978 to 1998 on 454 spontaneously diseased sheep of different breeds aged 2-8 years. Three groups of sheep were defined by plasma concentrations of 3-hydroxybutyrate (3-OHB) and calcium. 214 ewes suffered from ketosis (pregnancy toxaemia, 3-OHB > 1.6 mmol/l), 195 ewes and 5 rams suffered from hypocalcaemia (Ca < 2.0 mmol/l), and 40 ewes were sick with booth diseases simultaneously. Clinical findings differ only slightly in all three groups. In ketosis the time until the onset of clinical signs and the duration of the disease is somewhat longer, while locomotion disturbances are less severe than in hypocalcaemia and in the combination of both. In individual cases a differential diagnosis is not possible on the basis of clinical findings, and also acetonuria is not a reliable criterion. Therefore, a therapy is suggested to treat all three possible forms of disease: daily oral application of Na-propionate, Ca-lactate and K-chloride, and additional subcutanous injection of Ca-borogluconate, vitamin D3, alpha-Tocopherol and selenium at the beginning of the disease. Pathogenesis of both diseases are discussed, recommendations for feeding management are given.

  20. [The pathological/MR tomographic correlation and differential diagnosis of malignant kidney tumors].

    Science.gov (United States)

    Kreft, B; Flacke, S; Conrad, R; Pauleit, D; Bachmann, R; Wardelmann, E; Albers, P; Schild, H

    1999-08-01

    Evaluation of malignancy criteria in MRT of kidney tumors in correlation with the histopathological findings. 41 patients with suspected malignant kidney tumors were examined using a T1 SE sequence (TR/TE 300/10 ms) before and after i.v. administration of 0.1 mmol/kg Gd-DTPA and a T2 SE sequence (TR/TE 5500/150 ms). The results were correlated with the pathological findings. 38 malignant tumors were found: 29 renal cell carcinomas (RCC), 13 with solid growth, 11 with tubulopapillary growth, and three with mixed growth forms, one cystic RCC, and one chromophobic RCC, in addition, 6 urothelial carcinomas and three other malignomas. Typical MRT criteria for RCC were an inhomogeneity of the tumor with regions of slightly increased signal intensity on the T1-weighted image (59%) and regions with reduced signal intensity on the T2-weighted image (96%) as compared with renal parenchyma; these were due to histomorphological hemorrhage and hemosiderin deposits, respectively. A further criterion for RCC was a hypointense pseudocapsule in the T2 TSE sequence in 79% of the cases. The low-signal nature of RCC in the T2-weighted image correlates with hemorrhage and hemosiderin deposits. The detection of a pseudocapsule is useful in the differential diagnosis of solid tumors in the kidney.

  1. The Disfluent Speech of Bilingual Spanish–English Children: Considerations for Differential Diagnosis of Stuttering

    Science.gov (United States)

    Bedore, Lisa M.; Ramos, Daniel

    2015-01-01

    Purpose The primary purpose of this study was to describe the frequency and types of speech disfluencies that are produced by bilingual Spanish–English (SE) speaking children who do not stutter. The secondary purpose was to determine whether their disfluent speech is mediated by language dominance and/or language produced. Method Spanish and English narratives (a retell and a tell in each language) were elicited and analyzed relative to the frequency and types of speech disfluencies produced. These data were compared with the monolingual English-speaking guidelines for differential diagnosis of stuttering. Results The mean frequency of stuttering-like speech behaviors in the bilingual SE participants ranged from 3% to 22%, exceeding the monolingual English standard of 3 per 100 words. There was no significant frequency difference in stuttering-like or non-stuttering-like speech disfluency produced relative to the child's language dominance. There was a significant difference relative to the language the child was speaking; all children produced significantly more stuttering-like speech disfluencies in Spanish than in English. Conclusion Results demonstrate that the disfluent speech of bilingual SE children should be carefully considered relative to the complex nature of bilingualism. PMID:25215876

  2. [Symptoms related to addiction: elements for the differential diagnosis with personality disorders].

    Science.gov (United States)

    Badii, Franco

    2013-01-01

    Some manifestations, observed in situations of addiction, are often interpreted as symptoms of a personality disorder. On the contrary, they may not be referable to personality structural aspects, but they hold rather a functional aspect, linked to the implications of the relationship between the individual and the object of addiction. In particular, the personal meaning given to addiction holds an important role as regards the intensity of this relationship. This recalls the necessity of a thorough examination for differential diagnosis. The awareness of intervening in behaviour modalities, due to the process of addiction and not to preexistent personality features, modifies the perspective of action. As a result, generic modalities of treatment, leading to confused therapeutic routes, would be overcome, presuming that acting on other aspects interferes in addiction phenomena. In that way, it would be possible to pick out specific routes to act from the therapeutic point of view on the focus of addiction. The recovery of the meaning the patient gives to it and a following elaboration can bring to the awareness of different emotional and behavioural options to face moments that can reestablish the individual emotional process at the basis of addiction. From an organizational point of view, it would be possible to reserve the articulated and complex interventions for cases of comorbidity to those who really require.

  3. [Late life depression or prodromal Alzheimer's disease: Which tools for the differential diagnosis?

    Science.gov (United States)

    Gasser, A-I; Salamin, V; Zumbach, S

    2018-02-01

    executive functions could not differentiate between patients with late life depression and patients with prodromal Alzheimer's disease. A measure of global cognitive decline does not seem to be helpful in differentiating early Alzheimer's disease and depression, unlike an analysis of the neuropsychological profile on several composite scales, such as the Mini Mental State Examination. Furthermore, recent work has investigated the utility of olfactory or gustative markers with promising results and convenient tools for clinical practice. Concerning morphological brain imaging, only detailed volumetric analysis could show differences between the two diseases, but these techniques are not always available for clinical practice. It is the same for other recent techniques, such as quantitative electroencephalography, Near InfraRed Spectroscopy, Single Photon Emission Computed Tomography, or Transcranial Doppler Ultrasonography, which have received little attention so far as differential diagnostic tools. Finally, cerebrospinal fluid analysis could be useful, including beta amyloid levels. Despite numerous efforts in recent years, differential diagnosis of dementia from depression in the elderly remains difficult. Results of this review highlight the necessity of conducting more research in this area, with multi-method studies, using not only cognitive analysis but also cerebral imaging techniques. Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  4. Development of Intelligent Method for Differential Diagnosis of Specific Language Impairment

    Science.gov (United States)

    2001-10-25

    Grant Number Program Element Number Author(s) Project Number Task Number Work Unit Number Performing Organization Name(s) and Address(es) Dept...Development in a Grammatical SLI boy: Modularity and Innateness, Journal of Neurolinguistics 10, (1997) 75-107. [8] J.P. Craiger, D.F. Goodman, R.J

  5. Brucellosis: unusual presentations in two adolescent boys

    Energy Technology Data Exchange (ETDEWEB)

    Piampiano, P.; McLeary, M.; Young, L.W. [Dept. of Radiology, Division of Pediatric Radiology, Loma Linda University Children' s Hospital, Loma Linda, CA (United States); Janner, D. [Div. of Pediatric Infectious Disease, Loma Linda University Medical Center and Children' s Hospital, Loma Linda, CA (United States)

    2000-05-01

    Two boys presented with variable signs and symptoms of infectious disease that challenged diagnosis. One of the two patients had aortic valve vegetations and lower extremity aneurysms, and the other had calvarial osteomyelitis, epidural abscess, pleural effusions, and pulmonary nodules. Only after a battery of bacterial and fungal agglutination tests was the unsuspected diagnosis made in each of brucellosis from Brucella canis. (orig.)

  6. Supporting Boys as Readers

    Science.gov (United States)

    Serafini, Frank

    2013-01-01

    The challenges associated with boys and reading are focused on such factors as society's lack of focus on literacy skills, parents failings to inspire reading in boys, and internal motivational factors rather than looking at the environments created for reading in and out of school. In this column, several ideas for helping boys develop a…

  7. Age at cryptorchidism diagnosis and orchiopexy in denmark: a population based study of 508,964 boys born from 1995 to 2009

    DEFF Research Database (Denmark)

    Jensen, Morten Søndergaard; Olsen, Lars Henning; Thulstrup, Ane Marie

    2011-01-01

    Early treatment for cryptorchidism may be necessary to preserve fertility. International guidelines now recommend that congenital cryptorchidism be treated with orchiopexy before age 1 year. Acquired cryptorchidism should be treated at presentation. To our knowledge the rate of adherence to these......Early treatment for cryptorchidism may be necessary to preserve fertility. International guidelines now recommend that congenital cryptorchidism be treated with orchiopexy before age 1 year. Acquired cryptorchidism should be treated at presentation. To our knowledge the rate of adherence...... to these guidelines in recent years is unknown. Thus, we present data on age at cryptorchidism diagnosis and orchiopexy in recent Danish birth cohorts....

  8. Persistent Posttraumatic Wrist Pain - Tuberculosis Infection Should be in the Differential Diagnosis. A Rare Case Report.

    Science.gov (United States)

    Soman, Shardul Madhav; Patel, Bhavik Nandubhai; Shah, Pratik Dineshbhai

    2015-01-01

    It is uncommon for hand surgeons to diagnose and treat persistent post-traumatic radius fracture on the lines of tuberculosis infection even in developing countries especially when the clinical picture resembles more of a complex regional pain syndrome (CRPS). Although it works for many patients, some conditions that affect the wrist don't fall in this category and worsen with this treatment practice. We present a patient who had an extra articular distal radius fracture treated initially with percutaneous pinning and was treated as CRPS for the next ten months by local physician. He was eventually diagnosed with advanced tuberculosis of the wrist and a total wrist arthrodesis was performed. Only one such case was ever reported in literature. A 50-year-old male, came to our institute with the history of pain and fullness in the wrist since one year. One year ago he had developed an extra articular fracture of the distal radius which was initially treated with percutaneous pinning and a below elbow cast for six weeks. On removal of the cast one pin was found loose and the other removed eventually after two more weeks of immobilization. Patient continued to have pain with fullness around the wrist which was treated at local place with anti inflammatory agents and ice application. Patient had complaint of other constitutional symptoms. Initially patient had full range of motion which gradually decreased. X-ray showed characteristic signs suggesting of extensive tuberculosis of distal radius which was operated with wrist arthrodesis. Per operatively, fine rice granular granulation tissue was found, histopathological examination of which confirmed the diagnosis of tuberculosis. Though rare, every case of distal radius fracture complaining of chronic pain and signs suggestive of CRPS should have tuberculosis as one of the differential diagnosis, even if patient does not present any signs of tuberculosis or any primary focus is not identified. Even though skeletal

  9. Tremor stability index: a new tool for differential diagnosis in tremor syndromes

    Science.gov (United States)

    Shah, Syed Ahmar; Pedrosa, David J.; Cagnan, Hayriye; Mathy, Alexandre; Chen, Chiung Chu; Martín-Rodríguez, Juan Francisco; Mir, Pablo; Timmerman, Lars; Schwingenschuh, Petra; Bhatia, Kailash; Di Lazzaro, Vincenzo; Brown, Peter

    2017-01-01

    index can aid in the differential diagnosis of the two most common tremor types. It has a high diagnostic accuracy, can be derived from short, cheap, widely available and non-invasive tremor recordings, and is independent of operator or postural context in its interpretation. PMID:28459950

  10. Individualized differential diagnosis of schizophrenia and mood disorders using neuroanatomical biomarkers

    Science.gov (United States)

    Meisenzahl, Eva M.; Borgwardt, Stefan; Riecher-Rössler, Anita; Frodl, Thomas; Kambeitz, Joseph; Köhler, Yanis; Falkai, Peter; Möller, Hans-Jürgen; Reiser, Maximilian; Davatzikos, Christos

    2015-01-01

    Magnetic resonance imaging-based markers of schizophrenia have been repeatedly shown to separate patients from healthy controls at the single-subject level, but it remains unclear whether these markers reliably distinguish schizophrenia from mood disorders across the life span and generalize to new patients as well as to early stages of these illnesses. The current study used structural MRI-based multivariate pattern classification to (i) identify and cross-validate a differential diagnostic signature separating patients with first-episode and recurrent stages of schizophrenia (n = 158) from patients with major depression (n = 104); and (ii) quantify the impact of major clinical variables, including disease stage, age of disease onset and accelerated brain ageing on the signature’s classification performance. This diagnostic magnetic resonance imaging signature was then evaluated in an independent patient cohort from two different centres to test its generalizability to individuals with bipolar disorder (n = 35), first-episode psychosis (n = 23) and clinically defined at-risk mental states for psychosis (n = 89). Neuroanatomical diagnosis was correct in 80% and 72% of patients with major depression and schizophrenia, respectively, and involved a pattern of prefronto-temporo-limbic volume reductions and premotor, somatosensory and subcortical increments in schizophrenia versus major depression. Diagnostic performance was not influenced by the presence of depressive symptoms in schizophrenia or psychotic symptoms in major depression, but earlier disease onset and accelerated brain ageing promoted misclassification in major depression due to an increased neuroanatomical schizophrenia likeness of these patients. Furthermore, disease stage significantly moderated neuroanatomical diagnosis as recurrently-ill patients had higher misclassification rates (major depression: 23%; schizophrenia: 29%) than first-episode patients (major depression: 15%; schizophrenia: 12

  11. [Significance of serum iron in the differential diagnosis between vasovagal syncope and postural orthostatic tachycardia syndrome in children].

    Science.gov (United States)

    Li, Jia-wei; Zhang, Qing-you; Gao, Jie; Jin, Hong-fang; Du, Jun-bao

    2013-12-18

    To explore the predictive value of serum iron in differentiating between vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) in children. Totally 57 children (aged 4-17 years, POTS 40 cases, and VVS 17 cases) who were at the syncope clinic or admitted to the Department of Pediatrics, Peking University First Hospital from August 2009 to September 2012 were included in the study. The diagnoses were analyzed by the value of serum iron and receiver operating characteristic (ROC) curves used to explore the predictive value of different serum iron in differential diagnosis between VVS and POTS. There were significant differences in the median value of POTS [17.4 (interquartile range 13.5 -21.8) μmol/L] and VVS [8.9 (interquartile range 7.5-17.6) μmol/L] (P<0.01). When the value of serum iron was 11.8 μmol/L, the sensitivity and specificity of the differential diagnosis between VVS and POTS were 92.5% and 64.7%, respectively. The serum iron might be used as an initial diagnostic method in differential diagnosis between VVS and POTS, based on the history of the patients.

  12. Prenatal Diagnosis of Treacher-Collins Syndrome Using Three-Dimensional Ultrasonography and Differential Diagnosis with Other Acrofacial Dysostosis Syndromes

    Directory of Open Access Journals (Sweden)

    Daniela Cardoso Pereira

    2013-01-01

    Full Text Available Treacher-Collins syndrome (TCS is a rare dominant autosomal anomaly resulting from malformation or disruption of the development of the first and second branchial arches. It is characterized by micrognathia, malar hypoplasia, and malformations of the eyes and ears. The prenatal diagnosis using two-dimensional ultrasonography (2DUS is characterized by identification of facial malformations together with polyhydramnios. Three-dimensional ultrasonography (3DUS has the capacity to spatially display these facial malformations, thus making it easy for the parents to understand them. We present a case of TCS diagnosed in the 33rd week using 3DUS, with postnatal confirmation using cranial computed tomography and anatomopathological analysis.

  13. Prenatal Diagnosis of Treacher-Collins Syndrome Using Three-Dimensional Ultrasonography and Differential Diagnosis with Other Acrofacial Dysostosis Syndromes

    Science.gov (United States)

    Pereira, Daniela Cardoso; Bussamra, Luiz Claudio Silva; Drummond, Carolina Leite; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes; Aldrighi, José Mendes

    2013-01-01

    Treacher-Collins syndrome (TCS) is a rare dominant autosomal anomaly resulting from malformation or disruption of the development of the first and second branchial arches. It is characterized by micrognathia, malar hypoplasia, and malformations of the eyes and ears. The prenatal diagnosis using two-dimensional ultrasonography (2DUS) is characterized by identification of facial malformations together with polyhydramnios. Three-dimensional ultrasonography (3DUS) has the capacity to spatially display these facial malformations, thus making it easy for the parents to understand them. We present a case of TCS diagnosed in the 33rd week using 3DUS, with postnatal confirmation using cranial computed tomography and anatomopathological analysis. PMID:23653874

  14. Efficacy of thyroid ultrasound elastography in differential diagnosis of small thyroid nodules

    Energy Technology Data Exchange (ETDEWEB)

    Dighe, Manjiri, E-mail: dighe@u.washington.edu [Department of Radiology, Box 357115, 1959 NE Pacific Street, University of Washington, Seattle, WA 98195 (United States); Luo, Si [Department of Bioengineering, University of Washington, William H. Foege Building, N510B, 3720 15th Ave NE, Seattle, WA 98195-5061 (United States); Cuevas, Carlos, E-mail: cuevas@u.washington.edu [Department of Radiology, Box 357115, 1959 NE Pacific Street, University of Washington, Seattle, WA 98195 (United States); Kim, Yongmin, E-mail: ykim@u.washington.edu [Department of Bioengineering, University of Washington, Box 355061, Seattle, WA 98195-5061 (United States)

    2013-06-15

    Objective: To explore the efficacy of thyroid ultrasound (US) elastography in differential diagnosis of small thyroid nodules. Methods: This HIPAA-compliant study was approved by the Institutional Review Board and all patients provided written informed consent. Thirty-five patients with 38 small thyroid nodules as seen on transverse ultrasound image formed our study population. An US examination and a separate thyroid elastography examination with pulsation from the carotid artery used as the compression source were performed before fine-needle aspiration. Baseband US data were acquired for off-line elastography processing, where a semi-quantitative index for each nodule was calculated. The Kruskal–Wallis nonparametric rank sum test was used to assess equality of population means among the different types of thyroid nodules. Maximum likelihood estimation of the curve parameters for a binomial receiver operating characteristic (ROC) curve was performed. Results: Elasticity contrast index calculated with elastography was effective in distinguishing between small papillary thyroid carcinomas (PTMC, n = 8) and other lesions (n = 30) in small thyroid nodules (p = 0.0036). The area under the ROC curve for diagnosing PTMCs was 0.812 with a 95% confidence interval of 0.653–0.920. The cut-off value of ECI of 3.6 led to a sensitivity of 100% and a specificity of 60% for detecting PTMCs. Conclusion: Noninvasive evaluation of small thyroid nodules is possible using thyroid US elastography with in vivo compression to pick out the most suspicious thyroid nodules for fine-needle aspiration (FNA) and avoid FNA in benign nodules.

  15. Esclerodermia localizada: Diagnósticos diferenciales Localized scleroderma: Differential diagnosis

    Directory of Open Access Journals (Sweden)

    MB Leroux

    2011-09-01

    Full Text Available La esclerodermia localizada constituye un desorden autoinmune órgano específico, que compromete sobre todo la piel. Se caracteriza por inflamación seguida de esclerosis e incluye distintas formas clínicas. La etiología de la esclerodermia localizada no ha sido establecida. El diagnóstico diferencial incluye cuadros esclerodermiformes, desencadenados por factores intrínsecos y extrínsecos que están siendo estudiados. Entre ellos se incluyen: exposición a radiaciones o tóxicos, consumo de medicamentos, infecciones y enfermedades de origen endocrino-metabólico, genético e inflamatorio. En primer lugar, se debe descartar la esclerodermia sistémica. En segundo lugar, se clasifican las entidades con predominio de esclerosis o atrofia. Por último, se incluyen algunas enfermedades en un cuadro comparativo.Localized scleroderma is an autoimmune organ specific disorder with an important skin compromise. It is an inflammatory process with several distinct clinical characteristics. The etiology of localized scleroderma has not been established yet. Differential diagnosis includes sclerodermiform onset unchained by intrinsic and extrinsic factors that are presently studied. Among them must be taking into account: exposure to radiation or toxic agents, therapeutic drugs, infections and diseases of endocrine, metabolic, genetic or inflammatory etiology. Firstly, it must be point out that systemic scleroderma must be ruled out. Secondly, disorders predominantly with sclerosis and atrophy must be classified and lastly, some other diseases are included in a comparative table.

  16. Identification of marker genes for differential diagnosis of chronic fatigue syndrome.

    Science.gov (United States)

    Saiki, Takuya; Kawai, Tomoko; Morita, Kyoko; Ohta, Masayuki; Saito, Toshiro; Rokutan, Kazuhito; Ban, Nobutaro

    2008-01-01

    Chronic fatigue syndrome (CFS) is a clinically defined condition characterized by long-lasting disabling fatigue. Because of the unknown mechanism underlying this syndrome, there still is no specific biomarker for objective assessment of the pathological fatigue. We have compared gene expression profiles in peripheral blood between 11 drug-free patients with CFS and age- and sex-matched healthy subjects using a custom microarray carrying complementary DNA probes for 1,467 stress-responsive genes. We identified 12 genes whose mRNA levels were changed significantly in CFS patients. Of these 12 genes, quantitative real-time PCR validated the changes in 9 genes encoding granzyme in activated T or natural killer cells (GZMA), energy regulators (ATP5J2, COX5B, and DBI), proteasome subunits (PSMA3 and PSMA4), putative protein kinase c inhibitor (HINT ), GTPase (ARHC), and signal transducers and activators of transcription 5A (STAT5A). Next, we performed the same microarray analysis on 3 additional CFS patients and 20 other patients with the chief complaint of long-lasting fatigue related to other disorders (non-CFS patients) and found that the relative mRNA expression of 9 genes classified 79% (11/14) of CFS and 85% (17/20) of the non-CFS patients. Finally, real-time PCR measurements of the levels of the 9 involved mRNAs were done in another group of 18 CFS and 12 non-CFS patients. The expression pattern correctly classified 94% (17/18) of CFS and 92% (11/12) of non-CFS patients. Our results suggest that the defined gene cluster (9 genes) may be useful for detecting pathological responses in CFS patients and for differential diagnosis of this syndrome.

  17. DIFFERENTIATION BETWEEN Nocardia spp. AND Mycobacterium spp.: CRITICAL ASPECTS FOR BACTERIOLOGICAL DIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Edna Cleide Mendes Muricy

    2014-09-01

    Full Text Available New methodologies were developed for the identification of Nocardia but the initial diagnosis still requires a fast and accurate method, mainly due to the similarity to Mycobacterium, both clinical and bacteriologically. Growth on Löwenstein-Jensen (LJ medium, presence of acid-fast bacilli through Ziehl-Neelsen staining, and colony morphology can be confusing aspects between Nocardia and Mycobacterium. This study describes the occurrence of Nocardia spp. in a mycobacterial-reference laboratory, observing the main difficulties in differentiating Nocardia spp. from Mycobacterium spp., and correlating isolates with nocardiosis cases. Laboratory records for the period between 2008 and 2012 were analyzed, and the isolates identified as Nocardia sp. or as non-acid-fast filamentous bacilli were selected. Epidemiological and bacteriological data were analyzed as well. Thirty-three isolates identified as Nocardia sp. and 22 as non-acid-fast bacilli were selected for this study, and represented 0.12% of isolates during the study period. The presumptive identification was based on macroscopic and microscopic morphology, resistance to lysozyme and restriction profiles using the PRA-hsp65 method. Nocardia spp. can grow on media for mycobacteria isolation (LJ and BBL MGIT™ and microscopy and colony morphology are very similar to some mycobacteria species. Seventeen patients (54.8% were reported and treated for tuberculosis, but presented signs and symptoms of nocardiosis. It was concluded that the occurrence of Nocardia sp. during the study period was 0.12%. Isolates with characteristics of filamentous bacilli, forming aerial hyphae, with colonies that may be pigmented, rough and without the BstEII digestion pattern in PRA-hsp65 method are suggestive of Nocardia spp. For a mycobacterial routine laboratory, a flow for the presumptive identification of Nocardia is essential, allowing the use of more accurate techniques for the correct identification, proper

  18. Differentiation between Nocardia spp. and Mycobacterium spp.: Critical aspects for bacteriological diagnosis.

    Science.gov (United States)

    Muricy, Edna Cleide Mendes; Lemes, Romilda Aparecida; Bombarda, Sidney; Ferrazoli, Lucilaine; Chimara, Erica

    2014-01-01

    New methodologies were developed for the identification of Nocardia but the initial diagnosis still requires a fast and accurate method, mainly due to the similarity to Mycobacterium, both clinical and bacteriologically. Growth on Löwenstein-Jensen (LJ) medium, presence of acid-fast bacilli through Ziehl-Neelsen staining, and colony morphology can be confusing aspects between Nocardia and Mycobacterium. This study describes the occurrence of Nocardia spp. in a mycobacterial-reference laboratory, observing the main difficulties in differentiating Nocardia spp. from Mycobacterium spp., and correlating isolates with nocardiosis cases. Laboratory records for the period between 2008 and 2012 were analyzed, and the isolates identified as Nocardia sp. or as non-acid-fast filamentous bacilli were selected. Epidemiological and bacteriological data were analyzed as well. Thirty-three isolates identified as Nocardia sp. and 22 as non-acid-fast bacilli were selected for this study, and represented 0.12% of isolates during the study period. The presumptive identification was based on macroscopic and microscopic morphology, resistance to lysozyme and restriction profiles using the PRA-hsp65 method. Nocardia spp. can grow on media for mycobacteria isolation (LJ and BBL MGIT™) and microscopy and colony morphology are very similar to some mycobacteria species. Seventeen patients (54.8%) were reported and treated for tuberculosis, but presented signs and symptoms of nocardiosis. It was concluded that the occurrence of Nocardia sp. during the study period was 0.12%. Isolates with characteristics of filamentous bacilli, forming aerial hyphae, with colonies that may be pigmented, rough and without the BstEII digestion pattern in PRA-hsp65 method are suggestive of Nocardia spp. For a mycobacterial routine laboratory, a flow for the presumptive identification of Nocardia is essential, allowing the use of more accurate techniques for the correct identification, proper treatment and

  19. A radiographic study of differential diagnosis between dentigerous cyst and unicystic ameloblastomas

    Energy Technology Data Exchange (ETDEWEB)

    Na, Chae Young; Choi, Karp Shik [Dept. of Dental Radiology, College of Dentistry, Kyungppok National University, Daegu (Korea, Republic of)

    1993-08-15

    The purpose of this study was to obtain some information for the radiographic differential diagnosis between dentigerous cysts and unicystic ameloblastomas in the mandible. The authors observed and compared the clinico-radiographic features of 38 cases of dentigerous cyst and 32 cases of unicystic ameloblastoma associated with impacted mandibular molr. The obtained results were as follows: Dentigerous cyst occurred the most frequently in the 3rd decade, but unicystic ameloblastomas in the 2nd decade, and both lesions occurred with slight predilection in males. Average of lesional size of unicystic ameloblastomas was larger than that of dentigerous cysts, and lesions of over 25 cm{sup 2} were only in unicystic ameloblastomas. Cortical thinning and expansion were more frequently observed in unicystic ameloblastomas at 72.9% than in dentigerous cysts at 15.8%. Dentigerous cysts showed smooth border at 89.5%, but unicystic ameloblastomas showed smooth border at 53.1% and scalloped border at 46.9%. Dentigerous cysts showed well-defined outline at 81.6%, but unicystic ameloblastomas showed well-defined outline at 53.1% and moderate-defined outline at 46.9%. In both lesions, the mandibular 3rd molar was the most frequent causative tooth. Average of distance between the cemento-enamel junction and lesional wall attachment of the causative tooth was longer in unicystic ameloblastomas than in dentigerous cyats. Severe displacement of causative tooth was more frequent in unicystic ameloblastomas at 62.5% than indentigerous cysts at 23.7%. Root resorption of adjacent tooth and displacement of mandibular canal were more frequent in unicystic ameloblastomas at 65.2% and 61.5% than in dentigerous cysts at 15.8% and 38.1% respectively.

  20. A radiologic study of differential diagnosis between odontogenic keratocyst and unicystic ameloblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Chei Karp Shik [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Chonbuk National University, Chonju (Korea, Republic of)

    1995-02-15

    The purpose of this study was to obtain some information for the radiographic differential diagnosis between odontogenic keratocyst and unicystic ameloblastoma in the mandible. The author compared and analysed the clinico-radiographic features of 48 cases of odontogenic keratocyst and 32 cases of unicystic ameloblastoma. The following results obtained; 1. Odontogenic keratocyst and unicystic ameloblastoma occurred the most frequently in the 2nd and 3rd decades, and both lesions occurred with slight predilection in males. The most frequent lesional site was molar area in odontogenic keratocyst (50.0%) and mandibular angle and ramus area in unicystic ameloblastoma (71.9%). 2. Cortical thinning and expansion were observed with similar occurrences in odontogenic keratocyst (77.1%) and in unicystic ameloblastoma (72.9%). 3. Typical undulating lesional border was observed more frequently in odontogenic keratocyst (79.2%) than in unicystic ameloblastoma (46.9%). 4. Well-defined lesional outline occurred more frequently in odontogenic keratocyst (97.9%) than in unicystic ameloblastoma (53.1%). 5. Root resorption of adjacent teeth occurred more frequently in unicystic ameloblastoma (65.2%) than in odontogenic keratocyst (18.8%) respectively, but loss of lamina dura was frequently observed in odontogenic keratocyst (79.2%). And tooth displacement occurred more frequently in odontogenic keratocyst (50.0%) than in umicystic ameloblastoma (17.4%). 6. Displacement of mandibular canal occurred more frequently in odontogenic keratocyst (75.0%) than in unicystic ameloblastoma (61.5%). 7. Inhomogeneous lesional radiolucency occurred more frequently in unicystic ameloblastoma (53.1%) than in odontogenic keratocyst (39.6%).

  1. Anemia in inflammatory bowel disease: prevalence, differential diagnosis and association with clinical and laboratory variables

    Directory of Open Access Journals (Sweden)

    Rodrigo Andrade Alves

    Full Text Available CONTEXT AND OBJECTIVES:Anemia is the most frequent extraintestinal complication of inflammatory bowel disease. This study aimed to: 1 determine the prevalence of anemia among patients with inflammatory bowel disease; 2 investigate whether routine laboratory markers are useful for diagnosing anemia; and 3 evaluate whether any association exists between anemia and clinical/laboratory variables.DESIGN AND SETTING:Cross-sectional at a federal university.METHODS:44 outpatients with Crohn's disease and 55 with ulcerative colitis were evaluated. Clinical variables (disease activity index, location of disease and pharmacological treatment and laboratory variables (blood count, iron laboratory, vitamin B12 and folic acid were investigated.RESULTS:Anemia and/or iron laboratory disorders were present in 75% of the patients with Crohn's disease and in 78.2% with ulcerative colitis. Anemia was observed in 20.5% of the patients with Crohn's disease and in 23.6% with ulcerative colitis. Iron-deficiency anemia was highly prevalent in patients with Crohn's disease (69.6% and ulcerative colitis (76.7%. Anemia of chronic disease in combination with iron deficiency anemia was present in 3% of the patients with Crohn's disease and in 7% of the patients with ulcerative colitis. There was no association between anemia and disease location. In ulcerative colitis, anemia was associated with the disease activity index.CONCLUSIONS:Most patients present iron laboratory disorders, with or without anemia, mainly due to iron deficiency. The differential diagnosis between the two most prevalent types of anemia was made based on clinical data and routine laboratory tests. In ulcerative colitis, anemia was associated with the disease activity index.

  2. Differential diagnosis of alterations in arterial flow and tissue oxygenation on venoarterial extracorporeal membrane oxygenation.

    Science.gov (United States)

    Hofer, Anna; Leitner, Sylvia; Kreuzer, Michaela; Meier, Jens

    2017-09-05

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be life-saving in several clinical situations, but it is also one of the most invasive therapeutic procedures, with significant potential for life-threatening complications. Pulse pressure waves are typically very small or even absent at the onset of ECMO therapy, and will reappear with the improvement of cardiac function. A low pulse pressure may indicate low cardiac output due to heart failure during sustained ECMO support. A sudden loss of pulse pressure during ECMO therapy, however, may reveal complications like pericardial tamponade, hemothorax or pneumothorax. Near infrared spectroscopy (NIRS) has been shown to be useful in detecting cerebral and lower limb ischemic events during ECMO therapy and could furthermore improve differential diagnosis in the event pulsatility of the arterial pressure trace is lost. We are reporting on 3 different complications of ECMO and their impact on arterial pulse pressure, arterial oxygen tension and regional tissue oxygenation measured by NIRS. Pericardial hematoma, overinflation of the lung, and tension pneumothorax may impede cardiac output during VA-ECMO and cause a loss of pulse pressure. Monitoring of regional tissue oxygenation using NIRS, in addition to arterial and mixed venous oxygen tension, may allow early recognition and treatment of ECMO complications. Together with the appearance of a flat, non pulsatile arterial pressure trace as well as a reduction in mixed venous oxygen saturation the improvement of upper body rSO2 measured by NIRS enables timely recognition of complications that interfere with natural cardiac output during VA-ECMO.

  3. [Role of biomarkers in the differential diagnosis of acute respiratory failure in the immediate postoperative period of lung transplantation].

    Science.gov (United States)

    Ruano, L; Sacanell, J; Roman, A; Rello, J

    2013-01-01

    Lung transplant recipients are at high risk of suffering many complications during the immediate postoperative period, such as primary graft dysfunction, acute graft rejection or infection. The most common symptom is the presence of acute respiratory failure, and the use of biomarkers could be useful for establishing an early diagnosis of these conditions. Different biomarkers have been studied, but none have proven to be the gold standard in the differential diagnosis of acute respiratory failure. This paper offers a review of the different biomarkers that have been studied in this field. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  4. Differential diagnosis between occupational chronic intoxication with organic solvents and ethanol abuse by biological markers. Case report and literature review

    Directory of Open Access Journals (Sweden)

    Rascu Agripina

    2016-11-01

    Full Text Available Given the occupational exposure to substances contained in petroleum heated to high temperature, cholestatic liver disease, neurological signs and symptoms can occur. We present a case report of a male patient with no tobacco exposure or alcohol use, but with prolonged occupational exposure to petroleum vapours and natural gases like methane, propane butane who developed liver and neurologic disease, in the absence of protective equipment. Delayed diagnosis was established after 9 years of the first symptoms occurrence. Differential diagnosis with alcoholic etiology was considered and biological biomarkers were useful.

  5. Differential diagnosis of cerebral palsy: Lesch-Nyhan syndrome without self-mutilation.

    Science.gov (United States)

    Mitchell, G; McInnes, R R

    1984-01-01

    Athetotic cerebral palsy was diagnosed in a 6-month-old boy with no history of perinatal trauma. Lesch-Nyhan syndrome (i.e., complete deficiency of hypoxanthine-guanine phosphoribosyltransferase [HGPRT] ) was diagnosed only when the boy began biting his lower lip at the age of 10 years. It is suggested, on the basis of this case and others like it in the literature, that the delayed onset or absence of self-mutilation in patients with Lesch-Nyhan syndrome may be more common than has been previously suspected. In all males said to have cerebral palsy, HGPRT deficiency must be ruled out, preferably by measuring the ratio of uric acid to creatinine in a random urine specimen. PMID:6722697

  6. Unsupervised learning based feature extraction for differential diagnosis of neurodegenerative diseases: A case study on early-stage diagnosis of Parkinson disease.

    Science.gov (United States)

    Singh, Gurpreet; Samavedham, Lakshminarayanan

    2015-12-30

    The development of MRI based methods could prove extremely valuable for identification of reliable biomarkers to aid diagnosis of neurodegenerative diseases (NDs). A great deal of current research has been aimed at identification biomarkers for both diagnosis at early stage and evaluation of the progression of NDs. We present here a novel synergetic paradigm integrating Kohonen self organizing map (KSOM) and least squares support vector machine (LS-SVM) for individual-level clinical diagnosis of NDs. Feature are extracted in an unsupervised manner using KSOM on preprocessed brain MRIs. Thereafter, these features are fed as input to LSSVM for subject classification. The applicability of the proposed methodology has been demonstrated using 831 T1-weighted MRIs obtained from Parkinson's Progression Markers Initiative (PPMI) database. We have achieved classification accuracy of up to 99% for differential diagnosis of Parkinson disease with confidence interval of 99.9%. The potential for translation of similar research findings to clinical application is greatly dependent upon two factors (1) accuracy of subject classification achieved and (2) size of the dataset used. Here, we report very high accuracy achieved on one of the largest MRI datasets using multivariate analysis tools. In this paper, we describe a methodology that has the potential to be translated into first-line diagnostic tool for NDs. We also demonstrate the applicability of this methodology for diagnosing PD subjects in early stages of the disease, i.e., subjects in age of 31-60 years. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Differentiation and diagnosis of Pseudocercosporella herpotrichoides (Fron) Deighton with genomic DNA probes

    DEFF Research Database (Denmark)

    Frei, U; Wenzel, G.

    1993-01-01

    Repetitive genomic clones were used to differentiate between varieties within the species Pseudocercosporella herpotrichoides. From 21 clones tested 13 revealed restriction fragment length polymorphisms among isolates. Cluster analysis was performed based on these data. Differentiation of isolate...

  8. Aneurysmal bone cyst or giant cell tumour; Ranking of X-ray diagnosis in differential diagnosis. Aneurysmatische Knochenzyste oder Riesenzelltumor; Wertigkeit der Roentgendiagnostik zur Differentialdiagnose

    Energy Technology Data Exchange (ETDEWEB)

    Erlemann, R. (Institut fuer Radiologie, St.-Johannes-Hospital, Duisburg-Hamborn (Germany)); Picker, S. (Institut fuer Klinische Radiologie, Univ. Muenster (Germany)); Mueller-Miny, H. (Institut fuer Klinische Radiologie, Univ. Muenster (Germany)); Wuisman, P. (Orthopaedische Klinik und Poliklinik, Univ. Muenster (Germany)); Edel, G. (Gerhard-Domagk-Institut fuer Pathologie, Univ. Muenster (Germany))

    1993-04-01

    Depending on analysis of radiographic morphology, location and patient's age of 72 aneurysmal bone cysts (ABC) and 47 giant cell tumours (GCT), the following criteria suggest an ABC with a high positive predictive value: Location in the diaphysis (100%), in the shaft (92%), in the metaphysis or metadiaphysis (86%), patient younger than 17 yeras (97%) and growth rate grade Lodwick-IA (88%). GCT were selected via the following criteria: Epimetaphyseal location (82%) and growth rate grade Lodwick-II (100%). In 14% of the cases, differential diagnosis between both entities is radiologically impossible. (orig.)

  9. A case of an aneurysmal bone cyst of a metatarsal: review of the differential diagnosis and treatment options.

    Science.gov (United States)

    Iltar, Serkan; Alemdaroğlu, Kadir Bahadir; Karalezli, Nazim; Irgit, Kaan; Caydere, Muzaffer; Aydoğan, Nevres Hürriyet

    2009-01-01

    Aneurysmal bone cyst localized to the metatarsus, while not unheard of, is rather uncommon. The differential diagnosis for this lesion can be challenging, particularly in regard to the possibility of the presence of other giant cells containing tumors of bone, such as giant cell tumor, giant cell reparative granuloma, Brown's tumor of hyperparathyroidism, and telangiectatic osteosarcoma. We report a case of an aneurysmal bone cyst localized to the third metatarsal in a 14-year-old girl who presented with limping, progressively worsening local pain, and swelling in her left foot. The differential diagnosis for her condition was extensive. Ultimately, an en bloc resection was undertaken and the defect was replaced with tricortical iliac autograft. Pathological analysis of the resected tissue was consistent with aneurysmal bone cyst. There was complete healing with no sign of recurrence 3 years after the surgery. 4.

  10. Role of serum glypican-3 in the diagnosis and differentiation of small hepatocellular carcinoma from hepatitis-C virus cirrhosis

    Directory of Open Access Journals (Sweden)

    Eman A.E. Badr

    2014-09-01

    Conclusion: Serum GLP-3 levels are higher in HCC versus HCV cirrhosis, which can differentiate HCC from liver cirrhosis. Also, serum GLP-3 is highly sensitive and specific for detecting HCC. Moreover, GLP-3 is more sensitive than AFP for the detection of small HCC. Furthermore, a combination of both serum markers yielded an improved specificity and both sensitivity and specificity for the diagnosis of small and unicentric HCC, respectively.

  11. Optimization of Differential Diagnosis of Inflammatory Bowel Diseases Based on an Integrated Assessment of Oral Mucosa Status

    OpenAIRE

    N.S. Robakidze

    2015-01-01

    The objective of the investigation was to improve the differential diagnosis of inflammatory bowel diseases, on the basis of an integrated assessment of morphological data, the findings of optical imaging of tissues, and immunohistochemical examinations of the oral mucosa. Materials and Methods. We studied morphological and immunohistochemical characteristics of the oral mucosae in each of 26 patients with Crohn’s disease (CD) and 17 patients with ulcerative colitis (UC). We performed bot...

  12. Survivin Expression in Renal Epithelial Tumors: It's Usage in the Differential Diagnosis of Eosinophilic Renal Epithelial Tumors

    Directory of Open Access Journals (Sweden)

    Ayhan Ozcan

    2014-04-01

    Conclusions: Our results suggested that survivin may helpful in the differential diagnosis of renal tumors despite limited number of our cases. Experimental studies have revealed that inhibition of survivin induces apoptosis and enhance radiosensitivity of RCC cells. Taken together, to be known the proportion of survivin expression in subtypes of renal tumors may contribute to determine new therapeutic strategies for RCCs. This needs to be proven in more wide series. [J Interdiscipl Histopathol 2014; 2(2.000: 69-73

  13. Multiparametric computer-aided differential diagnosis of Alzheimer's disease and frontotemporal dementia using structural and advanced MRI.

    Science.gov (United States)

    Bron, Esther E; Smits, Marion; Papma, Janne M; Steketee, Rebecca M E; Meijboom, Rozanna; de Groot, Marius; van Swieten, John C; Niessen, Wiro J; Klein, Stefan

    2017-08-01

    To investigate the added diagnostic value of arterial spin labelling (ASL) and diffusion tensor imaging (DTI) to structural MRI for computer-aided classification of Alzheimer's disease (AD), frontotemporal dementia (FTD), and controls. This retrospective study used MRI data from 24 early-onset AD and 33 early-onset FTD patients and 34 controls (CN). Classification was based on voxel-wise feature maps derived from structural MRI, ASL, and DTI. Support vector machines (SVMs) were trained to classify AD versus CN (AD-CN), FTD-CN, AD-FTD, and AD-FTD-CN (multi-class). Classification performance was assessed by the area under the receiver-operating-characteristic curve (AUC) and accuracy. Using SVM significance maps, we analysed contributions of brain regions. Combining ASL and DTI with structural MRI resulted in higher classification performance for differential diagnosis of AD and FTD (AUC = 84%; p = 0.05) than using structural MRI by itself (AUC = 72%). The performance of ASL and DTI themselves did not improve over structural MRI. The classifications were driven by different brain regions for ASL and DTI than for structural MRI, suggesting complementary information. ASL and DTI are promising additions to structural MRI for classification of early-onset AD, early-onset FTD, and controls, and may improve the computer-aided differential diagnosis on a single-subject level. • Multiparametric MRI is promising for computer-aided diagnosis of early-onset AD and FTD. • Diagnosis is driven by different brain regions when using different MRI methods. • Combining structural MRI, ASL, and DTI may improve differential diagnosis of dementia.

  14. Differential Diagnosis of Patients with Inconclusive Parkinsonian Features Using [{sup 18}F]FP-CIT PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Park, Eunkyung; Hwang, Yu Mi; Lee, Channyoung; Oh, Sun Young; Kim, Young Chul; Choe, Jae Gol; Park, Kun Woo [Korea Univ., Seoul (Korea, Republic of); Kim, Sujin [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    2014-06-15

    It is often difficult to differentiate parkinsonism, especially when patients show uncertain parkinsonian features. We investigated the usefulness of dopamine transporter (DAT) imaging for the differential diagnosis of inconclusive parkinsonism using [{sup 18}F]FP-CIT PET. Twenty-four patients with inconclusive parkinsonian features at initial clinical evaluation and nine healthy controls were studied. Patients consisted of three subgroups: nine patients whose diagnoses were unclear concerning whether they had idiopathic Parkinson's disease or drug-induced parkinsonism ('PD/DIP'), nine patients who fulfilled neither the diagnostic criteria of PD nor of essential tremor ('PD/ET'), and six patients who were alleged to have either PD or atypical parkinsonian syndrome ('PD/APS'). Brain PET images were obtained 120 min after injection of 185 MBq [{sup 18}F]FP-CIT. Imaging results were quantified and compared with follow-up clinical diagnoses. Overall, 11 of 24 patients demonstrated abnormally decreased DAT availability on the PET scans, whereas 13 were normal. PET results could diagnose PD/DIP and PD/ET patients as having PD in six patients, DIP in seven, and ET in five; however, the diagnoses of all six PD/APS patients remained inconclusive. Among 15 patients who obtained a final follow-up diagnosis, the image-based diagnosis was congruent with the follow-up diagnosis in 11 patients. Four unsolved cases had normal DAT availability, but clinically progressed to PD during the follow-up period. [{sup 18}F]FP-CIT PET imaging is useful in the differential diagnosis of patients with inconclusive parkinsonian features, except in patients who show atypical features or who eventually progress to PD.

  15. Teaching differential diagnosis in primary care using an inverted classroom approach: student satisfaction and gain in skills and knowledge.

    Science.gov (United States)

    Bösner, Stefan; Pickert, Julia; Stibane, Tina

    2015-04-01

    Differential diagnosis is a crucial skill for primary care physicians. General practice plays an increasing important role in undergraduate medical education. Via general practice, students may be presented with an overview of the whole spectrum of differential diagnosis in regard to common symptoms encountered in primary care. This project evaluated the impact of a blended learning program (using the inverted classroom approach) on student satisfaction and development of skills and knowledge. An elective seminar in differential diagnosis in primary care, which utilized an inverted classroom design, was offered to students. Evaluation followed a mixed methods design: participants completed a pre- and post-test, a questionnaire, and a focus group discussion. Interviews were transcribed verbatim and answers were grouped according to different themes. Test results were analysed using the Wilcoxon matched-pairs signed-ranks test. Participants (n = 17) rated the course concept very positively. Especially the inverted classroom approach was appreciated by all students, as it allowed for more time during the seminar to concentrate on interactive and practice based learning. Students (n = 16) showed a post-test significant overall gain in skills and knowledge of 33%. This study showed a positive effect of the inverted classroom approach on students' satisfaction and skills and knowledge. Further research is necessary in order to explore the potentials of this approach, especially the impact on development of clinical skills.

  16. Accuracy of neuropsychological tests and the Neuropsychiatric Inventory in differential diagnosis between Frontotemporal dementia and Alzheimer's disease

    Directory of Open Access Journals (Sweden)

    Valéria Santoro Bahia

    Full Text Available Abstract The differential diagnosis between frontotemporal dementia (FTD and Alzheimer's disease (AD is sometimes difficult. Objectives: To verify the accuracy of neuropsychological tests and a behavioral disorders scale in the differential diagnosis between FTLD and AD. Methods: Retrospective data on 12 FTD patients and 12 probable AD patients were analyzed. The scores on neuropsychological tests (MMSE score, reverse digit span, delayed recall for drawings, semantic fluency of animals and the Neuropsychiatric Inventory (NPI in both groups were compared. Results: Both groups had similar performance on neuropsychological tests. All FTD patients and 50% of AD patients had neuropsychiatric abnormalities. The NPI score was 58.0±19.3 for the FTD patients, and 3.6±4.7 for the AD patients (p<0.01. Using a NPI cut-off score of 13, the sensitivity and specificity were 100% in this sample. The four most common neuropsychiatric disturbances in FTD patients were: apathy, aberrant motor behavior, disinhibition and eating abnormalities. Apathy and dysphoria/depression were the most common behavioral symptoms among the AD patients. Conclusions: In this study, NPI was found to be a useful tool for the differential diagnosis between FTD and AD. The neuropsychological tests commonly used in the medical office were unable to distinguish between the two groups.

  17. Value of Glut-1 and Koc markers in the differential diagnosis of reactive mesothelial hyperplasia, malignant mesothelioma and pulmonary adenocarcinoma.

    Science.gov (United States)

    Üçer, Özlem; Dağli, Adile Ferda; Kiliçarslan, Ahmet; Artaş, Gökhan

    2013-01-01

    Malignant mesothelioma (MM) is a primary malignant tumor developing from mesothelial cells lining the serosal surfaces and particularly the pleura, and has a very poor prognosis. It may display a variety of histological patterns and has a wide spectrum of cytomorphological characteristics, causing problems in its differential diagnosis from lung adenocarcinomas and sometimes from benign mesothelial proliferations. Immunohistochemical examination is the most useful method for this distinction. In our study, we aimed to determine the value of glucose transporter isoform-1 (GLUT-1) and K homology domain-containing protein (KOC) markers in the differential diagnosis of reactive mesothelial hyperplasia, malignant mesothelioma and lung adenocarcinoma. Our study included 30 samples of malignant mesothelioma, 30 samples of pulmonary adenocarcinoma and 30 samples of reactive mesothelial hyperplasia selected from the archives of the Fırat University Hospital's Pathology Department Laboratory. The samples were applied GLUT-1 and KOC markers by immunohistochemistry and the place of these markers in the differential diagnosis was examined. GLUT-1 was found positive in 80% of malignant mesothelioma cases, 83.3% of adenocarcinoma cases and 6.6% of reactive mesothelial hyperplasia cases. KOC was positive in 83.3% of malignant mesothelioma cases, 76.6% of adenocarcinoma cases and 46.6% of reactive mesothelial hyperplasia cases. There was no statistically significant difference between malignant mesothelioma and lung adenocarcinoma cases in terms of the diffuseness and intensity of staining with GLUT-1, whereas a significant difference was established when these groups were compared with reactive mesothelial hyperplasia cases. However, the KOC staining diffuseness and intensity results were similar to those obtained with GLUT-1. In conclusion, GLUT-1 and KOC markers do not differentiate malignant mesotheliomas from pulmonary adenocarcinomas but can be useful in differentiating

  18. Differential Diagnosis of Skin Ulcers in a Mycobacterium ulcerans Endemic Area: Data from a Prospective Study in Cameroon.

    Science.gov (United States)

    Toutous Trellu, Laurence; Nkemenang, Patrick; Comte, Eric; Ehounou, Geneviève; Atangana, Paul; Mboua, Didier Junior; Rusch, Barbara; Njih Tabah, Earnest; Etard, Jean-François; Mueller, Yolanda K

    2016-04-01

    Clinical diagnosis of Buruli ulcer (BU) due to Mycobacterium ulcerans can be challenging. We aimed to specify the differential diagnosis of skin lesions in a BU endemic area. We conducted a prospective diagnostic study in Akonolinga, Cameroon. Patients presenting with a skin ulcer suspect of BU were included. M. ulcerans was detected using swabs for Ziehl-Neelsen staining, PCR and culture. Skin punch biopsies were taken and reviewed by two histopathologists. Photographs of the lesions were taken and independently reviewed by two dermatologists. Final diagnosis was based on consensus, combining the results of laboratory tests and expert opinion. Between October 2011 and December 2013, 327 patients with ulcerative lesions were included. Median age was 37 years (0 to 87), 65% were males, and 19% HIV-positive. BU was considered the final diagnosis for 27% of the lesions, 85% of which had at least one positive laboratory test. Differential diagnoses were vascular lesions (22%), bacterial infections (21%), post-traumatic (8%), fistulated osteomyelitis (6%), neoplasia (5%), inflammatory lesions (3%), hemopathies and other systemic diseases (2%) and others (2%). The proportion of BU was similar between HIV-positive and HIV-negative patients (27.0% vs. 26.5%; p = 0.940). Half of children below 15 years of age were diagnosed with BU, compared to 26.8% and 13.9% among individuals 15 to 44 years of age and above, respectively (chi2 pdiagnosis of skin lesions in a BU endemic area, stratifying results by age and HIV-status.

  19. Interphase chromosome painting of paraffin embedded tissue in the differential diagnosis of possible male germ cell tumors

    Energy Technology Data Exchange (ETDEWEB)

    Blough, R.I.; Heerema, N.A.; Smolarek, T.A. [Indiana Univ. School of Medicine, Indianapolis, IN (United States)] [and others

    1994-09-01

    Germ cell tumors (GCTs) are a leading cause of cancer in young men ages 15-34, and in many cases have metastasized prior to clinical presentation. In some instances, metastatic GCTs have manifested as distinct, non-GCT malignancies, including rhabdomyosarcoma, peripheral neuroepithelioma, and neuroblastoma. In cases where the primary tumor is unknown, or of poorly differentiated pathology, the presence of non-GCT elements may obscure the diagnosis and choice of treatment regimen. Traditional cytogenetic analysis to screen for chromosome 12p rearrangements, especially i(12), is frequently desirable in such cases, but is often overlooked until other avenues of diagnosis are exhausted, at which point no fresh tissue remains. We have developed a reliable technique for fluorescence in situ hybridization (FISH) whole chromosome painting on interphase nuclei released from formalin fixed, paraffin embedded tissues (PET), using painting probes for chromosome 12p and 12q produced by chromosomal microdissection. Using bicolor FISH with these probes, the relative nuclear distribution of 12p and 12q regions can be observed. We successfully applied this technique to four tumors with poorly defined pathology or unknown primary tumors and with a differential diagnosis of GCT. In each case, 12p and 12q could be distinguished, and 12p regions appeared to be rearranged and overrepresented relative to 12q regions. In 3 of 4 cases, a putative i(12p) was identified. These results support a diagnosis of GCT or GCT origin in these three cases.

  20. Comparative X-ray morphometry of prenatal osteogenesis imperfecta type 2 and thanatophoric dysplasia: a contribution to prenatal differential diagnosis.

    Science.gov (United States)

    Bondioni, Maria Pia; Pazzaglia, Ugo Ernesto; Izzi, Claudia; Di Gaetano, Giuseppe; Laffranchi, Francesco; Baldi, Maurizia; Prefumo, Federico

    2017-11-01

    The purpose of the paper was to assess the morphometric parameters to improve the specificity of the ultrasound (US) signs for the early differential diagnosis between two lethal dysplasias, as thanatophoric dysplasia (TD) and osteogenesis imperfecta type 2 (OI-2). The diaphyseal length and the bowed shape of long bones associated with vertebral body dimension assessment were investigated in a group of 14 pregnancy terminations carried out in the time period 2007-2013. The definitive diagnosis was established after pregnancy termination by means of skeletal standardized X-rays, histopathology and gene analysis. TD and OI-2 long bones were significantly shorter than controls. No significant differences were observed between the two dysplasias. The bowing angle was higher in OI-2; a true angulation or eventually axial displacement was present only in the latter. Furthermore, they did not show any evidence of vertebral collapse. The thanatophoric dysplasia presented less bowed long bones, and never true angulation. The spine was steadily characterized by flattened anterior vertebral bodies. Long bone shortening is not a sufficient and accurate sign for early sonographic differential diagnosis between TD and OI-2. Angled diaphysis, axial diaphyseal displacement and a conserved vertebral body height in the prenatal period support the diagnosis of osteogenesis imperfecta type 2, while moderately regular bowed diaphysis associated with platyspondyly that of thanatophoric dysplasia.

  1. Lipid Resonance on In Vivo Proton MR Spectroscopy: Value of Other Metabolites in Differential Diagnosis.

    Science.gov (United States)

    Mohan, S; Verma, A; Lim, C C T; Hui, F; Kumar, S

    2010-06-01

    differentiated by the presence of succinate and acetate in pyogenic abscess, and amino acids in pyogenic/fungal abscesses. Choline was seen in neoplasms and in tuberculomas, but not in the abscesses. Thus, the presence of a lipid peak, when combined with features on other MR pulse sequences and available clinical data can help arrive at a specific diagnosis. (1)H-MRS should not be interpreted in isolation: it should always be correlated with conventional imaging features, and performing (1)H-MRS in isolation remains an important pitfall.

  2. Biotin and Thiamine Responsive Basal Ganglia Disease--A vital differential diagnosis in infants with severe encephalopathy.

    Science.gov (United States)

    Ygberg, Sofia; Naess, Karin; Eriksson, Mats; Stranneheim, Henrik; Lesko, Nicole; Barbaro, Michela; Wibom, Rolf; Wang, Chen; Wedell, Anna; Wickström, Ronny

    2016-05-01

    We report two siblings of Swedish origin with infantile Biotin and Thiamine Responsive Basal Ganglia Disease (BTRBG). Initial symptoms were in both cases lethargia, with reduced contact and poor feeding from the age of 5 weeks. Magnetic resonance imaging showed altered signal in the basal ganglia, along with grey and white matter abnormalities. The diagnosis BTRBG was not recognized in the first sibling who died at the age of 8 weeks. The second sibling was started on biotin and thiamine immediately upon development of symptoms, leading to clinical improvement and partial reversion of the magnetic resonance imaging findings. Genetic analysis of the SLC19A3 gene identified two mutations, c.74dupT and c.1403delA, carried in compound heterozygous form in both boys, each inherited from one parent. The first mutation has previously been described in children with BTRBG, and the second mutation is novel. Although the clinical picture in BTRGB is very severe it is also rather unspecific and the diagnosis may be missed. This report highlights the importance of considering biotin and thiamine treatment also in a European infant born to non-consanguineous parents, who presents with symptoms of acute/subacute encephalopathy. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  3. Neoplastic lesions of the temporomandibular joint (TMJ): diagnosis, differential diagnosis and intervention; Neoplasien des Temporomandibulargelenks (TMG). Diagnostik, Differenzialdiagnostik und Intervention

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Abolmaali, N.; Schedel, H.; Bergh, B. [Frankfurt Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Maeurer, J. [Radiologische Praxis am Prinzregentenplatz, Muenchen (Germany)

    2001-09-01

    Purpose. To evaluate the effectiveness of diagnostic and interventional radiological techniques for neoplastic lesions of the temporomandibular joint (TMJ). Material and methods. Modern diagnosis of the TMJ is based on the clinical use of conventional X-ray techniques, computed tomography (CT), magnetic resonance imaging (MRI) and interventional techniques like biopsies, vascular occlusion and ablation. Results. Conventional X-ray still forms the basic diagnostic procedure applied in open and closed mouth position. CT improves the diagnostic information and serves as the standard diagnostical instrument for cartaliganeous or osseous neoplastic lesions. MRI evaluates soft tissue infiltration in multiplanar techniques and high spatial resolution. Interventional vascular and ablative techniques improve the treatment of neoplastic disorders. (orig.) [German] Zielsetzung. Vorstellung der Wertigkeit bildgebender Verfahren fuer die diagnostische und interventionelle Radiologie des Temporomandibulargelenks (TMG). Material und Methodik. Die moderne Radiologie des TMG basiert auf dem Einsatz der konventionellen Roentgendiagnostik, der Computertomographie (CT) und der Magnetresonanztomographie (MRT), sowie interventioneller Verfahren wie der Biopsie, vaskulaerer Embolisationsverfahren und tumorablativer Verfahren. Ergebnisse. Als Basisdiagnostik dient die konventionelle Diagnostik in offener und geschlossener Mundposition der Erfassung von Funktionsstoerungen sowie ossaerer Destruktionen. Die CT erweitert das diagnostische Spektrum und verbessert die Differenzialdiagnostik fuer ossifizierende Prozesse. Der Einsatz der MRT erlaubt die Erfassung der Weichteilinfiltration sowie der Gelenkstrukturen. Vaskulaere interventionelle Verfahren dienen der praetherapeutischen Okklusion bzw. der palliativen Tumortherapie in Form der okklusiven Embolisation, der Chemoembolisation, oder auch der Tumorablation. (orig.)

  4. Multiple sclerosis: imaging, diagnostic criteria and differential diagnosis; Bildgebung, Diagnosekriterien und Differenzialdiagnose der Multiplen Sklerose

    Energy Technology Data Exchange (ETDEWEB)

    Harting, I.; Sartor, K. [Abt. Neuroradiologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany); Sellner, J.; Meyding-Lamade, U. [Abt. Neurologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany)

    2003-05-01

    Multiple sclerosis (MS) is the most common demyelinating inflammatory disease of the central nervous system (CNS), presenting with multifocal, disseminated inflammatory lesions referred to as plaques. Magnetic resonance imaging (MRI) typically depicts multiple, round to oval, circumscript lesions predominantly involving periventricular and subcortical white matter, brainstem and cerebellum. More recent investigations have demonstrated that the macroscopically visible plaques only present the tip of the iceberg: Already early in its course, MS causes neuroaxonal damage and diffusely involves the entire brain parenchyma including normal appearing white matter. These changes are reflected by strongly T{sub 1}w hypointense lesions and atrophy of early onset, by reduction of the neuronal Marker N-acetylaspartate (NAA) on spectroscopy, by a decrease of the magnetization transfer ratio (MTR), by an increased in diffusibility and decreased anisotropy on diffusion-weighted imaging (DWI). MRI imaging is an important tool in the diagnosis of MS by revealing the characteristic spatial and temporal dissemination of the cerebral and spinal manifestations of this disease. Diagnostic criteria increase the diagnostic specificity and allow better differentiation from other diseases with multifocal white matter abnormalities. (orig.) [German] Die multiple sklerose (MS) ist die haeufigste entzuendliche, demyelinisierende Erkrankung des zentralen Nervensystems (ZNS) Sie ist durch multifokale, disseminierte Entzuendungsherde, sogenannte Plaques, in den myelinhaltigen Strukturen des ZNS charakterisiert. In der Magnetresonanztomographie (MRT) sind multiple umschriebene, rundlich-ovale Laesionen der weissen Substanz charakteristisch, die bevorzugt im periventrikulaeren Marklager, an der Mark-Rindengrenze, im Hirnstamm und im Kleinhirn lokalisiert sind. Neuere Untersuchungen zeigen, dass die sichtbaren Entmarkungsherde nur die Spitze des Eisbergs sind: Bereits fruehzeitig verursacht die MS

  5. Validity of multiplex biomarker model of 6 genes for the differential diagnosis of thyroid nodules

    Directory of Open Access Journals (Sweden)

    Ducena Kristine

    2011-06-01

    Full Text Available Abstract Background Currently the cytological examination of fine needle aspiration (FNA biopsies is the standard technique for the pre-operative differential diagnosis of thyroid nodules. However, the results may be non-informative in ~20% of cases due to an inadequate sampling and the lack of highly specific, measurable cytological criteria, therefore ancillary biomarkers that could aid in these cases are clearly needed. The aim of our study was to evaluate the mRNA expression levels of 8 candidate marker genes as the diagnostic biomarkers for the discrimination of benign and malignant thyroid nodules and to find a combination of biomarkers with the highest diagnostic value. Materials and methods mRNA expression levels of eight candidate marker genes - BIRC5, CCND1, CDH1, CITED1, DPP4, LGALS3, MET and TFF3 was measured by real-time RT-PCR in paired nodular and surrounding normal thyroid tissue specimens of 105 consecutive patients undergoing thyroid surgery and compared between different types of thyroid lesions. Results Significant differences in the mRNA expression levels between the normal and malignant thyroid tissues and between benign and malignant nodules were found for BIRC5, CCND1, CITED1, DPP4, LGALS3, MET and TFF3, but not CDH1. On a single gene basis, relative quantity (RQ of LGALS3 had the highest diagnostic value for the discrimination of malignant and benign thyroid nodules (AUC = 0.832, P LGALS3 was RQ sum of LGALS3 and BIRC5 (AUC = 0.841, P LGALS3, BIRC5, TFF3, CCND1, MET and CITED1 that had considerably higher specificity than a single marker or two marker gene-based models (AUC = 0.895, P Conclusions This study confirmed that mRNA expression levels of 7 out of 8 candidate genes analysed have a diagnostic value for the distinction of benign and malignant thyroid nodules. The multiplex biomarker model based on 6 genes outperformed a single marker or two marker-based models and warrants feasibility studies on FNA biopsies and

  6. Ductal adenocarcinoma and unusual differential diagnosis; Duktales Adenokarzinom und ungewoehnliche Differenzialdiagnosen

    Energy Technology Data Exchange (ETDEWEB)

    Haage, P.; Schwartz, C.A.; Scharwaechter, C. [Universitaet Witten/Herdecke, Zentrum fuer Radiologie HELIOS Universitaetsklinikum Wuppertal, Wuppertal (Germany)

    2016-04-15

    Ductal pancreatic adenocarcinoma is by far the most common solid tumor of the pancreas. It has a very poor prognosis, especially in the more advanced stages which are no longer locally confined. Due to mostly unspecific symptoms, imaging is key in the diagnostic process. Because of the widespread use of imaging techniques, incidental findings are to a greater extent discovered in the pancreas, which subsequently entail further work-up. Ductal pancreatic adenocarcinoma can be mimicked by a large number of different lesions, such as anatomical variants, peripancreatic structures and tumors, rarer primary solid pancreatic tumors, cystic tumors, metastases or different variants of pancreatitis. Additionally, a number of precursor lesions can be differentiated. The correct classification is thus important as an early diagnosis of ductal pancreatic adenocarcinoma is relevant for the prognosis and because the possibly avoidable treatment is very invasive. All major imaging techniques are principally suitable for pancreatic imaging. In addition to sonography of the abdomen, usually the baseline diagnostic tool, computed tomography (CT) with its superior spatial resolution, magnetic resonance imaging (MRI) with its good soft tissue differentiation capabilities, possibly in combination with MR cholangiopancreatography (MRCP), endosonography with its extraordinary spatial resolution, conceivably with additional endoscopic retrograde CP or the option of direct biopsy and finally positron emission tomography CT (PET-CT) as a molecular imaging tool are all particularly useful modalities. The various techniques all have its advantages and disadvantages; depending on the individual situation they may need to be combined. (orig.) [German] Das duktale Adenokarzinom ist der weitaus haeufigste solide Tumor des Pankreas. Die Prognose ist sehr schlecht, insbesondere bei fortgeschrittenen, nicht mehr lokal begrenzten Tumoren. Bei meist unspezifischen geringen Beschwerden kommt der

  7. Berardinelli-Seip syndrome in a 6-year-old boy

    Directory of Open Access Journals (Sweden)

    Babu Priya

    2008-01-01

    Full Text Available A 6-year-old boy presented with abnormal habitus since birth, delayed language development, history of frequent falls since 9 months, and fever since 1 week. He was found to have hyperandrogenic features, generalized paucity of fat, generalized muscular overdevelopment, and brownish pigmentation over the flexural creases. Skin biopsy demonstrated features suggestive of acanthosis nigricans with an absence of subcutaneous tissue. After further investigation, a diagnosis of Berardinelli-Seip syndrome with bilateral pneumonia and generalized tonic clonic seizures was made. Clinical features, histopathology, differential diagnosis, and prognosis of this rare disorder have been discussed.

  8. ASSOCIATIONS BETWEEN EARLY MATERNAL DEPRESSIVE SYMPTOM TRAJECTORIES AND TODDLERS' FELT SECURITY AT 18 MONTHS: ARE BOYS AND GIRLS AT DIFFERENTIAL RISK?

    Science.gov (United States)

    Beeghly, Marjorie; Partridge, Ty; Tronick, Ed; Muzik, Maria; Rahimian Mashhadi, Mahya; Boeve, Jordan L; Irwin, Jessica L

    2017-01-01

    The goal of this study was to evaluate whether there are sex differences in children's vulnerability to caregiving risk, as indexed by trajectories of maternal depressive symptoms assessed from 2 to 18 months' postpartum, and children's rated attachment security in toddlerhood, adjusting for maternal social support and demographic risk. Analyses utilized longitudinal data collected for 182 African American mother-child dyads from economically diverse backgrounds. Participants were recruited at the time of the child's birth and followed to 18 months' postpartum. Results of conditional latent growth models indicated that an increasing rate of change in level of maternal depressive symptoms over time negatively predicted toddlers' felt attachment security. Higher social support was associated with decreasing levels of maternal depressive symptoms over time whereas higher demographic risk was associated with increasing levels of maternal depressive symptoms. A subsequent multigroup conditional latent growth model revealed that child sex moderated these associations. For male (but not female) children, a rapid increase in maternal depressive symptoms was associated with lower felt attachment security at 18 months. These findings suggest that boys, as compared to girls, may be more vulnerable to early caregiving risks such as maternal depression, with negative consequences for mother-child attachment security in toddlerhood. © 2017 Michigan Association for Infant Mental Health.

  9. For Which Boys and Which Girls Are Reading Assessment Items Biased Against? Detection of Differential Item Functioning in Heterogeneous Gender Populations

    Science.gov (United States)

    Grover, Raman K.; Ercikan, Kadriye

    2017-01-01

    In gender differential item functioning (DIF) research it is assumed that all members of a gender group have similar item response patterns and therefore generalizations from group level to subgroup and individual levels can be made accurately. However DIF items do not necessarily disadvantage every member of a gender group to the same degree,…

  10. Primary omental actinomycosis as a differential diagnosis of acute appendicitis in children. Case report

    Directory of Open Access Journals (Sweden)

    Sergio Castañeda

    2016-09-01

    Full Text Available Actinomycosis is a chronic suppurative granulomatous inflammation caused by Actinomyces species. Abdominal actinomycosis is a rare condition, with very low incidence in childhood, and usually associated to trauma or perforation of hollow viscera. We are presenting a case of a ten-year-old boy with omental actinomycosis mimic and appendiceal infection, without a history of trauma or perforation, suggesting a hemmatogen spread. The complete resection of the affected tissue may warrant a cure in spite of a short antibiotic curse.

  11. A difficult case of Hodgkin Lymphoma with differential diagnosis of tuberculosis and sarcoidosis

    Directory of Open Access Journals (Sweden)

    Nilüfer Göknar

    2015-06-01

    Full Text Available We report here the case of a 14-year-old boy with history of fever, weight loss, and mediastinal lymphadenopathy. The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process. He was diagnosed with Hodgkin’s lymphoma after several X-rays, computed tomography, positron emission tomography-computed tomography, laboratory tests and three lymph node biopsy. Clinicians should be alerted on new lesions and symptoms in high risk patients and should repeat diagnostic tests and lymph node biopsies as indicated.

  12. Some boys' problems in education

    DEFF Research Database (Denmark)

    Jørgensen, Christian Helms

    2015-01-01

    The last two decades have seen an increasing political concern in the high dropout rates and low performance in education of boys compared to girls – at times in the form of a ‘moral panic’. This has also been the case in Denmark where ‘the boy problem’ in education now is placed high on the agenda...... in VET. Secondly, it explores the role of VET for students at risk of dropping out based on individual qualitative interviews with 106 students, two-thirds male, attending vocational schools in Denmark. The analyses show that most students experience the dual system of VET as a valuable alternative...... to general education, but social and institutional processes of differentiation in the vocational schools place a significant group of students in a position where they have little chance of completing the programme. In the conclusion, some reflections are made on the effect of a recent reform of VET...

  13. Assessing significance of peripheral blood indicators for differential diagnosis and prognosis of thrombotic complications in polycythemia vera and secondary erythrocytosis

    Directory of Open Access Journals (Sweden)

    Kostiukevych O.M.

    2014-03-01

    Full Text Available The aim of the study – determining of changes in peripheral blood (PB in patients with secondary erythrocytosis (SE and polycythemia vera (PV, detection of discriminatory parameters levels of PB indicators and analyzing of their operating characteristics for differentiation of erythrocytosis and predicting of thrombotic events in patients with PV. Materials and methods. The material for the study was the results of clinical trials of 210 patients with erythrocytosis who underwent differential diagnosis between PV and SE. Results and discussion. The optimal threshold for differential diagnosis of red blood cells content between PV and SE is >6.08•1012/ L, the diagnostic value of the marker equals to the level of a good diagnostic marker (AUC=0.82; 95% CI=0.77-0.87, p 57.5% with its capacity – 0.72 (0.66-0.78, p 8.9•109/L, and the boundary of marker is consistent with a good level of efficiency (AUC=0.79, 95% CI=0.72-0.84, p287•109 /L" to differentiate erythrocytosis is 0.90 (0.86-0.94, p 55%" and "WBC >12.3•109 /L", according to the AUC (AUC=0.65; 95% CI=0.52-0.79, p=0.021 and AUC=0.66; 95% CI=0.55-0.77, p=0.003, respectively, corresponds to the average power level. Conclusion. Hemoglobin has not confirmed its value for the differential diagnosis between PV and SE. Using other parameters of PB with the aim of differentiating PV and SE is rational, but their discriminatory power levels greatly depend on the group erythrocytosis. In our cohort were obtained the following most appropriate criteria for inclusion of patients in the group of patients with PV: "WBC >8.9•109/L", "red blood cells >6.08•1012/L" and "hematocrit >57.5%". The most significant marker of general clinical blood test to differentiate between PV and SE is "platelets >287•109/L". Hematocrit over 55% and WBC over 12.3•109/L are valuable prognostic markers of thrombosis in PV patients, but their use is appropriate only in a cohort of patients with PV without

  14. [Low sensitivity of IGF-I, IGFBP-3 and urinary GH in the diagnosis of growth hormone insufficiency in slowly-growing short-statured boys. Grupo Español de Estudio de la Talla Baja].

    Science.gov (United States)

    Audí, L; Antonia Llopis, M; Luisa Granada, M; Hermoso, F; del Valle, J; Dolores Rodríguez-Arnao, M; Bel, J; Luzuriaga, C; Gallego, E; Marín, F

    2001-01-13

    The usefulness of IGF-I, IGFBP-3, and the urinary GH excretion in the diagnostic evaluation of growth retardation in boys with short stature was studied. Serum samples from two GH-stimulation tests and two 24-h urine samples were sent to a Central Laboratory to measure serum and urinary GH, serum IGF-I, IGFBP-3 and GHBP, both in absolute and standardized values (Z-score). Short children were classified as growth hormone deficient (GHD) (n = 25), and idiopathic short statured (ISS) (n = 54), on the basis of the peak stimulated GH concentration of or = 7.5 microg/l respectively. A group of 15 normally growing children and adolescents was also included. Height-velocity standard deviation score (HV)-SDS was lower and body mass index higher in GHD than ISS. Standardized IGF-I differed significantly by ANOVA among the three groups (p = 0.001). Multiple stepwise linear regression analysis with HV-SDS as dependent variable showed IGF-I SDS as the best predictor followed by peak GH clonidine response and uGH excretion. ROC curves showed optimum cut-off level for IGF-I SDS as 2.05 (sensitivity: 32%, specificity: 90%) and 1.14 for IGFBP-3 SDS sensitivity: 28%, specificity: 94%). Standardized IGF-I and IGFBP-3 measurements were highly efficient only in diagnosis of severe GHD, but they show low sensitivity for the diagnosis of isolated idiopathic GHD as defined according to the low GH response to stimulation tests.

  15. Cross-validation of biomarkers for the early differential diagnosis and prognosis of dementia in a clinical setting

    Energy Technology Data Exchange (ETDEWEB)

    Perani, Daniela [Vita-Salute San Raffaele University, Milan (Italy); San Raffaele Scientific Institute, Division of Neuroscience, Milan (Italy); San Raffaele Hospital, Nuclear Medicine Unit, Milan (Italy); Cerami, Chiara [Vita-Salute San Raffaele University, Milan (Italy); San Raffaele Scientific Institute, Division of Neuroscience, Milan (Italy); San Raffaele Hospital, Clinical Neuroscience Department, Milan (Italy); Caminiti, Silvia Paola [Vita-Salute San Raffaele University, Milan (Italy); San Raffaele Scientific Institute, Division of Neuroscience, Milan (Italy); Santangelo, Roberto; Coppi, Elisabetta; Ferrari, Laura; Magnani, Giuseppe [San Raffaele Hospital, Department of Neurology, Milan (Italy); Pinto, Patrizia [Papa Giovanni XXIII Hospital, Department of Neurology, Bergamo (Italy); Passerini, Gabriella [Servizio di Medicina di Laboratorio OSR, Milan (Italy); Falini, Andrea [Vita-Salute San Raffaele University, Milan (Italy); San Raffaele Scientific Institute, Division of Neuroscience, Milan (Italy); San Raffaele Hospital, CERMAC - Department of Neuroradiology, Milan (Italy); Iannaccone, Sandro [San Raffaele Hospital, Clinical Neuroscience Department, Milan (Italy); Cappa, Stefano Francesco [San Raffaele Scientific Institute, Division of Neuroscience, Milan (Italy); IUSS Pavia, Pavia (Italy); Comi, Giancarlo [Vita-Salute San Raffaele University, Milan (Italy); San Raffaele Hospital, Department of Neurology, Milan (Italy); Gianolli, Luigi [San Raffaele Hospital, Nuclear Medicine Unit, Milan (Italy)

    2016-03-15

    The aim of this study was to evaluate the supportive role of molecular and structural biomarkers (CSF protein levels, FDG PET and MRI) in the early differential diagnosis of dementia in a large sample of patients with neurodegenerative dementia, and in determining the risk of disease progression in subjects with mild cognitive impairment (MCI). We evaluated the supportive role of CSF Aβ{sub 42}, t-Tau, p-Tau levels, conventional brain MRI and visual assessment of FDG PET SPM t-maps in the early diagnosis of dementia and the evaluation of MCI progression. Diagnosis based on molecular biomarkers showed the best fit with the final diagnosis at a long follow-up. FDG PET SPM t-maps had the highest diagnostic accuracy in Alzheimer's disease and in the differential diagnosis of non-Alzheimer's disease dementias. The p-tau/Aβ{sub 42} ratio was the only CSF biomarker providing a significant classification rate for Alzheimer's disease. An Alzheimer's disease-positive metabolic pattern as shown by FDG PET SPM in MCI was the best predictor of conversion to Alzheimer's disease. In this clinical setting, FDG PET SPM t-maps and the p-tau/Aβ{sub 42} ratio improved clinical diagnostic accuracy, supporting the importance of these biomarkers in the emerging diagnostic criteria for Alzheimer's disease dementia. FDG PET using SPM t-maps had the highest predictive value by identifying hypometabolic patterns in different neurodegenerative dementias and normal brain metabolism in MCI, confirming its additional crucial exclusionary role. (orig.)

  16. Evaluation of iodinated MIBG scintigraphy for the differential diagnosis of adrenal incidentalomas

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Teruyasu [Izu Public Health Center, Shimoda, Shizuoka (Japan)

    2001-05-01

    The incidence of adrenal incidentaloma has recently increased with the advances of imaging modalities such as US, CT and MRI. The aim of this study is to evaluate iodinated MIBG scintigraphy for the diagnosis of pheochromocytoma selected for surgery in adrenal incidentalomas, because the operation of pheochromocytoma needs the accurate preoperative diagnosis for avoiding the unexpected surgical complications. Eight cases of incidentalomas estimated pheochromocytoma before the operation, were selected for this study. The significant uptake of iodinated MIBG was observed in 5 cases of them. The pathological diagnosis of 2 in 3 cases with its non-significant uptake, were the adrenal cortical tumor. That of 1 of 3 cases was pheochromocytoma. The optimal diagnosis for adrenal incidentaloma should be considered the careful analysis of signs and symptoms, past history, biochemical laboratory data, iodinated MIBG scintigraphy, CT and MRI to avoid the overdiagnosis. (author)

  17. CT Images of a Severe TMJ Osteoarthritis and Differential Diagnosis with Other Joint Disorders

    OpenAIRE

    K. L. Ferrazzo; L. B. Osório; Ferrazzo, V. A.

    2013-01-01

    Osteoarthritis (OA) is the most common arthritis which affects the human body and can affect the temporomandibular joint (TMJ). The diagnosis of TMJ OA is essentially based on clinical examination. However, laboratory tests and radiographic exams are also useful to exclude other diseases. The diagnosis of OA may be difficult because of other TMJ pathologies that can have similar clinical and radiographic aspects. The purpose of this study was to describe an unusual case of bilateral TMJ OA in...

  18. The differential diagnosis of red eye: a survey of medical practitioners from Eastern Europe and the Middle East.

    Science.gov (United States)

    Petricek, Igor; Prost, Marek; Popova, Anna

    2006-01-01

    A survey amongst ophthalmologists and general medical practitioners from nine countries in Eastern Europe and the Middle East was conducted to estimate the percentage of patients presenting with a red eye and to examine differential diagnosis and treatment. Practitioners recorded brief details of every patient seen and detailed information concerning signs and symptoms, differential diagnosis and treatment for all patients presenting with a red eye during 20 consecutive days in the period between May and September 2004. Red eyes accounted for approximately 15% of consultations with ophthalmologists and almost 6% with general medical practitioners. Allergic conjunctivitis was the most common diagnosis (35%), followed by dry eye (25%) and bacterial conjunctivitis (24%). General medical practitioners were far more likely to prescribe a combination topical antibiotic and steroid preparation than ophthalmologists. This survey illustrates that red eye remains a very important problem for both ophthalmologists and general medical practitioners. Identification of dry eye as a common cause of red eye symptoms and more appropriate treatment of dry eye, allergic conjunctivitis and viral conjunctivitis are key messages to emerge.

  19. Differential diagnosis in pediatric radiology. Vol. 1. Skull, spine, skeleton; Differentialdiagnostik in der paediatrischen Radiologie. Bd. 1. Schaedel, Wirbelsaeule, Skelett

    Energy Technology Data Exchange (ETDEWEB)

    Ebel, K.D. [ed.; Willich, E. [ed.; Richter, E. [ed.; Benz-Bohm, G.; Bliesener-Harzheim, J.A.; Ebel, K.D.; Oestreich, A.E.; Reinwein, H.; Schaper, J.; Schumacher, R.; Stoever, B.

    1995-06-01

    The book presents in-depth material covering the full scope of tasks and problems of differential diagnostic radiology in children. The particular approach chosen by the authors provides information that will solve even the most difficult cases, guiding the reader on his way from radiographic findings to appropriate diagnosis. All radiographic findings have been characterized and classified and put into a tabulated system relating them to the relevant differential diagnosis. The system of reference adopted specifies a given lesion or disease by reference to the most significant diagnostic keywords obtained from anamnesis, clinical data, and further diagnostic evaluation. The tentative diagnosis is taken as the basis for further specification illustrated by the characteristic X-ray pictures and full-text descriptions. Almost all diagnoses are accompanied by a comprehensive image documentation obtained by all currently available imaging methods. (MG) [Deutsch] Das vorliegende Buch gibt einen kompletten Ueberblick ueeber die gesamte Bandbreite der Differentialdiagnostik in der Paediatrischen Radiologie und soll so auch in schwierigen Faeellen den Weg vom Roentgensymptom zur Diagnose ermoeglichen. Alle relevanten Roentgensymptome werden systematisch charakterisiert und die entsprechenden Differentialdiagnosen tabellarisch zusammengestellt. Jede Erkrankung wird durch Verweise auf die wichtigsten differentialdiagnostischen Stichworte aus Anamnese, Klinik und weiterfuehrende Diagnostik naeher eingegrenzt. Ausgehend von der Verdachtsdiagnose werden wegweisende Roentgenbefunde in Wort und Bild dargestellt. Fast alle erwaehnten Befunde werden durch Abbildungen unter Beruecksichtigung aller moderner bildgebenden Verfahren dokumentiert. (MG)

  20. Prenatal diagnosis by isoenzymic differentiation of Treacher Collins' syndrome induced by retinoids in rats

    DEFF Research Database (Denmark)

    Granström, G; Kirkeby, S

    1990-01-01

    ear ossicles, short cochleas, defectively differentiated Meckel's cartilages, micrognathia, rudimentary malar bones, lateral facial clefts, fistulas and skin tags, all of which were similar to Treacher Collins' syndrome in man. The defects were accompanied by a pathological differentiation pattern...... of various isoenzymes in maxillary and mandibular processes. These isoenzymes could be detected in amniotic fluid from the 9th to the 20th days of pregnancy and showed a pathological differentiation pattern here as well. We conclude that a teratogenically induced syndrome affecting the first and second...