Ancillary Diagnostic Tests Research Articles

Inflammatory cerebrospinal fluid analysis in cats: clinical diagnosis and outcome

The medical records of 62 cats with clinical signs of central nervous system disease and accompanying inflammatory cerebrospinal fluid (CSF) analysis were examined retrospectively to determine if signalment, clinical signs, CSF analysis and ancillary testing could accurately predict the type of central nervous system disease that was present. An inflammatory CSF was defined as one in which a total nucleated cell count was greater than 5 cells/μl or one in which the total nucleated cell count was normal but the nucleated cell differential count was abnormal. Sex, degree of CSF inflammation, neuroanatomical location and systemic signs provided little contributory information to the final diagnosis. In 63% of the cases a presumptive diagnosis could be made based on a combination of clinical signs, clinicopathological data and ancillary diagnostic tests. CSF analysis alone was useful only in the diagnosis of cats with feline infectious peritonitis, Cryptococcus species infection, lymphoma and trauma. Overall, despite extensive diagnostic evaluation, a specific diagnosis could not be made in 37% of cats. The prognosis for cats with inflammatory CSF was poor with 77% of cats surviving less than 1 year.

Practice Pattern Variation in Ancillary Diagnostic Testing for Acute Asthma Exacerbations

Practice Pattern Variation in Ancillary Diagnostic Testing for Acute Asthma Exacerbations

Incidence of clinically unsuspected pulmonary embolism in mechanically ventilated lung transplant recipients.

The incidence of pulmonary embolism (PE) in lung transplant recipients has not been well established. The purpose of this study was to describe the incidence of clinically unsuspected PE in a cohort of lung transplant recipients requiring mechanical ventilatory support. These patients underwent surgical lung biopsy (SLBx) for progressive deterioration in the absence of a specific diagnosis. We retrospectively reviewed all SLBx pathology reports for mechanically ventilated lung transplant recipients with clinical deterioration, progressive radiographic abnormalities, or both at any time after transplantation. Our objective was to determine the incidence of clinically unsuspected PE in this patient population during an 11-year period. Clinically unsuspected PE was identified in 8 (19.5%) of 41 mechanically ventilated lung transplant recipients after a median of 20 days (interquartile range: 16.3, 148.8 days) after transplantation. There was a tendency for clinically unsuspected PE to occur in the early postoperative period, with the majority of events (75%) occurring within 14 weeks of transplantation. Pulmonary infarction occurred in 37.5% of cases and occurred uniformly during the postoperative period. The finding of pulmonary emboli on SLBx lead to confirmatory investigations in five (62.5%) of eight patients and changed management in seven (87.5%) of eight patients. A high index of suspicion and reliance on ancillary diagnostic testing may be insufficient to establish the diagnosis of postoperative pulmonary emboli. PE is an underappreciated complication contributing to respiratory failure in the early postoperative period in lung transplant recipients, warranting identification of putative risk factors and consideration for prophylaxis.

Use of immunohistochemistry to diagnose chytridiomycosis in dyeing poison dart frogs (Dendrobates tinctorius).

Chytridiomycosis, caused by Batrachochytrium dendrobatidis, is an emerging disease of both wild and captive amphibians, posing a threat to their survival in many parts of the world. As the disease can be difficult to diagnose on routine pathologic sections, the purpose of this study was to develop an additional method for visualization. To accomplish this, immunohistochemical staining was applied to histologic skin sections from four experimentally infected Dyeing poison dart frogs (Dendrobates tinctorius). Staining of the positive tissue sections was distinct and readily visualized, making this technique a valuable ancillary diagnostic test for this important disease.

Urinary and hepatic disorders in neonatal foals

Urinary tract dysfunction, such as acute renal failure, ruptured urinary tract, placental dysfunction (non-renal azotemia), candida cystitis, and infected/patent urachus, is commonly seen in neonatal foals. The diagnosis and management relies upon the clinical signs, measurement of serum chemistries, urinalysis, and ultrasonographic examination of the urinary tract and umbilical structures. Treatment of acute renal failure with crystalloids, colloids, vasopressors, furosemide, mannitol, and dialysis is discussed. An indwelling urinary catheter is placed to monitor urine output and prevent rupture of the bladder. Nephrotoxic drugs should be used only in euvolemic foals that are producing an adequate amount of urine. Guidelines for the prevention of nephrotoxic acute renal failure are provided. Liver disease is uncommon in foals, although frequently septicemic neonatal foals have increased liver enzymes and bilirubin values without any underlying liver disease. Differential diagnoses for liver disease in neonatal foals include Bacillus piliformis (Tyzzer's Disease), neonatal equine herpes virus-1 infections, hepatic damage secondary to neonatal isoerythrolysis, biliary obstruction secondary to duodenal ulceration, and umbilical vein infections. Portosystemic shunts and congenital deficiency in ammonia metabolism in Morgan foals often lead to central nervous system signs at 6–12 weeks of age, and are not considered disorders of the neonatal period. The diagnosis of hepatic disorders is based on the clinical signs, increases in liver enzymes, ammonia and bile acid concentrations, electrolyte concentrations, ultrasound of the umbilical structures and liver, and ancillary diagnostic tests such as transrectal portoscintigraphy, positive-contrast portography, liver biopsy and gastrointestinal barium study.

Diagnostic dilemmas in orbital inflammatory disease

Orbital inflammatory disease (OID) broadly describes a variety of pathologic processes and clinical presentations. OID may be idiopathic or may be secondary to a systemic inflammatory disease, retained foreign body, or infectious disease. OID includes the spectrum of bacterial or fungal infections, diffuse inflammation of multiple tissues (e.g., sclerosing orbititis or diffuse anterior OID), and preferential involvement of specific orbital structures (e.g., orbital myositis or optic perineuritis). Mimics of OID include congenital orbital mass lesions or orbital neoplastic disease such as lymphoma or rhabdomyosarcoma. The ultimate diagnosis and treatment plan relies on a careful history and detailed clinical examination followed by the judicious use of ancillary diagnostic testing and a comprehensive treatment plan. The purpose of this review is to provide an overview of the spectrum of diseases known as OID, with emphasis on specific diagnostic challenges in the evaluation and management of patients with idiopathic OID.

German Society of Cytology and Study Group “Cytopathology” of the German Society of Pathology, Abstract 118–125, Posters

Fine needle aspiration cytology (FNAC) can be a precious tool for the evaluation of lymphadenopathies in children and adolescents. The purpose of this study was to analyse the diagnostic accuracy of FNAC in a paediatric lymph node series. We report a series of 76 patients, aged up to 19 years, who underwent lymph node FNAC. In our series, 57 cases were diagnosed as non-neoplastic, including benign reactive hyperplasia and other inflammatory lesions, 18 cases were diagnosed as malignant and 1 case was diagnosed as suspicious for lymphoproliferative process, not otherwise specified. Sensitivity, specificity, positive predictive value and negative predictive value were 93 %, 100 %, 100 % and 98 %, respectively. Diagnostic accuracy resulted 98.6 %. FNAC is an accurate, minimally invasive method with minimal complications that allows evaluation of paediatric lymphadenopathies and a correct triage of reactive/inflammatory and neoplastic lymphadenopathies. The application of rapid on-site evaluation, the realization of a cell block and the application of ancillary diagnostic tests, including at least immunocytochemistry and flow cytometry, allows to achieve an excellent diagnostic performance.

Hemorrhagic bowel syndrome in dairy cattle: 22 cases (1997-2000).

To determine signalment, history, and clinical, necropsy, and microbiologic findings in dairy cows with hemorrhagic bowel syndrome. Retrospective study. 22 adult dairy cows from a single farm in Colorado. Medical records were reviewed for information on signalment, medical and reproductive history, the owner's chief complaints, results of physical examinations and ancillary diagnostic tests, treatment and response to treatment, results of microbiologic testing, and, if applicable, postmortem findings. Common clinical signs were acute signs of profound depression, decreased milk production, tachycardia, ruminal stasis, abdominal distention, and dark clotted blood in the feces. Rectal examination revealed distended loops of small intestine in 7 of 14 cows. Transabdominal ultrasonography revealed small intestinal ileus and distention in 12 of 12 cows and homogeneous echogenic intraluminal material compatible with intraluminal hemorrhage and clot formation in 4. Seven of 8 cows treated medically died; 9 of 13 cows that underwent surgery died or were euthanatized. Clostridium perfringens was isolated from fecal samples from 17 of 20 cows. The most common morphologic diagnosis at necropsy was severe necrohemorrhagic enteritis or jejunitis with intraluminal hemorrhage or blood clots. The most prominent histologic finding was severe, segmental submucosal hemorrhage and edema of the small intestine. Results confirm that in adult cattle, hemorrhagic bowel syndrome is a sporadic acute intestinal disorder characterized by intraluminal hemorrhage and obstruction of the small intestine. Clostridium perfringens was consistently isolated from the feces of affected cows. The prognosis for affected cows was grave.

Severity of angina pectoris and risk of ischemic stroke.

Ischemic stroke and coronary heart disease (CHD) share risk factors and pathogenic process, ie, atherosclerosis and thrombosis. We examined the relationship between severity of angina pectoris and its accompanying characteristics and the risk of incident ischemic stroke. We traced 3122 patients with stable CHD, included in a secondary prevention trial of lipid modification, the Bezafibrate Infarction Prevention trial. CHD was documented by a history of myocardial infarction > or =6 months and < 5 years before enrollment and/or stable angina pectoris with evidence of ischemia confirmed by ancillary diagnostic testing. Severity of angina pectoris was assessed according to the Canadian Cardiovascular Society angina classification, and heart failure functional class according to the New York Heart Association (NYHA) classification. Patients with severe heart failure or unstable angina on enrollment were excluded. During a mean follow-up period of 8.2 years, 186 patients developed an ischemic stroke. The cumulative rate of ischemic stroke increased in a dose-response manner from 4.7% in patients with no angina to 5.7%, 8.4%, and 12.9% in patients with angina classes 1, 2, and 3, respectively (P<0.001). Patients with NYHA functional class 1 had a 5.5% rate of ischemic stroke versus 7.3% and 9.6% in patients with classes 2 and 3, respectively (P=0.05). In a Cox proportional-hazard model adjusting for conventional risk factors and potential confounders, the hazard ratio associated with angina class 1 was 1.20 (95% CI, 0.83 to 1.74); class 2, 1.66 (95% CI, 1.12 to 2.45); and class 3, 2.35 (95% CI, 1.08 to 5.13), as compared with patients with no angina. Hazard ratios of ischemic stroke associated with conventional risk factors were 1.55 for a 10-year age increment, 2.16 for diabetes mellitus, 1.81 for current smoking, and 1.29 for a 20 mm Hg increase in systolic blood pressure. Severity of angina pectoris in patients with stable CHD predicts an increased risk of subsequent ischemic stroke. The association between angina class and incident ischemic stroke is independent of traditional vascular risk factors.

Chronic heart failure in Australian general practice. The Cardiac Awareness Survey and Evaluation (CASE) Study.

To investigate the frequency and general practitioner awareness of patients with chronic heart failure (CHF), and to evaluate a cardiac algorithm and document cardiac investigations performed in establishing this diagnosis. Between March and August 1998, consecutive patients aged 60 years and older presenting to their GP were assessed. In patients previously diagnosed with CHF, aetiology and diagnostic assessments were documented. In patients with suspected CHF (by a standardised algorithm, based on World Health Organization guidelines), further investigations and GP diagnosis were recorded. 80 consecutive patients were assessed by each of 341 GPs throughout Australia, reflecting the Australian metropolitan/rural population mix of 1996. This provided a total of 22060 evaluable patients. Estimated numbers of patients with CHF in general practice (previously and newly diagnosed); major aetiological factors; use of ancillary diagnostic tests; drugs prescribed. CHF was diagnosed in 2905 of 22060 patients (13.2%) (2485 previously diagnosed and 420 newly diagnosed). Major aetiological factors were ischaemic heart disease and hypertension. Echocardiography had been performed in 64% of previously diagnosed patients, but was performed in only 22% of possible CHF patients. Angiotensin-converting enzyme (ACE) inhibitors were prescribed in 58.1% of patients with CHF. Patients with evidence of left ventricular dysfunction were more likely to have received ACE inhibitors. CHF appears to be very common in the elderly, based on GP diagnosis of the condition. Of 100 patients aged 60 years and over presenting to their GP, two new cases of CHF will be detected using a simple clinical algorithm in conjunction with appropriate diagnostic tests. ACE inhibitors appear to be underutilised.

Clinical Characteristics of Coronary Heart Disease as Predictors of Ischemic Stroke: A Long-term Prospective Follow-up in the BIP Study.

P126 Objective: To assess characteristics and severity of coronary heart disease (CHD) predisposing to ischemic stroke, beyond conventional vascular risk factors. Methods: We prospectively followed up 3,122 patients with documented CHD included in a secondary prevention trial of lipid modification, the Bezafibrate Infarction Prevention trial. Patients had CHD documented by a history of myocardial infarction ≥6 months and &lt;5 years before enrollment and/or stable angina pectoris confirmed by ancillary diagnostic testing, and a selected lipid profile. Patients with severe heart failure or unstable angina upon enrollment were excluded. Results: During a mean follow-up period of 8.2 years, 186 patients developed an ischemic stroke. The rate of ischemic stroke was 8.8% among patients with an active anginal syndrome[class ≥2 according to the Canadian Cardiovascular Society angina Classification, (CCSC)]vs. 5.1% in patients with a CCSC class of 1 (p&lt;0.001). Patients with heart failure according to class ≥2 of the New York Heart Association classification had a 7.7% rate of ischemic stroke vs. 5.5% among patients with a class of 1 (no limitation of physical activity; p=0.03). In a Cox Proportional Hazard model adjusting for conventional risk factors, CCSC angina class ≥2 remained an independent predictor of ischemic stroke (Hazard ratio 1.43; 95%CI 1.05–1.96) and hospitalization for a confirmed diagnosis of unstable angina during follow-up conferred an additional independent increased risk (Hazard ratio 1.7; 95%CI 1.04–2.87). Hazard ratios of conventional risk factors, for comparison, where 1.49 for a 10 year age increment, 2.29 for diabetes mellitus, 1.75 for current smoking, 1.81 for peripheral vascular disease, and 1.14 for a 10 mmHg increase in systolic blood pressure. Conclusion: Active angina (CCSC class ≥2)and hospitalization for unstable angina during follow-up among CHD patients,confer an independent increased risk of ischemic stroke, beyond conventional vascular risk factors.

Lameness Examination in Cattle

Veterinarians are often asked to examine cattle for lameness. A good history, observation of stance and stride, and physical examination are critical to the diagnosis of lameness in cattle. Methods of examination, including observation of the animal at a distance and during movement, are described. Lameness grading systems and ancillary diagnostic tests are also discussed.

The diagnosis of aspergillosis in birds

The diagnosis of aspergillosis can prove to be a difficult challenge for the avian veterinarian. The diagnosis is based on the cumulative findings resulting from a thorough physical examination, appropriate hematologic and chemistry panel analyte analysis, radiography, endoscopy and laparoscopy, culture, and other ancillary diagnostic tests. Despite many of the advances made in diagnostic ability, the diagnosis is not as easy as it seems. The current methods for the detection and diagnosis of aspergillosis are reviewed.

Diagnosis of enteric disease in small ruminants.

Diagnosis of gastrointestinal disease in small ruminants requires integration of information obtained in the signalment, history, physical or necropsy examination, and ancillary diagnostic tests. The purpose of this article is to provide the practitioner with a review of the clinical features of several common gastrointestinal diseases of sheep and goats. Rumen acidosis, enterotoxemia, gastrointestinal parasitism, neonatal diarrhea, and salmonellosis are discussed, and where appropriate, reviews of the pathophysiology, prevention, and control of these diseases are cited for further reading.

The effects of perioperative hypothermia and the duration of anesthesia on postoperative wound infection rate in clean wounds: a retrospective study.

To determine the effects of hypothermia and duration of anesthesia on the infection rate in clean wounds in dogs and cats. Retrospective clinical study. Seven hundred seventy-seven dogs and cats undergoing clean surgical procedures. Records of animals prospectively evaluated for postoperative wound infection were retrospectively evaluated for the prevalence of perioperative hypothermia. Body temperatures during the perioperative period and the duration of surgery and anesthesia were recorded. Data were analyzed to identify differences between animals with infected and uninfected wounds and multiple logistic regression modeling was used to evaluate the independent contribution of risk factors to the incidence of postoperative wound infection. No statistically significant differences were found in the analysis of temperature data between animals with infected and uninfected wounds. Duration of anesthesia was significantly greater in animals with wound infections (P = .01). Multiple logistic regression modeling identified duration of anesthesia as a risk factor for postoperative wound infection independent of the duration of surgery. In animals with clean surgical wounds, mild perioperative hypothermia is not a significant risk factor for postoperative wound infection. The duration of anesthesia, however, is a significant risk factor independent of the duration of surgery. To decrease the incidence of postoperative wound infection, the duration of anesthesia should be minimized. Surgical time, as well as the time required for ancillary diagnostic tests while under anesthesia should, therefore, be kept to a reasonable minimum.

Visual Impairment in Infants: Localizing the Lesion on a Clinical Basis

Visual impairment in infants and small children differs significantly in underlying cause, clinical features, and therapeutic and prognostic implications from visual impairment which occurs during adult life. Areas of similarities and differences will be clarified. Visual impairment in infants and children arises from lesions of the globe, anterior visual pathways, posterior visual pathways, or a combination of these. Localization of the lesion rests on the recognition of certain clinical patterns that accompany lesions of each of these locations. This clinical recognition can obviate the need for much of the ancillary diagnostic testing. The major causes and general clinical features of visual impairment caused by lesions of the anterior and posterior visual pathways are provided and contrasted. Parental education, counseling, and support continue to be the most important areas in which the physician can help these children.

Insulinoma

Fundamental to establishing a diagnosis of insulinoma is first to consider the diagnosis when presented with the constellation of symptoms and signs that indicate hypoglycaemia. Prominent and most convincing are manifestations of neuroglycopenia. Although hypoglycaemia can be caused by a number of disorders, the combination of hypoglycaemia and endogenous hyperinsulinaemia is diagnostic of insulinoma. Our criteria now include a glucose level of 40 mg/dl with a concomitant insulin level of 6 μU/ml, a C-peptide level exceeding 200 pmol/l, and negative screen for sulphonlyurea. Ancillary diagnostic tests or the use of insulin surrogates may offer helpful confirmation. Localization is still evolving, but in our hands pre-operative ultrasound is the best and only pre-operative test that we obtain in the usual situation. Expertise and experience with other modalities at other institutions offer reasonable but more costly alternatives. Intraoperative ultrasonography provides significant benefit in both tumour localization and delineating important related anatomy. Insulinomas are virtually all located in the pancreas; 90% are benign, single, and are generally firmer than surrounding normal pancreas. Extensive exposure may be required to identify and remove safely the tumour. Enucleation is our preferred technique, but distal pancreatectomy for tumours in the body or tail is an excellent method as well. Pancreatoduodenectomy is rarely necessary. Complications most commonly relate to leak of pancreatic secretions, causing pseudocyst, abscess, or fistula. Except in MEN 1 syndrome, excision of a benign insulinoma equates with disease cure, and patients are often extraordinarily grateful as the change in their lives may be profound.

Gastric Cryptosporidiosis in Juvenile Red Drum

Abstract Pond-reared fingerling red drum Sciaenops ocellatus experiencing low mortality were found to be in poor physical condition. Histopathology revealed numerous 2–5-μm spherical organisms lining the gastric microvillus border and clusters of 4–7-μm organisms within epithelial cell cytoplasmic vacuoles suggestive of cryptosporidiosis. The diagnosis was confirmed by electron microscopy, with which life cycle stages were observed to be compatible with criteria established for Cryptosporidium spp. inother fish. Although few pathologic changes have been attributed to cryptosporidial infections in fish, a moderate inflammatory response in these red drum was elicited by the parasite in association with disruption of the normal tissue architecture, epithelial necrosis, and glandular loss. Ancillary diagnostic tests, including bacteriology and parasitology, were negative. The possible contribution of this organism to mortalities seen in these fish is discussed.

Advances in the use of Ancillary Diagnostic Testing in the Emergency Department Evaluation of Chest Pain

This article discusses the advances of ancillary studies used to evaluate the emergency department patient with chest pain caused by acute myocardial infarction (AMI) or ischemia. This article examines how these studies have improved the early detection of patients with AMI, improved differentiation of acute ischemic coronary events from nonischemic causes of chest pain, more accurately stratified patients for adverse outcome, and decreased the number of patients with AMI inadvertently discharged from the emergency department. Ancillary studies discussed include nonstandard ECGs, nuclear imaging, serum markers, and emergency department observation units. Emergency department echocardiography is discussed elsewhere in the issue.

Chainsaw penetrating neck injury.

A case of chainsaw injury to the neck is described. Previous reports in the English language are exceedingly rare. A brief discussion of safety features on chain saws is followed by a review of selective vs. mandatory surgical exploration in penetrating neck trauma, including the role of ancillary diagnostic tests.