Diagnosis Of Primary Disease Research Articles

Occurrence of different cancers in patients with Parkinson's disease.

Parkinson's disease is a chronic, progressive neurological disorder with well defined clinical and pathological features. Smokers are less likely to develop Parkinson's disease.1 The disease is associated with a reduced risk of cancer overall,2 but the risk of malignant melanoma may be increased.3 The objective of this study was to assess the occurrence of cancer in a large cohort of patients with Parkinson's disease. The study was based on three computerised registers in Denmark. From the Danish hospital discharge register we extracted all records of admissions of patients with a primary diagnosis of Parkinson's disease during 1977-89 and identified a cohort of 7046 people with the disease (3470 men and 3576 women). Information on cancer incidence and …

726-2 The Role of Myocardial Catecholamine: Promising or Proved in Diagnosis and Prognosis of Primary Heart Muscle Diseases?

The role of myocardial catecholamine concentration (MCC) in diagnosis and outcome of primary heart muscle diseases (HMD) is still incompletely defined. To elucidate this problem we analyzed diagnostic utility of MCC measurements in pts with biopsy proven myocarditis (BPM), hypertrophic cardiomyopathy (HCM), and idiopathic dilated cardiomyopathy (DCM). as well as MCC prognostic impact in DCM. Our study group consisted of 86 pts, 20 of them with BPM (80% males, aged 18–42 yrs), 34 HCM pts (64% males, aged 29–54 yrs) and 32 pts with DCM (75% males, aged 21–56 yrs). At the initial assessment all pts underwent cardiac catheterization and endomyocardial biopsy (EMB). Myocardial norepinephrine (MNEC). epinephrine (MEC). and dopamine (MDC) concentrations were measured in EMB samples using catechol-O-methyl-transferase radioenzymatic method. Obtained values (ng/g of fresh myocardial tissue ft) are shown in the table below: MNEC MEC MDC BPM 415.4 ± 71.1 † 57.3 ± 48 † 76.6 ± 9.2 ns HCM 781.0 ± 125.1 ** 91.3 ± 13.1 ** 78.1 ± 9.3 ns DCM 262.2 ± 68.9 † 36.9 ± 7.1 ‡ 72.6 ± 12.1 ns † -p < 001 (BPM vs. DCM); ** -p < 001 (HCM vs. BPM); † -p < 0.01 (HCM vS. DCM). In addition, we analyzed the effect of MNEC and MEC on the five years survival of 31 DCM pts. Survival (18/31) was significantly better in pts with higher MNEC (411.8 ± 43.4 ng/g ft survivors vs. 278.5 ± 75.7 ng/g ft non-survivors, p < 0.01) and MEC (55.3 ± 4.5 ng/g ft survivors vs. 39.2 ± 9.3 ng/g ft non-survivors, p < 0.01). Univariate and multivariate analysis demonstrated that both MNEC and MEC predicted long-term survival independently and their low concentrations were associated with increased mortality. In conclusion, these data indicate that MCC measurements may be helpful as a complementary tool in diagnostic evaluation of pts with HMD. Furthermore, MNEC and MEC should be considered as valuable prognostic markers of the long-term survival of DCM pts.

Conformance of clinical practice to established recommendations for the diagnosis and treatment of venous thromboembolic disease: Robin revisited.

Over a decade ago, Dr. Robin expressed concern regarding overdiagnosis and overtreatment of pulmonary embolism. Since that time, significant advances have been forthcoming in the diagnosis and treatment of venous thromboembolic disease. Using Continuous Quality Improvement concepts, this study revisits Robin's concerns and assesses the conformance of clinical practice at one institution with established requirements for the diagnosis and treatment of venous thromboembolic disease to identify remaining opportunities to improve care. The study design is a retrospective chart review. Medical records of all patients (N = 63) discharged from a university-affiliated teaching hospital from 7/1/89 to 6/30/90 with a diagnosis of primary venous thromboembolic disease were studied. Requirements for the diagnosis and treatment were established through review of the medical literature. Conformance to these requirements was assessed and described. Descriptive statistics were used. Only 7 of 63 charts (11%) met all requirements for the diagnosis and treatment of venous thromboembolic disease. Fifty-six charts (89%) failed to meet at least one criterion. There was no evidence of overdiagnosis of venous thromboembolic disease in patients with a discharge diagnosis of pulmonary embolism (N = 17). Eight of 62 patients (13%) demonstrated potential overdiagnosis of venous thromboembolic disease involving the lower extremities. Nine of 60 (15%) heparin therapies demonstrated significant nonconformance to recommendations. Fifty-four of 59 (91%) warfarin therapies failed to conform to recommendations. Eighty-three percent of these warfarin errors were considered to be technical. However, 17% were determined to be clinically significant. Of 5 patients treated with a transvenous filter device, 1 failed to meet therapeutic requirements. No patients received thrombolytic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of primary glomerular diseases in a French region. Variations according to period and age

Between January 1, 1976 and December 31, 1990, histological diagnosis of primary glomerular diseases (PGD) was made in 480 patients born and living at the time of diagnosis in a region of France, comprising 410,664 inhabitants, of whom 390,574 were aged from 10 to 80 years. The prevalence of PGD during a 70 year exposure to risk (10 to 80 years of age) was evaluated to 5.7 in 1000 (7.6 in 1000 males and 3.8 in 1000 females). The most common PGD was IgA nephropathy with a prevalence of 1.9 in 1000 (3.3 in 1000 males, 1 in 1000 females). The annual incidence of the disease was evaluated separately for three consecutive five-year periods: period A (1976-80), period B (1981-85), and period C (1986-90). Within each of these three periods the number of patients with PGD was 179, 170 and 131, respectively, and annual incidence was 9.3, 8.8 and 6.7 in 100,000. The incidence of IgA nephropathy remained the same throughout the three periods: 2.6, 3.1 and 2.5 in 100,000. The incidence of membranoproliferative glomerulonephritis decreased from 1981 onward (0.9, 0.5 and 0.15 in 100,000), while that of membranous nephropathy increased slightly (1.2, 1.6 and 1.7 in 100,000). Acute streptococcal glomerulonephritis virtually disappeared during periods B and C. Lipoid nephrosis was less frequent in period C and idiopathic proliferative glomerulonephritis with crescents slightly increased (0.3, 0.4 and 0.6 in 100,000). There was no significant difference between the three periods regarding the incidence of other PGD.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcome of cardiopulmonary resuscitation and predictors of resuscitation status in an urban community teaching hospital

Medical records of all expired patients as well as all patients designated on billing logs as having received cardiopulmonary resuscitation (CPR) during a 6-month period were reviewed. Patients were considered to have been ‘coded’ if they were found unresponsive and if the advanced cardiac life support (ACLS) protocol of the American Heart Association (AHA) was subsequently initiated. Of 105 patients who received CPR, 98 died during their hospital stay. Of the seven remaining patients, four had undergone coronary by-pass graft surgery, one was discharged in a persistent vegetative state, one died during an admission 2 months later, and one patient was transferred to another institution where he died. Various factors were studied in an effort to determine how patients on whom resuscitation was attempted differed from those who died without ever having received CPR. Patients who underwent CPR at least once during their hospitalization were more likely to have had cardiac diagnoses on admission ( P < 0.001), to have been postoperative ( P = 0.02), to have been admitted to a monitored bed on admission ( P < 0.001) to have received more days of intensive care ( P < 0.001) and to have received more specialist consultations ( P = 0.004). Patients not receiving CPR were more likely to have had a primary diagnosis of neoplastic disease ( P < 0.001), stroke or intracranial hemorrhage ( P = 0.02) or dementia ( P < 0.001). Age, race, or gender did not differ significantly between the two groups.

Cerebral Metastases Secondary to Ovarian Cancer: Still an Unusual Event

An incidence of cerebral metastases secondary to epithelial ovarian cancer as high as 11.6% has been reported in small series and related to the prolonged survival of ovarian cancer patients treated with platinum compounds (Hardy, J. R., and Harvey, V. J. Gynecol. Oncol. 33, 296-300, 1989). A review of the histories of 413 ovarian cancer patients, treated from 1981 to 1989 with platinum-based combination chemotherapy according to the protocols of the Gruppo Oncologico Nord Ovest (GONO) (North West Oncology Group), showed that only 9 patients (2.2%) developed clinical evidence of cerebral metastases. Six of 9 patients had FIGO Stage IIIc disease and 1 each with FIGO Stages Ic, IIc, and IV. All these patients had received cisplatin or carboplatin-based combination chemotherapy. Clinical response to initial cytotoxic therapy was as follows: complete response, 3 patients; partial response, 4 patients; stable disease, 1 patient; progressive disease, 1 patient. Cerebral metastases occurred at a median of 19 months (range 3-36) from diagnosis and median survival of patients with central nervous system (CNS) metastasis was 26 months (range 10-81) from diagnosis of primary disease and 8 months (range 1-45) from diagnosis of CNS involvement. The incidence of CNS metastases in our series is similar to that reported in the past and significantly lower than figures reported by the above mentioned paper. On the basis of our data we do not agree with Hardy and Harvey about the relationship possibly existing between prolonged survival and incidence of CNS metastases and, particularly, about the need for prophylactic cranial irradiation.

Clinical chemical diagnosis of diseases assisted by logistic regression illustrated by diagnosis of canine primary and secondary hepatobiliary diseases.

The purpose of the present study was to demonstrate the use of logistic regression models in the prediction of diseases using the prediction of canine primary and secondary hepatobiliary diseases as an example. Briefly, in a logistic regression model independent variables (i.e. the analytical results) are combined in a linear equation that is used to estimate the logarithm of the odds (logit) of an event (i.e. having primary or secondary hepatobiliary disease). From the estimated logit given by the logistic regression model, a conditional probability of the event (i.e. having primary or secondary hepatobiliary disease) can be calculated. Twenty-six dogs with verified primary and secondary hepatobiliary diseases and 19 dogs, initially suspected to have hepatobiliary diseases, but with apparently other diseases, were included in the study. The following clinical chemical parameters were measured: alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), alkaline phosphatase (AP), bilirubin(Total) (TB), urea, glucose, retention of bromosulphthalein (BSP), fasting and postprandial total serum bile acid concentration (FSBA and PSBA). Logistic regression analysis, using the CATMOD procedure in SAS, was used to select which of the measured parameters should be included in the model, and to derive a logistic regression model using the selected parameters. To observe more closely the potential of the logistic regression model, the model was also used to classify a test group consisting of 13 dogs (6 dogs with hepatobiliary diseases and 7 dogs with other diseases). By logistic regression analysis, ASAT and PSBA were selected to be included in the final model, and the final logistic regression model was Y = -3.194 + 0.044.PSBA + 3.251.ASAT. The logistic regression model classified correctly 38 (84%) of 45 dogs in the present study. Specifically, 21 (81%) of 26 dogs with verified primary or secondary hepatobiliary diseases and 17 (90%) of 19 dogs with various other diseases were correctly classified by the logistic regression model. When the model was used on the test group, 5 (83%) of 6 dogs with hepatobiliary diseases and 7 dogs (100%) of 7 dogs with other diseases were correctly classified. Even though the logistic regression model derived in the present study only serves as an example, thus reducing the practical usefulness of the derived logistic regression model, the present study indicates a great potential of logistic models for the diagnosis of diseases.

Kidney transplantation from living unrelated donors.

To compare patient and graft survival of recipients of kidneys from living, unrelated donors (LUDs); cadaveric donors; and living, related donors (LRDs) matched for zero (mismatched), one, or two (identical) haplotypes. Cohort study. Sixty-three renal transplantation centers affiliated with the Brazilian Transplantation Registry (accounting for more than 95% of the transplantation activity in Brazil). Patients having renal transplantation between January 1987 and March 1991. Of 2892 patients, 165 (6%) received transplants from LUDs; 964 (33%), from cadaveric donors; 183 (6%), from zero haplotype, HLA-matched LRDs; 1259 (44%), from one haplotype-matched LRDs; and 321 (11%), from two haplotype-matched LRDs. Patient and graft survival. Patients were followed for an average of 15.8 months. After adjustment for age, race, diagnosis of primary disease, history of previous transplantation, cyclosporine use, and number of transplants from LUDs per center, patient survival did not differ statistically for recipients of kidneys from LUDs and recipients of cadaveric kidneys (risk ratio [RR], 1.16; 95% Cl, 0.68 to 1.98). Little difference was seen between the adjusted death rate for recipients of zero haplotype-matched LRDs and recipients of cadaveric kidneys (RR, 1.13; Cl, 0.69 to 1.87). Similarly, in a multivariate analysis, recipients of kidneys taken from LUDs and zero haplotype-matched LRDs had a risk for graft failure that did not differ statistically from that of cadaveric kidney recipients (RR, 0.74; Cl, 0.45 to 1.22 and RR, 0.82; Cl, 0.53 to 1.25, respectively). Graft survival for recipients of kidneys from LUDs is similar to that from zero haplotype-matched LRDs and is at least as good as that achieved with cadaveric transplants.

Diagnosis and therapy of metastasis-induced pathologic fractures

Improved survival rates of cancer patients have led to an increase in the incidence of metastatic disease of the bone. Normal load and minimal trauma may result in pathological fractures. The malignant diseases most commonly diagnosed were breast cancer, bronchial carcinoma and hypernephroma. The majority of the patients treated were female. The average interval observed between diagnosis of primary malignant disease and occurrence of the pathological fracture was 2.8 years. The purpose of the surgical procedure is to achieve immediate and lasting stability and ultimately to increase and restore the quality of life. Immediate postoperative mobilization and early functional treatment are an indispensable part of the management of pathologic fractures. If possible extensive bone destructions involving the risk of fracture should be stabilized prophylactically. Specific techniques of composite osteosyntheses of fractures in metastatic disease of the bone are presented.

Outer Limits of Physiologic Hypertrophy and Relevance to the Diagnosis of Primary Cardiac Disease

Athletic training induces a morphologic adaptation of the heart, by increasing left ventricular cavity size and wall thickness. Wall thickening usually ranges up to 12 mm, but in 2% of athletes it may be more marked (13-16 mm). Athletes with the most substantial wall thickening are rowers, canoeists, and cyclists, competitive at elite levels for a substantial period of time. Therefore, physiologic left ventricular hypertrophy probably does not exceed 16 mm in thickness and is usually present in the ventricular septum, associated with an enlarged cavity size. Additional features of the physiologic left ventricular hypertrophy are the regression of wall thickening into normal limits (less than 13 mm) after a period of deconditioning and the consistent normality of the Doppler diastolic filling pattern.

Evaluation of diagnostic tests using relative operating characteristic (ROC) curves and the differential positive rate. An example using the total serum bile acid concentration and the alanine aminotransferase activity in the diagnosis of canine hepatobiliary diseases.

The value of a diagnostic test depends on most cases on its ability to discriminate between patients with and without a certain disease. One way of evaluating a diagnostic test is to use the relative operating characteristic curve (ROC curve) and the differential positive rate (DPR). The ROC curve displays the relationship between the true positive ratio and the false positive ratio for a range of cutoff values and it can be used to compare various diagnostic tests under equivalent conditions (equal true positive ratios or false positive ratios) and over the entire range of cutoff values. The DPR is the difference between the true positive ratio and the false positive ratio at various cutoff values and it can be used to obtain the cutoff value associated with the highest sensitivity and specificity. The purpose of this study was to describe the evaluation and comparison of diagnostic tests using ROC curves and DPR. Eventually, the positive and negative predictive values were used to assess the differences between the sensitivity and specificity obtained when the upper limit of the reference interval, or the optimal cutoff value indicated by the DPR, was used as cutoff value. To illustrate the methods, the 2 h post-prandial total serum bile acid concentration (PSBA) and the alanine aminotransferase activity (ALAT) in the diagnosis of primary or secondary hepatobiliary diseases in dogs were used. The ROC curves showed, as expected from previous studies, that PSBA was superior to ALAT in diagnosing dogs with hepatobiliary diseases. Using DPR, the optimal cutoff value for PSBA was suggested to be 15.48 mumol/l. Compared to the traditionally used cutoff value of 22.24 mumol/l, no decisive difference in the positive predictive values were observed. However, the cutoff value of 15.48 mumol/l appeared to produce higher negative predictive values compared to a cutoff value of 22.24 mumol/l. Seemingly, ROC curves and DPR are simple methods useful to the evaluation of diagnostic tests and due to the simplicity, there seems to be a great potential for these methods in the evaluation of diagnostic tests in veterinary medicine.

Raynaud's phenomenon. An update.

The pathogenesis of primary Raynaud's phenomenon remains an enigma. Most evidence favors a local abnormality in the digital arteries as opposed to an increased activity of the sympathetic nervous system. The local fault may involve the alpha 2-adrenergic receptors, which are most important in reflex sympathetic vasoconstriction. Cooling blood vessels increase the sensitivity of alpha 2-adrenergic receptors, increased levels of alpha 2-adrenergic receptors are present in primary Raynaud's disease, and patients show an increased sensitivity to alpha 2-adrenergic receptor agonists on finger blood flow. Serotonin has also been implicated, but the evidence is not compelling. In secondary Raynaud's phenomenon, vasospastic attacks can often be explained by a low arterial distending pressure, a thickened vessel wall, or absence of beta-adrenergic receptor activity. Diagnosis of primary Raynaud's disease relies on a typical history and normal physical examination, laboratory studies, and nailfold capillaroscopy. Finger systolic blood pressures during local cooling with ischemia may be helpful to document vasospastic attacks but does not distinguish primary from secondary Raynaud's phenomenon. The treatment of Raynaud's phenomenon is usually conservative. Pavlovian conditioning or biofeedback may be beneficial. When drug therapy is necessary, the calcium channel entry blocker nifedipine or sympatholytic agents have been shown to decrease the frequency and duration of vasospastic attacks in about two thirds of patients, although subjective improvement does not usually correlate with objective testing. Direct-acting vasodilators have not been shown to be of definite benefit. New therapies include prostaglandins, captopril, and the serotonergic antagonist ketanserin. Surgical sympathectomy has not been beneficial.

Diverticular Mass Mimicking Ovarian Malignancy

A patient is described with a large diverticular mass presenting with a clinical picture suggestive of locally advanced ovarian malignancy. Computed tomography demonstrated diffuse thickening of the wall of the sigmoid colon with infiltration of the peri-colonic fat. The imaging diagnosis of primary bowel wall disease was confirmed pathologically.

Thin basement membrane nephropathy as a cause of recurrent haematuria in childhood

A survey of 69 children presenting with recurrent or persistent haematuria and submitted to percutaneous renal biopsy at this hospital over a 17-year period, was performed to establish the incidence of thin basement membrane nephropathy (TBMN). A diagnosis of primary glomerular disease was established in 44 (IgA nephropathy in 16, Alport's syndrome in 13 and other varieties of glomerulonephritis in 15). Of the remaining 25 patients in whom light microscopical and immunochemical examination revealed no abnormalities, material for electron microscopy was available in 11. In eight of these (five of whom had a family history), TBMN was diagnosed on the basis of ultrastructural morphometric evaluation of glomerular basement membrane thickness. Assuming a similar proportion of the remaining 14 patients with renal biopsy specimens normal by light microscopy had TBMN, the probable frequency of this abnormality in the whole series would be 26%, very similar to that of IgA nephropathy. In the eight TBMN patients the mean glomerular basement membrane thickness ranged between 181 and 236 nm, whilst in 'control' biopsies from children with 'minimal change' nephrotic syndrome or IgA nephropathy, the mean thickness ranged between 242 and 333 nm.

A Comparison of Employment Rates of Patients Treated With Continuous Ambulatory Peritoneal Dialysis vs In-Center Hemodialysis (Michigan End-Stage Renal Disease Study)

This study examines factors associated with employment status in a stratified subsample of the Michigan End-Stage Renal Disease Study population. To reduce the variation in employment potential, the subsample consisted of nondiabetic patients aged 20 to 64 years. The patients were stratified on the basis of their treatment histories as follows: (1) treated by in-center hemodialysis only; (2) primarily treated by continuous ambulatory peritoneal dialysis; and (3) failed continuous ambulatory peritoneal dialysis, substituted by another form of dialysis. A significantly higher percentage of the patients undergoing stable continuous ambulatory peritoneal dialysis were in the labor force than were those undergoing in-center hemodialysis (27.4% vs 9.6%). Using logistic regression, even when adjusted for sex, race, age, education, marital status, primary diagnosis, and duration of end-stage renal disease, the stable continuous ambulatory peritoneal dialysis group was significantly more likely to be employed than the group undergoing either in-center hemodialysis only or the group that failed continuous ambulatory peritoneal dialysis.

Computed tomography of Crohn's disease--reevaluation.

The indications and CT features of Crohn's disease were reevaluated, based on 48 examinations in 28 patients. Although CT is indicated mostly in the complications of Crohn's disease, it played a major role in the primary diagnosis of Crohn's disease in 8 patients. 5 unsuspected patients had CT for other abdominal indications and 3 had the examinations as part of an elective diagnostic work-up. The following CT features of Crohn's disease are worthy of note: Bowel wall thickening is usually obvious and needs no measurement. Abscesses are often of inhomogeneous density and should be differentiated from inflammatory bowel conglomerates. Late CT scans can be helpful in this respect. Fistulae are not well demonstrated directly by CT. The fistulogram remains the examination of choice, when possible. Mesenteric lymphadenopathy is small and discrete. Mesenteric lipomatosis can be massive and is often a cause of bowel separations and mass effect.

Preliminary findings on the nature of dysphagia in patients with chronic obstructive pulmonary disease.

Findings on 14 patients referred for swallowing evaluations from the pulmonary unit of a rehabilitation hospital are presented. Patients were admitted to the hospital with the primary diagnosis of chronic obstructive pulmonary disease (COPD). Thirteen patients had tracheostomy tubes, and five were ventilator-dependent. Each patient received a bedside evaluation to assess the oral phase of the swallow, as well as videofluoroscopy to examine the pharyngeal phase. Results indicated that nearly all of the patients experienced some difficulty with both phases of swallowing. Oral and pharyngeal transit times were consistently slower than normal. Most patients demonstrated diminished coordination and strength of the oral and pharyngeal musculature. The overall picture was one of reduced strength in all aspects of the swallow, coupled with a reduced ability to use pulmonary air to clear the larynx and ensure airway protection. Consistent aspiration was observed in only 3 of the 14 patients, but 10 of the patients were judged to have a moderate swallowing dysfunction.

Tumour-associated monoclonal antibodies for the diagnosis and assessment of ovarian cancer.

A tumour-associated radiolabelled monoclonal antibody (HMFG 2) was used to investigate 51 patients who were referred with a pelvic mass and suspected ovarian cancer or recurrent disease. The day before operation the 123I-labelled antibody was injected and the patients then underwent radioimmunoscintigraphy immediately and again 4 and 22 h after the injection. An exploratory laparotomy with appropriate surgery was then performed and the tumours were staged. Tumours were positively imaged 3 min-22 h after injection in all the patients with ovarian cancer, with a mean 0.6% of the injected antibody taken up by the tumour. The presence of HMFG antigen on the tumour was confirmed by immunoperoxidase staining of the surgically-removed tissues. Of the 51 patients, 39 proved to have ovarian cancer. The accuracy of diagnosis and detection of primary and metastatic malignant disease was 95% when correlating pre-operative radioimmune scan findings and laparotomy findings. The procedure is minimally invasive, apparently without side-effects and offers information for tumour detection as an adjunct or alternative to existing methods.

Validation of hospital discharge diagnosis data for chronic obstructive pulmonary disease and other allied conditions.

The assumption that discharge diagnoses of chronic obstructive pulmonary disease and other allied conditions accurately reflect patient medical records was tested using a sample of 553 hospital discharges from the Pittsburgh, Pennsylvania area. Three validation criteria were used in reviewing patient hospital records: 1) the presence of abnormal spirometry test results; 2) reference made to a previous diagnosis of one of the conditions; and 3) reports of respiratory symptoms consistent with these conditions. The findings were that 1 per cent of the 432 cases with a primary diagnosis in this disease category and 10 per cent of the 121 cases with a primary diagnosis of heart disease and a secondary diagnosis in this disease category were not supported by any of the selected criteria.

Magnetic resonance imaging and hydatidiform mole.

Five women with complete and partial hydatidiform mole were examined by magnetic resonance imaging (MRI). Spin-echo pulse sequences (T2 weighted) were found to provide excellent resolution, while inversion-recovery pulse sequences (T1 weighted) gave better pathological detail. The myometrium was clearly seen on each patient and no invasion by the tumour detected. This corresponded to the histological findings. The potential uses of magnetic resonance in the diagnosis of primary and recurrent trophoblastic disease and its role in management are discussed.