Diagnostic Criteria In Patients Research Articles

Survival endpoint: con.

Survival is a complex outcome measure in patients with progressive motor neuron disease. The complexity and unavoidable confounding factors make the measure an inappropriate one to be used as a primary outcome. Many factors ineuence a patient’s mortality, including nutrition, respiratory assistance, attitude and caregiver support. Due to the interaction between these confounding variables, it is impossible to isolate survival as a single outcome, affected by a single treatment effect. As we devise improved adjunctive and symptomatic therapies, their impact on survival is even greater, confounding the measure even more. Current treatment options affect survival with a magnitude greater than the effect size we have often been seeking in recent clinical trials. Using the available diagnostic criteria for patients with amyotrophic lateral sclerosis (ALS) shows a vast heterogeneity among the clinical presentations considered under this single unifying diagnosis. Issues which affect survival, such as bulbar involvement, hypersialorrhea, rate of progression and pre-existing pulmonary and cardiac disease, are difecult to control, yet they are likely synergistic in their ultimate effect on a quantitative measure of survival. The relative risk of death in patients presenting with aggressive bulbar symptoms versus limb involvement only can be greater than eight times. 1 When included in the same trial, the range in survival, given the variability in natural history of disparate presentations, is often greater than the change in survival we desire to achieve with the proposed treatment. The impact on survival of symptomatic and adjunctive therapy is signiecant and dependent upon the patient’s predominant disability (bulbar vs. limb). Controlling for such therapeutic interventions is not adequate, as their potential confounding effects are not uniform across all ALS patients (Figure 1). The presence and extent of bulbar pathology, particularly respiratory compromise, may be the strongest predictor of survival. 2,3 Our current pattern of enrollment in ALS clinical trials is to include patients with a variable degree of respiratory impairment, often within a certain range, enabling us to predict the mortality during the study period. The assumption that these patients (with a similar range of forced ventricular capacity (FVC) values) will progress at a similar and predictable rate is unsubstantiated.

Minor cutaneous features of atopic dermatitis in South Korea.

Minor cutaneous features are important in atopic dermatitis (AD) because they are related to the ethnic or genetic background and to the etiopathogenesis of the disease other than atopic allergy. In addition, they can be used as auxiliary diagnostic criteria in patients with uncertain major features. It is our experience that our AD patients have characteristic features that have not been described previously in the literature. AD patients (n = 130) and control subjects (n = 198) were examined for the 32 conventional and seven additional minor features (sandpaper-like skin lesions on elbow/knee/lateral malleolus, hangnail, ventral wrist dermatitis, itchy hyperkeratotic papules on the dorsum of the hands, oily skin, fissured heel, and palmar erythema). The frequency of each feature was compared between AD patients and controls. The diagnostic significance of these minor features was analyzed separately in the childhood and adolescent-adult AD groups, and the age-related changes were documented. The seven additional features were significant for the diagnosis of AD in South Korean patients. Many of the other conventional minor features were also significant. Nine features were of diagnostic importance only in the adolescent-adult AD group, and three features were characteristic only in the childhood AD group. Our data suggest that ethnic backgrounds influence the phenotype of AD and that an additional seven features need to be examined to confirm the ethnic effect. As the general clinical presentation of AD is dependent upon age, the frequency of minor features varied in the different age groups.

Mucocutaneous criteria for the diagnosis of Behçet's disease: An analysis of clinicopathologic data from multiple international centers

Background: Although four of five of the new international criteria for the diagnosis of Behçet's disease relate to mucocutaneous lesions, disagreement exists as to the exact nature of cutaneous lesions (e.g., vessel-based vs follicular). Objective: Our purpose was to review clinical data, clinical photographs, and skin biopsy specimens from multiple medical centers throughout the world to monitor current practice in the implementation of mucocutaneous diagnostic criteria for Behçet's disease. Methods: Ten medical centers responded to a request to collaborate by sending clinical data, photographs of cutaneous lesions, and biopsy specimens from 22 patients. Results: Of specimens from 22 patients, 14 revealed a histopathologic pattern of neutrophils containing perivascular and interstitial inflammation, whereas specimens from three patients revealed only mononuclear cells in a vessel-based pattern. Biopsy specimens from three patients revealed primarily folliculocentric inflammation and an additional two specimens were from erythema nodosum-like lesions. Conclusion: Perivascular inflammation was the predominant histopathologic finding in specimens of cutaneous lesions in this clinical series. Folliculocentric lesions could not be predicted on the basis of review of clinical photographs. Histopathologic assessment of cutaneous lesions is crucial if the proposal is accepted that exclusion of folliculocentric lesions is important to ensure accurate implementation of diagnostic criteria in patients with suspected Behçet's disease.

Sensitivity of Radiographic Changes of Hand and Foot Joints as a Diagnostic Criterion in Patients with Rheumatoid Arthritis

Okubo S, Lehtinen K, Isomaki H. Sensitivity of Radiographic Changes of Hand and Foot Joints as a Diagnostic Criterion in Patients with Rheumatoid Arthritis. Scand J Rheumatol. 1992; 21: 145–47.

Recurrent kidney stones: causes and diagnostic criteria in patients from Campania (southern Italy).

A study was carried out on 180 recurrent kidney stone formers from the Campania region of southern Italy. The data showed that this hypercalciuric population was similar to that in previous studies; however, there was no difference in terms of parathyroid activity when compared with normal controls. The slightly depressed serum levels of vitamin D in hypercalciurics indicate that gut calcium absorption is not directly related to vitamin D levels. We found no difference in the prevalence of metabolic abnormalities associated with stone formation between the patients in this series and those in previous studies.