Incidental Diagnoses Research Articles

Health status and clinical diagnoses of 3000 UK Gulf War veterans

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000. 2252 (75%) of those attending were judged "well", of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21-63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder. The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.

Malformation de Chiari de type I de l’enfant : modes de révélation de 34 observations

Incidental diagnoses of Chiari I malformation are more and more frequent in pauci or asymptomatic children. The value of neurophysiological investigations for surgical indications is discussed. Objective. – To determine clinical presentations of Chiari I malformation and relative frequencies of severe and incidental forms, and to evaluate the usefulness of neurophysiological investigations for surgical indications. Methods. – This retrospective study included 34 patients admitted from 1984 to 2000, with Chiari I malformation diagnosis in different pediatric (intensive care, neurology and neurosurgery) units of a university hospital. Results. – The clinical presentation was severe (two children died) in four cases (12%). Signs of brain stem compression were found in 41% of cases, scoliosis in 21%, and incidental diagnosis in 26%. The polysomnography, performed in 12 cases, showed sleep-apneas in six cases. One child with an incidental diagnosis of Chiari I malformation had many sleep-apneas which required a surgical treatment. A surgical decompression was performed in 69 % of cases, with clinical improvement in 77%. Conclusion. – The high incidence (12%) of severe forms revealing Chiari I malformations justifies systematic neurophysiological investigations for the initial evaluation and the follow-up of Chiari 1 malformations, including the less symptomatic forms.

Neuroblastoma in Europe: differences in the pattern of disease in the UK

Neuroblastoma is a major contributor to childhood cancer mortality, but its prognosis varies with age and stage of disease, and some tumours regress spontaneously. Urinary screening programmes or clinical examination may detect the disease before symptoms appear, but the benefit of early diagnosis is uncertain. We examined the incidence, pattern, and presentation of neuroblastoma in four European countries. Population-based incidence rates were derived for France, Austria, Germany, and the UK. Age, sex, and stage distribution were analysed by Mantel-Haenszel techniques and Poisson regression. The proportion of incidental diagnoses (cases without symptoms found at routine health checks or during investigation of other disorders) and mortality rates were also compared. Between 1987 and 1991, 1672 cases of neuroblastoma were diagnosed in children under 15 years old (France, 624; Austria, 69; Germany, 493; UK, 486). Age-standardised annual incidence was significantly lower in the UK (10.1/million) than in France (12.5) and Germany (11.4). In the UK a deficit of low-stage disease in infants was accompanied by an excess of stage IV in older children. The UK had significantly fewer incidental diagnoses (8%) than Austria (27%) and Germany (34%). UK mortality rates were significantly higher than German or French rates. In the UK, neuroblastoma diagnosis is delayed, possibly because of a less rigorous system of health checks for children. Although some overdiagnosis occurs in mainland Europe, our data suggest that in the UK some low-stage cases, undetected in infancy, may later present as advanced disease. This finding has implications for screening programmes and organisation of routine surveillance of infant health in the UK.

Small renal neoplasms: clinical, pathologic, and imaging features.

Small renal neoplasms are being found more often because of the widespread use of abdominal CT and sonography. Little is known about their natural history. We therefore retrospectively reviewed clinical, pathologic, and imaging findings in 22 patients with surgically confirmed solitary renal neoplasms that were 3 cm or less in diameter. Eighteen lesions were first found by CT, three by sonography, and one by IV urography. Three lesions were discovered because the patients had hematuria. Nineteen were incidental radiologic diagnoses in patients without renal symptoms. Of 22 neoplasms, 15 (68%) were renal cell carcinomas, six (27%) were oncocytomas, and one (5%) was a lymphoma. Fourteen (93%) of the 15 carcinomas were confined to the kidney, and one showed microscopic capsular invasion. Metastases did not develop in any patient with carcinoma, indicating that small carcinomas usually have good prognoses. Patients with carcinomas had a mean follow-up of 42 months. All neoplasms were visible on CT. However, characterization of these lesions sometimes required a combination of CT and sonography and occasionally angiography. The carcinomas, oncocytomas, and solitary renal lymphoma could not be distinguished radiologically. Small renal neoplasms are most often found incidentally by CT performed in patients without renal complaints. Most are low-stage carcinomas, and some are oncocytomas.

Use of CT scan in the diagnosis of abdominal aortic aneurysms

Computed Tomography (CT) was used in evaluating five patients with abdominal aneurysms. In one case, an acute aneurysmal leak was evaluated by CT alone prior to surgery. In four cases, significant incidental diagnoses were made via CT. The use of CT in evaluating aorlic aneurysmal disease is discussed.