Differential Diagnostic Methods Research Articles

Diagnosis and Treatment of Primary Mediastinal Tumors and Cysts: Forty-two years report in a University Hospital

Background : The diagnostic and therapeutic approaches to mediastinal tumors and cysts have changed over the past three decades. This report summarizes our forty-two years of experience with these tumors. Methods : This study retrospectively reviewed 479 patients with primary mediastinal tumors and cysts that were diagnosed and managed over the past 17-year period (1985~2002) and compared them to the report of the previous 25-year result (1960~1985) in Yonsei University College of Medicine, Severance Hospital in Seoul, Korea. Results : During the 17 years, there were 479 cases of pathologically proven mediastinal tumors and cysts. Thymoma (38.2%) was the most common mediastinal tumor and has increased noticeably during recent years. The gender ratio showed a male predominance (1.3:1) and the age distributions were even over all the age groups. The most common sites of the tumor and the proportion(28.6%) of malignant tumors were the same as that previously reported. A diagnosis of a tumor in asymptomatic patients was possible in 174 cases (36.3%), which was higher that reported previously. The diagnostic yield of a fine needle aspiration biopsy was 68.6% in the total tumors and 80.9% in the malignant tumors. A surgical resection was the most frequently chosen treatment modality and was performed in 405 cases (84.6%). The complete resection rate was 91.1%, which is higher than the previous result of 78.8%. Conclusion : These results showed that the prevalence of mediastinal tumors and cysts, particularly thymoma, increased. A fine needle aspiration biopsy was a valuable preoperative differential diagnostic method for malignant tumors. The surgical and complete resection rate increased remarkably possibly due to the better applicable chest CT scans, the more frequent health check-up provided by the regular health promotion program for all people as a health insurance policy, and the improved diagnostic techniques in the pathologic, radiological, and clinical fields.

Ultrasound as a method of differential diagnostics of different types of destructive cholecystitis

Objective: The aim of this study is to determine the value of ultrasonography in the diagnostics of gallbladder pathology before laparoscopic cholecystetomy (LCh) and to carry out a comprehensive assessment of indications and contraindications of LCh. We also aimed to identify the most common causes of conversion from laparascopic to classic surgical treatment and to choose technique and tactics of LCh.

High antigenic cross-reaction among the bacterial species responsible for diseases of cultured freshwater fishes and strategies to overcome it for specific serodiagnosis

Antigenic sharing among the most commonly bacterial pathogens such as Aeromonas hydrophila, Edwardsiella tarda and Pseudomonas fluorescens of Indian major carps has been studied using immunological reactions such as cross-agglutination, disc diffusion and indirect enzyme linked immunosorbent assay (ELISA). The data were analysed using statistical analysis (SAS), version 6.12. The results showed high antigenic similarities among the bacterial whole cells, whole cell lysates, somatic ‘O’ antigens, lipopolysaccharides (LPS) and extracellular products (ECP). However, few or no similarities were observed in ECP components of <20 kD. The present study indicates a need to develop differential diagnostic methods based on serology by choosing the highly specific less cross-reactive ECP antigen.

Development of a foot-and-mouth disease NSP ELISA and its comparison with differential diagnostic methods

The gene encoding the nonstructural protein (NSP) of O/SKR/2000 foot-and-mouth disease virus (FMDV) was constructed to express under the polyhedron promoter of baculovirus. The expression of NSP was confirmed by indirect immunofluorescence assay (IFA) and Western blotting. The expressed NSP was applied as a diagnostic antigen for indirect-trapping ELISA (I-ELISA). An I-ELISA using monoclonal antibody (Mab) against 3A as trapping antibody was developed to differentiate infected from vaccinated cattle. The diagnostic efficiency of Mab linked I-ELISA was compared and evaluated with baculovirus expressed 3ABC I-ELISA from USDA and Mab (3A) linked E. coli expressed 3ABC I-ELISA from IZSLE through retrospective sero-surveillance. Compared with the two different I-ELISA methods, Mab (3A) linked I-ELISA using baculovirus expressed NSP showed the same level of sensitivity and specificity, indicating that this method is suitable for a differential diagnostic method in cattle.

Distribution of the total unsaturation in lipid components of plasma as a new differential diagnostic method in clinical analysis

Using ozonization and thin-layer chromatographic methods we determined the qualitative and quantitative correlation of unsaturation distribution (UD) in individual fractions of blood plasma lipids in children suffering from insulin-dependent diabetes mellitus (IDDM). The research was aimed at elucidation of biochemical criterion of the degree of metabolic disorders in children with IDDM and at development of methods for quantitative assessment of such disorders. Twenty children were examined during the compensation stage (group 1), and twelve during decompensation with ketoacidosis (group 2). The present investigation shows that in the case of insulin-dependent diabetes mellitus in children the total unsaturation distribution (TUD) in plasma lipid fractions were found to be decreased significantly compared to healthy controls. The pattern of TUD in plasma lipid fractions may serve as a new biochemical criterion for metabolic disorders and decompensation in IDDM.

Laboratory study on occult gastrointestinal bleedings: differential diagnostic method for the parallel study of intact and fragmented hemoglobin.

The authors produced various degradation products of human hemoglobin. With the aid of immune sera raised against native hemoglobin and their fragments, we examined the antigenicity of the intact molecule and fragments as well as the specificity and reactivity of the immune sera used. Since conventional guaiac-type reactions make no distinction between the different hemoglobin molecules and the methods described in recent years' publications only with immune sera raised against native intact hemoglobin, the demonstration of occult fecal blood has not reached the desired rate of efficacy in clinical practice. The authors recommend the introduction of a simple differential diagnostic methods suitable for the parallel examination of intact and fragmented hemoglobin.

Diagnosis of viral haemorrhagic disease of rabbits and the European brown hare syndrome.

Development of methods for the diagnosis of viral haemorrhagic disease and the European brown hare syndrome has proceeded at a steady pace over the last few years. The studies conducted by the authors demonstrate that, like VHDV, EBHSV is a calicivirus. The degree of correlation between the two viruses is a key question both for understanding their biology and interpreting the diagnostic results. A discussion of the similarities and differences between VHD and EBHS is followed by the presentation of the latest antigenic correlation results of the two viruses. Considering the absence of culture procedures to isolate either virus, the diagnostic methods discussed in this review are the haemagglutination (HA) test, immune electron microscopy (IEM) and enzyme-linked immunosorbent assay (ELISA) for virus detection, and the haemagglutination inhibition test (HI) and ELISA for antibody detection. The major obstacles, especially for the diagnosis of EBHS, are described; these are represented by morphological, structural and antigenic modifications due to proteolytic degradation. A differential diagnostic method for the two diseases, based on MAb ELISA, is presented. A final conclusion, drawn from the epidemiological analysis of the virological and serological data, is that EBHS and VHD should be considered as two distinct diseases, each caused by its own aetiological agent.

Catamnesis of Endogenous Psychoses according to the Differential Diagnostic Method of Karl Leonhard

The validity of the current systems of classification of endogenous psychoses has not yet been unambiguously demonstrated using the criterion of prognosis. An alternative to these systems may be seen in the Leonhard classification of endogenous psychoses. In a catamnestic study, 93% of the initial diagnoses and prognoses made between 1969 and 1973 could be confirmed in 1986.

Chemical and histochemical studies of normal and diseased human gastrointestinal tract. V. A differential diagnostic method for the histochemical classification of glycoproteins

A differential diagnostic scheme is described for the division of colonic epithelial glycoproteins into eleven histochemically distinct classes. The scheme depends upon the use of seven histochemical techniques which, collectively, permit the differential staining of O-sulphate ester, sialic acid and its side chain O-acyl variants and vicinal diols located on carbohydrate residues other than sialic acids. Elements of the scheme also provide a general approach to the classification of epithelial glycoproteins in anatomic sites other than the colon. Application of the scheme permitted the classification of the epithelial glycoproteins in the mucosa 0.5-5.0 cm from human colonic tumours and provided direct confirmation of previous observations that changes from normal in the relative proportions of either side chain O-acylated sialic acids or sialic acids and O-sulphate esters can occur independently of one another.

Spontaneous erythroid colony formation in erythrocytosis.

Erythroid colony formation from the bone marrow and blood of 30 patients with erythrocytosis has been studied. Seventeen patients formed spontaneous erythroid colonies. They included patients with polycythaemia vera (PV) and 4 patients who did not quite fulfil the Polycythemia Vera Study Group criteria for PV, but had suggestive evidence of a myeloproliferative disorder. Thirteen patients did not form spontaneous colonies. They included patients with secondary polycythaemia, patients with normal total red cell volume and patients with absolute pure erythrocytosis of unknown origin. All patients with PV, and none with secondary polycythaemias, had spontaneous erythroid colony formation. Three of 4 untreated and 2 of 9 treated PV patients had increased number of CFU-E colonies in bone marrow. From these results it can be concluded that erythroid progenitor cell culture is a useful differential diagnostic method in erythrocytosis patients who cannot be classified clinically under PV or secondary polycythaemias.

Principles and perspectives of urology and nephrology

It is an old rule that scientific analysis should begin with a precise definition of concepts. In this respect precision is a strict requirement for every member of the medical profession. When analysing the principles of urology and nephrology as special fields of science, we must understand the origin of both specialties, the essence behind their terminologies, the changes in the ideas with the lapse of time, to be able to foresee what future may bring. Urology had separated from general surgery about 100 years ago and now is accepted as an independent branch of surgery, a well-defined specialty. The denomination which truly reflects the essence in the background, has gained rights in terminology, but not absolutely so in practice. "Urology" or the often used term "urological surgery" means essentially a specialty devoted to the kidneys as uropoietic organs. Yet ipso facto as far as the embryological, anatomical and functional correlations are concerned, in practice urology includes the therapeutic surgery of the male genital organs. It was only in the thirties of this century that the inflammatory diseases of the male genital organs not requiring surgery have found their final place in dermatology; at the same time urology has ridden itself for good of the patronage of surgery and dermatovenerology. Thus, urology became concerned with all those diseases of the urinary and genital organs which required surgery or manipulations by means of special instruments. It is only natural that the interventions in a well-defined anatomical region have become differentiated; for this the peculiarities of the urogenital tract as well as the technical advances in special urological instruments and tools have furnished an excellent basis. For a long time after its separation from surgery, urology refused to concern itself with the treatment of the various conditior~s known under the term Bright's disease. Obviously for the same reason, urology devoted hardly any attention to other pathological processes affecting diffusely the renal tissues. Some justification for this could be found in the inefficiency of differential diagnostic methods and in the poor results of surgical treatment of the inflammatory renal conditions. In the 1920s the discoveries of Volhard and Fahr have entirely changed our approach to renal diseases. Their results evoked a particularly lively response

Coagulation Defects—Bleeding Tendencies.

Excerpt 1. Normal hemostatic mechanisms. 2. Classification of hemorrhagic diseases, both primary and secondary. 3. Differential diagnostic methods. 4. Research approaches to the problems of blood c...

A Differential Diagnostic Method of Mitralstenosis and Insufficiency by Means of Pulmonary Artery Pressure Response to 45 Degree Tilt

Pulmonary hemodynamics and respiratory functions have been investigated in various body positions. In these studies, however. especially of pulmonary hemodynamics some difficulties were encountered which came from the problem of the setting of reference zero point to measure the pressure common to variable body positions. The changes of pulmonary artery pressures refered to a settled zeropoint which were measured for ten minutes after tilting of the body head up at an angle of 45 degrees from the horizontal, were found to be not in-variable in different diseases and clearly showed different response patterns between stenosis or stenosis predominant and insufficiency or insufficiency predominant mitral valvular diseases. The pulmonary artery pressure response to 45 degree tilting is presented as a new, useful, differential diagnostic method for mitral valvular diseases, and for the determination of indication for cardiac surgery.

Significance of the Bordet-Gengou reaction in the gonorrhea clinic

The value of serodiagnosis, as a differential diagnostic method for gonorrhea, is now not disputed this is the opinion of prof. Oppenheim'a, one of the first to use the complement rejection reaction in gonorrhea back in 1906. At the Moscow meeting on the fight against gonorrhea (in December 1928) prof. Finkelstein said that the Bordet-Gengou method has passed the test stage and with the help of serodiagnostics it is possible to solve diagnostic, prognostic and therapeutic issues in the gonorrhea clinic.

A Bacteriologic Study of Secondary Invaders in Hog-Cholera

work of De Schweinitz, Dorset, and McBryde1 appeared that the etiology was cleared up. These investigations, followed by those of Hutyra,2 Uhlenhuth, Haendel, and others,3 established the feature of secondary invasion. As yet, attempts to differentiate the organisms found in hogcholera have not met with success. Apart from B. suisepticus, which is placed in the hemorrhagic septicemia group, none of the others can be separated sharply from B. paratyphosus B and from bacilli associated with meat poisoning. The morphologic, cultural, and serologic behavior of B. suipestifer places it in such close relation to these that a definite separation is not possible with the differential-diagnostic methods now available. The significance of this organism in hogcholera has long been recognized. It is possible by means of B. suipestifer to produce an experimental infection giving rise to pathologic changes which apparently correspond to natural hog-cholera. The bacillus of hog-cholera (B. suipestifer), altho present in a number of cases, is not found invariably in the organs of animals with the disease. In several outbreaks of hog-cholera studied by Smith in America, no such organisms were isolated. Preiss, in a systematic examination of 80 cases from different sources, found B. suipestifer