Pathoanatomical Diagnosis Research Articles

Development and reproductive qualities of sows of different breeds: innovative and traditional methods of assessment

Development and reproductive qualities of sows of different breeds: innovative and traditional methods of assessment

Intertester reliability of a movement impairment-based classification system for individuals with shoulder pain.

Background:Other than pathoanatomical diagnosis, physical therapy managements need the diagnosis of movement-related impairments for guiding treatment interventions. The classification system of the Movement System Impairment (MSI) has been adopted to label the musculoskeletal disorders in physical therapy practice. However, reliability study of this classification system in individuals with shoulder pain has not been reported in the literature.Objective:This paper investigated the intertester reliability of the diagnosis based on the MSI classification system in individuals with shoulder pain.Methods:The patients with shoulder pain, between the ages 18–60 years, were recruited if he or she had pain between 30 and 70 on the 100 mm visual analog scale for at least three months. The examiners who were two physical therapists with different clinical experiences received a standardized training program. They independently examined 45 patients in random order. Each patient was examined by both therapists on the same day. The standardized examination scheme based on the MSI approach was used. Patients were identified to subgroup syndromes according to scapular and humeral syndromes and also determining their subcategory syndromes. Six scapular subcategory syndromes included downward rotated, depressed, abducted, wing, internal rotated/anterior tilted, and elevated. Three humeral subcategory syndromes were anterior glide, superior glide, and medial rotated. More than one subgroup and subcategory of syndromes could be identified in each patient. The test results of each session were blinded to another therapist. The percentages of agreement and kappa statistic were determined.Results:The results showed that agreement levels in identifying subgroup syndromes was fair (71.11% agreement, kappa coefficient 0.34) and classifying subcategories syndromes were poor to substantial (73.33–91.11% agreement, kappa coefficient 0.200.66). The overall agreement and kappa value of the MSI classification of subcategory syndromes was poor (kappa coefficient 0.11; 95% CI 0.05–0.18). The agreement level of subcategories for scapular depression and humeral superior glide syndromes was substantial. The scapular winging, depression, and downward rotation were the three syndromes that were most frequently identified by both the examiners.Conclusion:The intertester reliability between therapists with different experience according to the MSI approach for shoulder pain classification was generally acceptable to poor due to the nature of the classification system. The standardized procedure and intensive training can be used for inculcating novice therapists with adequate level of intertester reliability of examination.

Can clinical assessment differentiate partial thickness rotator cuff tears from full thickness rotator cuff tears? A secondary analysis

Purpose: Shoulder pain causes significant disability, with rotator cuff disease as a common diagnosis. Differentially diagnosing partial tears of the rotator cuff tendons is difficult despite use of imaging and clinical examination. Our objective was to determine if a clinical assessment framework could discriminate between patients with partial and full thickness tears.Materials and Methods: Pre-operative baseline data from two randomized controlled trials of 452 adult patients awaiting rotator cuff repair were analyzed in this secondary analysis. Nineteen items from a pre-defined clinical assessment framework were investigated for association with the outcome of surgically confirmed partial or full thickness tear. Logistic regression tested independent associations and multivariable models were developed to create the most parsimonious model.Results: Thirty-two participants (7%) had partial thickness tears. Constant Power Score was the sole item associated with partial thickness tears (OR 1.07, 95% CI 1.02–1.12). Traumatic mechanism of injury trended toward significance (OR 2.17, 95% CI 1.06–4.48).Conclusions: Greater abduction strength (i.e., Constant Power Score) was associated with partial thickness tears. Other clinical assessment items did not differentiate between partial and full tears. Our results add to the growing body of research showing most clinical findings are not associated with a diagnosis in rotator cuff disease.Implications for RehabilitationGreater shoulder abduction strength (as measured with the Constant Power Score) was associated with partial thickness rotator cuff tears.Most findings within our clinical assessment framework did not distinguish between partial thickness and full thickness rotator cuff tears and thus, did not contribute to a differential pathoanatomical diagnosis.Since structural integrity of the rotator cuff and patient presentation show poor association, and rehabilitation intervention is often impairment-based, pathoanatomical diagnosis may not adequately direct non-surgical treatment. Including movement-based diagnoses or treatment classification systems in evaluation of rotator cuff disease may improve selection of appropriate conservative treatment.

DIAGNOSTIC INFORMATIVITY OF IMMUNOHISTOCHEMICAL BIOMARKERS IN CONDUCTING PRIVATIC PATHOLOGICAL AND ANATOMICAL RESEARCH OF PROSTATE CANCER

The results of an in vivo pathoanatomical differential diagnosis of primary acinar adenocarcinoma of the prostate and benign lesions of the prostate gland were analyzed using a transrectal biopsy of the prostate gland using an optimized panel of antibodies to high-molecular cytokeratins (clone 34E12), protein P63, AMACR, PSA and/or PSRA. The greatest diagnostic informativity of the basal cell differentiation marker of the columnar prostate epithelial cells was shown. The use of this set of biomarkers contributes to the establishment of a correct diagnosis and, in addition to the routine morphological examination of the biopsy material, can be recommended for carrying out an intravital pathologic anatomic differential diagnosis of prostate cancer.

Principles autopsy in cases of perinatal death

Achievements in modern medicine, allowed since 2012, significantly reduce perinatal mortality in the Russian Federation. Despite the impressive rate of decline in perinatal mortality, there are still quite a few deaths that could be prevented. Causes and mechanisms of death in the perinatal period, starting from the 22nd week of intrauterine fetal development, on the 7th day after birth, are significantly different from the tanatogenesis in a patient living more than 7 days. Our work presents perinatal mortality rates in the Russian Federation for the period from 2010 to 2016 and formulates recommendations for the consistent implementation of all stages of an autopsy of the deceased in the perinatal period in full. Issues of approaches to pathoanatomical research, principles of diagnosis formulation and correct registration of medical documentation in stillbirth and in cases of death in the early neonatal period were discussed. The main criteria that allow differential diagnostics between antenatal intrapartum fetal death and the death of a child in the early neonatal period are considered. In addition, we have developed a classification of pathoanatomical diagnosis, taking into account the characteristics of the perinatal period and the interaction in the “mother-placenta-fetus” system. The authors note that in the case of a fatal outcome in the perinatal period, the final pathoanatomical diagnosis, in addition to the generally accepted headings, should take into account the mother's condition (pathology of pregnancy, childbirth), as well as the pathology of the afterbirth.

ПАТОЛОГОАНАТОМИЧЕСКАЯ ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА БОЛЕЗНЕЙ, ПРИЧИНЯЮЩИХ ВНЕЗАПНУЮ СМЕРТЬ ПОРОСЯТ НА ОТКОРМЕ

ПАТОЛОГОАНАТОМИЧЕСКАЯ ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА БОЛЕЗНЕЙ, ПРИЧИНЯЮЩИХ ВНЕЗАПНУЮ СМЕРТЬ ПОРОСЯТ НА ОТКОРМЕ

Subacute de Quervain's thyroiditis: clinical and pathomorphological features of patients operated on thyroid gland.

Background. An annual increase in the number of patients with endocrine pathology is observed in Ukraine. SubacutedeQuervain's thyroiditis is a rare inflammatory disease of thyroid gland of viral etiology which on average occurs in 3 - 6% of cases among all thyroid pathology. Objective – to study clinical and pathomorphological features of Subacute de Quervain's thyroiditis of patients operated on thyroid gland in the last ten years. Меthods. Analysis of archival data results of pathohistological reports on the patients operated on thyroid gland in Lviv Regional Clinical Hospital in 2006-2015 and medical histories with diagnosed cases of Subacute de Quervain's thyroiditis was conducted. In ten years’ time 5587 cases of patients operated on thyroid gland pathology have been revealed, among them 17 cases of Subacute de Quervain's thyroiditis which is 0,3% from all thyroid diseases. There were only women among the patients and their average age was 56. Results. While studying the medical histories it was revealed that the most frequent women’s complaints were the following: feeling of a foreign body in the neck area, discomfort when swallowing, bulging on the front of the neck, dyspnea, general weakness. Subacute de Quervain's thyroiditis was not diagnosed clinically in any case, and in one third of the cases there was a suspicion of malignant thyroid tumor. Pathoanatomical diagnosis in half of the cases was combined and often Subacute de Quervain's thyroiditis was combined with a multi-nodule colloid goiter. Conclusion. Subacute de Quervain's thyroiditis is a rare pathology of thyroid gland without sufficiently characteristic pathognomonic signs that makes clinical diagnostics rather difficult. Thoroughly collected anamnesis and conducting of appropriate laboratory tests including ultrasonic diagnostics of thyroid gland help to diagnose Subacute de Quervain's thyroiditis.

Prenatal ultrasound diagnosis of Ebstein’s anomaly combined with Down’s syndrome: literature review and own observation

The rare prenatal diagnostics case of combined Ebstein’s anomaly with Down’s syndrome is presented. As a result of prenatal ultrasound screening at 22–23 weeks of gestation were detected specific characteristics of this congenital heart disease and soft sonographic sings of chromosome anomalies. The cordocentesis was executed and by way of classical cytogenetic analysis was defined the fetus’ karyotype: 47,XY+21. In connection with unfavorable prognosis the pregnancy was terminated. Pathologist’s report confirmed the pulmonary artery stenosis. Another autopcy marks of heart disease, such as pathology of tricuspid valve was not detected. Literature review of Ebstein’s anomaly combined with Down’s syndrome and the other chromosomal and genetic anomalies were presented and causes of dissonance of prenatal and pathoanatomical diagnosis were discussed.

Pathoanatomical diagnosis, treatment and preventive measures at pigs gastroenterocolitis

The reasons of the occurrence of gastroenterocolitis of pigs, their pathomorphological manifestations are being discussed, the schemes of treatment and prophylaxis are offered. The most common factor-related infections in pig breeding are colibacillosis, dysentery and ileitis (proliferative enteropathy). Colibacteriosis occurs from birth to 50–60-day age, and dysentery with ileitis - from 2 to 5–6 months. It was established that the development of gastroenterocolitis is associated with a violation of the balance of the microflora and the reproduction of pathogenic strains of microorganisms, which can lead to the development of colibacteriosis, dysentery and ilite, sometimes – clostridiosis. In the pathoanatomical picture of colibacteriosis erosive gastroenteritis predominates, for dysentery – hemorrhagic colitis, for ileitis – proliferative ilite and colitis, for clostridios – hemorrhagic-necrotic enterocolitis. The analysis of veterinary measures carried out on farms showed a lack of a systematic approach to the treatment of factor infections. This was especially true for small farms, which attracted attention to the limited range of antibiotics, incorrect dosage of drugs, chaotic use of antimicrobial treatments. Experimental authors have compiled a universal preventive scheme for subspigmented piglets and breeding animals of the group that contained measures against gastroenterocolitiss of different etiologies. The work emphasizes the general prevention of diseases of the digestive system: providing animals with balanced quality feeds, improving the conditions for keeping pigs and conducting adequate medical and preventive measures.

Preweaning mortality in piglets in loose-housed herds: etiology and prevalence

Preweaning mortality in piglets is a welfare issue, as well as an ethical and economic concern in commercial pig farming. Studying the causes of preweaning mortality and their prevalence is necessary to reduce losses. Preweaning piglet mortality was investigated in a field study including 347 sows from 14 loose-housed Norwegian piglet-producing herds. A total of 5254 piglets were born in these herds during the study period, and 1200 piglets were necropsied. The cause of death was based on pathoanatomical diagnosis (PAD). Preweaning mortality of all piglets in the study was 23.4%, including 6.3% stillborn. The two main causes of preweaning mortality in live-born piglets (n=4924) were trauma (7.1%) and starvation (2.7%). Piglets dying of an infection accounted for 2.0%. Among the necropsied piglets (n=1200), 29.1% had died due to trauma, 26.8% were categorized as stillborn and 11% had died of starvation. Piglets that had died of trauma, had a mean time of death of 1 lactation day (LD 1), ranging from LD 0 to LD 21. The mean time of death of piglets that died due to bacterial infection was LD 9, ranging from LD 0 to LD 31, with Escherichia coli accounting for most infections found in necropsied piglets. Farmers were able to identify death by trauma in piglets, but were less able to identify death due to hunger. Most piglets that died in the preweaning period, died of trauma. Surprisingly, this included large and well-fed piglets. The second most prevalent cause of preweaning mortality was starvation. Improved monitoring may reveal piglets with low body mass index, and additional nutrition may contribute to increase the survival rate.

Skin Blood Flow in Diabetic Peripheral Neuropathy: A Focused overview of Patho-Anatomical Diagnosis and Therapy

Skin Blood Flow in Diabetic Peripheral Neuropathy: A Focused overview of Patho-Anatomical Diagnosis and Therapy

Cone Beam Computertomography (CBCT) in Interventional Chest Medicine - High Feasibility for Endobronchial Realtime Navigation

Introduction: Currently there are several advanced guiding techniques for pathoanatomical diagnosis of incidental solitary pulmonary nodules (iSPN): Electromagnetic navigation (EMN) with or without endobronchial ultrasound (EBUS) with miniprobe, transthoracic ultrasound (TTUS) for needle approach to the pleural wall and adjacent lung and computed tomography (CT) -guidance for (seldom if ever used) endobronchial or (common) transthoracical approach. In several situations one technique is not enough for efficient diagnosis, therefore we investigated a new diagnostic technique of endobronchial guided biopsies by a Cone Beam Computertomography (CBCT) called DynaCT (SIEMENS AG Forchheim, Germany). Method and Material: In our study 33 incidental solitary pulmonary nodules (iSPNs) (28 malignant, 5 benign; mean diameter 25 +/-12mm, shortest distance to pleura 25+/-18mm) were eligible according to in- and exclusion criteria. Realtime and onsite navigation were performed according to our standard protocol.22 All iSPN were controlled with a second technique when necessary and clinical feasible in case of unspecific or unexpected histological result. In all cases common guidelines of treatment of different iSPNs were followed in a routine manner. Results: Overall navigational yield (ny) was 91% and diagnostic yield (dy) 70%, dy for all accomplished malignant cases (n=28) was 82%. In the subgroup analysis of the invisible iSPN (n=12, 11 malignant, 1 benign; mean diameter 15+/-3mm) we found an overall dy of 75%. For the first time we describe a significant difference in specifity of biopsy results in regards to the position of the forceps in the 3-dimensional volume (3DV) of the iSPN in the whole sample group. Comparing the specifity of biopsies of a 3D-uncentered but inside the outer one third of an iSPN-3DV with the specifity of biopsies of centered forceps position (meaning the inner two third of an iSPN-3DV) reveals a significant (p=0,0375 McNemar) difference for the size group (>1cm) of 0,9 for centered biopsies vs. 0,3 for uncentered biopsies. Therefore only 3D-centered biopsies should be relied on especially in case of a benign result. Conclusion:The diagnostic yield of DynaCT navigation guided transbronchial biopsies (TBB) only with forceps is at least up to twofold higher than conventional TBB for iSPNs <2cm. The diagnostic yield of DynaCT navigation guided forceps TBB in invisible SPNs is at least in the range of other navigation studies which were performed partly with multiple navigation tools and multiple instruments. For future diagnostic and therapeutic approaches it is so far the only onsite and realtime extrathoracic navigation approach (except for computed tomography (CT)-fluoroscopy) in the bronchoscopy suite which keeps the working channel open. The system purchase represents an important investment for hospitals but it is a multidisciplinary and multinavigational tool with possible access via bronchial airways, transthoracical or vascular approach at the same time and on the same table without the need for an expensive disposable instrument use.

Telerehabilitation mediated physiotherapy assessment of ankle disorders

Musculoskeletal injuries are the most common source of chronic pain and disability. The ankle joint is the most common of these injuries and without adequate rehabilitation function can be severely impaired. Access to physiotherapy rehabilitation services can be limited due to geographical remoteness and a shortage of services in rural and remote areas. Telerehabilitation is a potential solution to bridge this service delivery gap. The aim of this study was to determine the criterion validity and reliability of conducting a remote musculoskeletal assessment of the ankle joint complex using telerehabilitation technologies compared with a face-to-face assessment. This study utilized a repeated measures design to assess 15 subjects (mean age 24.5, SD 10.8 years) presenting with ankle pain. Conventional face-to-face assessments were compared with assessments performed via a telerehabilitation system. A similar agreement of 93.3% in patho-anatomical diagnosis and an 80% exact agreement (chi(2) = 4.267; p < 0.04) in primary systems diagnosis was found between face-to-face and telerehabilitation assessments. Clinical observations were found to have very strong agreement (k = 0.92) for categorical data and significant agreement (93.3% agreement; chi(2) = 234.4; p < 0.001) for binary data. A high level of inter- and intrarater reliability was found for the telerehabilitation assessments. This study demonstrates the criterion validity and reliability of remote musculoskeletal assessments of the ankle joint complex using telerehabilitation.

Atraumatiske skulderlidelser

Shoulder pain (usually non-traumatic) is the third most common cause of consultations for musculoskeletal pain in primary health care. This article discusses challenges within diagnostics and treatment of non-traumatic shoulder pain. The article is based on literature identified through a non-systematic search in PubMed and the Cochrane library. One clinical test alone is generally not sufficient to make a pathoanatomical diagnosis. The incidence of degenerative changes in the normal population makes it difficult to interpret diagnostic images. MR is mainly indicated as part of a preoperative assessment and upon a specific indication. For diagnosis of the rotator cuff, ultrasound is as good as MR. Clinical studies do not show clear effects of specific treatment. This may be caused by methodological weaknesses of the trials evaluated and that patient characteristics and placebo effects contribute to the diagnosis. Injection with glucocorticoids seems to be well founded in patients with adhesive capsulate (frozen shoulder). With subacromial pain, supervised physical exercise and surgical treatment have similar effects, but there is not sufficient evidence to recommend particular treatments for rupture. Non-traumatic shoulder pain is usually diagnosed adequately from the medical history and a combination of clinical tests; conservative treatment is most often adequate. When diagnostic imaging is required, ultrasound should be the first choice.

Current Management of Acute Musculoskeletal Pain in the Ambulatory Care Setting

Three issues related to the management of acute musculoskeletal pain in the ambulatory care setting deserve more attention than they currently receive: pain assessment, the degree of diagnostic specificity needed to select treatment, and gaps in the care that clinicians need to consider. This article describes several pain assessment instruments and explains why they are appropriate in the acute care setting. It also reviews several reports demonstrating that most patients with acute musculoskeletal pain, particularly low back pain, cannot be given a definitive pathoanatomical diagnosis. Therefore, categorizing the pain as mechanical or secondary to underlying causes is sufficient to select and institute treatment. Gaps in care, such as the need for increased patient education, accurate information to dispel misconceptions about therapy, and additional safety and efficacy data about drugs used to treat acute musculoskeletal pain, are also addressed.

What Is the Relationship of Low Back Pain to Signs of Abnormal Skeletal Metabolism Detected by Bone Scans?

In approximately 80-85% of patients with chronic nonspecific low back pain (NSLBP), a precise pathoanatomical diagnosis cannot be identified. Mechanisms of bone nociception may contribute to NSLBP. To determine whether findings on bone scans, which provide a pathophysiological picture of functional activity, are associated with self-reports of NSLBP intensity. A cross-sectional study of the relationship of self-reported chronic NSLBP intensity to the uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area. Patients referred for bone scans who were at least 18 years old. Subject reports of pain intensity and intensity of uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area. Among subjects who were 65 years or younger, the age-adjusted worst pain intensity accounted for 45% of the variability in the amount of tracer uptake (r = 0.67, P = 0.0006). The association was not significant for those older than 65 years. Further studies should be conducted on possible mechanisms relating bone nociception to chronic NSLBP in individuals who are 65 years or younger.

Condrosarcoma mesenquimal primario en el mediastino

Cartilaginous lesions of the mediastinum are quite rare and primary cartilage forming tumors arising within the mediastinum are even more exceptional. Radiologic findings are unspecific. However, certain characteristics can orient the diagnosis. They are presented one mediastinal chondrosarcoma case in adult patient of patho-anatomical diagnosis. The findings described entail chest radiography, computed tomography and magnetic resonance.

266: Pathoanatomical diagnosis after heart transplant in patients with cardiomyopathy – does it match pretransplant diagnosis?

266: Pathoanatomical diagnosis after heart transplant in patients with cardiomyopathy – does it match pretransplant diagnosis?

Self-Care Guidelines for the Management of Nonspecific Low Back Pain

Low back pain is a very common disorder among adults. However, most low back pain is nonspecific; it has no known cause and cannot be given a precise pathoanatomical diagnosis. Nonspecific low back pain can be very painful, but it is not serious; it is basically an age-related disorder that is affected by differences in occupation, genetics, and personal behavior. There are many different treatments for nonspecific low back pain, but most of them are ineffective. Most patients improve considerably during the first 4 weeks-with or without medical treatment. There is increasing support in the medical literature for patients to assume more responsibility for self-care, and less dependence upon the health care provider. Evidence-based self-care guidelines are presented for use by both the health care provider and the patient. The guidelines offer advice regarding medication, exercise, physical activity, coping skills, and prevention of the next episode.

Nonoperative Management of Low Back Pain and Lumbar Disc Degeneration

The approach to the management of low back pain has undergone substantial change in recent decades. Low back pain can often present as a difficult problem to solve. It is a loosely defined diagnosis that may refer to multiple patterns of pain with complex issues surrounding its pathoanatomical diagnosis and treatment. There is a paucity of evidence from the health professional literature regarding its cause, management, and prognosis. The difficulty of managing patients with low back pain stems from the fact that there often is very little association between any pathological physical findings and the patient's pain and disability. The professional must then find ways of clinically treating a syndrome that betrays the principles of basic science. In recent years, the advancement in diagnostic modalities and therapies has led to the belief that there are precise and treatable organic causes of low back pain. The quickly evolving worlds of radiology, electrodiagnostics, and injection techniques have yielded advances in diagnostic reliability and more directed treatment plans. Many who routinely treat axial low back pain favor the idea that identification of a particular pain generator should be aggressively pursued and identified. Only after a thorough attempt has been made to provide a focused pathoanatomical diagnosis should the diagnosis of a nonspecific low back disorder be accepted by the patient or physician. With the understanding that there are still many difficulties in the management of low back syndromes, this lecture will review some of the available nonoperative modes of low back pain treatment, which can be applied regardless of whether a particular pain mediator has been identified. Currently, low back pain is epidemic in the United States. Its annual incidence has been projected to be 5% per year, with an associated prevalence of 60% to 90%1. The one-month prevalence of low …