Prominent Role In Diagnosis Research Articles

Spontaneous transomental hernia: a case report of a rare internal hernia with a challenging diagnosis

Introduction and Importance: Transomental hernia (TOH) is an extremely rare clinical condition that represents 1–4% of all internal hernias. Spontaneous TOH occurs in patients with no history of surgery or previous abdominal trauma. It happens after protrusion of the abdominal viscera, commonly the small bowel loops through a defect on the great omentum. Presentation of the case: We present a case of occlusion due to TOH in a 66-year-old man who underwent a laparotomy, and operative exploration showed 10 cm of small bowel incarcerated through a defect in the right side of the greater omentum of 4 cm in diameter. Discussion: The diagnosis is usually delayed because symptoms are nonspecific. Postoperative morbidity and mortality are important because patients present most frequently with gangrenous bowel, making morbidity and mortality higher. Therefore, it constitutes a critical surgical emergency and must be quickly recognized and managed. Computed tomography (CT) scan plays a prominent role in diagnosis. Midline laparotomy is the main emergency approach for patients with unknown bowel obstruction. Some authors suggest a laparoscopic approach, but it requires a surgeon’s experience and propitious patient’s conditions. Conclusion: TOH is the rarest type of internal hernia with extremely difficult preoperative diagnosis due to nonspecific semiology. This type of hernia has the highest morbidity and mortality rates of all internal hernias. Thus, it must be suspected whenever there is bowel obstruction of unknown origin and quickly managed.

Ankyloglossia in Australia: Experiences and perspectives of parents and caregivers

ObjectivesTo investigate the perspectives and experiences of parents of infants with ankyloglossia in Australia. MethodTwo hundred and sixty-seven parents across Australia responded to an online survey including their experiences of having a child with ankyloglossia. Descriptive statistics were used to analyse quantitative data. ResultsParticipants were from all Australian states and territories, with the majority residing in New South Wales and Victoria. Ankyloglossia diagnoses typically occurred within the first two weeks of life, driven mainly by difficulties with feeding. Lactation consultants played a prominent role in diagnosis, particularly in rural areas. Surgical interventions were common, with frenotomy using scissors or scalpel being the primary treatment. Aftercare recommendations, including stretching the frenotomy wound, were prevalent. Most parents received education about ankyloglossia, primarily through verbal and written information. Parents generally reported high satisfaction with the effectiveness of treatments, favouring surgical interventions. However, satisfaction with health professionals' support did not consistently correlate with the likelihood of consenting to the treatment again, and those who conducted their own research on ankyloglossia expressed lower satisfaction with health professionals’ support. ConclusionsThe experiences of Australian parents in their infant's diagnosis, management and education of ankyloglossia varied greatly. Clinical guidelines for all relevant health professionals are needed to ensure standardised diagnosis and management processes. In future, this will help guide evidence-based diagnosis and intervention for infants with ankyloglossia.

Evaluation of thoracic vertebrae in healthy White New Zealand rabbit (Oryctolagus Cuniculus): Computed tomographic and morphometric study.

BackgroundComputed tomography currently has a prominent role in diagnosis and evaluation of vertebral column. On the other hand, a thorough knowledge about vertebral column property in normal state is prerequisite an accurate diagnosis of different abnormalities in this region.ObjectiveThe purpose of this study was to present a complete and exact descriptive and morphometric evaluation of thoracic vertebrae in rabbits with computed tomography. In images which were constructed by CT, several structures and different parts of the thoracic vertebrae have been named.MethodsTen healthy, mature, White New Zealand rabbits were evaluated. The morphologic and morphometric parameters of the thoracic vertebrae were studied. In this study, several parameters of thoracic vertebrae, such as vertebral body height, spinous process height, transverse process length, transverse process width, etc., were measured by computed tomography.ResultsSome parameters, such as spinal canal height, spinal canal width, pedicle length, pedicle width, end plate width, and endplate height, had no significant difference through thoracic vertebrae but other parameters, such as vertebral body height, transverse process length, transverse process width, spinous process angle, transverse process angle, and vertebral body length, had a significant difference.ConclusionsIn this study, a comprehensive anatomic atlas of CT anatomy of the thoracic vertebrae was produced for use by veterinary radiologists, clinicians, and surgeons. Finally, we must mention these two important points: (1) Many of the differences observed between rabbits and humans are based on the way the trunks of these two creatures are located on the ground and the differences in the way their bodies move. (2) In studies that are done by modelling humans on animals, it should be noted that the terms used in animal anatomy are different and the names are used using the principles of veterinary anatomy.

Radiation Exposure From Diagnostic Imaging in Patients with Lymphoma - The Cost Of The Cure?

IntroductionThe American Cancer Society anticipates the diagnosis of 80,000 new cases of lymphoma in the US in 2013. Cancer Research UK estimates that more than 80% of Hodgkin Lymphoma (HL) patients and more than 60% of Non-Hodgkin Lymphoma (NHL) patients will be alive 5 or more years after diagnosis. As survival rates improve, focus shifts to ensuring quality of life in survivors and decreasing potential toxicity. Radiological procedures play a prominent role in diagnosis, staging and assessment of treatment response. Exposure to ionizing radiation has been linked to an increased risk of malignancy (Pearce et al 2012, Miglioretti et al 2013, Mathews et al 2013). Cumulative exposure in excess of 75mSv has been estimated to increase cancer mortality by 7.3% (Cardis et al 2007). There is a paucity of data in the literature regarding cumulative radiation exposure in patients with lymphoma. In cancer treatment, the aim is individualized management strategies. This should also be the goal for diagnostic procedures (O' Neill et al 2011, Fletcher et al 2012). MethodsA retrospective review of all patients on a prospectively maintained database with biopsy proven HL or NHL between January 2009 and July 2012 was conducted in a University hospital group. The cumulative effective radiation dose (CED) was calculated using standardized procedure-specific radiation dose levels. ResultsFour hundred and eighty six patients were included in the study. Mean (SD) age at diagnosis was 59 (17) years and 15% were aged < 40. Fifty-nine percent were men. Sixteen percent had HL; 84% had NHL. There were a total of 1127 patient-years of follow-up, with 15% having <1 year and 10% having 5 or more years of follow-up.Ninety-nine per cent of patients had diagnostic imaging. A total of 5748 radiological procedures were performed, equivalent to one procedure every 70 patient days of follow-up.The median estimated total CED ( IQR) per subject was 69mSv (42-118). Forty- six percent had a total CED >75mSv and 14% had a total CED >150mSv – SeeFigure 1. CT contributed 89% of the radiation dose and PET-CT contributed 8%.Patients aged <40 had a median CED (IQR) of 89mSv (55-124). Seventy-five per cent of these patients had a potentially curable malignancy (66% had HL; 5% had Diffuse Large B Cell Lymphoma; 4% had Burkitt Lymphoma). Patients who underwent stem cell transplantation had a median CED (IQR) of 162mSv (135-225) with 59% having radiotherapy as part of their management.Univariate analysis showed that age (p<0.001), duration of lymphoma (p<0.001) and stage (<0.001) were associated with CED. DiscussionThis study highlights the considerable ionizing radiation exposure from diagnostic imaging in patients with lymphoma. This is especially relevant in young people who would be considered the most radiosensitive and at highest risk for secondary malignancies.Low grade lymphomas are relapsing and remitting in nature and frequently require re-staging imaging over many years. Longer follow-up will be required here to potentially explain the non-significant trend between histological subtype and different CED.The American College of Radiology stated in 2013 that when used appropriately, the benefits of ionizing radiation far outweigh the risks. However, to minimize risk, institutions should participate in national dose registries. With the widespread use of Picture Archiving and Communication System (PACS), this will be feasible.Low dose CT imaging has emerged as a mechanism for minimizing CED. Dose reduction strategies incorporating patient-specific information would optimize imaging while minimizing the harmful effects (Shah et al 2012). Novel CT reconstruction algorithms allow diagnostic quality imaging to be obtained at reduced radiation doses without the prohibitive noise that would otherwise be present (Prakash et al 2010).Procedures which do not involve ionizing radiation such as MRI and ultrasound are becoming increasingly popular. There is growing interest in PET-MRI for staging of malignancies (Appenzeller 2013) but as yet, PET-CT remains superior.For patients with potentially curable lymphoma, particularly young patients with higher CED, consideration should be given to these strategies. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Integration of gene signatures using biological knowledge

Gene expression patterns that distinguish clinically significant disease subclasses may not only play a prominent role in diagnosis, but also lead to the therapeutic strategies tailoring the treatment to the particular biology of each disease. Nevertheless, gene expression signatures derived through statistical feature-extraction procedures on population datasets have received rightful criticism, since they share few genes in common, even when derived from the same dataset. We focus on knowledge complementarities conveyed by two or more gene-expression signatures by means of embedded biological processes and pathways, which alternatively form a meta-knowledge platform of analysis towards a more global, robust and powerful solution. The main contribution of this work is the introduction and study of an approach for integrating different gene signatures based on the underlying biological knowledge, in an attempt to derive a unified global solution. It is further recognized that one group's signature does not perform well on another group's data, due to incompatibilities of microarray technologies and the experimental design. We assess this cross-platform aspect, showing that a unified solution derived on the basis of both statistical and biological validation may also help in overcoming such inconsistencies. Based on the proposed approach we derived a unified 69-gene signature, which outperforms significantly the performance of the initial signatures succeeding a 0.73 accuracy metric on 234 new patients with 81% sensitivity and 64% specificity. The same signature manages to reveal the two prognostic groups on an additional dataset of 286 new patients obtained through a different experimental protocol and microarray platform. Furthermore, it manages to derive two clusters in a dataset from a different platform, showing remarkable difference on both gene-expression and survival-prediction levels.

Bronchoalveolar Lavage as a Diagnostic Tool

Bronchoalveolar lavage (BAL) provides an important diagnostic tool that can facilitate the diagnosis of various diffuse lung diseases. BAL fluid can be analyzed to determine white blood cell (WBC) profiles and to detect respiratory pathogens. Although BAL is seldom useful as a "stand-alone" diagnostic test for the diagnosis of diffuse infiltrative lung disease, when combined with clinical data and high-resolution computed tomography of the chest, BAL WBC profiles can contribute significantly to the diagnosis of specific forms of interstitial lung disease (ILD). Additionally, BAL can play a very important role in the diagnosis of respiratory infection, and it is useful in monitoring the lung allograft and in evaluating pediatric lung disease. Examination of BAL cells or acellular components of BAL via gene microarray technology or proteomic analyses may allow BAL to assume a more prominent role in diagnosis and management of lung disease in the near future.