Relevant Diagnosis Research Articles

Corticosteroid-responsive narcolepsy type II after COVID-19: A relevant differential diagnosis of post-COVID syndrome (a case report).

Excessive daytime sleepiness is a possible symptom of post-COVID syndrome and is also the cardinal symptom of narcolepsy, a rare life-long sleep disorder with a possible autoimmune background. Recent reports indicate that COVID-19 infection may trigger narcolepsy. However, it remains unclear how best to identify and treat such cases. A 25-year-old male developed daytime sleepiness after COVID-19 infection. A diagnosis of narcolepsy type II was made based on pathologically shortened sleep latencies in polysomnography and multiple sleep latency tests (MSLT) together with several sleep-onset REM-sleep periods (SOREMs). Pupillography and neuropsychological testing revealed reduced alertness levels. Hypocretin levels in the cerebrospinal fluid were borderline. Based on the postulated autoimmune background of narcolepsy, we performed an intravenous high-dose corticosteroid pulse therapy with methylprednisolone. Narcoleptic symptoms immediately and consistently remitted after the corticosteroid pulse. Follow-up after 4 months revealed normalisation of sleep latencies, no further SOREMs in the MSLT, and increased alertness in pupillography and neurocognitive testing. No further wakefulness promoting drug therapy was required. Narcolepsy should be considered in the differential diagnosis of post-COVID syndrome with leading symptoms of daytime sleepiness. Furthermore, immunosuppressive therapy may offer a treatment option in managing an otherwise lifelong disorder in select cases.

Non-Coding RNAs as Potential Diagnostic/Prognostic Markers for Hepatocellular Carcinoma.

The increasing incidence of hepatocellular carcinoma (HCC), together with the poor effectiveness of the available treatments, make early diagnosis and effective screening of utmost relevance. Liquid biopsy represents a potential novel approach to early HCC detection and monitoring. The identification of blood markers has many desirable features, including the absence of any significant risk for the patients, the possibility of being used as a screening tool, and the ability to perform multiple tests, thus allowing for the real-time monitoring of HCC evolution. Unfortunately, the available blood markers for HCC have several limitations, mostly related to specificity and sensitivity. In this context, employing non-coding RNAs (ncRNAs) may represent an interesting and novel diagnostic approach. ncRNAs, which include, among others, micro interfering RNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), regulate human gene expression via interactions with their target mRNA. Notably, their expression can be altered in HCC, thus reflecting disease status. In this review, we discuss some notable works that describe the use of miRNAs, lncRNAs, and circRNAs as HCC biomarkers. Despite some open aspects related to ncRNA use, the presented works strongly support the potential effectiveness of these molecules as diagnostic/prognostic markers for HCC.

Long-Term outcomes after stress echocardiography in real world practice: five-year follow-up of the UK Evarest study.

Stress echocardiography is widely used to assess patients with chest pain. The clinical value of a positive or negative test result to inform on likely longer-term outcomes when applied in real world practice across a healthcare system has not been previously reported. 5503 patients recruited across 32 UK NHS hospitals between 2018 and 2022, participating in the EVAREST/BSE-NSTEP prospective cohort study, with data on medical outcomes up to 2023 available from NHS England were included in analysis. Stress echocardiography results were related to outcomes, including death, procedures, hospital admissions and relevant cardiovascular diagnoses, based on Kaplan-Meier analysis and Cox proportional hazard ratios. Median follow-up was 829 days (IQR 224-1434). A positive stress echocardiogram was associated with a greater risk of myocardial infarction (HR 2.71, 95% CI 1.73-4.24, P<0.001), and a composite endpoint of cardiac-related mortality and myocardial infarction (HR 2.03, 95% CI 1.41-2.93, P<0.001). Hazard ratios increased with ischaemic burden. A negative stress echocardiogram identified an event-free 'warranty period' of at least five years in patients with no prior history of coronary artery disease, and four years for those with disease. In real-world practice, the degree of myocardial ischaemia recorded by clinicians at stress echocardiography correctly categorises risk of future events over the next five years. Reporting a stress echocardiogram as negative correctly identifies patients with no greater than a background risk of cardiovascular events over a similar time period.

Detection of breast cancer using machine learning on time-series diffuse optical transillumination data.

Optical mammography as a promising tool for cancer diagnosis has largely fallen behind expectations. Modern machine learning (ML) methods offer ways to improve cancer detection in diffuse optical transmission data. We aim to quantitatively evaluate the classification of cancer-positive versus cancer-negative patients using ML methods on raw transmission time series data from bilateral breast scans during subjects' rest. We use a support vector machine (SVM) with hyperparameter optimization and cross-validation to systematically explore a range of data preprocessing and feature-generation strategies. We also apply an automated ML (AutoML) framework to validate our findings. We use receiver operating characteristics and the corresponding area under the curve (AUC) to quantify classification performance. For the sample group available ( , 18 cancer patients), we demonstrate an AUC score of up to 93.3% for SVM classification and up to 95.0% for the AutoML classifier. ML offers a viable strategy for clinically relevant breast cancer diagnosis using diffuse-optical transmission measurements. The diagnostic performance of ML on raw data can outperform traditional statistical biomarkers derived from reconstructed image time series. To achieve clinically relevant performance, our ML approach requires simultaneous bilateral scanning of the breasts with spatially dense channel coverage.

Foix-Alajouanine syndrome: a comprehensive overview of rare but relevant diagnosis.

Foix-Alajouanine syndrome (FAS) is an uncommon neurological disorder marked by the gradual development of spinal cord congestion. First documented by Foix and Alajouanine in 1926. Although it is infrequent, delayed or misdiagnosis is nonetheless prevalent, resulting in inadequate therapy and unfavorable results. Using the PubMed database, MEDLINE, and EMBASE, we collected data on FAS patients and conducted a pooled analysis. The term 'FAS' was used to search for related articles. Our search was restricted to previous clinical case reports or series that were published in English. Non-English articles were excluded. We included the articles in the period from 1974 to 2024. Articles were eligible if the radiographic and clinical findings were indicative of FAS. A thorough research analysis was performed, examining case reports that specifically addressed this issue. This study examines the clinical symptoms, difficulties in diagnosis, methods of treatment, and outcomes related to FAS. FAS predominantly impacts the elderly population. A total of 26 patients were diagnosed with FAS. The median age of affected individuals was 53 (SD ±15.96). The ratio of males to females is roughly 5:1. The clinical manifestations encompass gradual muscle weakness and sensory impairments. The diagnosis is dependent on radiological evaluations, specifically MRI and digital subtraction angiography. Possible treatments include endovascular therapy, surgical closure of arteriovenous fistula, or a combination of the two. Significant improvements in neurological impairments can be achieved by early intervention. The diagnosis of FAS continues to be difficult due to its infrequency and varied clinical manifestations. Prompt and precise diagnosis is essential for proper intervention, typically utilizing endovascular or surgical methods. Additional research is required to determine prognostic markers and enhance long-term care techniques for this rare neurological condition.

The Differential Diagnosis of Leg Ulcers.

Chronic wounds on the leg (below the knee) are called leg ulcers. They have many causes, and thus patients with leg ulcers are treated by many different kinds of medical specialist. Appproximately 80% of sufferers have chronic venous insufficiency (CVI) and/or peripheral arterial occlusive disease (PAOD). Knowledge of the relevant differential diagnoses is important for appropriate treatment, particularly for patients with atypical findings or an intractable course. This article is based on publications retrieved by a selective search in PubMed, including current guidelines and expert recommendations. The diagnostic evaluation of a leg ulcer can be structured according to the ABCDE rule. This involves individualized, targeted history-taking (anamnesis); bacteriological testing; clinical examination; ancillary testing, particularly for perfusion (defective vascular system); and extras, such as biopsies. Specifically, we present in this article the main aspects of the complex diagnostic evaluation of venous leg ulcers, arterial leg ulcers, vasculitis, vasculopathy, calciphylaxis, pyoderma gangrenosum, necrobiosis lipoidica, ecthyma, and squamous cell carcinoma. There remain many unsolved problems, including interactions between the various areas of clinical treatment and the relative paucity of relevant high-quality research. A timely differential-diagnostic evaluation for the many diseases that can cause leg ulcers, which require treatment from representatives of many different medical specialties and health professions, is a prerequisite for their effective individualized treatment.

Experiences of access to care, diagnosis and rehabilitation among a multiethnic patient population with long-COVID in Denmark

Abstract Background and aim The aim of the study was to explore the experiences of accessing care, diagnosis, and rehabilitation among patients with long-COVID in a multiethnic population in Denmark. Methods Qualitative research using semi-structured interviews among a purposive sample of 18 people diagnosed with long-COVID, according to the NICE guideline, in the Capital Region of Denmark. Participants were sampled to secure variation in sex, age, ethnicity, migration status and education. Our interview guide was developed using the theoretical framework of candidacy. Interviews were transcribed verbatim, and member checked, and subsequently analyzed using thematic framework analysis and NVivo software. Results The analysis generated four categories: i) living with long-COVID, ii) access to care, iii) experiences in the healthcare system, and iv) experiences with rehabilitation. A main category was identified from these categories: limited knowledge of COVID resulting in uncertainty, which challenged nearly all aspects of access to diagnosis, care and rehabilitation among the informants. In particular, ethnic minorities experienced that their motives for seeking care were questioned or had the experience of differential treatment. In general, participants perceived to be themselves responsible of recovering, while also struggling with the mental, social and work-related consequences of their long-COVID. Conclusions Our study demonstrated how the emergence of a new viral disease with unknown long-term sequelae results in a group of patients who to a great extend carry the burden of getting better themselves. More research into relevant diagnosis, care and support for long-COVID patients is needed, especially among ethnic minorities.

Real-world effectiveness of primary care psychological therapy for depression and anxiety in patients with coronary heart disease

Abstract Background Depression and anxiety are often inadequately treated in patients with coronary heart disease (CHD), despite mental health issues being associated with poorer quality of life, higher cardiovascular morbidity, and higher mortality. Talking therapies, such as cognitive behavioural therapy, are the recommended first-line treatment for depression and anxiety symptoms in CHD patients. However, the evidence for their effectiveness was considered low in a recent Cochrane review, and trial participants may not represent patients treated in routine clinical settings. Purpose To assess the effectiveness of routinely-delivered talking therapies in patients with CHD from nationwide primary care talking therapy services in England, and to compare their treatment outcomes to patients without a CHD diagnosis. Methods Healthcare records from 1.9 million patients who completed a course of treatment (≥2 treatment sessions) via NHS Talking Therapies for anxiety and depression (NHS TTad) between 2012-2019 were linked to Hospital Episode Statistics, the Mental Health Services Data Set, and death records. Standard NHS TTad outcome indicators (recovery, reliable improvement, and reliable deterioration) were examined in three groups, with (1) any CHD (n=41,317; ICD-10=I20-I25), (2) acute coronary syndromes (ACS, n=29,991; I21, I22, I20.0), and (3) chronic CHD (n=40,524; I20.1-I20.9, I23-I25) at baseline. Effect sizes for pre-post treatment changes in depression and anxiety symptom measures (PHQ-9 and GAD-7) were calculated using the adapted Cohen’s d for within-subjects design (dav). Outcomes were also compared to those of propensity-score matched control groups without the relevant diagnoses, using logistic regression. Results After completing a course of talking therapy, 49.8% (95%CI=49.3;50.3) of patients with CHD recovered from depression or anxiety, 69.4% (95%CI=69.0;69.9) saw reliable improvement in symptoms, and 7.3% (95%CI=7.0;7.5) experienced reliable deterioration in symptoms. There were large reductions in both depression (dav=-1.02) and anxiety symptoms (dav=-1.03) on average. Compared to a control sample of patients with no diagnosis of CHD, those with a CHD diagnosis were less likely to recover (OR=0.87[95%CI=0.84;0.89]) or reliably improve (OR=0.84[95%CI=0.81;0.87]) and more likely to reliably deteriorate (OR=1.28[95%CI=1.21;1.36]), when matched on age, sex, ethnicity, deprivation, baseline depression and anxiety symptom scores, self-reported long-term health condition, and waiting times between referral, assessment, and treatment. The findings were consistent for patients with ACS and those with chronic CHD. Conclusions Nearly half of CHD patients who received primary care talking therapy recovered, in line with the UK Government target of 50% recovery for the services. Nevertheless, compared to otherwise similar patients without CHD, those with CHD at baseline had worse psychological treatment outcomes.

Large-scale analysis reveals racial disparities in the prevalence of ADHD and conduct disorders

The primary purpose of this study is to highlight trends in the prevalence of attention deficit/hyperactivity disorders (ADHD) and conduct disorders (CD) between non-Hispanic White and non-Hispanic Black populations and identify potential diagnostic disparities between these groups. De-identified electronic health record data on the TriNetX platform of patients diagnosed with ADHD, CD, or both between January 2013 and May 2023 from 50 healthcare organizations in the US were used to investigate racial and sex disparities in the prevalence of ADHD and CD diagnoses. With a cohort of 849,281 ADHD patients and 157,597 CD patients, non-Hispanic White individuals were ~ 26% more likely to receive ADHD diagnosis and ~ 61% less likely to be diagnosed with CD than non-Hispanic Black individuals. The mean age of diagnosis of ADHD was over 8 years older for White patients than for Black patients, with a disproportionately higher number of White patients diagnosed in adulthood, compared to a comparatively negligible number of Black patients diagnosed with ADHD in the same age group. Additionally, Black females were the cohort least likely to be diagnosed with ADHD, while White females were the cohort least likely to be diagnosed with CD. Race disparities exist between Black and White populations, and sex disparities exist within each population. More information is needed to determine contributors to these differences, although implicit biases and systemic racism may be key contributing factors. Presenting evidence and increasing awareness of culturally relevant diagnoses can reduce unconscious bias and move toward more informed and objective psychiatric evaluations.

Expert System For Diagnosis of Mental Health Disorders in Students Using Case-Based Reasoning Method With a Web-Based Positive Psychology Approach

Mental health issues among students have become a significant concern affecting their quality of life and academic performance. An effective expert system is needed to diagnose and provide appropriate interventions. This research develops a web-based expert system that utilizes the Case-Based Reasoning (CBR) method combined with a positive psychology approach to diagnose mental health disorders in students. The CBR method identifies similarities between new and previous cases, while the positive psychology approach focuses on individual strengths and potential for growth. The system integrates a database of student mental health cases and CBR algorithms to produce relevant diagnoses. This study investigates four types of mental health disorders: panic, anxiety, stress, and depression. The method used for data analysis is Case-Based Reasoning. The diagnosis results are based on calculations from symptom choices within the system, where each symptom has a weight. The highest similarity calculation obtained from past cases is used as a solution to address the problem. System testing, based on expert knowledge with 15 test data samples categorized by mental health disorders and 38 symptoms, achieved an accuracy rate of 85%.

Multisystem ALK-Positive Histiocytosis With DCTN1::ALKFusion in an Adult, Responsive to Alectinib: Case Report and Literature Review.

Anaplastic lymphoma kinase (ALK)-positive histiocytosis has emerged as a clinically relevant diagnosis featuring a wide span of clinical presentations, which are unified by the presence of ALK-positive histiocytes on histopathology and molecular drivers involving the ALK kinase gene. This report presents an adult case of multisystem ALK-positive histiocytosis with xanthogranuloma-like features on histopathology that was responsive to ALK inhibition, and includes a review of ALK-positive histiocytoses with cutaneous involvement reported in the literature. A 56-year-old male developed a widespread eruption of red-brown papules on the face, trunk, and upper extremities. Histopathological evaluation revealed a well-circumscribed, nodular dermal infiltrate of epithelioid histiocytes with Touton giant cells, rare bizarre multinucleated cells, and focal emperipolesis. The lesional cells were positive for CD68 and ALK1 immunohistochemical stains, and negative for CD1a. Next-generation sequencing identified a DCTN1::ALK fusion. On imaging, he was found to have bone, lung, soft tissue, and salivary gland involvement. ALK inhibition was initiated with alectinib, resulting in rapid improvement of cutaneous lesions and eventual complete resolution of abnormal imaging findings, which was sustained at 24 months of follow-up. This case adds to the spectrum of ALK-positive histiocytoses and further demonstrates the positive response with targeted therapy.

The Acid-Stimulated Self-Assembled DNA Nanonetwork for Sensitive Detection and Living Cancer Cell Imaging of MicroRNA-221.

Herein, a novel functional DNA structure, acid-stimulated self-assembly DNA nanonetwork (ASDN), was proposed for miRNA-221 sensitive detection and high-resolution living cancer cell imaging. Significantly, the self-assembly of ASDN only occurred in the acidic extracellular environment of cancer cells, which could be endocytosed by cancer cells to eliminate the interference of noncancer cells and deliver the ASDN into cancer cells. Subsequently, endogenous miRNA-221 could trigger the catalytic hairpin assembly within ASDN, resulting in the separation of the fluorophore Cy5 and the quencher BHQ2 to recover the substantial Cy5 fluorescence signals, thus achieving signal amplification for sensitive detection of miRNA-221 with a detection limit of 5.5 pM, as well as facilitating high-resolution and low-background imaging of miRNA-221 in cancer cells. In consequence, this strategy provides an innovative DNA nanonetwork to distinguish cancer cells from other cells for sensitive detection of biomarkers, offering a meaningful reference for the application of DNA nanostructure self-assembly technology in relevant fundamental research and disease diagnosis.

The effect of disc deformation on the dynamic response of multi-disc systems: A tilting-impact model originating from the wet clutch

Analyzing the dynamic response of a wet multi-disc clutch is crucial for relevant fault diagnosis research. However, characterizing the tilting-impact phenomenon between the friction discs remains ambiguous. This paper presents a tilting-impact model of a multi-disc system under dry conditions and investigates the effect of disc deformation on the system dynamics. Firstly, Euler angles and Euler kinematic differential equations are introduced to describe the spatial position and orientation of the spinning-tilting disc. The aligning centrifugal moment, spline friction force, and tilting-impact forces for both flat and deformed discs are derived. A bench test is conducted to validate the model by comparing simulation and experimental signals at various rotation speeds. The results indicate that the occurrence of tilting-impact phenomena in dry conditions requires external disturbances, and the discs eventually stop tilting-impacting once the disturbance subsides, and the system with deformed discs experiences longer recovery times. Furthermore, the tilting-impact forces in systems with deformed discs are smaller than those with flat discs only.

Comparative Study to Evaluate the Accuracy of Differential Diagnosis Lists Generated by Gemini Advanced, Gemini, and Bard for a Case Report Series Analysis: Cross-Sectional Study.

Generative artificial intelligence (GAI) systems by Google have recently been updated from Bard to Gemini and Gemini Advanced as of December 2023. Gemini is a basic, free-to-use model after a user's login, while Gemini Advanced operates on a more advanced model requiring a fee-based subscription. These systems have the potential to enhance medical diagnostics. However, the impact of these updates on comprehensive diagnostic accuracy remains unknown. This study aimed to compare the accuracy of the differential diagnosis lists generated by Gemini Advanced, Gemini, and Bard across comprehensive medical fields using case report series. We identified a case report series with relevant final diagnoses published in the American Journal Case Reports from January 2022 to March 2023. After excluding nondiagnostic cases and patients aged 10 years and younger, we included the remaining case reports. After refining the case parts as case descriptions, we input the same case descriptions into Gemini Advanced, Gemini, and Bard to generate the top 10 differential diagnosis lists. In total, 2 expert physicians independently evaluated whether the final diagnosis was included in the lists and its ranking. Any discrepancies were resolved by another expert physician. Bonferroni correction was applied to adjust the P values for the number of comparisons among 3 GAI systems, setting the corrected significance level at P value <.02. In total, 392 case reports were included. The inclusion rates of the final diagnosis within the top 10 differential diagnosis lists were 73% (286/392) for Gemini Advanced, 76.5% (300/392) for Gemini, and 68.6% (269/392) for Bard. The top diagnoses matched the final diagnoses in 31.6% (124/392) for Gemini Advanced, 42.6% (167/392) for Gemini, and 31.4% (123/392) for Bard. Gemini demonstrated higher diagnostic accuracy than Bard both within the top 10 differential diagnosis lists (P=.02) and as the top diagnosis (P=.001). In addition, Gemini Advanced achieved significantly lower accuracy than Gemini in identifying the most probable diagnosis (P=.002). The results of this study suggest that Gemini outperformed Bard in diagnostic accuracy following the model update. However, Gemini Advanced requires further refinement to optimize its performance for future artificial intelligence-enhanced diagnostics. These findings should be interpreted cautiously and considered primarily for research purposes, as these GAI systems have not been adjusted for medical diagnostics nor approved for clinical use.

An 8-SNP LDL Cholesterol Polygenic Score: Associations with Cardiovascular Risk Traits, Familial Hypercholesterolemia Phenotype, and Premature Coronary Heart Disease in Central Romania.

Familial hypercholesterolemia (FH) is the most significant inherited risk factor for coronary heart disease (CHD). Current guidelines focus on monogenic FH, but the polygenic form is more common and less understood. This study aimed to assess the clinical utility of an 8-SNP LDLC polygenic score in a central Romanian cohort. The cohort included 97 healthy controls and 125 patients with premature (P)CHD. The weighted LDLC polygenic risk score (wPRS) was analyzed for associations with relevant phenotypic traits, PCHD risk, and clinical FH diagnosis. The wPRS positively correlated with LDLC and DLCN scores, and LDLC concentrations could be predicted by wPRS. A trend of increasing LDLC and DLCN scores with wPRS deciles was observed. A +1 SD increase in wPRS was associated with a 36% higher likelihood of having LDLC > 190 mg/dL and increases in LDLC (+0.20 SD), DLCN score (+0.16 SD), and BMI (+0.15 SD), as well as a decrease in HDLC (-0.14 SD). Although wPRS did not predict PCHD across the entire spectrum of values, individuals above the 90th percentile were three times more likely to have PCHD compared to those within the 10th or 20th percentiles. Additionally, wPRS > 45th percentile identified "definite" clinical FH (DLCN score > 8) with 100% sensitivity and 45% specificity. The LDLC polygenic score correlates with key phenotypic traits, and individuals with high scores are more likely to have PCHD. Implementing this genetic tool may enhance risk prediction and patient stratification. These findings, the first of their kind in Romania, are consistent with the existing literature.

Risk factors and recurrence of hyperemesis gravidarum: A population-based record linkage cohort study.

There are limited contemporary population-based studies on the risk factors for hyperemesis gravidarum (HG), a severe type of nausea and vomiting in pregnancy. This study aimed to determine the prevalence and trend of HG over time, identify risk factors for any and multiple HG health service visits during pregnancy, and investigate HG recurrence across pregnancies. This population-based record linkage cohort study featured births in New South Wales, Australia from 2010 to 2019. Hospital and emergency data collections were used to identify health service visits for HG using relevant diagnosis codes and were linked to the corresponding pregnancy on the birth data set. Outcomes included any HG and multiple HG visits during pregnancy, and HG recurrence across pregnancies. Annual HG prevalence was calculated, and negative binomial regression was used to examine standardized prevalence trends. Risk factors for any HG and multiple HG visits within a pregnancy were examined using Robust Poisson models with generalized estimating equations and Prentice-Williams-Peterson Gap Time models, respectively. Rates and risk of recurrence were calculated for women with a second and third pregnancy. Of the 955 107 pregnancies, 21 702 (2.3%) were classified as HG. There was an average annual increase of 6.8% (95% CI 5.3-8.3) in HG prevalence. Younger maternal age, multiple pregnancies, and selected preexisting conditions were associated with an increased risk of HG, with the strongest factor being HG in any previous pregnancy (risk ratio 8.92, 99% CI 8.43-9.44). Hyperemesis gravidarum recurrence at the second (28.9%) and third (54.7%) pregnancies was high. Hyperemesis gravidarum history is the strongest risk factor for HG, which has implications for counseling and care that women receive around pregnancy.

Opticopathies in the differential diagnosis of retinal diseases - part 1

Due to the close anatomical, functional and trophic relationships between the optic nerve and retina, a wide variety of diseases affecting both structures have reciprocal effects on each other, which must be considered in the differential diagnosis to avoid misdiagnosis. Therefore, it is essential to assess pathological changes in both structures in context to differentiate the type and location of the primary lesion from its consequences, as well as to correctly classify coincidences and disease-specific lesion patterns in both organ components.This article highlights the typical symptom constellations and lesion patterns of optic neuropathies and retinopathies. An attempt is made to identify the reciprocal characteristic relationships of the respective lesions in both structures in various disease groups, as well as to present their respective roles in the differential diagnosis.In the first part of the article, typical optic neuropathies in the context of various syndromic and non-syndromic retinal dystrophies are initially examined. Subsequently, the relationships between different hereditary and acquired mitochondriopathic optic neuropathies and possible accompanying retinal changes are analysed, and their pathogenesis and relevant differential diagnoses are discussed.It is demonstrated and exemplified how important it is in general, but also specifically in regard to the disease groups discussed in this article, to have a careful and targeted diagnostic approach in each case, considering both the retinal and optic nerve findings, in order to avoid misdiagnosis.

Hemoptysis due to severe obstructive sleep apnea

Although OSA is rarely mentioned as a clinically relevant differential diagnosis of hemoptysis in the literature, we report on a patient with chronic hemoptysis, which was caused by repetitive intrathoracic negative pressures due to severe upper airway obstruction.A 56-year-old overweight patient (BMI 32 kg/m2), with a long history of smoking (40 PY) and who complained of pronounced daytime sleepiness, was referred 2 years ago in March and last year in the summer to our emergency room because of long lasting mild hemoptysis.Sedation during bronchoscopies induced hypopharyngeal collapse accompanied by severe obstructive apneas and massive inspiratory negative pressure. Simultaneously, multiple petechial and larger flat mucosal bleeding as fresh blood coverings occurred on the bronchial mucosa. At the first presentation, the patient wished no further diagnosis. During the second presentation, polysomnography including transcutaneous CO2 measurement showed a severe OSA in combination with hypoventilation (AHI of 76/h, desaturation index: 128/h; medium PCO2 value of 56 mmHg). OSA was treated effectively with oronasal positive pressure.With this case report we underline the generally underestimated implication of strong intrathoracic negative pressures in severe OSA as a clinically relevant differential diagnosis of hemoptysis.

Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma

Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma

IBCL-187 Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma

IBCL-187 Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma