Sensitivity Of Clinical Diagnosis Research Articles

Clinico-pathological correlation study of cervical lymph node masses.

One hundred and ten cases of cervical lymph node masses were subjected to clinical evaluation and aspiration cytology. Eighty six cases which subsequently underwent open biopsy were subjected to histopathological evaluation. Accuracy, specificity and sensitivity of clinical diagnosis were 86.1%, 93.6% and 91.1% respectively as compared to 88.3%, 97.6% and 93.6% respectively for aspiration cytology. Reliability coupled with other advantages makes aspiration cytology the first line investigation in evaluating cervical lymph node masses reserving open biopsy for certain specific indications. Based on the conclusions a protocol is being recommended for evaluation of cervical lymph node masses.

Maternal diagnosis and treatment of children's fever in an endemic malaria zone of Uganda: implications for the malaria control programme

A mother's ability to suspect malaria in the presence of fever has important consequences for child survival in malaria-endemic areas. This paper presents results of a clinic-based study of mothers' abilities to suspect malaria in the event of recognizing fever and other physiological and behavioral changes associated with the disease. The study population consisted of all (439) women or mothers who had accompanied children 5 years and below to the Old Mulago Hospital, Kampala, Uganda over a 10 day period during the malaria season of 1992. The children were those who had fever as a major complaint at the time of the visit or those who had fever in the last 7 days and were visiting the clinic for the first time for the current illness. The children were physically examined and their blood tested for malaria parasites. Mothers' diagnosis was compared with clinical and laboratory diagnosis of malaria. Mothers associated the presence of fever with several types of illness and malaria was often not suspected. Only 40% of the mothers suspected malaria in their children. The mothers were poor at recognizing malaria when, in fact, it was present. The sensitivity of the mothers' diagnosis of malaria was found to be 37%; 63% of malaria cases were misclassified as other conditions. The doctors classified most (92%) of the cases presenting with fever as having malaria, but laboratory tests indicated that only 64% of the children really had malaria. The sensitivity of clinical diagnosis was 98%, but the specificity was only 18%. Ninety percent of the mothers gave some medicines before visiting the health centre; and, of these, 76% gave modern drugs exclusively, including antimalarials, antipyretics, antibiotics and other drugs. Among the modern drugs given to children suspected of having malaria, 50% were antimalarials. The most commonly used antimalarial was chloroquine tablets. Mothers indiscriminately administered antimalarials to children irrespective of the perceived cause of the fever. There is need to educate mothers to suspect malaria first in every case of febrile illness, just like the doctors do, and about the first line drugs for the treatment of malaria.

Aortic stenosis in elderly people: an evaluation of clinical and echocardiographic diagnosis.

In a prospective study to assess the sensitivity and specificity of clinical diagnosis against echocardiographic diagnosis in elderly people, 41 patients were studied in two 6-month periods. Overall clinical and echo diagnosis agreed in 75% of cases, but the clinical diagnosis of aortic stenosis was poor in the initial period. Adapting the lessons which were learnt in this initial period in a repeat of the study, the sensitivity of clinical diagnosis of aortic stenosis improved from 0.38 to 0.75. Additional information was gained in 50% of cases by echocardiography, and enabled the clinician to modify treatment in 50% of cases. Aortic stenosis in elderly people may be without clinical signs. Routine echocardiography increases the sensitivity of the clinical diagnosis, and may have major therapeutic implications for the elderly patient.

Histologic Features and Sensitivity of Diagnosis of Clinically Unsuspected Cutaneous Melanoma

The purpose of this study was to assess the sensitivity of clinical diagnosis of cutaneous malignant melanoma and to evaluate histologic characteristics of lesions not clinically diagnosed as such. Of 1,784 cases of histologically proven cutaneous malignant melanoma submitted routinely to a university dermatopathology laboratory between 1985 and 1990, 583 (33%) were not clinically suspected. The overall sensitivity in clinical diagnosis was 67%. Histologic features evaluated included presence of melanin, pagetoid spread of melanocytes, degree of inflammation, regression, presence and degree of sun damage as evidenced by solar elastosis, presence of melanin in the cornified layer, and coexisting nevus cells. Melanomas clinically thought to be nevi had less solar elastosis and most frequently had associated nevus cells. Those thought to be basal cell carcinomas had less melanin in lesions and less melanin in the cornified layer, and most often had foci of regression. Lesions thought to be keratoses showed melanin in the cornified layer 70% of the time, more often than any other type of lesion. Melanoma may be unsuspected clinically in a significant number of cases and can be mistaken for less serious cutaneous neoplasms. Histologic features of these lesions correlated well with original clinical diagnoses.

Clinical features and diagnosis of venous thrombosis

The clinical diagnosis of venous thrombosis is inaccurate because the clinical findings are both insensitive and nonspecific. The sensitivity of clinical diagnosis is low because many potentially dangerous venous thrombi are clinically silent. The specificity of clinical diagnosis is low because the symptoms or signs of venous thrombosis all can be caused by nonthrombotic disorders. For these reasons, a practical approach for the diagnosis of venous thrombosis is important. A current approach to the diagnosis of clinically suspected venous thrombosis favors the use of impedance plethysmography over Doppler ultrasonography as the main test for this disorder. This is because impedance plethysmography is precise and objective, whereas the interpretation of Doppler ultrasonography is subjective and requires considerable skill and experience to form reliable diagnoses. The use of serial impedance plethysmography has been evaluated recently in a prospective study. The rationale of repeated impedance plethysmography evaluation is based on the premise that calf vein thrombi are only clinically important when they extend into the proximal veins, at which point detection with impedance plethysmography is possible. Therefore, by performing repeated examinations with impedance plethysmography in patients with clinically suspected venous thrombosis, it is possible to identify patients with extending calf vein thrombosis who can be treated appropriately. Impedance plethysmography is performed immediately on referral; if it is positive in the absence of clinical conditions that are known to produce falsely positive results, the diagnosis of venous thrombosis is established, and the patient is treated accordingly. If the result of the initial impedance plethysmography evaluation is negative, anticoagulant therapy is withheld, and impedance plethysmography is repeated the following day, again on day 5 to 7 and on day 10 to 14. If impedance plethysmography becomes positive during this time, a diagnosis of venous thrombosis is made and anticoagulant therapy is commenced. Positive impedance plethysmography in the presence of conditions known to produce a false positive result (for example, congestive cardiac failure) should be confirmed by venography. If noninvasive tests for the diagnosis of venous thrombosis are not available, a clinical suspicion of venous thrombosis should be objectively confirmed or excluded by performing ascending venography.