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Chylous ascites is an unusual condition. Many causes, usually malignancy, are responsible. In the present article, the authors define chylous ascites, describe the pathological physiology, etiology, diagnostic procedures and management. The case of a man aged 74 years with chylous ascites on account of malignant lymphoma in the retroperitoneum is presented.
The problem of noncompensating combinations of two variables in two sample cases was treated in regard to clinical and diagnostical decisions. The given representation allows a clear registration of the wrong classifications due to a single test variable plus its decrease by noncompensating combinations. The net gain of correct classifications can be checked on significance by means of a binomial, respectively sign test.
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Routine examinations done in patients with pneumonia are following: chest radiograph, Gram stain and culture of sputum. For patients who require hospitalization two sets of blood culture should also be performed. Gram stain and culture of pleural fluid are advised in patients with pleural effusion. Serological testing is important in the diagnosis of atypical pneumonia, but they usually provide retrospective information useful mainly in epidemiological studies. Less frequently used methods are following: bacterial antigen-detection and molecular biology techniques, which may be applied to sputum samples and other biological specimens (pleural fluid, blood, urine etc.). Invasive diagnostic techniques (bronchoalveolar lavage (BAL), protected specimen brush (PSB) or transtracheal aspiration (TTA)) are performed mainly in patients with nosocomial pneumonia especially in critically ill ones. For intubated and mechanically ventilated patients those methods are used to confirm the diagnosis of pneumonia, but for other nosocomial patients the aim is to find causative organism. In spite of higher efficiency of invasive techniques (comparing to non-invasive), one should remember that they may cause dangerous complications and thus before applying them it is necessary to consider if potential benefits overweight risk.
The suggested tool's set designed for express-diagnosis of urolithiasis and for ultrasonic screening of the kidneys, which comprises a new diagnostic technology ("Litos-System'), provides for stating a diagnosis even before the renal calculi begin to take shape.
A technique for preparing such a diagnosticum, that specifically detects antibodies to Opisthorchis egg antigen, has been developed. Examinations of opisthorchiasis patients with the use of this diagnosticum have shown that the diagnostic titres of the total activity of the blood serum antibodies to the egg antigen and to the Opisthorchis somatic antigen have been detected with equal frequency. Parallel use of the egg and the previously developed (with the somatic and metabolic antigens) erythrocytic diagnosticums improves the reliability of the serologic diagnosis of chronic opisthorchiasis.
Peripheral arterial disease (PAD) is a frequent complication of diabetes mellitus. In the first phase of the San Luis Valley Diabetes Study, diagnostic criteria for PAD were evaluated in 607 controls and 343 diabetics. Normal ranges, and the lowest 2.5 percentile of the distribution of ankle/arm systolic blood pressure ratios were derived from a non-diabetic subset of the population with a very low probability of PAD. From this subgroup, abnormal ankle/arm ratios were defined as less than: 0.94 at rest, 0.73 after exercise, and 0.78 after reactive hyperemia. Using these criteria, PAD was identified in 130 subjects from the study population of 950 (prevalence of 13.7%). In contrast, a history of intermittent claudication, or an absent pulse in the extremity were uncommon findings in the study population, and thus had a low sensitivity and positive predictive value for PAD diagnosed by vascular laboratory criteria. We conclude that vascular laboratory tests provide a useful, and objective means of determining the prevalence of PAD in a geographically-based population of diabetic and control subjects.
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BACKGROUND: Mental stress testing is considered a reliable method for diagnosing patients with coronary heart disease (CHD) who may be at risk for future events. It has been shown recently that myocardial ischemia induced during mental stress tests is specifically associated with peripheral arterial vasoconstriction. HYPOTHESIS: The study was undertaken to test the diagnostic capability of peripheral arterial tonometry (PAT) to detect peripheral arterial vasomotor changes. METHODS: We monitored pulsatile finger blood volume changes using a specially designed finger plethysmograph, PAT that can detect peripheral arterial vasomotor changes. Equilibrium radionuclide angiography (ERNA) was simultaneously performed in 18 male patients at rest and during a mental arithmetic stress test with harassment. All patients had previously diagnosed coronary disease and positive exercise tests. Myocardial ischemia was diagnosed by ERNA when global ejection fraction fell > or = 8% during mental stress or new (or worsened) focal wall motion abnormalities occurred. Peripheral arterial tonometry tracings were considered abnormal when the pulse wave amplitude decreased by > or = 20% from baseline. RESULTS: In 18 patients there were 16 usable studies. In eight patients, both ERNA and PAT were abnormal, and in six patients the tests were negative by both methods. In two cases, the results were discordant. Therefore, when considering an abnormal PAT tracing as indicative of mental stress-driven myocardial ischemia, concordance of the two methods was 88%. CONCLUSION: The use of PAT may facilitate both clinical testing and research during mental stress.
A quick and simple method has been developed to detect the presence or absence of the endogenous Rous-associated virus (RAV) element ev1 in chickens. The procedure consists of a one-tube multiplex polymerase chain reaction (PCR) involving three oligonucleotide primers that are specific for the upstream flanking region, the long terminal repeat (LTR), and the downstream flanking region of the proviral insert, respectively. The multiplex reaction allows for the unambiguous discrimination between ev1+/ev1+ homozygote, ev1-/ev1- homozygote, and ev1+/ev1- heterozygote birds. The method works best with purified genomic DNA as substrate, but can also be used with rapidly prepared, "crude" DNA samples. The combination of speed with the safety of a nonradioactive procedure, and the ability to perform large numbers of assays by a semi-automated procedure, make this method attractive for large-scale screening projects. The ev1 locus has been used as a model system to demonstrate the feasibility of the PCR diagnostic approach. However the same principle should be applicable to the analysis of other RAV-type ev loci, as well as endogenous elements belonging to other families of viruses as sequence information for the flanking regions of these inserts becomes available.
Based on literature of the last 30 years we present the current view concerning diagnosis of the communicating hydrocephalus. Till now various methods of the assessment of hydrocephalus have been used in order to select patients for shunt treatment. No single factor, considered apart from the other diagnostic criteria, is sufficient to undertake the decision of shunting. According to current opinion the lumbar infusion test is the most valuable in the assessment of hydrocephalus, supporting us with the data of pressure-volume relations in patient. Based on our own experience the infusion test is not only useful in the preoperative investigation, but also for the assessment of proper shunt function.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
161 patients with multiple sclerosis were observed according to C. M. Poser's scale. The diagnosis was definite in 73.9% of cases, probable--in 14.9% and doubtful in 11.2% of patients. The diagnostic significance of magnetic resonance tomography (MRT) was estimated as well as of visual evoked potentials (VEPs), mid-latency auditory evoked potentials (MAEPs), viscocontrastoperimetry and pallesthesiometry (vibratory sensation). MRT revealed alterations in 80.3% of 71 cases (97.5% at definite diagnosis). The results of investigation of evoked potentials differed from normal values: VEPs in 100%, MAEPs in 72.6% of 26 patients observed. Visocontrastoperimetry revealed disorders in 75,2% of 113 cases, pallesthesiometry in toes--in 100%, in fingers--in 68.9% of 116 patients observed.
BACKGROUND: Herpesvirus infections of the central nervous system are often severe but are fortunately rare. The incidence of these infections has however, increased in recent years as a consequence of an increase in the number of immune-compromised individuals. New diagnostic procedures have improved our ability to diagnose these infections and herpesviruses may yet be implicated as the cause of further neurological diseases with no known aetiology. Methodological standards for selection and evaluation of patient materials are essential to the provision of reliable diagnosis, yet few studies have addressed this important issue. OBJECTIVES: To describe and define methodological standards and reference methodology for diagnosis of herpesvirus infections of the CNS. STUDY DESIGN: Information gathered by literature review. RESULTS: Only for herpes simplex encephalitis is there sufficient data to allow the definition of reference methodology. Good methodological standards exist but few studies have adhered to these standards. As methods for the detection of specific intrathecal antibody synthesis are well established yet under-used in diagnostic virology, the principle of these measurements is reviewed in some detail. CONCLUSIONS: Herpesvirus infections of the CNS are of increasing importance. High quality, multi-centre studies are needed to establish the value of the new diagnostic test procedures if further improvement in the diagnostic sensitivity and specificity of these procedures is to be achieved.
In the SFNC series (248 patients), the histological diagnosis was obtained after surgical resection in 116 patients (46%). Mortality was 3.4%, 54% had stereotactic biopsies which is the most safe and efficient diagnostic procedure. Our results suggest that surgical resection should be reserved for tissue diagnosis.
BACKGROUND: Koi Herpesvirus (KHV) affects both juvenile and adult common carp and koi, and is especially lethal to fry. The high mortalities caused by the disease have had a negative impact on the international koi trade. Different diagnostic techniques have been used to detect KHV, including: isolation of the virus in cell culture, electron microscopy, several PCR tests, ELISA and in situ hybridisation. All of these methods are time consuming, laborious and require specialised equipment. RESULTS: A rapid field diagnosis of KHV in common and koi carp was developed using loop-mediated isothermal amplification (LAMP). The LAMP reaction rapidly amplified nucleic acid with high specificity and efficiency under isothermal conditions using a simple water bath. Two methods of extracting DNA from host tissue were compared: extraction by boiling and by using a commercial extraction kit. A set of six primers--two inner primers, two outer primers and two loop primers--was designed from a KHV amplicon. The reaction conditions were optimised for detection of KHV in 60 min at 65 degrees C using Bst (Bacillus stearothermophilus) DNA polymerase. When visualised by gel electrophoresis, the products of the KHV LAMP assay appeared as a ladder pattern, with many bands of different sizes from 50 base-pairs (bp) up to the loading well. The KHV LAMP product could also be simply detected visually by adding SYBR Green I to the reaction tube and observing a colour change from orange to green. All samples positive for KHV by visual detection were confirmed positive by gel electrophoresis. The KHV LAMP had the same sensitivity as a standard PCR assay for the detection of KHV. CONCLUSION: This paper describes an accelerated LAMP assay for diagnosis of KHV. The entire procedure took only 90 minutes to produce a result: 15 minutes for DNA extraction; 60 min for the LAMP reaction; 2 min for visual detection using SYBR Green I. The test can be used under field conditions because the only equipment it requires is a water bath.