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[Endocrine ophthalmopathy. Clinical symptoms, classification, diagnostic classification, indications for treatment (author's transl)].

The clinical aspects and classification of "endocrine ophthalmopathy" were described. The clinical picture is of importance for the physician in nuclear medicine who is involved with the diagnosis and therapy of hyperthyroidism. In vivo and in vitro investigations in nuclear medicine regarding the classification of ophthalmic findings are derived from disturbances in control of the regulatory systems of the hypothalmas-pituitary-thyroid which are parallel to the ophthalmic processes. The clinical forms of endocrine ophthalmopathy and the thyroid findings which accompany it were systematized and an appropriate therapeutic procedure for the respective anomaly was described.

Graves Disease

The classification of depressive disorders. II. A review of historical and physiological classification studies.

A review of recent classification studies of depressive disorders based on historical data and physiological indices was made. It was found that historical variables, such as age of onset and family background, are potentially useful to distinguish depressive subgroups, although these groupings did not differentiate consistently unipolar from bipolar depressives. While the physiological indices do not support the present psychiatric nosology, single physical signs were found to differentiate subgroups within the effective disorders. The implications of these findings for a different research model were discussed.

Adjustment Disorders

Artifactually induced VEP classification of form and color attributes: a refutation of "Neuroelectric concepts: form-color classification" by William J. Hudspeth (1993)

An algebraic analysis of the procedures used in "Neuroelectric Concepts: Form-Color Classification," Brain and Cognition, 21, 226-246 (1993) by William J. Hudspeth reveals that the article's results are artifactual, having been produced by the introduction of strong linear dependencies during data transformation. The same pattern of principal results is shown to obtain by applying Hudspeth's procedures both to arbitrarily selected EP input data having no connection to form or color discrimination, and to waveforms composed of sequences of random numbers.

Artifacts

Computerized EEG pattern classification by adaptive segmentation and probability-density-function classification. Description of the method.

A phenomenological model for the representation of clinical EEGs is proposed. It assumes each individual record to consist of a few repetitive patterns which are described sufficiently by their power spectra. An algorithm for automatic EEG evaluation is described. It consists of two steps, a segmentation process which isolates the elementary patterns, and a clustering procedure which groups similar patterns with each other. Results are represented in graphical form. Diagnostic classification is not attempted. An appendix highlights the advantages of autoregressive modelling for EEG spectral analysis and, in particular, the estimation of the power contained in the various "rhythms".

Biometry

Computerized EEG pattern classification by adaptive segmentation and probability density function classification. Clinical evaluation.

A series of 63 clinical EEGs showing a variety of normal and abnormal patterns was analysed by computer with particular reference to the different types of pattern within the same EEG. Boundaries between different patterns were established by means of adaptive segmentation, so that the duration of the resulting segments was determined by the particular EEG itself (thus the term 'adaptive'). Four channels from each EEG were analysed, paired (left and right) channels were simultaneously segmented and analysed interactively. Similar segments were then clustered without supervision by estimating a probability density function in a 2-dimensional 'feature space' having dimensions of mean frequency and mean power. Individual clusters emerged as well-defined peaks of the surface, individual segments or small groups of duration insufficient to constitute a separate cluster, being identified as 'singular events' (e.g., rare sharp waves, artifacts). The autocorrelation function was used to characterize the EEG both for the segmentation and for the subsequent clustering of the resulting segments. In confirmation of our previous work, adaptive segmentation based on the autocorrelation function of the EEG was found to be quite satisfactory. Unsupervised clustering by estimation of the probability density function in feature space was found to give the correct number of clusters (usually less than 5) in a majority of the records (65%), but in the remaining minority of cases (35%), either overclustering or underclustering occurred. Further, the 'singular events' were occasionally partly included in a formal cluster. Comparison of these results of EEG clustering by unsupervised probability density function estimation with earlier results obtained by supervised hierarchical clustering suggests that there may be subtle cues used by the electroencephalographer in the classification of EEG patterns which have not been adequately approximated by the computer algorithms thus far used in this work. Hence at least some minimal degree of supervision in the clustering process may be necessary, at least for the present. On the other hand, the method recommends itself for the representation of illustrative EEG summaries which, in conjunction with a short written report, would provide the clinical neurologist with a sufficient picture of the real EEG without, in most cases, the need to inspect the original record.

Action Potentials

Personality disorders: model for conceptual approach and classification. Part II: Proposed classification.

In Part II of this article we propose a model for classification of normal and deviant personality types. First, we outline a matrix that classifies normal and deviant behaviors by combining three levels of functioning (normal, neurotic, and borderline) with specific long term behavior types. Second, we describe in some detail eight discrete syndromes that meet criteria for PDs presented in Part I of the article (Vol. 47, No. 4, pp. 558-571, this Journal).

Humans

Symposium: classification of leukemia. 1. The classification of acute leukemia.

Two main forms of acute leukemia have been recognized by the French-American-British (FAB) group: myeloid (AML) and lymphoblastic (ALL). Some types of AML can be diagnosed on well prepared bone marrow films stained with May-Grünwald-Giemsa. Poorly differentiated types, myeloblastic (M1) and monoblastic (M5PD), need confirmation by positive cytochemical reactions (Sudan Black B, myeloperoxidase and non-specific esterase). There are 2 sub-types of promyelocytic leukemia: M3 typical, hypergranular and M3 variant, microgranular. The M3 variant has a more acute course, higher WBC and may require cytochemistry to demonstrate promyelocytic differentiation. Electron microscopic cytochemistry can also help in the classification of difficult AML cases; the 'platelet-peroxidase' reaction, for example, is essential for the diagnosis of megakaryoblastic leukemia, a disorder often presenting as 'acute' myelosclerosis. Three morphological types are seen in ALL: L1, predominantly in children, L2, more frequently in adults, and the relatively rare L3 or Burkitt type. Immunological and enzyme markers (ALL and la antigens, terminal transferase, etc.) help define the cell phenotype: (1) non-B, non-T ALL with 3 forms (common, null and pre-B), (2) T-ALL, related to but distinct from T-lymphoblastic lymphoma, and (3) B-ALL, usually with L3 morphology, There is growing evidence that the FAB morphological types correlate with prognosis in ALL independently of other factors. The immunologically defined types also correlate with prognosis but not as an independent variable.

Acute Disease

[Histological classification of malignant non-Hodgkin's lymphomas and patient survival: the Kiel classification versus the working formulation].

In 163 out of 251 histologically classified malignant Non-Hodgkin's lymphomas, a comparison was made of the patient survival with respect to both histological type and malignant grade according to the Kiel Classification (KC) and the three prognostic groups of the Working Formulation (WF). As expected, the survival rate of 94 low-grade malignant lymphoma cases (KC) was significantly better than that of 69 high-grade cases (p < 0.0001). Similar results were found both for 46 low grade cases (WF) in comparison to 50 high grade cases (p < 0.001) and for 67 intermediate grade cases (WF) compared with the 50 high grade cases (p < 0.05). The survival rates of low and intermediate grade cases (WF), however, showed no statistically significant difference. The low- and high-grade malignant lymphoma entities of KC, which together constitute the intermediate grade of WF, differed significantly with respect to patient survival (p < 0.05). Therefore, it appears that an intermediate grade is not essential in the KC.

Humans

Hyperlipidemia, dyslipoproteinemia and apolipoproteinopathia--classification and risk of atheroslcerosis. Part I: Principles of classification and methods of dyslipoproteinemia determination.

This paper sums up new findings in the field of pathogenetic relations between lipid and lipoprotein metabolical disorders on the one hand and the risk of early forms of atherosclerosis on the other hand. Detail classification of disorders proceeds from precise clinical and biochemical criteria, genetic considerations and therapeutical aspects. It provides definitions of hyperlipidemia, hyperlipoproteinemia, normolipidemic (latent) dyslipoproteinemia, secondary hyperlipidemia, apolipoproteinopathia and relatively harmless (benign) hyperlipidemia. The paper provides detail tables and systematic graphs.

Adult

Classification and prognostic evaluation in multiple myeloma. A retrospective study of relationship of survivals and responses to chemotherapy to immunological types, 20 single prognostic factors, 15 clinical staging systems, and 6 morphological classifications.

In a group of 136 completely followed up patients with multiple myeloma, the prognostic significance of the immunological myeloma types, of 20 different single prognostic factors, of 15 clinical staging systems, and of 6 morphological classifications was retrospectively investigated by means of the calculation of mean survivals, survival curves, and responses to chemotherapy. A univariate analysis was employed in order to correlate each prognostic parameter at presentation with the survival in the whole group; a multivariate analysis according to the Cox's hazards regression model was used in order to select the most powerful prognostic variables. The patients were grouped according to the myeloma immunological types, to the mean value of each single prognostic factor, and to each stage of the clinical and morphological systems. Causes of death were also related to immunological multiple myeloma types. All single variables, except age and serum calcium, presented a significant relationship with the survival, even if at different significance levels. Cox's regression model selected among them, serum levels of beta 2-microglobulin, percentage of bone marrow plasma cells, hemoglobinemia, lytic bone lesions, and Bence-Jones proteinuria as the most significant factors related to survival. Each clinical and morphological staging system divided groups of patients with significant differences in mean survivals, or in survival curves, or in response to therapy. Multiple myeloma type IgA and micromolecular, with Bence-Jones proteinuria, and type lambda were associated with a poor prognosis, with low therapeutical response, and with the development of fatal renal failure. All these parameters, together with new prognostic factors, are useful in the prognostic evaluation, and, when applied in different steps of the diagnosis and the therapy, allow of studying the clinical course of multiple myeloma under different perspectives, in order to have a more complete picture of the disease and of the single patient.

Adult

The classification of anxiety disorders in current and future classifications.

Comments are made on the main categories by which specific states of morbid anxiety are classified in the ICD-9, ICD-10, DSM-III and DSM-III-R. The latest classifications, ICD-10 and DSM-III-R, contain many more such categories than ICD-9, and although they differ in the priority given to panic versus agoraphobia, the content is very largely similar. ICD-10 contains several categories of special interest to mental health workers in developing countries and primary health care.

Anxiety Disorders

An International Classification of Retinopathy of Prematurity: development of the classification of the late stages of retinopathy of prematurity.

In another publication [6], an agenda for ROP was outlined for the future. High on that list was the completion of the task of classifying ROP. This has been accomplished, but it is obvious that no classification is any better than the use to which it is put. This is the case with this work. Its implementation in a prospective, controlled trial of surgical therapy of end-stage ROP will more than justify the labors of all who participated in its development.

Anterior Eye Segment

Classification of animal lymphomas: the implications of applying Rappaport's classification for human lymphomas to experimental tumors.

One hundred and seventy animal lymphomas (species ranging from molluses to monkeys) were reclassified histologically according to the modified Rappaport classification for human lymphomas. The results were correlated with the etiology of the lymphomas, their clinical course, and in selected cases with their immunological type. The study stresses the value of such a procedure for comparative reasons, allowing a more adequate selection of animal models for human lymphomas.

Animals

Classification of acute non-lymphocytic leukemia according to the distribution picture of peroxidase activity and cell size: correlation between the classification and therapeutic response.

A distribution picture was prepared on the basis of the correlation between peroxidase activity and cell size in leukemic cells using an automated leukocyte differential counter (Hemalog-D). From this, acute nonlymphocytic leukemia was classified into three groups in which the therapeutic response was examined. The leukemic cells of Group I were medium or large and were negative or weakly positive to peroxidase. These cells were characterized by their location in the upper part of the normal lymphocyte distribution. The leukocyte differential count, measured by a computer on the basis of the distribution picture, showed an increase in large unstained cells (LUC) and lymphocytes. The leukemic cells of Group II were large and positive to peroxidase and were characterized by their location in the right upper part, across the region of LUC, monocytes, basophil and neutrophil leukocytes as seen in the distribution picture. The findings of Hemalog-D showed an increase in LUC, remainder and neutrophil leukocytes. The leukemic cells of Group III were medium-sized and moderately or strongly positive to peroxidase. This group was characterized by their location in the lower part of normal neutrophil leukocytes and Hemalog-D showed an increase in neutrophil leukocytes. A total of 71 patients with acute nonlymphocytic leukemia were assessed according to this classification. Group I (14 patients): 11 with acute myelogenous leukemia (AML), 2 with acute monocytic leukemia (AMoL) and 1 with acute myelomonocytic leukemia ( AMMoL ); Group II (17 patients): 7 with AML and 10 with AMoL; Group III (40 patients): 28 with AML, 4 with AMoL, 1 with AMMoL and 7 with acute promyelocytic leukemia (APL). These groups were treated with the protocol (DCMP two step, BH-AC DMP, BH-AC AMP) established by the Yamada Leukemia Study Group of the Japan Welfare Ministry Cancer Research Project (chairman Yamada, K). The complete remission rate was 35.7% in Group I, 58.8% in Group II and 85.0% in Group III. The difference between Groups I and III was statistically significant (P less than 0.005), as was the difference between Groups II and III (P less than 0.1), while that between Groups I and II was not significant. The median survival was 12 months in Group I, 9 months in Group II and 15 months in the Group III and the difference between Groups I and III was statistically significant (P less than 0.05). Group III included a small number of AMoL and APL patients in addition to AML, while Groups I and II consisted mainly of patients with AMoL and AML.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent

[Myocardial diseases: their etiology, nomenclature and classification (apropos of the classification of noncoronarogenic myocardial lesions published in Kardiologiia No. 5, 1978)].

The main forms of "noncoronarogenous" diseases of the heart muscle and the problems of their nomenclature are discussed, an attempt is made in particular to determine the borderline between the concepts of "myocardial dystrophy" and "cardiomyopathy". The article also deals with the role of infections in the origin of inflammatory processes in the heart muscle (myocarditis) and its dystrophy. A conclusion is drawn on the expediency, from the standpoint of nomenclature, to designate the pathological condition of the myocardium in the course of an infectious disease only by the term "myocarditis". The relation between "primary cardiomyopathies" and Fiedler's idiopathic myocarditis is discussed. The possible role of virus infection in the origin of the indicated forms of myocardial diseases is considered. The classification of noncoronarogenous myocardial lesions published in Kardiologia (1978, No. 5) is discussed. The author of the present article thinks that it may be appraised quite favourably on the whole, and also makes some remarks.

Cardiomyopathies

[Classification and prognosis of supravesical urothelioma with the new TNM classification].

We report on 149 patients with supravesical urothelioma (transitional cell carcinoma of the upper urinary tract) treated in our hospital during the years 1967-1991. The introduction shows the distribution of sex and age as well as the localization of the tumor. Main topic of this paper is a new definition of the clinical pathology of supravesical urothelioma by means of the TNM classification published 1987. Based on the pathological pioneer work of P. Hermanek our results are as follows: during the first diagnosis pT3 predominates with 30.2%, followed by pT1 with 25.5% and pTa, pT1 and pT4 with a relatively low incidence. G2 predominates with 47.7%; G1 and G3 have almost the same frequency. The G/pT ratio shows a decreasing linearity for G1 from pTa to pT4; for G2 there is equivalence of pT1-pT3; and pTa and pT4 are relatively rare. With respect to G3, pT3 predominates with 51%, followed by pT4, pT1 and finally pTa with zero frequency. The G/M ratio shows M0 only for G1, 10% M positive for G2 and 15% M positive for G3. The 10-year survival rate for patients with R0 resection and stage pTa is 64% and for pT1-pT4, 33-36%. The 10-year survival rate for patients with G1 tumor is 51%, and that for G3 tumors 30%. Multicentric occurrence and carcinoma in situ have no prognostic significance in our sample. As is well known, papillary growth has a better prognosis than solid infiltration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Is the Durie and Salmon diagnostic classification system for plasma cell dyscrasias still the best choice? Application of three classification systems to a large population-based registry of paraproteinemia and multiple myeloma.

There are a number of systems for diagnosing multiple myeloma, myeloma variants and monoclonal gammopathy of undetermined significance. We compared three systems, those according to Durie and Salmon, to Kyle and Greipp, and to the British Columbia Cancer Agency, using material from a population-based registry of 847 patients with a paraproteinemia or multiple myeloma. Of these, 157 underwent both bone marrow and X-ray examinations and were subsequently included in our analysis. The differences between the systems were small, even though in only 64% of the cases the diagnosis according to all three systems was identical. The system used by the British Columbia Cancer Agency turned out to be the shortest and easiest system reviewed here. We propose a more frequent application of this system instead of the more commonly used Durie and Salmon and Kyle and Greipp criteria.

Adult