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Results for “diagnostic methods”

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PubMed2003

Ventilator-associated pneumonia in intubated children: comparison of different diagnostic methods.

OBJECTIVES: To compare different methods for diagnosis of ventilator-associated pneumonia in intubated children. DESIGN: Prospective epidemiologic study. SETTING: Pediatric intensive care unit of a tertiary care university hospital. PATIENTS: All consecutive pediatric intensive care unit patients <18 yrs of age with suspected ventilator-associated pneumonia. INTERVENTIONS: For all patients, the following diagnostic methods were compared: 1) clinical data using Centers for Disease Control criteria; 2) blind protected bronchoalveolar lavage, evaluating quantitative cultures, bacterial index of >5, Gram stain, and presence of intracellular bacteria; and 3) nonquantitative cultures of endotracheal secretions. The reference standard used was clinical judgment of three independent experts (Delphi method) who retrospectively established by consensus the presence of ventilator-associated pneumonia based on clinical, microbiological, and radiologic data. Concordance between each diagnostic method and the reference standard was evaluated by concordance percentage and kappa score. Validity was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and global value. RESULTS: A total of 30 patients were included in the study. According to the reference standard, ventilator-associated pneumonia occurred in 10 of 30 patients (33%). Bacterial index of >5 in bronchoalveolar secretions showed the best concordance compared with the reference standard (concordance, 83%; kappa, 0.61). Bacterial index of >5 also showed the best validity (sensitivity, 78%; specificity, 86%; positive predictive value, 70%; negative predictive value, 90%; global value, 90%). Intracellular bacteria and Gram stain from bronchoalveolar secretions were very specific (95% and 81%, respectively) but not sensitive (30% and 50%, respectively). Clinical criteria and endotracheal cultures were very sensitive (100% and 90%, respectively) but poorly specific (15% and 40%, respectively). CONCLUSION: Our data show that the most reliable diagnostic method for ventilator-associated pneumonia is a bacterial index of >5, using blind protected bronchoalveolar lavage. Further studies should evaluate the validity of all these methods according to the gold standard (autopsy).

Bronchoalveolar Lavage Fluid↗

PubMed1984

Psychiatric assessment of children. I. Diagnostic method.

An account is given of a diagnostic method which appears to be little known in child psychiatry. It is based on observable deviations in facial expression and motor functions. In the author's opinion it helps to distinguish depressions of different origin as well as symptoms suggesting mild brain lesions.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

Evaluation of chronic venous disease in the lower limbs: comparison of five diagnostic methods.

To compare the usefulness of five diagnostic methods in ensuring deep vein patency, and in demonstrating site(s) of incompetence, 39 patients with clinical signs of chronic venous disease of a leg were included in a study of deep, superficial and perforator veins using triplex ultrasound (TUS), ascending phlebography (AP), descending phlebography (DP), continuous wave Doppler (CWD) and ambulatory strain gauge plethysmography (ASGP). One patient withdrew from the study. It was not possible to use all five methods in all 38 cases, and the methods could only be used partly in some cases. TUS, which allows anatomical, morphological and functional evaluation of the venous system, was chosen as the reference method. There was poor agreement between TUS and AP, and no agreement between TUS and ASGP, in the diagnosis of venous occlusion. AP demonstrated reflux (abnormal valves) in 7 of 22 patients with competent veins at TUS, and missed reflux in 13 of 15 patients with incompetent veins. Similarly, CWD overdiagnosed reflux in 13 of 20 patients and missed the reflux in 3 of 14 patients. DP was only technically possible in 11 patients. ASGP diagnosed venous reflux in all patients with incompetent deep veins, but also indicated deep vein or perforator vein reflux in all but one patient with competent deep veins. The agreement between TUS and the other methods in evaluating reflux in the deep veins was not better than that expected to occur by chance, Cohen's kappa being less that 0.20. It is concluded that AP, CWD and ASGP are of little value in the work-up of patients with deep venous insufficiency.

Adult↗

PubMed1993

[Diagnostic methods considering tubal factors in infertility].

The diagnostic methods of tubal factor in infertility have been presented in this paper. In details have been discussed PJ, PK, HSG and pelvic examination. These examinations themselves constitute the basic ones in infertility. We turned our attention into technical details and possible mistakes which may occur at the time of performing them, these misinterpretations may lead to absolutely wrong conclusion and diagnosis. Authors have wide experience in performing the discussed examinations and this allows them to share their opinions. Over the years several thousand of PK and HSG examinations have been carried out and also 1000 laparoscopies.

Female↗

PubMed1993

[Primary mesothelioma of the pericardium: diagnostic methods. A case report].

Clinical picture and diagnostic methods in a patient with primary pericardial mesothelioma are described. Echocardiography shows an intrapericardial mass in direct continuity with left ventricular wall. Magnetic resonance imaging is essential to define mass dimension and extension and show cardiac wall and contiguous tissues infiltration. The histological characteristics are defined by using TAC-guided needle biopsy and needle aspiration.

Biopsy, Needle↗

PubMed1978

[Evaluation of diagnostic methods. Application to the diagnosis of benign or malignant colonic tumours (author's transl)].

The evaluation of diagnostic methods has become a necessity in clinical practice in order to select those techniques with the best possible cost-effectiveness ratio. Using simple informational indices such as sensitivity or specificity, it is possible to analyse the literature devoted to diagnostic methods in a given disease. This method is here applied to the problem of the detection of colonic tumours, benign or malignant, and gives an estimation of the informational value of occult blood examinations, rectosigmoidoscopy, simple barium enema, double contrast barium enema and colonoscopy.

Barium Sulfate↗

PubMed2004

The proposal of noninvasive quantitative diagnostic method of the atherosclerosis and the clarification of organ correlation of atherosclerosis and oxygen metabolism.

The proposal of noninvasive diagnostic method of mechanical degradation of vascular wall is clinically useful and it will be correlated with noninvasive diagnostic method of atherosclerosis. Supersonic Doppler effect sensor has been used to measure blood flow velocity as a noninvasive measuring method. However, it is remain problem whether the output from the Doppler effect sensor really detects the pure blood flow velocity. Theoretically, when the Doppler effect sensor is set perpendicular to the blood flow direction, that is, perpendicular to the blood vessel, the output will correspond to the expansion velocity of blood vessel wall, because it detect the frequency of Doppler shifted supersonic scattered from vascular wall. Previously, on the basis of this concept, using Doppler effect sensor, we showed this method can really detect the deformation velocity of blood vessel wall and it correlates the degradation of elastic property of blood vessel. Furthermore, using this proposed measuring method, atherosclerosis is found to progress correspondingly with the visco-elastic degradation of vascular wall. In this paper, on the basis of our proposed method, the quantitative noninvasive estimation method of the degradation of vascular wall and the progressive degree of atherosclerosis by unique parameter has been proposed. Using this method, the degradation of vascular wall is correlated to the oxygen metabolic function of blood vessel corresponding to the function of oxygen transportation and progression of atherosclerosis. Furthermore, the organ correlation on the atherosclerosis between lower limb and carotid is investigated by this proposed method.

Algorithms↗

PubMed2005

Diagnostic methods in hepatic encephalopathy.

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome in patients with liver disease and/or portosystemic shunting that affects quality of life and prognosis. The diagnosis is primarily based on clinical criteria that classify HE into 5 grades of severity ranging from normal mental status (grade 0) to coma (grade 4). As this clinical classification is rather subjective, additional diagnostic methods are required. Biochemical diagnostic tests can be used to confirm or exclude the diagnosis and to monitor the effect of treatment. An elevated ammonia level plays a central role in the pathogenesis of HE and can be determined in arterial, venous and capillary blood. Neuropsychological and neurophysiological tests are more sensitive and objective in diagnosing HE than the clinical criteria. Neuropsychological tests are especially of great value because of their high sensitivity for the detection of minimal HE and their low costs. The more sophisticated diagnostic tests such as magnetic resonance spectroscopy or positron emission tomography are mainly used for investigational purposes. This review will highlight these different diagnostic methods and comment on its pitfalls, clinical significance and overall applicability.

Diagnosis, Differential↗

PubMed2006

[Invasive and non-invasive diagnostic methods for evaluation of hypovolemia in acute pancreatitis].

Severe acute pancreatitis leads to a dramatic fluid loss in the intraperitoneal space which may result in circulatory decompensation. Sequestration of fluid can amount up to 40 percent of the circulating blood volume. The amount of fluid and electrolyte replacement is often misjudged leading to a higher rate of complications and a higher mortality rate of the disease. Furthermore, subsequent and adequate fluid resuscitation seems to influence the prognostic course of the disease by improving the perfusion and oxygenation of the pancreas. Otherwise volume overload may cause cardiopulmonary decompensation in the case of synchronous cardiopulmonary comorbidities. Therefore, an important part of treatment relies on careful haemodynamic monitoring, if necessary managed in an intensive care unit. Usually most patients with acute pancreatitis will be treated on a non-intensive medical ward which allows a differentiated and continuous haemodynamic monitoring only to a limited extent. Apart from monitoring circulatory parameters and measuring central venous pressure, there are other clinical methods, laboratory tests and radiological diagnostic procedures to determine the amount of intravascular fluid deficit and the individual volume demand of patients with acute pancreatitis. Prospective clinical trials for evaluation of pancreatitis-specific volume management do not exist so far. The aim of this review is to provide background information on invasive and non-invasive diagnostic methods for detection of circulatory hypovolemia in acute pancreatitis.

Blood Volume↗

PubMed2002

The agreement between two diagnostic methods in binary cases: a proposal.

This report can be considered as a resource in the analysis of agreement among raters, clinical tests, observers, judges or experts. The focus is on diagnostic methods. When the true results of diagnostic methods cannot be obtained, studying the agreement between them can reflect the difference between methods. Normal statistical procedures tackling this are not enough for deciding about the agreement from a clinical point of view. The clinical question is whether the new method agrees sufficiently with the old one. In binary cases, a solution for deciding about the agreement from a clinical viewpoint is introduced. The overall agreement is a duality and needs to be studied in two steps. In the first step, a condition for accepting the agreement is proposed: both methods need to have the same nosologic sensitivity and specificity. In the second step, another condition is proposed: the level of the agreement should be greater than a critical value, defined by the clinicians. When both steps show satisfactory results, the new method can replace the old one. The statistical procedures for testing both steps are presented.

Clinical Laboratory Techniques↗

PubMed1980

Gastroesophageal reflux in infants and children comparative accuracy of diagnostic methods.

To assess the diagnostic accuracy of methods employed for detection of gastroesophageal reflux, 30 infants and children with symptoms of GER were evaluated by upper gastrointestinal series, gastroesophageal scintiscan, measurement of mean resting lower esophageal sphincter pressure, esophageal intraluminal PH measurement (acid reflux test), and endoscopy. Fifteen control patients were also evaluated by the above studies. GER was demonstrated by UGI in 15 and by GE scintiscan in 17 study patients. LESP less than 15 mm Hg was noted in 12 and a positive acid reflux test was obtained in 29 study patients. Esophagitis was detected in two (of 30) study patients radiographically and in 15 (of 21) study patients by upper gastrointestinal endoscopy. Pulmonary aspiration of gastric contents was not detected by the radionuclide method. None of the 15 control patients had GER demonstrated with any of the above methods. These studies indicate that (1) the acid reflux test correlates most closely with symptoms of GER; (2) THE GE scintiscan is complementary to the UGI in the diagnosis of GER, i.e., the combination increases sensitivity; (3) normal LESP does not necessarily exclude GER; and (4) endoscopy is superior to the UGI in detecting the presence of esophagitis.

Adolescent↗

PubMed2004

Development of a hemi-nested RT-PCR method for the specific determination of European Bat Lyssavirus 1. Comparison with other rabies diagnostic methods.

A simplified hemi-nested reverse transcriptase polymerase chain reaction (hnRT-PCR) has been developed to determine specifically the European Bat Lyssavirus 1 (EBLV-1) nucleoprotein gene. The specificity of this method was determined by using the seven genotypes of lyssavirus by RT-PCR, Southern blot and sequence analysis. Compared to the rabies diagnostic methods, the hnRT-PCR showed a higher sensitivity for the detection of small amounts of EBLV-1 virus. In view of these results, we suggest this new hnRT-PCR should be performed for the epidemiological survey of bat colonies, also providing rapid detection and genotyping of EBLV-1 until now encountered in all naturally infected bats in France.

Amino Acid Sequence↗

PubMed1994

A comparison of diagnostic methods in adolescent girls with and without symptoms of Chlamydia urogenital infection.

OBJECTIVE: To evaluate the clinical utility of various diagnostic tests, two enzyme immunoassays and a chemiluminescent DNA probe were compared with cell culture (with monoclonal antibody confirmation) for the diagnosis of endocervical Chlamydia trachomatis infection. DESIGN: The clinical performance of four diagnostic methods for Chlamydia trachomatis urogenital infections were compared, using specimens generated from consecutive pelvic examinations. SETTING: Subjects were recruited from an urban adolescent clinic that provides primary and referral care. PARTICIPANTS: A total of 479 adolescent female subjects were enrolled. The order of sample collection was randomized. Subjects were stratified according to whether they were asymptomatic (n = 228) or symptomatic (n = 251). MEASUREMENTS AND RESULTS: Discrepant analysis was performed when culture was negative and nonculture technique was positive. The subject was considered to have chlamydia if culture was positive, or if one or more nonculture techniques, with that test's confirmatory assay, were positive (consensus-positive). Prevalence of chlamydia was 11.0% in the asymptomatic, and 20.7% in the symptomatic, group. Overall, 32.5% of the infected subjects were asymptomatic. Sensitivity of diagnostic methods varied from 52% to 80% in the asymptomatic subjects, compared with 65% to 81% in symptomatic subjects. Culture sensitivity was 75% to 80%. The specificities of all tests were 96% or greater. Accuracy of nonculture methods varied from 89.5% (DNA probe, symptomatic subjects) to 96.9% (enzyme immunoassay asymptomatic subjects). CONCLUSIONS: There are significant differences in symptomatic subjects when evaluating accuracy of test outcome, using a consensus-positive criterion. Asymptomatic infections account for nearly one third of adolescent females infected with chlamydia. The prevalence of chlamydia urogenital infections are underestimated by any single diagnostic test, particularly in the asymptomatic patient.

Adolescent↗

PubMedDate not supplied

Tc-99m labeled red blood cells scintigraphy: a diagnostic method for orbital cavernous hemangioma.

PURPOSE: To evaluate Tc-99m labeled red blood cells scintigraphy (Tc-99m RBC scintigraphy) as a diagnostic method for orbital cavernous hemangioma. PATIENTS AND METHODS: Retrospective analysis of the medical records of all patients who were diagnosed as suffering from orbital cavernous hemangioma over the last 16 years. RESULTS: Medical records of 12 patients with orbital cavernous hemangioma were identified. In all twelve patients, the tentative diagnosis of orbital cavernous hemangioma was made by CT scan. In all of them, the diagnosis was established by Tc-99m RBC scintigraphy, demonstrating a typical picture of "perfusion blood- pool mismatch" (This is normal radionuclide angiography, followed by a variable radionuclide uptake during the early blood-pool study and an intensive radionuclide uptake during the delayed blood-pool study). The tumor was surgically removed in all 12 patients. This diagnostic method was found to be reliable as no single case was recorded in which the preoperative diagnosis was not confirmed pathologically after surgical removal of the tumor. CONCLUSIONS: Tc-99m RBC scintigraphy is a reliable method for diagnosing orbital cavernous hemangioma. It should be included in our arsenal of diagnostic techniques, particularly for cases which are otherwise difficult to diagnose.

Adult↗

PubMed1992

[Topical diagnostic methods in primary hyperparathyroidism].

The efficiency of USI of the neck, scintigraphy of the parathyroid glands (PTG) with selen-methionine and selective catheterization of veins (SCV) of the neck and mediastinum for preoperative determination of the localization of the source of hyperproduction of the parathyroid hormone was analyzed on the basis of results of examination of 149 patients including 51 patients with primary hyperparathyroidism confirmed during the operation. It was noted that none of the methods of topical diagnostics used in the work is thought to be universal for different clinical situations. A method of their complex use is proposed which foresee USI of the neck as the first step. In case of insufficient information of the results of USI the authors propose SCV of the neck and mediastinum as a method of choice which allows the size and level of the altered PTG to become more exact and which makes further search with the help of other methods of topical diagnostics more purposeful and effective.

Adolescent↗

PubMed1987

Experience with local rectal cancer excision in light of two recent preoperative diagnostic methods.

This study analyzes the usefulness of two diagnostic methods: endorectal echotomography and adenolymphoscintigraphy. Echotomography is an important means for determining the extent of a tumor beyond the rectal wall, whereas lymphoscintigraphy is useful in demonstrating the metastatic locations in lymph nodes. These two modes of evaluation may permit an evaluation of the extent of the tumor and the possible involvement of regional lymph nodes before a surgical operation. Although the case material is limited, the statistical data can lead one to believe that, in the near future, a reasoned choice will be possible between local excision and abdominoperineal resection. The study includes 60 endorectal echotomographies and 26 lymphoscintigraphies (20 with 99mTc colloid and six with 201-Tl colloid).

Adult↗

PubMed1999

Evaluation of the polymerase chain reaction in comparison with other diagnostic methods for the detection of Chlamydia psittaci.

Various diagnostic methods exist for the detection of Chlamydia psittaci. In the current study, the test performance of polymerase chain reaction (PCR) was compared with other testing methods used in the diagnosis of C. psittaci. Tissue and fecal specimens (n = 119) of avian and mammalian origin were tested by PCR and one or more of the following methods: cell culture, enzyme-linked immunosorbent assay, and direct fluorescein-conjugated monoclonal antibody staining. Several gold standards, based on results of testing methods other than PCR, were used to calculate the following test performance characteristics of PCR: sensitivity and specificity, with their 95% confidence intervals; kappa statistics, a measure of intertest agreement; and lambda statistics, a chance-corrected estimate of the sensitivity and specificity. Overall, the test performance characteristics of PCR were low compared with the other testing methods. Possible reasons for the poor test performance of PCR in the current study include destruction of the organisms during storage, interference with the PCR by other reagents, or technical errors.

Animals↗

PubMed2006

[Development of rapid and simple genomic diagnostic method].

To develop the rapid and simple genomic diagnostic method, we analyzed the partial dnaA sequence of 27 mycobacterial species. The partial dnaA sequence could distinguish M. kansasii and M. gastri. Based on this region and RLEP sequence of M. leprae, we established the loop-mediated isothermal amplification method (LAMP) to detect each species. The LAMP method for M. kansasii and M. gastri, could detect 500 copies. Five copies of M. leprae genomic DNA could be detect in 30min. To simplify the sample processing, the LAMP assay was performed with FTA filter paper. M. leprae bacilli were applied on filter paper that lyses bacilli and bound DNA, eliminating sample centrifugation and extraction procedures. Assays of number standards showed reproducible detection rate 50 bacilli of M. leprae. Thus, The LAMP assay combined with FTA card has the advantages of rapid and simple detection and provides a practical, economical, and specific method for the diagnosis of M. leprae and NTM infection.

Bacterial Proteins↗