Quality of life in short adults

We examined whether psychiatric patients knew their diagnosis, the significance they attached to it, and the impact of being informed in a systematic fashion according to their wishes. We also assessed whether the nature of the psychiatric diagnosis influenced what patients were told by their psychiatrists. The three parts of the study included questionnaire responses from 28 consultant psychiatrists: case-note reviews and questionnaire responses of 200 adult psychiatric in-patients: and a pilot study informing 28 adult psychiatric day hospital patients of their diagnosis according to their wishes. The results showed that of 126 in-patients, 53% had not been told their diagnosis, although most wanted to know. Of those informed, 75% agreed with their diagnosis. The majority of patients considered a psychiatric diagnosis to be as real as a physical diagnosis and helpful in their treatment. Patients with schizophrenia were less likely to have been informed of their diagnosis, and psychiatrists were also more reticent regarding the diagnosis of personality disorder. All patients who were systematically informed, in the pilot study agreed with their diagnosis. We conclude that most patients agree with their diagnosis and its usefulness. All patients should be asked whether they want to know their diagnosis and be informed appropriately.     

Does autopsy of antenatally diagnosed malformed foetuses aid genetic counselling?

BACKGROUND: Many pregnancies are terminated because of ultrasonographic diagnosis of malformation in the foetus. A detailed foetal autopsy is needed to arrive at a definite diagnosis on the basis of which genetic counselling can be provided. METHODS: Sixty-one foetuses, terminated because of antenatal diagnosis of congenital malformations by ultrasound, were autopsied. The ultrasound diagnosis was compared with the diagnosis reached after autopsy. RESULTS: In 31 cases (51%) the autopsy provided additional findings. In 21 cases (34.4%), the autopsy changed the primary diagnosis. The revised diagnosis led to a change in the risk of recurrence in 18 cases (29.5%). CONCLUSION: Genetic counselling depending solely on ultrasonographic foetal diagnosis may be erroneous. For appropriate genetic counselling, a detailed foetal examination should be carried out after termination in cases with ultrasonographically detected congenital malformations.     

Quantitation of porcine reproductive and respiratory syndrome virus RNA in semen by single-tube reverse transcription-nested polymerase chain reaction

The diagnosis of osteoid osteoma can be difficult. We present eight children where the diagnosis of osteoid osteoma was difficult, due to a clinical history suggesting an alternative diagnosis, misleading radiological findings, or where the osteoid osteoma was in an unusual site. In some cases, diagnosis was only reached after biopsy, despite radiological investigation and radioisotope studies. The diagnosis should be considered in a child with bony pain or bony swelling, especially where the history is a chronic one. We present a radiological algorithm for the investigation of patients suspected of having an osteoid osteoma.     

Diagnosis by intra-operative cryostatic section in suspected malignant melanoma (author's transl)

In 233 (40.6%) of 535 patients referred for hospital treatment with a strong suspicion of melanoma, a diagnosis of malignant melanoma could be established on the grounds of the macroscopic clinical picture alone. In 302 patients (56.5%) a clinical diagnosis was not possible so that an intra-operative cryostatic section investigation was necessary to determine future operative measures. This gave a clear diagnosis of malignant melanoma in 101 (34.4%) patients and a benign pigmented skin tumor was established in 171 (56.6%) patients. In 14 cases (4.64%) no diagnosis could be made from the cryostatic investigation. In 16 (5.3%) patients diagnosis from cryostatic section had to be corrected after analysis of paraffin sections. Altogether an accuracy of over 85% was achieved.     

Attention deficit/hyperactivity. Diagnostic criteria and classification]

Following several reports on treatment of adults with attention deficit/hyperactivity disorder, diagnostic problems regarding the diagnosis are discussed. Symptoms and criteria have changed considerably over the years. Many of those who were given this diagnosis earlier would probably be given a different diagnosis today. Patients should be diagnosed according to the latest diagnostic criteria, but these are developed for children, and are not always adequate for adults. Knowledge regarding the manifestation of the disorder in adults is not sufficient. In order to make this diagnosis in an adult, there must be evidence of the symptoms at the time of examination and also in childhood. The latter may be difficult or impossible to demonstrate. Reliable information on the symptomatology of attention deficit/hyperactivity disorder in adulthood will not be available until children who are given the diagnosis today according to DSM-IV or the research criteria of ICD-10 have been followed up in adulthood.     

Amebiasis--a differential diagnosis from inflammatory bowel disease

Entamoeba histolytica is a very uncommon etiology of travelers diarrhoea, but may be an important differential diagnosis to inflammatory bowel disease. A misdiagnosis of amoebic colitis as inflammatory bowel disease followed by inadvertent treatment with corticosteroids may be fatal. Current techniques for the diagnosis of amoebiasis include stool studies, endoscopic biopsy and serology. Demonstration of haematophagous trophozoites in feces or in tissue biopsy is the definitive method for diagnosis. Unfortunately both methods have many drawbacks. If the specimens are negative, serology can support the diagnosis especially in a non-endemic area where a positive test is highly predictive of current disease.     

Rapid genetic diagnosis at 7-9 weeks gestation: diagnosis of sex, single gene defects and DNA fingerprint from coelomic samples

Prenatal diagnosis (chorionic villus sampling (CVS) or amniocentesis) is performed at a relatively late stage of pregnancy (11-18 weeks). Such tests have significant disadvantages including increased risk of miscarriage and delay before results are known. Earlier prenatal diagnosis (< 11 weeks) has been discontinued because of the risk of fetal abnormalities. Recently fetal cells have been recovered from the coelomic cavity at 7-12 weeks gestation (coelocentesis). This study has established that highly sensitive fluorescent polymerase chain reaction (PCR) can provide rapid (4-5 h), reliable and accurate multiple genetic diagnoses (sexing and single-gene diagnosis) from coelomic cells. As prenatal diagnosis has a significant risk of contamination, we have also shown that coelomic cells can be simultaneously DNA fingerprinted to determine that contamination has not occurred. This earlier method of prenatal diagnosis would be very valuable, as it may overcome some problems of later conventional prenatal diagnosis and allow reassurance/treatment to be undertaken at a much earlier stage. Successful application of these techniques may supersede alternative methods of prenatal diagnosis. Although these techniques appear very promising, extensive clinical trials must be undertaken to determine safety of coelocentesis, diagnostic reliability and accuracy in a clinical setting.     

Cholelithiasis in children and adolescents (authors transl)

Cholelithiasis is a rare, but important condition to be considered in the differential diagnosis of abdominal symptoms in childhood and adolescence. A survey over a 20-year period revealed 10 cases between the ages of 11 and 20 years, with a clinical history of cholelithiasis of between 5 days and 6 years. The most consistent finding was epigastric or right upper quadrant pain. Serum chemistry did not contribute conclusively towards the diagnosis. Hereditary spherocytosis was demonstrated in 3 cases, 2 had familial gall bladder disease, whilst in the rest no cause could be found. Two patients are described in some detail: one girl with spherocytosis and a bilirubin of 78 mg/100 ml, presenting with choledochal obstruction and pancreatitis, and another girl with a history of recurrent abdominal pain, negative radiologial and chemical pathological findings and a tentative diagnosis of neurosis. Oral cholecystograms lead to the diagnosis in most cases; however i. v. cholangiograms should be considered whenever the diagnosis appears in doubt. All cases were treated by cholecystectomy and recovery was uneventful in 9 patients. Cholecystectomy should be performed in all patients with gall stones, even in the absence of symptoms.     

齿轮典型故障诊断研究

介绍了齿轮的几种典型故障的特征及诊断方法。在齿轮故障诊断过程中，应用振动诊断方法可以解决变速设备中齿轮的绝大部分问题，有时还可以综合应用温度、磨损、失效分析以及无损探伤等辅助诊断手段，进一步提高齿轮故障诊断的准确性和可靠性，实现对设备管理的技术支撑和保障作用。     

The differential diagnosis of Meniere's disease

The diagnosis of "classic" Meniere's disease is easy to make. Unfortunately, Meniere's disease is a diagnosis of exclusion and many disease entities can mimic Meniere's disease. Thus, it is essential to eliminate other possible etiologic agents for complaints that could be related to Meniere's disease before making this diagnosis. This article evaluates the differential diagnosis in Meniere's disease.     

Giant-cell tumor in soft parts in a patient with osseous Paget's disease: diagnosis by fine-needle aspiration

In this report, the cytological features and differential diagnosis of a case of giant-cell tumor (GCT) in soft tissues in a patient with osseous Paget's disease (PD) are described, with histological confirmation. Characteristic cytological findings include a diffuse cellular population of neoplastic cells composed of two types: one group of polygonal or round mononuclear small cells, exhibiting a thin-rim, dense cytoplasm and single hyperchromatic nuclei; and the second group of multinucleated, osteoclast-type giant cells with dozens of round nuclei, showing occasional micronucleoli. A prominent feature is the presence of numerous capillary structures surrounded by tumor cells. The differential diagnosis includes a number of other neoplastic and reactive processes in which giant cells may be abundant. The cytological features of GCT appear to be characteristic enough to allow a suggestive diagnosis. However, the final diagnosis should be made only after the lesion has been studied histologically.     

Narcolepsy in children--a diagnostic and therapeutic challenge

Narcolepsy is a socially and psychologically disabling disease that most often develops in adolescence or early adulthood. In a number of studies about one-third of the patients had experienced the first symptoms before the age of 15. The diagnosis and subsequent treatment is usually not established until several years later, often ten to fifteen years after the appearance of the first symptoms. If unrecognized and untreated, narcolepsy may lead to serious psychological and social problems during childhood and early adulthood, which may in turn cause difficulties in social adjustment later in life. This stresses the importance of early diagnosis. The diagnosis is based on clinical and polysomnographic criteria. In children, however, the clinical symptoms and polysomnographic findings may be atypical, making it difficult to establish a definite diagnosis. Three patients, two five-year olds and one four and a half-year old, are presented to illustrate the problems and considerations which must be taken into account in the diagnosis and treatment of children with narcolepsy.     

Differential diagnosis in patients with disorders of the patellofemoral joint

Anterior knee complaints are difficult diagnostic problems. It cannot be overstated that the most important information available is to be found in the patient's history. Onset, quality, and quantity of symptoms must be assessed. This information is then synthesized to determine the specific functional disabilities resulting from the patient's anterior knee disorder. Once a history is obtained, a consistent, methodical physical examination can be performed to narrow the differential diagnosis. Radiographic evaluation is used to further hone the differential or to confirm the most likely diagnosis. Ultimately, a specific working diagnosis is selected and treatment is tailored to changing the underlying structural or biomechanical abnormalities that led to the patient's complaints.     

CT diagnosis and differential diagnosis of renal spaca occupying lesions (author's transl)

In 76 patients with space occupying lesions of the kidneys CT scans were performed. Size, shape and localisation of the kidneys could well be demonstrated by this method. Space occupying lesions were clearly seen, and solid tumors could be differentiated from cysts. However differential diagnosis between either primary renal cell carcinoma and metastases or between malignant and benign mass lesions was not possible. There was no problem in the diagnosis of hydronephrosis where as a differentiation between inflammatory changes and solid masses proved to be difficult. CT scanning seems to be usefull in the diagnosis of renal space occupying lesions. As a non invavise method it should be performed previous to renal angiography, which thereby becomes unnecessary in many cases.     

The assessment of light intensity preference in psychiatric patients: a questionnaire

PROBLEM: Psoas abscesses are really rare so that the diagnostic onset is commonly very late. The differential diagnosis to other retroperitoneal processes is therefore important. METHOD: In a period of observation of 6 years 21 patient were treated with psoas abscesses. The evaluation of 16 records was done retrospectively under consideration of etiology, history, clinical examination, lab results and x-ray/CT/MRI etc. RESULTS: With the knowledge of the anatomy of the ilio-psoas muscle the clinical examination gives us important information about the diagnosis of psoas abscess. The history and the clinical examination precede the further diagnostics and are condition for high rates of sensitivity and specificity. Lab results indicate an absedation without being specific. The exclusive position of radiological diagnostics is undisputed. Ultrasound, x-ray and leucocyte marked bonescan are proven to be helpful in cases of unknown location of the abscesses. Method of choice seems to be the contrast enhanced CT-scan. The differential diagnosis includes gastrointestinal or renal disorders as well as pathology of bone or joints. In our cases differential diagnosis was complicated since the diagnostic onset was delayed and the initial therapy was not adequate. The diagnosis "abscess of the psoas" does not imply a general regime for therapy therefore an individual treatment in consideration of percutaneous and operative drainage has to be recommended. In selected cases a combination therapy is advised. CONCLUSION: In every case of retroperitoneal symptoms the differential diagnosis of an abscess of the psoas has to be regarded. The diagnosis is subtil and requires clinical and laboratory examinations as well as contrast enhanced computerscan. The therapy follows operative measures. The technique has to be individually decided.     

Ultrasonographic appearance of fallopian tube carcinoma

Preoperative diagnosis of tubal carcinoma is difficult and a diagnosis cannot usually be established until the time of operation. However, since prognosis is strictly related to the stage of the neoplasm, it is very important to be familiar with the clinical and imaging characteristics of primary fallopian tube carcinoma in order to make an early and accurate diagnosis. This report presents the ultrasonographic features of three cases of fallopian tube carcinoma and reviews the literature on the subject.     

Geriatric neuropsychology

Contends that evaluation of the elderly presents a great challenge to the neuropsychologist. Appropriate age norms are not available for most tests, and the complex interaction of age and disease makes diagnosis difficult. Changes in mental status secondary to toxic-metabolic disturbances appear to be more common in the elderly than the young. Psychiatric illness, especially depression, may also produce dysfunction that can be mistaken for nonreversible cognitive change. Only by being aware of the characteristic pattern of impairment in these disorders can accurate diagnosis be made. Though few forms of dementia can currently be treated, proper diagnosis and management of dementia patients is also dependent on understanding the neuropsychological profile of each dementing disease. Problems related to the differential diagnosis of older individuals are discussed with regard to these issues, and approaches to evaluation are recommended. (107 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Synovial chondromatosis and chondrosarcoma. A study of the relationship between these two diseases

PURPOSE OF THE STUDY: This retrospective study concerns six patients in whom chondrosarcoma was suspected to develop in synovial chondromatosis. We discuss for these cases different diagnosis. The authors expose the clinical signs and radiological aspects which suggest malignant transformation. We report the indispensable criteria for established diagnosis of malignant transformation of synovial chondromatosis and appropriated forms of therapeutic management were suggested. MATERIALS AND METHODS: Six patients, 3 males and 3 females from 36 to 58 years of age were included in this study. Three patients presented 6 months, 3 years and 25 years history of synovial chondromatosis of the knee joint. When the malignant transformation appeared, a surgical biopsy was performed and the pathologist diagnosed a chondrosarcoma in all cases. For the other three patients, the chondrosarcoma and synovial chondromatosis were diagnosed at the same time. The localization was shoulder, hip and knee. A surgical biopsy was performed and the pathologist diagnosed chondrosarcoma. Synovial chondromatosis was diagnosed by histologic examination of the resection or amputation specimen. TREATMENT AND RESULTS: Four patients had thigh amputation, one patient had "en bloc resection" of the hip-joint and the last patient had resection of the shoulder joint. In all cases, the histologic examination diagnosed chondrosarcoma and synovial chondromatosis. All patients were free of disease. DISCUSSION: The malignant transformation of synovial chondromatosis is rare but this diagnosis must be established to perform appropriate treatment. Other possible diagnosis are: low grade synovial chondrosarcoma initially diagnosed as a synovial chondromatosis. Bertoni believes that all cases of malignant transformation of synovial chondromatosis are initially low grade chondrosarcoma. We believe that his criteria are too strict for diagnosed chondrosarcoma. coexistence of synovial chondromatosis and synovial chondrosarcoma. These 2 diagnosis are extremely rare and their coexistence are unlikely. secondary synovial chondromatosis developed into chondrosarcoma. We don't have histologic criteria to confirm this diagnosis in all our cases. The symptoms that should suggest a malignant transformation of synovial chondromatosis were: rapid late deterioration of clinical conditions, bone invasion diagnosed by X-ray films and medullar invasion discovered by MRI. According to us, the indispensable criteria to diagnose malignant transformation were: 1.) histologic diagnosis of synovial chondromatosis established before diagnosis of chondrosarcoma, 2.) histologic diagnosis of chondrosarcoma on the same anatomic site as the synovial chondromatosis, 3.) diagnosis of chondrosarcoma and synovial chondromatosis on the same resection specimen. Only the three first cases were in accordance with these criteria. The treatment must be a "en bloc resection" of the joint or an amputation. CONCLUSION: Malignant transformation is rare, but this diagnosis should be established to perform adequate treatment. This diagnosis should be suspected when a rapid deterioration of the clinical status appeared and when bone involvement was detected by MRI. However, the danger still lies in the misinterpretation of the synovial chondromatosis as chondrosarcoma. This diagnosis can be made with clinical, radiological and pathological criteria. The treatment must be a wide resection or an amputation.