Bladder sensory power factor (BSPF): a novel diagnostic tool

45 patients who had received total laryngectomy for laryngeal neoplasia were reviewed with CT, using a study protocol for systematic evaluation as well as the identification of the principal sites of probable recurrence. The advantages of this technique, and some of the considerations which have to be taken into account to avoid error in diagnosis, are commented upon.     

Immunocytochemistry as a diagnostic tool

ICC is a powerful technique to gain information about pathological processes in peripheral nerve beyond the limits of classical histopathology. ICC can aid in the identification of cellular infiltrates (T cells, B cells and macrophages), in the definition of their state of activation (MHC class I and II molecule expression), in the localization of cellular adhesion molecules (vascular and intercellular adhesion molecule 1) involved in trafficking of inflammatory cells through the endothelium and, finally, in the identification of locally produced cytokines (interferon gamma, interleukins and tumour necrosis factor). Moreover, ICC can identify pathological deposits, such as immunoglobulins and amyloid, within nerves and can be used to study the expression of myelin sheath proteins as they change in disease. In this chapter, basic immunocytochemical findings in experimental diseases of the peripheral nervous system, such as WD and immune-mediated demyelination, are summarized and discussed in the context of similar observations in sural nerve biopsies.     

Inhibin expression in ovarian tumors and tumor-like lesions: an immunohistochemical study

We investigated 203 ovarian tumors and tumor-like lesions for inhibin expression using a monoclonal anti-inhibin alpha antibody. Inhibin was present in the tumor cells in all 14 primary adult granulosa cell tumors (4 luteinized) plus 3 metastatic, all 10 primary juvenile granulosa cell tumors plus 1 metastatic, 10 of 11 thecomas, 3 of 11 fibromas, 4 of 11 sclerosing stromal tumors, 6 of 11 Sertoli cell tumors (1 oxyphilic), 7 of 11 Sertoli-Leydig cell tumors, 1 gynandroblastoma, 10 primary ovarian sex cord tumors with annular tubules plus 2 metastatic, 8 of 9 steroid cell tumors, both pregnancy luteomas, 1 of 2 unclassified sex cord tumors, 2 of 5 gonadoblastomas, 9 of 10 female adnexal tumors of probable wolffian origin, and in the non-neoplastic stroma of many carcinomas and germ cell tumors. The tumor cells were inhibin-negative in 10 fibrosarcomas, 12 small cell carcinomas of hypercalcemic type, 24 germ cell tumors (except for a focus of inhibin-positive syncytiotrophoblast in one case), and 17 ovarian carcinomas. Two of the three inhibin-positive fibromas showed diffuse immunostaining and were associated with evidence of estrogenic activity. Among nine Sertoli-Leydig cell tumors with available clinical data, four that were more than minimally inhibin-positive were accompanied by androgenic manifestations; five inhibin-negative or only minimally positive tumors lacked such evidence. Inhibin immunostaining may be useful in the differential diagnosis of inhibin-positive sex cord tumors versus histologically similar inhibin-negative neoplasms, but inhibin negativity does not preclude a diagnosis of sex cord tumor. The unexpected, common inhibin positivity of female adnexal tumors of probable wolffian origin indicates that inhibin staining cannot be used to differentiate these tumors from Sertoli cell tumors. Inhibin immunostaining is also helpful in identifying potential steroid hormone-secreting cells in the non-neoplastic stromal component of epithelial, germ cell, and other ovarian tumors.     

The stethoscope as a diagnostic tool

It is not the purpose of this article to list the stethoscopic findings in various diseases, nor to discuss such conditions in detail, all of which may be found in any good text book of medicine. Rather, an attempt will be made to assess the significance of the stethoscope, with its limitations, in clinical diagnosis. Does it in fact now have a role of any importance, or is it merely carried as the doctor's traditional badge of office?     

Know your borderline: Countertransference as a diagnostic tool.

Addresses some special difficulties that borderline patients present to psychotherapists. The central focus is on the countertransference issue and its process in the therapist. Some of these countertransference reactions provide the therapist with diagnostic "clues" specific to this group and reasons why this is so baffling and difficult for many therapists are discussed. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunohistochemistry: a prognostic as well as diagnostic tool?

The assessment of proliferating cell populations has been used to aid in the differentiation of benign from malignant neoplasms, and it has been hoped that assessment of proliferation markers and oncogenic determinants holds information regarding prognosis. Various markers, including Ki-67, p53 protein, bcl-2, and proliferating cell nuclear or paraffin-embedded tissue. These determinants may prove useful in understanding the biology of certain neoplasms and may carry prognostic information that influences clinical management. Results in this developing field must always be interpreted in the clinical and histological context. This article reviews the applicability of some commonly available markers to selected skin disorders.     

Beyond anatomy: MR imaging as a molecular diagnostic tool

Technical advances in software and hardware make MR imaging competitive with CAT scanning as an anatomic imaging tool. Although anatomic relationships remain important, increased understanding of cell structure and function is rapidly moving us toward diagnosis and treatment at the cellular level. By virtue of its reliance on nuclear magnetic spin moment, MR imaging is responsive to real time physico-chemical characteristics of cells and tissues being imaged. This intrinsic advantage of MR imaging is being rapidly developed through the use of targeted imaging agents and magnetic resonance spectroscopy. Imaging agents that target specific cell populations have been prepared by using monoclonal antibodies, liposomes, and short peptides bound to chelates containing paramagnetic atoms. Using magnetic resonance spectroscopy, the chemical composition of tumors can be analyzed and compared with normal tissues in vivo and in vitro. Areas of possible clinical usefulness for magnetic spectral analysis include: (1) in vitro or in vivo characterization of lesions as benign or malignant, (2) differentiation between in situ and invasive carcinomas, (3) determination of responsiveness to specific chemotherapeutic regimens before their institution, (4) study of in vivo drug metabolism by neoplasms, and (5) assessment of response to therapy and of residual disease at the completion of therapy. Early experiences in these parallel fields show great promise, with widespread clinical applications expected in the near future.     

Magnetic resonance cholangiopancreatography: a novel approach to the evaluation of suspected pancreaticobiliary neoplasms

BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is a new noninvasive diagnostic method for pancreaticobiliary (PB) imaging without endoscopy, sedation, or iodinated contrast. The purpose of this study was to evaluate the ability of MRCP to depict pancreatic and biliary ductal anatomy compared to that of endoscopic retrograde cholangiopancreatography (ERCP) and to evaluate the ability of MRCP to accurately diagnose PB neoplasms. METHODS: Twenty patients had MRCP, and 17 also had ERCP. All studies were read prospectively by experienced reviewers blinded to other imaging data. Pathologic diagnosis was made in all patients. RESULTS: Bile duct dilatation seen by ERCP in 14 of 17 patients was correctly identified by MRCP in all 14 patients, and normal ducts were correctly identified by MRCP in the other 3 patients. The pancreatic duct was visible on MRCP in the pancreatic head in 17 of 20 patients, the body in 17 of 20 patients, and the tail in 15 of 20 patients. At ERCP, pancreatic duct dilatation was present in 11 cases and was identified by MRCP in 10 of them. Eighteen of 20 patients had malignant PB neoplasms. MRCP indicated PB neoplasm in 19 patients. Seventeen of these 19 patients had histologically confirmed malignant neoplasms pathologically, whereas 2 had benign pathology (both chronic pancreatitis). Among the 17 patients who also had ERCP, MRCP and ERCP correctly agreed on a final diagnosis of malignant neoplasm in 14 cases. In the three cases in which MRCP and ERCP disagreed on a final diagnosis, MRCP was correct in one and incorrect in two. CONCLUSIONS: MRCP can accurately and noninvasively delineate PB ductal anatomy and diagnose PB neoplasms comparably to ERCP. MRCP is an interesting new noninvasive method for evaluating patients with suspected PB neoplasms.     

Immunophenotyping as a diagnostic tool to differentiate lichen planus from chronic graft-versus-host disease: diagnostic observations on two patients

BACKGROUND: Lichen planus (LP) and the lichenoid variant of chronic graft-versus-host disease (cGVHD) can present with similar clinical and histological findings. The distinction, although difficult, is important both prognostically and therapeutically. The mechanism and effector cell phenotypes have also shown to differ between the 2 entities. While the lichenoid infiltrate of LP is predominantly T lymphocytes helper/inducer cell phenotype, the suppressor/cytotoxic subset appears to play a major role in cGVHD. The aim of this study is to determine whether the immunophenotypic character of the lichenoid infiltrate can aid in distinguishing the 2 entities. METHODS: Biopsies were obtained from 2 patients with lichenoid papules and a history of transplantation. Light microscopy revealed lichenoid inflammation in both cases characterized by a band-like lymphohistiocytic infiltrate at the dermal-epidermal junction. Immunochemistry was performed on fresh tissue using a panel of monoclonal antibodies including anti-CD1a, CD3, CD4, CD8, CD16, CD20, CD28, and CD68. Results were quantitated using computer-assisted image analysis. RESULTS: We found that in both cases the majority of cells stained with pan T cell marker CD3+. One case demonstrated predominantly CD4+ T cells and increased numbers of CD1a positive Langerhans cells, while the lymphokine natural killer cell activity (LAK) markers anti-CD16 and anti-CD28 were largely nonreactive. Conversely, the second case contained predominately CD8+ lymphocytes and very few CD1a positive Langerhans cells with abundant LAK cell anti-CD16 and anti-CD28 reactivity. CONCLUSIONS: Based on these findings, the former was classified as lichen planus and the latter as lichenoid cGVHD. The diagnoses are substantiated with clinical history and follow-up information. We conclude that immunophenotypic characteristics of the infiltrate can be a useful tool in differentiating lichenoid cGVHD from lichen planus.     

Transatrial access to the normal pericardial space: a novel approach for diagnostic sampling, pericardiocentesis, and therapeutic interventions

BACKGROUND: A nonsurgical means to access the normal pericardial space could provide opportunities for diagnostic sampling and therapeutic interventions. Because there are currently no approved nonsurgical methods to accomplish this, we tested a new approach in large animals. METHODS AND RESULTS: A catheter system was employed in a percutaneous approach from a femoral vein to pierce the right atrial appendage. Pericardial access was confirmed by placement of a radiopaque guidewire visible under fluoroscopy (6 dogs, 13 pigs). In 7 of the pigs, pericardial tamponade, produced by injection of saline or heparinized blood into the pericardial space through this route, was confirmed by fluoroscopy and hemodynamic evidence. The feasibility and safety of this access route were tested with multiple repetitions in all 19 animals. At the end of each of the 17 acute experiments, direct inspection after thoracotomy revealed no hemopericardium, laceration, or bleeding on catheter withdrawal. In 24-hour survival studies performed in 2 of the 6 dogs, the animals exhibited no behavioral signs of discomfort or untoward consequences on recovery from anesthesia. Histology revealed only a small (approximately 1-mm) fibrinous plug at the site of puncture. CONCLUSIONS: The percutaneous approach via the right atrial appendage provides a rapid, safe route to access the normal pericardial space for diagnostic sampling and to alleviate high-volume and low-volume (<200 mL) pericardial effusions. The access route is potentially useful for selective administration of therapeutic agents, growth factors, gene vectors, and cardioactive and vasoactive agents to the heart.     

Omeprazole as a diagnostic tool in gastroesophageal reflux disease

OBJECTIVE: To determine the diagnostic value of empirical treatment with omeprazole in the diagnosis of gastroesophageal reflux disease (GERD). METHODS: Patients with symptoms suggestive of GERD underwent upper gastrointestinal endoscopy and 24-h esophageal pH monitoring. Patients with reflux esophagitis grade 0 or 1 were included in the study and were randomized to double-blind treatment with either 40 mg omeprazole or placebo o.m. The effect of treatment was evaluated after 1 and 2 wk with a symptom questionnaire with a four-grade Likert scale, and symptomatic response outcome was compared with the results of 24-h pH-metry. RESULTS: Ninety-eight patients were included; however, 13 were excluded from the final analysis because of protocol violation. Of the remaining 85 patients, 54 had no signs of esophagitis at endoscopy, and 31 had esophagitis grade 1. The pH registration showed pathological gastroesophageal reflux in 47 patients (55%). Forty-one patients were randomized to treatment with omeprazole and 44 to placebo. There was a significant correlation between the pH registration result and response to omeprazole (p = 0.04, chi2), but not to placebo (p = 0.16). With pH-metry as the gold standard, the omeprazole test had positive and negative predictive values of 68% and 63%, respectively, for the diagnosis of GERD. When the omeprazole test was used as the gold standard, the positive and negative predictive values of pH monitoring were 68 % and 63 %, respectively. Similar sensitivity was found when the pH-metry was compared with presence of esophagitis. CONCLUSION: Determination of the symptomatic response to 40 mg of omeprazole for 14 days is a simple and inexpensive tool for the diagnosis of GERD, with a sensitivity and specificity comparable to 24-h pH monitoring.     

Tympanometry as a screening tool in the NICU: is it effective?

This study assess the usefulness of the tympanogram as a screening tool for identifying otitis media and serous otitis media in preterm infants. Twenty-six infants from the NICU were assessed on the same day by two examiners using tympanometry and pneumatic otoscopy. The results were recorded separately and compared after all infants were tested. An audiologist independently interpreted each of the tympanogram strips. There was very little agreement between tympanometry and otoscopy results. The tympanogram was not found to be a repeatable or a reliable screening tool for assessing otitis media and serous otitis media in the NICU population. It was concluded that the NICU nurse must be aware of the signs and symptoms of otitis media and serous otitis media. If this diagnosis is raised for an infant in the NICU, careful visualization of the tympanic membrane should be carried out along with referrals to ear, nose, and throat and audiology experts.     

IgA antibodies to tissue transglutaminase: An effective diagnostic test for celiac disease

OBJECTIVE: Tissue transglutaminase (tTG) is the main autoantigen recognized by endomysial antibodies. The aim of this study was to assess sensitivity, specificity, and predictive value of IgA and IgG antibodies to tTG in the diagnosis of celiac disease compared with endomysial antibodies. STUDY DESIGN: We established enzyme-linked immunosorbent assay procedures to measure IgA and IgG antibodies to tTG in sera from 48 untreated and 33 treated patients with celiac disease and from 63 patients with gastrointestinal disease who were in a control group. Sera from 10 patients with celiac disease were examined at various times after gluten was reintroduced into the patients' diet. RESULTS: Both IgA and IgG to tTG were significantly (P <.001) higher in serum of untreated patients with celiac disease versus those in the control group; IgA but not IgG was significantly (P <.001) higher in untreated versus treated patients with celiac disease. IgA and IgG antitissue tTG had a diagnostic sensitivity, specificity, and positive predictive value of 92% and 21%, 98% and 97%, and 98% and 83%, respectively. The concordance rate of IgA anti-tTG with IgA antiendomysial antibodies was 95%. In 5 of the 10 patients undergoing gluten challenge, IgA antiendomysium antibodies were detected earlier than IgA anti-tTG antibodies. CONCLUSIONS: tTG-based enzyme-linked immunosorbent assay is an effective diagnostic test, although immunofluorescent-based assays are more sensitive, particularly during gluten challenge.     

The Denture Frame Analysis: an additional diagnostic tool

The purpose of this study was to evaluate the Denture Frame Analysis. This adjunctive cephalometric analysis of the lateral headfilm was introduced in Japan, but no data exist for the Caucasian population at present. One-hundred-and-six Caucasians were randomly selected and assigned to one of four groups, according to their malocclusion: Angle Classes I, II, and III, and anterior open bite. Statistical testing showed significant differences among the four groups for most of the measurements investigated. The Denture Frame Analysis distinguished the different types of malocclusion, and evaluated skeletal and dental relationships. The occlusal plane aids in the determination of the objectives and limits of orthodontic therapy.     

Computer-assisted assessment of hamster ovarian follicle pools: a novel approach

With computerized image capture, primordial and primary follicles were easily and reproducibly measured. This technology appears ideal for following rarely studied small follicle populations and may have utility in the direct evaluation of superovulation protocols and other drug therapy.