scholarly journals Results from a PI-RADS-based MRI-directed diagnostic pathway for biopsy-naive patients in a non-university hospital

2021 ◽  
Author(s):  
Jeroen S. Reijnen ◽  
Jon B. Marthinsen ◽  
Alf O. Tysland ◽  
Christoph Müller ◽  
Irina Schönhardt ◽  
...  
Keyword(s):  
Transrectal Ultrasound ◽  
Safety Net ◽  
University Hospital ◽  
Diagnostic Pathway ◽  
Clinically Significant ◽  
And Performance ◽  
Diagnostic Work ◽  
Almost All ◽  
Work Up ◽  
First Time

Abstract Purpose To assess the safety and performance of a MRI-directed diagnostic pathway for patients with first-time suspicion of prostate cancer in a non-university hospital. Methods Between May 2017 and December 2018 all biopsy-naive patients examined in our hospital followed a MRI-directed diagnostic work-up algorithm based on PI-RADS score. In short, PI-RADS 1–2 was generally not biopsied and PI-RADS 3–5 was reviewed by a multidisciplinary team. Patients with PI-RADS 4-5 were all referred to biopsy, either transrectal ultrasound-guided biopsy or MRI in-bore biopsy for small tumors and for sites difficult to access. PI-RADS scores were compared to the histopathology from biopsies and surgical specimens for patients who had prostatectomy. Non-biopsied patients were referred to a safety net monitoring regimen. Results Two hundred and ninety-eight men were enrolled. 97 (33%) had PI-RADS 1–2, 44 (15%) had PI-RADS 3, and 157 (53%) had PI-RADS 4–5. 116 (39%) of the patients avoided biopsy. None of these were diagnosed with significant cancer within 2–3.5 years of safety net monitoring. Almost all high ISUP grade groups (≥ 3) were in the PI-RADS 4–5 category (98%). Prostatectomy specimens and systematic biopsies from MRI-negative areas indicated that very few clinically significant cancers were missed by the MRI-directed diagnostic pathway. Conclusion Our findings add to evidence that a MRI-directed diagnostic pathway can be safely established in a non-university hospital. The pathway reduced the number of biopsies and reliably detected the site of the most aggressive cancers. Graphic abstract

Surgery in autoimmune pancreatitis

2021 ◽  
Author(s):  
Sara Nikolic ◽  
Poya Ghorbani ◽  
Raffaella Pozzi Mucelli ◽  
Sam Ghazi ◽  
Francisco Baldaque- Silva ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Single Centre ◽  
Age At Surgery ◽  
Diagnostic Work ◽  
Work Up

Introduction: Autoimmune pancreatitis (AIP) is a disease that may mimic malignant pancreatic lesions both in terms of symptomatology and imaging appearance. The aim of the present study is to analyse experiences of surgery in patients with AIP in one of the largest European cohorts. Methods: We performed a single-centre retrospective study of patients diagnosed with AIP at the Department of Abdominal Diseases at Karolinska University Hospital in Stockholm, Sweden, between January 2001 and October 2020. Results: There were 159 patients diagnosed with AIP, and among them 35 (22.0%) patients had surgery: 20 (57.1%) males and 15 (42.9%) females; average age at surgery was 59 years (range 37-81). Follow-up period after surgery was 67 months (range 1-235). AIP type 1 was diagnosed in 28 (80%) patients and AIP type 2 in 7 (20%) patients. Malignant and premalignant lesions were diagnosed in 8 (22.9%) patients for whom AIP was not the primary differential diagnosis but, in all cases, it was described as a simultaneous finding and recorded in retrospective analysis in histological reports of surgical specimens. Conclusions: Diagnosis of AIP is not always straightforward, and, in some cases, it is not easy to differentiate it from the malignancy. Surgery is generally not indicated for AIP but might be considered in patients when suspicion of malignant/premalignant lesions cannot be excluded after complete diagnostic work-up.

scholarly journals Causes of brain dysfunction in acute coma: a cohort study of 1027 patients in the emergency department

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Wolf Ulrich Schmidt ◽  
Christoph J. Ploner ◽  
Maximilian Lutz ◽  
Martin Möckel ◽  
Tobias Lindner ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Laboratory ◽  
Brain Dysfunction ◽  
University Hospital ◽  
Unknown Etiology ◽  
Efficient Management ◽  
Observational Study Design ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Background Coma of unknown etiology (CUE) is a major challenge in emergency medicine. CUE is caused by a wide variety of pathologies that require immediate and targeted treatment. However, there is little empirical data guiding rational and efficient management of CUE. We present a detailed investigation on the causes of CUE in patients presenting to the ED of a university hospital. Methods One thousand twenty-seven consecutive ED patients with CUE were enrolled. Applying a retrospective observational study design, we analyzed all clinical, laboratory and imaging findings resulting from a standardized emergency work-up of each patient. Following a predefined protocol, we identified main and accessory coma-explaining pathologies and related these with (i.a.) GCS and in-hospital mortality. Results On admission, 854 of the 1027 patients presented with persistent CUE. Their main diagnoses were classified into acute primary brain lesions (39%), primary brain pathologies without acute lesions (25%) and pathologies that affected the brain secondarily (36%). In-hospital mortality associated with persistent CUE amounted to 25%. 33% of patients with persistent CUE presented with more than one coma-explaining pathology. In 173 of the 1027 patients, CUE had already resolved on admission. However, these patients showed a spectrum of main diagnoses similar to persistent CUE and a significant in-hospital mortality of 5%. Conclusion The data from our cohort show that the spectrum of conditions underlying CUE is broad and may include a surprisingly high number of coincidences of multiple coma-explaining pathologies. This finding has not been reported so far. Thus, significant pathologies may be masked by initial findings and only appear at the end of the diagnostic work-up. Furthermore, even transient CUE showed a significant mortality, thus rendering GCS cutoffs for selection of high- and low-risk patients questionable. Taken together, our data advocate for a standardized diagnostic work-up that should be triggered by the emergency symptom CUE and not by any suspected diagnosis. This standardized routine should always be completed - even when initial coma-explaining diagnoses may seem evident.

scholarly journals ICHD-3 is significantly more specific than ICHD-3 beta for diagnosis of migraine with aura and with typical aura

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Carl H. Göbel ◽  
Sarah C. Karstedt ◽  
Thomas F. Münte ◽  
Hartmut Göbel ◽  
Sebastian Wolfrum ◽  
...  
Keyword(s):  
Emergency Room ◽  
Diagnostic Criteria ◽  
Migraine With Aura ◽  
University Hospital ◽  
Headache Disorders ◽  
Ischemic Attack ◽  
Diagnostic Work ◽  
The University ◽  
Work Up

Abstract Background In the emergency room, distinguishing between a migraine with aura and a transient ischemic attack (TIA) is often not straightforward and mistakes can be harmful to both the patient and to society. To account for this difficulty, the third edition of the International Classification of Headache disorders (ICHD-3) changed the diagnostic criteria of migraine with aura. Methods One hundred twenty-eight patients referred to the emergency room at the University Hospital of Lübeck, Germany with a suspected TIA were prospectively interviewed about their symptoms leading to admission shortly after initial presentation. The diagnosis that resulted from applying the ICHD-3 and ICHD-3 beta diagnostic criteria was compared to the diagnosis made independently by the treating physicians performing the usual diagnostic work-up. Results The new ICHD-3 diagnostic criteria for migraine with aura and migraine with typical aura display an excellent specificity (96 and 98% respectively), and are significantly more specific than the previous ICHD-3 beta classification system when it comes to diagnosing a first single attack (probable migraine with aura and probable migraine with typical aura). Conclusions The ICHD-3 is a highly useful tool for the clinical neurologist in order to distinguish between a migraine with aura and a TIA, already at the first point of patient contact, such as in the emergency department or a TIA clinic.

Interview Scores Correlate with Fellow Microsurgical Skill and Performance

2017 ◽  
Vol 34 (03) ◽  
pp. 211-217 ◽  
Author(s):  
Charles Butler ◽  
Hiroo Suami ◽  
Patrick Garvey ◽  
Jun Liu ◽  
Jesse Selber ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Selection Process ◽  
Training Experience ◽  
Interview Process ◽  
Evaluation Of Performance ◽  
Surgical Trainees ◽  
Academic Center ◽  
And Performance ◽  
Almost All ◽  
First Time

Background The interview process for surgical trainees aims to select those individuals who will perform best during training and have the greatest potential as future surgeons. The objective of this study was to evaluate the relationship between criteria assessed at interview, technical skills, and performance, for the first time, to optimize the selection process for a Microsurgery fellowship. Methods Twenty microsurgery fellows in three consecutive annual cohorts at a single academic center were prospectively evaluated. At interview, subjects were scored for multiple standardized domains. At the start and at end of the fellowship, microsurgical technical skill was assessed both in the laboratory and operating room (OR) using a validated assessment tool. At the end of the fellowship, there was a final evaluation of performance. Results At the start, microsurgical skill significantly correlated with almost all domains evaluated at interview, most closely with prior plastic surgery training experience. At the end of the fellowship, skill level improved in all trainees, with the greatest improvement made by the lowest ranked and skilled trainees. The highest ranked trainees, however, made the greatest improvement in speed. Conclusions The results of this study, for the first time, validate the current interview process to correctly select the highest performing and most skilled candidates and support the effectiveness of a 1-year microsurgical fellowship in improving microsurgical skill in all trainees, irrespective of their initial ability. The importance of valuing the relative quality of prior training and experience at selection is also highlighted.

scholarly journals Raccontaci lʼipertensione

2011 ◽  
Author(s):  
Alfonso Lagi ◽  
Ranuccio Nuti ◽  
Stefano Taddei
Keyword(s):  
Blood Pressure ◽  
Cross Section ◽  
Real World ◽  
Online Questionnaire ◽  
Treatment Data ◽  
Diagnostic Work ◽  
Work Up ◽  
First Time ◽  
Diagnostic Work Up

For the first time, a detailed study has been carried out on the real world of people suffering from high blood pressure, involving the doctors who are directly in contact with them, who shoulder the responsibility of the diagnosis and make the decisions about treatment. Data were collected from fifty-eight patients diagnosed and monitored in the clinics by twenty-nine specialist physicians who supplied information about the diagnostic work-up, the follow-up and the therapy. The data were collected using an online questionnaire and were processed statistically. The result is a cross-section of interesting and original results, featuring a number of peaks of excellence and various troughs of negative criticality, which call for reflection and for decisions on action to be taken. The figures are hence useful for both clinicians and epidemiologists and all those who are involved with medical governance.

scholarly journals Cognitive complaints compared to performance on a mental state screening test in elderly outpatients

2008 ◽  
Vol 2 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Renata Kochhann ◽  
Ana Luiza Camozzato ◽  
Cláudia Godinho ◽  
Maria Otília Cerveiro ◽  
Letícia M.K. Forster ◽  
...  
Keyword(s):  
Mental State ◽  
Screening Test ◽  
The Elderly ◽  
University Hospital ◽  
Cognitive Screening ◽  
Cognitive Complaints ◽  
Cognitive Complaint ◽  
Elderly Outpatients ◽  
Clinically Significant ◽  
And Performance

Abstract Memory and other cognitive complaints are common in the elderly population. However, the clinical meaning of these complaints remains controversial. Objectives: The goal of this study was to investigate the association between cognitive complaints and performance on a mental state screening test in elderly patients attended for the first time at the Neurogeriatric and Dementia (NGA) Outpatient Clinic within a major University hospital. Methods: Two hundred patients referred to the NGA Clinic during 2005, 2006 and 2007 first semesters participated in the study. The variables of interest were: (a) source of and reason for referral; (b) whether or not they had previously been evaluated with the screening test (Mini Mental State Exam - MMSE) by their physicians before referral to our specialized clinic; (c) cognitive complaints; and (d) performance on the screening test (MMSE) at the NGA Clinic. Results: The main reason for referral to the NGA clinic was cognitive complaints 63% (N=126), where only 5% (N=10) of the referred patients had been previously evaluated by the cognitive screening test (MMSE or equivalent). Of the 135 patients who presented cognitive complaints during the first appointment, 52 (38%) presented MMSE scores below the education-adjusted cut-off. No association between cognitive complaint and performance on the MMSE during the first evaluation at the NGA Clinic was observed (c²=3.04, p=0.1). Conclusions: Although cognitive complaints among elders should not be disregarded, the mental state screening evaluation is crucial for the detection of clinically significant cognitive impairment.

scholarly journals Clinical Characteristics and Outcome of Patients with Infective Endocarditis Diagnosed in a Department of Internal Medicine

2020 ◽  
Vol 9 (3) ◽  
pp. 864
Author(s):  
Louis Kreitmann ◽  
David Montaigne ◽  
David Launay ◽  
Sandrine Morell-Dubois ◽  
Hélène Maillard ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Infective Endocarditis ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
High Sensitivity ◽  
University Hospital ◽  
Delay In Diagnosis ◽  
Duke Classification ◽  
Diagnostic Work ◽  
Work Up

Clinical manifestations of infective endocarditis (IE) can be highly non-specific. Our objective was to describe the clinical characteristics of patients initially referred to a department of internal medicine for a diagnostic work-up, and eventually diagnosed with IE. We retrospectively retrieved adult patients admitted to the department of internal medicine at Lille University Hospital between 2004 and 2015 who fulfilled Duke Classification criteria for definite IE. Thirty-five patients were included. The most frequently involved bacteria were non-hemolytic streptococci. Most patients presented with various systemic, cardiac, embolic, rheumatic, and immunological findings, with no sign or symptom displaying high sensitivity. The first transthoracic echocardiogram was negative in 42% of patients. Furthermore, definite diagnosis required performing at least 2 transesophageal examinations in 24% of patients. We observed a trend towards decreased survival in the subgroup of patients in whom the delay between onset of symptoms and diagnosis was >30 days. In conclusion, patients who are initially referred to internal medicine for a diagnosis work-up and who are ultimately diagnosed with IE have non-specific symptoms and a high percentage of initial normal echocardiography. Those patients require prolonged echocardiographic monitoring as a prolonged delay in diagnosis is associated with poorer outcomes such as death.

Risk of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope: role of correlation between symptoms and electrocardiogram findings

EP Europace ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. 1729-1736 ◽  
Author(s):  
Pietro Palmisano ◽  
Pier Luigi Pellegrino ◽  
Ernesto Ammendola ◽  
Matteo Ziacchi ◽  
Federico Guerra ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Permanent Pacing ◽  
Hazard Ratios ◽  
Group A ◽  
Clinically Significant ◽  
Diagnostic Work ◽  
Group B ◽  
Electrocardiogram Ecg ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Aims  To evaluate the risk of syncopal recurrences after pacemaker implantation in a population of patients with syncope of suspected bradyarrhythmic aetiology. Methods and results  Prospective, multicentre, observational registry enrolling 1364 consecutive patients undergoing pacemaker implantation for syncope of bradyarrhythmic aetiology (proven or presumed). Before pacemaker implantation, all patients underwent a cardiac work-up in order to establish the bradyarrhythmic aetiology of syncope. According to the results of the diagnostic work-up, patients were divided into three groups: Group A, patients in whom a syncope-electrocardiogram (ECG) correlation was established (n = 329, 24.1%); Group B, those in whom clinically significant bradyarrhythmias were detected without a documented syncope-ECG correlation (n = 877, 64.3%); and Group C, those in whom bradyarrhythmias were not detected and the bradyarrhythmic origin of syncope remained presumptive (n = 158, 11.6%). During a median follow-up of 50 months, 213 patients (15.6%) reported at least one syncopal recurrence. Patients in Groups B and C showed a significantly higher risk of syncopal recurrences than those in Group A [hazard ratios (HRs): 1.60 and 2.66, respectively, P < 0.05]. Failure to establish a syncope-ECG correlation during diagnostic work-up before pacemaker implantation was an independent predictor of syncopal recurrence on multivariate analysis (HR: 1.90; P = 0.002). Conclusion In selecting patients with syncope of suspected bradyarrhythmic aetiology for pacemaker implantation, establishing a correlation between syncope and bradyarrhythmias maximizes the efficacy of pacing and reduces the risk of syncopal recurrences.

scholarly journals Diagnostic work-up in patients with possible asthma referred to a university hospital

2015 ◽  
Vol 2 (1) ◽  
pp. 27768 ◽  
Author(s):  
Vibeke Backer ◽  
Asger Sverrild ◽  
Charlotte Suppli Ulrik ◽  
Uffe Bødtger ◽  
Niels Seersholm ◽  
...  
Keyword(s):  
University Hospital ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals PNPLA3 and SERPINA1 Variants Are Associated with Severity of Fatty Liver Disease at First Referral to a Tertiary Center

2021 ◽  
Vol 11 (3) ◽  
pp. 165
Author(s):  
Georg Semmler ◽  
Lorenz Balcar ◽  
Hannes Oberkofler ◽  
Stephan Zandanell ◽  
Michael Strasser ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Liver Stiffness ◽  
Nucleotide Polymorphisms ◽  
Risk Variants ◽  
Tertiary Center ◽  
Clinically Significant ◽  
Diagnostic Work ◽  
Work Up

Single nucleotide polymorphisms (SNPs), including PNPLA3 rs738409 and SERPINA1 rs17580, have been identified as risk modifiers in the progression fatty liver disease (alcoholic (ALD) or non-alcoholic (NAFLD)). While PNPLA3 has been studied in various settings, the value of both SNPs has so far not been addressed in a real-world cohort of subjects referred for a diagnostic work-up of liver disease. Thus, liver disease severity was assessed in 1257 consecutive patients with suspected ALD or NAFLD at the time of referral to a tertiary center. Advanced chronic liver disease (ACLD) was present in 309 (24.6%) patients and clinically significant portal hypertension (CSPH) was present in 185 (14.7%) patients. The PNPLA3 G-allele was independently associated with a higher liver stiffness measurement (LSM; adjusted B: 2.707 (1.435–3.979), p < 0.001), and higher odds of ACLD (adjusted odds ratio (aOR): 1.971 (1.448–2.681), p < 0.001) and CSPH (aOR: 1.685 (1.180–2.406), p = 0.004). While the SERPINA1 Z-allele was not associated with a higher LSM or the presence of ACLD, it was independently associated with higher odds of CSPH (aOR: 2.122 (1.067–4.218), p = 0.032). Associations of the PNPLA3 G-allele and the SERPINA1 Z-allele with CSPH were maintained independently of each other. The presence of both risk variants further increased the likelihood of ACLD and CSPH.

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