“Cyst at Porta” in Infants with Cholestatic Jaundice: The Time to Act Is Now

Automated Development of Clinical Strategies Using Multistage Decision Analysis

Methods of Information in Medicine ◽

10.1055/s-0038-1635469 ◽

1986 ◽

Vol 25 (04) ◽

pp. 207-214 ◽

Cited By ~ 3

Author(s):

P. Glasziou

Keyword(s):

Decision Tree ◽

Decision Analysis ◽

Decision Trees ◽

Optimal Strategy ◽

Cholestatic Jaundice ◽

Clinical Strategies ◽

Simultaneous Study

SummaryThe development of investigative strategies by decision analysis has been achieved by explicitly drawing the decision tree, either by hand or on computer. This paper discusses the feasibility of automatically generating and analysing decision trees from a description of the investigations and the treatment problem. The investigation of cholestatic jaundice is used to illustrate the technique.Methods to decrease the number of calculations required are presented. It is shown that this method makes practical the simultaneous study of at least half a dozen investigations. However, some new problems arise due to the possible complexity of the resulting optimal strategy. If protocol errors and delays due to testing are considered, simpler strategies become desirable. Generation and assessment of these simpler strategies are discussed with examples.

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Duodenal strongyloidiasis – Our 15-year histopathological experience at a tertiary gastrointestinal centre

Tropical Doctor ◽

10.1177/0049475520962744 ◽

2020 ◽

pp. 004947552096274

Author(s):

Latika Gupta ◽

Kavita Gaur ◽

Puja Sakhuja ◽

Barjesh C Sharma ◽

Ravindra K Saran ◽

...

Keyword(s):

Duodenal Biopsy ◽

Cholestatic Jaundice ◽

Histopathological Findings ◽

Young Females ◽

Eosinophilic Infiltrate ◽

Elderly Males ◽

Immunocompromised State ◽

Duodenal Biopsies

In order to emphasise the importance of histopathology in the clinically unsuspected diagnosis of duodenal strongyloidiasis, we report six cases diagnosed on duodenal biopsies identified from the database over a period of 15 years, and clinical, endoscopic and histopathological findings were analysed retrospectively. Four were elderly males and the remainder young females. Only one patient had an underlying immunocompromised state. Three presented with cholestatic jaundice and simulated hepatobiliary malignancy. In all cases, endoscopy provided non-specific findings. Only one case showed a predominant eosinophilic infiltrate. Eggs, larvae and adult forms of strongyloides were seen in crypts and showed intense basophilic staining on HE stain. It is concluded that since mostly undetected clinically, duodenal biopsy serves as the first step in the diagnosis of strongyloidiasis. Hepatobiliary manifestations, though very infrequent, should raise the suspicion for strongyloidiasis and thus necessitate the need for duodenal biopsy.

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