Diagnostik und Therapie unklarer Gallengangsstenosen

2020 ◽  
Vol 145 (05) ◽  
pp. 306-312
Author(s):  
Jenny Krause ◽  
Hanno Ehlken ◽  
Christoph Schramm
Keyword(s):  
Treatment Options ◽  
High Specificity ◽  
Accurate Diagnosis ◽  
Diagnostic Methods ◽  
Curative Treatment ◽  
Biliary Stenosis ◽  
Diagnostic Challenge ◽  
Diagnostik Und Therapie ◽  
Over Time ◽  
Insufficient Sensitivity

AbstractBiliary stenoses represent a differential diagnostic challenge. Diagnostic methods to clarify the underlying dignity are often invasive, and provide high specificity beside insufficient sensitivity. In many cases, an accurate diagnosis is only possible over time, and therefore limits curative treatment options. This article provides an overview of the diagnostic challenges and treatment options for unclear biliary stenosis.

scholarly journals Comparison of diagnostic methods of malaria by peripheral smear, centrifuged buffy coat smear and rapid antigen detection test

2017 ◽  
Vol 5 (10) ◽  
pp. 4532 ◽  
Author(s):  
Bhavnaben A. Vora ◽  
Rajan S. Bindu
Keyword(s):  
Endemic Area ◽  
Buffy Coat ◽  
Antigen Detection ◽  
Accurate Diagnosis ◽  
Diagnostic Methods ◽  
Diagnostic Challenge ◽  
Peripheral Smear ◽  
Common Life ◽  
Rapid Antigen Detection Test ◽  
Life Threatening

Background: Malaria is common, life threatening infection in endemic area and presents diagnostic challenge to laboratories in most endemic areas. A rapid and accurate diagnosis is a pre requisite for effective treatment, especially for potentially fatal cases of falciparum infection.Methods: Total 200 patients presented with fever and chills, were taken for study and performances of peripheral blood and centrifuged buffy coat smear were compared against the result of rapid antigen detection test (standard method).Results: out of 200 cases, 55 were positive by rapid detection test.30 of P. vivax, 24 of P. falci and 1 was mixed infection. Peripheral smear had 85.5% sensitive and 100% specific compared to RDT which was 100 % sensitive and specific whereas centrifuged buffy coat was 92.7% sensitive and 99.3% specific.Conclusions: Easy, rapid, most sensitive and specific diagnostic method will help in early diagnosis and lead to decrease in morbidity and mortality.

scholarly journals The ‘wave sign’ in hip arthroscopy: a systematic review of epidemiological factors, current diagnostic methods and treatment options

2020 ◽  
Author(s):  
Jason Derry Onggo ◽  
James Randolph Onggo ◽  
Mithun Nambiar ◽  
Andrew Duong ◽  
Olufemi R Ayeni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Protective Factor ◽  
Treatment Options ◽  
Arthroscopic Surgery ◽  
Classification Systems ◽  
Diagnostic Methods ◽  
Suture Repair ◽  
Significant Heterogeneity ◽  
Epidemiological Factors

ABSTRACT This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle >65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P<0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P<0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P<0.05), 12-months (MD=22.0, P<0.05) and 28-months (MD=17.5, P<0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.

scholarly journals The Role of Conventional and Stereotactic Microwave Ablation for Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2963
Author(s):  
Corina Kim-Fuchs ◽  
Daniel Candinas ◽  
Anja Lachenmayer
Keyword(s):  
Literature Review ◽  
Intrahepatic Cholangiocarcinoma ◽  
Microwave Ablation ◽  
Treatment Options ◽  
Tumor Biology ◽  
Tumor Ablation ◽  
Curative Treatment ◽  
Complication Rates ◽  
Curative Therapy ◽  
Incidence And Mortality

Background: The incidence and mortality of intrahepatic cholangiocarcinoma (ICCA) is increasing worldwide and curative treatment options are limited due to the aggressive tumor biology and often late diagnosis. Resection of the primary tumor remains the only curative therapy available, as the benefit of palliative chemotherapy and radiotherapy is relatively small. In contrast to hepatocellular carcinoma, minimal-invasive thermal tumor ablation, and in particular stereotactic tumor ablation for small primary cancers or metastases, is not established and data are scarce. Methods: We conducted a literature review in the field of ICCA ablation and retrospective analysis of 10 patients treated by stereotactic microwave ablation (SMWA) for either primary ICCA or liver metastases of ICCA. Results: While current guidelines have no consensus for ablation of primary ICCA, some state that it might be an option in inoperable patients or those with recurrent disease. The literature review revealed 11 studies on microwave ablation for ICCA reporting that MWA for ICCA ≤ 5 cm might be safe and could be a treatment option for patients who are not candidates for surgery. No data has been published on stereotactic microwave ablation (SMWA) for ICCA. The analyses of our own data of 10 patients treated by SMWA for primary ICCA (n = 5) or recurrent ICCA (n = 5) show that the treatment is safe and efficient with short hospital stays and low complication rates. Conclusion: Although thermal ablation, and in particular SMWA, might be a minimally invasive and tissue-sparing curative treatment alternative for small ICCA in the diseased liver and ICCA metastases, the oncologic benefit still needs to be shown in larger studies with longer follow-up.

scholarly journals The Emerging Factors and Treatment Options for NAFLD-Related Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3740
Author(s):  
Chunye Zhang ◽  
Ming Yang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cancer ◽  
Fatty Liver ◽  
Early Stage ◽  
Primary Liver Cancer ◽  
Treatment Options ◽  
Underlying Mechanism ◽  
Diagnostic Methods ◽  
T Cell Therapy ◽  
Nonalcoholic Fatty Liver

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, followed by cholangiocarcinoma (CCA). HCC is the third most common cause of cancer death worldwide, and its incidence is rising, associated with an increased prevalence of obesity and nonalcoholic fatty liver disease (NAFLD). However, current treatment options are limited. Genetic factors and epigenetic factors, influenced by age and environment, significantly impact the initiation and progression of NAFLD-related HCC. In addition, both transcriptional factors and post-transcriptional modification are critically important for the development of HCC in the fatty liver under inflammatory and fibrotic conditions. The early diagnosis of liver cancer predicts curative treatment and longer survival. However, clinical HCC cases are commonly found in a very late stage due to the asymptomatic nature of the early stage of NAFLD-related HCC. The development of diagnostic methods and novel biomarkers, as well as the combined evaluation algorithm and artificial intelligence, support the early and precise diagnosis of NAFLD-related HCC, and timely monitoring during its progression. Treatment options for HCC and NAFLD-related HCC include immunotherapy, CAR T cell therapy, peptide treatment, bariatric surgery, anti-fibrotic treatment, and so on. Overall, the incidence of NAFLD-related HCC is increasing, and a better understanding of the underlying mechanism implicated in the progression of NAFLD-related HCC is essential for improving treatment and prognosis.

scholarly journals Patterns of Survival Among Patients With Myeloproliferative Neoplasms Diagnosed in Sweden From 1973 to 2008: A Population-Based Study

2012 ◽  
Vol 30 (24) ◽  
pp. 2995-3001 ◽  
Author(s):  
Malin Hultcrantz ◽  
Sigurdur Yngvi Kristinsson ◽  
Therese M.-L. Andersson ◽  
Ola Landgren ◽  
Sandra Eloranta ◽  
...  
Keyword(s):  
General Population ◽  
Life Expectancy ◽  
Excess Mortality ◽  
Myeloproliferative Neoplasms ◽  
Treatment Options ◽  
Large Population ◽  
Relative Survival ◽  
Population Based ◽  
Population Based Study ◽  
Over Time

PurposeReported survival in patients with myeloproliferative neoplasms (MPNs) shows great variation. Patients with primary myelofibrosis (PMF) have substantially reduced life expectancy, whereas patients with polycythemia vera (PV) and essential thrombocythemia (ET) have moderately reduced survival in most, but not all, studies. We conducted a large population-based study to establish patterns of survival in more than 9,000 patients with MPNs.Patients and MethodsWe identified 9,384 patients with MPNs (from the Swedish Cancer Register) diagnosed from 1973 to 2008 (divided into four calendar periods) with follow-up to 2009. Relative survival ratios (RSRs) and excess mortality rate ratios were computed as measures of survival.ResultsPatient survival was considerably lower in all MPN subtypes compared with expected survival in the general population, reflected in 10-year RSRs of 0.64 (95% CI, 0.62 to 0.67) in patients with PV, 0.68 (95% CI, 0.64 to 0.71) in those with ET, and 0.21 (95% CI, 0.18 to 0.25) in those with PMF. Excess mortality was observed in patients with any MPN subtype during all four calendar periods (P < .001). Survival improved significantly over time (P < .001); however, the improvement was less pronounced after the year 2000 and was confined to patients with PV and ET.ConclusionWe found patients with any MPN subtype to have significantly reduced life expectancy compared with the general population. The improvement over time is most likely explained by better overall clinical management of patients with MPN. The decreased life expectancy even in the most recent calendar period emphasizes the need for new treatment options for these patients.

Heart failure in an elderly population

2001 ◽  
Vol 11 (4) ◽  
pp. 311-321
Author(s):  
DN Carmichael ◽  
Michael Lye
Keyword(s):  
Heart Failure ◽  
Treatment Options ◽  
Clinical Syndrome ◽  
Point Of View ◽  
Diagnostic Challenge ◽  
The Common ◽  
Characteristic Features ◽  
The Many ◽  
Neuroendocrine Activation ◽  
Symptoms And Signs

Heart failure has been defined in many ways and definitions change over time. The multiplicity of definitions reflect the paucity of our understanding of the primary underlying physiology of heart failure and the many diseases for which heart failure is the common end-point. Fundamentally, heart failure represents a failure of the heart to meet the body’s requirement for blood supply for whatever reason. It is thus a clinical syndrome with characteristic features – not a single disease in its own right. The syndrome includes symptoms and signs of organ underperfusion, fluid retention and neuroendocrine activation. The syndrome arises from a range of possible causes of which ischaemic heart disease is the commonest. From the point of view of a clinician, the underlying pathology will determine treatment options and prognosis. The extensive range of possible aetiologies present a diagnostic challenge both to correctly identify the syndrome amongst all other causes of dyspnoea and to identify the aetiology, allowing optimization of treatment.

scholarly journals Surgical Approach to Splenic Hydatid Cyst: Single Center Experience

2013 ◽  
Vol 98 (4) ◽  
pp. 346-353 ◽  
Author(s):  
Cengiz Eris ◽  
Sami Akbulut ◽  
Mehmet Kamil Yildiz ◽  
Hasan Abuoglu ◽  
Mehmet Odabasi ◽  
...  
Keyword(s):  
Hydatid Cyst ◽  
Surgical Approach ◽  
Treatment Options ◽  
Clinical Findings ◽  
Partial Cystectomy ◽  
Diagnostic Methods ◽  
Septic Complications ◽  
Single Center Experience ◽  
Medicinal Treatment ◽  
Splenic Hydatid Cyst

Abstract The benefits and risks of surgery for splenic hydatid cyst (SHC) remain controversial. We aimed to share our experience about a surgical approach for SHC. Sixteen consecutive patients with SHC disease who underwent open splenectomy at our hospital between January 2006 and July 2012 were retrospectively evaluated. Data on the patients' demographic features, clinical findings, radiological and serological diagnostic methods, and surgical and medicinal treatment options were collected and used to generate descriptive profiles of diagnosis, treatment course, and outcome. The patient population was composed of 6 females and 10 males, with an age range of 18 to 79 years (mean age: 47.0 ± 18.0). Radiological examinations detected hydatid cysts in spleen alone (n = 7) or both spleen and liver (n = 9). Preoperative serological testing identified 13 of the patients as IHA positive. All except 1 patient received a 10- to 21-day preoperative course of albendazole therapy and all patients received vaccination 1 week prior to surgery. Seven patients underwent splenectomy. The remaining patients underwent splenectomy with partial cystectomy and omentopexy (n = 6), partial cystectomy and unroofing (n = 1), pericystectomy (n = 1), or pericystectomy with partial nephrectomy (n = 1). All except one patient received a 10- to 45-day postoperative course of albendazole. No patients developed serious complications or signs of recurrence during the follow-up. The clinical profile of SHC disease at our hospital includes diagnosis by radiological methods, splenectomy treatment by simple or concomitant procedures according to the patient's symptoms, cyst size, number and localization, and compression of adjacent organs, and adjunct vaccination to decrease risk of postoperative septic complications. This profile is associated with low risk of complications and high therapeutic efficacy.

scholarly journals Practical application and validation of the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines for the diagnosis of idiopathic pulmonary fibrosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Angela R. Shih ◽  
Chayanin Nitiwarangkul ◽  
Brent P. Little ◽  
Benjamin W. Roop ◽  
Sreyankar Nandy ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Interobserver Variability ◽  
High Specificity ◽  
Classification Performance ◽  
Accurate Diagnosis ◽  
Practical Application ◽  
Test Characteristics ◽  
High Positive Predictive Value ◽  
Usual Interstitial Pneumonitis

Abstract Background Accurate diagnosis of idiopathic pulmonary fibrosis (IPF) is essential to inform prognosis and treatment. In 2018, the ATS/ERS/JRS/ALAT and Fleischner Society released new diagnostic guidelines for usual interstitial pneumonitis (UIP)/IPF, adding Probable UIP as a CT category based on prior studies demonstrating this category had relatively high positive predictive value (PPV) for histopathologic UIP/Probable UIP. This study applies the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines to determine test characteristics of CT categories in academic clinical practice. Methods CT and histopathology were evaluated by three thoracic radiologists and two thoracic pathologists. Comparison of consensus categorization by the 2018 ATS and Fleischner Society guidelines by CT and histopathology was performed. Results Of patients with CT UIP, 87% (PPV, 95% CI: 60–98%) had histopathologic UIP with 97% (CI: 90–100%) specificity. Of patients with CT Probable UIP, 38% (PPV, CI: 14–68%) had histopathologic UIP and 46% (PPV, CI: 19–75%) had either histopathologic UIP or Probable UIP, with 88% (CI: 77–95%) specificity. Patients with CT Indeterminate and Alternative Diagnosis had histopathologic UIP in 27% (PPV, CI: 6–61%) and 21% (PPV, CI: 11–33%) of cases with specificities of 90% (CI: 80–96%) and 25% (CI: 16–37%). Interobserver variability (kappa) between radiologists ranged 0.32–0.81. Conclusions CT UIP and Probable UIP have high specificity for histopathologic UIP, and CT UIP has high PPV for histopathologic UIP. PPV of CT Probable UIP was 46% for combined histopathologic UIP/Probable UIP. Our results indicate that additional studies are needed to further assess and refine the guideline criteria to improve classification performance.

Management of necrotic immature permanent maxillary incisors using a modified technique of revascularisation

2021 ◽  
Vol 14 (3) ◽  
pp. e240203
Author(s):  
Arun Mayya ◽  
Shruti Bhandary ◽  
Advith Kolakemar ◽  
Ann Mary George
Keyword(s):  
Platelet Rich Plasma ◽  
Blood Clot ◽  
Treatment Options ◽  
Permanent Teeth ◽  
Treatment Modalities ◽  
Successful Outcome ◽  
Modified Technique ◽  
Platelet Rich Fibrin ◽  
Periapical Lesions ◽  
Over Time

The management of necrotic immature permanent teeth has always been a challenge to endodontists. Various treatment modalities have been tried and tested for achieving a successful outcome. Revascularisation is one among these treatment options, which is gaining widespread attention among endodontists. The growing body of evidence demonstrating the success of revascularisation has led to different variations of this treatment option. Clinicians have over time used different scaffolds such as blood clot, collagen, platelet-rich fibrin (PRF) and platelet-rich plasma for revascularisation. This case report outlines the management of immature maxillary central incisors with pulp necrosis and large periapical lesions in a 19-year-old female patient with a modified technique of revascularisation by combining PRF and blood clot. At the end of 12 months, the patient was completely asymptomatic along with regression of the periapical lesions.

scholarly journals Diagnosis of Growing Pain in Bangladeshi Pediatric Population

2013 ◽  
Vol 5 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Santosh Kumar Saha ◽  
Aditi Modak ◽  
Kamrunnahar Chowdhury ◽  
Md Saleh Uddin ◽  
Dilip Kumar Ghosh ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Pediatric Population ◽  
Accurate Diagnosis ◽  
Clinical Aspects ◽  
Limb Pain ◽  
Diagnostic Challenge ◽  
Growing Period ◽  
Frequent Site ◽  
Slow Growing

Background: Unexplained limb pain is a major diagnostic challenge. Parents become very much worried as their physician are not sure regarding accurate diagnosis of unexplained limb pain. Majority of the limb pain are due to Growing pain which can be diagnosed by using Standard Criteria. Objectives: The purpose of the present study was to see the clinical aspects of growing pain and to determine the causes of unexplained limb pain. Methodology: This study prospectively examined the presence of growing pain in a self reported population of children with limb pain of unexplained etiology attending National Center for Control of Rheumatic Fever and Heart Disease over the period of 6 months. Results: Total 57 children of 3-12 yrs of age were enrolled in this study and out of them 43(75.4%) were diagnosed as Growing Pain. Mean age of growing pain was 7.77(2.66). 19 children (44.2%) were male and 24 (55.8%) were female. Most frequent site of pain was calf (65.1%) and 95% cases pain occur at night. Growing Pain usually occur at slow growing period (86%) than rapid growing period (14%). Conclusion: Majority of unexplained limb pain are growing pain which is benign. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16251 J Shaheed Suhrawardy Med Coll, 2013;5(1):46-48

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