Further Trial of Clinical Diagnostic Index for the Malignancy Diagnosis of Mammary Nodules.

1975 ◽  
Vol 61 (1) ◽  
pp. 5-16 ◽  
Author(s):  
Sergio Di Pietro ◽  
Alberto Re
Keyword(s):  
Early Diagnosis ◽  
Mammary Carcinoma ◽  
Clinical Investigation ◽  
Diagnostic Errors ◽  
False Negatives ◽  
Negative Results ◽  
Clinical Diagnostic ◽  
Benign Nodules ◽  
Diagnostic Index

The results of a further trial of a clinical diagnostic index (CDI) for ill-defined mammary nodules, based on the algebrical results of positive numerical values (for a suspect feature), or negative numerical values (for non suspect feature), attributed to 10 characteristic semeiological features, previously described, are reported. 222 nodules were clinically examined, all subsequently subjected to mammography and 188 of them to ther-mograpy; they were then operated and examined histologically. Of 106 malignant nodules the accuracy of the CDI was 88.6 % with 4.7 % false negatives; for mammography 65 % with 21.7 % false negatives; for termography (out of 87 cases) 66.6 with 23 % false negatives. The accuracy in 116 benign nodules was 45.6 % for the CDI, 32.7 % for mammography and 29.7 % for termography (out of 101 cases). In three cases of malignant nodules in women below 35 years of age, all three examinations gave negative results. The relations between the diagnostic errors of the three examinations, as well as the dimensions and histo-type of the nodules are also considered. It may be concluded, that the CDI is a simple rapid and highly accurate clinical investigation for early diagnosis of mammary carcinoma.

Description and Trial of a Clinical Diagnostic Index for the early Diagnosis of Mammary Carcinoma.

1973 ◽  
Vol 59 (1) ◽  
pp. 63-76 ◽  
Author(s):  
Sergio Di Pietro ◽  
Alberto Re
Keyword(s):  
Early Diagnosis ◽  
Mammary Carcinoma ◽  
Clinical Investigation ◽  
Benign Lesion ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Benign Lesions ◽  
Clinical Diagnostic ◽  
The Right ◽  
Diagnostic Index

A method of clinical investigation has been developed for the early diagnosis of mammary carcinoma based on the scoring of 10 Symptomatologie features of mammary nodules of doubtful malignancy. These features are: variations in size, consistency, form, surface, limits, mobility, protrusion, pain on pressure, presence and nature of secretion from the nipple, nature of axillary lymph nodes. Each feature is scored +2, + 1, 0, −1 or −2 according to whether it points to a malignant, doubtful or benign lesion, +2 and −2 indicating a more definite degree one way or the other. The number emerging from the algebric sum of the ten scores is rated as the complex score or clinical diagnostic index. The validity of the method was tested in 93 cases of clinically doubtful mammary nodules later subjected to histologic examination. The method yielded the right answer in 91 % (compared with 80 % for mammography) and false negatives in 2.2 % (compared with 15 %) of the 46 cases of mammary carcinoma. It yielded the right answer in 48.9 % (compared with 42.5 % for mammography) and 34 % false positives (same percentage as for mammography) of the 47 benign lesions. Thermography, used in about four-fifths of the cases, showed a much lower success rate. The combined outcome of clinical diagnostic index and mammography made it possible to avoid the preliminary classification of carcinomas as benign lesions. It was therefore concluded that the method is useful in uncertain mammary nodules, though the results of a larger trial, now in progress, must be awaited before expressing a definite verdict.

Value of Autopsies in the Study of Diagnostic Errors in Respiratory Medicine

2019 ◽  
Vol 70 (3) ◽  
pp. 1037-1039
Author(s):  
Diana Veronica Turcu ◽  
Adina Magdalena Turcanu ◽  
Cristina Grigorescu ◽  
Alexandru Patrascu ◽  
Irina Chiselita ◽  
...  
Keyword(s):  
Respiratory Diseases ◽  
Diagnostic Errors ◽  
Global Scale ◽  
Respiratory Medicine ◽  
Post Mortem ◽  
Clinical Diagnostic ◽  
Autopsy Report

Diagnostic errors are real and are causing harm to patients on a global scale. However, the methods for measuring diagnostic errors are underdeveloped. One very important tool in this regard is the use of autopsies, in order to point out the cases where the actual affliction was missed and to quantify the incidence of such mistakes. We have carried out a study to compare the clinical diagnostic with the post mortem autopsy report in 119 patients who have died at the Pulmonology Hospital in Iasi, Romania, between January 2nd 2016 and January 2nd 2017. The purpose of this research is to determine the incidence of diagnostic errors and to identify the most missed or overlooked respiratory diseases.

scholarly journals Diagnostic and severity scores for Cockayne syndrome

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
M. A. Spitz ◽  
F. Severac ◽  
C. Obringer ◽  
S. Baer ◽  
N. Le May ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Severity Score ◽  
Wide Spectrum ◽  
Genetic Disorder ◽  
Continuous Distribution ◽  
Cockayne Syndrome ◽  
Clinical Severity ◽  
Diagnostic Score ◽  
Clinical Diagnostic ◽  
Severity Scores

Abstract Background Cockayne syndrome is a progressive multisystem genetic disorder linked to defective DNA repair and transcription. This rare condition encompasses a very wide spectrum of clinical severity levels ranging from severe prenatal onset to mild adult-onset subtypes. The rarity, complexity and variability of the disease make early diagnosis and severity assessment difficult. Based on similar approaches in other neurodegenerative disorders, we propose to validate diagnostic and severity scores for Cockayne syndrome. Methods Clinical, imaging and genetic data were retrospectively collected from 69 molecularly confirmed CS patients. A clinical diagnostic score and a clinical-radiological diagnostic score for CS were built using a multivariable logistic regression model with a stepwise variable selection procedure. A severity score for CS was designed on five items (head circumference, growth failure, neurosensorial signs, motor autonomy, communication skills) and validated by comparison with classical predefined severity subtypes of CS. Results Short stature, enophtalmos, hearing loss, cataracts, cutaneous photosensitivity, frequent dental caries, enamel hypoplasia, morphological abnormalities of the teeth, areflexia and spasticity were included in the clinical diagnostic score as being the most statistically relevant criteria. Appropriate weights and thresholds were assigned to obtain optimal sensitivity and specificity (95.7% and 86.4% respectively). The severity score was shown to be able to quantitatively differentiate classical predefined subtypes of CS and confirmed the continuous distribution of the clinical presentations in CS. Longitudinal follow-up of the severity score was able to reflect the natural course of the disease. Conclusion The diagnostic and severity scores for CS will facilitate early diagnosis and longitudinal evaluation of future therapeutic interventions. Prospective studies will be needed to confirm these findings.

scholarly journals Peripheral nerve biopsy: Is it still important for the early diagnosis of neural leprosy?

2021 ◽  
Author(s):  
Isabella Sabião Borges ◽  
João Victor Aguiar Moreira ◽  
Thales Junqueira Oliveira ◽  
Maria Fernanda Prado Rosa ◽  
Gabriel Nunes Melo Assunção ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Early Diagnosis ◽  
Peripheral Nerve ◽  
Clinical Evidence ◽  
Early Recognition ◽  
Diagnostic Errors ◽  
Nerve Biopsy ◽  
Skin Lesions ◽  
National Reference Center ◽  
Neural Impairment

Background: The early recognition of neural impairment in leprosy represents a challenge in clinical practice and peripheral nerve biopsy may be required for diagnostic. Objective: Characterize the epidemiological, clinical, electroneuromyographic, laboratory and histopathological aspects of patients undergoing peripheral nerve biopsy during investigation of primary neural leprosy. Methods: 104 patients with peripheral neuropathy, referred to a national reference center leprosy, were biopsied. All patients had clinical evidence of peripheral neuropathy associated with the absence of skin lesions and were being investigated. Results: Of 104 biopsied, leprosy was confirmed in 89.4%. 66 were classified as primary neural leprosy and 27 as neural relapse or reinfection. All cases confirmed presented asymmetric neural impairment with predominance of sensory symptoms (88.2%), followed by muscular weakness and/or amyotrophy in 44.1% and pain in 34.4%. Neural thickening of one or more nerves was observed in 78.5% of the patients. The biopsied nerves were: ulnar (67.8%), superficial fibular (21.5%), sural (8.6%), radial (1.1%) and deep fibular (1.1%). 29% presented histopathological abnormalities and 4.4% acid fast bacilli. Nerve and superjacent skin qPCR were positive in 49.5% and 24.8% of cases, respectively. The patients with multiple mononeuropathy presented higher frequency of neural thickening (p<0.0001) and histopathological abnormalities (p=0.0077), but lower rates of positivity of ELISA anti-PGL-I (p=0.0100), qPCR in the peripheral blood (p=0.0157), and in the slit skin smear (p=0.0032). Conclusions: Peripheral nerve biopsy is an important tool in the investigation of primary neural cases, contributing to the early diagnosis and reducing diagnostic errors and the need for empirical treatment.

scholarly journals Alkaline Phosphatase in Neutrophil Leukocytes of Patients with Infectious Mononucleosis and the Effect of Corticosteroid Therapy

Blood ◽  
1965 ◽  
Vol 26 (4) ◽  
pp. 479-488 ◽  
Author(s):  
LUDMILA ŠRÁMKOVÁ ◽  
KAREL KOUBA ◽  
NADĚŽDA BENDOVÁ
Keyword(s):  
Alkaline Phosphatase ◽  
Early Diagnosis ◽  
Corticosteroid Therapy ◽  
Infectious Mononucleosis ◽  
Negative Results ◽  
Laboratory Examinations ◽  
Alkaline Phosphate ◽  
Neutrophil Leukocytes ◽  
Infective Agent

Abstract A marked increase in the activity of the neutrophil alkaline phosphate enzyme (NLAPA) was observed in bacterial tonsillitis whereas in infectious mononucleosis the amount of enzyme in the leucocytes was either decreased or normal. NLAPA of patients with tonsillitis decreased in proportion to the receding disease; in infectious mononucleosis the enzyme increased during convalescence. In 16 of 20 patients with infectious mononucleosis, NLAPA increased after corticotherapy. The value of the enzyme in patients with infectious mononucleosis was much higher after superinfections caused by a different infective agent than after corticotherapy. The studies demonstrate the value of NLAPA examinations in the early diagnosis of infectious mononucleosis, carried out during the acute febrile state and especially during the first days of the illness when all other laboratory examinations may still give negative results.

scholarly journals Optimization of Early Diagnostics of Prostate Cancer

2020 ◽  
Vol 6 (5) ◽  
pp. 97-104
Author(s):  
N. Stepanov ◽  
Z. Duvayarov ◽  
I, Bystrova ◽  
T. Chepaikina ◽  
V. Kostrova
Keyword(s):  
Prostate Cancer ◽  
Differential Diagnosis ◽  
Early Diagnosis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Diagnostic Errors ◽  
Decay Products ◽  
Examination Methods ◽  
Special Examination ◽  
Diagnostic Capabilities

The prevalence and incidence of prostate cancer is gradually increasing both in our country and in countries near and far abroad. The difficulties in the differential diagnosis of prostate cancer are convincingly evidenced by the fact that the level of diagnostic errors reaches 40%. It should be noted that in assessing the differential diagnostic capabilities of the indicators of the clinical and special examination methods for patients with lower urinary tract symptoms, disagreements were found in 46–77% of the analyzed clinical signs, the changes of which mainly reflect the negative nature of the effect of tumor decay products on the patient’s body. The aim of the study was to improve the early diagnosis of prostate cancer by using the mathematical method of differential diagnosis of prostate pathology, as well as the rationale for the proposed method for early diagnosis of prostate cancer in patients with clinical symptoms. Using our proposed method for early diagnosis of prostate cancer makes the diagnosis not only reliable and accurate, but also independent of the level of qualification of the urologist and his personal experience, allows you to unify, optimize and personify the differential diagnosis of prostatic hypertrophy and prostate cancer.

Phenothiazine Derivatives in Urine: "False Nagative Results" With the Forrest Color Test (FPN), and a Method for Their Elimination

1965 ◽  
Vol 11 (10) ◽  
pp. 914-919
Author(s):  
K N Campbell
Keyword(s):  
False Negative ◽  
False Positives ◽  
Phenothiazine Derivatives ◽  
Color Test ◽  
False Negatives ◽  
Delayed Reaction ◽  
Negative Results ◽  
False Negative Results ◽  
Phenothiazine Drugs ◽  
Urine Specimens

Abstract More than 100 Forrest color tests (FPN) were performed on urine specimens from patients taking phenothiazine drugs. The results obtained showed &gt; 20% "false negatives" and 6% "false positives." A delayed reaction due to possible individual patient variation seems to have been the cause for false-negative results. These false negatives were shown to disappear when test readings were delayed for 1-5 min. Some false positives were due to liver dysfunction.

Onychomycosis Infections

2017 ◽  
Vol 107 (4) ◽  
pp. 280-286 ◽  
Author(s):  
Aditya K. Gupta ◽  
Kerry-Ann Nakrieko
Keyword(s):  
False Negative ◽  
Kappa Statistic ◽  
False Negatives ◽  
Negative Results ◽  
False Negative Results ◽  
Repeated Sampling ◽  
Polymerase Chain ◽  
Serial Samples ◽  
Repeated Samples ◽  
Infecting Organisms

Background: Mycological culture is the traditional method for identifying infecting agents of onychomycosis despite high false-negative results, slower processing, and complications surrounding nondermatophyte mold (NDM) infections. Molecular polymerase chain reaction (PCR) methods are faster and suited for ascertaining NDM infections. Methods: To measure agreement between culture and PCR methods for identification of infecting species of suspected onychomycosis, single toenail samples from 167 patients and repeated serial samples from 43 patients with suspected onychomycosis were processed by culture and PCR for identification of 16 dermatophytes and five NDMs. Agreement between methods was quantified using the kappa statistic (κ). Results: The methods exhibited fair agreement for the identification of all infecting organisms (single samples: κ = 0.32; repeated samples: κ = 0.38). For dermatophytes, agreement was moderate (single samples: κ = 0.44; repeated samples: κ = 0.42). For NDMs, agreement was poor with single samples (κ = 0.16) but fair with repeated samples (κ = 0.25). Excluding false-negative reports from analyses improved agreement between methods in all cases except the identification of NDMs from single samples. Conclusions: Culture was three or four times more likely to report a false-negative result compared with PCR. The increased agreement between methods observed by excluding false-negative reports statistically clarifies and highlights the major discord caused by false-negative cultures. The increased agreement of NDM identification from poor to fair with repeated sampling along with their poor agreement in the single samples, with and without false-negatives, affirms the complications of NDM identification and supports the recommendation that serial samples help confirm the diagnosis of NDM infections.

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